photo by: Chad Lawhorn/Journal-World photo

Brian Alexander, author of the book "The Hospital: Life, Death and Dollars in a Small American Town," was the keynote speaker at a KU symposium on challenges in health care on Friday, Nov. 5, 2021.

Your community’s next leading activist may come from a place you wouldn’t expect: the hospital’s boardroom.

A panel of health care leaders from across the country gathered at the University of Kansas on Friday to discuss coming changes for small and rural hospitals, and they agreed that the chief executives of those hospitals likely would have to undergo change too.

“I look at what the skill set will be in health care leadership in the future, and I don’t think it will be the institutional training of today,” Brock Slabach, chief operating officer of the National Rural Health Association, told an audience at KU’s School of Architecture and Design. “I think hospital administrators in the future will be community organizers. They’ll need to be marshaling the resources in the community.”

And maybe picking the political fights too.

“That’s a scary thing for them to do,” said keynote speaker Brian Alexander, author of the book “The Hospital: Life, Death and Dollars in a Small American Town.” “I get why they don’t want to do it. We have people shooting at public health offices in our country. So, nobody wants to wade into the politics of this stuff, but they are going to have to.”

Health care leaders may think they are doing enough without diving into the politics, but Alexander told the crowd they weren’t. For instance, a growing focus in the health care industry both nationally and in places like Lawrence is addressing the “social determinants of health.” Often, those efforts may lead to changes like creating more clinics in poor or underserved areas of a community. That’s great, Alexander said, but also lacking.

“You aren’t fighting the social determinants of health if you aren’t fighting the political fight,” Alexander said.

That could mean fighting for Medicaid expansion, which many hospitals have done, but also needs to include fighting for things like higher minimum wages and other such topics that typically haven’t emerged as part of health care lobbying efforts, he said.

Health care leaders were on the KU campus Friday as part of a symposium hosted by the KU Institute of Health + Wellness Design, which has a growing reputation as a research leader in how health care facilities can be better designed to meet new challenges.

Health care facilities likely will look much different in the future, several panelists said. Slabach said he cautioned hospitals to think hard about new facilities they are building today because it would be easy to have a facility that is out of step with changes that will happen over the next 10 years.

“You have to really think about how you become a convener of health in the community,” he said. “I think you may be creating a campus that has multiple functions, not just for health care.”

Other panelists said technology may accelerate change in the near future. Chris Emond, chief financial officer of Mat-Su Health Foundation in Wasilla, Alaska, said companies like Google and Microsoft were investing heavily in health care and were good bets to come up with products that would significantly alter how health care is delivered in the future.

Charisse Oland, a hospital consultant and former administrator in South Dakota, Minnesota and Wisconsin, said the pandemic has been the rip-the-Band-Aid-off moment for telemedicine. After years of bureaucrats pushing back against potential fraud that could occur via telemedicine, the pandemic forced the industry to think about whether “people really have to get in their car and go to the hospital.”

Several leaders said the country now needed to think about overhauling the entire health care industry. Alexander said he began writing his book with an open mind about whether America needed to move to a universal health care model. But now, he said he was convinced it was the only solution.

Not everyone on the panel went that far, though. Oland said she definitely would “defend the American health care system as the best in the world,” but that doesn’t mean there still aren’t elements that need to be changed.

She said the country’s emergency departments already operated with a “bastardized version of socialized medicine,” and said some tremendous inequities existed in the health care system. But those inequities go beyond just rich versus poor or urban versus rural or one class versus another.

Oland previously was the leader of a specialty hospital that served children with special needs and disabilities that required hospitalization. She said those children came from all types of social structures and environments, but they often shared one characteristic that is an indictment of the current system.

“Eventually they all bankrupt their parents,” she said.

She said the country had a chance to fix problems in the health care system.

“We have to focus on what’s not working and getting past some denial,” she said.