Is lack of attention to "The primary purpose" killing the medical field?

34 Long time ago, when I was a landscaper, I had a friend who owned a business. He owned a laundry-mat. He started it off right too: Put in new dryers that worked better, fixed some issues with the plumbing, made the place as a whole more energy efficient, installed some much requested jumbo washers (for comforters and such), improved the building security and had the placed manned/staffed during busy hours in case someone needed assistance. His laundry-mat was, when it started, the talk of the town. He had people driving past others to go to his. To really get things rolling, he even scored some contracts with local businesses to do their laundry (one cafe, a small assisted living place and somewhere else)............so much so he had to employ a night shift person who did it all.

There was room for improvement, but he had built a very good base/foundation for the business. One thing a lot of customers requested was that he sell detergent/fabric softener/dryer sheets right in the laundry-mat. He only had a small dispenser with stuff in it, the ones that sell little one load portions of detergent. He planned on doing that after he expanded. So, business went on as usual, no hitches.

Then he got, IDK............weird about stuff. Was sorta penny pinching everything to death. His coin/change dispenser frequently didn't deposit the right amt. of coins if someone put anything larger than a $1 in it. I saw him once get into it with someone who claimed they only got 17 quarters for their $5. He kept trying to come up with new ways to improve his business and make it more profitable, but his ideas were OFF THE WALL. Tried selling cigarettes, but then people said they'd quit using his place cause too many people were outside smoking and they didn't want their clothes smelling like it. He started selling sports cards from behind the counter, hence he had a lot of younger people coming in getting in the way of people doing laundry. He also made a bunch of displays and sold other sports collectibles.........bobble heads, mini-helmets, you name it. The last idea was a maid service that took your laundry and did it while cleaning the house. It never got off the ground. All the while, he quit doing things to improve the laundry-mat functions. Never put in the larger detergent dispenser everyone was wanting. A few dryers were out of commission and they stayed that way. He was putting so much money into sports memorabilia and equip. to get his maid service going............he couldn't be bothered with keeping what was going right........going.

I asked him one day "Are you in trouble, did you gamble yourself into some debt or something"? He hadn't (he'd done this once before), and his business was doing fine, he just wanted more. His words: "I wan't a business that does more than just fine." So he kept on with his ideas until all the laundry-mat customers were run away. Then the assisted living place he did laundry for closed and a few months later, he was in the proverbial "red". He ended up spending a lot of money fixing things so he could sell the place to an older guy who just wanted to run a simple laundry-mat. That guy he sold it to still owns it today plus three more in the surrounding areas.

I see more and more businesses making the same mistakes my friend made. Heck, there is a burger joint near me that also rents movies. Why? There is Netflix and Redbox for that. Why not just make a better burger than your competition? Another burger joint down the road is your regular boring old burger joint, but their burgers are really good. They have a line at their window at all times it seems, while the DVD/Burger symbioses is dead and closes early most days.

And hospitals are doing the same thing. Spending millions on outlandish ideas and constantly changing this/that policy in an effort to make more money. My hospital recently implemented "Valet Parking" and from all the emails and big ceremonies dedicated to it you'd have thought they cured cancer. They paid an outside consulting firm to show them how to better schedule people according to predicted peeks in census. CEO's routinely get paid thousands in bonuses for implementing staff cuts that don't save hundreds. But thats not all. They recently announced they are going to sell jewelry outside the cafe .

Wouldn't it be easier/wiser to just quit trying to avoid having to staff yourself and go ahead and do so? You'd save a lot of money in lawsuits, PG scores would skyrocket and people would choose you as a healthcare provider over the competition, regardless of whether or not the competition offers valet parking. You know, be like the burger joint that just serves better burgers.
Interesting I really enjoyed reading your post, thank you

That's funny!! My hospital has valet parking and sells jewelry in the newly renovated gift shop, yet they're cutting staff, raising staff ratios and cutting pay

My hospital is starting to offer automotive detail service in the ambulance bays. ER staff will be washingwaxing the ptcustomer vehicles while they are being seen. Should be a nice way to fill in staff down times......OK, maybe not. Thats just as reasonable as the jewelry sales, book sales and every other wild hair sale that comes up.Hospitals doing only healthcare would be a novelty.

Greed that is all it is. Pure greed. Isnt that the American way of life? How to get more and more money? Great post!

Let's see, the hospital where I work has 2 gifts shops, 2 coffee shops, and monthly sales of something or another. Sometimes its jewelry, sometimes its electronics, sometimes its movies/books, oh and recently they added a Chick-fil-a (which I might add charges more for their food than a regular Chick-fil-a) Plus the two other places we have to eat now charge for those little packets of jelly, butter, creamer, plastic cups and plates. Sometimes when I walk down the main hall I feel like I am at the mall not the hospital...And you know what I love the most, today in our hospital newsletter it had a list of benefits of working here and my favorite one: free parking (who cares that our parking is 4 or 8 blocks away and we have to take a shuttle to get here.) So I am sure once they stop being nice to us they will start charging us parking too. -__________-

Quote from ff-phrnmy hospital is starting to offer automotive detail service in the ambulance bays. er staff will be washingwaxing the ptcustomer vehicles while they are being seen. should be a nice way to fill in staff down times......ok, maybe not. thats just as reasonable as the jewelry sales, book sales and every other wild hair sale that comes up.hospitals doing only healthcare would be a novelty.

Quote from mariposabellaGreed that is all it is. Pure greed. Isnt that the American way of life? How to get more and more money? Great post!

I'm going to play devil's advocate. The gift shops, valet parking, concierge service, flat screen tvs, wooden floors and all the other seemingly foo-foo, unecessary, wasteful add-ons are investments with a specific goal in mind. Elective procedures. That's where the money is and those are the folks who can afford it. That's the market the hospitals are trying to attract. I guess we'll see if the roi plays out as expected.

I thoroughly enjoyed that post!You put into words what I have thought many times and I found your friend's experience with the laundromat, not only interesting, but a fabulous comparison to what is wrong with hospitals.Nice.

Quote from eriksolnoh, wait a second. what they forgot to mention was that they were charging the people from the "community" for the car wash, charging more than the local professional car wash station. mind you, the people who were doing this event were all volunteers, their pay for spending 4 hours of their off weekend in the hospital parking lot.....................lunch, at the hospital cafe..............not allowed to exceed $4.

Quote from FLmomof5Is it greed? Really?In the OPs post, it was mentioned that customers were getting frustrated with the change machine giving less than full value. Also...they weren't able to use all of the machines because they didn't function properly.The OP is so very correct that the owner of the laundromat would have been better off sticking with what works.Here is the disconnect....providing the medical care alone isn't working. Medicare/Medicaid reimbursement rates are at or below the cost of service. Insurance companies have also restricted reimbursement and care. Lawsuit happy folks have driven up the cost of doing business for both the hospitals and the doctors. The issues are complicated, interwoven and cyclical (as in what goes around comes around)....but the bottom line remains the same....the level of profitability of providing pure medical care is decreasing. It sounds like the CEO is trying to add something that is more profitable. Believe it or not, there is about a 300% markup on jewelry! Try doing that with a CAT scan! Honestly, I think a simple gift shop is OK, but the level of other "mall" like kiosks is getting borderline silly.According to Forbes: "The median operating margin for 200-bed hospitals and above was slightly negative (-0.7%) last year. That means the money that was brought in from patients fell short of what they needed to spend on staff, equipment, buildings and other items."[http://www.forbes.com/2010/08/30/pro...clinic_2.html]Yes, there are *some* hospitals that are very profitable, but as the article shows Mayo, as an example, uses the funds from its profitable hospitals to fund at least one unprofitable one in the south and to open another one in Jacksonville.That is not greed. Yes, some CEOs have extraordinary incomes. They were brought in to help get some profitability. (We may disagree with these silly little shops and valet parking, et.al., and the majority of their methods, but they probably thought: we gotta try SOMETHING.) You cannot operate a hospital in a vacuum! The bills have to be paid, salaries met, equipment purchased and/or maintained....all the while you have a demanding public that wants the best of the best for the least.I don't have the answer. If I did, I would have the CEOs job! But, I think there are too many out there trying to villify that which should not be.Let's back up...WAY back. There were things out there called manufacturing corporations. They paid a wage to their employees, most of whom, only had a HS education. They had job security. They felt underpaid. They saw those "enormous" checks of the elite that ran the company and felt it unfair. They formed unions. They demanded MORE. They got their pay raises, their "takes an act of God to fire you" level of job security, medical insurance (silver platter level) and fantastic retirements. To fund this, the manufacturers raise the price of the products. The foreign products were now cheaper and more affordable than the domestic products. The majority of the population could better afford the foreign products so sales monopolies on this side of the pond decreased.....In the meantime, the greatest education in the world began producing the greatest medical innovations as well. To pay for these innovations, prices increased. To pay for the greater increase in reimbursements, insurance companies had to increase premiums or they would go bankrupt. This then fell back on to the employers.... $15K per employee for medical insurance? OK...so they started charging the employee a portion. Folks screamed about that, so HMOs were created to manage costs.All the while, law schools were pumping out legions of lawyers. We joke about the "ambulance chasers", but they are some of the best compensated lawyers out there! To combat these lawsuits, malpractice insurance was created....and because the awards got larger and larger....the premiums to hospitals and doctors skyrocketed. That cost of business had to be passed on to the consumer (in the form of increased medical costs/co-pays/insurance premiums,etc.)!Before the manufacturing revolution, people were happy with getting a paycheck to raise their families. Then we went for paid holidays, vacations, medical, dental, education, retirement.....these aren't free. They have to be paid for. The guy that risked everything he had to create a business can't just hire an employee for a wage anymore. He is the one who took the risk so that you could have a job. He deserves to be compensated for his success.There is an implication being propagated by the media that it is corporate greed (of the upper eschelons) that is creating the train wreck this country is headed for. Did it not start at that lower level? When being paid a days wage for a days work was no longer good enough...?Think about it for a second. The MAJORITY of 200+ bed hospitals run below breaking even! The populace wants perfect outcome from their medical care and will sue (even when unjustified) if they don't get it! (God forbid you have a less than perfect baby, for example.) The employees at the hospital want maximum wage and they want maximum benefits and a low patient ratio. You as the owner of that hospital want the hospital to succeed....so you hire the best CEO you can find. He may not be "cheap", but he is there to create profitability. The untouchables: You cannot raise prices anymore because the insurance companies won't give the reimbursement and the government will give even less. You have to ensure "perfection" (or at least "pleasing") in hospital experiences for the patient. This will reduce the likelihood of lawsuit. You still are expected to purchase the latest and greatest equipment even for rural/semi-rural areas. Business is all about managing costs. So, for all our nurses here.....if you were CEO, what would YOU do?In another post a while back, I showed how taking away the CEOs pay wouldn't increase nurse pay by more than a token. Another point I would make is that if YOU, the nurse, felt you could do better and got your MBA and then the CEOs job.....I would believe that you would feel you EARNED that pay.

I'm sorry, FLmomof5, but I have to diagree with you. I work for a hospital that is flush with cash. I know this because as a charge RN we attended semiannual meetings where the CFO reported this to us. The economy went south so their reimbursement make-up or payor mix changed. They took in less money over the past 2yrs but were by no means anywhere close to dire financial staits. Their response? Eliminate the education department, most msn prepared rn saw their jobs eliminated, freeze pay and cut shift differentials, cut pto time, contract out environmental and laundry services, eliminate cafeteria for the night shift, increase insurance premiums and copays, eliminate incentive pay for float team RNs, inact lean staffing, increase the number of pts a RN is responsible for, freeze hiring and mandate overtime (this is not a complete list but you get the picture). All of this happened while building a new surgical wing and cancer center. What cuts did administration take? They gave up 8 hrs of pto time each year. Our laundry and environmental services are horrible. We often receive dirty linens in our linen closet, run out of linens and other supplies on a daily basis and our rooms are often dirty after they were supposedly cleaned. I guess you get what you pay for. When ever we voice our concerns about how these cutbacks are effecting patient care, we are labeled and reprimanded for being negative. I'm sorry but patients come to the hospital for nursing care, not jewelry, book sales or even to visit the CEOs. The problem with some administrators is that they fail to recognize and appreciate that. We are who makes a hospital great. The docs in our town practice at both hospitals but they and their patients choose ours because of the care we provide. They look at us an expenditure. Can an administrator operate a hospital without nurses? Absolutely not but that does not stop them from treating us like they can.