It may seem that officials at Howard County General Hospital are putting the cart before the horse with plans to reorganize departments and increase staff workloads.
The effort is aimed at cutting costs at a time when the hospital is facing increased competition from health maintenance organizations, private health insurers and outpatient clinics. The changes will go into effect even though the hospital doesn't plan to hire a consulting firm to analyze its patient care and purchasing procedures until February. So, some might ask: What's the hurry?
For one thing, the state agency that sets hospital rates is shrinking the annual increase allowed next year. And the rapid changes in health care during the past decade have forced major transformations at other area hospitals. Many larger institutions have already turned to offering specialized care and opening more profitable outpatient clinics. Howard County General, a private, non-profit facility, has been slow to react. The hospital is developing its focus on oncology, cardiology, maternal and child care and ambulatory services. Its outpatient facility is scheduled to open in 1996.
Meanwhile, hospital officials have wisely chosen to confront problems now, before they face a crisis. Officials expect the hospital to post a $2.6 million surplus in 1995, on an operating budget of $76 million. If the hospital were to falter, it could be vulnerable to takeover, something its operators say could jeopardize the facility's community mission.
Under the plan, related departments will merge, and some employees will be retrained and reassigned. The hospital also hopes to increase productivity over the next few years and avoid layoffs among its 1,300 employees.
Some staffers warn that changes may come at the cost of good care. That's a legitimate concern, and officials must employ rigid quality controls for the hospital to remain successful. To avoid change because of the risks, however, would be foolish. Despite the fact that health care reform has stalled in Washington, industry changes continue at a rapid pace nationwide. Even as the hospital reorganizes, members of the state's largest medical society, the Medical and Chirurgical Faculty, have formed a company to explore ways of competing more effectively against private insurers. The cost of service and the quality of care are two sometimes opposing forces in the current health care turmoil. Those institutions that offer the best care at the lowest cost will continue to be players in the game.