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What’s Good for General Motors ...

Medical Staff Affairs Monthly, January 14, 2009

On October 1, 2008, the Ford Model T celebrated its 100th anniversary. The first Model T was assembled October 1, 1908, at the Piquette Avenue Plant in Detroit. In nearby Flint, MI, the General Motors Corporation was also founded in 1908. Walter Chrysler was a Johnny-come-lately, with Chrysler Motor Company not being founded until June 6, 1925, from a reorganization of the Maxwell Motor Company. Over time, these entities grew in size and complexity but served the needs of their customers well for many decades. They provided reasonably priced transportation that met the needs and desires of their customer base. The American automobile became so entwined in the culture of the country that it was hard to separate the two. Truly the relationship was a win-win. Indeed, a quote by then-GM CEO Charles Erwin Wilson was easily misconstrued as: "What's good for General Motors is good for the country." The actual quote before a Senate confirmation vetting Wilson's nomination as Eisenhower's Secretary of Defense was: "I have always felt that what was good for the country was good for General Motors, and vice versa."

As times changed and the world progressed, these icons of American capitalism and human industry became progressively less nimble and able to move quickly with a changing market and set of world economic forces. The companies became more out of touch with their customer base and its needs. In short, the "big three" became less relevant in meeting the challenges of 21st century America. The recent economic recession has plunged the "big three" into varying degrees of crisis ranging from ventilator support for Chrysler to varying degrees of monetary prop-up for GM and Ford.

The organized medical staff also had its birth and growth in the early 20th century. The Flexner Report on American medical education and supported by the Carnegie Foundation was released in 1910. In this same time period, the Clinical Congress of Surgeons of North America was meeting annually and in 1913 morphed into the American College of Surgeons in 1913 under the leadership of Franklin Martin, MD. Standards for improved care in hospitals and the whole concept of peer review and performance improvement blossomed across the country. The organized medical staff grew and flourished and served both physicians and hospitals well for many decades. But changes began to occur that threatened this working alignment, including the emergence of lack of financially aligned incentives. Increasing competition and mistrust began to erode the fabric of the previous social contract.

In a similar vein, the American hospital industry, in many instances, has evolved into large bureaucratic organizations that are perceived to be inefficient and, even worse, unsafe. The adoption of information technology, a culture of safety, and other initiatives long ago adopted by other high-risk industries seem to have eluded many American hospitals. A fundamental shift needs to occur in the way CEOs conduct business and the way their boards hold everyone accountable. It is often said that if airlines had the safety record of U.S. hospitals, they would have been grounded long ago.

The question as we begin 2009 is whether the American auto industry as it is currently structured and led can survive all the changes that have occurred. It has been slow or simply unable to respond to changing conditions in its environment. Some debate whether it is even worth saving. A similar concern hangs over the organized medical staff as we enter 2009. The question is also whether the current structure is the vehicle to lead physicians and hospitals successfully into the future. How much needs to be shed? Or changed? Or maintained? The good news is that a crisis represents both a "danger" and an "opportunity". The danger is the potential loss of 100-year-old organizations that have served long and well. The opportunity is the chance to design and reinvigorate these old chassis to carry us into a successful future. The challenge for both hospital and medical staff leaders is to learn what has happened and why, but more importantly, what is being tried and where. In our recent book, The Greeley Guide to New Medical Staff Models, 18 models were identified. Since publication, another four have emerged. The fundamental question becomes: What are the strategic initiatives that will ensure physician and hospital success in your community? And to achieve these strategic objectives, what will your medical staff look like in five years?

People frequently resist change. Many flat out refuse to change. Yet it is precisely the organization that can balance stability and change and move forward that will succeed in this increasingly complex and unforgiving healthcare environment. The big three must change or they may not survive. So too do hospitals and medical staffs. Finally, a salute to those courageous physicians and hospital executives who are trying their best to navigate their organizations to the changes needed to thrive and prosper in the current healthcare environment. They are often chastised and mitigated, but so was Ernest Codman when he tried to make changes a century ago.

Until next time, be the best that you can be and continue to do the right thing for your patients.

William K. Cors, MD, MMM, FACPE, CMSL
Vice President Medical Staff Services
The Greeley Company

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