Becker's ASC Review

64 HEALTHCARE NEWS 64 The problem of stuffy hospital CEOs By Molly Gamble R ather than pay, tenure or organization size, one determinant of hospital and health system leaders deserves outsized importance: their humanity. No one who leads or operates a hospital or health system wakes up in the morning and chooses to be out of touch, dull, overly regulated or a walking font of corporate-speak. Instead, these regressions likely occur over time and are influenced by the close company one keeps, ego, and connections — or lack of — to one's community, among other things. While becoming out of touch has always been a risk for people who sit in positions of power, tolerance for arrogant leaders will only diminish in a time of heightened scrutiny of CEO earnings and hospitals' nonprofit status, a delicate workforce that is continuing to eye the door, and needed focus on health inequities that have persisted and are even worsening. e problem stands to compound the problem. If leaders are out of touch to start with, there's no promise they'll read the room now and course-correct. Here's how that could play out: the stuffy CEOs will get stuffier and the down-to-earth servant leaders will only command more attention — deservedly so. Ivory towers aren't inevitable. Some health systems are fortunate to be led by people who hold meetings in diners to level the playing field, refuse to accept the office furniture upgrades that come from the promotion of senior vice president to executive vice president, wear sneakers with suits, write handwritten thank-you cards, give credit always, condemn all-talk, no-walk posturing, broach difficult topics and conversations with front-line staff and, most importantly, see their job as ensuring that healthcare providers have what they need to do their job and do it well. Everyone can lead this way if they choose. Here are a few ways the out-of-touch and grounded leaders stand apart: 1. How they talk about their vulnerable patients. Out-of-touch leaders tend to discuss them with a tone of otherness or paternalism, sharing stats like 56 percent of Americans being unable to cover an unexpected $1,000 bill as if it is shocking. Or perhaps they latch onto one patient story to illustrate challenges people face in navigating our dysfunctional healthcare system. A single mother working two jobs missed a doctor's appointment? No kidding. Down-to-earth leaders, on the other hand, don't do much hand-waving around patients' limitations or disadvantages. ey treat cultural competency as an inherent responsibility, and see patients who are poor, non-English-speaking, uninsured or underinsured, isolated, technologically challenged or experiencing other vulnerabilities in the center of what they do — not on the fringe or in the category of "other." Instead of seeing their role as alerting others to their existence, down- to-earth leaders put their energy toward serving their communities with more inclusive and accessible healthcare. ey have a wide range of programs and initiatives their organizations have enacted to better reach people, and results to show for it. eir actions far outweigh their words. 2. e questions they answer and the questions they dodge. Every leader has a ratio of the number of questions they squarely answer and those they walk around. Media is in a privileged position to get a sense of this, whereas front-line employees may have fewer glimpses into it unless leadership routinely rounds or conducts town hall meetings. Out-of-touch executives indirectly answer questions, Razor-thin hospital margins become the new normal By Alan Condon H ospital finances are starting to stabilize as razor- thin margins become the new normal, according to Kaufman Hall's latest "National Flash Hospital Report," which is based on data from more than 900 hospitals. External economic factors including labor shortages, higher material expenses and patients increasingly seeking care outside of inpatient settings are affecting hospital finances, with the high level of fluctuation that margins experienced since 2020 beginning to subside. Hospitals' median year-to-date operating margin was -1.1 percent in February, down from -0.8 percent in January, according to the report. Despite the slight dip, February marked the eight month in which the variation in month- to-month margins decreased relative to the last three years. "After years of erratic fluctuations, over the last several months we are beginning to see trends emerge in the factors that affect hospital finances like labor costs, goods and services expenses and patient care preferences," Erik Swanson, senior vice president of data and analytics with Kaufman Hall, said. "In this new normal of razor thin margins, hospitals now have more reliable information to help make the necessary strategic decisions to chart a path toward financial security." High expenses continued to eat into hospitals' bottom lines, with February signaling a shift from labor to goods and services as the main cost driver behind hospital expenses. Inflationary pressures increased non-labor expenses by 6 percent year over year, but labor expenses appear to be holding steady, suggesting less dependence on contract labor, according to Kaufman Hall. "Hospital leaders face an existential crisis as the new reality of financial performance begins to set in," Mr. Swanson said. "2023 may turn out to be the year hospitals redefine their goals, mission, and idea of success in response to expense and revenue challenges that appear to be here for the long haul." n

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