The Rules

PREHN’S RULES OF HOSPITAL ADMINISTRATION:

1. Simpson’s Law of Simplicity:  Either this will work out OK or it will make for an interesting story.

2. Brock’s Bylaw:  Speed + Execution = Results

3. Morrison’s Mantra:  Anytime a major charge or shakeup happens at your hospital, your staff will have 3 questions:  (1) What about me?  (2) What about me? (3) Oh, by the way, what about me?

4. Mary Ann's Mantra: Never let them see you sweat.

5. Johnson’s Judgment: Every once in a while, you just gotta throw a dead body out in the hall.

6. Viator’s Verdict: You might as well take all the undeserved praise, because you’re gonna get all the undeserved blame.

7. Morrison’s Maxim: Hospital CEOs should change every 3 years because if you haven’t created enough enemies in 3 years to get yourself fired, you’re not pushing hard enough.

8. Prehn’s Proclamation: If it ain’t working, use a bigger hammer.

9. Prehn’s Prescript (previously known as Prehn’s Rule of Free Drinks at Happy Hour): The cheaper the product, the more consumers will complain about the quality.

10. DON's Definition:  CNOs who seek equality with CEOs lack ambition.

11. The Simpson Elucidation of the Chain of Ridicularity:  The longest distance between two points utilizing as many people and forms as possible in a corporate chain of command in order to review and analyze any requested decision or action without there ever having to be a substantive decision.

12. Prehn’s Precept:  When you don’t know what you’re doing, walk fast & act worried.

13. Shane’s Sayng:  Show up, act interested.

14. McCurdy’s Maxim:  I’ll panic when it happens.

15. Jim Injunction:  Volume cures all ills.

16. Colin Powell’s Quote:  You can’t make someone else’s choices. You shouldn’t let someone else make yours.

17. Andretti’s Axiom:  If everything is under control, you’re not going fast enough.

18. Weinstein’s Wisdom:  Sometimes its paranoia, sometimes its just sensitivity

19. Prehn's Perrill:  My job ate my life.

20. Aleen's Advice:  When your boss is manic, rise to the level of their mania to communicate an adequate sense of urgency.

21. Aleen's Advice:  (to nursing staff) You will NEVER get in trouble for being nice to a patient/family member.  Get them what they need to be comfortable.

22. Harrison’s Three Laws of the Universe:

• Hurry up, get to the point, I don’t have a lot of time
•  Don’t sweat it, most of it turns out to be B.S.    anyway 
• I don’t have to be the smartest guy in the world, I just have to be the smartest guy in the room

23. Lee's Law of Timing:  If you have to have an answer right now...it's no!
 

• Corollary - Lack of planning and/or preparation on your part does not constitute an emergency on mine.

25. Prehn’s Expediency Formula:  Results are simply a matter of time & money.  The more money you have, the less time you need.  And vice-versa.  R = f [T:$]

26. Reformation of Martin Mull’s Observation:  Being a hospital CEO is like having a bowing alley installed in your head.

The Wizard of Oz

After 30+ years of leading healthcare organizations, I've come to the conclusion that organizational behavior and leadership, particularly during times of crisis & turmoil, is best illustrated by the story of the Wizard of Oz.  I won't rehash the entire story--almost everyone has seen the movie at least once--but to recap, Dorothy gets swept away and finds herself in the strange land of OZ.  She asks the Glenda, the Good Witch, how to get back home and Glenda says that only the Great Oz can help her.  So Dorothy sets out to find the Great Oz and along the way faces many obstacles but, in the end, reaches her goal.

The story has what I believe are the four key components of leadership & crisis management in healthcare organizations:  (1) CRISIS...in this case, being lost in OZ, (2) JOURNEY...in this case, setting out on the Yellow Brick Road, (3) LEADER...in this case, the Great Oz, who all believe has the power to solve the crisis, and (4) TASKS...Dorothy and her friends are given a challenge by the Great Oz--bring back the broom of the Wicked Witch--and he will grant their wishes, i.e., solve their problems.

Now let's apply the metaphor to a hospital reeling from a bad accreditation review and subsequent threat of losing their accreditation.  The CRISIS is the bad survey and the fear that it could cripple or even shut down the hospital...the Quality Department feels particular heat that their jobs may be on the line, along with the clinical leadership.  So they begin the JOURNEY to resolve the crisis but they're fearful and not sure how to solve the crisis so they go to the LEADER who, most believe, has the knowledge and power to solve their problems.

But does he?  No!  Like the Great Oz himself, the LEADER is the man behind the curtain...not all powerful and all knowing, but simply in the titular position of appearing so by virtue of his office.  But does he appear weak and unknowing in the face of the crisis?  No again.  Like the Great Oz, he listens to the plight of the staff and then suggests/assigns a series of TASKS they must undertake before "he" can grant their wishes.

So the team sets /off to complete their assigned tasks and, once completed, return to the LEADER so he can grant their wishes/resolve the conflict.  But what do they find?  Like Dorothy and her friends returning to Oz, in completing the tasks they find THEY had the power all along. 

Perhaps most of us in leadership positions hope that no one ever pulls back the curtain to reveal that we are not the Great Oz, but simply the man behind the curtain, but in understanding the dynamics of crisis management in an organization also understand the journey by which is may be resolved.

NEXT:  THE RULES

The Strange World of Healthcare

Commentator Paul Harvey once illustrated how complicated and bizarre the world of healthcare is by using the metaphor of your local grocery store:  "What if your grocery store had to operate under a system similar to how hospitals operate?" 

Imagine:

1.  Before you go shopping, you would have to enlist the help of an "expert" to determine what groceries were needed.
2. Before going to the store, you'd have to contact your "managed grocery store provider" to request permission to go to the store.  They would check and see how many times you've been recently, whether the visit was reasonable & customary, and select a "preferred grocery store" in their "network"...even if that store was in the next town over.
3. Once at the store, the "advanced practice grocer" would review your shopping list.  She'd also have to access your personal "grocery record" to assess what groceries you'd bought in the past and determine what groceries were allowed by your plan.  Generics preferred.
4. Your grocery record, by the way, would contain a list of every grocery you ever bought, what it was used for, and whether there were any negative outcomes or led to additional shopping
5. You would then make your way to the "grocery payment clerk" who would total up your groceries.  The total cost of your groceries?  $250.  Your bill?  $1,250.  Why??  Because you have to make up the shortfall caused by the last two shoppers who were on government plans that don't pay the actual cost of their groceries so someone has to make up the difference and that would be YOU.  The industry calls that "grocery cost shifting."
6. By the way, your local grocer is thinking hard about giving up groceries altogether and getting into the bar business because the red tape is driving is costs higher every year just as his reimbursement keeps getting cut.

We are, indeed, in the strange world of healthcare.  What other business can you think of in which the consumer doesn't pay for the goods & services, a 3rd party (ie, insurers or government) does?  Or a business where the major decision makers in the organization--in this case doctors -- aren't employed by the organization or, for that matter, held accountable by the organization?  Or a business increasing focused on "customer satisfaction" in which the very services we provide often cause "customer dissatisfaction"...the post-surgical pain, the painful rehabilitation following knee-surgery, blood draws, vital signs taken in the middle of the night?

...and all of this done in an industry that is the most highly regulated in the world...more highly regulated than Wall Street, the space program, or the banking industry. 

Is it little wonder that we have trouble sleeping at night?

NEXT:  THE WIZARD OF OZ