Saturday, May 12, 2007

Open letter to Mr. Levy

Open letter to Mr. Levy:

How is it that you have the time to blog while running a hospital? Have you run into any negative reactions from the faculty or others within the hospital? It would seem fairly high risk when attempting to gain and retain respect with employees, peers, and others who inevitably may be affected or left with an impression by your musings. As a member of senior management in an investment firm in the private sector, I can undoubtedly state that the reaction to my taking the time to be on the Internet each day would be perceived as unacceptable by my colleagues, my Board, and by shareholders. Indeed, I can't even risk writing my full name here. Sharing one's thoughts within one's own organization is vital and important, but opining in stream-of-consciousness fashion on all things publicly seems somewhat reckless and is easily (mis?)interpretable as narcissism. Have you encountered this opinion before from your colleagues or others and what has been your response/ explanation? It's fascinating to me that you would feel the compulsion to do it.

Kind regards,
Dave


Dear Dave,

Here are some specific answers to your questions.

How is it that you have the time to blog while running a hospital? If you note, most of my posts are filed early in the morning or late at night, when I am at home. The real question should be, "How is is that you have time to blog when you should be doing the laundry?"

Have you run into any negative reactions from the faculty or others within the hospital? Not once. Our place celebrates diversity of opinion.

It would seem fairly high risk when attempting to gain and retain respect with employees, peers, and others who inevitably may be affected or left with an impression by your musings. Musings!? These are rigorously supported conclusions, arrived at after years of scientific inquiry. After all, I work in an academic medical center, where everything I post has been subject to peer review.

I can't even risk writing my full name here. That may be the saddest thing you have written, saying much more about your life and place of employment than mine.

Sharing one's thoughts within one's own organization is vital and important, but opining in stream-of-consciousness fashion on all things publicly seems somewhat reckless and is easily (mis?)interpretable as narcissism. Blogs are inherently narcissistic. I admitted that from the start. As for "stream-of-consciousness", please read the posts more carefully. As for "reckless," you don't know me personally, but those who do know that I say the same kinds of things in person.

Have you encountered this opinion before from your colleagues or others and what has been your response/ explanation? This blog is subject to disdain by my colleagues in some other hospitals. Really. You can see it on their faces when the topic is raised in their presence. They are deeply offended by it and think it unacceptable for the CEO of a Harvard hospital. Of course, they have never said anything to me directly. Then, they would have to admit that they read it.

It's fascinating to me that you would feel the compulsion to do it. It is fun. Apparently, too, it is informative and interesting to others, and shouldn't it be part of my job to inform people about the many issues facing hospitals? Who else is better equipped to explain what we do, how we do it, what makes it hard, and what makes it rewarding? CEOs give interviews to reporters, who then filter the information and put it through the wringer of an editor who wasn't even at the interview. Is that a better way to tell the world what happens in a hospital? Similarly, when was the last time you actually read the letter from the CEO in a corporate annual report?

Dave, at latest count, there are 71 million blogs out there. At least a few are posted by CEOs of large organizations. The reason to write a blog is that you think you have something worthwhile to say. The market test is whether people read it.

If you go to the very bottom of this blog, you will see a number: That is the number of "unique visitors" who have chosen to drop by since I plugged into StatCounter in October. Also, click on "blogs that link here" to see who else refers people to this site. Both are not huge numbers by blogosphere standards, but, as you know, my readers are very high quality people.

Many thanks for taking the time to write,

Paul

25 comments:

Anonymous said...

Paul,

I can't agree more with your answers.

And I would like to send a message to the author of the open letter:

Free your mind...and the rest will follow

Julio

Aaron said...

I definitely agree, Paul - I'm a former Boston resident, about to be a California attorney, and while I stopped reading most of the Boston blogs, I still keep up with yours because of the unique insight you have on management in the public service.

You have a lot of great things to say, and it's obvious that your way of doing things means that you really get a great deal of respect from your employees - maybe this is the difference between Dave's environment and yours.

Thanks for continuing to write.

p a kenney said...

Paul,

I, for one, was very pleased to encounter your blog, remembering the fellow I got to know somewhat during the MWRA/Cape wars of the early nineties. What I have read is interesting and relevant...both your posts and the responding comments. You inhabit a world that touches all of us sooner or later but which is far removed from our usual daily lives. Receiving the insights of a successful non-MD ceo of a world renowned hospital share his experiences and thoughts with the rest of us is a rare and grand experience.

And, two final thoughts: the indisputable success of your first years at the helm of BIDMC and the fact that 'Dave' is the only person out of the hundreds who have commented to voice such concerns tells us everything we need to know. Blog away, brother, blog away. What better elements to have in a blogger...a gigantic intellect and a good heart.

Open letter to Dave: relax!

vkrn said...

I'm an incoming BIDMC preliminary IM intern, and I love your blog. I subscribe to it, look forward to every new post, and have commented on your entries (eggs, anyone?). I am proud that our hospital CEO is so accessible, thoughtful, and proactive about discussing both the strengths and weaknesses of our hospital.

Medicine is marked by a tradition of hiding errors from patients, which stems often from a subtle feeling of superiority to those who are outside the medical establishment. Negative reactions from other hospital administrators about this blog, which talks frankly about our field, simply reflects that same attitude. Unfortunately, it is that attitude which has widened the gap between caregivers and patients, as evidenced by the latest kickback scandals which physicians have become embroiled in, whether with unnecessary MRI screenings or pushing brand-name drugs.

I would point to the Mayo Clinic in Rochester as a good example of how openness only helps, not hurts, an institution. Recently, Mayo sent a team to film undercover the experience of a patient navigating his way through the hospital bureaucracy. Instead of hiding the less-than-smooth intake process, Mayo featured the results in a front-page article of one of its magazines that both staff and patients can read. Why? To highlight the areas Mayo needed to improve, and to make a public commitment to improving.

Criticism that our CEO should not be blogging contributes to the fallacy that speaking openly and honestly to the public demeans or threatens us. I heartily disagree with the detractors: Shining a bright light on our inner workings invites our patients to speak up as partners in the effort to improve the BIDMC experience. Mr. Levy's blog engages all of us in a vigorous dialogue aimed at raising our game.

P.S. Any decision on the cruelty-free egg question?

Anonymous said...

I found reading both the letter and your responses very amusing. My husband is in love with Warren Buffett's wit (which I admit, having just attended my first shareholder's meeting, is of substantial quality), but you must be a close second, Paul!
But thanks to Dave for raising some questions that I am sure people have been thinking, and let's not disrespect Dave for his letter, people. I would be curious how Dave found your blog and what he gets out of reading it, however.

As to the other hospital CEO's, I am sure they are just envious, and angry they didn't think of it first.

Locus Potus said...

Mr Levy-

I also enjoy your blog, however, I'd just like to ask your thoughts about blogging if you weren't the CEO. Do you think such openness could hinder the career of someone aspiring to climb the ranks in medicine?

There have been a couple of recent comments in the medical student blogosphere of school administrators and residency program directors who monitor student blogs and look unfavorably upon them. They even go as far to say that it would hurt their chances to match, which I'll extend even to faculty positions, etc.

Can you only speak out when you're the boss?

Thanks.

Patient Dave said...

Speaking as another Dave, I'll chime in. Pardon the length, but this is real, and it's affected me personally.

First, I'll thank Other Dave for voicing what I imagine a lot of other people silently think.

And I understand his concern: I've worked in an environment where the last thing anyone wanted to do was admit to a customer that we made a mistake; the company didn't want to bear any consequences or hurt its (false) image.

It was a nasty culture, and ultimately co-workers began hiding mistakes from each other. Aside from the ethics questions, the hiding "work" became a substantial waste of resources, hurting shareholder value.

In contrast, when Paul has posted statistics (for instance about central line infections - see the Feb 16 archives), he's made a point of saying that for improvement efforts to work, we have to get beyond the culture of blame.

And I'll tell you, when I became an in-patient at BIDMC this winter and the doctor started his prep to insert a central line in *me*, I was damn glad to know that I was in a hospital where they're actively doing everything they can to make the process safe, including openly discussing any time when something goes wrong.

Plus, my nurse (and doctor) were happy to talk freely about the blog discussion and the controversy it raised around Boston. Mind you, some staff didn't agree with everything Paul said - but that proved Paul was being straight about open discussion: people didn't feel they had to hide their real thoughts.

As for the resulting culture: at least twice I've submitted suggestions based on my in- and out-patient experiences, and each time I've found out that the hospital actually acted on my suggestion - within a month!

So please, Other Dave, try to imagine working in an environment where EVERYONE, right up to the CEO and the board, is truly and constantly interested in doing the best they can, including identifying and correcting every mistake that anyone catches. Hard to imagine, eh? But that's what we have here.

Is this a legitimate use of a CEO's time? You bet your patoot.

The key is that the CEO has to really mean it, and put their actions where their blog-mouth is. Without that, it IS bogus and a waste of time.

BC said...

I really appreciate this blog and read it almost every day. I've learned a lot, and I especially like the ability to post comments.

One thing I'm curious about is Paul's assessment of the value of his blog relative to his expectations when he first launched it. Has it made it easier to drive some of his initiatives within the hospital, especially those that require doctor cooperation? Has the reaction from the public and the media been, on balance, a plus or a minus in making BIDMC a better place? Is lack of time the major reason why more CEO's have not started blogs? If not, what is?

Anonymous said...

Paul,

When patients have been in the Beth Israel emergency room for treatment, does the hospital follow up to find out how many come down with infections later, especially if follow-up treatment is done by doctors in the Beth Israel system? If not, shouldn't this kind of information be relayed back to the emergency room staff so they can learn how well they are doing to reduce infections?

Paul Levy said...

Locus potus,

You certainly do have to be more careful when you care about how people may use your blog in evaluating you for possible job applicatione, school admission, or promotion. But with 71 million of them out there, people have nonetheless foudn a way to express themselves.

Paul Levy said...

vkrn,

We can't use those eggs because, for patient purposes, we use must use deshelled, pasteurized eggs to make sure there are no harmful bugs living in them. The cage free eggs are not available that way, and, if they were, would undoubtedly be very much more expensive.

Paul Levy said...

To bc,

"Has it made it easier to drive some of his initiatives within the hospital, especially those that require doctor cooperation?" As I have mentioned elsewhere, this is a surprisingly effective management tool, in that it gives people just that much more incentive to do well when they know that results like infection rates will be broadcast to the world.

"Has the reaction from the public and the media been, on balance, a plus or a minus in making BIDMC a better place?" A plus -- see above.

"Is lack of time the major reason why more CEO's have not started blogs? If not, what is?" Most good CEOs are good a time management. You make time for the things that are important. That's not the reason. Sorry, though, I can't give the reasons for others' inaction on this front. Maybe they will submit comments in reply.

Dave said...

Dear Paul -

Thanks to you and all others who responded for providing me with an answer to my questions. I will write later to respond to some of your viewpoints, but in the end it would seem that in your organization it works and is accepted; that is the real litmus test. I think it's difficult to extrapolate to other settings but if it works for you, great.

I'll tackle the issues of potential other interpretations of your actions other than what you perceive as potential jealousy at a different time. I suspect that there is a delicate balance in the Harvard community and that no one at the behemoth and self-aggrandizing Partners wants to hear from you and likely mocks you in private. The question surrounds where more valid stakeholders in the area, like Harvard Medical School which must reign in the egos at all of the different hospitals, stands in the mix. The egos at Harvard bring together a bit of "herding cats" mentality, and it's sad that you all need to compete and bring in the Harvard name as if it somehow makes you special. I have served on boards of other academic centers and always admired the more team-based environments made possible at places like Hopkins, Cleveland Clinic, UCSF, Penn, Duke, etc., where there is enough centralized control to work together and not vet silly personal issues. That is why I don't envy you or your colleagues at any of the Harvard hospitals. Boston is a small city with too many hospitals and not enough patients, and Harvard just adds to the dismay by having too many hospitals without enough disease. You guys need to work together to serve the community - not your own egos - and this blog probably doesn't help that higher calling of working together for the health of Boston's people and the best non-conflicted use of your collective resources to get things done academically. It's a sad statement about egos over ethics, but I'd be REALLY enlightened to hear what the guys who call all the shots at larger, more centralized universities do. I wouldn't want my child to go to HMS - too many hospitals and not enough control over the people results in too much ego-massaging and not enough work.

Best,

Dave

Paul Levy said...

Thanks, Dave. Please read my posts about the HMS system below: http://runningahospital.blogspot.com/2007/01/harvard-medical-system.html and http://runningahospital.blogspot.com/2007/04/even-harvard-can-do-it.html.

It is quite true that Harvard finds virtue in its "each tub on its own bottom" view of the world and that cooperation among the Harvard-affiliated institutions and even within the University is not emphasized. I, too, was more familiar with a more centralized place (MIT) and found the collegiality there to be very enabling. One of the reasons I enjoy being at BIDMC is that it has more of that latter approach -- and a great sense of warmth and cooperation.

But please understand that HMS does not try to "reign in all the egos" at the affiliated hospitals. Unlike many other medical schools, the hospitals are separate corporations from the university. This probably makes your argument all the stronger!

Dave said...

Thanks for the links to the other posts; very interesting.

Paul Levy said...

My pleasure. Very odd, no?

Paul Levy said...

Some great comments on Kevin, MD in response to his post. Check them out. http://www.kevinmd.com/blog/2007/05/disdain-for-paul-levys-blog.html#comments

BTW, Kevin's site is awesome! He's the one to ask, "How do you have time to do this!"

Anonymous said...

I wish CEO of the United States of America writes a blog like Paul.....

Roy M. Poses MD said...

On Health Care Renewal (http://hcrenewal.blogspot.com/) we write about how concentration and abuse of power in health care challenges our core values, and argue for more transparent, accountable, representative, and ethical leadership of health care organizations. The Running a Hospital blog is a great example of how to make such leadership more transparent, and hence more accountable. Writing this blog is one way Paul Levy is exceptional. My hat's off to him for doing so.

It is, unfortunately, very telling that he is the only CEO of a major hospital or academic medical center to write anything remotely like the Running a Hospital blog.

Anonymous said...

Transparency and access to information have been the themes in the investment world. Healthcare in this region is slow to change (some good and bad) With events such as the HCA buyout, Caritas Christi merging, Cleveland Clinic adverting in local papers, CVS expanding Minute Clinic it seems the CEO has a lot to blog about.

Anonymous said...

Dave needs to relax - I appreciate your blog and wonder how corporate would react to an HCA or Tenet CEO blogging...

ObGynThoughts said...

Thank you for your blog!
I believe it is an excellent idea in general and and excellent public relations move in particular.
The buzz around it helps increase the reputation of BIDMC (just in case it has room for improvement).

Most importantly: BIDMC stands out as an open institution. The leadership does not seem to consist of a few rarely seen suits quietly working in the corner offices of the top floors, but seems to be out in the open, approachable, close, near, human, people like you and me. People you can talk to, relate to, chat with.
That makes them the leadership likeable and is an invitaton to talk, to comment, to share ideas, to inspire.
I only see good things coming from this! Please continue!

thank you said...

Thank you for this blog. I think having a CEO who is open to ideas such as embracing technology and using it for transparency is refreshing and commendable. I wish more companies would do it and learn how to master it without having it as a PR spin.

Kudos and keep it up.

PS. It's good to be the king, isn't it? :)

Tom said...

I adore this blog.
Please don't ever stop it.

SFG said...

Hasn't anyone thought of the PR angle? A blog says to the world, "See? The CEO has a forum anyone can ask question on. We have nothing to hide."