Nurses Return to Work After Approving Agreement
Physicians Unite on Need to Retain Welch Road Medical Offices
Vaccine Program Receives Federal Grant to Study Immune System Response to Viruses
Researchers Encourage Minority Patients to Participate in Cancer Studies
A time to heal, to move forward
by: Lawrence M. S H U ER
We can all find useful lessons from two critical incidents in the past year. At their most basic levels, the failure of the UCSF-Stanford merger tells us that what may look good on paper may not pan out in practice. More recently, the nursing strike and its arbitrated settlement in late July teaches us that no side triumphs in a prolonged labor dispute.
While it's useful to comment on and analyze these sentinel events, it's more important to move forward constructively. "I told you so" or "This should have never happened" need to be stricken from our vocabularies.
In a constructive spirit, I'd like to say that many of us still agree that in theory the merger was a good idea. The belief that we could create a better medical center by combining the clinical care of two first-rate medical schools was enticing. The possibility of having better contracting leverage with third-party payers was seductive. However, differing cultures in the faculty and different conditions in the facilities made the merger unworkable. It was supposed to be a marriage of equals, but somehow by the end it didn't feel that way. We did learn a lot about UCSF as well as about ourselves in the process. Some of the advantages of improved contracting and operations were achieved during the period of merger.
In retrospect, the relationship was hobbled by cost overruns, not lack of quality care. I think most of us would agree that if we'd been able to achieve budgetary savings, we would still be merged - and most of our medical staff would be advocates, or at least silent supporters.
On another matter, I think this summer we also learned that no one can come out of a strike feeling euphoric. Victory on either side is not an outcome of labor negotiations in the year 2000. Labor negotiations are dependent on fairness and, in the best case scenarios, a win-win outcome is achieved.
On an ongoing basis, CRONA [the Committee for the Recognition of Nursing Achievement] undoubtedly feels it has a responsibility to achieve a salary for its members that allows them to live and work in this area. The hospital has a fiduciary responsibility to balance its books and avoid an increasing deficit. Meanwhile, we as a medical staff feel a need to continue patient care, research and teaching regardless of what is occurring around us. In the wake of labor negotiations reported widely in the media, patients and families are left to make up their own minds after they ponder the viewpoints of management and the union through the filter of their own beliefs and perception of the realities.
While none of us would ever recommend that we host a strike because of its educational value, a by-product of the past month was that nurses from all over the country came to work at our institution. These nurses made suggestions, introducing us to new ways of getting things done.
While we look forward to getting back to normal, we cannot completely forget that the CRONA strike was painful for nurses, the hospital administration, physicians and patients. While I'm sure that nurses have seen their relative earning power decrease in Silicon Valley as housing costs continue to escalate, they are not alone. We see teachers, police officers, residents, interns and even faculty facing the same dilemma. I think that the hospital and the nurses should not be adversaries in this situation. The hospital faces continued pressures to cut costs as reimbursements for health care go down, placing our institution in a precarious position.
For more than a decade, the leadership of Stanford Hospital and Clinics has been grappling with the need to cut costs and increase revenue through the annual Operations Improvement exercise. The institution in this case is all of us -doctors, nurses, technicians, unit clerks, administrators, etc. We must work collaboratively to find ways to improve our fiscal situation. No "sugar daddy" is available to bail out Stanford University Medical Center. Stanford University has kept the medical center at arms length fiscally and there are no signs that the University wishes to change that relationship.
At this point, it is a waste of time to decry the merger or, worse, to gloat that "we knew better." It is an excellent time to remember that we are not only physicians, but citizens as well. It is appropriate that all of us as health care workers write our members of Congress, etc., to implore them to improve health care financing. By the way, I think we are most effective when we can address issues that have directly inhibited us from serving patients optimally.
The alternative to our being proactive is for the present situation to continue, meaning that many academic health care centers across this country will fail. I believe we would see the demise of quality medicine in the very country that has been the envy of the world for the research and discovery in medicine. Also, our U.S. training programs, which are regarded as the world's best, are in high demand. Will we be able to continue to lead in this effort if there is no relief from the current trend of fiscal squeezing? It is hard to be optimistic. We must educate the public, our patients, and enlist them in this effort to support our health care system if they want hightech, high-quality, efficient medical care to continue. If we can make the case with our policy makers in Washington, maybe the situation for medical care will hold more promise.
Perhaps the broadest lesson from the demise of UCSF Stanford Health Care is the notion that when something doesn't pan out, you keep moving forward
