The Overview

You know that song by Johnny Cash, I've Been Everywhere? Yeah, in a way that's kind of my anthem. You see, for over 20 years I've been across America, Canada, UK, and Europe working with hospitals large and small on their digital strategies. I've walked the halls of a ton of major metropolitan health systems (I've gotten lost in their sprawling labyrinths plenty of times too), I've worked with private hospitals in the UK that exclusively cater to wealthy families from the Middle East (gold Lamborghinis with Arabic plates are somewhat of a giveaway), and I've crossed the threshold of many a community hospital. I know what these places look like, I know what they smell like, I know what they sound like, I know what their towns are like, and I can definitively say that community hospitals and big-city metropolitan hospitals could not be more different.

While I want to focus this article on the differences between these two types of institutions, I first want to pay homage to the one significant way they're similar.

The Uniform Similarity | Front-Line People Called to Do Good

No matter what hospital I go into, no matter how big or small it is, no matter where it is, no matter what country I'm in, the one glaring similarity is a collection of very stressed-out healthcare workers that willingly subject themselves to a difficult life in an effort to do good for others. When I look into their eyes, I see stress and exhaustion, but I also see a uniform resilience fueled by a deep passion and purpose. It's nothing short of remarkable. These are the people that will always stand out to as superheroes. I have the utmost respect for every spectrum of front-line healthcare worker and consider myself fortunate to be able to work alongside these people. Their passion, mission, purpose, resilience, drive, determination transcends above all bureaucracy and politics found in every healthcare institution across the globe.

Now, let's get into some of the differences.

Patients | Numbers or Neighbors?

Stating the obvious here, but metropolitan hospitals are in metropolitan areas. Obviously, this means metropolitan amounts of people are serviced by these hospitals. These cities are often fast bustling places filled with energy, constant noise, constant action, art, top-shelf sports teams, loads of traffic, trendy restaurants, and just about anything one could want. However, no matter where you go or when you go there you've got crowds to deal with. Crowds of people just as important as the other, but also just as forgettable. This scenario can be somewhat of an oxymoron in that you have so many people connect with, but so little connection. Often, the loneliest one can feel is being surround by tons of people, but not having a connection to any of them.

This situation naturally plays out in the hallways of metropolitan hospitals. To be clear these metropolitan hospitals offer world class care, but that amazing care must be spread across a sea of humanity. Naturally, the outcome is often the sheer volume of people removes the humanity from the individual, and people can become mere numbers. One of the first hospitals I visited in my professional career was New York University Health System in the heart of NYC. I come from a rural area in northeast Texas, and I was shocked to see Registration Staff sitting behind three-inch-thick bullet-proof glass engaging with patients via a two-way microphone/speaker system and a stainless steel sliding drawer. Obviously, this is all there for good reason, but these necessary measures serve as chasms between meaningful human connection for both the patient and the employee. To be clear this situation invariably takes a toll on the front-line workers who want to do good, but it's difficult for anyone to stand firm amidst the constant wave of endless people needing help.

Community hospitals could not be more different from their metropolitan counterparts. It's clear that the heartbeat of the hospital is in sync with the heartbeat of their community. People in the community are not in as much of a rush to get from one place to another. Out in the community people generally acknowledge others more and are kinder to one another because the abundance of time seems to afford it. All these interactions that occur throughout a normal day in one of these communities is a basic acknowledgement of the humanity one person sees in another regardless of whatever walk of life they come from.

How Community Hospital Staff Engages with Patients

This vibe carries over into the community hospital. There is an acknowledgement and understanding from the entire hospital staff that the patients entering their facility are not there for a "good time". They're at the hospital because something is wrong with themselves or worse, with someone they love. Community hospital staff are much more free to readily meet these patients with a genuine human connection, extending to them the undercurrent of empathy that serves to ease the patient's anxiety. It's these interactions that subtly but surely connects to with the patient in a way that lets them know there are people that genuinely care for them. They are made to feel like real people and not just a number.

How Community Hospital Staff Engage with Each Other

Often, I'll come to these community hospitals for a meeting with a group of people to discuss business challenges and solutions. When I arrive to these facilities my contact will often greet me at the main entrance and carry me to a meeting room which could be anything from a corporate boardroom to a tucked away windowless training room in the furthest corner of the basement of the facility. Along the way to this meeting space, I keep my eyes open and pay attention to how the staff engages with one another to see what kind of team and culture I'm dealing with, and these community hospitals rarely disappoint. I see staff in the hallways smiling, making eye contact with one another, and engaging with one another in ways that show a deep relationship. I see conversations where people use each other’s first names, they ask about their spouses and kids by name, and they ask about how someone's weekend was. It is clear that they have a level of comfort with one another that can only come from years of familiarity, and that they deeply care for one another.

Leadership & Ivory Towers

Community Hospitals | Just a Walk Down the Hallway

When I arrive to the meeting space in the hospital the room always fills up with hospital staff ranging from Registration Clerks to departmental directors, VPs, and C-Level executives. This is a broad group of people that represent the front-line workers all the way up to the most senior leaders of the hospital. As they congregate in the room it's clear from their engagements that they all seem very familiar with each other as I noted in the previous section. Funny enough, it can be hard to get these meetings going sometimes because everyone is enjoying conversation and connection with one another. I must tear them away from their engagements with one another so we can get down to business and that's a good thing!

Though the years and countless interactions like this I've noticed something consistent about community hospitals that I believe feed this scenario. Hospital leadership and front-line workers are all able to come to my meeting by simply walking down the hall from their office to the meeting room. What I'm getting at is that hospital leadership is actually at the hospital! The C-Suite is in the same building where the front-line workers are engaging with patients in care, treatment, and healing. Hospital leadership walks the same halls as their staff and their patients. Hospital leadership sees with their own eyes, hears with their own ears, smells with their own noses what's going on at the ground level of the hospital. In community hospitals there rarely are fortified ivory towers inhabited by disconnected C-Level executives.

Metropolitan Hospitals & The Ivory Tower Syndrome

My meetings at metropolitan hospitals could not be more different than those with community hospitals. For starters when I meet with leadership of metropolitan hospitals rarely do these meetings occur at the hospital itself. Rather, these meetings occur at an offsite corporate office that's blocks or even miles away from the hospital. With large corporate health systems that have dozens of hospitals and hundreds of clinics spread across multiple states we'll see a corporate office that's nowhere near their hospitals. Just take a trip to Nashville TN and you'll see exactly what I mean.

This distance in geographic proximity also fosters a distance in connection to the staff and the patient care that occurs at their hospitals. I'm 100% certain that these people would bristle and take offense at what I'm saying here and rightly so. I'm not saying that they're not committed or that they don't care, but I am saying that distance is... well... distance, and there's a natural byproduct of that. The bottom-line is that metropolitan leadership consistently seems to reside in an ivory tower and the corporate structure and distance creates a vast divide between front-line workers, patient care, and corporate hospital leadership.

Community hospitals generally don't have as pungent a smell of corporate bureaucracy on them as their metropolitan counterparts.

Community Connection & Engagement

Community hospitals and metropolitan hospitals are both a major part of their community. They serve their communities by offering care, educational classes, and a vast array of free services. With metropolitan hospitals we yet again see the difficulties of engaging and connecting with a community that's just massive. When you have so many areas to connect with where do you even start? It's just overwhelming! They do however seem to have plenty of gala events that offer their wealthy patrons the ability to rub elbows and impress each other though massive donations. However, even when you have net patient revenue in the billions those professional sports team sponsorships don't pay for themselves!

Again, community hospitals are just different. They're made of people who are in and of the community. As a result, they know the heartbeat of their community and can be in sync with it directing their events to specific areas of need in the community. Their efforts are often seen and felt much more acutely than in metropolitan hospitals where their efforts are diluted over a massive population.

The Wrap Up

I'm thankful for the commitment of all the front-line workers at these facilities who dedicate their lives to doing good for others. I'm so thankful we have these heroes serving their communities.

However, in my 20+ years of interacting with hospitals of all shapes and sizes I just see something incredibly special in community hospitals. I admire how connected they are with their community and the way they see their patients as neighbors over numbers. Recognizing and connecting with the humanity in their patients and within each other always warms my heart, and I'm humbled, honored, and privileged to be able to serve these facilities and all the wonderful people they're made of.

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A Note About the Tech Providers that Serve Community Hospitals

Clearly community hospitals hold a special place in my heart and I'm not alone in that. I've been able to work with some great people at other tech companies who service these hospitals, and they too see what makes these hospitals so special. A big shout out to my friends at MEDITECH, ForwardAdvantage, Cloudwave, DRFirst, and the like who live in this world and support these people.