A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.
–Wayne Gretzky

Recently, I attended an end-of-year review with one of our hospital partner’s executive team. We reviewed our performance for the past year, and discussed mutually strategic goals and how to improve upon our excellent service. As part of the conversation turned to improving the patient experience, we talked about the need to modernize an older department. We then initiated a discussion on how many beds are needed for anticipated volume. Of course we were predicting growth in the next several years.

It was then that the CEO asked us to consider a different scenario, one in which patient volume was flat or declining as healthcare continues to change and more resources are moved to keep people out of the hospital.

It was a reasonable question and, in the perfect future envisioned by some, ER visits will drop and patients will have more access to primary care. Of course, all acknowledge that that future, if it occurs, may be quite far off. But when faced with justifying a several million dollar investment how can you be sure of a return on that investment vs. putting those dollars to use in building other parts of the infrastructure needed for the future delivery system? How do you prepare for a future you know will be quite different but at a time uncertain?

It’s a challenge every hospital CEO and executive team face as they prepare year-end budgets and allocation of precious capital in today’s healthcare environment. Couple that with an antiquated payment system that is still stuck in a percentage of Medicare fee for service model only compounds the problem.

Every forward-thinking healthcare leader knows more care needs to be moved to lower-cost outpatient settings and incentives need to be in place to encourage gainsharing to providers for saving the system dollars while improving quality. Antiquated rules on self-referral also need to be updated to encourage less costly care.

In times of great change there is always a period of uncertainty and chaos. The current period defines change.

So how does a hospital leader continue to manage the present while preparing for the future? The answer is to make small bets. Innovation and experimentation will occur on the fringes. This includes investments in patient centered medical homes and innovative outreach programs into the community. Some of these efforts will show success, others will fail. Some will fail because they are poorly timed, others because they are poorly executed. The advantage of placing small bets is the mitigation of losses as you continue running your current business.

Partnerships with progressive physician groups also needs to occur. No one has the complete answer or we would have already implemented the “right” solution to what ails our healthcare system. If we are to learn anything from non-medical businesses than we should realize that partnerships hold a much greater chance of rapid success then large monolithic system solutions. That does make things more complicated in devising mutually beneficially strategies that achieve the triple aim in healthcare. That is, however, where the puck is going and where we all need to be.

Angelo Falcone is Chief Executive Officer, Medical Emergency Professionals (MEP).  He blogs at the EmergencyDocs Blog.