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Time Capsule: My Secret Nostalgia for Small Hospitals

April 6, 2012 Time Capsule 2 Comments

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in March 2007.

My Secret Nostalgia for Small Hospitals
By Mr. HIStalk


I have a dream at least once a week. I’m working in a tiny hospital in a flyspeck of a town, an architecturally outdated cinderblock building plopped in a big field in the shadow of lofty mountains. I’m running my little department nearly single-handedly. I’m feeling good, relaxed, and confident that I’m making a great contribution. I like the administrators, the physicians, and my co-workers.

If you’ve ever worked in a small hospital, you know how honorable and satisfying a profession that can be. The commute is traffic-free and I just might stop off on the way to work to buy bag of biscuits for the people I work with. If anyone in my family has medical needs, I know they’ll be treated very well by my peers who are – dare I say it? – friends. The “we’re all in this together” feeling is universal.

In other words, I’m back in the 50-bed hospital I worked for right out of college. The soft gauze of time has probably softened the memory of low pay, stretched resources, and plain-Jane facilities. Still, I never had to attend meetings, I didn’t worry about being on the wrong end of a corporate back-stabbing, and I knew I could make a difference in just about any way I chose. I was on top of my game and I knew it.

I miss it, even though I’m sure it’s changed since then. Sometimes I think I shouldn’t have been so anxious to move up to bigger and allegedly better places with their layers of bureaucracy, unchecked egos, and big but sometimes poorly managed budgets and IT projects.

I like small-hospital IT, even though it’s the minor league of the industry. I keep reminding myself that the majority of hospitals aren’t sprawling medical complexes – they’re little buildings where proud locals are born and will die, with no interest whatsoever in heading off for an impersonal and often dangerous big-city medical center.

Any plans to raise healthcare’s technology bar must include that majority of hospitals that are small, poor, and under-resourced. They need simple, affordable technologies that work, not $25 million systems that require a small army of support staff and an ego- driven CIO making $400,000 a year.

Luckily, some very good vendors are happy to sell into these little hospitals at an affordable price. In fact, some of their customers have outdone their big- hospital peers in rolling out CPOE, paperless medical records, and IT-driven improvements in outcomes. I love to see that. Too often, they feel inferior at the modest scope of their efforts.

I’m sometimes guilty of getting on my high horse about big-hospital IT. That’s odd since, as an insider, I know how poorly it can work even in a big hospital. I’ve played a role in huge IDNs that bought little hospitals and haughtily tossed out all their highly functional systems just for our own IT convenience, i.e. “standardization,” knowing that they were actually way ahead of us with their little econobox IT stuff because they actually used it right. Too bad.

Maybe I’m just being uncharacteristically and overly sentimental, but I’d like to give a respectful nod to that great majority of hospitals that vendors, consultants, and member groups often forget about. Some of us in seemingly glamorous places have a secret: we recognize that you sometimes do a better job for your patients than we do for ours. And, in our dreams, at least, we sometimes come back home.

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Currently there are "2 comments" on this Article:

  1. Funny you should mention working in a 50 bed hospital and how it’s changed. Yes, but I believe, for the worse in that small hospitals are being gobbled up by bigger hospitals or hospital systems with deep pockets.
    Or closing their doors like Cheboygan Medical Center in Cheboygan, MI. (If you’re wondering where that is, it’s where the UP and LP meet or very close.)
    There were bought out by McLaren but, according to CMS, licensing and re-certification issues kept the deal from completing. So, with cash on hand only getting them through Tuesday, April 3 only, they closed their doors.

  2. The rural hospitals our staff work with have had more advanced IT applications installed and operational than most of the metro facilities in our neck of the woods for years (e.g. Online MARs and bedside medication /verification). Yet, these same rural facilities have had to give up all of their investments in technology and the people power required to successfully implement it because the metro facilities and physician practices push their way in. In most cases, these facilities have taken a huge step backward in HIT in order to adopt the standards by the metro gorillas. That is why I had to laugh at the response to Mr. hISTalk’s question recently about whether or not the rural facility’s quality increased or decreased when they merge with a metro facility. I would have liked to have seen the demographics of those that responded – I bet most of them worked for those same arrogant metro facilities doing the takeovers. Where are the savings in HITECH when it encourages massive replacements of perfectly running technology?

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