September 22, 2021
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David Burda
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Consumerism Outcomes System Dynamics
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What Executives Think of Their Own Health System’s Performance

They say the first step to recovery is admitting you have a problem. That sage advice apparently applies equally to people suffering from an addiction and people running a health system.

A new study in the Journal of Healthcare Management reveals a big gap between what many executives think of their health system’s performance and how their system actually performs. You can download  this interesting look at healthcare executive denial here.  

Researchers from the Rand Corp. wanted to know if there was any connection between the subjective performance of a health system, as expressed by senior executives, and the objective performance of the same health system, as measured by publicly available quality of care and patient safety indicators.

To find out, the researchers interviewed 138 executives at 24 health systems in four states: California, Minnesota, Washington and Wisconsin. Each of those states has an independent agency or organization that collects and reports performance data from hospitals, health systems and medical practices. The study did not identify the executives or the health systems.

Using the objective data from the state agencies and organizations, the researchers separated the 24 health systems into three buckets—high, medium and low performers—based on how well the systems scored on the publicly available performance measures.  Of the 24 systems, nine were high performers, eight were medium performers and seven were low performers. 

Then the researchers interviewed the executives from the systems, asking them whether they thought their system was a high performer, medium performer or low performer and why. They also asked the executives about the factors that separate the high performers from the low performers. 

In 14 of the 24 cases, subjective performance was different from objective performance:

  • Six execs said their system’s performance was high when it was actually low
  • Five execs said their system’s performance was high when it was actually medium
  • One exec said their system’s performance was medium when it was actually low
  • And two execs said their system’s performance was medium when it was actually high

None of the executives rated their system’s performance as low although seven of the systems were objectively low performers.

In the 14 cases where subjective performance differed from objective performance, the executives cited a number of reasons other than clinical quality and safety for giving their system high marks, according to the study, including:

  • Comparisons to the performance of local competitors
  • Performance in national rankings
  • High customer satisfaction and loyalty
  • Effective leadership
  • Strong financial performance  

None of that really matters much to a patient if the care is lousy, dangerous or expensive.

In the two cases where the execs said their systems performed worse than they actually did, the execs, the study said, “… reported substantial variation in performance across the system and commented on the need to standardize operations and better align organizational cultures across clinical sites.”

Those are the health systems where you’d want to go if you were a patient. They’re better than they think they are. They have a chip on their shoulder. And they know what they have to do to get better. Improvement starts with self-awareness.  

As for what makes the difference between a high-performing health system and a low-performing one, the executives almost universally cited three factors:

  • Organizational culture
  • Organizational governance
  • Staff engagement and satisfaction

Yet, clearly, many of the health system execs in the study don’t take their own advice.

If you want to learn more on this topic, please read “Should Consumers Trust Hospital Advertising?on 4sighthealth.com. You already know that answer, but it’s worth your time.

Thanks for reading.

About the Authors

David Burda

Dave is 4sight Health’s biggest news junkie, resident journalist and healthcare historian. He began covering healthcare in 1983 and hasn’t stopped since. Dave writes his own column, “Burda on Health,” for us, contributes weekly blog posts, and manages our weekly e-newsletter and weekly podcast, 4sight Friday and 4sight Roundup. Dave believes that healthcare is a business like any other business, and customers—patients—are king. If you do what’s right for patients, good business results will follow. Follow Burda on Twitter @DavidRBurda and on LinkedIn.

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