Some fourth anniversary thoughts on joining the Borg

Four years ago this month, my family practice elected to join a local hospital owned and managed outpatient medical group. It has not gone as planned.

Our practice was successful and thriving. We believed we could negotiate from a position of relative strength. (We were certainly not seeking a bailout.) We were looking for resolution of our inability to compete with larger groups in recruiting new providers, and felt we could offer considerable wisdom and experience from our 25 years of growth, innovation, and practice management. The hospital acknowledged during our discussions that they envied our productivity, efficiency, quality, and the morale and dedication of our staff.

We were assured that we would be able to retain our essential character and told that it would be crazy to change and break something that works so well. We were also promised that there would be a process whereby we and they examined and compared how things were done in different settings, with the intent of looking for and disseminating best practices. Our smaller size compared to theirs (8 versus 200+ providers) and their larger capitalization would also be an opportunity to let us be a place to experiment with alternative approaches, a laboratory for innovation.

We were naive. As soon as the ink was dry, the hospital leadership with whom we negotiated walked away, turning over management of our practice to someone not part of (and we learned later, never informed about) the negotiating process, and reneged on their commitment. 

Over the past four years, there has been no process to look for and disseminate best practices. We have been gradually forced to look and function more and more as part of their homogenous corporate entity. We have, indeed, been a laboratory, but not for provider generated ideas of innovation, but as a test site for software upgrades.

Aside from a sense of personal betrayal, one of my biggest frustrations and disappointments has been the lack of robust, open and horizontal (as opposed to minimal channeled, and hierarchical) discussion among the practices themselves. This has had three unfortunate impacts:

  1. It inhibits progress and lessens excellence by stifling innovation.
  2. It prevents collaboration.
  3. It keeps power concentrated in the hands of a small number in leadership and administration.

I think the first and second outcomes are accidental, but the third outcome is intentional. There is a greater commitment to control than quality, and the fear of loss of control overwhelms the desire for improved quality.



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