Nick's Blog

I Fired a Fish This Week

The closest I’ve ever come to admitting my obsession with bullies came this week.  As I was walking toward the Men’s Room, my cell phone rang. Coincidentally, I was standing near a chair that was almost directly in front of one of our many fish tanks.  As the conversation went on, my eyes were drawn to the fish.  That’s when I noticed him; the biggest fish in the tank. He had little orange fins coming out of the bottom of its belly.  This dude was out of control.  He was chasing and biting every one of the fish in the tank, Alpha fish. 

This attacking went on during my entire conversation.  Chase, bite, chase bump, bite, chase; it was a flashback from my eighth grade year when some big, dumb junior used to grab my hat and throw it around the bus. Then, the coward would take my lunch and smash it into a baseball sized, brown wad of inedible nothingness.  He harassed me until I had one of my bigger friends threaten him one day. 

Now, this fish was really getting me riled up.  I was annoyed, then irritated, then exasperated, and finally infuriated.  What the heck?  This hospital is famous for treating its workforce, patients and physicians with dignity, compassion, and respect, and here was this bully fish chasing everyone around.  No matter where they went in the tank, he swam as fast as he could to scare and try to scar them.

 I went back to my office and ruminated for awhile about this aquatic creep, and my blood pressure kept going up until I could hear my heart thumping in my ears. No more. This fish had to go. I walked out to the tank and got the phone number of the fish tank maintenance people.  It was then that I realized that all of this was pretty silly. It is simply what nature is all about, survival of the fittest.  “Okay, alright, calm down, sleep on it,” I said to myself.  It’s just a big, mean, despicable fish. It’s not a person. It’s not disrupting the balance of life.  Just because it’s a wicked, shameful, loathsome, contemptible, wicked son of a #!%$ fish, there was no reason for me to continue to obsess over it.  

That night, I kept waking up, thinking about that fish and all of the nice little fish who were being attacked, threatened, and terrorized because of this storm trooper.  When I got to work, I walked into the office of the closest fish attendant, a wonderful employee who feeds them and makes sure the lights get turned on and off each day, and I said, “Get rid of the fish with the orange fins.”   She smiled and replied, “Really?”   “Yep, I want him fired,” I replied.  “Send him to some other fish tank full of fish that are bigger than he is.”  Just get him out of here!”   She laughed quietly, and said something like, “No one is safe when you’re in one of these moods.”

That day, the fish tank attendant came for a visit, placed our aquatic terrorist in a big plastic bag, and said, “Don’t you worry, I’ll take him to a safe place.”  Heck, safe was the last thing I wanted for this guy.  Later that afternoon, I was standing in front of the other fish tank at our research center and what I saw was nothing short of a war.  They made our orange finned guy look like Nemo.  “What’s this all about,” I asked our receptionist.  She smiled and said, “These are bad, bad fish. They are Cichlids, and all they do is chase each other all day, eat their young, and make life miserable."  No leadership there.  Fish tanks can be just like work.  Guess it depends on who you have for a boss.HTML

The Future?

When someone tries to predict the future, it always reminds me of the story of the man who looked in the crystal ball. He got crystal in his eye. In spite of that challenge, here is my shot at 21 years of observing the area's health care competition.

We have been permitted, and that word was not accidentally selected, to have two very good years here at WMC.  We have had 24 months of considerable growth; growth that has allowed us to feel the comfort of at least believing that we can have a positive future.  Having worked with the individuals currently charged with creating success at the neighboring hospital, it is not difficult to predict what they would need to accomplish to claim complete success in the local market. 

A few weeks ago, we saw the announcement and local editorial endorsement of a Back to the Future health care decision to create a MedWell type facility less than two miles away from WMC that will be open to patients on off hours. Obviously, one of the measures of success that would be applied to this facility would be that of capturing those patients now coming to Windber Medical Center's Emergency Room between the hours of 3 and 8 PM and on weekends.  If their service is fast, inexpensive, and thorough, they will impress patients, and perhaps capture market share that has shifted to WMC from the local geography.  The new target will also be the hundreds of employees coming into the region this summer and fall.  After all, convenience and the prejudice of bigger is better will both potentially come into play at a facility like this.

The other phenomena that has taken place locally has been one of uniting numerous independent surgeons into one group. This is something that only one or two things might have caused; the Pennsylvania malpractice insurance crisis that has discouraged seasoned surgeons from attempting to pay exceptionally high insurance premiums and the potential promise of a new surgi-center would both fit into the category of "tipping point" phenomena that would contribute to this perfect storm.  Realizing that these individuals have been in fierce competition for decades makes this union even more suspect.  Following the logic previously outlined, it would also make sense that these surgeons would consider moving their secondary, less complicated work to a new surgery center in the area where the most growth is occurring, the East Hills, about 1.5 miles away from the only even slightly serious competition in the area, WMC.

Finally, with surgeons and walk-in patients coming to the very old Richland High School where the neuroscience center, MRI, PET/CT and other x-ray modalities are located, only one other major move would make sense to attempt to capture the 150,000 plus patient visits coming to WMC. That would be to move as many Richland based physicians into that same building as well.  These physicians could then feed the new center.  Because they already own the building, construction costs would be minimal, and potential profits would be higher.  (Watch for construction crews at an old school near you.)

So, as I look into my crystal ball, the solution seems to be very clear. We at Windber Medical Center must prepare for the worst, and "continue to work to be the best."  

The only way that WMC will survive into the future is for our employees to provide service that is so far above and beyond the norm that any potential patient would literally have to be dragged away from our optimal healing environment. 

Although the percentage of patients represented at WMC is only about 8% of the health care volume in the area, it is the closest and easiest 8% to target.  If anyone looks at Bedford, Somerset, Altoona and Indiana's growth since Lee was closed, it is clear that leakage of patients from this area is occurring at much higher volumes, but, like Willie Sutton supposedly said when asked why he robbed banks, "It's where the money is."  If you asked our neighbor why they have abandoned the heart of town and targeted the East Hills, they would have to say, "It's where the patients are." 

My friends, this is neither brain surgery nor rocket science, it is what it is -- competition, and only the best and brightest with the most carefully laid out survival plan will succeed.  Remember, our patients are our future, and our philosophy, our smile, our skill and our attitudes will result in our future being bright. 

A Time to Reflect On Life

With the passing of Tim Russert, we are all made critically aware of the fragile nature of life and our need to embrace every moment as a gift.  Obviously, within a split second, every aspect of our lives can change, and, as in Mr. Russert's case, can end.  This is not a blog about instant death, and it is not just about recognizing our mortality.  It is about preparing for our passing carefully.

Liz Szabo, a writer with USA Today described in a recent article the cancer patient experience by saying, "Patients with advanced cancer often don't know how long they have to live or how chemotherapy will affect their lives."  According to a study by the Journal of the American Medical Association, many physicians either don't give patients that type of information or the patients only "hear what they choose to hear, or very often misunderstand what is said to them."

This situation often leads to patients requesting incredibly disruptive and sometimes painful therapies that have no hope of succeeding.  According to the study, more than 20% of Medicare patients who have advanced cancer begin a new chemo regimen two weeks before they die.  Many times patients are admitted to hospice days or hours before they die. 

What has been observed in cases like this was that the patient often misses the opportunity to repair relationships, get their spiritual house in order or even prepare the necessary documents such as advanced directives.

Where is this going?  Sarah Harrington, an assistant professor at Virginia Commonwealth University School of Medicine in Richmond, co-author of the quoted article, indicated that "in the last few weeks or months of life, a lot of good work can be done." 

One of the points brought up in the article was that only about 37% of physicians told patients how long they had to live. This fact was not surprising to us because we have seen dozens of patients who were admitted to hospice over the years return home and live several more months or years. This particular prediction is not always dependable. The other fact quoted in the article, however, was that many patients learned more about their cases from other patients than from their physicians. 

The article concluded with the suggestion that "patients and their families may have to take the initiative in finding answers to important questions."  Thomas Smith, co-author and Chairman of Hematology and Oncology at VCU's Massey Cancer Center suggested that the following questions should be asked by any patient in this situation:   What are my options?  Can I be cured?  Will I live longer with Chemo?  Should I consider Hospice or Palliative Care?  Who could help me cope?  What do I want to pass on to my family to tell them about my life?  

Palliative care is not limited to cancer.  All end-of-of life diagnoses qualify patients for hospice and palliative care.  Tim didn't need or have this opportunity, but for those who do, embrace it.  The primary thing that can be delivered to the patient and their family is the comfort of having caregivers dedicated to helping you move through your transition.  It is what they do.  These amazing people, volunteers, employees and physicians are dedicated to "paying it forward." 

So, as we eventually face our own mortality, as we evaluate what it is that we want to share with our families, as we consider the legacy that we wish to leave, having a clear mind and looking to those professionals who can help us is not only necessary, it is imperative. This transition can come in the blink of an eye. 

Transparency

Transparency is a hot subject in health care these days.  The front page of last Sunday's New York Times carried a story about a physician who told his patient immediately after surgery that he had made a mistake, and basically apologized and asked for forgiveness.   Even with about 1,000,000 active attorneys in the United States working to make a living, the concept of telling the truth before it evolves into a lawsuit is more and more in the forefront of our literature. 

This week, I received a three page E-mail that was transparent, but it was not from us, it was about us.  It was so transparent that it should rock our collective souls.  As a patient-centered hospital that has reached some degree of recognition nationally, this letter represented not an A in patient centered care, but very close to a C, or worse. 

The person who took the time to record their stay at Windber Medical Center was painfully thorough.  Their hospitalization was over a 74 hour period when the house was full.  We were extremely busy, and somewhat short on some staff members, and a few key physicians were away.  This patient recorded every aspect of their experience.  They let us know when water was or wasn't delivered to the room, when the rooms were cleaned, where the nurses were and how often they delivered meds, checked their IV's, provided them with medicine, and met the patient's medical and/or personal needs. 

If it were not possible to determine who this patient was from the content of the letter, in the spirit of full disclosure, I would have reprinted it here for everyone to read. Instead, I will simply delineate the lowlights of its content.

The hardest thing about this letter for me was that we have been working for eleven years to bring improvement to the entire process, to improve health care delivery, and to provide an optimal healing environment. But, when things get rough, we seem to revert back to business-as-usual, circa 1997, and from the transparent report that this former patient provided, we did not always act appropriately. 

At a board, physician, and senior leadership meeting last week, I found out that one of our patient-centered practices had simply been discontinued without notification. This practice provided appropriately for patients, families and staff.  When it was discontinued, only the patients were being taken care of, and they were being cared for in an inferior manner compared to the original practice.  We have met with the appropriate staff members, and we are now back in the business of nurturing all of our stakeholders.

 
It seems to me that our reaction to stress and hard work might be like that of a rubber band.  As soon as the tension reaches its peak, that rubber band attempts to go all the way back to its original shape.  We are a Planetree Hospital.  We DO NOT do brain surgery, heart surgery, trauma or neonatal care.  We DO NOT have hundreds of specialists surrounding our campus like most academic medical centers.  Rather, we are a primary acute care hospital and our differentiation is patient and family centered care.  We are philosophically dedicated to treating our patients and their loved ones with dignity.  We are known for providing the highest touch care in the region.  After reading this patient's letter, it seems to me that they could have been in any hospital USA. 

If we believe that our mission is to provide the most wonderful, nurturing care, then we need to do that consistently.  A few weeks ago, a patient who was leaving the hospital said to one of our vice presidents, "Do you ever empty bedpans here?"  The question struck her as unusual . . . until she read the letter. 

We are all in this together.  We can only be as good as our weakest employee, and our future depends totally upon working not only as a team, but as a humane, caring, nurturing, loving team. 

Between our nurses, Integrative Health Team, our volunteers, pastoral care, our aids, housekeepers, dietary department and couriers, we should be in and out of rooms dozens of times a day.  No one should have to  wait for an overdue medication or just a cold glass of water. 

In closing, this is not a blog that is intended to demean, take unfair shots, or berate our staff, it is meant to say that transparency is exactly that: transparent.  Between the State Inspections, the Joint Commission and our own secret shoppers, transparency is here to stay, and we won't continue to grow without the total commitment from each and every one of us to work above and beyond the call of duty on all shifts.

In closing, the letter said, "You had one Golden Girl who was amazing in every way throughout my entire stay.  Her name is Debbie, and she is the pinnacle of everything you stand for as a Planetree hospital."

So, special thanks from us to you, Debbie.  You and people like you are our future. 

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

An Editorial Comment

Several years ago, we decided to be progressive and build a new building to house the Windber Research Institute.  Yes, it was risky.  Yes, it would take an enormous amount of hard work and good luck to even make the organization sustainable on a long term basis, but the optimists won, and we launched the effort to build. 

The journey to completion on that building was not only significant, it turned out to be extremely difficult.  Don't get me wrong, the architects did a great job.  Engineering was fine, and all of the members of our building committee worked hard to bring it to fruition. 

Interestingly enough, due to nearly 18 months in delays and some difficult publicity, we ended up losing three biotech companies that had intended to locate here in Windber.  They went to New York State, New Jersey and Harrisburg.

Now, several years later, after trying to attract new biotech organizations to our building, we found several physicians who were willing to move in, but, unlike the companies that had previously chosen us, these physicians cannot do their work without contiguous parking spaces for their patients.  Consequently, a year ago, we began our quest to assist our neighbors at St. Mary's Byzantine church by providing a parking lot for their use on weekends.  This would also provide the needed spaces for the doctors offices during the week.  It was all about neighbors helping neighbors, for which the community would be richer.

Fortunately, or—depending upon your point of view—unfortunately for some, our medical facilities are currently being stressed because of increased use.  We are growing fast and, to meet those demands, must continue to expand.  This growth cannot take place in a vacuum.  To continue to grow takes both money and co-operation, and both are sometimes very hard to come by. 

If we want a sub specialist on our campus, parking must be a consideration.  If the emergency room is to be large enough to accommodate the demand, it needs to be doubled in size.  If there is no place for education, large meetings, or significant activity space for children's exercise programs, a building must be built.  Finally, the need to accommodate the birth of numerous babies will also require more physicians and more space.

If we cannot grow, we will all pay the price, and that price will include inconvenience and lack of adequate expansion capabilities.   

Let's hope and pray that co-operation will become the key to forward movement.  Otherwise, we will spend countless dollars, hours and energy staying small.  Our future rests in our ability to treat more people more efficiently, and that cannot happen without co-operation. 

Success in EVERY direction!

Remember the story about the frog in the pot of water?  If the temperature goes up little by little, the frog stays put and it finally gets cooked.  Well, the magic number there was 212 degrees!  Windber Medical Center is right now at 210 degrees.   We are COOKIN'!!   But, in our case, it is not only positive, it is also amazing and exciting.

The Pennsylvania Mountains Healthcare Alliance recently received a $1+ million grant to begin connecting all of our hospitals together through fiber connectivity.  The potential ramifications of this network are virtually limitless.  They include the ability to do everything from provide disaster recovery for our network hospitals to all types of clinical and entrepreneurial activities.

WMC's as-yet-unannounced fund drive is already up to $2M, and our employees have donated more than $75,000 in the past few weeks.  That's a million a month with months to go.  These funds will allow us to put in our new emergency department, expand the obstetrics/nursery area, to add a new entrance from Somerset Avenue and much more.  Thanks to everyone who has donated and to Attorney Tim Leventry, Campaign Chair, and the hard working team that is making this happen. 

Due to the tireless work of Susan Ott and our Joint team, preparation for Joint Commission seems to be moving along very well, too.

The Windber Research Institute has finally begun to receive all of the grant funds that were caught up in bureaucratic bottlenecks over the past year and a half.  This will ensure our continued expansion and growth with the addition of several new employees at both the research PhD and technical levels.

A new local company, Illumina, is providing our physicians with the opportunity to begin sophisticated clinical trials for their patients, potentially a national or international patient draw. 

The new team at the Joyce Murtha Breast Care Center includes several RN's, our psychologist, and numerous other staff members.  This combined team is making amazing progress.  The new Woman'sCare program at the Breast Center is only two months away from formal launch, and will include several sophisticated new modalities, treatments and opportunities to help women in our area and around the world.

Financially, we are having the best year in our 102 year history.  Of course, it is critical that our financial performance is at this level so as to allow us to purchase and install our new computer system.  That project is making us all a little crazy, but is coming along very well, too. 

So, for the nay sayers, the disbelievers, the cynics and the worry warts; all we can say is too bad, so sad.   

WindberCare is thriving, patient numbers are growing, and nothing, absolutely nothing will get in the way of the wonderful optimism that our employees demonstrate toward our patients and stakeholders every day. 

Person Tim Leventry

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Random Thoughts. . . Learn From Your Mistakes

Make sure you know the question before you give the answer.

My kids taught me a lot about this job. At age seven, my son said, "Dad, where did I come from?" I knew that question was coming, but I had not expected it that soon. "Son," I said, "Let me explain about life" As I began my meticulously rehearsed tale of the birds and the bees, I slowly explained the nuances of life, love and more bees.

I was perspiring profusely as I stumbled over these sensitive descriptions. After about ten minutes of squirming, stuttering and stammering I said, "Do you understand, son?" To which he turned to me and said, "Heck, Dad, I knew all that stuff. I just wanted to know what hospital I came from, Mercy or Windber?"

Learn to share.

Hospitals deal every day in life and death issues. They are extremely complex and multifarious places. Emotions can run very high as well as we deal with the challenges and mysteries of life. Helping people to share has been a very large part of my life. Helping them to share resources, time, space and all aspects of life is a very important contributor to our success as both care givers and human beings. When I was eight, my Aunt Mildred gave me three pieces of bubble gum. As I was walking home with all three pieces stuffed into my jaw, a group of kids jumped me, pinned me down, took my gum right out of my mouth and divided it up between them. It would have been a lot easier on me if I had just kept a few pieces out to share.

Finally, don’t repeat it if you don’t understand it.

In any organization there always seems to be someone who takes great pleasure in telling the story when they aren't really sure of its meaning. After standing near Jack, a 15 year old sixth grader at school one day, my vocabulary expanded exponentially. He talked about mysterious things that made no sense to me, but he was big and I was small. In my world, that meant that Jack knew all. That night when my mom told me, the little third grader, to get ready for bed, I looked up at her standing beside my grandmother, aunt and dad and said, "I don’t have to go to bed, you @$#%&*$@!"

My limp cleared up right before I had to walk across the stage to pick up my college diploma thirteen years later.

Learn from your mistakes.

What it is all about . . .

Recently, my opinions have created some serious buzz in both our hospital and around our area.  My philosophical stand on patient-centered care is well known.  It has been the driving passion behind my entire life's work.  As a teacher and as a hospital administrator, it has been my commitment to do whatever was necessary to protect first, the kids, and now, our patients; to make them the center of our universe.

It is essential that we are reminded that each of us is a part of a much larger community, mankind. Obviously, some of us internalize these musings as coming from a leader who is not getting his hands dirty in the trenches, and the observation is absolutely accurate.  Unlike Braveheart, I am not out there in the middle of the battle.  I am not dealing with the nuts and bolts of the day to day challenges of patient care, but my role as a leader is to provide clear direction and to enable Windber Medical Center to have a bright, successful future.  The only way that this can occur is through differentiation.  How can we be different from other care centers?

It is important, however, that we detach from the intensity of our emotions now and allow ourselves to cultivate a more global perspective.  How would you want your mother or child to be treated?  How would you, as a patient, want to be cared for here?  If the answer is that you would like to be the center of that care, you are being honest and forthright.  That is all that this is about.  It is about putting the patient first.

But we are reminded of our limitations.  We are, after all, only human, and the daily challenges are real; our ability to deal with every element of our lives is real, and the pressures of life and death challenges are not easy to overlook.  So, we must focus on the fact that "we are not the enemy."  We must be the shining spot where patients know they will be protected, loved and compassionately embraced.

A Short Clarification

Let me begin with a very sincere apology. I am truly sorry if I did not make clear the substance of my article in last Monday's Business Review of the Trib. It was about Love, Compassion, Nurturing, and most importantly, making the patient, not the professional, the center of care.  It doesn't matter if a physician, like the amazing doctors here at Windber Medical Center, makes rounds at midnight, 2:00 AM or 9:00 PM if the patient and their family is the center of their care. Our physicians and staff, carefully ensure that their patients do receive this type of care.  This is was what it should all be about, making the patient, not the professionals, the center of our healthcare world.  This is what makes Windber Medical Center the wonderful place that it is.