Sunday, September 28, 2008

Remembering Mrs. Brown

Ula Brown Maclachlan, who passed away Thursday, was the widow of John L. Brown, the founding President & CEO of Community General Hospital. Mr. Brown was hired in 1958 to design and build the new Community Hospital on Onondaga Hill in Syracuse, NY. He retired in 1982 and died in 1986.

Perhaps 15 years ago, Jerry L. Harris, Mr. Brown’s successor as CEO, gave me a file of personal papers that belonged to Mr. Brown – correspondence, personal notes, the agenda of his interviews for the CEO position, etc. Jerry found the papers in his files, and he asked me to review the documents, saving anything of importance to Community General. I made copies of several documents I thought were relevant for the hospital, but most of the papers were personal in nature. I packed them up and sent them to Mrs. Brown.

A while later, Mrs. Brown sent me the kindest note. To today’s sensibilities her note would seem somewhat dated, quaint, perhaps even politically incorrect. But I was touched by her thoughts.

Paraphrasing (from memory), this is what she said. Mrs. Brown thanked me for sending the documents, saying that she read them with interest and that many fond memories were recalled. She said the documents were especially interesting to their children, Bill and Christine. Mrs. Brown commented to the effect that “when a man is at his most productive, his children are too young, too unaware, or too uninterested to understand the significance of his accomplishments.” She said that Mr. Brown's personal papers provided an opportunity for their children to better understand what Mr. Brown had accomplished and what he meant to the community.

Today, I recall Mrs. Brown, her work at Community General as a founding member of the Auxiliary and as a Volunteer, her life in the community, and the love and support she gave to family and friends.

Saturday, September 20, 2008

More discussion on SEIU

Paul Levy referenced my recent post about the SEIU corporate campaign in his blog, Running a Hospital. Paul is the CEO of Beth Israel Deaconess Medical Center.

Paul's posting elicited some lively follow-up comments, including one that seemed to compare picketing my house to put pressure on contract negotiations at a nursing home with the civil rights protests of the 1960's! Another comment on Paul's blog said, "The hubris is takes to compare any modern day civil rights staggering." After reading the comments on Paul's blog, I added my own:

Captains-of-industry imagery and class-stereotypes are powerful tools for motivating and for bullying, and the SEIU is masterful at using these tools. Employing the signs and symbols of civil protest, however, does not automatically confer legitimacy on one’s point-of-view or actions.

The SEIU is an organization, like any other. It has no special status as somehow “more moral” or “more politically legitimate.” Because it alleges something does not make it true.

In the days since the SEIU picketed at my home, numerous SEIU members have told me they disapproved of the activity. Some have apologized. They have usually done so after briefly looking over a shoulder so as not to be overhead.

One local labor leader called me last weekend to express personal support and to take issue with the SEIU’s tactics. Significantly, this leader said he was not comfortable expressing such an opinion publicly.

To read Paul's post and the comments it prompted, go to Corporate Campaign in Upstate New York. See also the comments on my initial post, as well.

Wednesday, September 17, 2008

Wrong-side surgery

Today’s newspaper carries a story about a wrong-side surgery at St. Joseph’s Hospital Health Center. My thoughts go first to the patient – and then to the caregivers at St. Joe’s.

The story recalls a wrong-side surgery that took place at CGH in 2004, about which I wrote last year. I learned about our medical error the morning it happened, and we conducted a root cause analysis that same day. I promptly apologized to the patient for our medical error, and I apologized to the surgeon because our safety processes did not prevent the error.

Hospitals are complex places where modern medicine allows us to do much good for patients, but modern medicine is accompanied by risk. All hospitals rely upon internal processes to reduce the risk of error, but we didn’t follow our process – we failed our patient and we failed each other – one day in 2004.

Following the root cause analysis, we took many other actions to improve our safety processes. We reached out to another hospital administrator who had experienced a wrong-side surgery; she helped us learn from that experience. We invited the Joint Commission to conduct an on-site review, we visited a local company to learn about industrial safety processes, we hired an operating room consultant to help us improve, and we made changes in our Universal Protocol. We re-trained all staff, and each member of the Medical Staff committed to following the Universal Protocol.

Because health care involves human beings, mistakes, regrettably, are possible – not just in the Operating Room, but anywhere. That’s why standardized processes help fallible individuals safeguard patients .

Today's news story reminds us that the lessons from our own wrong-side surgery must remain fresh for all of us.

This posting appeared in a different form on December 16, 2007.

Friday, September 12, 2008

SEIU's corporate campaign

Yesterday members of SEIU 1199 picketed my home. Interestingly, the picketing was not intended to influence me at Community General Hospital, where I am CEO. Instead, SEIU seeks to use me to pressure one of Community’s employees who serves on the Board of Iroquois Nursing Home. I have declined to apply the pressure.

Earlier this year SEIU conducted an organizing campaign at Iroquois. Having won its election on March 7, 2008, SEIU is negotiating its first contract – a process that is not apparently proceeding to its liking, judging by the calls and personal visits I have received from Al Davidoff, SEIU Vice President.

SEIU has made Iroquois the object of a “corporate campaign” intended to pressure, to intimidate, and to publicly embarrass the organization. As a tactic, corporate campaigns have been used by SEIU with organizations across the country, including such notables as Beth Israel Deaconess Medical Center, Sutter Health Care, and even the California Nurses Association. Anyone interested in learning more about this tactic need only search the Internet for “SEIU corporate campaign” and read the links that appear.

Corporate campaigns employ the methods of community organizing, political action, and public relations, such as letter writing, telephone calls, picketing, and publicity. SEIU corporate campaigns target elected officials, as well as candidates for office, and they involve outside organizations in an effort to bring additional pressure on the Board and management of a target organization – in this case, Iroquois Nursing Home.

Along with St. Joseph’s Hospital Health Center and Crouse Hospital, Community General Hospital shares the responsibility to appoint Board members to Iroquois. We three hospitals established Iroquois to meet a community need some 15 years ago, under the auspices of Plaza Corporation, Inc. Plaza is the sole member of Iroquois Nursing Home and Rosewood Heights Nursing Home. Plaza's two nursing homes are independent, not-for-profit corporations, separately licensed by New York State, each with its own Board of Directors.

As the three members of Plaza, Crouse, St. Joseph’s, and Community have the responsibility to appoint qualified community representatives to the boards of both Iroquois and Rosewood. Community’s appointees to Iroquois have served as Directors there from four to 15 years each.

Board members have the legal responsibility for nursing home governance. They are fiduciaries – that means, the Directors have legal responsibilities to the residents of the nursing home and to the communities served by the nursing homes.

About a year ago, the Iroquois Board elected one of the Community-appointed Directors as it chairperson. SEIU thinks that makes Community responsible for decisions made by the Iroquois Board. Mr. Davidoff has asked me to intervene with the Community employee serving as Board chairperson. The intention is to bring pressure from Community General Hospital's management upon a hospital employee who has fiduciary responsibilities at Iroquois.

I have explained to Mr. Davidoff – as I did to his predecessor, Marshal Blake – that Community sees Board membership at Iroquois as a community service, not as a puppet of Community’s administration.

Mr. Davidoff has informed me that SEIU would seek to generate unfavorable publicity for Community General Hospital, unless I make an effort to interfere with the Board of an independent, not-for-profit facility. That apparently is the price one pays for doing the right thing in the face of an SEIU corporate campaign.

Thursday, September 11, 2008

Saturday, September 6, 2008

A hospital's characters and its stagecraft

It is commonplace to see the drama of the medical profession portrayed in the popular media. But Hospital, a new book by Julie Salamon, is remarkable for the way it captures the life of a hospital in all its confusing, infuriating and inspiring complexity.

For one year Ms. Salamon had virtually unlimited access to Maimonides Medical Center in Brooklyn, NY – its people and its facilities, day and night. Pam Brier, the President and CEO of Maimonides, knew Ms. Salamon was an experienced writer, the author of other books, whose journalism credits include the New York Times and Wall Street Journal. Nonetheless, it took courage for Pam to give a reporter carte blanche at her hospital.

Pam Brier ends up as one of the characters in Hospital. We see Pam on stage, and we sense her presence even off stage. She addresses the men in a mosque to discuss Maimonides’ cancer center. We see Pam in day and night staff meetings as she demands spending cuts. One night she rounds in the emergency department. We overhear her fretting about patient volume. One manager sulks, thinking he’s been ignored by Pam. A doctor thinks she plays favorites.

I serve with Pam Brier on the Board of the New York eHealth Collaborative, but I do not know her well. I was fascinated to see her, through Julie Salamon’s eyes: someone with personal courage, a bit eccentric, plenty of worries, fully engaged in the life of her hospital and its difficult relationships.

But Hospital is not just Pam Brier's story. There are 69 other characters in the book – doctors, nurses, residents, patients, social and community workers, environmental aides, executives. We see them as the author does, as complicated, interesting, flawed, and worthy individuals.

Hospitals are political environments, as are all places where human beings work together and compete for resources, satisfaction, and respect. “Political intrigue and turf wars,” writes Julie Salamon, “were not unique to Maimonides; struggles for space, equipment, staff, and money were part of the hospital life.”

Beyond the politics and the professional jealousies, the book tells something about a hospital's stagecraft. We see the importance of medical record coding, length of stay management, case mix, and health insurance contracts. There are neighborhood politics. There are donor politics. These are unseen forces that shape a hospital world, and they help give this book its fascinating reality.

Despite financial pressures, despite individuals who give or take offense, despite various ethnic tensions, an undercurrent of hope buoys Hospital. At one point Dr. Alan Astrow, Associate Director, Medical Oncology, reflects:
In the contemporary world, when we speak of an invisible hand that drives us, it is often assumed that we are referring to the marketplace and the invisible hand of economic self-interest. But most physicians and nurses, I think, want to see themselves as more than simply one party in a financial transaction. Why do we do what we do? What keeps us going? Not just that we ought to care but why? Faced with a suffering or demanding patient whom we might prefer to avoid, where do we find the strength to enter the patient’s room?
Here is the author herself, summing up:
Depending on the day or night, life in the hospital could seem full of exquisite promise or pointless despair…Yes, individual doctors and nurses behaved badly, sometimes inexcusably so. Clerks were rude to patients and to each other. People made mistakes. Yet I was constantly struck by the sense of urgency that accompanied desires for fairness, for compassionate medicine, for efficiency, for meaning – and yes, for cleaner rooms. Both Pam Brier and Margie Morales (a member of the environmental staff) struggled to sort the unwanted from the wanted, to make the hospital what it should be. They needed their lives to matter.
Thank you, Pam Brier, for giving Julie Salamon the ability to research and write Hospital. I'm not sure I would have been as brave.