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To a certain extent the consultant would have to point out to you how the data was flawed and present their own data as rebuttal. I think it is fine to question data that was not compiled by the orthopaedic service, but then one of the surgeons really has to sit down with the folks collecting the data and determine where the inaccuracies lie. Doesn’t have to be the chairman, but maybe a registrar or someone they trust.

Very difficult in a trauma center (at least one that handles major multisystem blunt trauma) to put all the orthopaedic patients in one area, has that been done in other centers in Ireland?

In agreement with several of the comments above, particularly with the environment you described; seems like any large organizational change may be only successful with a real shift in culture. More like a controlled burn then putting out small fires. We have had some success with recruiting the established employees to serve as champions of change while making it clear to them that change was coming. This may help to incentivize the more established folks to go along with the changes rather than resist them.

I would agree with Bruce, if there is one area that needs more resources it would be mental health care. From a hospital standpoint I wonder whether it would be more cost effective to underwrite the cost of group and cognitive therapy outpatient services that are more accessible for patients. Outpatient services are not reimbursed to cover costs, but considering the resources consumed by a single inpatient boarding in the ER, it may be cost neutral for you. Trick would be getting several of the area hospitals to do the same thing….

On May 11, 2017, Ted commented on The Dilemma of a Repless Model :

The implant switch may not be as much a challenge as replacing the rep’s function of supervision of instrument processing and delivery as well as inventory control. We had a similar move with simpler implants such as intramedullary nails and were universally unsatisfied with the results. The costs to the hospital to provide a similar level of organization and service with a hospital employee rather than vendor employee were more than the hospital wanted to allocate and we went back to the old system. Their is absolutely an opportunity here, but the hospital has to commit to retaining the implant coordinator and paying them on the same level as the rep.

On May 11, 2017, Ted commented on Strategic Decision – Merge or Stay Independent :

Having some experience with several of the larger health systems you mentioned, I would really hold out joining a larger system unless you all were absolutely forced to. You all should absolutely be able to compete on price and satisfaction relative to larger organizations which would certainly be to your advantage.

One of the reasons for the success of your organization is the ability to adapt and innovate and unfortunately I don’t think that would be preserved with a merger with a larger organization.

If withholding of PCP referrals is the main reason for a desire to merge, contracts which you could certainly provide at a competitive price may be a better option than merger.