On May 27, 2016, the Mayor, Dr. Joseph Webb, Dr. James Hildreth, and Councilmember Erica Gilmore announced a plan for an independent third party assessment of the financial and governance structure of Nashville General Hospital. The goal is to strengthen the long-term viability of this important Nashville institution.
I am glad that this project is going to happen. I want to share some of my thoughts about what I think will happen.
To start, though, I think it is important to acknowledge some of the difficulties in talking about the hospital. This is a topic where the words we use matter. For example, while Nashville General Hospital does serve a significant number of indigent patients, calling it a “hospital of last resort” suggests an inherently poor quality of service. And, while Metro has been budgeting $35 million for the hospital’s operating budget, calling it a “subsidy” suggests the money is a handout. Unfortunately, in the context of historical racial segregation in our nation and state and city, these word choices can sometimes send a conversation in a bad direction almost immediately.
I believe that Nashville General Hospital is an important institution in Nashville. I believe we can take care of all Nashvillians with high quality health care. I believe that the money Metro pays is an investment in all of us, not a handout.
With all of that said, here’s what I think I know:
- There is at least one media outlet that has called this an “independent audit.” It is not an audit. The term used has been “financial assessment.” I have said previously that I would like to see the hospital have more resources to help with its budgeting and cash forecasting.
- I have worked with KraftCPAs and Kevin Crumbo on projects before. They are good at what they do. They won’t come in with preconceived notions. They will have their hearts in the right place. Kevin never sought attention for it, but he was instrumental in re-working the Contributor’s business plan a few years ago (when they increased price and publication frequency). He donated his time and expertise then to help the Contributor survive and thrive. His work with the Nashville Symphony is also well-documented.
- This financial assessment is consistent with Dr. Webb’s goals. To accomplish major change, you have to be very good at the fundamentals. The hospital just hired a new CFO, and Dr. Webb is still pretty new himself – now is the perfect time for this project. If there is a strong finance function to provide strong financial reporting, then the hospital will be able to make strong decisions.
- I have one Council colleague who tweeted yesterday that, with “an entity that is subsidized $35 million a year,” it is important to know more. I have another Council colleague who replied, “what will this…tell us that we already don’t know?” These are both legitimate sentiments – but I think the limited phrasing available in 140 characters on Twitter creates the risk of possibly stumbling over the language problems I mentioned. We have to see the money as an investment in critical health care infrastructure. That re-frames everything. And we have to acknowledge that facts are our friends – more facts lead to better decision-making.
- It is important to avoid the blame game as more facts are learned. If the facts show that there are improvements that might be made, that doesn’t mean someone has done a bad job. Seriously, look around your own workplace – most of us work in a place where most everyone is hard working and good at what they do. But there is always room to grow, to get more competitive, to turbocharge your organization. Nashville General Hospital is no different – having ideas for improvements does NOT necessarily mean anything about how good a job any single individual is doing. Embracing and empowering ideas for improvement is how the best change happens. I believe Dr. Webb shares this view and that’s why he is a partner in this new financial and governance assessment.
Finally, I want to thank Mayor Barry, Dr. Webb, Dr. Heldreth, and Councilmember Gilmore for collaborating on this project. This is the right time for everyone involved to have a fresh assessment of the hospital’s finances.