BALANCING ACT: JOBS VERSUS HEALTHCARE PLANNING

There is a growing body of evidence that the demand for inpatient acute care beds will decline over the next ten years, despite the aging of the population. This, on top of data suggesting that current inpatient bed capacity is underutilized, has led many policy experts to believe that RI has too many hospitals. Overlooked in this conclusion is that hospitals are much more than inpatient beds. They serve as a nexus for healthcare delivery in a community and increasingly are responsible for recruiting and managing traditional physician practices and other outpatient services. There is also the issue of the distribution of hospital beds and what constitutes reasonable access, particularly in an emergency. That said, there is a strong argument to be made for fewer beds and morphing some hospitals into strong ambulatory care delivery systems that are focused on population health management.

Some people, myself included, felt that we had an opportunity to pursue a rational plan for healthcare delivery and population management in Woonsocket and Westerly, as the hospitals in both communities found it impossible to sustain their current profile of services. In both instances, the communities and the staff fought to preserve a full-service hospital. Although there was concern about access to services by the communities, maintenance of employment was the primary goal of hospital staff and the communities. In both instances, the staff were willing to make concessions related to working conditions to preserve the hospital and their jobs. In the case of Landmark Hospital in Woonsocket, the staff are apparently faced with an unknown out-of-state bidder as the only remaining option after Steward Healthcare System withdrew after three years of negotiations.

"Although there was concern about access to services by the communities, maintenance of employment was the primary goal of hospital staff and the communities."

There is clearly a dilemma here as health planning goals appear to conflict with disruption to people’s employment and their lives. One wonders if there isn’t a way to pursue a more balanced approach. The first step in such an approach is to better understand the health needs of a community and, in conjunction with residents of the area served by a hospital, determine what services are necessary to meet those needs. It’s impossible to do this in a crisis, but in the case of Woonsocket we had four years to think this through. The second step is to consider what kind of healthcare roles will be necessary in the new system and where the jobs will exist. Finally, retraining may be necessary to prepare workers for the new roles.

These situations raise the question of whether we will ever be able to plan the healthcare delivery system of the future or whether we will stumble from one crisis to the next? Maybe my approach is oversimplified, but there has to be a better way to approach these situations, particularly if demand for hospital beds is going decline and we’re going to face more situations like Westerly and Woonsocket in the future.

I look forward to your comments. --Lou Giancola