ACHE Session: Healthcare's Response to Globalization

The increasingly flat world of global healthcare is of concern here in Holland (and of course an increasingly worldly staff composition is of concern for US hospitals as well).

Here's some good data from an ACHE Congress seminar (March 10-13th):

Central Question: How is globalization affecting the operation and management of healthcare facilities in the US?

Takeaway Points:

* Reciprocal permeability of globalization (movement back and forth of dollars and people - staff and patients)"

* "collective impact seems to be getting more intense by the year"

* "see hospitals responding in more of a bottom-up approach as opposed to there being a centralized function in hospitals - maybe we need corporate strategies for dealing with the global environment - monitor the environment for changes that are significant in the world."

* "It's happening to us..." no information on flow of dollars/personnel in terms of consultants moving back and forth - US based firms and staff establishing bases abroad.

Quote of the day: "Healthcare is a little bit late to the table in thinking about this."

MEDICAL TOURISM/Travel to Care - should have been a session in this presentation.

From the Audience:

* Medical tourism and need to staff physicians in developing markets will create opportunities.

* Hospitals going public in India. India, Saudi Arabia are having docs go back and start hospitals and recruit fellow doctors to RETURN (Boomerang Providers).

* Cleveland Clinic has 1B budget to come up with overseas revenue streams (businesses go where the growth is...they can see markets developing and opportunity for gain).

The Old Standards are Still Hanging Around:

* Treating patients with limited English proficiency is still a big deal - about 18% of US population speaks language other than English at home. 80% of hospitals surveyed report they encountered LEP patients at least monthly. 97% large hospitals (300 beds), 64% small hospitals (under 100 beds)- ALL affected (some regional variations, teaching hospitals more likely 98 % vs. 75% other hospitals).

* Move beyond anecdotes to measurement (metrics).

* Why the global labor market (movement of docs, nurses, consultants, etc)?

We are:

* moving to work

* moving for training

* pull factor = increased demand

* push factor = motivate workers to come to greener pastures

Migratory Health Worker Stats:

* US recently became largest importer of foreign nurses (implications on international healthcare diplomacy/relationships? are we viewed as 'stealing nurses?' no real statistics on how much money they lose when a nurse leaves for the States) - 80% come from developing countries

* Phillipines is largest 'exporter' of trained nurses - 30%

* "foreign educated nurses tend to work more and work harder" "doing the work that we don't really want to do"

* integration of global workforce is happening beyond the periphery of traditional border states - California 29% are foreign-trained - NY, NJ, Fla approx. 24%

* remittances ($ sent home from employees abroad) are significant source of 'international aid'

* IMGs = international medical graduates (25% of US workforce is international, India, Philippines, Mexico, Pakistan, Dominican Republic import most docs)

* States with most IMGs practicing = 40% in NJ, just under 40% in NY, 35% in Fla, state median is 17%)

* States with most IMG residents = North Dakota (what is their board, commerce dept. doing?), Wyoming, New Jersey - perhaps Visa requirements for underserved areas - also largest maybe due to influence of population density? less population equals far higher percentage of residents foreign docs?

* Top 3 IMG specialities- internal medicine (36%), psychiatry!?(31.4%), anesthesiology (29%)

* 2007 - only about 42.4% of 2,313 residency positions in primary care were filled by DOMESTIC medical graduates (THE CHANGING FACE OF AMERICAN PRIMARY CARE) - the primary care melting pot

Home Organizational Applications:

Do study based on exit interviews/new hire interviews...why do nurses leave other hospitals and why do they COME work at our hospital? Do nurses migrate internationally (externally) for the same reasons they migrate nationally (internally)? Ask nurses why they leave...answers may include:

*quality of life migrant

* career advancement migrant

* partner/spouse/family migrant

* adventurer migrant

* salary migrant*

* hours migrant*

* culture migrant*

From the Audience:

* Nurses leave because less training/orientation via preceptorship once working on units

* Lack of nursing faculty/training pushes need for more internal training programs/mentorship programs (critical thinking & communication skills - scope of practice, when to challenge physcians, etc) - hallelujah!

* "the nursing shortage in the US will be around for awhile- don't be in a rush to go" - from former Phillippines hospital administrator - 7,000 islands - average tenure 3 to 6 mos at tertiary care centers...1 year if you're lucky - fair amount of Philipino docs who are converting to nursing to practice/work in the US - larger effects on Phillippino culture - nurses acting as welfare agents, rest of family may not work

* "We're in such a hurry to put nurses at the bedside" - need for greater training and acculturation

TOP 3 Impacts of Workforce Shorage (2006 data):

1. Decreased staff satisfaction (shocker)

2. ED overcrowding

3. Decreased patient satisfaction

From the Audience - Creative Potential Solutions (They Need an IDEO Session...):

* Idea to fund schools overseas specifically to 'farm' nurses for US work? "what we need to do is create a different kind of market that doesn't ignore the need" - panelist question - argument from military administrator re: incentives to stay, come back after period of service abroad

* Innovative international exchange programs: partner with hospitals abroad. Send 1 US nurse abroad, import 5 foreign nurses. Train them. Let US nurse recruit others while in country, also send best practice research back from countries.

* Send your middle management pipeline to other countries via partner facilities. Let them get their feet wet with complexity and strong mentorship here. Established management/execs may not be willing to live the expat lifestyle. Ability to enlarge leadership pool.

Meaty summary but there are some very good lessons hidden amongst the data. Are you tracking international medical professionals at your organization?