What Have You Done For Me Lately?

A few years ago I got started down a path thanks to a library director friend in Oklahoma who asked me to teach a class specifically for hospital librarians.  While he worked in an academic medical library he noticed that hospital librarians in his area needed some help thinking of different ways to prove their value or justify their existence, especially in light of the Affordable Care Act (which was very new at the time and nobody knew what would happen…but they knew it would have a pretty big impact).

In preparation for the class, I did a lot of research on the ACA.  I was and still am not an authority on the ACA but I did learn a lot about the changing landscape that hospitals would be (and now are) dealing with.  The biggest change was moving from a fee for service model to a value based model of providing healthcare services.

(Gross over simplification of the ACA coming next….if you want more info click here for a very detailed LibGuide on it.)

Traditionally hospitals were paid on how many procedures they did and billed.  If you had a heart attack were admitted, then released, and then readmitted a few days later…they were paid for the services they provided each time you were admitted.  The ACA now penalizes hospitals that have readmission rates for certain conditions, procedures, etc. In the heart attack example the hospital would still be paid for the services they provided BUT they would also incur a penalty if their readmission rate for heart attacks was too high.  In the beginning these penalties happened for just a few conditions such as heart failure but it has evolved to include more conditions AND acquired hospital conditions like infections.  Every hospital is ranked on these things and those with the poorest score are penalized.  Those with the best score are rewarded.

Not only are hospitals in competition with each other over their reimbursement rates. But they are also in competition for patients.  Now days it is very common for patients to have a very high deductible for care.  If a patient has to spend $4000 before their insurance kicks in, they are going to look for and compare the costs of hospitals.  Both patients and insurance companies are doing this.

So what does this mean for the librarian and why on earth did I focus on this in my class in Oklahoma?  It means that hospitals have to completely change their financial and caregiver goals.  This also means that they are looking at EVERY department in the hospital to see how it fits into these new goals of the hospital.  So cardiology, environmental services, IT, and yes the library all are judged by administration as to how they help the hospital meet their goals.  Clinical departments have a leg up on departments like the library because they can point directly to numbers to tell hospital administration what they are directly doing to impact the hospital goals.  Heck even environmental services has a leg up on the library.  “Was your room clean?” is a question on the HCAHPS hospital survey that patients receive to rate their hospital experience…..which also directly impacts ACA reimbursement.

So while other departments are able to point to specific data to illustrate to the administration how their department helps the hospital achieve its goals, the library has no such data.  Sure we do literature searches and support the caregivers, but what data do we have to show that those searches impact the hospital’s goals?

I recently attended a meeting where hospital administration explained the hospital’s strategy and goals and then explained how the clinical departments fit into those goals.  The administrator then explained how they will be working with non-clinical departments in the near future to develop appropriate measures to support the hospital goals.  DING DING DING At least the administration realizes the value of the non-clinical departments and will be working with them to create MEASURABLE goals that help the hospital meet its goals.  I am not so sure every hospital administration is reaching out to their non-clinical departments like this.

After hearing of the hospital administration mentioning non-clinical departments accountable for providing measurable data that supports the hospitals goals, I had a flashback to my Oklahoma group 2 years ago and to the other ACA and the library classes I taught after them.

Hospital administration wants to know specifically how you help them meet their goals.  They are asking “What have you done for me lately?”  I hope for your sake you just don’t tell them you do literature searches to support the doctors and nurses who treat patients.  Because while that is true….they are going to need to know in a 3 bullet point slide how literature searches lead to their hospital goals being achieved.  It is not their job to fill in the blanks as to how the lit searches do that.  It is your job.

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