Former President & CEO, INTEGRIS Health

A Place of Sanctuary

Published in The Journal Record
October 22, 2014

Comedienne Joan Rivers died in a hospital.  Her last day on earth did not start in a hospital, but an outpatient center where she underwent a simple, routine procedure.  Apparently something went terribly wrong necessitating her transfer to the hospital where she could not be resuscitated.

There’s a movement in health care today holding that hospitals are too big, expensive, clumsy, and inept in our modern society.  The future in this philosophy is for smaller and more nimble outpatient centers, which data suggests are a wave of the future.  They specialize in low risk, low acuity procedures with high margins.  They usually have good results with high patient satisfaction scores.  Perhaps their best attribute (because of low acuity and thus high predictability) is delivering their service for a package price, often at a fraction of what the same procedure might cost at a hospital.  This leads some to speculate these factors will ultimately see the diminishment of hospitals as we know them today.

This speculation has some validity.  But let’s examine the bigger picture.  Hospitals are the place for the poor to go when no one else will care for them.  Hospitals are the place that educates our physicians, nurses, and medical personnel.  Hospitals are also the place to which free-standing centers turn when patients, such as Joan Rivers, crash.  When severe tornadoes threatened this community thousands guaranteed their survival by entering storm shelters.  At those very moments hospitals were open and operating.  Hospitals are always there no matter what the circumstance, no matter what the tragic event – manmade or natural.  Hospitals are the place that provides low margin services, such as emergency rooms, which the free market wouldn’t touch.

The fact is hospitals cannot survive simply on high risk, high acuity, low margin business, which is exactly what we as society need when we are most threatened.  We will always need a place to care for the 70-year-old brittle diabetic, or the severely injured car crash victim.  The blue sign with the white “H” is the constant symbol that this is a place of sanctuary in the most difficult of times.  Hospitals must ultimately find a way to answer this new threat.

Joan Rivers died in a hospital, and that’s exactly the point.

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