Organizational Obesity: Are health care organizations too fat?

I’ve recently been kicking around potential reasons for the notorious slow-to-change health care organization phenomenon (fact?).

There are many potential possibilities: slowing down the speed of change in an environment that is controllable while the rest of the world changes minute-by-minute around it.  Financial incentives.  Variability of patient needs.  Dependence upon “contractors” to send business their way.  The list is lengthy.

But here is another thought: are health care organizations too heavy administratively?  Are there too many administrators, executive vice presidents, senior vice presidents, vice presidents, directors, managers, billers, processors, assistants, communicators, marketers, analysts, information servicers, health informaticists, human resourcers, etc.?  Could organizational obesity be the ultimate contributor to the unalterable tardiness of progress?

I don’t know the answer.  But what I do suspect is that beefy administrative staffs (as opposed to beefy patient care staffs) creates a largesse bureaucracy.

Stiff and rigid bureaucratic structures created by corpulent administrative staffing reduces accountability.  That (lack of) accountability can then be passed amongst the pertinent corporate players until an initiative fizzles out, money runs out, or industry changes require movement to another objective.

If you’re shaking your head, I’d rather it be done if you know for sure that this is not the case.  You very well could be right.  Because I’m just wondering and proposing.  Heck, I’m planning a career in health care administration.  But if you’re shaking your head because you are relatively sure, I’d ask you to dig deeper.

The problem is that traditional bureaucratic organizations have more layers between the people making decisions and the people affected by those decisions.  Flatter organizations would be in tune to the needs of patients and front line staff—the people whose needs are (should be!) the organization’s focus.

But instead, this solution: add another administrator and create another department to connect with patients.  And the march toward organizational obesity carries on.  Connecting with patients is every employee’s job.  Even the employee most removed from patient care will encounter a patient sooner or later.

SSM Healthcare in St. Louis has cut its organization’s staff by nearly 200 employees in 2008.  Most recently, it was mostly hospital top managers receiving pink slips.  This editorial says:

Most losses have been part of a larger shift to make the SSM system more cohesive. Most decisions on human resources, finance and technology will be made at two regional offices or at corporate.

Efficiency matters.  Productivity matters.  SSM is looking to find a way.  Is it the beginning of a trend?  Too early to say, but the current economic situation is not helping.

Varied payer demands, complex regulatory and accreditation requirements, and complicated management needs have made larger administrative staffs necessary in health care.  But has health care staffing become too fat?

The new health care environment is pushing for more value.  Again from the St. Louis Post-Dispatch:

Hospitals are facing increasing pressure to improve care while cutting costs. Quality directives from managed-care companies and the government are coming with slight, if any, increases in payment. And lately, some hospitals are seeing fewer patients.

Higher quality, better patient care, lower cost.  Increased value is not achievable through deep cuts of direct patient care staff.  That leaves one other group.  Guess who it is.