Reputation seems to fit within the chicken-or-egg paradox. Top talent flocks to institutions with the best reputations, and institutions with top talent have the best reputations — and therefore a competitive advantage.
This is true in healthcare, just as it is in other industries. If you are the CEO of a company that needs to attract capital, Goldman Sachs is likely at the top of your list (assuming you can afford them), because you know using Goldman gets you access to the top minds in the industry. The same goes for the general counsel who is seeking the best counsel available; he knows a top-tier firm will deliver.
In healthcare, we don’t necessarily need to go to a top-rated medical center for routine medical care. Quality is about the same, and often costs are lower, at community-based centers. But, there’s no doubt, at least in my mind, that if I, or a loved one, was diagnosed with a life-threatening condition, like cancer, I’d be running to the closest U.S. News & World Report Honor Roll or Becker’s Hospital Review 100 Great Hospitals in America hospital.
U.S. News & World Report has long used reputation as a factor in its annual rankings and has received considerable flack for doing so. This may be somewhat warranted, as outcomes data for many conditions are just as good at community-based facilities as they are at well-recognized academic medical centers. In response, U.S. News’ recently announced next years’ list will reduce the weight given to reputation from 32.5 percent to 27.5 percent.
Reputation, though, still makes up nearly a third of the ranking formula. I’m sure many facilities with great outcomes and care, but that lack national and international reputations, aren’t happy, and that’s fair. However, if the ranking is intended to be a true best-of-the-best list — representative of where healthcare providers would send their parents and children, if diagnosed with complex and life-threatening conditions — (and I believe it is), it’s fair to include the less-than-scientific measure of reputation. After all, there isn’t reliable outcomes data for the rarest or most complex conditions, because there simply isn’t enough information on them, so perhaps we can think of reputation as a stand-in for this consideration.
But what if your hospital isn’t on the Honor Roll? What if you’re a great community-based provider, and that’s all you want to be — all that your mission calls for?
Are you limited in the type of talent you can attract?
Perhaps in some ways, but luckily for healthcare leaders and recruiters, healthcare isn’t I-banking. People don’t enter it simply to make money. Of course, a high salary is a great benefit, but the vast majority of clinicians enter healthcare to help others, either through direct patient care, or through scientific discovery.
And many providers enjoy working in rural and urban environments because it allows them to make a bigger impact, giving back to the community. An investment banker who starts at a lower-tier firm doesn’t experience that sense of contribution.
In fact, the reason the “Goldman model” works so well for Goldman is that the firm doesn’t actually want to retain every new MBA it hires. “You bring in people young, you don’t pay them much, and you get a lot of value out of them. At the same time, you don’t want everyone to be managing director,” Prof. Bidwell told HBR. The same goes for top law firms; not everyone can be a partner at a top-tier firm.
Healthcare is different. In general, health systems want every physician, mid-level provider and RN it attracts to stay with the system — and its community — for their entire career.
So, while the most recognizable health systems in the country have a lot in common with Goldman Sachs when it comes to how they recruit talent, smaller and less prestigious providers (luckily) don’t have to count themselves out of being able to recruit bright minds. Instead, they should focus on their attributes that, for the right candidates, are more important than reputation: a sense of purpose, of meaningful work and of ties to an organization and community that outweigh the resume-improving benefits of working at a top-tier program. After all, in healthcare, reputation only matters to patients in a small percentage of very complex or severe cases. For everything else, compassionate care close to home is much more important.
