A recent article in the San Francisco Chronicle by John Gerzema, co-CEO of the Harris Poll, caught my eye. In it he refers to research that seems to indicate that larger organizations are less trusted and esteemed by the people they serve. He put it this way:
“To sum up, the bigger you are, the less trusted you are, and companies that have the best reputations are small, or they have found a way to connect more personally—or ‘act small.'”
He was referring to private enterprises and not health care organizations per se. Nevertheless, I believe his observation has applicability to the health care scene.
There has been a great emphasis in health care in getting bigger. All the pundits say it is a great idea and we know the pundits are never wrong. Misinformed sometimes but never wrong as they are consultants and wise people.
Actually I think they are both misinformed and wrong.
Here in California, we have mega-monster health care systems like Kaiser, Sutter and Dignity. In bowing to the god (or goddess–take your pick) of bigness, they homogenize and centralize and in the process lose differentiation. They become big blobs.
I became familiar during my years at NorthBay Healthcare with many locally based health care systems. They fly under the pundits’ radar but they have much more local presence than the mega-monsters. They have to do well locally if they are going to do good at all.
They sponsor Little League and Bobby Sox teams. They participate in “Fun Runs” and local fund rasing events. They sponsor public schools serving children of less economically advantaged parents. Their employees proudly wear their logos and colors. They do all of this without having to check in with Oakland or Sacramento or San Francisco or whereever the lords of the mega-monsters live.
They don’t have pension funding problems. Unlike the mega-monsters which sometime seem to be wildly merging two financially challenged health care systems in the hope that magically the deficits will disappear, the small guys are financially stable and much quicker to react when financial problems do occur.
Perhaps even more importantly, the smaller guys tailor their services for the needs of their local community rather than the needs of a spoke and hub health care system. The spread of technology is making providing locally based advanced services easier. All those specialists being trained by the academic medical centers do need some place to land.
When you are rooted in a community, you make different decisions in a different way. You have no place to hide and no one in a far away place to blame if things go awry.
The mega-monster health care systems have a lot to learn from the small guys. Small is the new big—-and trusted.