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Feb 11, 2013: Mussi, my beloved tabby from South Chicago, did not return from his nightly outing! At first, I thought he was just extending his nightly trip for a few hours, but Mussi remained gone until after midnight. I started searching the neighborhood over and over, calling his name. After hours of fruitless search activities, I gave up and went to bed. I tossed and turned restlessly until the following morning. Early in the morning, I got up and combed the neighborhood again. I extended the search area a few blocks, puzzled at the situation. I kept calling his name “Muuussssiiii!” Nothing! Where could he be?

On no occasion had Mussi ventured far from the house in the past. In seven years, he’d never disappeared like this. Our silent agreement entailed him checking in with me every 30 minutes or so. He had always been sticking to it. So, what happened all of a sudden? My mind played out the worst horror scenarios. Was he locked in some dark basement? Kidnapped? Run over? Chased away by other cats, or worse, dogs? I felt so desperate that I could not think straight. I was way too depressed and anxious.

I alarmed my family and friends, who were at a loss for words. Everyone loved Mussi and knew him as the most intuitive, smart, gentle tiger from Chicago. They felt sorry for me, as I was still reeling from pain due to another crisis and certainly had enough sorrows. After many more searches, I decided to get help. I asked my sister to contact a woman she calls “witch”, her intuitive friend, healer and animal communicator for advice. This woman tuned in and felt that Mussi was slightly injured and hiding in a basement somewhere. She did not feel that he was locked in, but simply hiding out. She said that she would send him energy and guide him home.

No cat appeared. I checked the basements I could get access to and informed the neighbors to do the same. My frustration grew with every passing hour. I scanned the entire area, again and again. Where could this cat be? A neighbor and I checked two buildings’ ground floors and garages for a cat sign, to no avail. Instead, she introduced me to her cats, who I greeted suspiciously. They looked guilty and could have been involved in chasing Mussi away. Everyone was a suspect at this point. Even the other two black cats from the neighbor straight across seemed to paw around shiftily. I clearly needed sleep!

I started tagging the entire district and beyond with “Desperately Seeking Mussi” posters. The initial batch I put up two days after Mussi’s disappearance, covering several blocks. The densely populated area did not make the choices for flyer placement and neighbor conversations any easier. There were simply too many places where Mussi could be hiding, it was making me dizzy. So, I put flyers on any suitable spot; on buildings, doors, lamp posts, garage doors, garbage bins, you name it – Mussi posters went up! Within days, everyone in the area knew my cat was missing.

As the desperation grew, I decided to talk to one of my friends in LA about an animal communicator she had used years back when her cat was missing. She could not remember the name of the lady in Seattle, so I googled on my own. I found her and sent an emergency request. I guess the animal psychic grasped the severity of the situation. She called me back the same day, after I transferred a bit over a hundred bucks to her PayPal. The information she apparently obtained from Mussi was that he went down an alley way, across a field and then crawled into a hole. He seemed to find the inside of the new territory interesting and decided to hang out for a while. This sounded totally unlike Mussi. She claimed that he wasn’t locked in and could potentially get out on his own. She further mentioned that the building was near my house and that we would be reunited one day.

I continued to put more posters up in the neighborhood and ask around. A guy called from a few blocks away, claiming that he had spotted Mussi in his yard. I drove down there instantly, but the cat, of course, was gone. I checked the area, but there was no hint of Mussi.

I expanded the poster and search area a few more blocks. I tagged the post office, the outside of stores, pretty much all lamp posts in the area, bus and train stations. It was cold out. Deep winter had arrived. It did not make Mussi’s survival or my search any easier. Many ol’ nights I froze my fingers off, posting flyers. I did not want to imagine what the cold spell meant for Mussi, wherever he was. I could not bear the thought of Mussi freezing to death somewhere out there in midwinter.

My phone really starting ringing now. I received calls from numerous people, claiming they spotted Mussi in the cemetery, close to a bus station and sitting on a trail and under a car. However, none was able to either snap a picture or catch the cat. As I was at work, it was not always feasible for me to drop everything and follow vague leads.

Then, one Saturday, I got a call from a French lady who found and held a grey tabby captive. She snapped a picture and sent it. I was on a horse when I got the call, about an hour away. I hurried back as the somewhat blurry picture could have been Mussi. An hour later, I found the French lady in the described area, with four children and a cat gathered around her. Deeply impressed at her determination and persistence, I thanked her immensely for trying to help. Unfortunately, the captured cat was not Mussi and could get released.

It had been way over a week now and still no cat. He was my precious baby, who moved from Chicago to Zurich with me, three and a half years ago. He loved Switzerland as he could venture outside, which was not feasible downtown Chicago. All my life I’ve had cats, but none as special as Mussi. I was deeply connected to him and loved him from the bottom of my heart. Mussi to me resembled a cat embodiment of Mother Teresa. I knew he was alive, but I simply was unable to fathom where. I missed his cuddling up to me every night, his comfort when I was not feeling well and the many different faces and sounds of Mussi.

Where was he? I knew he would have never left on his own. Increasingly, I started to suspect he was abducted. Or did he attempt to go back to his old house where we lived until a few months prior, and got lost on the way there? I had alerted the ex-neighbors and skimmed the area. Nobody had seen Mussi there. The old neighbors, who used to watch Mussi, were on constant lookout for him. I knew they’d do a great job, but I tagged the entire area with Mussi flyers.

I got a call from an energy healer who lived near my old house. She said she spotted my flyer and just a few minutes after spotted a cat that looked like a spitting image of Mussi. She swore it was him. Her intuition, she said, never lied. So, I drove down there to see if I could still see traces of my cat, but there was nothing.

Despite all the Mussi search activities that had been ongoing for two weeks, I decided to go snowboarding for a couple of days. I needed to get away. I was going insane. On my way home Sunday night from the mountains, I got a call from my cosmetologist who lived near my old house. Her voice was frantic as she screeched something about having caught my cat and that I should show up right away to pick him up. I drove down to her house, still dressed in snowboard pants. Indeed, she was sitting in front of a tabby, but it wasn’t Mussi. However, that cat was clearly lost and confused and looking for his home. A beautiful kitty this guy was and I felt sorry for him. Adrienne said, “Just take him instead or yours!” Sorry, but there was no quick replacement for Mussi! It broke my heart to see this cat hysterically searching for his home. So, I told Adrienne that if nobody else takes him in the coming days, I would, temporarily anyway! Luckily, a neighbor was kind enough to give him shelter a few days later.

I had also reported Mussi missing with petlink.com, the chip company, hoping that a finder would take him to a vet or hospital where he would get scanned and reported to me. Further, I advised animal clinics and vets in the area about the missing Mussi. Online, I had posted missing Mussi ads on various lost pet sites.

I started receiving emails from people who identified with my pain and tried to give advice. Some mentioned to intensify the search after midnight, others insisted I should not give up hope as they had lost their cats for up to a year and then got reunited. One person even offered to come help search at night or in the wee hours.

A lady from about five blocks away called saying “Don’t tell anyone, but I feed the foxes at night.” I said that I would not utter a word and that she should continue. It seems that the past few nights, a cat had shared the fox’s chicken leg she dropped outside her window. In fact, the cat was faster than the fox and got its share early on. The lady insisted that the fox food thief was my cat. I agreed to check up on it. She promised to call the same night right after dropping the chicken outside. She did. I immediately left my house to see the scene for myself. And really, a cat showed up just five minutes after the chicken was out to feast on it. But it wasn’t my kitty – again! But now I was an insider of the fox feeding conspiracy!

I contacted another animal communicator somewhere in Nevada. She tuned in and dowsed the map of my surrounding area. She claimed a neighbor was holding Mussi hostage and that I should launch an attack on that house. She was sure. I got binoculars, sat myself in a bush at night and ogled the area. No cat. I even put fliers in all mailboxes belonging to that building, rang a few doorbells and asked, but nothing.

More calls were coming my way. A clerk who worked in a nearby company reported “Oh, your tomcat has been visiting us here for weeks. I will send you a picture.” I did receive the photo. A nice, totally happy tabby stretched out on his desk. While he looked similar, it was not Mussi. I thanked him and felt he was glad that the long tiger wasn’t my cat. He seemed to love this tabby visiting him in the afternoon for playtime.

I decided to push my luck and contacted Joseph McMoneagle, a super famous remote viewer, who worked for the US Army for twenty years, remote viewing and finding top secret military buildings, equipment and people. After his stint in the Army, he became famous remote viewing for corporations or live on Japanese TV. Joe had written several bestsellers on the topic and was the rock star in the field of “psychic spy” work. I met Joe a few times in Virginia and decided to ask for help. A regular session with him usually cost thousands of dollars, but he was kind enough to supply a drawing with indications about the cat’s whereabouts. I surveyed the specified area, but could not find anything that looked like Mussi. I put up more flyers in the pointed out area, which led to a few calls of cat sightings, but nothing serious. A cat as a target appears a lot harder than a human or a machine.

The cat who stretched out on the clerk’s desk got reported to me again by a local football club member. He called and said “I found your cat and am holding him in our clubhouse.” I ran down there and saw the same tabby stretched out on the floor, watching football with the dudes. What a funny sight it was. This cat seriously got around. I thanked them for the effort and left, dejected. It had been almost four weeks now and I started to lose hope.

That famous tabby got reported a third time by a nice woman about a mile away from my house. He had invaded her balcony and gave sinister stares at her indoor kitty.

But where in the world was my tabby?

Then, I got a call from many blocks away in the middle of the night one Friday. A couple had captured a tabby, sent a blurry picture that left too much room for interpretation. So, again, I drove down there to check and of course, it wasn’t Mussi. But I had to follow these leads just to make sure.

Another neighbor, an old lady, called me twice to pledge allegiance and promised to turn over every rock in the neighborhood. She had spotted tabbies and just needed a color picture to confirm which one was mine. I happily supplied her with a picture. The lady was retired and had all day to skim the vicinity. Unfortunately, she never reported the “right” tabby.

By now, the entire neighborhood was involved in the search and people really got talking. The community became a real community again because of Mussi. Everyone was on a mission to recover the sweet little furry creature.

I hired another highly recommended animal communicator. What did I have to lose? His results left me unimpressed. He pointed out a tree-covered park-like area and insisted the cat was hiding there. The homes right behind that area appeared to be another target for him. Long ago, I had tagged flyers all over that area. However, I ventured down there again to check and found Mussi-like fur on a field. It looked like a cat-fox fight had taken place. My heart sank to the ground. I thought, of course, the fox took and devoured him. My mom agreed with my suspicion. But who really knew? Sure thing was – this animal communicator made another 175USD of me – for nothing.

Another “pet detective” from Los Angeles, who works on a donation basis, suggested Mussi to be near that same area. As she apparently combines her common cat search sense with psychic intuition, she recommended to sit near that area with a book, as cats supposedly come out when one is quiet and reading. While this may work for other cats, I knew Mussi would come immediately if he did spot me. She further recommended to put out “fish trails” from various directions to my house. Supposedly, a few of her clients got their missing cats back with this tactic. As I left no stone unturned, I mixed up cat food with fish sauce and trailed it from numerous directions to my deck. After a while, I spotted several confused cats sitting on or near the trail and enjoyed quite a few cat visitors on my deck. The perplexed cats stared at me in disbelief. They seemed to ask, “Are you insane?” Well, was I? I started to believe myself that I’d gone over the edge.

A young woman named Kerstin contacted me (she saw my posters) and insisted she’d help me in my search. So, one Sunday she came to my house and we once again, scanned the entire area. Once more, we came back empty-handed. She volunteered to print colored Mussi pictures and hand them out in the neighborhood (my flyers were black and white). She further offered to help me further in my quest and stayed in touch. I really appreciated the help and got more and more amazed about the community and the remarkable people in it.

Mussi had been missing for a month and a half now and my hope for successful recovery sank to rock-bottom levels. Which cat would survive for this long out there in the cold or locked in somewhere?

While I was still getting calls from people who spotted tigers under cars, crossing the road or invading their balconies, I knew none of these were Mussi. He was elsewhere. Perhaps, he was far away, locked in a prison or dead. I had a bleak picture in front of my eyes. Yet, somehow, I still felt him alive, but barely.

Beginning of April, I felt the need to get away from it all and joined a four-day Tibetan Buddhist meditation up in the Alps. The theme fittingly was “Purification” – just what the doctor ordered. I bathed in the marvelous energy and was able to get really deep into meditation and cleanse quite a few impurities out of my system. I felt like a load was lifted off my shoulders after four days and with renewed energy I went home. Before I left there, a friend mentioned “Now, Susanne, I would be surprised if your cat reappeared as your karma has completely changed.”

She was right. Before midnight, less than week after the meditation, on April 11, 2013, I received an email from petlink, reporting Mussi had been found. I thought it was a joke. I contacted them immediately and got information where and who to contact for further data. He got scanned by the animal hospital in Zurich! I was amazed at this outstanding service. At the same time, I got a call from a neighbor, very early on that infamous Friday morning, telling me about a half-dead cat she found that night.

The nice woman, named Nathalie, breathlessly told a story about how she found Mussi, who appeared to be paralyzed, totally starved and dropped in front of her garage. Someone must have put him there and set some milk in a bowl next to him. She said she did not know what to do at first, but immediately googled for options on cat rescue services. She called one of the numbers she found and within an hour, the animal rescue service “Tierrettungsdienst” showed up to take the seriously emaciated cat to the animal hospital. Before they came, Nathalie walked up to one of my flyers to get Mussi’s name. She then went back to him and called him “Mussi.” He responded with a weak, desperate “meow.” She had never seen an animal in such bad shape before, unable to coordinate his limbs, yet still alive. She stayed and talked to him for over an hour until the rescuers showed up to take him to the animal hospital in Zurich (Tierspital Zurich).

All I could do after I heard this story is cry and frantically make my way to the hospital. The grim description of my cat’s condition left me with little hope to find him alive. Tears gushed down my cheeks, I was unable to control any of it. I called my family to share the news. They could not grasp that Mussi was alive. They were in complete and utter shock. At the hospital, Mussi was reported as a “homeless cat”, but not for long. I both dreaded and longed to see him. I was expecting the worst. Then they brought him in. He had spent the night at the ICU and just got released. Here he was. Just a bag of bones, unable to coordinate any movements, totally emaciated, still panicked – a heart wrenching sight. My heart ached. I cried relentlessly. But Mussi recognized me. He meowed and tried to lift his head. The fact that he was released from the ICU meant that he would most likely live as an assistant “illegally” told me! The vets, however, were careful in giving me complete reassurance, but mentioned the chances for his survival were good. I could not believe it – he would live!

Thanks to a nice neighbor, petlink.com, the animal rescue service, my 200 flyers that I posted, and the animal hospital, Mussi was alive and we were reunited.

But immediately, questions creeped into my head. What would his future look like? And where had he been? Could he recover from this?

According to Nathalie, who found Mussi, a locked in, meowing cat would have been detected in her building. People passed the storage areas in the basement on their way up to the apartments. Frightened meows would have been heard. Was Mussi locked inside another building? Did he crawl to this garage with his last strength after finally having been released? Perhaps, we will never know.

Nevertheless, he must have got water from somewhere, as otherwise, survival would have been impossible. Perhaps, he licked dew or rainwater was able to enter his prison? For certain, he’d had no food for two months, judging by his gaunt state. Two months!!

His legs were bandaged up, an IV fed fluids and much needed vitamins into his veins. I sat there stunned, staring at not even half the cat Mussi used to be. I still could not believe he was back and alive. It took me a few days to grasp that. For quite a while I suffered from nightmares about the starvation camp he was locked in. Although, I was overjoyed about his return, the pictures of his prison took a while to fade.

The vets and staff at the university animal hospital in Zurich gave Mussi the best care! They were fantastic! Mussi even received daily physical therapy to get his muscles and nerves working again. And he wanted to live! That was the most important ingredient. And he was loved and received healings from many friends and family on a daily basis.

The worst problem was his severe deficiency in Thiamine, an essential B vitamin for cats. Depletion of such causes ataxia (loss or coordination), seizures, inability to raise the head and twitching. Mussi suffered from all the above. B1 or Thiamine is not stored in a cat’s body and is quickly depleted. Two months of starvation led to severe B1 deficiency. The drip would help, but it took time.

Vets and staff shook their heads in disbelief about Mussi’s survival. They were stunned at the strength and willpower of this cat. They had to admit that they had never seen a case like him before.

I visited the American patient every day in the hospital. For five days, he was too apathetic and exhausted to notice much around him. He just slept. Any efforts on his part to try and move resulted in seizure-like attacks, which left him frustrated.

Many, many friends, energy and Pranic healers, Reiki masters kept sending Mussi healing energy and in doing so sped up his recovery. These remarkable people had helped in the search for Mussi all along. Perhaps, it is these miracle workers who helped Mussi survive for two months in a dark basement? May be the Pranic energy kept him alive as we kept sending it all that time he was missing too. I am deeply grateful to everyone who helped and supported the search and recovery, in spirit, mentally, physically or energetically.

After one week, Mussi’s lethargy lifted a bit, and so did his head. He was able to bend the head from side to side and his eyes followed me slowly but curiously. Another day after, Mussi got up on his shaven (to insert the IV), skinny legs and pressed his behind against my scratching hand. “Wow!” I cried out in amazement. Mussi was back!

Mussi got up and walked around the entire room after only two weeks in the hospital! What an incredible cat. When he arrived on April 11, 2013, the vets thought him more in nirvana than here on Earth. And only two weeks later, the Chicago kitty was back on his paws!

Around the same time, I had a long discussion with one of the friendly vets at the hospital. He was recovering very quickly, he said, unusually quickly. The staff at the hospital knew Mussi as Miracle Mussi, a true hero. Although, he suffered a few setbacks, like inflamed, overworked pancreas or a low red blood cell count, nothing could stop Mussi now from a total comeback. He was determined to come home and get his old, sweet life back. And so he did, on May 3, 2013 – Mussi arrived at home.

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Prescription For Hospital Survival Is Growth, Not Cutbacks

The United Health Fund recently reported that 13 of 35 non-profit, acute care hospitals in New York City are in such financial distress that their long-term viability is in doubt — a warning for all health care institutions struggling to survive.

But the traditional cost-cutting and layoff prescriptions for health care providers in trouble are not sufficient to solve this growing problem. Hospitals cannot continue to slash their way to survival without sacrificing quality and patient services. Traditional cost reduction often leads to additional market share erosion and revenue loss. As the health care system moves into an environment focusing more on patient/customer satisfaction, the traditional management responses could result in even greater losses for the hospital. Patients may stop coming because of reduced or non-existent services, the fact that their doctors have gone elsewhere, or the perception that the hospitals reputation is declining. Doctors may leave due to declining service quality, experiences with inadequate clinical and support staff, and frustration with outdated equipment and facilities.

Maverick Healthcare Consulting has found that financial difficulties can often be more effectively solved with growth strategies that expand and enhance existing revenue streams, create new sources of revenue and increase market share. These strategies include investments in enhanced quality to increase patient and physician satisfaction; investments in equipment and staffing that will speed the patient experience, improve convenience and increase patient volume and throughput; and investments in new services that enhance a hospitals profile and make it much more competitive for market share.

Maverick Healthcare Consulting has had the opportunity to assist a number of Greater New York hospitals in designing and implementing creative approaches towards growing out of the financial doldrums. Following are some examples of these types of improvements. In addition to improving quality and service, such actions were instrumental in avoiding layoffs and other sacrifices for the communities they serve, and in creating new employment opportunities as projected revenue streams and services were successfully achieved.

A New York City community hospital was losing hundreds of thousands of dollars each month and was about to close its doors. Although its cost structure was well below almost any of the other hospitals in the area, it was still suffering financially. In light of declining reimbursement and patient volume, and with a growing concern regarding continued liquidity, in order to preserve its vital core of services for the community, the hospital turned to the tactic that had helped it avoid past financial difficulties: cost reduction. However, this time the tactic worked against the hospital. Having eliminated virtually all of the fat from the organization, in desperation, the hospital was left with little to reduce other than the muscle. To better manage expenditures, the hospital reduced surgical hours of operation, postponed needed investments in the expansion of surgical services, and delayed replenishment of surgical equipment required by many of its surgeons. This resulted in surgeons beginning to take their patients elsewhere. Vital patient flow improvements to the emergency department (the major source of admissions for the hospital) were postponed, and increasing overcrowding resulted in more patient walkouts and more frequent diversion of ambulance traffic to other hospitals. Admissions declined, exacerbating the financial crisis. Vendor payables were stretched to the limit and the hospital began having difficulties receiving shipment of necessary supplies. The hospital was in a classic downward spiral.

To halt the precipitous decline, the popular prescription for a sick hospital was changed, and an entirely different regimen of investment and growth was implemented. Through a strategic mind-shift, management took a new approach towards the situation. Cost cutting and layoffs were out, and focusing the remaining capital of the institution on investment in growth became the master game plan. Investments were made in quality and staff education, surgical and emergency services capacity, and in service lines that both fill a vital community health need and produce a positive bottom line contribution. The hospital’s investment orientation, and its careful selection of key productive assets in which to invest, was the fulcrum around which a new team turned itself around and became an inspiration to its community, physicians and employees

The hospital has not lost a cent in the last six months and is well on the road to recovery.

The North Shore/Long Island Jewish Health System on Long Island in New York is another organization that has improved its market position through investment and growth. North Shore/LIJ is one of the larger not-for-profit health-care systems in the country with 18 hospitals and revenues in excess of $3.2 billion. The System has a record of stellar growth over the last decade as it came to realize that cutting costs was not the only way to prosper in a competitive New York environment. Instead, the System focused on growth through development of new services for existing markets throughout Long Island, Queens and Brooklyn.

Early on, the Glen Cove Community hospital joined the North Shore /LIJ System. Glen Cove was a very traditional community hospital facing an increasingly hostile competitive environment. Its board realized that if things continued the way they were going, the hospital would soon deplete its reserves. A new direction was needed. So it joined the North Shore/LIJ Health System.

The North Shore at Glen Cove growth plan began with the development of a patient rehabilitation program. Once this program took hold and was successful, a second phase of growth was started. A surgical services program was created and an orthopedic surgeon employed. As a result, this 250-bed community hospital is financially solvent and a successful member of the North Shore/LIJ Health System.

North Shore applied this successful formula in several other institutions on Long Island, including, for example, Syossett, Plainview, and Forest Hills – all of which are successful organizations and prospering from investments in growth initiatives.

Additionally, early in its formation, the System invested in a rigorous quality management system that has shown its worth through the introduction of common policies and procedures geared towards the measurement and production of higher quality outcomes. Working in concert with the medical staffs of each of its member hospitals, the System has been able to raise the standard of care for all patients and the expectations of its medical staff to levels not previously available on Long Island. A direct result of these activities is the designation by AARP of the North Shore University Hospital in Manhasset as the Best Hospital in America for customer service by its membership.

Obviously, not all hospitals and health systems have the resources, stamina, desire or know-how to implement a successful growth strategy similar to NSLIJ. In fact, some have determined that in light of the risk and challenges associated with a merger/acquisition oriented expansion strategy (despite the success of NSLIJ, there have been many other publicly discussed merger/acquisition failures), they would be better served to invest in quality of service and throughput improvements in their core facility. The University Hospital in Newark, associated with the University of Medicine and Dentistry of New Jersey, presents an example of a hospital that has done this last approach extremely well.

Like most other large academic hospitals, years of continuing governmental and commercial reimbursement reductions, deferring investment in aging plant and equipment, increasing indigent volume and escalating costs of labor and materials had taken their toll on University Hospital. To break the downward spiral, University Hospital leadership developed a multi-tiered growth plan. The first tier of the plan focused on the financial stabilization to stop the spiral. The organization focused the talent of hundreds of skilled employees and physicians on the design of dozens of Strategic Work Group (SWG) initiatives to improve the core operational and financial process effectiveness of the hospital. SWG success provided investment capital to fund the second tier of activity: Strategic Growth. University Hospital invested in the renovation and enlargement of its trauma center, the enhancement of staffing and equipment, and in the redesign of dozens of cross-departmental processes that had previously created barriers to entry in the ED. Similarly intense investment and improvement efforts focused on the Operating Room. Key ancillary and support departments such as the Laboratory, Radiology, Admitting, Discharge Planning, Environmental Services and Transport were redesigned and enhanced to support an increased volume of patients. At the same time, improved contracting and physician services brought more throughput to revenue generating centers such as the OR, ED and Patient Care beds. This leadership insight and courage produced results: hospital revenues, cash and volumes increased dramatically, and in 2003 the hospital experienced its first positive operating margin in many years.

These experiences are just a few examples of why growth in times of crisis, as opposed to layoffs and cutbacks, can be exactly the prescription to hospital illness.

Moreover, the impact of such growth strategies can be optimized when an organization establishes aggressive goals in each of its functional areas; selects a measurable approach, monitors activity, and addresses underlying process and workflow redesign resulting in positive and lasting change; allocates sufficient resources to achieve growth; and measures progress against objectives making necessary modifications along the way.

In place of cutbacks and layoffs, hospitals should be thinking about the following strategies to preclude or overcome financial instability:

o Increasing quality, capacity and patient flow in areas that produce revenue

o Producing new business from new patient bases

o Expanding revenue-producing areas

o Improving medical research and grants management.

To build the revenue base and increase market share, health-care organizations should also consider:

o New program development

o New ambulatory services strategies

o New provider/payer network planning

o New mergers and acquisitions

o Increasing quality of care, patient safety and satisfaction

o Increasing physician job satisfaction.

The winds of change continue to blow throughout the health-care system, scattering old ideas and failed solutions. But one major change is long overdue: struggling hospitals must begin to choose growth over decline. From better access management to improved staff scheduling and patient care, to the development of new businesses and markets, a turnaround action plan can be implemented without cutbacks and layoffs. It is one medicine with very pleasant side effects.

Scott has assisted a wide variety of health care organizations (hospitals, academic medical centers, IDNs, colleges of medicine) to develop and implement innovative solutions to chronic strategic and operational threats. His broad base of strategic planning, process/operations design, quality improvement and financial experience has allowed him to develop a track record of success in helping clients to achieve significant margin growth and sustainable competitive advantage.

Prior to forming Maverick Healthcare Consulting, Scott was a Principal at the ImPart Group, and spent 16 years at Deloitte Consulting, where as a Partner, he was co – leader of the firm’s health care industry Performance Excellence and Reengineering practice.

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Hospital Survival

This article explores one of the most challenging and interesting questions that hospital boards are facing as they move into 2014 and the future.

This article is written within the context of healthcare DAVID vs. GOLIATH that is occurring at all levels. At the hospital level, hospitals are merging into other hospitals and independent hospitals are finding it more challenging to thrive on their own. At the hospital-physician level, the system has shifted toward one in which nearly 50 percent of all physicians are employed by hospitals and health systems, and nearly 80 percent of all physicians have some sort of financial relationship with hospitals. There is also increased consolidation among payors (although a great deal of this consolidation has already happened over the last 10 years). This has resulted in only several key payors existing in most markets. Finally, payors are increasingly re-entering the healthcare provider business, either as a hedge against provider market power in certain markets or in an effort to attempt investment in areas outside of insurance.

1. Can A Hospital survive independently?

Today, we see more hospitals being gobbled up by the massive profit centers. This bodes well to take a peek inside. Many hospitals are examining whether they will be able to survive as independent entities over the next several years. A couple of studies have looked at the key factors leading to hospital bankruptcies and the key factors that can be used to assess whether a hospital is in a position to survive independently or not. One study, for example, shows that the three biggest causes of financial instability for a hospital and potentially leading to bankruptcy are mismanagement, increased competition and significant reimbursement changes. For an overview of issues impacting hospital viability, see “Factors Associated with Hospital Bankruptcies: A Political and Economic Framework” by Amy Yarbrough Landry & Robert J. Landry published in the Journal of Healthcare Management in July 2009. The article also notes that “bankrupt hospitals are smaller than their competitors. They are also less likely to belong to a system and more likely to be investor owned.”

Here are my factors which can be used to help assess whether or not a hospital can survive independently. These included:

Does it have a high standard quality of care? Alternatively, is it the type of hospital that a staff member or Board member would take his or her family to?

Does it have geographic barriers?

What does its payor mix look like?

Does it have a good management structure?

What does its asset base look like? Does it need to make significant capital investments? Does it need to make significant renovations or build a replacement hospital? Does it have other significant obligations ahead that it can’t fund?

What is its cost structure? Is it locked into long-term pension liabilities? Long-term lease rates? Or other long-term fixed costs that are not changeable?

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