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How Hospitals Will Thrive and Win

by Jonathan Bush, President & CEO

As utterly terrifying as it is to have recently published my ideas on health care in a book – nailed them to the mast with an uncomfortable permanence – there have also been many surprising upsides. I’m just coming off a whirlwind two-month roadshow of keynotes and panel discussions structured around the themes of the book that has left me humbled and inspired. There was the moment speaking at Boston Children’s Hospital where tears flowed as I told the story about Morgan, a girl suffering from an auto-immune disorder, who posted a YouTube video asking her care team not to interrupt her sleep with rounds at night. There was Datapalooza, a beltway confab, where I actually caught myself complimenting CMS on their recent releases of valuable data (before demanding a lot more, of course). And there were heady discussions among the pines at the Aspen Ideas Festival where, seated on a panel between Rushika Fernandopulle, the CEO of Iora Health, a radical disruptor of “the system,” and Toby Cosgrove of Cleveland Clinic, one of the undisputed leaders of “the system,” I found myself nodding in agreement at much of what they both had to say.

But amid the swirl of discussion and friendly verbal jousting and sparring, I fear my views on some topics didn’t always emerge from my mouth the way they live inside my head and heart. One important one was related to the role of hospitals in the future of health care. So here’s some clarification of my views on this very complex subject: Like most observers of our bloated health system, I know for certain we don’t need all of the hospitals we have today. That’s an actuarial fact. We simply can’t afford the redundancy, cost and waste and it’s my prediction that over the coming years the market will right-size, some hospitals will have to close – there will be winners and losers. The winning hospitals will be the ones that compete fiercely on demonstrable quality, service, and cost. They will be the ones that match passion for their historic missions with a near-equal passion for operational and service excellence, that restructure the entire care experience around the patient, and measure themselves relentlessly against the highest standards. They will be the ones that figure out how to truly coordinate patient care, not just within but well beyond the walls of their organizations.

The winners will come in many sizes and shapes. They will include faith-based nonprofits founded by dedicated religious orders committed to delivering quality care for all, especially the poor and vulnerable. The very best of this elite group will pair their unflagging commitment to a healing ministry with the most advanced knowledge, experience, and technology – in this manner they will continue to evolve, and thrive, in this ever-changing health care landscape. The winner circle will encompass smaller community hospitals as well; those that know how to operate lean and smart, are able to compete on price, and can translate their community presence, talent, and “brand” into patient loyalty. And the winners will include those academic medical centers that have the foresight and fortitude to shed the commodity business that others can do better and cheaper to focus on expanding their geographic footprint and product managing the most complex procedures with the rigor and discipline of an Apple or Amazon. And the winners, in all their diversity, will share one common trait: the capacity to reinvent themselves and stay nimble in a rapidly changing market. For some hospitals, success may require complete transformation, while for others it will mean tacking strategically in order to stay on course.

Beyond the requirement for hospitals to shift, grow, and adapt, they will have to navigate the dynamics of local and regional playing fields, which I’m keenly aware are far from level. There is a palpable tension between achieving sufficient economies of scale to ensure high quality patient care while avoiding monopolies that create higher prices with little net increase in quality. I don’t know what the correct trade-off here is – as it will mean different things in different markets – but I know that trade-offs are involved, are always complex, and must ultimately net out on the side of patients and their care.

I remember back in my ambulance-driving days being in room 4 of Charity Hospital in New Orleans and having my hand, literally, on a beating human heart. The intense concentration of medical brilliance and deep human compassion found in hospitals continues to inspire me with awe and gratitude and makes me want to help them be the very best they can be. Yes, in my disruptive heart of hearts, I look forward to the shakeup of the hospital market that is coming. It won’t be easy, but in the long run, I believe it will be for the greater good. But even more, I look forward to watching and celebrating (and ideally counting as clients!) the winners who successfully reinvent themselves and figure out how to continue doing well by doing the right thing.

Jonathan Bush is the President and CEO of athenahealth.

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