Twelve things on every hospital administrator's ED wish list
Twelve things on every hospital administrator's ED wish list
Keep administrators happy by monitoring patient satisfaction levels, keeping them up-to-date on departmental programs
As any ED manager knows, keeping your administrator happy requires more than quality patient care. "When negotiating, you have to get inside your administrator's mind," says Larry B. Mellick, MD, MS, FAAP, FACEP, chair of the department of emergency medicine and director of pediatric emergency medicine at the Medical College of Georgia in Augusta. Here are 12 areas of excellence to present to administrators:
1. Public satisfaction. Much to their dismay, administrators are often on the receiving ends of complaints from unhappy patients. "Sophisticated patients know if they want to make an impact with their complaint, they can go over your head to your boss," says Mellick.
Most administrators are hypersensitive to complaints, says Mellick. "They have a tendency to overreact and see a single complaint as the tip of the iceberg," he explains. "They also tend to assume the complaint is correct, which may not be the case."
This attitude can cause administrators to look at the ED in an unfavorable light and become defensive. "Most of the time, administrators tend to identify themselves with the institution and take complaints personally," Mellick notes. "They may also become somewhat embarrassed by complaints and view them as having a negative reflection on their own image."
On the flip side, administrators love compliments. "They often assume compliments mean they must be an astute administrator to hire such an excellent leader and group of physicians and nurses in the ED," says Mellick.
Bring compliments to administrators whenever possible. "Any time the ED receives a positive comment, take the opportunity to do some internal marketing and distribute this information throughout the hallways," Mellick recommends.
2. Program growth. ED managers should create new product lines and expanded services on an ongoing basis, but administrators want to see continual growth of those programs, Mellick stresses. "The sign of a healthy, vibrant program is one that is growing in volume and revenue," says Mellick.
When you approach administrators about investing money in a program, come with evidence of growth. "It helps significantly to be able to walk into their office and show bar graphs or charts that demonstrate evidence of growth or increased revenue," says Mellick. "Most administrators don't like to gamble. They want a sure thing."
Be upfront if there is a lag time expected between a program's start-up date and its ultimate outcome as a revenue generator, Mellick advises. "Most administrators realize there will be a lag time between investment and evidence of positive results, but the shorter that time is, the better," he says.
When negotiating, it's important to consider the long-term success of your program, not just the venture capital you need to start it up. "Don't overlook important components that will help the program be a success," says Mellick. "Factor in the dollars you'll need for marketing your new program."
It's also important to factor in enough money for adequate nursing or clerical staff if you're correct in your prediction for increased volumes." The worst thing is to increase your volumes and then have patients get poor service and not come back," says Mellick.
3. Pride in your excellence. Administrators love to boast about an ED with a reputation for excellence. "They may not necessarily say things to you directly, but you'll catch them bragging to others about the high quality of your program," says Mellick.
As a leader, you need to establish a vision for excellence. "That may mean defining the ED of the future with innovative use of technology, or creating a department that is organizationally unique," says Mellick.
Administrators want to be proud of the ED, as a program they are overseeing. "They as administrators want to look good, and they have to deliver gold nuggets to their own supervisors," says Mellick. "Evidence of a nationally recognized program, or one that is leading locally, is ammunition they can use to bolster their own career advancement. Ask yourself if you are creating results that an administrator would love to take responsibility for on his or her CV."
4. Self supporting programs. Being fiscally solvent is the major indication your ED's programs are a success. "The fiscal health of a department is extremely important to an administrator," notes Mellick. "They don't want a program in the ED that requires a subsidization of thousands of dollars a year just to keep it healthy."
ED managers need to search for every possible opportunity to increase revenues and save money, Mellick urges. "Establish a culture of being good stewards of resources," he says. "Learn to go without nonessential things until you have the revenue to pay for them."
Avoid creating programs that are a dollar drain. "If you do, be careful not to start several such programs at once, because the cumulative impact of waiting for the lag time to pass can cause significant anxiety for the administrator," says Mellick. "Be willing to create programs in a controlled and carefully thought out manner."
Study the net revenue generated for the hospital from each admission that comes through the ED, recommends Mellick. "That number can vary anywhere from $3,000-$8,000 in revenue," he notes. "If you start doing your arithmetic, it becomes very obvious that each ED admission benefits the hospital's ultimate revenue."
Multiply that net revenue by the average number of daily admissions and by the days of the year, to demonstrate the financial benefit that resulted from these admissions, Mellick advises. "Even if at the moment, you find yourself in a situation where you are not free of subsidizations, it's important to demonstrate the impact that your admissions have on the hospital's bottom line," he says.
5. A national model. Not every ED needs to be a national model, it just needs to be efficient and well-run, says Mellick. "But, if you have something that is unique locally, or in the state, or the nation, make sure administration knows that," he says.
If you are invited to another facility as a consultant for other programs or have outside colleagues come to look at your program, this is evidence that you are creating a national reputation, says Mellick.
ED managers need to clearly present this to administrators. "Most administrators don't have an expert understanding of what is outstanding or unique in the delivery of care in emergency medicine, so you need to become an expert at self-marketing," says Mellick.
6. A minimum of increased FTEs. Another feather in an administrator's cap is the ability to keep FTEs to a minimum. "Many administrators' idea of success is to reduce the number of employees but maintain the same level of service," says Mellick. "This is a significant area of pride for administrators."
One of the most difficult things for ED managers to accomplish is acquiring additional FTEs, says Mellick. "Be very careful to ask for an FTE only when you're absolutely sure you need it," he warns. "The easiest way to ruin your credibility is to ask for an FTE, then find out later you didn't need it. That will hinder any future attempts at picking up additional staff for a long time into the future."
7. Clear justification of your needs. Whether you are asking for more space, additional staff, or equipment for your ED, present evidence of your needs, says Mellick. "The best way to convince an administrator there is a legitimate need, is to have honestly looked at the pros and cons of both sides," he recommends. "That will help you establish a credible argument."
Be honest and objective about your request, Mellick says. "If there is a down side to a decision, be the first to identify it," he advises. "You will get more credibility pointing out the negatives than [you will by] waiting for the administrator to point them out."
Never ask your administrator for anything without having done the necessary homework to support the validity of your request, says Mellick. "They will see you as wasting their limited and valuable time, and this will damage your credibility."
Administrators are uncomfortable with a "trust me" attitude, he says. "However, we as ED managers do find ourselves in that situation at times, when we have no evidence or data, only a vision of where we want to be," says Mellick. "In this setting, your credibility from past successes is extremely important. That is why it should be protected at all costs."
8. Stamina of purpose. If you immediately capitulate when administrators deny a request, they tend to assume it wasn't important, says Mellick. "Remain positive and optimistic even when you hear the word no, which means no pouting or reacting negatively," he adds. "You may need to repeatedly go back to the drawing board, review your argument and justification, and present the request again."
Administrators may deny the request to measure its validity, says Mellick. "It is not uncommon for administrators to test the necessity of your request and personal resolve, and, in some ways, to assess you as an effective leader, by saying no the first time to everything you request," says Mellick. "If they say no and never hear anything again about what you so passionately presented to them previously, then they have to assume the need wasn't as strong as you indicated."
Instead of giving up, come back repeatedly until it's clear that the answer is really no, says Mellick. "But when you do come back, give the administrators some alternative ways of making the request happen," he says. "Be creative for them, because you can rest assured they don't have the time to solve your problems for you."
9. A strong view of the future. ED managers need to present a solid vision of the future, says Mellick. "You need to provide a sense that you know where you are going," he says. "This vision has to fit in with the overall vision of the institution."
10. Cooperation with managed care. "Administrators will appreciate your cooperation with primary care physician requirements and the implications of managed care for the ED," says Kym A. Salness, MD, FACEP, director of the Emergency Medicine Center at the Milton S. Hershey Medical Center in Hershey, PA. "If you are up to speed on whatever managed care means in your area, that knowledge is seen as extremely useful to administrators."
11. No problems. Above all, administrators want the ED to look good and run smoothly. "They want it to be a showcase of institutional pride that they can tour their board members through, not a little dark hole that generates nonstop problems and unhappy customers," says Salness.
Administrators want you to resolve complaints independently. "They want 100% happy patients and no lawsuits," says Salness. "Of course that's not possible, but whatever complaints do come should be resolved immediately. When the administrator gets a nasty note from a patient, they want to send it down to you and get it handled. All they want to see is a cc: indicating that you've made Mrs. Smith happy, and a QA (quality assurance) plan to fix the problem if it's systemic."
Potential problems should be identified and dealt with through your ED's QA system. "A decade ago, QA was viewed by many of us as busy work and the bane of our existence. But today, if your hospital administrator has to nag you about not providing proactive leadership for QA, you will be a short-termer for sure," Salness warns.
Administrators shouldn't be dealing with complaints about the ED, Salness emphasizes. "The complaints that come to you should be addressed immediately," he says. "Your administrator should never get a letter that begins, `I've called the ED three times and they have done nothing.'"
12. A team player. ED managers should participate on hospitalwide committees, Salness recommends. "The ED director should never be one of the docs who avoids that kind of work," he says. "It's an easy way to endear yourself to the hospital administration, and have the ED recognized as part of the core fabric of the institution's medical staff.
Avoidance of committee work comes with a heavy price, stresses Salness. "Emergency physicians tend to try to avoid that work, and that has gotten us into trouble over the years," he notes. "We need to reverse that image for our own sake. That's how you build up your treasure chest of connections with administration."
Active participation can build credibility with administrators. "You can't go in and expect to get things from an administrator based on work that you are going to do in the future," says Salness. "You need to build up a trunkful of work you already have done, which includes showing up on committees."
Make sure the ED's successes are constantly on the mind of administrators. "Don't wait for negotiating time to bring up the two or three good things you did," Salness emphasizes. "Keep subtly reminding them over the years of the dozen good things you're always doing."
A "can do" attitude is essential. "The more you can take on, the better, rather than slinking away from a difficult project like the other medical staff will do," says Salness. "ED leaders should constantly be ingratiating themselves and intertwining themselves with the business of the institution."
ED leaders should take Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards seriously, says Salness. "You need to assume the entire responsibility for that piece of the survey as it pertains to your ED," he stresses.
Many ED managers view JCAHO as a nuisance, Salness notes. "We may secretly wish somebody else would take care of it for us, and get by with as minimal input as possible," he says. "But that attitude will get you in trouble with your administrator, who wants a little gold star for the ED. Your administrator expects everybody in a leadership position to do whatever it takes to make your area look good."
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