by Nick Jacobs

As I approach my retirement from running a hospital Tony asked me to write some thoughts regarding this position.

Remember, no matter how far you push the envelope; it still ends up to be stationery.

The primary reason that I wanted to be the President/CEO was so that I would have the power to make things happen. After nearly thirty years of working to achieve that status in healthcare; after three degrees, two certifications and a fellowship, when the mantle of power was finally bestowed upon me, I made a choice to “never be a president like the majority of the presidents who had been in charge of me.” My primary motivation for this path was that, for the most part, their leadership had not felt very rewarding or productive. The discomfort that they had caused both me and my family was why I wanted to become the boss.

It was my dream to become a benevolent despot, a kind and reasonable leader who cared about his co-workers, but clearly was in charge.

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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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by Nick Jacobs

Dale Dauten in an article written for CAP Today entitled, A Call for Imagination, talks about the differences between great bosses and ordinary ones. His first very salient point was that one boss spends the day answering questions while the other spends the day asking questions. Mr. Dauten quoted the late business guru, Peter Drucker, as having said, “My greatest strength as a consultant is to be ignorant and ask questions.”

What a phenomenal gift, ignorance. Think of it. The recognition that ignorance can be strength. By studying best practices, by asking plenty of questions, by not knowing the answers, and finally by leading thought patterns toward better, faster, cheaper; things can change in a positive manner. By asking the “what would it take” questions, we have an opportunity to short circuit the usual objections because it assumes the old methods aren’t enough.

Instead of asking, “Is that the best you can do,” the uplifting question, according to Dauten, becomes “How could it be even better?”

So, the call completely changes from a call for accumulated knowledge to a call for imagination, and the old methodologies begin to change dramatically.

by Tony Chen

Over at the hospital impact social network, there have been a few very insightful comments about hospital culture:

Mike said: "Hospital cultures are very segmented as well. Not only are they segmented by profession i.e. nursing, medicine, ancillary services etc. but also intra-professionally within in each discipline i.e. Nursing - ER, ICU, Med/Surg; Medicine - Surgery, ER, Attendings Residents and the list goes on. Each group has their own expertise they bring to the table and each are jocking for position on many issues depending on the impact. Bottom line hospitals have very dynamic cultures."

Isn't it this type of culture that breeds the "not my job" type of attitude? And when the "not my job" is running point for a patient's care, devastating things happen.

Jane had an interesting solution for this particular problem:

One of my answers is..return the role of "head nurse" to its original purpose. That is, overseeing the care given to all patients on a unit, teaching nurses how to improve their practice, engaging other members of the care team in true care planning, making rounds with physicians and talking with families. Not managing a budget, finding staff, sitting on innumerable committees and spending almost no time actually on the unit.

This comes down to investing in additional resources to the head nurse with the many administrative tasks. While I like this idea, I think there are some administrative/strategic initiatives that only the "head nurse" who knows what's going on could really implement.

Speaking more generically about hospital culture, I saw this very interesting insight from Denny:

"For leaders, the most critical thing they can do to shift a "culture" is find out what the conversations are that their people are having. Not only is it important to know what people are saying to each other, but also what are they saying to themselves about the way things are. When a leader knows what people are saying about "the way it is around here," the leader then has an opportunity to address the issues and make a difference."

I like this explanation because everyone can grasp this. Hospital culture isn't some warm fuzzy thing that only consultants talk about - it is the unwritten norms of behavior and the frank conversations. Of course, this means that the people trust the leader enough to share!

by Nick Jacobs

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.