When Your Plow Is A Pencil

President Eisenhower once said, "Its easy to be a farmer when the farm is 900 miles away and your plow is a pencil", referring to the ineffectiveness of the federal government to direct farming activities from Washington DC.  My experience in healthcare has been similar.

Large, national, for-profit healthcare companies have made many positive contributions to healthcare in America by leveraging their size and capital to build hundreds of hospitals, expand hospitals into rural and underserved areas, and use competition among providers to drive efficiencies, outcomes, and patient satisfaction.  But in growing too large, a company can easily risk losing touch with each individual hospital and its unique, community-based challenges.  Former Speaker of the House Tip O'Neill used to say "all politics are local" and the same is true of healthcare management.

One of the hospital companies I worked for in the past was bought out by a larger, more national competitor...so far, so good.  However, I should have sensed the impending doom when someone called from our "new" corporate headquarters located halfway across the country to discuss information technology needs and started the conversation by asking where we were located.  I named the city and he asked "what state is that in?" and when I answered, then asked me to give him a rough idea as to what major cities were nearby.  Now this wasn't a recruiter or a consultant cold-calling for business, this was a member of "senior leadership" who could not find one of his "own" hospitals on a map...and hadn't even bothered to google us or our location.

So, okay, its a big country and this was a big company so maybe my expectations were set alittle high, but this lack of knowledge about local conditions was compounded by a corporate culture of control and centralization, i.e., "Don't make any decisions unless we give you the green light" which meant I had no authority to adjust to changing local conditions and no one at corporate had the insight into local conditions that we had...being local, after all.

It reminded me of a job I had when I was in grad school.  I was a DJ in a 50's-themed bar/restaurant in Baton Rouge that was owned by a national company based in Dallas.  Now I had been a DJ for years and had just left one of most successful clubs in the city, so I pretty much knew my way around a turntable and knew how to keep the dance floor packed.  But this company was smarter than us hicks in Louisiana and had a "national director of entertainment", based in Dallas, whose job included faxing a playlist to each DJ in the field, each day, listing which songs to play in which order...."4:01 pm:  Round Around the Clock; 4:04 pm:  Earth Angel" and so forth. 

The problem is its easy to be the DJ when your club is 900 miles away and your turntable is a fax machine.  I was forced to play the wrong song at the wrong time, time and time again, and watch the crowd drift away.  I had been warned that varying from the playlist meant instant "de-hiring" but, one day, I had finally had enough, dedicated "With This Ring" to a couple celebrating their 40th wedding anniversary and watched the dance floor fill.  My manager raced to the booth and told me if I did that again, it was my job.  I told him:  "Jack, see that record right there?  Its going to run out in about 2 and a half minutes.  Think fast", took off my headset, and walked out of that club with The Platters singing "with this ring I promise to always love you..." as I hit the parking lot.  Never even went back to pick up my last paycheck.  Moral of the story?  That company went out of business in less than 18 months.

The challenge with healthcare management is the same, I think.  In order to benefit from the opportunities a national presence affords a company, the company has to hire good local hospital operators and then learn to get out of their way.  All healthcare is local, so the management must be, too.

The Ripple Effect

In a world of six billion people, it’s easy to believe that the only way to initiate profound transformation is to take extreme action, to make some big splash. Its the same in hospitals:  The attention goes to the high profile, high impact events...a ground-breaking surgery, the construction of a new wing, the recruitment of a large physician practice, the opening of a new Center of Excellence.

Each of us, however, carries within us the capacity to change the world in small ways for better or worse. Everything we do and think affects the people in our lives, and their reactions in turn affect others. As the effect of a seemingly insignificant word passes from person to person, its impact grows and can become a source of great joy, inspiration, anxiety, or pain. Your thoughts and actions are like stones dropped into still waters, causing ripples to spread and expand as they move outward. The impact you have on the world is greater than you could ever imagine, and the choices you make can have far-reaching consequences. You can use the ripple effect to make a positive difference and spread waves of kindness that will wash over the world.

The recipient of a good deed will likely feel compelled to do a good deed for someone else. Likewise, someone feeling negativity will be more likely to pass on that negativity. One act of charity, one thoughtful deed, or even one positive thought can pass from individual to individual, snowballing until it becomes a group movement or the ray of hope that saves someone’s life. Every transformation, just like every ripple, has a point of origin. You must believe in your ability to be that point of origin if you want to use the ripples you create to spread goodness. Consider the effect of your thoughts and actions, and try to act graciously as much as possible.

A smile directed at a stranger, a compliment given to a friend, an attitude of laughter, or a thoughtful gesture can send ripples that spread among your patients, your loved ones and your friends, out into your community, and finally throughout the world. You have the power to touch the lives of everyone you come into contact with and everyone those people come into contact with. The momentum of your influence will grow as your ripples moves onward and outward. One of those ripples could become a tidal wave of positivity.

Jobs Are Like Girlfriends...

I just left a CEO position with one of the larger for-profit hospital companies in the country.  I was only with them for 3 years and I think I can say with confidence that both of us are happy I'm gone.  A headhunter asked me yesterday, "What did you like about working for Company X?"  My immediate reaction was to say something snappy like "Not much" but as I responded I found there was alot I like about my experience:  The people I worked with, the location of the hospital, what I learned in 3 years, the connections I made, the people we helped.  

Another interesting thing about the experience:  The hospital changed hands 3 times in the 2.5 years I was there.  I was heavily recruited by original owner Company V...they were supportive but gave me the authority to make changes, they trusted my experience & instinct, and we achieved excellent results.  For a few months there I was a regular healthcare rock star.

About a year after joining, Company V bought Company W, the original V leadership group that had recruited me left and I now reported to W leadership.  Totally different style, agenda, and strategy...I un-learned the "V" way and learned the "W" way.  And almost 9 months later, the entire company was bought by Company X...and another 180-degree change in focus. And 90 days later, X and I parted company.

What's the positive?  Well, in the course of 2.5 years, I worked for 3 of the biggest names in the business.  I went to school on 3 completely different yet equally successful business models.  I learned new technical systems like patient accounting and marketing systems.  And I met alot of great people.  I'm a better CEO for the experience.

It occurs to me that jobs are alot like girlfriends:  You learn something from every one of them, even the ones that turn out bad.  Margaret Ann taught me about Led Zepplin...before dumping me for her ex.  Harriet showed me the backstage at Disney where she worked...before she started dating the guitar player from the Disney band.  Alina taught me the magic of LSU football...and I married her.

Charter Medical taught me volume cures all ills.  OhioHealth taught me that innovation creates opportunity.  Baton Rouge General taught me an organization should stick with their core mission and when you forget that, trouble awaits.  River Parishes taught me to not let your medical staff get too far ahead of you.  Triumph Healthcare taught me Speed + Execution = Results.

So as I start a new position on Monday, I won't burn my bridges behind me, forgetting everything except the memory of the smell of smoke and the impression that once my eyes watered.  Instead I'll remember what I learned from each of my former employers and use it to foster success in my new "relationship..."