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To improve community health, choose mission over money

September 11th, 2013

by Thomas Dahlborg

Dwight D. Eisenhower once said: "The supreme quality for leadership is unquestionably integrity. Without it, no real success is possible, no matter whether it is on a section gang, a football field, in an army or in an office."

Recently a good friend of mine told me a story about identifying the perfect job in healthcare administration, one that aligned with both his head and heart and would allow him to fulfill his personal and professional goals.

The position--Executive director of a physician hospital organization (PHO).

When he read the organization and position description, he was thrilled to see the overall aim for the organization and the person in this role was to improve the health of the community. "An organization that truly gets it. An organization that is living its mission and creating a structure which allows for its vision to become a reality." He was so excited.


My friend continued ... "I wrote my cover letter and updated my resume highlighting my successes in developing systems to improve the health of patients, families and communities, and of course contracting and other key aspects of this type of role. I sent this information along to the hiring manager and then waited."

A week later he received a reply and an initial interview was scheduled.

"The call began and I could not contain my excitement. I shared how the mission and vision of the organization resonated with me. I shared how thrilled I was at the focus of this position and began to highlight my successes in this realm ... and then the hiring manager cut me off."

The hiring manager made it perfectly clear that what was written in the organization and position description was not actually what they were seeking. The aim of this role is in fact to optimize reimbursements to the hospital in general and specific to the PHO to optimize the revenue distribution to the hospital relative to any risk sharing and/or other shared funding arrangements with the physicians.

Even though the organization is in the midst of creating an accountable care organization (ACO), my friend learned the focus of the organization remained on revenue generation, filling beds and market share. The health of the community was not a performance metric associated with this position or a key driver of the organization's improvement as a whole.

The hiring manager went on to share how the person in this role is essentially walking on the edge of a razor blade, "Wearing the hat of representing the entire PHO (physicians and hospital) but in reality always focusing on the financial benefit of the hospital."

To say my friend was devastated would be an overstatement. To say he was mightily disappointed and took himself out of the running for this role is far more accurate.

I find this situation to be quite troublesome as we seek to improve the health of our communities.

"Unquestionable integrity," according to President Eisenhower, is essential for any success. And yet the institution referenced above (and unfortunately representing others) is not honoring its mission and vision but developing and implementing systems that at a minimum take resources and focus away from improving the health of communities and focuses them on revenue generation, filling beds and market share.

It also concerns me that it's public facing persona is diametrically opposed to the reality of what the institution represents.

We can do far better.

Clearly an organization needs a margin to achieve its mission. It also needs a mission to achieve its margin.

As healthcare leaders we can ensure it achieves both. As I shared previously, healthcare organizations can improve their bottom line by honoring their mission and vision, and doing what is right and honorable with integrity. This is not an either or equation. It can't be or we will not be helping our communities but rather doing them harm.

Thomas H. Dahlborg, M.S.M., is chief financial officer and vice president of strategy for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being.


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