by Nick Jacobs

Upon entering the world of healthcare management, it only took about a week for me to “get it” regarding the realities of the job. Having started my adult work life as a professional musician, band and orchestral director, the structure of a hospital was so similar that it was, in fact, almost disconcerting. Obviously, the entire ensemble was in some way reportable to me, and, not unlike standing on the conductor’s podium and looking into the music score in front of you, running a hospital had dozens of departments, each with specific assignments and each interconnected. For me, a Systems Approach to running a hospital was not only necessary, it was also imperative.

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My humorous references to the similarities between managing a wind ensemble, an orchestra and a marching band were clearly applicable to running a hospital. In fact, many of the problems faced were more like doing this on a junior high level. The majorette mothers were often represented in spirit by the auxiliary, our string players were smiliar in character and intellectual bent to our specialty surgeons, and many times, the drummers were running the place. What did it all mean?

If the patient arrived in the Emergency Department and needed registered, then a preliminary examination by a triage nurse followed by blood tests, respiratory treatments, x-rays, and surgery, each department had to co-operate in order to achieve the necessary end results. For those of my peers who believed that they could correct one piece of the system without touching another, a hard lesson was to be learned. Not unlike the discomfort created for your entire body that comes from a nasty splinter, each department is dependent upon the other in so many subtle and not so subtle ways that it is difficult to understand how badly out of tune the resulting piece will sound if things aren’t corrected. It is indeed a delicate balance where every player needs attention, clear direction, support, encouragement, and the occasional corrections.

During the first one hundred days, challenges are few and far between. You are given running room, plenty of rope and the benefit of the doubt with very few significant budgetary restrictions, and a relatively free hand to move forward. That period of employment is typically the hypothetical honeymoon period. Tolerance runs high. People embrace your ideas with baited breath, and you can get away with many wonderful initiatives if you can just work fast enough.

It is immediately after that period of time when things get a little more tense, the wagons are circled, the hard core lifers begin to dig in, and the bullies start to do their magic to ensure that nothing will really upset the power structure that they had worked so hard to create. Consequently, we brought in the proverbial blow torches and melted the frozen culture as quickly as possible so that it could be repositioned and refrozen in its new formation before the honeymoon ended. We became a Planetree hospital, kicked off a major fund drive, expanded into more remote geographies, added physicians, painted the entire interior, laid out a new expansion project, began a realignment of management, and started a comprehensive advertising campaign.

So, if I could give anyone advice about this time period, it would be to remember the delicate nuances between the various sections or departments, to make as many board backed intelligent but bold moves as possible and to listen carefully to the music because if it gets too out of tune, a severance might not be too far behind.