Strategic plan lacks substance

Strategic plan lacks substance

To the editor,

The Board of the EARH, as announced at its last meeting, has posted on the district’s website a draft of its so-called “Strategic Plan.”

Sad to say, it is a textbook example of the difference between decision-making and “management,” the supposed art taught in business schools, an “art” that thrives on gobbledygook like “mission statements” and “visions,” and is big on, yes, “Strategic Plans” that are all empty buzzwords and no substance.

If that seems a harsh assessment, let’s look at what the actual plan has to say; sadly, it is painfully easy to mock.

The “Mission” is “Achieving excellence through exceptional quality to serve the health care needs of District residents and travelers.” Translated: a health-care facility whose mission is to provide good health care. Wow.

How about the “Vision?” “EARH and its District clinics is a regional hub for health care in Eastern Adams County offering exceptional care in a modern healthcare facility enhanced by advanced technology and linked to a regional network of health care partners.” Translation: a regional health-care facility that is… a health-care facility for the region.

But let’s not forget the “Values” parts: “Integrity, Compassion, Collaboration, Customer Service, Accountability, Stewardship, Excellence, Agility” Translation: the facility staff should try hard to do their jobs well. Shakespeare is always on point: “My lord, it needs no ghost come from the grave to tell us this!”

And it goes on and on throughout in the same tone of pompous obviousness; Goal No. 1 is “Achieve excellent outcomes in quality, patient safety and patient satisfaction.” One wonders how many people sat round a conference table for how many hours before they achieved that penetrating insight: “Do your jobs well.”

The cream of the jest is that this is not some make-work project invented to keep idle hands from doing the Devil’s work: it ate the time of a number of hard-working people with real tasks to perform, and it cost money, since an expert consultant was hired to oversee the task – presumably because such deep insights as we have seen are not available to non-experts.

Having had some decades’ experience in management, I will offer a competing Mission Statement and Vision, and I will even forgo the charge of thousands of dollars for producing it. Mission statement: stay in business. Vision: jack up income till you at least stop bleeding money so you don’t eventually go bankrupt. There: wasn’t that easy?

Let’s be clear: the thoroughly predictable results of thoroughly avoidable actions have turned the district’s operations from earning roughly 10 percent profit on net income, which profits were being salted away as a sinking fund for eventual facility replacement, to bleeding away more money every month than was previously being saved.

Check the financials (they’re online): the swing is on the rough order of $100,000 per month. In the past four months alone, the district has lost exactly $460,388; the district’s budget for this year shows it expected to gain $568,600 in 2011. It has, that is, lost over 80 percent as much in four months as it had expected to gain in an entire year. And the bleeding continues. Look again at that number: an average bleed of $115,097 a month over the last four months; that’s around $3,775 lost each and every day, day after day.

Now the patient base lost to Hometown Family Medicine is just that, lost, irretrievably: the income drop from that is permanent. And while there are moves that can cut expenses, aside from the huge monthly cost of hiring locum (temporary) physicians as staff (which is unavoidable for the moment), there is really relatively little room for significant cuts; mostly, it’s rearranging deck chairs on the Titanic. So it is – or would seem – blindingly obvious that the district’s runaway No. 1 priority right now has to be finding new sources of income to try to balance the books.

But, with the funds saved over hard and long years now bleeding away at a nightmare rate, what do we hear is the central focus of planning? Going ahead with spending $10 million to $15 million ­– money that the district does not have and which it would need to borrow heavily to get – on a new facility, as soon as practicable. There are wrong, seriously wrong, priorities there.

Fortunately (sort of), the percentage of the district’s population base that has used it for primary care has always been unusually low.

That means that there is a pool of potential users, folks who are now going 45 minutes or, more commonly, an hour away to get their primary medical care.

The district needs to find out why those people have been going so far away for what is available right here, and they urgently need to persuade them to instead use their local facility. (Add that need-to-persuade to the “Vision” statement.)

Keep in mind, though, that it will be tremendously difficult to sell someone getting their health care elsewhere on using the district as long as there are no permanent physicians on the staff; the locum doctors are no doubt well qualified, but people want to deal with “their” doctor, not someone who may well not be there the next time they go in for care.

That, in turn, means that the district must get in permanent physicians as soon as humanly possible – yet, in doing so, it must be extravagantly careful not to rush the process just to have a body or two in place.

To get new patients, the district will have to create a campaign centered on those new physician hires, who, for better or worse, will become the face of the clinic to the community.

That collective face must be one that appeals, that draws people to say, “Well, maybe I should try these guys after all.” A mistake in selection, even of technically “well-qualified” physicians, could well be literally fatal to the survival of the district.

There is an election this year for three of the seats on the governing hospital board.

This is a time when the very existence of a local emergency room and general health-care facility – things very literally vital to the community – is in danger.

It is correspondingly vital that every voter examine the candidates and their ideas with intense care.

Remember the old saying: managers stand and decide; non-managers sit and talk about “the decision process.”

Eric Walker

Ritzville