Does the mission reach the bedside?
What you measure, you can improve.
Measuring this is a challenge.
Look at what gets counted
Every year the ministry files a 990 and fields a survey. Here is what those two documents actually record.
Unreimbursed Medicaid
The gap between what you charged and what Medicaid paid. It is usually the largest number in the community benefit report. Nobody wants more of it, and improving it would mean getting paid less.
A shortfall
Charity care dollars
Closer to real, and still a spend line. Under a third of patients who could not afford their bill ever receive it, and about half were never told it existed.
Money moved
Community health programs
Counted as activity delivered, aggregated to the system. Nothing below the hospital, and nothing about who was reached against who needed it.
Activity
Engagement and culture survey
It works and it should be kept. It measures how an employee experiences their work. It was never given the job of recording what the ministry did in a specific situation.
Sentiment
Bringing the Mission to the bedside
Challenging
Say it out loud in a board meeting and everyone nods, because it is true and it is why the building exists. It is also the only commitment in the ministry with no number, no owner, and no review date.
We checked whether anyone asks
Thirteen published instruments used in United States health systems, coded item by item where the item text is public.
151
Items whose text could be verified
92
Ask whether you agree with a statement
0
Ask the respondent what happened
The four instruments most widely fielded in acute care contain no mission item at all. Not a weak one. None.
Your people already know
They watched it happen, or fail to happen, on a Tuesday. Many of them have already worked out what would fix it and have no way to send it. Nobody has ever asked them in a form that could carry the answer.
So we ask everyone. Not a focus group. Not a sample of ten. Everyone in the scope gets a prompt and a box, and they type or dictate, which is the same thing they do all day in a text message. What makes it work is what the prompt asks for. Not whether you agree that we live our values. What happened. What did you do. Who decided. How often does that happen.
If the name on the building changed tomorrow and the sponsors were gone, what would actually be different about your Tuesday?
One prompt, fourth round. Hypothetical, so it is safe to answer honestly. Concrete, so it cannot be answered with a value statement.
Everyone is included
Environmental services, food service, transport, security, and revenue cycle spend a significant amount of time with patients, and they are asked in this process.
What comes back
Thousands of accounts, structured into categories, each carrying the class of evidence behind it. Per site: a level in each category, the lowest one named, and the specific condition holding it down. No mean, no index, no composite.
The spread between your sites is the finding. The bottom gets worked. The top gets studied for practice worth transferring across the ministry. And where leadership's predictions sit far from what the workforce described, that is a Management finding rather than a site finding.
One boundary, stated plainly
This tells you whether the mission is reaching people. It does not tell you whether you are being faithful to it. That second question belongs to your sponsor and your ethicist, and we would decline answering it if you asked.
Your people have been carrying this the whole time.
Thirty minutes. Bring one thing about the mission you wish you could see across your sites, and we will tell you whether this method could show it to you.
My Background and Why
For forty seven years I have had the privilege of working with not for profit healthcare, and with many of the Catholic, Christian, and Jewish systems within it. One thing sets them apart from every other kind of organization I have ever worked with, and it is their missions.
I have helped design and build a great many of the reports that run off the revenue cycle described above. Those reports are good at what they were built to do. None of them measures the mission. Measuring it is genuinely hard, which is why it has gone unmeasured, not because anyone stopped caring about it.
My second great uncle helped plan the Northwest railway and did the work of obtaining the deeds to the land it was built upon. Right behind him came the Sisters of Charity of Leavenworth, building hospitals. I have had the honor to work with all of them.
Mission driven healthcare in this country is nothing less than the greatest social entrepreneurship story in the world. This is offered as a way to help keep the focus on the mission.