Healthcare, Leadership, and Economics

Leadership when everything seems to be falling apart

It’s getting to be hard to sustain confidence. And specifically confidence in leadership. I get up every day and think about how to allocate scarce resources to the best use for improving the health of the communities we serve. It’s now harder than ever to sustain confidence that the interconnectedness of organizations, government, and individuals will work well. Have our elected officials, corporate executives, the SEC, all been paying attention and thinking about the security and welfare of average families?

There seems to be an awful lot of evidence of selfishness, focus on short-term gain, and unwillingness to warn of consequences. Just read this from the New York Times. 

We are all interdependent. Why is this such a surprise? For our health system to be successful, our patients need access to good insurance, they need to be able to afford to take their medications, and fill their car with gas, heat their home, and pay their mortgage. We are going through hard times. It appears they will get worse before they get better.

So what really matters in difficult times? I think the same things that matter during good times — core values, confidence in our ability to influence the future, and trust in each other to support doing the right thing. We will need our neighbors, friends, and leadership even more when times are difficult. Scarce resources just got much more scarce. We will be focusing more on basic needs and less on luxuries.

In health care, there will also be difficult times. As a leader in a local health system, I see several realities we will face in the next few years:

• Health care will become even more unaffordable, from the insurance premium to the cost of prescriptions.
• The pressure to reduce costs in health care will be extreme, and will lead to some unpopular decisions, such as closure of services, and even some institutions.
• People will forgo usual care and medications, leading to increased emergency room use and hospital admissions.
• Doctors and hospitals will have difficulty borrowing money to make capital investments, slowing the growth of technology and facilities in health care.

Here in Vermont, and at the health system in Bennington, we have “stayed the course” of focus on core values. The patchwork quilt - the interconnectedness of organizations works better in Vermont. Our health care leaders are running more cost effective organizations than most of the country.

We will be challenged to dramatically improve that in the short run, and we are starting from a better base. Our bankers did not get caught up in the “irrational exuberance” of risky lending practices, and foreclosure rates in Vermont are among the lowest in the nation. Our citizen legislature, and elected officials, are more connected with the needs of real people. Leaders in health care, business, and government, know each other, and care about the communities we live in.

Community hospitals are a precious resource. Preserving them will be hard work, and some things we have learned to count on will change. We are here for the long term, and we will be here to take care of our neighbors, even if we have fewer resources than we have learned to live with in the past. It’s the right thing to do.