hospital impact

by Nick Jacobs

Is it possible that we do not know everything there is to know about healing and health? In 1974 my neighbor asked me to help him with a piece of concrete that had been dislocated by the winter's frosts. We both bent over, lifted the 250 lb. slab, and his instructions were to drop it into place on the count of three. Well, at the count of three I glanced and saw his foot still firmly planted under the concrete. He had planned to pull it out. I didn't realize that, and held onto the concrete. I then could not stand up straight, and was bent like the letter L. Clearly, something had happened to my young year old back.

My neighbor carefully placed me into the front seat of his car, drove me straight to the emergency room, and the treatment began. First an x-ray where the physician asked if I had ever been a professional football player. When I had stopped laughing, I wiped the tears away from my eyes, and said, "Nope, but thanks." We can't miss the nuance of what occurred next. Muscle relaxants and the threat of what has been described as traction resulted in nothing, absolutely nothing. I couldn't walk, couldn't sit, couldn't stand, and felt as if a long hot knife was stuck in my back.

Two weeks later another friend saw me struggling to walk, put me in his car and drove me to a physician's office. This was a doctor that I was not familiar with, but he was pleasant, took my blood pressure, suggested that I have a Martini every night before dinner, looked at my feet and said, "Oh, this is simple, your sacro is out." He pulled on my right foot and said, "Okay, we're done here." I stood up and felt fine.

He was a DO, a doctor of osteopathic medicine who had been trained in manipulation. Although I was a teacher at the time, it seemed perfectly clear to me that medical professionals with varying views on treatments don't necessarily talk much.

In 1997 when I became the CEO of a hospital, my first decision was to become a Planetree Hospital and to create a menu of options for our patients. Because I am not clinical or medical, nothing was particularly sacred to me. My only concern was that our patients got better, and that we didn't fill our halls with quacks and unqualified tricksters.

Consequently, we introduced many aspects of complementary and alternative medicine, but the difference at our facility was that we used only medical professionals to deliver those modalities. We opened our patient rooms to accommodate family members 24hrs. a day, seven days a week. We placed double beds in our OB suites. We employed musicians, aroma and massage therapists. Our therapy dogs are there for the asking.

The concept is to provide a healing environment. The concept is to allow certified accupuncturists, manipulation trained DO's, PT's, OT's and others to provide those treatments chosen by our patients. The United States citizens are spending billions of dollar each year on these treatments, and many times they are administered by uncertified individuals.

It is my desire to give our patient partners choices. If they get better because their loved one is permitted to stay with them around the clock, or if a dog's love moves them back to health, it doesn't really matter to me. Just so they get better.

We use a very strenuous allied health professional credentialing process to approve these clinical specialists. We take medicine very seriously, and we pay out more than a million dollars each year on general liability and malpractice insurance but have paid out, on average, less than $20,000 a year for all claims in these areas because, if you treat people as partners, not patients, if you treat them with kindness and love, and if you don't make them leave their diginty at the door, they will be your partner. If you create a healing environment void of negative energy, mean employees and limited access to their loved ones, they will heal.

As a consumer, does it make you wonder why we all aren't embracing this philosophy?

by Tony Chen

Ah, the joys and travails of the wild wild west of the healthcare blogosphere.

This past week, I discovered a website (I won't dignify it with a link) that was squatting on hospital impact. They copied hospital impact content, the hospital impact design and likeness, and created a site with a very related url. All the on-going links on the site were to hospital impact. Except that they added a few ... shall we say... "not safe for work" pictures and links.

So you could imagine my dismay when I saw my thoughtful post on Cleveland Clinic's Chief Executive Officer "by Tony Chen" on their site accompanied by very suggestive pictures and links.

I emailed some blogging and lawyer friends for advice. I went to DomainTools to figure out who the culprit was (someone from Istanbul). So I emailed them, their web hosting company, as well as the Turkish Embassy. I was also about to email Google to see how to get their site de-indexed.

Nonetheless, the site was completely changed within 24 hours - all of the hospital impact content/likeness was removed. In my opinion, it was the email to their hosting company threatening legal action that did it.

Word to the wise blogger: check out this link about bloggers FAQ and IP protection.

I guess lots of popular blogs go through this, it's almost a rite of passage. So maybe I should be honored that hospital impact was popular enough to rip off!

by F. Nicholas Jacobs

The rise and fall of the Cardiac surgeon as the star around which the medical universe rotates has been an interesting phenomenon to observe. In fact, three years ago when I was approached by a physician placement agency to hire a newly graduated, Ivy League trained, cardio thoracic surgeon to fill a vascular surgery position at our acute care hospital, all of my "spidey senses" kicked into action.

Why would a multi-million dollar man, a top trained, cardiac surgeon want to come to a primary care hospital for a vascular surgery assignment? It was at that very instant that I dove into heart surgery research. As the age and acuity level of our patients had continued to climb almost exponentially, heart surgeries had dropped in our area from approximately 600 to 450 to 350 a year during the previous ten year period. Then I saw the national figures that revealed a decline from a high in 1997 of 350,000 to about 250,000 coronary artery bypass surgeries in 2004.

As the recipient of six coated stents over the same ten year period, it had always been clear to me that the new, multi-million dollar men were the invasive cardiologists. Having read the latest reports on coated stents, we Boomers with six packs in our chests are nervously taking our aspirin and Plavix and waiting for that potentially fatal clot to materialize during our next stress filled situation?

I personally was a member of that very small club of 1% that had an injury to my artery ensue during my first procedure and a near fatal misfortune take place after my last invasive procedure. So much for the 1% rule. For me it’s been a 66% complication rate, two out of three procedures, but my physicians had thousands of otherwise successful procedures to their credit before and after me.

One autumn morning I overheard a conversation between a local cardiac surgeon and an Emergency Room physician. The surgeon said, "Yeah, he has 15 stents and finally wants a bypass. The problem is, it's going to take a giraffe's leg vein to bypass all of that metal." That would be another potential complication from the “full metal jacket” rule of stent implantation.

So, as it turned out, our cardiac surgeon was looking for a medically under served area where he could work to get his Green card and eventually his American citizenship, but, in general, graduating residents are having a challenge just finding the job they want. In fact, according to a recent article in USA Today, 12% of the finishing 88 cardio thoracic residents received no job offers in 2004, and that was before the bottom nearly dropped out of the open heart surgery business.

So, what do you call a heart surgeon who finishes in the last quadrant of his program? You still call him Doctor, but, to find work, he may have to specialize in lung or heart valve surgeries instead of bypass.

Maybe someday we will discover, like Dr. Dean Ornish has professed, that diet, exercise, group support and stress management will completely reverse heart disease, or maybe, like the 1973 Woody Allen movie, "Sleeper," proclaimed, it will be determined that chocolate cake, deep fried foods and smoking will be the cure. Either way, changes continue to be a reality in the world of heart disease treatment, and, until we stop lounging on our couches, over eating inappropriate food, working too many hours a day, and not practicing regular stress management program; we will continue to add to those negative statistics.

by Nick Jacobs

As a seasoned student in Graduate School for Master's number two, I remember my professor's very carefully positioned discussion around the concept of Situational Ethics. Joseph Fletcher (1905-1991) was given credit for conceiving of this philosophy, and numerous religious philosophers have been uncomfortable with him ever since.

It has been described as a system of ethics that evaluates acts in light of their situational context rather than by the application of moral absolutes. The concept of ethics tailored to a specific situation certainly seemed like a great way to explain away the gray or, depending upon your geography, the grey issues with which we are confronted every day.

Regardless of the moral or religious implications, it is what it is, and I have come to learn that our society and most societies embrace this philosophy in a multitude of ways. If the Material's Management Director receives a favor in the form of a trip or a gift from a vendor, and that gift is beyond a limited value, that may be considered problematic for the organization. If a senior officer, though, is flown to a reception in the vendor's corporate jet, wined and dined, and then taken to a professional sporting event in an attempt to influence that officer into using that company's product, does that present the same problem? If a U.S. Congressman is flown at no cost by a lobbyist, that now is considered problematic, but if the lobbyist is from an academic institution, that is considered okay.

If a board member puts undue influence on an executive to do business with his company, how does that play out? Sarbanes-Oxley sends a very clear message that the business community is expected to do things differently than the way they have been done in the past, but I've already heard of cases in health care governance where specific board members have required the calculation of just how much business is too much business to be pushed to the extreme before the law kicks in for non profit corporations.

According to the Columbus Dispatch, in 2000, 13 of central Ohio’s corporate boards were dominated by insiders — company executives, consultants and lawyers. Some owned jets that they leased to their companies. Others owned office buildings that their companies rented. Still others were relatives of the CEO.

Bottom line? Corruption by any other name is often called doing business in many countries, and in some countries, it is truly considered an art form. Who do you know? How do you take care of your friends and the friends of your friends? What financial favors do they do for each other? Unfortunately, in many cases, if you don't play by the rules of the GOB's (Good Ole Boys), there can be a heavy price to pay, unemployment.

So, for all of you who are looking at a high powered future, study the rule books and stick to your guns, but, unless you work for an absolutely wonderful board, hold onto your hats because situational ethics can be very difficult to surmount.

Regarding ethics in the military, Robert Prentice, a professor of business law at the McCombs School, said, "Nobody up the line is taking responsibility. Everyone is trying to pin it on the little guys." Remember, that little guy could end up being YOU.

Final thought, putting on make-up or shaving in the morning usually requires one to look in the mirror, and that can become challenging for those who are better known as the players. Of course, that depends on the situation.

by Tony Chen

Cleveland Clinic has hired Dr. Bridgett Duffy to the post of Chief Experience Officer, "a newly created role designed to ensure all aspects of the patient experience at Cleveland Clinic meet the highest standards." Dr. Duffy was previously the Chair of the Brain-Heart Institute at the Cleveland Clinic and an accomplished healthcare consultant.

This "experience designer" job is one of the "hot jobs of 2007" according to Fast Company. Here's Fast Company's take on what the job is really like:

Experience designers go beyond the look of a place, creating a unique experience in which shoppers can immerse themselves. From cellular boutiques to the American Girl doll store on New York's Fifth Avenue, the shops created by an experience designer are often considered works of art; mini universes unto themselves. Experience designers are involved in every aspect of creation -- from choosing accent colors on walls to slanting the windows in the right direction. The next time you go into a boutique and you feel as if you've just had an "experience" -- you have, and someone went to a lot of trouble to make you feel at home.

Now of course, I'm sure Dr. Duffy won't be picking out wall colors. Nonetheless, she will be looking at "small things" that will collectively add up to a patient experience. This is particularly important for Cleveland Clinic, so that patients walking into their Florida site get the same "experience" as those walking into their Cleveland site.

This could be great development for the hospital sector. By definition, hospitals will always be difficult, messy, complex, and scary places to be in. Life and death, disease and sickness, brokenness and fear will always be walking down our bleached hallways. So doing whatever we can do make hospitals as enjoyable (relatively speaking, of course) and unintimidating; whatever we can do to make patients feel at home and to feel like people (On one blog, the comment was "it's about time, that place is a human warehouse!") will go a long way in delighting patients (and as Nick would say, clinical outcomes!). In some sense, this is really Planetree and also the If Disney Ran Your Hospital Series are all about.

Dr. Duffy has her work cut out for her - the patient experience isn't her job - it's everyone's job. She'll be the champion and the cultural architect. She'll also have to be a mountain-mover to change people's behavior in an environment that is structurally centered around functional expertise, not patients.

By the way, Healthleaders has a how-to guide on creating "experiences" in hospitals.

by Tony Chen

There has been some very thoughtful posts lately in the healthcare blogosphere on topics near and dear to my heart:
- The future of integrated health systems by Scott MacStravic highlights Carilion Health System's recent attempt at becoming an IHS.
- First Name or Last by David Williams on a patient complaint about being called by their first name at a hospital. Personally, I prefer Tony over Mr. Chen any day.
- Google Health: A Virtual-Doctor in Your Family by Bob Coffield wonders what Google is up to in healthcare. I have no doubt there are dozens of folks right now at Google thinking up new, crazy ideas that will change the healthcare landscape significantly.
- More on storefront clinics by Paul Levy, going against some of his counterparts and supporting these clinics. If you hadn't heard, a lot of folks in MA are trying to make it hard for these clinics to operate.
- Paul Levy also offers up the highlights of his hospital's FY07 Operating Plan. How does his areas of focus differ from our hospital's?
- Matthew Holt's got some goodies on Health 2.0, including an interview with Sermo (who've been getting a lot of attention lately) and news of the acquisition of an early-stage healthcare 2.0 company, Healia. Health 2.0 is coming!

by Tony Chen

Paris Regional Medical Center has sued health blog the Paris Site for defaming the hospital and releasing confidential patient information.

Paris Regional Medical Center is seeking damages in an amount sufficient to compensate the hospital for its injuries and losses resulting from defamatory statements on the blog, as well as punitive damages for the "willful, malicious and reckless attacks" on the hospital's reputation, the News reports.

Click here to read the blog's response. An excerpt:

"This site has been an outlet for pent-up frustrations for many of us, and only a few have actually put in their real names. 'twould be a shame if they should bear the brunt of Essent's wrath."

There has been some (very random) threads here at Hospital Impact as well - click here.

What do you think?

by Nick Jacobs

Having been an observer of scientific research projects for the past seven years, I have recently made an observation that undoubtedly proves irrefutably that parallel universes do exist. On a recent beach trip, six young mom's in our family and our extended family decided to send their hunters off to deep sea fish for Father's Day, leaving two grandfathers and a four year old boy behind to protect the house.

Because he was not included in the fishing trip, the boy would have been crushed, but the old dudes bailed out his dad and mom by inviting him to go fishing with us. Neither of us had been fishing since we were young dads, about thirty years ago, so the day was already predetermined to be interesting. We strapped the little guy into his car seat and left in search of a fishing pier. It took us about forty minutes and fifty four dollars for gasoline, a bottle of Superman apple juice, some Halloween candy corn and a piece of beef jerky.

When we arrived at the fishing pier and entered the main building, it was like a time warp. In a large glass case there sat a talking humanoid Pirate that told fortunes. Then we passed 70 different pinball, video, basketball and bowling machines. When we finally arrived at the cashier's corner, eight more bucks lighter; we saw reality in a completely different light. Renting two poles with sinkers and hooks required an $80 deposit. Miscellaneous fishing fees were $48, and that included a bag of blood worms. Our wrists were then stamped, and we went out onto the pier and into the blazing, morning sun.

We were instructed to cut the blood worm which contained what seemed to be about a pint of blood. The little boy became very quiet, looked at me and said, "You're killing him." At that point I taught him about regeneration. Then we launched the baited hooks into the Atlantic Ocean and five minutes later caught a four inch fish which we promptly threw back into the sea. After about 90 seconds more, the little guy looked up and said, "Poppa, I want to go home now." He turned and started walking toward the exit.

On the way home he cried out for a toy, we stopped and bought him a little pirate, armed to the teeth, and a motorcycle for a grand total of $5.34. When we walked into the beach house, he opened his motorcycle and the wheel fell off. He stopped crying 20 minutes later when his mom convinced him that it would go to the broken toy hospital and be fixed.

If you're wondering about my introduction to parallel universes, it should be perfectly clear to you by now that this trip was exactly like scientific research. You start out not knowing where you're going; spend lots of money trying to get there; have great expectations; end up with much less than you or anyone had anticipated; have to throw it back in, and too many times, the wheels fall of.

Parallel universes.

by Tony Chen

Two great articles by two guys named Scott. Both are tracking the pulse of "consumer-driven" healthcare in different ways.

Go over to the World Health Care Blog for a great strategy forecast for retail clinics by Scott MacStravic

And head over to Matthew Holt's blog for a Healthcare 2.0 priming the pump post by Scott Schreeve, MD.

by Christopher Cornue

As we organize services across our organizations, there are multiple strategies we use to align the various individuals affecting a specific disease-state or service. These groups and services are often referred to as Service Lines, or, as I am reluctant to actually put into writing, Product Lines. Since I am so hesitant to actually use this term, I guess I need to explain further. In the 70s and 80s, I believe the general terminology used for this structure was Product Line; however, the meaning was very different. Although I wasn’t involved in healthcare until the mid-90s, my understanding was that Product Lines focused more on marketing and growth efforts, not on the broad scope of current Service Lines. I’ve always had a hard time labeling these efforts under the scope of “Product Lines” … as the connotation is that we’re taking care of widgets, not patients.

Well, now that I’ve had my say about Product Lines … let’s talk about Service Lines and why I think it does matter to call them such. With the label of “Service Line,” we can best incorporate the broad scope of a specialty, service or line. For example, when I’ve been creating service lines at my current hospital, we make them interdisciplinary with individuals involved in a patient’s care from presentation through discharge (as much as we can). Additionally, we focus on four “foundations” that drive our efforts & services: Quality, Growth/Outreach, Fiscal Responsibility/Accountability and Satisfaction (Patient & Provider). When we align these efforts (re: services) around a specific Service Line, we have the best opportunity to have quality outcomes (that are measurable and trending), control our expenses, enhance our revenue and leverage these successes to grow our volume responsibly. E. Preston Gee, author of Service Line Success, states that Service Lines allow “an organization to better understand the dynamics at play within the subcategories of its business.” A perfect example of this is the aligning of competing forces in a Cardiovascular Service Line (no small task … but very rewarding when it works!). Furthermore, Gee suggests that Service Lines force “the organization to institute a discipline of measurement and accountability” – which I believe is key in today’s environment. I could talk ad nauseam about this topic (trust me, ask anyone who works with me!!), and may discuss further in a future posting – so beware! So, that’s why I prefer the “Service Line” moniker and for me, yes it does matter. What do you think and what successes have you had?

by Tony Chen

I've been watching the NBA Playoffs this year. Arguably the story has been LeBron James skillz & basketball IQ versus the Spurs talented (and equally intelligent) trio. While it doesn't hurt to have boatloads of talent, it is really the mental game that has set apart the good teams so far.

This year, I noticed a lot of commentary about LeBron James and other players working tremendously hard at getting better. More specifically, they work tirelessly at leveraging their physical advantages and their mental game. I found myself almost inspired by these players who realize that the physical gift they've been given can be amplified many times over through good ole fashion hard work & clarity of mind. This is the one chance they get and they're taking it head-on.

This got me thinking - if the world watched our work lives on TV, would they be inspired by how hard (and smart) we work? Do we realize that this is our one chance to make an impact on thousands of people's lives? Are we more concerned about our stat line or if our team wins?

Even the superstar players work out and relentlessly practice fundamentals - passing, dribbling, & free throws. How much emphasis do we spend on working on our fundamentals - communication, meeting management, delegation, and project management? And how much time do we spend working on our "mental game" - our leadership IQ?

By the way, here's an interesting post from FastCompany on what business leaders can learn from LeBron James.

by Tony Chen

Check out this list of the world's top 100 healthcare blogs, based on GooglePageRank, Bloglines subscribers, technorati authority ranking, etc.

And yes, Hospital Impact is #57.

by Nick Jacobs

The Baby Boomers are not about to be plutoed.* (Plutoed, according to BuzzWhack.com means to be unceremoniously dumped or relegated to a lower position without an adequate reason or explanation.)

We Boomers have paid our dues and have spent a lifetime changing the world in many ways. Unlike the way our parents and their parents were treated by the health care system, we are not about to be ignored, uninformed or pushed aside by our hospitals and our physician's offices. We will not be treated as sheep or second class citizens, and we will not leave our dignity at the door. So, be prepared.

Remember, we are the generation that created free love, enormous credit card debt, the dot.com boom and bust, the Internet. (Sorry, that was Al Gore, but wait, he is a Baby Boomer!) We've had thousands of public schools built for us, seen our colleges expanded to accommodate us, and we've watched this country adapt to our needy, greedy ways for the last 50+ years. With this group of former, wild eyed, hippies and now conservative investors, it ain't over till it's over. We don't plan to go out quietly, easily or soon.

Look at the impact we have had on the stock market, the real estate market, the clothing industry. In fact, I specifically remember the day, at age 33, when I arrived home in a new pair of jeans that were supposedly one inch smaller in the waist than I was. It was a certifiably, braggable moment until my spouse pushed the Newsweek across the counter to me. Featured on the front cover was a picture of a person in blue jeans, and the caption was "Levi's changes their jeans to pear shaped to fit the growing Baby Boomers."

It's a given that we are not going to accept hospital gowns that expose our us. We are not going to wait for the convenience of the radiologist who decides to work out and take an extra long lunch in he middle of the day or the pathologist who just doesn't want to work on the weekend. We are not going to accept the medical center that puts us in a waiting room and never explains why they are so late meeting our needs. We are not going to embrace your green jello and high fat menus. We are not going to allow you to expose us to 10,000 unquestioned radiological procedures, the equivalent to living on the Sun for a year or two.

We are, however, going to need thousands of plastic surgeons, personal health coaches and medical liaisons to help us navigate the system, and, eventually, we'll want gerontologists who understand the nuances of the aging body.

My first heart cath was back in 1997. When I was taken back to my room, the dietary staff brought me bacon and eggs and a packet of instant Sanka. My first question was, "Who paid for the bacon and eggs, the heart surgeon who was grooming me for his next case?" Then my next question was "When can you bring me a decaf latte with soy milk?"

We are not really interested in excuses for nasty employees, dirty rooms and hallways, limited visiting hours, lack of wireless and cell phone access, poor signage, no parking, limited availability to massage therapists, burned toast. We are especially bored with completely disconnected medical care where the docs don't communicate with each other, or medical records that aren't available or on time. We will ask about your infection rate. We will ask why your emergency room doesn't provide access to relatives, and why your only 100% commitment to excellence is typically your financial department.

Oh, yeah, and who ever decided that homes for the aging should consist primarily of a semi-private bedroom and hallway for each patient? There is no way we're going to sit in the hall and be wheeled into the cafeteria to hear Lawrence Welk. We will demand video I-pods with all of the albums of The Rolling Stones and probably some legalized marijuana to alleviate eye pressure for glaucoma.

So, fasten the seat belt of your fancy, leather, boardroom chairs. The Boomers are coming. We're used to being catered to, pampered, respected and nurtured. We are not going to be plutoed, and, if you don't get it, we'll make sure that we give the trillions of dollars that we have to pass along to those who do. Love ya, man.

by Nick Jacobs

The topic of controlling health care costs has been the center of attention at the last three conferences at which I have been either a speaker or an attendee: Consumer Health World Conference in Las Vegas, World Healthcare Congress in Washington D.C. and the Health Forum Integrative Medicine Conference in San Diego. The general consensus has been that we need an overhaul, but what makes up a viable retooling that will be acceptable to all?

At the World Health Conference we heard that preventative medicine is one of the major cures applicable to our health system. If we could continue to make strides in the promotion and societal acceptance of exercise, smoking cessation, decreased consumption of saturated fats and complete deletion of Trans fats, we would see exponential changes in our overall health status as we reduce diabetes, obesity, heart disease and cancers.

Of course, the logical conclusion at the Forum was to make an entire menu of complementary and alternative medicine solutions available to everyone, a.k.a., bring to the mainstream those healing cures, traditions, and treatments that indigenous man has embraced for thousands of years. Consequently, those incurable maladies that typically have required surgery after surgery with no curative results will be addressed by embracing a holistic care to treat the root causes. Be it spirituality, stress management techniques, energy treatments or music therapy; there are sometimes cures in nontraditional complementary and alternative medicines that could never be uncovered with antibiotics, surgery or any other version of the presently accepted healing modalities that feed our current $2+ trillion dollar health system.

We have also explored the possibility of keeping our elderly citizens at home as long as possible. This can be achieved through the use of high-tech equipment intended to monitor and to help remind them to take their medicines. According to some experts, if only a quarter of the current nursing home residents could remain in their homes this would result in a savings of more than $12 billion a year.

Like it or not, retail medical clinics or basic health care centers in commercial outlets that can take care of problems that are expensively addressed in our overcrowded emergency rooms are seen as extremely viable alternatives to the high cost care currently being administered in our hospitals.

Another huge initiative will be the unification of medical records using the Internet. Every patient would then carry a USB drive containing his or her medical records. These records could be downloaded by any doctor anywhere, or better still, the individualized Patient Identification Number with a personal Pin would make those updated records available on line.

Several other major suggestions that were put forth during these conferences included the implementation of a Market-based Universal health system, financial assistance for low income individuals, and equal tax treatment.

The bottom line, however, is that we, as an industry will be consistently challenged to become more transparent in our charges, quality indicators, physician performance report cards, accreditation ratings, and more as our country searches for a way to care for the nearly 50 M uninsured, and the aging Baby Boomers

by Nick Jacobs

It's amazing to me how much and yet how very little has changed during the past ten years. The subtleness of the metamorphosis is similar to the 212th degree, the point at which water goes from hot to boiling. First, you're hot, and then you're cooked.

Today I put on a new suit. It was the same size, same cut, same style and same manufacturer, but today, I looked like a watermelon in a silk stocking. That extra pound must have been the tipping point. After 20 years, the 42 Regular was not happening. If the coat button had launched and become airborne, it could have killed someone.

Another thing happened today that was totally my fault. My words took the moment to a boil.

Many of you have read about my periodic consternation relating to scientists and the world of science. Sometimes, just sometimes, as they apply science to living, the participants view of life becomes a little skewed. Sometimes the brilliant scientists think about things too long, or they get into too much analytical detail, but the characteristic that is the most worrisome to me is that they come from a world where normalcy involved feeding, holding, loving and talking to bunnies for months, and then cutting them open to see what impact the experiment had on their arteries.

It was because of this trait that I decided to hire some hard working, fun loving, spirited, people to liven the place up a little. So, a few years ago, four terrific people joined us to bring additional life, spirit, fun, and spontaneity to the institute.

At 3:55 this afternoon, I was running out of the door on my way to a doc meeting in the hospital when I noticed something for the third time that week, new paper signs. No one could ever fully appreciate my hatred for paper signs unless they had spent the past twenty years living inside of my suits. You see, I had a boss who scoured the eight floors of the hospital building where I had worked to find these paper things, and then, rather than take them down, he just screamed at me. You see, paper signs represented transience, instability, poverty and unsupervised spontaneity to him and now to me. These signs in question had been breeding over the past few weeks, like the flimsy metal hangers that the laundry gives you. You start out with two, and by the end of the week you have a laundry bag full.

So, as I left the building, I turned to one of my happy souls and said, "What the heck are these signs doing here?" Unfortunately, she took it personally. She had been asked to help make the signs, and, as an artist, she took pride in her work. It was as if I had screamed, "Hey, your kid is ugly!" As Joe Lieberman would say, "Bipartisanship means never having to say you're sorry." Why couldn't I just have said, "Let's get some permanent signs?" Maybe it would have been better to have said, "This sign is so beautiful that we should get it memorialized by having it bronzed?"

Anyway, I was later informed that I had upset my friend very much. Running out the door with three other people who observed my despicable remark probably didn't help.

So, I'm dedicating this blog to all of those people who have been hurt by my curt, CEO, verbal shots. In Shakespeare's Twelfth Night, he writes, "Life is full of sadness. The best years of life are short. Events are cruel. And other people are cruel. In such a world, it is your DUTY to find and cherish whatever real happiness you can."

So, Cathy, and all the Cathy's I've boiled, I'm sorry. It wasn't personal. It's just that those paper signs are killin' me.

by Nick Jacobs

Almost every week someone says to me, "How did you make the transition from being a teacher and professional trumpet player to running a hospital and a research institute?" In so many ways, it is exactly the same job. Clearly, the human mind sometimes has trouble grasping non-traditional career paths. As a young man, my passion was for helping people through education. It was clear to me that you could change a person's life almost completely with enough information.

There is no question that my journey was out of necessity. During the 70’s and 80’s the area where my family decided to settle we experienced the highest out migration of any city in the United States except for East St. Louis, Missouri. This was due largely to something called the Johnstown Flood. Unemployment reached 19% and my most demanding job was to find a way to continue to be employed to care for my family. So, at age 40 with a B.S. and an M Ed in hand, I headed back to Carnegie Mellon University for a second Masters in Public Management/Health Systems Management. It was a good decision, a unique program and a very different approach from the typical MHA or MBA because it exposed us to all aspects of public management. After that the Executive Program for Health Systems Certification at Harvard put some meat on the bones, and finally, the Fellowship from the American College of Healthcare Executives finished the credentialing journey. It took nearly a decade in total and almost more hours than a typical day held, but it provided the ticket to passage.

Would I do it again? Truthfully, my desire to nurture and care for people has been fulfilled in every way. The gift of healthcare delivery is second only to helping a lost kid find their way through education. Am I disappointed in the Medical Industrial Complex? Sure, but nothing that man has touched is perfect. My only advice to the student readers is that sometimes the hard way is more meaningful. All but my B.S. degree were attained while employed. It was extremely difficult to put in a 70 hour week and then drive to Pittsburgh two hours each way after work, but the experience was very rich because of the direct applicability to my job on a daily basis. School is great, and continuing education is a must. Don’t stop.

by Nick Jacobs

The general public is totally dependent upon people in my position to stand up and take responsibility for running a competently staffed hospital. Each and every one of us is dependent upon those individuals trusted with our lives to be kind, competent, capable and sure of their skills.

There is no reason for staff members to treat you poorly. There is absolutely no rationale for anyone to ignore, talk down to, or mistreat either you or a loved one. Do not be afraid to stand up for yourself or your loved one. There is no reason for you to receive poor treatment. Allow yourself to become empowered.

You should not be exposed to unnecessary infections. You should not be subjected to an ineffectual physician or staff member. You should not be kept in the dark about your treatment. Your loved ones should not be kept away from you. You should do or have done what you want.

That’s my story, and I’m stickin’ to it.