Being "Out There"

Here’s why this message differs from the others I’ve written each Saturday morning since 2002.¹ I’ve switched from posting it on the CGH Web site to a posting it as an entry on a blog.

In one sense, blogs are no different from other kinds of Web sites – the messages are “out there” on the Internet, available to anyone at anytime. But a blog is little more “out there” than a more static Web site because readers can subscribe to a blog. Once subscribed, readers are notified automatically of any new entries on the blog via email or RSS feed. If you like, you can easily subscribe using the form in the sidebar of this blog.

Blogs are also more “out there” because there’s a blogging community that reports on blogs, comments on new entries, categorizes and rates blogs, and consolidates comments about blogs. In other words, there’s an active dialogue in the “blogosphere,” i.e., the "world of blogs."

I am not the first hospital CEO to write a blog. Credit for that probably has to go to Paul Levy, the President & CEO of Beth Israel Deaconess Medical Center in Boston. I commented upon Mr. Levy’s blog in an earlier posting. His commentary is remarkable both the subject matter he chooses and in the quality of his discussion. It is also noteworthy for its sheer quantity. In his first seven months as a blogger, Mr. Levy generated entries containing words equivalent to two years on my humble writings.

After I wrote about Mr. Levy, David Rothman, Information Services Specialist for the CGH Medical Library, asked if I'd like to convert my weekly “CGH Family Letter” to a blog. He offered to help and actually set up the template I am using, including the “More than Medicine” name, which is derived from CGH’s tagline.

For the past several weeks David helped me navigate the blog format in a “private beta” where only he and I had access to it (thank you, David). That has given me time to learn how the blog might look and feel – and to continue my education about blogging. A week or so ago, I suggested it was time to publish the blog for everyone to see, and David announced it on his own popular blog.²

Within days of More than Medicine blog going live, Paul Levy had added a link to More Than Medicine on his blogroll and I have since reciprocated. David has already called my attention to the first comment on More Than Medicine from John Sharp, an Information Technology manager who works at “a major medical center in Northeast Ohio.” Said Mr. Sharpe:

"Some of …[Quinn’s] posts are rather long but thoughtful and keep true to the More than medicine theme….Will be interesting to see how many more hospital CEOs hop on this bandwagon."

OK, so now I am “out there,” but it really doesn’t change my purpose – to comment upon the events and issues facing CGH (and health care generally), either as they occur to me or in response to comments or suggestions from others.

Please let me know what you think – and what you think I should be writing about.

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[1] I started writing a weekly letter to CGH employees and other members of the hospital family on October 20, 2002 – three weeks after I became President & CEO of Community General Hospital.

[2] David’s blog was recently rated one of the top ten health care-related blogs by the Healthcare 100 index.

The Pierian spring

I had a teacher in high school who used to chide us if we got too full of ourselves. “A little learning is a dangerous thing,” he would say. “Drink deep, or taste not the Pierian spring: There shallow draughts intoxicate the brain, And drinking largely sobers us again.” The teacher was quoting Alexander Pope, an English poet of the 18th Century.[1]

According to Greek mythology, the water of the Pierian Spring, located in ancient Macedonia, was a source of knowledge and inspiration. Pope’s poem says that superficial knowledge (“shallow drafts” from the spring of knowledge) only confuse and intoxicate. But acquiring greater knowledge (“drinking largely”) is sobering. In fact, the poet goes on to say that, when you become more knowledgeable, you gain greater perspective and better critical judgment.[2]

This week I was pleased to salute 15 CGH employees who have been “drinking largely” from the spring of knowledge. CGH’s annual Rose Awards ceremony honored 15 students who achieved new levels of educational achievement within the past year: one high school Regents Diploma, three Associate Degrees, six Bachelor Degrees, and five Certificates.

Employees who continue their learning improve their careers and benefit CGH, as well. Ultimately, their skills and abilities benefit the patients we serve.

Continuing one’s education while working in not easy. It requires self-discipline, a lot of midnight oil, and the support and understanding of one’s family. The loved ones of working students deserve praise and congratulations, as well.

Please acknowledge these members of the CGH family for their educational milestones. Each honoree received a Rose Award this week.

• Scelena Bressette, Respiratory Care, Bachelor of Arts (Biology), Lemoyne College


• Dedra Brown, Physical Medicine & Rehabilitation, Bachelor of Science (Nursing), Keuka College


• Julius Brown, 3 West, Associate Degree of Applied Science (Nursing), Onondaga Community College


• Melisa Delaney, ED, Certification in Emergency Nursing


• Patricia Francescotti, 3 West, Associate Degree of Applied Science (Nursing), Onondaga Community College


• Leah Neider, ED, Certification in Emergency Nursing


• Andrea Neulander, 2 West, Bachelor of Science (Nursing), Nazareth College


• Martha Savage, Nursery, Bachelor of Science (Nursing), Keuka College


• Kolanda Scott, Information Services, Bachelor of Professional Studies in Applied Computer Technology, Syracuse University


• Jennifer Shaffer, Medical Imaging, Bachelor of Science (Nursing), Lemoyne College


• Shanise Singletary, Food Service, Regents Diploma, Corcoran High School


• Nancy Thompson, Financial Services, Master Certificate in Health Administration, Syracuse University


• Susan Tiby, Nuclear Medicine, Certification in Nuclear Cardiology


• Dea Wilson, 3 West, Associate Degree of Applied Science (Nursing), Onondaga Community College


• Kurtis Wilson, Nuclear Medicine, Certification in Nuclear Cardiology

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[1] Alexander Pope (1688 - 1744) is regarded as one of the greatest English poets.
[2] Pope, Alexander. “A little Learning.” You may read this 18-line poem at the following web address: http://www.poetsgraves.co.uk/Classic%20Poems/Pope/a_little_learning.htm

What makes a good doctor?

About 25 years ago, when Dr. Lou Wasserman was a young member of the Medical Staff, I was a young manager at CGH. Sometimes I would sit at the cafeteria table with Dr. Jack Prior, who was then the Chair of Pathology. Doctors would join Dr. Prior’s noontime table for clever conversation and talk of difficult cases. When the young Dr. Wasserman sat at the table one day, Dr. Prior asked him, “What did you make of such-and-such a case?” Dr. Wasserman was effusive with facts, observations, and conclusions. For a few minutes the two of them were in a world of their own, discussing the case.

On another occasion, I was in a meeting with Dr. Martin Black, who was at the time CGH’s Vice President of Medical Affairs. Dr. Black was a cardiologist, like Dr. Wasserman. Dr. Wasserman knocked on the door and interrupted our meeting with a quick question. Had Dr. Black, he wanted to know, had a chance to review the EKG tracing that he, Dr. Wasserman, left for him? “I’ll get back to you later today,” Dr. Black said and, after Dr. Wasserman left the room, he winked at me.

Dr. Black lifted from his desk the EKG that Dr. Wasserman had mentioned. It was clipped to a reprint of a medical journal article. “Dr. Wasserman doesn’t know it,” Dr. Black said with mischief in his eye, “but I wrote a paper on this exact EKG abnormality years ago.” Dr. Wasserman had left the EKG strip to challenge Dr. Black, the senior doctor, in identifying an interesting problem. Dr. Black was gleefully planning to one-up Dr. Wasserman by giving him the medical paper he had written on the subject.

As a lay person, I was impressed by the conversations Dr. Wasserman held with Dr. Black and with Dr. Prior. His interest in medicine was earnest, and it was obvious that the more senior members of the Medical Staff appreciated his enthusiasm.

Today Dr. Wasserman is President of the Medical Staff, and he recently addressed the Quality Committee of the Board of Directors. “What makes a good doctor?” he asked rhetorically, then he answered the question by reading from a short piece he had written. Dr. Wasserman listed 22 attributes of “a good doctor.”[1]

“A good physician talks to the patient and not at the patient,” he said, and, “A good physician searches at all times for new clues to confirm or refute an initial clinical diagnosis.” Dr. Wasserman continued, “A good physician performs specific tests to achieve specific goals (avoiding a shotgun approach…).”

“A good physician is an educator,” he said. “No one can know it all in medicine,” Dr. Wasserman observed. “A good doctor learns by study, and also by observing and learning from his or her peers.”

Dr. Wasserman’s short essay put into words the intellectual eagerness and honesty I had observed decades earlier. It is a thoughtful thing to do, to reflect on your own profession and to list the things that make you and others better at your daily work.

I asked Dr. Wasserman to share his “good doctor” list with the members of the Medical Executive Committee, and he did so at its next meeting. After that meeting, Dr. David Halleran told me that Dr. Wasserman’s thoughts reminded him of a new book by Dr. Jerome Groopman, How Doctors Think. He said the book discusses “how to avoid certain mental errors a doctor can make.”

Dr. Groopman is a Harvard University professor and researcher.[2] It is essential, Dr. Groopman writes, “for even the most astute doctor to doubt his thinking, to repeatedly factor into the analysis the possibility that he is wrong.”[3]

In his work Dr. Groopman recounts clinical cases where it took a long time, and sometimes required several different physicians, to make a correct diagnosis. He writes about thinking errors that doctors – or indeed, anyone – can make. It is only by being aware of the possibility of such errors that one can take steps to prevent them or discover and correct them if they have occurred.

Doctors are always reading, learning, attending lectures and classes. They practice new skills, and they help each other learn skills by proctoring one another. But the thing that strikes me about Dr. Wasserman’s thoughts and about Dr. Groopman’s book is their self-awareness. Knowledge is not always about things outside oneself. There is also knowledge of how one thinks and works. This self-knowledge can help one do a better job. It can help avoid falling into inadvertent error.

Years ago when he challenged Dr. Black to identify the abnormal EKG strip, Dr. Wasserman was keeping his thinking skills at a high level. A few weeks ago, when he sat with a yellow pad and reflected upon what it means to be a good doctor, he was keeping his practice skills at a high level.

“These are just some of my thoughts regarding the qualities of a good physician,” Dr. Wasserman told the Medical Executive Committee at the end of his brief essay. “If everyone applies these principles, Community General Hospital, and all out practices and patients will benefit.”


[1] Dr. Wasserman wrote to me: “I actually wrote this ‘What makes a Good Doctor’ document after Dr. [Thomas] LaClair [Chair of Family Medicine] and myself had a discussion regarding what he and I could communicate to the FP (Family Practice) residents regarding the qualities of a good physician.”
[2] Dr. Groopman holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is chief of experimental medicine at Beth Israel Deaconess Medical Center, Boston.
[3]] Groopman, p. 9

I covered a lot of ground at yesterday’s employee meetings

At my ‘Round the Clock meetings for employees yesterday and this morning, I talked about Dr. Frederick Goldberg, who will join CGH this month as Chief Medical Officer.¹ You can say hello to Dr. Goldberg at a welcome reception in the Personnel Lounge from 7:30 to 9:00 a.m. on Friday, June 22. His first day on-the-job will be the following Monday, June 25.

I told of Dr. Goldberg’s background: he was a Phi Beta Kappa² graduate of Franklin and Marshall College, where he won numerous prizes. He received his medical degree from the University of Pennsylvania, and he completed his internship and residency in pediatrics at Upstate Medical Center.³ He also holds a MS degree in health care management from Harvard University’s School of Public Health. Dr. Goldberg joins us after a five-year stint as Senior Vice President/ Chief Medical Director at Faxton-St. Luke’s Healthcare in Utica. I look forward to working with Dr. Goldberg, and I salute and thank Dr. Andrew Merritt, who has done such a good job as interim Chief Medical Officer, a position he promptly and graciously accepted last October.

I covered a lot of ground in yesterday’s employee meetings: (1) our financial performance so far this year; (2) how we fared in this year’s state budget process (with a caution about the cuts in Medicare payments proposed by the federal government for October); (3) an update on the status of the Berger Commission as it affects CGH and Van Duyn Home & Hospital; and (4) a discussion of the payments to our pension fund.

With respect to financial performance, I am glad to report that CGH met its overall budget through the first four months of 2007. That’s a big change from the same time last year. Through April 2007, CGH has a bottom line (what’s left after expenses) of $498,000 on total revenue of $40.5 million – this compares with a loss of about $1.3 million on total revenue of $36.2 million through the same period in 2006. So we are doing better than last year.
As it was initially proposed, the New York State budget would have cost CGH $938,000 annually. Many employees signed letters, Board members contacted elected officials, and members of the CGH family participated in the health care rally last March in Albany. As the budget was passed on April 2, about $495,000 was restored to CGH, but that still means the state budget will cost CGH $443,000 a year – a significant amount we have no choice but to absorb. I acknowledged State Senator John DeFrancisco who secured in the state budget a $200,000 grant for CGH patient care equipment. This is the second time Senator DeFrancisco obtained state funds for CGH –previously he secured $500,000 for the cardiac cath lab. Thank you, Senator!

I am not able to say exactly how CGH will comply with the decisions of the Berger Commission that became law on January 1. The Commission requires CGH to assume control of Van Duyn, to combine its skilled nursing beds with Van Duyn, and to downsize the combined total by about 75 beds. We continue in discussions about how to do this with the county and with the state. Recent developments: the county sued the state to stop implementation of the Berger decisions, and two area legislators introduced bills that would reverse the Berger Commission as it applies to Van Duyn and CGH. Meanwhile, we support the goals of the Berger Commission, we continue working on how to comply, and we are applying for state funds that have become available to assist compliance by facilities that are affected by Berger Commission decisions.⁴

Finally, I told employees about the multi-million payments CGH is making to the pension fund this year and next. I showed employees the accompanying graph, comparing CGH’s current payments to the pension fund with payments dating back to 1987. This picture clearly shows just how much cash CGH is using this year to keep the pension fund properly funded. Over $ 9 million.

The good news is that CGH has the cash to make the required payments to its pension fund.⁵ The bad news: spending so much cash on the pension plan means that buying capital equipment is difficult right now. We have to make priority decisions every day about the equipment or renovations that are the most important for spending the limited dollars we have available. CGH’s capital spending this year is the lowest it has been since I became president (September, 2002).

Why the big pension spending? Because CGH wages have grown significantly in the last five years. Since pension payments are based on employees’ wages, the cost of the pension fund has increased. Pension fund assets grow in two ways – by the appreciation of the invested funds and by employer payments. Because of higher wages, the pension plan assets need to be increased. Because the stock market’s performance in recent years has been lackluster, the pension fund has not appreciated as much as we would have hoped. That means higher CGH payments are required. This is not expected to continue indefinitely. As you can see in the graph, annual pension payments are forecast to come down to about $2 million-plus in two years.

At the meetings, I talked with employees about CGH’s future plans, about patient safety, and about patient satisfaction – important subjects, all. I’ll say more about them in future family letters.

CGH was very busy yesterday, and many employees could not take the time to attend my meetings. My thanks to all those who did stop in, and my thanks to all who did not attend because you were busy with our most important work – patient care.

Sincerely,

Tom Quinn, CEO

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¹ Dr. Goldberg’s official CGH title is Vice President - Medical Affairs and Chief Medical Officer (CMO). Dr. Martin Black, a past CGH Vice President – Medical Affairs, is also a Phi Beta Kappa member.

² Founded in 1776, the Phi Beta Kappa Society recognizes academic excellence in undergraduate liberal arts and sciences. Only about one percent of the nation’s college graduates are invited to become Phi Beta Kappa members.

³ Upstate Medical State is now called SUNY Upstate Medical University.

⁴ The New York State Commission on Health Care Facilities in the 21st Century, chaired by Steven Berger, recommended the closing of 16 hospitals and nursing homes across the state and the restructuring of 62 hospitals and nursing homes. Its recommendations automatically became law when they were not rejected by the State Legislature last year. In Syracuse the Commission recommended the combination of CGH and Van Duyn under CGH control. The Commission also decided that Crouse Hospital and SUNY’s University Hospital should merge as a private hospital that is not a part of the SUNY system.

⁵ Proper funding of its pension plan is critical to a hospital’s long term success. The principal reason Auburn Memorial Hospital filed for bankruptcy last April was the amount of money it owes for pensions. According to the Post-Standard (April 25, 2007), Auburn Hospital’s “debt consists of more than $13 million owed to the federal Pension Benefit Guaranty Corp.”