It is easy to blame “big bad pharma” for everything that is wrong with healthcare. It is worth remembering that prescription drugs represent only one piece of the total healthcare-cost equation.
To many, it is just as easy to blame the doctors, nurses, technicians, administrators, and thousands of other employees working inside large healthcare systems.
Healthcare is expensive. It is complicated. There are egos, inefficiencies, mistakes, long waits, confusing bills, aging facilities, staffing shortages, and dozens of other things that make healthcare providers easy targets for criticism.
Until you need them. Then it becomes a very different story. I recently had the opportunity, although “opportunity” probably isn't the word I would have chosen, to experience the healthcare system from the other side. And it caused me to rethink something I have been teaching for decades.
What Is the Value Proposition?
For most of my career, I have been designing, developing, and delivering business acumen simulations for healthcare organizations. One of the fundamental concepts we teach is the importance of understanding an organization's value proposition.
What exactly are you promising your customers (patients)?
For a healthcare system, is the value proposition innovative, world-class clinical care supported by the newest technologies, facilities, and specialists?
Is it patient-centricity, where the facilities and equipment may be a little older, but the interaction between provider and patient is extraordinary?
Or is it fundamentally a low-cost strategy, providing an appropriate standard of care efficiently and affordably to as many patients as possible?
Those are very different strategies.
They require different investments, capabilities, operating models, and financial decisions.
But my recent experience made me realize that there is another variable I haven't adequately captured in the business simulations we build.
The people delivering the strategy have to believe in it. More importantly, they have to live it.
The Missing Variable Is Heart
During my recent healthcare experience, I had several eye-opening interactions with the people who actually make a healthcare system work.
Not the CEO. Not the CFO. Not the Chief Nursing Officer.
Not the people who develop the enterprise strategy or approve the capital budget. The people changing dressings. Taking vital signs. Moving patients. Cleaning rooms. Answering questions. Bringing medications. Coordinating care. Finding something a patient needs at 2:00 in the morning.
The people nobody sees when we look at a hospital's annual report. And I realized that one of the most important variables in healthcare economics may be one of the hardest to put into a spreadsheet.
Heart.
And no, I don't mean the cardiology department. I mean the fundamental attitude an employee brings to the job. Is the employee checking the box, completing the assigned tasks, counting down the hours until the shift is over, and collecting a paycheck?
Or does that employee believe his or her job is to take whatever resources the organization has provided and use them to create the best possible outcome for the patient?
Those two employees may have the same title. They may make the same salary. They may work on the same floor with the same equipment under the same manager.
But economically, they aren't the same employee. And from the patient's perspective, they aren't even close.
Heart Has an ROI
This is where the conversation becomes business acumen rather than simply a nice story about dedicated healthcare workers. Because heart has economic consequences. The employee who notices something isn't right and speaks up can prevent a complication.
The nurse who spends an extra few minutes making sure a patient understands discharge instructions may reduce the chance of a readmission.
The technician who communicates clearly may reduce anxiety, confusion, and wasted time. The employee who takes ownership of a problem instead of saying, “That's not my department,” can prevent a small issue from becoming an expensive one.
And the team that communicates, collaborates, and genuinely cares about the patient can create an experience that strengthens the reputation and value proposition of the entire healthcare system.
The opposite is also true. Indifference has a cost. Poor communication has a cost. Lack of ownership has a cost. Turnover has a cost. Mistakes have a cost.
And a culture where people simply do their jobs rather than own the patient experience has an enormous cost. Suddenly, something that sounds very “soft” becomes very financially real.
Strategy Doesn't Live in the Boardroom
There is another important business lesson here.
Executives can spend months defining a healthcare system's strategy. They can create PowerPoint decks, establish strategic priorities, approve billions of dollars in capital investments, install sophisticated technology, and define dozens of KPIs.
But none of that is the strategy.
The strategy becomes real when someone walks into a patient's room.
That moment is where the organization's value proposition is actually delivered.
And that means leadership alignment has to travel all the way from the executive team to the person delivering the most basic element of patient care.
If the CEO believes the organization differentiates itself through extraordinary patient-centric care, but the person interacting with the patient believes the goal is simply to get through the shift, the strategy is broken.
No amount of capital investment fixes that.
Maybe We Need a New KPI
As someone who builds business simulations for a living, I find this experience making me think differently about the models we create.
We are very good at modeling the following:
We can model almost anything.
But perhaps we haven't adequately modeled the thing that connects all of them: the degree to which employees are aligned around the value proposition and personally accountable for delivering it.
I am not suggesting we create a financial statement line called “Heart.”
Although I have to admit, I'm tempted.
What I am suggesting is that healthcare leaders need to understand that culture, engagement, coaching, accountability, and employee alignment aren't separate from business performance.
They are drivers of business performance.
The healthcare worker nobody sees may be making dozens of tiny decisions every day that never appear on a dashboard.
But collectively, those decisions determine whether the strategy works.
And when you are the patient lying in that bed, you quickly understand just how much those decisions are worth.