PREHN'S LAWS OF HEALTHCARE ADMINISTRATION, Part Deux

Here’s an update to my previous post on the Laws of Healthcare Administration, sayings or quotations from friends, colleagues, and other sages about the perils of “Life in the Big Chair.” 

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.                CEO Caveat:  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.           CNO’s Conundrum:  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.           The Law of Crisis Management:  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:

a.    Hurry up, get to the point, I don’t have a lot of time

b.    Don’t sweat it, most of it turns out to be B.S. anyway

c.     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! 

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

b.    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:$]

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

25.           Granger’s Grail:  Understand reality.  Define perception.

26.           The Law of Distributional Dynamics:  When the sh*t hits the fan, it won’t be evenly distributed. 

27.           A Few Good Hospital Administrators:  “You can't handle the truth!  I have a greater responsibility than you can possibly fathom. You have the luxury of not knowing what I know…And my existence, while grotesque and incomprehensible to you, saves lives...You don't want the truth. Because deep down, in places you don't talk about at parties, you want me on that wall….”

28.           The Bear Bryant Theory of Succession:  You don’t want to be the coach who replaces Bear Bryant.  You want to be the coach who replaces the coach who replaces Bear Bryant.

29.           Captain James T Kirk’s Advice on Advice:  “One of the advantages of being the captain, Doctor, is being able to ask for advice without necessarily having to take it.”

30.           The Elenbaas Idiom:  Honor performance, growth and results. (Ron Elenbaas)

31.           “Like Throwing Moon Pies at Mardi Gras”:  Sometimes all your customer, physician, or staff want is a token of their “special-ness.”  It is not the size or value of the token that matters, it is the fact that they got it and someone else didn’t.

32.           Ashleigh Brilliant’s Axiom:  “I don’t have a solution, but I certainly admire the complexity of the problem.”

33.           Dale’s Dictum:  If you want to gather honey, don’t kick over the beehive.

34.           Carnegie’s Credo:  You can’t win an argument.

35.           General Patton’s Law of Battle Strategy:  Pick your battles so they’re small enough to win and big enough to matter.

Free Drinks 4-to-7 and Other Truisms

Back when I was in grad school at LSU, I financed my education by owning a bar & restaurant with some friends, fellow LSU Tigers.  You could also say that I learned at least as much running that bar as I did studying on campus.  Some of what I learned actually proved valuable when I started my career in hospital administration. 

For example, suppliers don’t extend credit to bars and restaurants because the business is notoriously (and correctly) thought to be risky and clubs close without warning all the time.  The federal government, in its wisdom, allows you to pay less than the minimum wage, figuring that the staff will make it up in tips.  Turnover is astronomical…we didn’t measure it in annual percentage turnover like we do in the hospital, we measured it in DAYS:  “Well, that new waitress lasted a week…that’s better than our last two hires!”

And, unlike (most) of our “customers” at the hospitals, most of our customers at the bar had been drinking.  So…

1.     “Difficult” Is Relative:  If you can run a cash-only business in a highly competitive and chaotic environment with staff who make make $2 an hour serving customers who are drunk, running a hospital is easy.

2.     Free Drinks 4-to-7 Rule:  The less a customer has to pay for a product, the less they value the product and the more likely they are to complain about the quality.  Happy Hour comments:  “Hey!  These drinks suck!  And such small glasses” , “Hey!  I said I wanted THREE cherries in my Scotch!”,  “Hey!  Why don’t we get free burgers to go with our free drinks, huh?”  Likewise, my experience has been that “free” services by the hospital generate the most complaints.  Patients will complain vigorously about the wait time for free cholesterol screenings, but I’ve never heard anyone complain about the wait time for open heart surgery.  So now I tend not to provide “free” health screenings, for example, but will change a modest fee of, say, $10 for a complete health screening.  Customers value the service more, are more satisfied, and tend to complain less. 

3.     If You’re Not Paying For It, You’re the Product Not the Customer:  A variation on the Free Drinks 4-to-7 Rule is the Pretty Girls Drink Free Rule.  When this rule is in play, the Pretty Girls believe they are getting free drinks because they are pretty.  Wrong.  They are getting free drinks because men want to be where pretty girls are and if you can stock your bar with Pretty Girls, lots of men with expense accounts and money to spend will populate your bar.  Therefore, complaints by Pretty Girls don’t get a lot of traction.  Similarly, the Free Cholesterol Screening for Old Fat Guys is not because we love Old Fat Guys, its because we’re looking for open heart surgery patients.  Recognize there is no free lunch.

 

4.     Align The Goals:  Our waitresses made $2 an hour + tips.  Our goal as bar owners was to maximize profits by selling as many drinks as possible and as many expensive drinks/bottles of wine/champagne as possible.  How do you align the waitresses’ goals with our goal of driving volume + price?  Simple.  We shared a percentage of our total sales with the wait staff.  We said:  “Each night, the waitresses will split 5% of what’s in the cash registers.”  A busy Friday or Saturday night would generate $10,000 to $12,000 in sales, waitresses’ share would be $500-$600.

Similarly, all of my key staff in the hospital are on bonus plans tied directly to the goals we’ve set for the hospital.  The more successful the hospital becomes, the staff shares in that success.

5.     Customer Service Counts:  We all remember our waitress Monique who night after night stood in the service hall behind the bar, smoking cigarettes and talking to her friends while her customers were ignored.  Alina, who had her own section to cover, would end up taking care of Monique’s customers too, because (1) she hated to see unhappy customers and (2) she understood that the more & better service she provided, the more tips she would make.  At the end of the night when the waitresses totaled their tips, Monique would ask – seriously – “Why do I only have $28 in tips and Alina has $530?  That’s NOT FAIR!” 

Customer Service in the hospital is my passion…what can each one of us do on a daily basis to make this a more positive experience for our “customers.”  I seek out staff that have that same attitude.  Recently, I took over a new hospital and reorganized the management team.  For one particular department, I promoted one of the relatively new staff members to the Director role because I had observed first-hand his attention to patients, his passion for customer service, his ability to align his goals with those of the hospital.  After I made the announcement, another staff member in that same department came to my office and told me my decision “was not FAIR!” because he had been an employee here for 19 years and “deserved” the promotion.  I told him….

6.     “Fare” Is What You Pay To Ride The Bus:  Bar Logic Darwinism:  Survival of the Customer Friendliest.  Monique lasted 3 shifts.  Alina was there when we eventually sold the bar.  The good survive…fast, friendly, customer focused…those that make the bar a great experience for the customers…those who bond with the customers in a way that keeps them coming back.  Exactly the same in the hospital business…without the tips.

7.     “Fun” is a Retention Strategy:  That bar closed 33 years ago.  When those of us who worked there remember that place, what we remember is not the grind, the long hours, the occasional bar fight…what we remember is the fun.  The bar tricks, the after-parties, the Saturday morning backgammon tournaments,  the Sunday afternoon cookouts.  That’s what kept us together during those tough nights at the bar and that’s what’s kept us friends across the decades. 

And it’s the same at the hospital.  Hospital work is tiring, stressful, hard work.  Its important to make time for fun.  Last Friday, we treated the entire staff to a barbeque lunch with all the fixins’ (and we made sure the night shift got fed, too) and, you know, the most fun was actually doing the cooking, cutting up in the kitchen, telling jokes.  Whether its “Wear Your Favorite Team Shirt” on Friday, volleyball on the green after work, or a impromptu celebration when we reach a new census record, FUN is the glue that holds us together.

Now, if I could just combine these experiences and maybe launch the world’s first hospital-based bar & lounge, I’d REALLY be on to something!

I Have A Reflexive Urge To Disagree With You

“I have an angry patient who wants to talk to ‘The Administrator,’” he says as he leans into my office, the smallest hint of a smirk on his face. 

“What’s he angry about?,” I’ll ask. 

“I don’t know, but he’s really, really angry, and he’s scaring the staff and he demands to talk to you,” is the reply.

Ugh.  Of all the fun stuff that hospital administrators get to do, talking to disgruntled patients, aka “customers”, is one of my least favorite.  My wife says its because I don’t like conflict…but I deal with conflicted situations all day long elsewhere in the hospital, so maybe that’s not it.  My dad says its because I want everyone to like me…but my mentor, CEO Bill Morrison, said if “everybody likes you, you’re not doing your job” and I believe that to be true.  Maybe I don’t like feeling like we’ve let the patient down, failed to meet our customers expectations. 

But at the same time, I’m always curious as to what the complain might be, and maybe just alittle incredulous that anyone would complain about our fine operation. 

 

So, off I go to find the patient.  I used to say “off I go to find the patient and resolve this issue” but over time I’ve discovered that sometimes people don’t want the issue resolved, matter of fact, sometimes I make it worse when I try.  What’s that Terri Clark country western song?  “I Just Wanna Be Mad for Awhile.”  My wife tells me the same thing, “Sometimes I just want you to listen and not try to solve my problem for me.”  So, I’ve learned to:

1. Be Quiet:  Introduce myself, say “I hear you have something you want to share with me.” And then be quiet. 

I then follow with four additional steps that I’ve found help effective deal with conflicted situations:

2. Listen:  Duh. “Listen”?  Thank you, Dr. Obvious!  But what I mean is “actively listen.”  Active listening includes:  Maintain eye contact.  Nod to show I’m listening.  Don’t interrupt.  When the patient pauses, as if to say “now YOU say something”, I’ll simply say “What else is going on?” or “Can you elaborate?” Most of all, I resist the temptation to interrupt, argue, or otherwise say “You’re WRONG!”

3. Evaluate:  While I’m listening, I’m evaluating what’s being said, how its being said, what’s motivating the conversation.  First, try to see the issue from the patient’s point of view…someone told me once “If its true for the patient, its true…their perception IS they’re reality.”  Second, evaluate the content.  My good friend and psychiatrist Dr John Parkinson told me that “every conversation takes place simultaneously on two levels:  The manifest content or what’s actually being said, and the latent content or what the patient is trying to communicate.  For example, the manifest content of  “I haven’t seen my nurse in over 8 hours!!!” doesn’t mean “and I’m worried about her”, it more likely means something like “And I’m scared for my safety.”  So I put myself in their shoes and figure out what’s being said and, more importantly, what it means.

4. Reflect:  In order to make sure I’m receiving what the patient is sending,  I use one of those standard psychologist techniques:  reflect the patient’s comment by repeating their comment back to them in the form of a question:  “So, you’re saying that it was so noisy last night that you couldn’t sleep?”  “So, you thought the tech was too rough moving you to your wheelchair this morning?”

5. Ask what their expectations are.  “How would you like me to resolve this?” or “What would you like me to do?”  or “What can I do for you today to improve your stay with us?” 

Interestingly, I’ve found that if I allow the patient (or staff member, for that matter) vent, show that I’m listening and interested, and reflect their concerns to show my understanding, more often than not when I ask what I can do, they say something like “I don’t need you to do anything, I just wanted to make sure you knew about it.”

What comes next is one of the lessons I learned from my father, who told me he learned it in the military:

“Tell people what you’re going to do.  Do it.  Then go back and tell them it’s been done.”

…and I’ll try to remember all this the next time someone knocks on my door and says “I have a very angry patient on 3-North who demands to talk to you…”!