Os egos institucionais são demasiado fortes...

Um artigo que vem pôr no papel, de forma organizada, um conjunto de ideias que partilho mas que nunca consegui reunir desta forma "Charting a Clear Course in Rough Seas A New View on Hospital and Health Systems Strategy".
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Deparo com tantas organizações públicas e algumas privadas (universidades, por exemplo) que padecem deste mal: confundir estratégia com a simples existência; confundir estratégia com a posse dos activos que permitem produzir; confundir estratégia com localização; confundir estratégia com a bondade do que se faz para o bem comum:

"hospitals have thought of their form as a set of assets: a regional footprint, a network of facilities on a campus, or an ambulatory surgery center.
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In this regard, hospitals and health systems tend to look at function and form more narrowly than their counterparts in other industries, which define their function as the way that they attract customers (their value proposition) and their form as their capabilities (their distinctive strengths) as well as their assets. A retailer, for instance, will think of its function as the mix of products that attract purchasers, and those products will change as its customers change their tastes; the retailer’s form is not just assets such as real estate and inventory, but also the design skills and merchandising capabilities that support that function.
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a health organization will gain a greater benefit from defining its function the way companies in other industries do—as a distinctive value proposition, based on a nuanced understanding of the community’s needs. Similarly, there are benefits to thinking about the health organization’s form in terms of capabilities and operating models, rather than just assets."

Claro que cá falamos mais de hospitais públicos do que privados. Por um lado a pressão para a poupança, que leva a instituições de saúde cada vez maiores por causa do pretenso aumento da eficiência com a centralização, dinossauros incapazes de prestar um serviço de qualidade e com humanidade; por outro lado, a pressão para crescer para prestar cada vez mais serviços, para assegurar mais financiamento, mesmo que em competição com outros hospitais públicos vizinhos.

"“Five years from now,” said the CEO of a major academic medical center at a recent hospital conference, “our organizations will look very different. They will operate with different incentives, different business models, and different footprints.” He added that as the industry evolves from volume to value, (Moi ici: Nós por cá ainda estamos na onda do crescimento, do aumento da dimensão das instituições, na criação de mega-hospitais, e comprazemos-nos com essa evolução...) both the function and the form of hospitals and health systems will change."

Sem estratégia ficamos reféns de egos institucionais:

"if the mission does not prioritize strategic objectives, it can become a repository of “nice to have” activities, championed by local supporters but not really needed. These missions often sound like laundry lists of everything that an organization could provide: teaching, research, and leadership in every possible service line, across the entire care continuum and at every severity level. Such a scattershot view of the organization’s function can lead it to fragment its efforts and become a “jack of all trades, master of none.” 

Sem estratégia não há verdadeira especialização:

"Hospitals and health systems can also be overly constrained in their thinking about their form.
Traditionally, hospitals have defined their form as their assets - land, buildings, medical technology, and physician practices.
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As a result of this way of thinking about their mission, many health systems today are characterized by a form and a function that are suboptimal, rooted in the past, and yoked to their legacy assets. This problem manifests itself as a lack of focus;

Como todas as organizações humanas, excepto as tribos e as famílias, existem para servir pessoas exteriores  a elas, definir uma estratégia passa por definir para quem se trabalha:

"Many healthcare providers feel that they do not have the luxury of choosing their customers - or saying no to others based on their service area, socioeconomic status, or diagnosis. In fact, the term “customer” is controversial in some health organizations for this reason. However, there is merit to defining the target customer as someone you want to attract and win over - even if you have to serve everyone who walks in the door. Choosing a target customer is not about saying no (Moi ici: Não é necessariamente dizer não, mas é assumir que o grosso dos recursos ou da atenção não vai ser consumido com certos grupos); it is about selecting a center of gravity and aligning the bulk of your organization’s resources behind it."