by Tony Chen

One of the things that fascinates me the most about being in the healthcare industry is this tension between providing societal good and driving for profits. Ya'll know how I feel about this by now - these goals are not mutually exclusive, in fact, we have to be passionately two-minded. The moment we lose sight of either fundamental purpose is the moment we've failed.

As I was studying for my CHE (well, now it's FACHE) exam, I was reminded by one of our founding fathers. Good ole Ben Franklin, while conducting a fund drive, built his case for our nation's first hospital (The Pennsylvania Hospital, 1760) like this:

1. We need a refuge for the unfortunate, and Christianity will reward you for your generosity to this cause.
2. You might need it yourself this very night
3. Among other things, we can keep contagious people off the streets.
4. We can certainly handle this better as a community than as individuals.
5. Grants from the Crown and the Commonwealth will lower the out-of-pocket costs.

a nice little reminder...

by Nick Jacobs

Why do many cardiologists forget to encourage their patients to take advantage of health insurance covered cardiac rehab?

Why do insurance companies pay for $45,000 full gastric bypass surgeries that can have some relatively serious negative side effects while not paying the $15,000 for bariatric banding surgeries?

By Nick Jacobs

Why, when it comes to hospital care, do family members go against their loved ones wishes so often?

When you have a mammogram, a thallium stress test or a myriad of other tests that are 20 to 30% less than 100% accurate, do they remind you often enough?

Why is it that most hospital food tastes worst than any food you can buy in England?

Can anyone tell me why teachers who hate kids stay in teaching, why physicians who hate patients don't become radiologists, anesthesiologists or pathologists and why hospital administrators who hate physicians don't just run widget factories?

Finally, why is it that so many people have only black and white opinions? Is it possible that they've never read a book?

This one is a good example of a botched job and a good recovery. You'll hear this all the time in the hotel industry. Something doesn't go right forthe customer's experience and they're mad. You do something above and beyond what they expect to make it better for them. All of the sudden, the fuming customer who was going to campaign against you is your best supporter. Enter viral marketing...

My mom was a patient of your hospital last month. She is 96 years old and I am her 73 year old daughter. Mom hated the food because your diet lady said she shouldn't have salt. So, I stopped at KFC and brought her dinner every night. I know your nurses said that she didn't have teeth when she was admitted, but I brought her teeth with me that first night and we kept them in the Styrofoam, KFC cup. So, someone threw away her teeth. Don't get me wrong, I am grateful that you were willing to buy her new teeth, but I think it's important that your nurses and cleaning ladies check the KFC cups in the future. You never can tell when you'll find more teeth.

Connie P.

more fan mail for Windber. How do we get all of our patients to feel this way about our hospitals?

Dear Mr. Jacobs,

I graduated from nursing school 42 years ago and have watched with interest the changing health care environment of this area. It is amazing to me that, after 100 years, Windber Medical Center only continues to grow and get stronger at a time when other organizations your size are closing all around. My life has taken me to many different places, but this hospital is the most amazing hospital I have ever seen. It is gratifying to me that the very essence of Windber's Hospital has never really had to change. It has always strived to provide national and now international quality care. I am proud of this hospital, and proud of the wonderful people who work here who never quit providing the most friendly, warm and loving care possible. Our doctors are the best, and your employees simply can't be beat. Why would anyone want to go to any other hospital?

Keep up the great work.
Anne K.

as always, keep sending your great patient stories to me: tony[at]hospitalimapct[dot]org.

I'm doing this for the sake of better hospitals - we can learn from the mistakes as well as the successes. Read previous stories on string quartets & Surgeries, Christmas, Crayons, and Cramps, and Harry Potter, Hamburgers, and Hemmorroids, and nakedness.

Part I: Life Falling Apart.
Part II: Carpet Pieces
Part III: Please, anything but hospitals!

By Nick Jacobs

After working in health care management for eight years, the opportunity came for me to assume a hospital presidency. We also won’t discuss the fact that my election to this position was by a one-vote majority.

The hospital was nearly one hundred years old, was started by a coal mining company to take care of its workers. When Western Pennsylvania coal went out of style due to high pollution levels, the hospital and the town also fell out of favor.

The population dropped from 12,000 to 4,500, and my first visit to the facility revealed PeptoBismol looking pink, painted walls, indoor outdoor carpeting in the maternity area with duct tape over the torn sections, furniture that looked like a bad sequel to the Brady Bunch, snow leaking through the windows of the conference room and a bottom line generated almost completely by not paying the employees an appropriate salary.

The hospital is seven miles away from nearly a four hundred bed tertiary care center in a fiercely competitive area where the population has continued to drop precipitously for the past three decades. The other trait not unfamiliar to areas such as this is that, because the population has dropped so dramatically, the wealthy have fought to remain in control financially and politically at whatever cost to and, most times to the determent of the area.

The hospital needed a vision, and that vision was one that had been part of me since my walks along the streets of East Liberty with Pittsburgh Press paper bag slung snugly over my shoulder. It was to become a hospital that was owned and used by the people in a way that would not only save their lives in an emergency, but would save their quality of life on a daily basis.

My commitment to public health was well documented, and my commitment to courtesy, service and cleanliness were always present. To convert this old, tired coal mining hospital into the hospital of the future as stated by Donna Shalala on her visit to Windber, PA two years ago, would take an inordinate amount of work and some luck.

The Planetree philosophy of care was a topic of my studies at both Carnegie Mellon and Harvard, and, although it was dismissed as too soft by the business professors, it was truly an answer that was waiting to be discovered. Planetree was the Sycamore tree under which Hypocrites lectured. More importantly, it is a belief in patient centered care.

“Planetree embraces the concept that the mind and body are intricately interrelated and that healing must address the needs of the mind and spirit as well as the body. All facets of the Planetree model – open communication, patient choices, family/friend involvement, music, art, massage, architecture, use of complementary therapies, and others – work to uphold this concept.

Because the hospital had a hospice, it was relatively easy to convince the board that the need existed to be kind, caring, compassionate, loving, and nurturing to patients. Why not?

Previous weeks I've eluded to the fact that as patients, we remember the little extra touches of compassion. We remember the "above-and-beyond" moments. Sometimes, though, what we remember is really all in a day's work for caregivers.

I am not sure this is the type of patient story you are looking for. I want to write about the impact that one nurse had on me prior to my surgery (cholecystectomy) earlier this year. I was a naive, scared patient. I’m sure it was all in a day’s work to the nurse, but to me, she was exceptional. Here is my “Thank You” note to the nurse who was in the room with me prior to surgery:

Dear Nurse:

To be honest, I can’t recall the nursing duties you performed. All I know is that when you were in the room with me, I wasn’t afraid. It wasn’t really anything you said, it was your demeanor and personality. You weren’t worried, so I shouldn’t be either. And thank you for not laughing (too hard) when I came to the realization that if all I was wearing was a hospital gown, and they were going to be operating on my stomach, someone was going to see me naked! You told me a couple of funny OR stories (no names, of course) and we giggled like schoolgirls. Like I said, when you were in the room with me, I wasn’t afraid. Thank you for that.

as always, keep sending your great patient stories to me: tony[at]hospitalimapct[dot]org.
I'm doing this for the sake of better hospitals - we can learn from the mistakes as well as the successes. Read previous stories on string quartets & Surgeries, Christmas, Crayons, and Cramps, and Harry Potter, Hamburgers, and Hemmorroids.

by Nick Jacobs

Part I: Life Falling Apart.
Part II: Carpet Pieces
Part III: Please, anything but hospitals!

After five years of exponential growth and State recognition, the three county, Laurel Highlands convention and visitors bureau recruited me to take over the tourism effort for the area.

A week after taking the job, the truth came out. Two of the three counties represented by the bureau had withdrawn their funding. Round three began. We were nearly broke. It took me a few months to realize the power of the 23 senators and representatives and the 15 county commissioners who were providing the funds to help support our efforts.

We hired sales representatives from the radio industry who were hungry and put them on the road. They tripled our membership base. We opened donated buildings as tourism centers in five counties. We hired employees from government-supported programs for senior citizens. We opened a convention service and went on the road with busloads of costumed volunteers representing our festivals and tourist sites. We delivered presents to every media outlet in a five State area. We began speaking nationally about the beauty of the area and produced a song about the area recorded by the Cleveland Symphony. (Pittsburgh wasn’t available.)

Within a year we had grown into one of the largest tourism agencies in Pennsylvania and within three years had created over 3500 jobs for the area.

It was in January of 1988 when job offers began to pour into my offices in Town Hall in Ligonier PA. Having just turned forty, it was clear to me that my prime income earning years were here, and my nonprofit salary was not going to easily help me get the kids through college. Oddly, within a two-week period, job offers from former board members, a U.S. Senator and a local hospital all came tumbling through my hands.

In the past few years there had been several opportunities to move to Cambridge, Massachusetts; Ft. Lauderdale, Florida; and the Hamptons on Long Island, New York. Each of these offers had been met with tears in our house from my wife and children.

My family did not, could not and would not leave. My wife was a local television celebrity and was performing as a vocalist in several groups in the area. Consequently, when the offer to head up a marketing division of a bank, be an administrator for a U.S. Senator, a broker in commercial real estate or the executive director of a to be formed hospital foundation came my way, it was a tough decision for me, but easy for her, stay here.

There was one thing that was clear to me. After having produced outstanding performing ensembles in a city that had the largest out migration of population of any city in the U.S. except East St. Louis, Missouri, I knew the taste of success. (The student population dropped from 13,000 to 3400 in ten years.) After having taken a bankrupt arts organization and moving it into one of the largest rural arts organizations east of the Mississippi, and finally, after creating 3500 jobs in only three years in tourism, failure was not going to be part of my future.

Create a new image, a new grandiose vision, recruit top notch people, and fund raise. If the dream is large enough the money does come.

As I traveled to Washington D.C. for my Senatorial interview, my wife contacted me to tell me that the local Hospital, rumored to be listed for sale in the Wall Street Journal, wanted to interview me before my D.C. interview.

It was always clear to me that a hospital was not a place that would make me happy. There was nothing about a hospital that appealed to me. They didn’t smell good. They didn’t feel good. They were not sensitive.

This would be an easy decision. Let me do anything except work in a hospital.

After spending the pre-interview night at the Washington Hilton, my phone rang, and it was a recruiter hired by the hospital who had been sent to Washington D.C. from Salem, Massachusetts. He had been sent to intercept me at breakfast prior to my interview with the Senator. His geographic center should have clearly indicated to me that there was Juju or at least witchcraft at work.

His advice was simple. Make the most outrageous demands, and you’ll be rejected for the hospital job. Little did I know that this was the way every physician negotiated with every hospital president and it just made me a more attractive candidate to the CEO. The demands included a second master’s degree from Carnegie Mellon, a certification from Harvard, a significant raise, and training to become the president of the hospital. My demands were met immediately, and the trap snapped closed on me.

Part I: Life Falling Apart.
Part II: Carpet Pieces
Part III: Please, anything but hospitals!

It was in December of 1979 that my wife saw an advertisement in the Washington Post for an executive director of an arts organization in Somerset County, Pennsylvania. Somerset County borders Johnstown, Pennsylvania and was most recently both the sight of the crash of heroic Flight 93 and the successful delivery of nine coal miners from the flooded Quecreek mine.

After carefully crafting my resume and filling it with references from local luminaries harvested through my teaching experiences, the call came to us for an interview. Upon arriving at the old building serving as the headquarters for this rural arts center, the search committee welcomed me into what had obviously been a bedroom.

Because my experience included no training or skills in arts management, it was easy for me to decide which of my interview skills to move to the forefront. It was my decision to make jokes with the committee.

When things began to look seriously like we were heading toward a second interview, it was obvious that we needed professional help. After some extensive exploration, a mentor and old friend floated back to the surface of my life. One of my college professors in both my graduate and undergraduate work was serving as the Director of the Arts for Pennsylvania. After one frantic and desparate call, he agreed to meet me in a Greek restaurant on the North Side of Pittsburgh. We ate gyros for three meals. We spent the better part of an entire Saturday discussing the answers to the questions that were sure to be posed by the committee at the second interview.

As they say on the streets, “we kicked ass and took names” at that interview. The other 137 candidates became fish food as the board elected me to head up a rural umbrella arts organization in Somerset County, Pennsylvania.

It was 1980. Jimmy Carter had just left office and Ronald Reagan decided to eliminate funding for the arts wherever possible. Welcome to round two of “Reality Bites.”

Upon reaching the office for the first day of work on February 2, 1980 in my Johnny Carson three piece, polyester, brown suit, it was obvious that things were not quite the same as had been portrayed to me by my search committee friends. The 66 year old semi-volunteer secretary informed me that it was my responsibility to fire up the wood burner. She also informed me, “All of our money was spent on advertisements for this job in the Wall Street Journal, Washington Post, and New York Times. We’re broke.”

It wasn’t clear how totally correct she was until Price Waterhouse completed the very first audit ever a month or so later and informed me that they had good new and bad news. The good news was that there was $2500 left in our accounts. The bad news was that the audit had cost $2600.

It was clear, however, that the right side of my brain, the creative side, would be my only salvation. Creativity was always my strong suit. When it was clear to me that payroll was going to be a problem, my first thought was transportation. In short, if you have a truck in Somerset County, you can find money.

The only problem at that time was that we hadn’t been in the job long enough to make plans. At 33 years of age, in a small town where you have just been named head of a nonprofit umbrella arts organization, saving face was important and collecting enough money to pay salaries became the first order of business.

We needed money, and one of my board members and later my board chairman was the President of a local bank. It did not seem feasible that anyone would just provide money to me, the new guy. He did have a repossessed truck in his parking lot that always burst into flames upon ignition.

This very generous man and his very generous bank donated that fire (making) truck to the art center. The Pennsylvania Department of Public Welfare provided us with two employees to man the vehicle.

The new director of art center (i.e. yours truly) instructed them to follow carpet trucks. That’s right, carpet trucks. Each time the truck stopped at someone’s home to deliver and install new carpeting, we asked to have the old carpet donated to the art center for a tax deduction. Then on Saturday night at the local auction barn, the carpet was sold, and we made payroll until our new plans to become the leading rural arts presenting organization in Pennsylvania took hold.

This practice only went on for a few months. During that time we had bricks and labor donated to replace the front steps. We found an artist who painted acrylic portraits of athletes, and in a rural, farming/mining community, that was art. We planned a German beer festival with cotton candy and some more art. We offered dog training classes. We built a room that was made from scraps from the Coleman Trailer Company that was just like a cloud. Nearly 2000 people visited that room over nine months. We discovered something called “goof” at the paint store, paint that was mixed incorrectly. For a dollar a can that became our new look in the galleries.

The real change came when one day a young ad man between jobs made an offer to help me tell the story. He made a slide show that was all about my dreams. We never indicated that any of it was true or that it was a dream. Within two years we had made presentations to over 163 groups and organizations and had grown into one of the largest rural arts organizations east of the Mississippi. Our membership grew from 300 to 3000, and we were working with every school district in the County. We had 125 arts classes running in six different locations, had 10 gallery shows, two festivals and a dozen concerts each year. Things were really starting to click into gear.

All of you know that Nick Jacobs' hospital is a Planetree facility - here are a few letters from patients who've experienced it. Does anyone else have a string quartet in residence at their hospital? wow...

as always, please send your patient letters/stories to tony[at]hospitalimpact[dot] org. if you missed last's weeks edition, click here. Why am I collecting your great patient stories? For the sake of better hospitals.

This String Quartet played for a dying patient's family in our Palliative Care unit. They (the string players) were in residence with us for an entire summer.

"Your playing is so beautiful, it made me cry. My Dad is in Heaven now, and he played the violin so sweetly, like you guys. I just wanted you to know that my Dad is playing with you and thanks so much for letting me hear your beautiful music that I've missed so much. I just wish I could sit and listen all day to you and DAD. Thanks, Kris

(here's proof that folks do look up quality statistics, or at least, they hear about it)

Dear Mr. Jacobs,

I am writing to you to tell you how grateful and happy both my husband and I are with Windber Medical Center. My husband is in the critical care unit now with an infection after open heart surgery at X* Hospital. It's three weeks post surgery and he refused to go back to that hospital because there is no comparison between the care there and here. There's also no comparison between their infection rate and yours. I know for a fact that there are so many people who would rather be here at Windber Hospital. The care is so great here and I know most of our health problems can be taken care of just fine here. So, each day I thank God and you and your people for everything that you do. This hospital is a very special place and we love it.

Thank you,

Nancy H.