There's nothing remarkable about it

Johann Sebastian Bach reportedly said, "There's nothing remarkable about it. All one has to do is hit the right keys at the right time and the instrument plays itself."

Sometimes I think that running a hospital is just the same. Treat every patient with exactly the right mix of clinical excellence, service quality, kindness and respect and "the instrument plays itself."

Of course, the ability to do that resides in the coordination of well-intentioned, thoughtful, and supported people working in harmony and cooperation.

Recently, we had a chance to spend some time with people from a group called Value Capture. They relayed the content of speech by former Secretary of the Treasury Paul O'Neill at the Harvard Business School. He outlined the three questions every employee should be able to answer affirmatively every day in order for an organization to have the potential for greatness:

Am I treated with dignity and respect by everyone I encounter, regardless of role or rank in the organization?

Am I given the knowledge, tools and support that I need in order to make a contribution to my organization and that adds meaning to my life?

Did somebody notice I did it, i.e., am I recognized for my contribution?

Here at BIDMC, we strive to treat each patient as though he or she is a member of our own family, and we try to treat one another the same way. We could all debate whether we should measure success in this way, or in the way stated by Mr. O'Neill, or by more formal statistically valid metrics of patient care and patient satisfaction. We know we are better on these fronts than many places -- and we know we have improved during the last few years --but better does not represent success and is not the standard we choose to set for ourselves. We still have lots of work to do on all fronts.

One reason I have published good and bad stories about our place is to let you know both where we are doing well and also how we are trying to improve. My aim is also to let our staff know that we freely and openly choose to be held accountable to the public we serve. I believe that shining sunlight on a organization tends to drive improvement.

Some people have told me that this is a risky strategy, that people will use this information against us -- for commercial purposes, political purposes, or otherwise. Our message to those who would try is that there is nothing we do poorly that we ourselves would not choose to improve. So if you have suggestions to make about how we can get better, we welcome them in that spirit. If, however, you choose to use this information for your own purposes, or in an unhelpful way or simply to gain advantage, we will nonetheless evaluate what you say as objectively as possible and still try to use it to get better.

"Hitting the right keys at the right time" is hard for someone playing a Bach minuet. It is arguably harder for an organization of 8,000 people taking care of 40,000 inpatients and 500,000 outpatients per year. In either case, though, the solution requires practice, practice, practice -- and it is especially effective when the practice is in front of an engaged and informed audience.