Open letter to a newly hired hospital CEO

“In the vacuum of hi-tech management, no one will hear you scream.”
Copyright, 2004.

First, let me say that from where I stand, I don’t know why anyone would want to become the top hospital administrator – it’s such a risky business (no pun intended). Having said that, I want to hand over the two cents that have been burning holes in my pocket for years.

In 1971, just prior to market-share economics taking over health-care, George C. Scott won an Oscar for his starring roll in the black comedy, “The Hospital.” At one point in the movie, Mr. Scott, who plays a hospital CEO, yells to a group of community protesters, something like, “You want to run this hospital? Fine. It’s yours.” He then storms out the door. George does return to his responsibilities, but from what I have seen, some of his colleagues in the real world can relate.

Practically speaking, being the top administrator in a large organization usually assures one thing – no matter what choices you make, a sizable group under you will be disappointed by your decision. That, as it has often been said, can’t be avoided. But what I want to describe concerns a different kind of decision making, one you may not know you don’t want to hear about.

I know you have training and/or experience in staff allocation, budget management, marketing strategies, and patient survey analysis. And I know these subjects are taught in schools, debated at round tables, presented in journals, and discussed during board meetings and at your own employment interview. I also know that these subjects touch on issues of medical equipment maintenance, new technology acquisitions and allocation, JCAHO and state regulations and surveys, FDA and manufacturer product recalls, new diagnostic procedures and physician recruitment, incident reporting, malpractice law suits, market dominance, and perhaps the idea that treatment delays affect length of stay due to “equipment down-time.” Well, maybe you have not run into all these yet, but I bet you will.

I know you are trained and experienced in administering tasks, yet you may not be as focused on technology issues as you are on other more comfortable ones.

A good title for a contemporary high-tech hospital film might be, “In The Vacuum of Management, No one Will Hear You Scream.” Like no other area of administration, you the CEO, are alone when it comes to a sure and clear road to follow in managing technology. We might as well be describing how some teenagers learned about sex and relationships: certain aspects may have been taught in school, you might have been handed a book to read, or had the daughter/mother-father/son discussion, but you also learned by making mistakes on your own. Furthermore, the subject may still have an element of taboo associated with it.

One difference between learning about the management of medical technology and learning about sex may be the active interest in the later.

I know perfectly competent mothers, fathers, teachers, lawyers, car salespeople, and business managers, who actively avoid doing home repairs or learning more about computing than the “My Computer” icon shows them. The point is that although you may be alone carrying the torch of responsibility, you are not the only CEO in this “Peyton Place” industry to shy away from having an intimate affair with technology.

Shy away from technology? I hear you say that you are not working in a vacuum – you have minions who manage, you have consultants, “GE special package deals,” “all-encompassing insurance umbrellas,” and outsource “guarantees.” I hear you say, “I can not know it all; my environment is constantly changing. My job is to delegate.” And I agree. In a sense, you are not alone. But if you are shy about peering around corners, your shyness may cause blindness.

It is true, there are people who know more about technology than you, just as there are physicians, nurses, and Electrical Engineers with training and experience qualified to direct their services. So what’s the unique concern regarding the use of technology in treating patients? With all due respect to the aforementioned professions, the force impacting health-care is Biomedical, or Clinical Engineering, the heart, muscle, and bone of medical technology.

As overseer of “the buck stops here,” consider the meaning technology has for you, and consider getting closer to the various ways your hospital and your patients are impacted by it. It might not need reciting, but: Injury to patients due to medical errors including equipment failure (nationally, just beginning to get a handle on this); the cost of malpractice law suits; how in-house vs. outsourcing service effects cost and quality of service; the true costs of owning equipment (including maintenance, over time); planning obsolete equipment replacement and disruption to service; cost savings from advance equipment replacement planning, and vendor negotiations. And following JCAHO to the letter but not truly understanding the issues as they impact you today into the future.

The idea of “getting closer to technology” is not about passing surveys, saving money, or effectively marketing your services, though all these are necessary activities. It is about taking a hard personal look at the source of these issues – technology in your environment. It’s about seeing firsthand the effectiveness and efficiency of your operations.

The good news is that participating doesn’t have to be too complicated nor that difficult; it just has to be active.

Delegate: make those who are responsible for the oversight of technology in your institution – whether they are an in-house department, or an outsource vendor – feel it. Occasionally meet directly with them and make them talk the talk, even if you don’t understand it all. It’s good for you, and good for them to think they’re really being watched.

Read reports, and ask questions: periodically ask a specific question you develop from reading your Environment of Care minutes (or product evaluation committee, or other relevant group). It may not be true in your institution, but if the minutes of this meeting are simply filed and forgotten, you may be an unwitting participant in “bureaucratic amnesia.” You may also find a few active committee members who actually appreciate the attention to detail, and those may be the ones you want around for the long-run.

Make your T.O. make sense: if your key technology person is reporting to the same administrator that manages laundry, security, and housekeeping, with all due respect, that may be the wrong person. Place Biomedical under a nursing director, or physician – someone who at least understands the terminology.

Look long-term in terms of cost: if dollar savings is going to be a primary concern when it comes to medical technology oversight, develop a financial assessment that includes things like costs buried in Department of Health reviews, bad press, malpractice suites, and length of stay increases due to equipment failure. You may not be able to easily demonstrate savings due to the catastrophes you avoid, but these things are real. Speak with your lawyers, they know risk assessment.

If you’ve read this far, I want to tell you what a friend of mine said upon reading a draft: “If you’re going to successfully pitch to a CEO (or department manager), put the solutions up front, followed by the discussion.” I said, “I did that. Most of the ideas at the end are known, it’s the phobia, or shyness, that’s often not acknowledged.”

Practically speaking, acknowledging means allocating some portion of time to something for which you can not see a clear and comfortable result. My guess is, that’s a hard thing for most CEOs (and VPs, etc.) to do. You may also feel it’s not your place to intrude, but to the degree you acknowledge these issues, you will intrude, and will find increased options in addressing this complex environment.

Ultimately, running from the “heat in the kitchen” means you are running to more fires. Years ago, I overheard a conversation between two residents: “Around here, you’ve got to go fast enough to keep up, but not so fast you leave it all behind.” Mea culpa. Carpe diem.

Bottom line? In engaging your environment, you’re no different than any other hospital employee, you have to be there.

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