Nick's Blog

Flat on my Back (Again)

Well, I guess that with a one and a three year old running around the house, being exposed to large birthday gatherings with lots of sick kids, working in a hospital, and traveling from city to city, it's bound to catch up with you, and it has.  I'm currently living through what was my annual (and now seems like my semi-annual) slimming down session.  No food in 48 hrs and . . . well, you get the picture.  So, Thanksgiving was in bed, and so was the day after.

There are those who believe that I beat myself up so badly for months at a time, that the inevitable crash-and-burn has to hit where my body just screams out . . . enough!  There are others, however, who tell me to just wash my hands more thoroughly.

So, what's going on?  We are working toward formation of a for-profit corporation to enable us to move forward with our Netherlands partnerships.  We are continuously redesigning the staffing at WRI, primarily due to changing reimbursements and grants.  We are having the best financial year ever at Windber Medical Center, but, don't misunderstand that one, we need to have the best year ever.  Two of our radiology suites and a C arm went down within a week of each other, and they all will be replaced within the month.

Our free articles for "Our Town" are developing a readership following. If you haven't seen any of them, they may actually help you smile once in a while.

HospitalImpact.org continues to gain readership as do our articles in Hospital News, also free.  You may be wondering how I find time to write. . . and so do I.  It just seems as if, because I can't play the trumpet around sleeping babies, and my drawing has taken a hiatus due to a floater the size of a tyrannosaurus in my left eye, maybe the writing gives me a chance to do something other than focus on resource allocations and, well, resource allocations.

Finally, I want to comment on being a High "I."  For those of you who don't know what that means, there is something called the DISC personality profile.  You can find it on-line.  High "I's" are typically people people,  and are typically not presidents or football coaches.

There are lots of good things about high "I's."  Most of which revolve around the fact that we're usually nice.  We like people to like us, and we are sometimes charming; not always, but sometimes.  Well, when I became President of the hospital, I had plenty of concerns about being a High "I" personality type.  You see, High "I's" will do almost anything to avoid conflict.  They want to be diplomats.  They want to have happy endings.  Then, I discovered that Dwight Eisenhower was a High "I," and I felt better.  He had all of those High "D" generals reporting to him, and still got the job done through leadership and consensus.

Let me close this by saying that the biggest problem I've had as a High "I" has been in my selection of the people who work the most closely with me.  My inner self told me that I needed people who would pay attention to detail because I usually don't.  My intuition was strong enough to lead me toward some scientists and mathematicians.  It was not a MENSA IQ that made me realize that these people needed varying backgrounds to fill in all of the pieces of the puzzle.

Well, I can tell you that, of the eighteen or so people who have been selected by me for those spots over the past ten years, only about nine have worked out.  If this was baseball, I'd be rich, but, in health care, it's been a royal pain. 

So, for those of you who have been able to hang with me, God Bless You. . . and for those of you who have not, you're probably just as happy that life took you in a different direction, because I'm sure I just MADE YOU NUTS.

Music and LIFE

It's no secret that my first forty-plus years or so were totally wrapped up in music.  Actually, it all started when my Aunt Mildred gave me my Cousin Jack's drum sticks at the age of eight.  You see, Jack and Uncle Bill were great drummers. So, my private lessons began when I was two years short of a decade, and continued through graduate school. There were tens of thousands of dollars worth of private, one-on-one instruction from all makes and models of teachers. 

This blog, however, was intended to give you an idea about goal setting and accomplishments related to that end. 

At age 15, my professional trumpet teacher in Pittsburgh informed me that it was time to prepare for the Carnegie Mellon Honors Band auditions.  This 100+ member band was made up of only the area's very best musicians.  Literally hundreds and hundreds of music students from all over Western PA, Ohio and West Virginia converged on the CMU campus and stood in front of the region's top teachers to compete for the highly prestigious positions available in this phenomenal band.  For example, a couple of hundred trumpet players would vie for the 10 or so seats available to trumpet players.

So, what was the drill?  First, those individuals who studied with the top music professors in the City of Pittsburgh had an edge.  It was important for me to get a spot with Carnegie Mellon's Anthony L. Pasquarelli who, for many years, was the most sought-after free lance trumpeter in Pittsburgh.

What else did it take? It took disciplined practice, hours and hours of practice.  It took discipline to also keep from over extending myself during the normal, daily musical endeavors, i.e., don't blow  your brains or your lips out at the football game or the Thanksgiving parade. 

The other very very big requirement was to select the proper solo.  Typically, the solos were professional level, and required months to learn and then to memorize.  Actually, the solos were usually written by Herbert Clarke, who is widely considered one of the greatest cornet soloists of all time. and, believe me when I tell you that this guy was a freak of nature.  It was ALMOST impossible to even get through one of his solos. 

Then came the intangible, development of self-confidence.  Tony taught us how to appear self confident. He taught us how to carry ourselves when we walked into the room.  He taught us how to take out our horns and look confident and self assured, and then, as a back-up, he insisted on our carrying in a glass of water in case we got dry mouth from nerves.  We also performed in front of our peers for practice to help us get over the nerves thing.

When the day came, you stood in line for a long long time, went into the room, played pieces of your solo for the judges, and waited for a week or so to hear who made it. 

Here's the part that made music real: After three years of trying and trying, practicing and practicing for literally hundreds of focused hours and a total commitment of heart, mind and soul I took my best shot.  After three years of work to make sure I had the right, professional trumpet, the best possible lessons (that were twice as much as we could afford), you were armed and ready.  After driving back and forth to Pittsburgh every Saturday for three years and memorizing the impossible solos, you knew you were on the right track.  After mastering my nerves and my ability to play the required music, the results came back three times that I had not made it.  The last year, I believe that I made alternate.  That meant that, if one of the kids on last chair got sick, I would have had a chance to get into the band. I never got into the Honors Band. 

Why, you may ask?  It was because of God or nature or fate.  Talent was the only uncontrollable thing that kept me out.  It might have been the fact that my teeth were a little crooked and my folks couldn't afford braces.  It might have been because I was the work horse of my high school marching band, and this all took place during football season when my lip felt like chopped liver most of the time, but, most probably, it was because at least ten of the players were just more talented.

What a great life lesson/s.  Getting into that band was the single most important thing in my life at that time, and my efforts never were good enough to get me in.  Practice was never the problem.  Commitment was never the problem.  Sensitivity to the music was never the problem.  Pure, raw, unadulterated talent was most probably the problem.  Regardless, the discipline, the persistence, the training, the hard work, the desire have all stayed with me for my entire life.

So, let me end by saying, "Keep music in the schools."  It really can make a positive difference in plenty of lives, and it's also good to remember that the people who don't make all of their goals have plenty to prove the rest of their life.  Hence, my total commitment to all of my jobs these past several decades. I'll show those yum yums . . .

My Kind of Town, Too.

The Nuts and Bolts of Patient Centered Care. That was the title of one of my recent presentations (Download a copy) to an insurance risk group in New York City.  Interestingly, this is the second insurance group who has requested me to speak this year through our friends at Planetree.  It's all expenses paid, and I donate the money to the Windber foundations.

As I looked out across the sea of risk managers, administrators, attorneys, and physicians, I knew that my presentation would be a real stretch to this collection of mostly left brainers.  Why?  Because every creative thing that we do at Windber Medical Center is not conventional wisdom.  In fact, much of it flies directly in the face of the so-called conventional wisdom.

It's fun when we describe our therapy dogs as they go room to room, our 24-hour, seven day a week visiting hours, the double beds in the OB suites, live plants, the greenhouse, five volunteers for every patient, family care givers, accommodations for loved ones in the patient rooms, decorative fountains, music, aroma therapy, fresh baked bread, massage, cosmetology, yoga, reiki, acupuncture, drum circles, the music room, et al.  These things are certainly NOT the norm in most hospitals.

The piece that really gets their attention is when we can prove quantitatively that the total amount of insurance premiums paid out for malpractice and general liability is 96% more than the amount that is paid out by our insurance companies in settlements for any type of related claims.  That also means that, instead of the normal 95% in 95% paid back out, our insurance companies are only paying about 4% in claims for us in those two areas. That's probably why the insurance companies love us.

Understand that many of these attendees are number crunchers.  That's why, when I get the chance, I always quote to them the infamous, rich words that I so blatantly stole from my mentor, my very own Yoda, my Tibetan monk-like teacher, Leland Kaiser: 

Nothing has to be the way it is.
No way is the right way.
We have the power to change reality...
...AND there are no boundaries.

So, you can design your future because the bigger the dream, the easier it is to get the more people that will support it.  By the time I say this, they usually sink to the floor in a nearly comatose state.

That's when I come in for the kill by saying:

• Our infection rate is only 1%. That's 8% below the national average.
• Our mortality rate is the lowest in the area for adjusted acuity.
• Our length of stay dropped from 4.3 to 3.4 days.

The question is, what is the question?  If you treat people with respect and dignity, with love and a total commitment to their health, it works. They don't sue you because they know you care about them.  They don't hate you because they know that you respect them.  They recommend you to their friends and relatives because they trust you.

As the brain surgeon says: "This is NOT rocket science." And as the rocket scientist says, "This is NOT brain surgery."  If you put people into a healing environment, they heal.  If they are not living in complete terror about the next unknown that is going to happen to them, they heal.  In fact, their white blood cells may actually be given a chance to work!

You can wash your hands 24 hours a day, seven days a week, and you should. But... people will still get infections if you restrict their loved ones from being with them, if you treat them like a body part, if you don't tell them what's coming next, and don't give them choices in their care.  Instead, one of our senior leaders always says about Windber Medical Center, "We do not make our patients leave their dignity at the door." 

Buzzzzzzzzzzzzzzzz

Early on in my health care career, a consultant was hired by the system executives to evaluate the management team of which I was the newest member.  After about two days of interacting with the CEO, COO, CFO, VP of Nursing, VP of Human Resources and me, the consultant candidly pulled me aside and said, "Of all of the management teams I have interacted with, this team has the lowest 'Buzz' level I've ever encountered."  My response was, "What do you mean?"  To which he replied, "I had to check to see if they even had a heart beat." 

It was about three months after that visit that, one by one, the team began to move on.  In fact, I had a group photo of the seven of us and, one by one, the team began to vanish.  It was like the movie, "Back to the Future," where the faces disappeared from the page until I was the only person left from the team. 

The lesson that I learned was that you need to Buzz to survive.  It's funny because, as I look over our teams, my personal radar takes me right back to the old Buzz level!

Now, the Buzz that I look for is not a negative, gossipy, whiny, cry baby buzz.  It's a pumped up, positive, excited, let's-grow-and-go-and-make-it-happen buzz.

If I want to be depressed, afraid, or to encourage myself to move back to Fayette County to live in an abandoned coke oven, there are absolutely people in the hospital and research institute that, no matter what the day or time, can take me there.

On the other hand, if i want to see a phenomenal future, feel total optimism and get the adrenaline flowing, I can find people here to take me there, too.

Which one are you?

Don't answer.  Walk up to the mirror and answer this question out loud to yourself.  "How are you doing today?" 

Okay, Buzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz!!!