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what's the big deal about budget season?

Those of you who know me in person may have detected a bit of increased tension over the last few weeks. I find I am not as fun to be around as usual. I am probably scowling more than I am smiling. I have frequent headaches.

Why?

Because it's "budget season"

Just as in any other business, the Children's Hospital has to spend its money carefully, so that we are still around the next day to provide service for more children who need us. As opposed to other businesses, we cannot simply charge a price that reflects the value of our service. We cannot, nor do we want to, refuse care to those with limited means. But we cannot be complacent with losing money day after day, month after month, and year after year. Every year since my arrival in 2007, we have spent the summer months preparing our budget for the next fiscal year--which starts on October 1. To meet my personal responsibilities as a member of the Carilion leadership community, not only do I have to work with my administrative and finance partners to develop a sound budget, but together we have to review all the services we provide, assess the costs and benefits of these services and determine how much money we can afford to lose on each one. In just a few days, we will be "presenting" our operational and financial plan to the overall Carilion leadership for approval.

I have to face the fact that I sometimes have conflicting and competing priorities.

My first priority is the provision of highest possible quality care to the infants, children and adolescents in the Roanoke Valley as well as throughout southwest Virginia. Providing this care, however, engenders significant cost. As responsible members of the healthcare community we have to be able to decrease the cost of care, while upholding and improving quality, access to pediatric subspecialists in addition to generalists, and state-of-the art hospital care in our inpatient and critical care units.

How will we achieve these simultaneous and seemingly incompatible goals?

By constantly evaluating what we do, and asking the key questions necessary to make our systems of care better. We can no longer afford to say: "This is how we have always done it." We cannot sit complacently watching as costs continue to rise. This means we sometimes have to say "No" to even some of the best and most patient- and family- friendly ideas and services. This means some of the physicians and nurses might get angry with me. Unfortunately, it comes with the territory. The fun parts of leadership are countered by the difficult decisions, the heart-wrenching times when we might be denying a child the ability to get their necessary specialized care as "Close To Home" as we would like. If you have been reading this blog for any time whatsoever, you might be asking how someone so committed to humanism, and so interested in child advocacy would put herself into a situation like this. I look at it a bit like I looked at my decision to practice pediatric critical care for so many years. Just as I was able to explain to friends and family members, that IF I didn't care for the critically ill and injured, they would still be there, they would still be sick and sometimes they would die. Maybe, by applying my skills carefully and humanely, just maybe a child might survive who was otherwise going to die. Or maybe the family of a dying child would be cared for just a little bit better than if I wasn't there.

I look at leadership in the same way.

The same decisions would have to be made, even if I was not involved in making them. Who knows what the outcome would be? I hope I add something positive to the discussion. I hope I advocate appropriately for what our child patients and their healthcare providers need. I hope I can minimize some of the distress the providers feel when they are asked to do more with less. So, while I may feel more stress than usual during this time of the year, I still love what I do. I still love ALL of what I do. Patient care, teaching, research and administration.

Have you felt the "stress of budget season?" How do you make your toughest decisions?

photo credit: iluvcocacola via photo pin cc

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