As a hospital senior executive for a good part of my career, I lost track of the number of times I heard a colleague mutter, "You couldn't make this up." This phrase - often cast in the form of an expletive – was usually made around some hospital incident rooted in a serious human failing.
Whether patient, administrator, employee or physician, any hospital leader soon learns they can spend 80 percent of their time dealing with 20 percent of people without the right organizational values.
Don't get me wrong - I believe in the innate goodness of people. As a hospital CEO, I was in 2009, along with my executive team, named Top Leadership Team in Healthcare for Mid-Sized Hospitals by HealthLeaders Media. We accomplished this honor through servant leadership and building a new hospital culture from the bottom, up. This accomplishment was followed by a lack of success in two subsequent CEO positions that, while very humbling, affirmed my personal values.
Writing my novel Medical Necessity (available on Amazon) was a lot of work, but inspirational. I organized my story around five central ideas.
1 – Holding everyone accountable is the toughest part of leadership - In my career, I worked for leaders and I worked for bosses. What I noticed about leaders is that they were able to achieve really outstanding hospital organizational success (profits, safety, quality outcomes) by being transparent, authentic and even vulnerable. They understood that to have happy patients, they had to have happy employees. Holding hospital staff accountable for values and behaviors that they help craft is very inspiring to employees. However, the biggest challenge was getting the medical staff up to speed, even with a physician champion. For example, if a physician yells at the staff, it's the CEO's and physician champion's job to reel that doctor in and hold them accountable for that behavior. A lot of hospital bosses - as opposed to leaders - won't do this until something bad happens.
2 - Those who benefit from the way things are always fight change – I had a particular challenge at one hospital when I started and found some really egregious physician contracts in place. Some of these were just terrible contracts, but others were illegal under Stark and Safe Harbor laws. In the short time I was there, I was able to get the illegal contracts corrected. These contracts were not set-up illegally out of maliciousness, but rather out of a lack of knowledge about the law. The effected doctors were none too happy and pressured the Board (whom I kept informed of these issues) to end my own contract. I like doctors; good relations and mutual respect with medical staffs have characterized my career. But they are people like everyone else, feeling the downward pressures on their income. The Board genuinely feared that these doctors would leave the community no matter how much I assured them I would recruit replacements. It takes a commitment from the Board level down to make change in a hospital.
3 - It's easy to forget about patients - In my career as a COO and CEO, I made daily rounds in my hospital to visit staff, patients, visitors and the medical staff at least 75 percent of any given month (including weekends, night and holidays). Often I didn't feel as if I had time to do this. I had meetings, phone calls, emails and people who wanted face time in my office. But once I got out on the floors and in the departments, I always felt inspired. It reminded me why I was there – to take care of people. I also heard what I needed to hear up on the floors, rather than what people thought I wanted to hear in my office.
4 - Critical conversations don't get any easier over time - Most people don't like confrontation, including me. But I learned over time as a hospital administrator it was better to sit down and talk to someone – doctor, manager, employee, family member, or patient – before a little problem became a big problem. These conversations were always easier when the hospital had a well thought out, employee supported set of organization values and behaviors. Then it wasn't my opinion, but rather the shared vision to which the organization aspired.
5 - Cultural misunderstanding of hospitals is widespread – and it's often our own fault - One of the conversations that inspired me to write my novel was a talk that I had with an administrative assistant who was a temp when I started in the hospital. I pretty quickly realized that the two of us were not a good match. This temp was blunt and angry with people and that's not my style. We soon sat down (see #4 above) and I asked her why she wanted to work in a hospital. She actually gave me her notice and told me she was returning as executive assistant to a CEO of a Fortune 200 company. And she told me, paraphrasing here: "You know John, I used to think that hospitals were these great places of healing where everyone worked together for the greater good of the patient. I know now that's not true, that doctors and hospitals view patients as a commodity. It makes me wish I will never be a patient again." I also soon left that health system when I realized its organizational values promoted the exact culture she described.
It's often been said that you have to write about what you know. In my novel, I hope that I have told a story that everyone who cares about great healthcare wants to know.
John W Mitchell pursued his life long dream of being a writer after one too many disappointments as a hospital administrator. He lives and writes on the Western Slope of Colorado for a wide range of clients, from healthcare to craft beer. He has just self-published his novel 'Medical Necessity' under the pen name of J. Willis Mitchell. John still takes care of people by serving as a volunteer adaptive ski instructor. He is in awe of these clients with disabilities, who have the courage to plummet downhill at high speed despite their limitations. John can be reached at john@snowpackpr.com
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