Nick's Blog

CEO Talk. . . To Our Employees

Mickey Meece of the New York Times recently wrote an article entitled, "Doing the unexpected for employees pays off." He described a small company, Vurv Technology, a developer of human resources software, where the supervisor of two employees came to the founder and CEO, Derek Mercer, and suggested that they purchase two good used cars for two employees who were having trouble making the commute to work.

The alternative for the company would have been to pay out much more than the $10,000 paid for those two vehicles to find replacement employees. Valuable time would also have been lost during the search and training of those new employees as well.

In this case, it was a relatively simple analysis where both the risk and the opportunity were examined. It is often a balancing act of helping people while not destroying company profits. In the case of a nonprofit hospital, if there is no money, there can be no mission, but the mission requires passion and commitment that can only come from helping our staff do their work and experience the satisfaction of being a healthcare employee.

Recently, one of our competitors bragged about the improvement of their employee satisfaction ratings on a scale from 1 to 100% from the low to the mid sixties. Your ratings of WMC are about thirty points higher than their best score. The secret, according to Dan Rozycki, president of the Transtec Group in Austin Texas, is to attempt to build the ultimate workplace.

That has always been our goal, to make Windber the employer of choice, and with the full support of the Board of Directors we have tried very hard to make WMC a very special place to work. Of course, it is not Utopia. Our pension took a real beating a few years back and just now is beginning to move toward competitive levels. The benefits are good, and, over the past few years we have made significant progress with our salaries as compared to other hospitals, nursing homes and medical offices, i.e., the marketplace.

The real differences, however, come in the form of the various qualitative offerings that are not always widely utilized. Yes, we still have tuition reimbursement, reduced fees for Healthstyles, prescription, dental, optical and other normal benefits, but we also have staff members who are employed to help you and our patients to experience optimal healing within our environment; massage, reiki, music and aroma therapy, drum circles, spiritual healing services, acupuncture, picnics, a Pirate's game, and a medical staff that is willing to step up to the plate to defend you from abuse from their peers, i.e., an anti-bullying philosophy. That is not only significant; it is also very rare in most hospitals.

No, we haven't had the money to buy anyone cars lately, but we sure are trying to do the right thing  while we move forward in an unbelievably competitive environment. We know that some of our staff has the mistaken belief that we are flush with money. Let me assure you, after being woefully under funded for years, we are always struggling to take care of all of the needs of this organization.  In spite of that, the good news is that people have voted with their feet to come to Windber for their care, and we are seeing daylight and growth. The better news is that we are committed to continue to work toward becoming the healthcare employer of choice for this region. You are our most important asset, and you are doing an unbelievable job.  On behalf of the board and administrative staff, all I can say is thank you for caring.  Thank you for being the amazing people that you are.  Buildings, equipment, and publicity are not the determining factor.  Day after day people tell us about your great work, your caring work, your kind and gentle touch.  Windbercare care is YOU.

$4.3 Trillion in U.S. Health Care Spending?

"Money doesn't make you happy.  I now have $50 million, but I was just as happy when I had $48 million."
–Arnold Schwarzenegger

According to an article in Internal Medicine News by Mary Ellen Schneider, spending on health care in these United States is projected to reach 20% of the gross domestic product on the one hundredth anniversary of my father's birth, 2017.  Of course that projection is only an estimate made by CMS, the Centers for Medicare and Medicaid Services.  That estimate is, of course, based upon a continued escalation of nearly 7% each year for the next nine years.  In lay terms, that escalation would mean that the total dollars spent on health care would hit $4.3 trillion...Whatever a trillion is? I still can't fathom a billion of anything.) 

We all should realize by now that this spending in the public sector, Medicare and Medicaid, will increase due to the first wave of Baby Boomers entering the Medicare system in 2011.  My 78 million peers, like the lemmings, are working their way toward the proverbial wall, and for those of you who will have to carry the load until we are wearing our wings, that is not a pretty financial picture. 

The same economists from CMS are predicting a decrease in reimbursements to physicians over the next several years while Home Health will likely grow faster than most other sectors except perhaps prescription drugs. 

What does it all mean?  We are spending more on health care in the United States than any industrialized country in the world and, truthfully, our overall age of death is significantly surpassed by many of those "spending less" countries.  How can that be?  Well, for one thing, we have 47 million uninsured citizens in this country and no one really knows how many illegal aliens. Why so many uninsured?  They don't vote.  The vast majority are young, single mothers with small children, and this does not take into consideration the illegal aliens who are also not insured. 

Back to the answer. . . prenatal care is inadequate and infant mortality in the United States is still an embarrassment.  A few of the countries that do better than us in the world in infant deaths per thousand are:  Australia, Austria, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Ireland, Japan, South Korea, New Zealand, Norway, Portugal, Spain, Sweden Switzerland and the United Kingdom.  Hmmmmmm?  Could it be because we spend 30% of our annual health care dollars on the last thirty days of life, and less than 4% of our monies on preventative and wellness care? 

Of course, Hospice would be a tremendous help.  We could reduce expenditures on end of life care, properly care for our babies with the excess funds, and ensure that our uninsured are properly covered as well, but what politician is willing to touch that electric third rail of the electorial subway tracks? 

We could begin by putting in a network of sidewalks, bike trails, and walking trails.  We could actually walk once in a while and treat our bodies like a true temple, not the "Temple of Doom."

One of the least often heard issues revolving around these expenditures is the continuation of our archaic hospital system.  It is based on the acute care model, and the vast majority of our diseases are chronic.  We rush the victim to the hospital, patch them up, send them home and then rush them back again without any commitment to behavioral modification.  I have seen individuals reverse their heart disease from diet, exercise, and stress management.  Why can't we embrace this concept, reward these activities, and change our society?  The millions of bicycles in Europe are no accident. 

So, as I've quoted in some other blogs, "Change or Die," or just spend ourselves into oblivion as we attempt to prop up a system that should have gone out with the Industrial Revolution.  Good luck kids, your ole man needs you to keep working to cover my health insurance.   

Under Which Shell is the Pea?

It started in the fall of 2001. In fact, the official opening was about a month after 9/11.  The potential seemed limitless, and the future appeared to be incredibly bright.  We would start a research institute, discover a few cures, design some specific drugs or vaccines, collect some tissues and the money to support us could easily be garnered through intellectual property, patents, contracted services, and value added research.

The first challenge that appeared was the question mark?  "Windber?" They would say.  "Windber?" No matter if it was a potential hire, a potential lender or investor, a prominent scientist or a health care luminary.  "Windber?" They would say.  "What is Windber?"   "Where is Windber?"  Many of them spelled it Winder or Wimber, and the fact that the CEO was not an MD or a PhD made it all the more ominous to the traditionalists.  There were no major hits on Pub MED, and the only piece of information that was broadly recognized was that we were a DOD subcontracted research center.  I remember Dr. Dean Ornish saying, "What do you want from me?"  My response, "Help me take the question mark away from the word Windber."

Over the first few years, we traveled more than 200,000 air miles following leads that were produced from the Washington D.C. connections: Austin, Houston, Seattle, Miami, Boston, New York, San Jose, San Diego, Philadelphia, Las Vegas, Pittsburgh and Chicago to name a few.  We met with companies and scientists all over the United States and then Italy, England, The Netherlands, Germany, Nigeria, Serbia, Greece and Asia.  At one point, we counted over 200 organizations that "wanted to work with us," but, as we sorted the wheat from the chaff, we discovered that most of them either wanted to try to take OUR grants away, or just to leverage us to get to our grant sources.

During that time, we had several leaders go through our door: six to be precise.  From 2001 to 2007, we  attempted to stabilize the scientific and medical leadership role for the organization.  Some did not like the lack of cultural stimulation in Windber and refused to move here.  Others were intent on furthering their own careers by endearing themselves to our sponsors, while still others were just not comfortable with the culture that we were attempting to create.

Our original vision for WRI was to create a research center that was unlike any in the world.  As a former professional musician, it was my desire to not build a theater and fill it with individual stars, but to create an ensemble, an interdisciplinary team of genomics, proteomics, histopathology and biomedical informatics specialists; to have the highest quality, largest and most pristine regulated, tissue, blood and serum collection; to have one central data repository; to literally build Disney World for scientists with the newest and most comprehensive list of equipment they could ever need, and then to tie it all together with fiber lines that allowed nanosecond communications of huge quantities of data.  All of that would be wrapped around centers of clinical excellence that would help us advance our research by implementing/translating appropriate discoveries to the bedside almost immediately.

It was a dream that everyone now admits was, to say the least, bodacious, but it was ours.  At first we ran into resistance because the PhD's were trained to be individualists. What's the old saying?  There's no "I" in team.  Then we ran into problems because there was too much data to be analyzed in the data repository and created a new group to analyze that data.  Everyone had problems with the disconnect between Hospital Administrator and Academic, but things are getting better there on both sides, and what dream would be complete without huge challenges. 

We made numerous discoveries regarding the truth or dare  aspects of the world of science.  What was truth?  What was not?  What was replicable?  What was smoke?  What was for the good of the patient, and what was for the good of the individual scientist?  Just like the worlds of insurance, architecture, engineering, music or academia, there are always those who are better at wool pulling than reality, but that also goes with the territory.  In fact, the only thing that was consistent throughout all of this was our Principal Investigator, Dr. Craig Shriver.  He was our rock every day, week, month and year of this journey. 

Our greatest challenge has been that of working with the bureaucracy that controls our finances.  Generally, those within the bureaucracy are insensitive about timely distribution of finances, i.e., making payroll.  No one cares if the interpretation of a rule removes an entire family from your employ, or alters the future of science for all of mankind.  One of my most vivid memories was a discussion with a bureaucrat about the devastating consequences of a decision that was being made against our mission.  She looked at me and replied in a very cold hearted way, "We don't care about cures for cancer."  "This is about our interpretation of those words."

And so, eight years later, I can say with complete confidence that, like so many other systems at the national level, be it health care, science or government; It's broken, and change, comprehensive change is what is needed.  We must find ways to create the appropriately aligned incentives so that scientist are connected at the hip on all projects relating to the good of mankind.  Keeping the final ingredient to what may prove to be the secret sauce hidden in a computer is not acceptable.

We must also remove the aliquot syndrome and replace it with human interaction so that the scientist does not feel the lack of attachment to an anonymous human sample but instead looks that patient in the eye and realizes the intensity of the mission.  To save the life of a 37 year-old with a four year old child is not aliquot theory.  It is human to human.

We must find a way to move our research dollars away from pure basic science and toward big science.  We must reward our pharmaceutical companies to seek out vaccines and individual treatments, not just blockbuster drugs. 

We must find connecting links that make ensembles the future, not individuals.   

Finally, we must replicate the model of the Windber Research Institute because, with all of its challenges, I'm still convinced that it is years ahead of the other more traditional science models.  We study people.  We share our data.  We work in multi disciplinary teams.  We actually meet our patients and hear them speak about the challenges of their diseases.  We have MD's and PhD's working side by side.  Our goal is to move answers from the bench to the bedside as soon as possible.  We are passionate about our work and your lives. 

WRI in Windber, Pennsylvania, is on track to break the rules to find the discoveries that will change healthcare for our fellow man in ways that could only have been a dream just seven years ago.  Thank you to all of our dedicated scientists and employees.

The rest of you may consider joining us.   We're outside of that box where you live, and out here there is an entire universe of opportunity.  It just takes an ensemble to play the song. 

Alone Again in Crystal City . . .

It's Friday night and the road to D.C. was wet from the pounding rain as I made my way from the Flood City to Crystal City, from Flight 93 to the Pentagon, from America's County to America's Capital.  Dinner consisted of an apple and some trail mix, and now it's time to prepare here in room 1205 at the Courtyard for a meeting tomorrow morning that may bring a new collaborator to the table for the Windber Research Institute. 

The old line, "You have to pay to play," seems right on tonight. 

The Research Institute has had a very active few weeks as we continue to attempt to expand and grow so that we might add additional jobs to the local economy. Some weeks, this proposition is harder than others. Moving forward, is often a major challenge.  We are still hopeful that this will not be the case this time around.

On a much brighter note, however, our researchers and integrative health staff successfully completed Phase One of the Yamaha research program with Dr. Barry Bittman this week. This study should be completed by sometime this Fall.  It was fun observing people as they played music to relax.  Obviously, they never had any of my former music teachers.   I'm convinced that would have been a research project. If you missed even one note, they GAVE you high blood pressure.   

Our own Dr. Lori Field, a local native and Johns Hopkins grad, was written up in several prestigious publications for her work on African American breast cancer last week.  She presented her findings at a major conference in San Diego and captured the attention of several key science writers.

According to Dr Field's analytical work, African American women are slightly less likely to be stricken with breast cancer, but, when they are, not unlike their black male counterparts with prostate cancer, the disease often strikes them younger and can be much more deadly. 

She and her team compared tumors stored in our tissue repository from black and white women that were matched for both the stage of breast cancer represented and the age of the donor with the disease.  All of these women were participants in our research activities, were either members or dependents of members of the U.S. military, and all were being treated at Walter Reed Army Medical Center.  The fact that they were members of the military Tricare insurance program removes any previous bias from the equation that black women may not have had equal access to health care.   

Our researchers found 65 genes with significant differences in activities between the black and white women.  Very few of the identified genes had any previous link to breast cancer.  Lori suggests that the possible differences could be caused by "an altered epigenetic chemical regulation of the genes."  If you are be somewhat unclear as to what the full implications of that statement may be, I'm sure she would be happy to explain it over a cup of coffee.

Bottom line, however, is that Dr. Field and her peers at the Research Institute are working to find new targets for drugs that could improve survival for African American women. 

You go, Lori. We are really proud of you and your work. (My kids always tell me that, without Lori back in high school in the 90's, they may have never gotten through advanced math and science.)

WRI's partnership on proteomic research through use of samples from our unique tissue repository was also announced last week with the Department of Energy's prestigious Pacific Northwest Lab. 

It is my sincere hope that, within my lifetime, breakthrough science at WRI will lead to unique, new cures for our friends, families and loved ones.

Finally, we are still seeing growing progress with our fund drive.  Last Saturday we hosted another successful social event where more than 120 people were present to learn more about WMC.  It was a great night.  Special thanks go out to the Foundation staff for all of their efforts and to the true driver behind this work, Fund Drive Chair, Attorney Tim Leventry.  "We think we can. We think we can. We think we can."

Also at the event, our Chairman, Ted Hollern, was honored for his dedication, service and leadership at WMC since 1975.  Ted received this award because of his hard work and commitment to the employees and medical staff of Windber Medical Center.  Of course he will be the first to tell you that it is not about Ted, but believe me, it's about Ted.  He has almost as few hours of sleep as some of the rest of us who carry the heavy mantle of responsibility to ensure the success and sustainability of a community hospital in a country where 47million people are uninsured and 78 million more of us are heading toward the proverbial hill. 

It's unique when a 54, 57 or 102 bed hospital (depends on who's counting the beds), can not only survive in the United States but thrive.  I've discovered that, no matter the size of the place, the issues are the same.  Having been in leadership positions in a 150 bed, 650 bed and now smaller facility, the primary difference is in the amount of help, consultants and cash you have.  In the bigger operations, you just add more zeros to the reports.   It was a lot easier telling the story with a million dollars vs. $50,000, but it is what it is. 

In spite of all of the challenges, and there were many more than normal this year, we're happy to report that WMC is headed toward it's best year in 102 years. 

Now, we just need to keep up the good work in every area. 

Managers, Smanagers...It's Over

Kenneth Cloke and Joan Goldsmith wrote a very interesting book entitled The End of Management. In this book, they assert that managers are the dinosaurs of our modern organizational ecology. They go on to assert that the "'Age of Management' is finally coming to a close."  Their treatise is that "the need for overseers, surrogate parents, scolds, monitors, functionaries, disciplinarians, bureaucrats, and lone implementers is over. . . "

If, by now, you managers are wondering what comes next, our authors assert that the new need, the true need in modern day business is for "visionaries, leaders, coordinator coaches, mentors, facilitators, and conflict resolvers." 

In a recent conversation with an "old school" manager/friend, I reached out to explain to him why he was alienating his subordinate.  I explained very carefully that management as a self-contained system fails to open the heart or free the spirit.  This approach has truly taken our organization to new heights.  Of course, one can only work within one's comfort zones, and many managers, especially, old school managers, only know one approach, and that is, the industrial revolution way. 

Let me suggest that you analyze the quality of the individuals with whom you work.  Then, step back and realize just how amazing those individuals are with "butterfly" qualities.

Do not penalize your charges because of your insecurities.  Build a team that "has your back" by empowering them to be all that they can be.

The revolution quoted by Cloke and Goldsmith is one of "turning the inflexible, autocratic, static, coercive bureaucracies into agile, evolving, democratic, collaborative, self-managing webs of association."  From our perspective, the object is to allow those butterflies the freedom to fly. 

How do you manage a butterfly?  Work together on the goals and then get out of its way.  Provide it with just the very basic, fundamental needs and goals of your organization, and then trust it, love it, empower it, and encourage it.

If I could possibly find one example that would clearly embrace our success as an organization, it is that of doing everything possible to kill "parent to child management."  It is not enough to move into the 21st century with our thinking; it is most important to identify those individuals who get it and then give them the space "to do it." 

Are they traditional?  Do they do everything the way you were taught in the "dark ages of the industrialized style of management?"  Nope.  Will it drive you crazy when you look for them, and discover that they are not on the flower where you expected to find them?  Sometimes.  Will they accomplish more than you have ever dreamed if you treat them with dignity, respect, love and freedom?  Oh, yeah. 

You see, it is not about control.  Control is only necessary for those who are not trustworthy.  Better than trying to control a non trustworthy individual, simply help them find work somewhere else.  If they don't get the mission, don't understand the philosophy, and don't work to their capacity, they shouldn't be there. 

On the other hand, if they are loyal, trustworthy, committed, and caring, back off and allow them to soar, and you will never see results of the kind they that they will deliver to you or your organization. 

If they look at it as a job, if they are only comfortable with myriad rules, time clocks and books of policies, they are stuck in the past. 

Leadership means trust.   

The End of Management, Kenneth Cloke & Joan Goldsmith