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.


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

Recent Comments

Shawn, you are correct. I do enjoy the time we spend together struggling with these issues. I learn a tremendous amount. Just as in everything else we do, its great to work wtih people who share a passion for what we do. Thanks for the comment. And thanks for reading!

Thanks so much for the kind words, Kim. Yes, I think leadership, regardless of its specific stripes, is always focused on the same things. Thanks for stopping by!

Another good example of your blog being on the topic of leadership! Leadership always makes for tough calls and times that are trying (even times the lengths of seasons or longer). The last paragraph resonates. All the toughest decisions ultimately come down to what is best for the client. The complicated part of that simple statement is that what is best for the client also means being able to access a solvent organization. The toughest decisions all tap our relationships, too--another reason the role of the leader as a relationship builder is so important.

Thanks for G+ ing me. G+ is my main social media site now. I used facebook sometimes and twitter to direct traffic to G+
I am making comments this week on my blog http://healthtrain.blogspot.com . Glad to hear Romney picked Ryan...good choice he knows what we can't afford to spend. The federal check book is overdrawn and we are running on'draft protection' paying dearly with interest. We need to turn off the faucet and find a way to give charity care once again. It worked before but we all got lazy and sucked off the teat of medicare and other federal and state programs. The paperwork and B.S. are killing all of us. When I started I gave my patients either a written statement at each visit, most paid themselves or billed there own insurance themselves. Today we do all the work for them, the insurance companies and medicare. Then they are gutsy enough to question everything we do. That costs more $$$. Your kids are being screwed by the system. None of us would mind giving free care if we had a tax credit of some kind for in kind contributions..that would of course be politically incorrect because the average ignorant lay person supposed we are all rich because of the 'palaces' we work in. Brick and mortar and IT have replaced caring. Me? I retired last year and spend about 10 hours a day politicking, writing and advising people like Joe Lieberman, Paul Ryan and others on the way it really is.

Thanks for stopping by, for reading, and for leaving your comment.

You summed up the purpose of budget very nicely. I am often asked why I chose healthcare finance, it is a very challenging profession with lots of long hours. My answer is similar to yours. I have the privilege of helping thousands of children and women via the decisions that I make. I am certain that not all of my decisions are 100% right (as I know you have witnessed!), but I always put the patient first and do my very best to use our limited resources to do the most good. If I am not the one protecting these precious resources for the most important customers of any industry (patients who often can't do for themselves what needs to be done for them), who will?

I hope one day we will have enough resources to provide every needed aspect of healthcare to all patients, until that day however, you and I get to continue having budget fun every summer! (you know you love spending so much of your time with your wonderful finance guy!)

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

Close to home links

Carilion Clinic Children’s Hospital
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The AAP website for parents
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Roanoke Times Medical blog
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