Fear and Change Update – it’s freezing in here

So, I hesitated writing yet again, as we are in a frozen state of instability.  We are at the end of our second stage of transition, about to enter our third.  Our temporary CEO has less than three months left;  our new CEO starts July 1^st, and that necessitates another period of waiting as she assesses the lay of the land.

Meanwhile much of the leadership in the hospital is frozen.  Many have been laid off, and many remain afraid of losing their jobs or having them change in a way that is not acceptable.  Our hospitalist consultant’s report is pending – back in a week – and I can’t tell my docs what to expect until we get it back and decide as an institution what we will do with it. Decisions need to be made, weekends have to be staffed, vacations have to be planned, but we can not make long range plans, we can not hire.

Meanwhile ICD 10 is coming and RAC requests charts every 45 days, each time asking for 1 – 2 hundred thousand dollars, and these things things take up tremendous human and monetary resources.  Medicare and medicaid are broke,  the number of never events we will not get reimbursed for increases and we have no idea what health care reform will look like and how it will affect hospitals and hospitalists.   Many hospitals in Connecticut are in the midst of this frozen/change process.  It’s not institution specific, although my institution, being in a poor city with two hospitals, is getting the brunt of it.  Someone wise recently said to me that if you want to be in the most stressful field in the country right now, work in education or medicine, and live on a coast.  It starts on the edges and moves inward.

Meanwhile my excellent docs continue to do their excellent work.  The patients are so very sick, and require attention to their bodies and souls.  Sometimes the needs of the patients feel overwhelming but once I’m in the room with them they give me my energy back.  Making a diagnosis is ALMOST always a game we can win,  although we may not be able to save the patient.  Making a connection with a patient and their family is almost always a personally satisfying experience.  The state of modern health care and our hospital, however,  is another matter.

I want to write this leadership blog full of tips on successful hospitalist leadership, but presently I will continue to talk about is what it’s like to hold steady, be transparent but professional and careful.   Also, spring is here and it’s going to warm up.