Saturday, March 07, 2009

Town meetings @ BIDMC

Looking at these smiling people, you would never think that the topic of the day was possible layoffs, reduction of employee benefits, and other such matters. As promised in my message a couple of days ago, we held the first of a series of town meetings yesterday to explain our financial situation and to solicit ideas and suggestions from people as to how we might meet this year's budget gap.

Over 600 people joined in three quickly assembled sessions. And we will hold more next week, too.

Then, in a couple of weeks, I will send out another message listing the ideas that seem to be practical, legal, and implementable -- along with their budgetary impact -- and conduct a rough survey of our staff to see which ones they favor. Then, by April 1, we will decide what we are going to do and the schedule for doing it.

As expected, the response from the staff has been spectacular. People have a terrific sense of community and are quite willing to make sacrifices for the good of their fellow workers. (And, as you can see in the picture above, people are maintaining a good sense of humor, too.) I'm going to post some of their comments for you below so you can get a sense of the sentiment.

Beyond the general feeling, I was very, very pleased when I asked people if they agreed with my predisposition to protect our lower wage earners (e.g., transporters, housekeepers, food service people) from measures we take, even if it means that other people have to give up more of their salary and benefits. The response was overwhelmingly positive, as you can see in Brenda's and others' notes below.

In this era of sometimes cynical and sometimes selfish behavior, I was heartened by the response of our folks. They are kind people who view themselves as a family and who are approaching our hospital's financial problems with a true generosity of spirit. Here are some examples. First, from Brenda, a nurse in our neonatal intensive care unit:

Paul,
I attended today's 4pm town meeting and about halfway through the meeting, I found myself on the verge of tears. Not just because of how worried I am, and not because of how sad the situation makes me, but because of how overwhelmingly proud I feel to be a part of the BIDMC community.

I have worked in the NICU since November 2007, so I am pretty new to the hospital. I have worked in several different hospitals and I have never witnessed what I witnessed today. First you began by telling us how hard you were trying to avoid layoffs. Any CEO could say that. But what impressed me was the deeply human way you explained how difficult this process is. The fact that you are considering that many employees' spouses have already lost jobs, and that you know employees who lose jobs will have a very hard time finding new ones showed such compassion and respect that I was stunned. However, your request that we try to minimize the effect any cuts will have on the lowest-paid employees was what brought me to tears-- that and the loud applause you received after making that request.

I know the next few months will be extremely difficult for all of us. But it is so comforting to know that the people I work with are not just sitting back and letting things happen. After this afternoon's meeting, we had our own "post-town meeting meeting" to review what you had said, and to toss around suggestions. I know those little meetings are happening all over the medical center. I have never been prouder of the people I work with and the hospital I work for.

---
From Brian in finance:

First of all, I sincerely appreciate your honesty and openness. Thank you for that. It’s refreshing to see that in this day and age.

I am a new employee here, only being here three weeks. I wasn’t going to email you, but I felt that I just had to. I was laid off back in October from the hospital I worked at in Rhode Island. I collected unemployment until I got my job here.

Obviously, I want to keep this job. I’m sure I echo most people’s thoughts when I say that no one wants anyone else to be laid off, and we are all willing to do whatever is necessary to make sure that as few as possible actually lose their jobs.

I think the ideas on taking pay cuts, or maybe working one day a week less, can work. I stand behind whatever decisions you and the Senior Management team makes. Thank you for you candor, and please keep us all informed!

---
From Lindsay, a nurse:

I have been here at BIDMC for 10 years. I am a huge supporter of your leadership and your willingness to include all staff in your decision making. Our floor just had a staff meeting on Monday to discuss ways we could cut costs for our floor. We were all in agreement to find out if it was an option to eliminate the 3% pay raise, and our manager was going to look into this. So, that would be my vote as a first measure to save some money.

I look forward to attending your town hall meeting tomorrow to discuss other options if necessary. Thank you for including all members of BIDMC in making this hard decision.

---
From Carol, a nurse:

I am hoping people weigh in on some of your solutions, such as reducing future earned time accruals or forfeiting past accruals of earned time. I know I personally would be willing to forfeit some past accruals of earned time if it would prevent lay-offs.

---
From Julie, a technical assistant:

Your letter has tapped into what I have been thinking about for the last few weeks. It had occurred to me that perhaps forgoing one's annual raise would be helpful, and I was going to throw the idea out to you, but had not managed yet to put anything in writing. It was a tough idea to come up with, since I look forward to that raise every year, but if it would mean that we don't have to lay someone off, or reduce services, I would agree wholeheartedly to do so.

I think that you express what has been floating around in our collective unconscious; we look at what is going on in the world, and it is a small leap to see how our hospital is affected. I do think, though, that people at the lowest pay grades should not see any reduction in their raises.

---
From Kathleen, a nurse:

I think it is important to keep as many of us working as possible. I would forgo my 3 percent increase and give us a day of ET to help avoid layoffs. I am concerned about our coworkers who are making a lower wage. I'm sure you're aware that life has gotten more expensive. I hope there is a way that people who are on the lower end of the totem pole can still receive their increases.

---
From Catherine, a nurse:

I would be more than happy to forgo a pay raise and reduce my earned time if that would mean another person in the hospital could keep their job. I think this is a great idea and I hope my colleagues feel the same.

---
From Martha, a medical technician:

I am very sure that most of us in nuclear medicine would be willing to give up the 3% pay raise and also give up some of our earned time to prevent layoffs.

---
From Wilbert, a respiratory therapist:

One week of unpaid LOA, 3% of wage reduction, night and weekend differentials, temporary elimination of annual raise and bonuses, efficient work load and staffing all combined are 100 times better than laying off a single employee. Make a quick survey of these vs lay-off. This should tell us the best way to go about it.

---
From Bernice, an MRI technician:

I would rather take the loss of my yearly raise then see a fellow employee laid off.

---
And from Ediss, a program manager:

Thank you for this informative note and for the openness with which the issue is presented and being discussed. We held a brief department meeting this morning and everyone is very appreciative of your approach and the invitation to contribute ideas to inform decision making. I've encouraged everyone to write directly to you too to express their thanks and let you know their ideas.

So far, everyone feels that giving back earned time is the way to go--less painful than going a day without pay (like the City of Lynn apparently did) as you don't really feel the loss in your weekly paycheck. Staff are very committed to everyone feeling the pain a little and saving jobs where ever we can.

These are initial reactions. Hopefully we'll come up with additional cost-savings ideas to contribute to the overall effort but for now, a huge thank you from your grateful employees.

68 comments:

Anonymous said...

Mr Levy,
I fully support the concept of working some shifts without pay, with holding raises and shift differentials on days after 3pm and weekends.
Since few folks from the Red Sox come to our hospital as patients for any reason why pay the Red Sox organization to be known as "The Hospital of the Red Sox" (If I want to go to a game, I'll pay the full ticket price if it means us keeping our jobs).
I believe that some departments and their stucture should be evaluated. Directors who maintain top heavy departments with managers and supervisors who are engrossed in research while the daily funcion and care of the patients become secondary. (Quality patient care is now synonymous with research....) It does however protect those who have a vested interest in being published.

Lisa Hickey said...

“Transparency” and “community” are two buzz-words of today, but I am hard pressed to think of many examples where they come together as clearly as they did at the meeting you described. It is wonderful to see people rise to the occasion when you, as a leader, are able to say: “Here are our options. What do you think?” Thank you and bravo.

Paul Levy said...

Dear Anon 3:18,

Thanks very much. But I need to clarify that an important part of our mission as an academic medical cneter is to conduct research. While we will expect the research side of th ehouse to economize as well in the future, we need to be careful to keep it healthy, too.

Thanks, Lisa!

e-Patient Dave said...

I find myself unexpectedly in tears as I read this too.

Through the years I've heard, too many times, managers say "People will let you down. Watch." Now I realize, I'm moved because these emails restore the belief in humanity I had when I was growing up.

Imagine the entire country working this way. The entire world. As the man said, you might say I'm a dreamer - but I'm not the only one. Keep it up.

Lachlan Forrow, MD, FACP said...

No one will be surprised that as I often do I'll quote Albert Schweitzer here:

"Our humanity is by no means so materialistic as foolish talk is continually asserting it to be. Judging by what I have learned about men and women, I am convinced that there is far more in them of idealist will power than ever comes to the surface of the world. Just as the water of streams we see is small in amount, compared to that which flows underground, so the idealism which becomes visible is small in amount, compared with what men and women bear locked in their hearts, unreleased or scarcely released. To unbind what is bound, to bring the underground waters to the surface: mankind is waiting and longing for such as can do that."(Out of My Life and Thought, pp. 113 f.)

We're seeing now just what runs in the deep ocean currents of BIDMC.


And thinking about that last sentence of Schweitzer's, all it sometimes takes to reveal what's in the deep waters is giving people a chance to express what they themselves think is the right thing to do. If more people were given that chance more often, I don't think responses like BIDMC staff are showing would be as surprising as they might be to some people.

This is, of course, one of the most important tasks of leadership, maybe the single most important.

And on the subject of leadership, what's going on in BIDMC right now makes me think about one of Schweitzer's favorite books, the Tao te Ching (yes, Schweitzer was a leading German scholar of Chinese philosophy, too):

"When the Master governs, the people
are hardly aware that he exists.

Next best is a leader who is loved.
Next, one who is feared.
The worst is one who is despised.

If you don't trust the people,
you make them untrustworthy.

The Master doesn't talk, he acts.
When his work is done,
the people say, "Amazing:
we did it, all by ourselves!"

--Lachlan Forrow, MD
Director, Ethics, Palliative Care, and Community Service Programs
Department of Medicine
BIDMC

Anonymous said...

I hope all this gets into the globe what a positive spin on a sensitive time for all involved.

Anonymous said...

hmmm....protect those that make the least. Admirable and kind hearted, yes. If that is the trend, what will those experienced bedside nurses say when they get laid off in favor of those nurses making less money? Who will guide the inexperienced nurses and house staff? Everyone has bills to pay, mortgages to meet. Everyone.

e-Patient Dave said...

I posted about this on my own blog:

What if, in tough times, leaders could treat workers as responsible adults, and workers proved them right?

Mark Graban said...

Thanks for your sharing your approach to leadership Paul. The engagement of the hospital employees as a true team and community is impressive to me as an outsider and follower of your work.

I'm assuming that this post tells only part of the story, that while labor and salaries are the highest cost by percentage for a hospital, that there are also opportunities to reduce costs through process improvement? I'm sure that's being worked on, but just not discussed in post?

Are employees being engaged in small and quick improvements that can make their work easier, saving time, and reducing cost (while also improving service)? Any employee can ask "what can I do today, right now, to make my job easier?" What rework or wasted motion can be eliminated or reduced?

For example, if nurses are wasting time each day running around and searching for equipment and supplies, can a better system be put in place to make sure the things that are needed are always available? A little bit of creativity and effort can save time spent searching for wheelchairs, blood pressure cuffs, etc. This saved time can help reduce OT but can also help reduce patient LOS, which might also lead to big savings for the hospital.

Forgoing a 3% raise makes a difference and is commendable if people are volunteering that. But it's probably good to remember that more significant cost savings might be right in front of people's faces if people can be re-oriented from working around the same problems every day to a mindset where problems get solved "permanently" through root cause problem solving and permanent countermeasures that prevent the same problem from recurring. Can employees share these ideas across departments?

I'm probably preaching to the choir (to Paul) but wanted to make this point for other readers and get comments.

As a baseline, it is said that employees at companies like Toyota and Canon generate an average of $4,000 in small cost savings PER EMPLOYEE per YEAR. Surely, the same is possible in hospitals (not just BIDMC) if we can harness the creativity of all of the smart caring people in healthcare.

Best wishes to you and everyone at BIDMC. Again, it's very impressive to see this level of engagement, that Paul isn't just retreating to the executive suite and making "numbers driven" decisions without also engaging in the human reality of our workplaces and work relationships.

e-Patient Dave said...

Mark Graban,

I'll take this one off Paul's hands. :) (I don't work there, I'm a patient. My day job is in high tech so I'm familiar with the issues you cite.)

You're right, process improvement is a huge opportunity in healthcare, and this blog and this hospital are outspoken advocates and vigorous practitioners of what you're describing.

Here's a search for "process improvement" on this blog. The first screen shows the 20 most recent posts, dating back to 9/4/08. The best example, I think, is the Oct. 19 SPIRITed Transport, an update on one project in BIDMC's ongoing SPIRIT process improvement program.

btw, my favorite blog by a LEAN/Kaizen-oriented doctor is Ted Eytan, who currently works for the Permanente Foundation.

Anonymous said...

Where are the physicians? Their employment status differs (this being Harvard), but they are in a position to see resource distribution from other angles. They are part of the community, and should be engaged to contribute information that will help process improvement work that will save money and enhance quality.

Quality improvements can save money and lives. Rather than retreat from SPIRIT, this work should be accelerated and spread with an emphasis on eliminating waste wherever it is found.

Anonymous said...

Is it not realistic to cut "perks" first. Eliminate % bonuses for CN3 and CN4, suspend reimbursement for classes, tuition, do not hold a nursing awards reception at Fenway, have a ceremony in the auditorium. Tow the line with no perks, no raises. It would be a mistake to start taking away from employees who are barely scraping by with what they currently have. As a hospital community we have to take a stand together, shut off your computers at night, shut off lights in empty rooms, it is quite embarassing what we waste in this economy. RN-CVICU

Anonymous said...

I agree with previous comment. It makes sense to cut "perks" first and not be as wasteful at work. I also agree with suspending yearly merit raises. We could do without resource nurse differentials. However eliminating night and weekend differentials is unfair. Nights and weekends are the most unappealing, and many times most difficult (due to the increased patient load) shifts. You can't expect the people who work the off-shifts to get the same pay as those that work days. Otherwise no one will want to work them.

Anonymous said...

I just read Paul's most recent letter to the employees and am deeply troubled by the fact that he feels we need to feed our residents. We have just lost a very hard working, enviromental services employee due to a lay off and and Paul is concerned that the residents wont eat if we don't order food for meetings? This poor man probably wont be able to feed his family but don't worry, Harvard residents will eat well.

Anonymous said...

I totally agree that we all need to take some cuts but to say the only people to be worried about is those we are the low wage earners is degrading to those us we have worked to get credentials to have a higher paying job, we have spent lots of money to do such. We also too have the same type of bills as those we earn less. I have no problem giving up a day of Et so that we can all stay on but lets not label it for a certain group.

Keith said...

The most common idea considered so far has been to give up the 3% increase this year, which is probably smart. The other is to reduce sick time hours, which on the face of things is a good idea, but you may want to consider it as a percentage of hours rather than an absolute number as those who were hired more recently or are 'lower on the totem pole' accrue more slowly and would be impacted more if it were a specific number of hours.
Where is your Physicians Organization and how can they help, haven't heard anything from them?
Be careful not to get rid of all your employee perks as even in this economy, you need to retain quality employees and certainly keep spirits high... be selective and continue to consult the group.
On the research side (my interest at another institution), it is important to keep this area vibrant given the benefit that it brings to your institution in indirect costs, not to mention the critical part of your mission that research plays. The same annual raise and accrual time plans above can be implemented on the research side (though you largely cannot recover these dollars from grants to use toward overall operating costs, check with the lawyers on this one anyway).
Warning, some of these ideas may sound silly, but some very simple things can go a very long way that are applicable to both research and clinical labs. Institute immediately a program to reduce energy costs... get your staff on board to be militant about turning off equipment when not in use (computers, shakers, hoods, photocopiers). Close the sash on fume hoods when not being used, this saves an amazing amount of energy. Work with telecom to be sure that people aren't taking advantage of the work phone to contact friends and family in far away places. Find ways that your Pathology department can reduce hazardous waste volume and that your basic science research areas can reduce biohazard waste, both very costly. Its harder to put an number on these for planning purposes, but following through can only help.
Just a few ideas from a concerned neighbor.

Anonymous said...

Forgoing a 3% merit raise is likely to be minimal for upper income folks, but more difficult for lower income.
Would suggest a layered approach with continued 3% merit raise for those making ?<40k/year, 2% raise for those making 40-80K/year, 1%merit for those 80-120k, and none for those >$120k/year.
Similarly, if pay cuts are needed to preserve jobs, would protect the lower income folks with no cuts for those making <40k, 1% paycut for those making 40-80k, 2% for those 80-120k, etc.

When I pass the BIDMC Shapiro building in the evening/night - many many lights are on. I suspect we could save a lot of $$ on electricity by being more vigilent about shutting off the lights and turning off computers and monitors.

Anonymous said...

Best of luck during this difficult time. So much for health care being recession proof. It is amazing how the employees have rallied but to say that housekeepers and kitchen workers should be protected is a bit much. The people that care for the patients should be protected more. The nurses, the aides, etc. They really make what your hospital is! And it would not be right to get rid of shift differentials; who really wants to work nights and weekends.

Paul Levy said...

Dear anon 9:16,

Er, that was a joke!

Anonymous said...

Eliminating night and weekend differentials might not be appealing, but reducing the diff from &7.00 to &5.00 would help out. Also, revamping the perks in ...no more.... work 36 hours...get paid for 40 hours. If this would prevent layoffs..then these perks now need to be looked at. Times have changed and we all need to do our part to help our co-workers.

Keith said...

Sorry for the second post, but a few more things came to mind... do you think your staff would pay, your PO, heck, everyone at BIDMC would be willing to pay $1 or $2 per week more for their health insurance?
I don't think you do, but if you match 403b type programs, you should reduce or eliminate this, your neighbors haven't done this for quite some time.
Tuition reimbursement for relevant coursework related to the employee's position should stay in tact as much as possible, its motivating, helpful in employee development, and a bit unexpectedly one of those perks if taken away creates resentment (from what I've seen).
Again, good luck.

Anonymous said...

In today's times, it doesn't make sense to be paid to carry a beeper when the call-ins are very mimimal.
How about getting paid only when you do get called in.

Anonymous said...

Are there still employees working 24 for 40? This in itself could save 1 person's job!

Anonymous said...

I agree with the comment about the "low wage earners". I worked very hard for my education; to get where I am today. The "low wage earners" are good people but they choose what they do. They have every opportunity to better themselves. In most cases, they choose not to.

Cut out the ridiculous resource nurse differential. Forget Fenway Park and give up "The Official Hospital of the Red Sox". None of them come here. Give up the yearly 3% raise. I would pay a few dollars more for health care. Give up a few hours of earned time; it seemed to help a few years ago. Don't go the route of taking away the shift differentials; nobody would work there. Perhaps take away holiday pay? That would impact everyone. It would be more fair than taking differentials away.Work hard to keep from laying off nurses and coworkers as they are the backbone of the hospital.

PeterEverett said...

What a delight to see my all-time favorite quotation on governance (chapter 17 from the Tao Te Ching, with Lord Acton coming in a close second) quoted above by Dr. Forrow. It should be read every morning by every government and corporate executive before going to work.

Regarding ways to save money. If BIDMC has layoffs, it harms the value of the association with the Red Sox. I have no idea if or what it costs to be the "Official Hospital of the Boston Red Sox", but the Red Sox are good people, and would probably be amenable to a renegotiation of the agreement if it meant saving some jobs. If they pitched in, it would enhance their image and the relationship with BIDMC.

Anonymous said...

Personally, losing some ET accrual would feel less painful than forgoing a raise.

Sarah said...

I don't know if this would be considered an unethical term, however.

Taking the approach of sport venues across the country, would it be possible to charge a $20 fee to all patients no matter what each time they have any service done at BIDMC?

With the recent report stating there are 1 million visitors a year, this fee could cover the $20 million costs.

Or use a fee to cover $8 million (operating) from the $20 million.

I know it is probably far fetched, but just an idea.

Anonymous said...

I realize the state of the state is in a very rough, and fragile state, but to panic right now is running awayany chance to help with an answer.
I can't speak for everyone but one thing I know for sure is that I need my job, and I am thinking other's do also. I feel we can sacrifice certain areas such as the Co. contribution to the 401-K , and I also believe the lucheon's can be looked into , maybe more of a reduction and more selective process. Am I willing to forgo my yearly raise that I work hard for each year " NO ",to reduce personal in my department would be ludicrist. I am a police officer here at the BID, and believe me we are to the bare minimum each day I work , with more and more requests from other departments for more coverage.
Lets be very careful in targeting areas that will put more burden on our families.

Anonymous said...

Wow RN - CVICU,

For someone that is makeing around 100k I don't think you should talk about what the majority of the staff can aford to give up. Your pay is around the 75th%tile of the hospital. Maybe you should just sit back and be supportive of what those making a living wage are willing to give up.

Paul Levy said...

Dear Anon 11:49,

That's a very inappropriate comment. It is one thing to disagree, which is fine. But there is no need to be mean about it. Everyone's ideas are valued here.

Lachlan Forrow, MD, FACP said...

I'd add two points to my earlier post.

1. This crisis and physician incomes, starting with my own

I have been a physician for over 25years, have been at BIDMC for over 20, and am an Associate Professor at Harvard Medical School. Despite this level of seniority, I make just 85% of the average internist's salary in the U.S., only slightly more than new internists just out of residency. This is, however, not terribly out of line with what other general internists who choose to work here make, though that depends on what you do (clinical time generally pays more than teaching roles, for example). I make just over 50% of the average cardiologist's salary, and less than 20% of a partner in most leading Boston law firms. (Most of my college faculty thought I would go to law school.) These numbers are all quickly available on the web, and I think it's probably a reasonable guess that BIDMC generally pays salaries to its physicians that are reasonably competitive with other academic medical centers, but less than one would make in full-time private practice, since we all trade possible income for the satisfaction of teaching and other academic roles. My wife and I are worried about how we are going to pay for college for our children (ages 12-19), and regularly wish I were paid more, which I personally think would still be a bargain for both BIDMC and Harvard.

BUT: The hardship on me and my family of these financially-constrained times is not remotely comparable to the hardship a BIDMC colleague who loses her/his job will have to endure, especially in this economy where finding another job will be so tough.

SO: I'm not volunteering for a pay cut, but let's include physicians in these discussions about BIDMC finances, and -- as "the transparency hospital" -- let's be as transparent as we can be.


2. Longer-term

While I am proud of all the BIDMC staff who have offered to forego income for at least the near future in order to help save the jobs of other BIDMC staff, and while few of us choose to work here only for the money, we are not going to be the best medical center in the world (the only thing that would have many of us ever be satisfied) if we are below norms at comparable institutions of salary. So I think that it is imperative that whatever short-term sacrifices BIDMC staff choose to share in, we are all working to make sure that the path we are forging leads to BIDMC being an attractive place to work financially. For those of us who have families to support, this means being at least competitive in salaries with other places that would want us. If (but only if) we are competitive in salaries, and if we are the most satisfying place to work in other ways, we will continue to attract the very best people, which Jim Collins (see my earlier post) points out is the ultimate determinant of ongoing success.

--Lachlan

Lachlan Forrow, MD
Director, Ethics, Palliative Care, and Community Programs
BIDMC

Anonymous said...

Paul,
Regarding anon 9:16. Sorry, but I did not find that humorous. I don't find any of this funny.

Staff Nurse said...

I think that all direct care givers need to be more prudent about how wasteful we are. For example- laundry. We waste so much of it. Piles of clean laundry accumulate in rooms, and often get thrown back into the dirty laundry. We should only be bringing what we, the staff, and they, the patients, actually need in the moment. Bottom sheets and blankets should only be changed when soiled- not daily. Pull pads should only be used for incontinent or otherwise soiled patients, and we should be using the old fashioned draw sheets in place of them when appropriate. It is my understanding that laundry is done by the pound, and these suugestion alone could cut those daily pounds in half. And although I am not sure exactly how much money it could save, I am sure that cutting any daily expense in half would surely contribute to our goal of saving $20 million this year. It's easy and will cost us nothing to implement except the cooperation of the staff and the enforcement of the floor managers.

Anonymous said...

I totally agree with Staff Nurse. Also, how about taking a good hard look at what kind of trash is actually going into our "red bags"? I worked at a hospital who really cut down on their red bag waste and saved millions in disposal fees! Every little thing helps. Very little money out to save millions.

Anonymous said...

It is difficult to comprehend how an organization that strives to remain world-class can shrink itself to achieve greatness. Understanding the real financial challenges threatening the organization's survival, you simultaneously need to be thinking about areas in which you have medium-long term growth opportunities. For example, perhaps your alliance with the Joslin Center, combined with building up the endocrinology service, provides leverage to corner the diabetes market in New England; type 2 diabetes is the fastest growing health problem confronting our nation.

Anonymous said...

I think that going to a more paperless system would be a huge money saver. I work in a clinic where we still put out lab slips, when others are able to do it on the computer. And we put out so many pink slips to make appts, which should be done with just a click of a button. That alone would save alot.

Anonymous said...

In reference to the comments made on 3/9 at 2:36pm concerning red bag trash. A number of yrs ago I was working at a large facilty much like BIDMC and this issue came up. In short, the soiled contaiminated trash belongs in the red bags and nothing else. We saved lots of money by following that simple rule. Thumbs up to whoever for bringing that up. As for pay raises, see ya. Less ET, ok. Premium pay on holidays and w/e's at least on days and a lesser amt for nights, ok. And lastly the Red Sox, I do not think that the public is fooled when they see the signs lining Brookline Ave, but when so and so gets hurt, (Usually MGH)I think it's clear. Is there a good reason beyond us regular staff to keep them onboard???? Thanks for your time....

Ray Scott - JRS Medical said...

Mr. Levy,
If their is any way we can cut down your medical supplies costs & shipping? If we know you are going to be a long term customer we can keep our margins to a minimum.

I highly respect what you are doing for your staff and how open you have been with them about the financial situation. This is rare in this industry. Even if JRS Medical can only save a few thousand dollars a year that will add up over the next 10 years.

What you are doing reminds me of 1 of the Paradoxical commandments by Keith M. Keith: "Honesty and frankness make you vulnerable.
Be honest and frank anyway."


Keep up the good work, inspite of some of the not so nice comments on this post!

Nurse said...

We currently have 3 different options to use to clean our patients with- soap, gel and foam. The foam is by far the best and most widely used product, but it is supplied in an enormous container that only get fully used in ICU's and for veru lengthy admissions. Is there a way we could have this Aloe Vesta washing foam installed into each patient care room, like Calstat? If there isn't a company manufactured wall mount, any type of cabinet space saver (often used in kitchen cabinets to hold cleaning supplies) could easily be secured to the bathroom door, or elsewhere on the walls in the rooms. I cannot even tell you how many patients use less than 10 squirts of this product, and the entire bottle is thrown out. If we could accomplish this, we could also eliminate the purchase of the shower gel (that gets put into each Pink Bucket when a patient arrives to each unit, but never gets opened, and is then thrown in the trash) and we could also limit the use of the dial bar soap (which probably isnt even expensive, but these ALSO get put into the pink buckets, don't get used, and get thrown in the trash). Keeping the bar soap for our Aloe-allergic patients only and using those large Aloe vesta bottles in their entirity would be more cost-efficient

Anonymous said...

Regarding Anonymous's trsh suggestions- I totally agree. We are lazy about where we put things. Cardboard ends up in the regular garbage, non-sharps in the sharps bins, and improper use of the red bins isn't even half of our wasteful waste. Have we thought about recylcing? I am not even sure I have seen a recylcing bin anywhere in the medical center. Do we really need cardboard trays in the cafeteria? The amount of paper that gets thrown in the regular trash in the patient rooms alone could cut trash expenses. All the gauze and most supplies are packaged in some sort of paper or otherwise recyclable material.

Staff Nurse said...

Paul- a hospital in California went through similar budget problems, and also reached out to their staff for suggestions, saving $14 million. this is noe article I found that could be helpful
http://www.stanfordhospital.com/newsEvents/newsReleases/2008/employeesSpeakUp
I hope you find it helpful

Anonymous said...

Dear Paul, I agree there are certain actions we need to take to help us out of this financial crisis but I truly hope that the pension plan and 401k will not be affected. I have worked at this institution since 1982 and am slowing reaching my retirement and would hate to think that I would have nothing after working here in good faith all these years.

I would however favor holding back on the 3 percent annual raise, holding earned time accrual for a couple of weeks as they have done in the past and perhaps even premium pay for the upcoming summer and winter holidays to help.

Would you ever offer early retirement again??

Thanks,

Thanks.

Anonymous said...

If you do decide to lay off people, would it be based on hospital seniority or department/unit seniority? I have been at BIDMC for 6 years and started working in a new department a few months ago. There are people in my department who started there before me, but have only been in the hospital for about a year. I think it is fair to take into account a person's dedication to this hospital! I also think that foregoing the 3% annual increase is a great idea if it would help reduce the number of people losing their jobs!

Anonymous said...

Mr. Levy,
Thank you for being so upfront and honest with us and giving us the opportunity to have a voice in this matter I know many people who work at other hospitals and there CEO's are not as forthcoming. I also have also heard comments from people I know at BWH and Tufts that have said you are going to layoff nurses because we are not union. I don't feel this to be true at all and I am a former employee of a union hospital and I know if a union gets in BIDMC its going to cause more harm than good especially now. I also want to give a suggestion. What about people giving back some PTO. Or when sick calls come in can they have the option of taking it unpaid?

Paul Levy said...

To all,

Thanks for these and other suggestions. We'll be summarizing and offering another chance for comments and input before deciding.

Anon 8:07,

The people with whom you talked at BWH and Tufts might be imagining what they want, but they have no basis for commenting on our approach to these matters. That approach is, very simply, what I have laid out to all of our staff, and which has generated all the helpful comments you have seen hear and elsewhere. It's pretty straightforward: Layoffs may be necessary, but I am committed to doing all possible to avoid them. Perhaps they have never seen this kind of approach in action before and are projecting their feelings upon our situation.

Anonymous said...

Hi Paul,
Having been a "victim" of the 2001 BIDMC layoffs (right before you arrived), I just want to say how much I appreciate your openness in this predicament. The pain of my layoff was lessened thanks to a supportive and honest supervisor. I will always remember BIDMC as a very humane place... Best of luck.

Anonymous said...

Paul,
A 25 year veteran of BIDMC, I appreciate the open nature of this very painful discussion. I personally think ET accrual and/or reduction in already accumulated hours is an accross the board fair way to cut. I am not in favor of losing the 3% raise, it seems less 'fair' if you will, that some have had a recent merit increase and others will have to go without. I agree with others who have said that although I make a good salary, I have obligations to children and family that will be difficult to meet in these economic times without an annual raise. (ET would be easier to give up...although I think it should be 8 or 16 hours accross the board, not 10% of your ET bank.)

I would also be open to taking 1-2 days off without pay if that was helpful. I think to tamper with retirements and 401K is also a mistake.

Will you consider offering early retirement packages? I am also interested in how layoffs will happen.

Anonymous said...

I truly appreciate you openness to feedback, Paul. Similarly to others I am also willing to take a reduction in ET to help assist in this unfortunate financial situation, but I don’t think taking 10% of one’s ET bank is fair to those who have saved their time. Reducing ET by a straight number across the board would be more appropriate, in my opinion.

In addition, I would just like to make a comment on a recent observation of mine. I was made aware of several hospitalist’s functions over the past week at the same time our hospital is working towards reducing expenses and potentially losing valuable hardworking employees. I am aware of the 10 year hospitalist’s anniversary and completely agree their hard work should be recognized; however, daily speakers, lunches, breakfasts, and a catered dinner including open bar at the (all too expensive) Harvard Club is unacceptable with the current financial condition of BIDMC. On top of the daily festivities financed by BIDMC, I am aware additional employees worked during these days to enable the hospitalist to attend such functions. I find it difficult to justify such spending given BIDMC’s financial situation. How can BIDMC justify spending so much money on such festivities when we are talking about people losing their jobs? Who is responsible for such spending? I wonder if the individual hospitalist would have preferred to cancel these activities so the funds could be allocated in more useful ways…like saving BIDMC jobs.

Thanks for listening.

Paul Levy said...

Dear Anon 9:43,

This was not a BIDMC function. It was organized by the Department of Medicine faculty practice.

Monica said...

Hello Mr. Levy,

I work in the financial depertment and I would like to submit and idea. Instead of hiring new employees I was thinking that we need an extra body in this department and I'm pretty sure all over the hospital so maybe we could have a mentoring/internship program where graduates or future gradutes could come and assist as well as get there internship hours. I am a graduate od Medical Administration and it helped me gain experience and it would save us money and help them learn. Just a thought!

M.M.C.J

gbubley said...

I think that others should know that the physicians are aware of the need to do their part. We dont have ET time to give up, but our Medical Faculty Physicians group headed by Dr. Stuart Rosenberg is looking into what we might be able to do.

Anonymous said...

Dear Paul-
We need to focus on waste and long-term solutions. One thing must change...the culture of the hospital. Too often patients are being admitted from the ED to the floor and then immediately discharged as there is no medical reason for them to be admitted in the first place. Where is the solution to this ongoing issue? Why can't the hospitalist be consulted and prevent these admissions.? Another issue is around discharge. Families are dictating when pts will leave BIDMC not the MDs. These are all hospital days we are not being reimbursed for. Physicians need to be supported (by the hospital, IDT, and their dept head) when they make medical decisions around discharge and not be easily pursuaded when a family threatens lawsuits. How can we make these changes happen as they both will help improve BIDMCs financial situation.

Paul Levy said...

Dear anonymous,

I don't want to seem insensitive to the issues you raise, or to suggest that the concerns you raise might not be legitimate, but these kind of gross generalizations about clinical problems are not helpful. Cultural change starts with people like you pointing out the problems on the ground when they occur, not in this kind of forum. I don't know if you are a doctor or a nurse or have another position, but you have the power to call out problems in real time and make proposals to change thing. A recitation of the sort you offer here really does not help identify the root causes of the problems you mention. Please try again, but this time on the floors and in the units.

Anonymous said...

Paul-
The failure of our hospital is nothing but a symbol of the crashing health system in the USA. United States medicine is the least cost effective medicine in the industrial world. We spend millions of dollars on unnecessary tests b/c of the lack of evidence-based medical knowledge of physicians and fear of litigation. I am a BIDMC MD and I receive patients admitted through our ED after they go through extensive unnecessary radiological testing that was done only b/c the ED physicians have no time to obtain an adequate history and perform quality exam. These tests contribute to our current financial burden and harm patients by exposing them to radiation, contrast, and the sequelae of false positive testing. Our medical students and residents are learning these deviated practices and are running tests rather than expanding their medical knowledge, using critical thinking, and applying cost effective medicine. Any effort I exert in changing this culture among residents and students is met with resistance as this deviated way of practing medicine has become nothing but the norm. The "excellence of teaching rewards" go to "nice", "fun", and "friendly" doctors and not to excellent teachers.

Paul Levy said...

Dear anon 10:26,

Please see my comments to the person posting above. Gross generalizations do not solve problems. If your efforts at improvement are not being accepted, perhaps you are going about it the wrong way. I don't know what department you are in, but I know all of the chiefs are looking for ways to improve the quality of care. Have you addressed your concerns with your chief? Have you offered suggestions that could be implemented and are practical?

Your last sentence is an indication of some annoyance. I know, in contrast, that the teaching awards actually are based on real ability. Niceness and fun are not the criteria used.

Anonymous said...

I strongly support giving up the 3% pay raise, change in shift pay, changes in 401k & so much more in order to prevent layoffs. What I like best is having an "amount" determined by the CFO that allows individuals to choose which options they will give up.

I personally am not in favor of reducing earned time--people need to take time off to have a life balance. SO, if people could choose which benefits to give it, I think it would work.

Thank you for listening to "us"! We are all in this together!

Anonymous said...

My vote is an acceptance of a temporary wage freeze and a temporary freeze of the 401K match. None of these things are pleasant but both were anticipated and both can be temporary. I feel that whatever we do everyone needs to participate. When people suggest eliminating the holiday or shift differential I always wonder do these people work at straight 9-
5 M-F? We have to be careful to be fair in these measures. While no
one is happy about this I would hope that everyone will to do their part.

I have heard some co-workers express an interest in taking a week off w/o pay. While this is not something I would like to do others are.
Thanks for trying to figure this out through such an ongoing process.

Sara said...

Paul-

I read the article about your wonderful initiative and wanted to compliment you personally for what you are doing. My name is Sara McHale, and I have written to you before, first commending an exceptional nurse I first met in 2005.

I have been going to BIDMC/BIDNeedham since 2005 for major and minor medical problems- many are lifethreatening. The care I have received is top notch on physical, personal, neurological, psychological, thoughtful, and lifesaving levels. Since then I have been in the SICU where your employees were top notch to me and my family (especially while I was in a coma), the Emergency Room too many times to count where they were nice as well, and many patient floors at BIDMC and BIDNeedham.

Paul, I am not surprised by your genorosity and kindness of spirit toward your employees during these difficult times. I have said these folks are truly "priceless people" and they truly are "people driven", not "money driven" (as some doctors I've known but not here- back in Rhode Island).

With Sincere Respect and Gratitude,
Sara McHale
Needham, MA

Karen Rae said...

Your way of thinking is exactly what the world needs most right now. Coming together rather than dividing. I strongly believe the world, the universe, has a way, if needs by force, to bring together what has been separated. You are a wonderful example as to how we can come together agian.

I read this quote by Einstein the other day, I feel it suits the worlds honest endeavours well.

"We can't solve problems by using the same kind of thinking we used when we created them."

Thank you for helping us to find another way of thinking.

Sara said...
This comment has been removed by the author.
Sara said...

I like what you said as well, Karen Rae.

Jens said...

I just read about this in the news, and I just felt I had to write and say I am glad that there are still heads of entities that care as much as you do for the people that you lead. Hats off to you sir, you are a beacon of light in treacherous times.

Anonymous said...

Dear Mr. Levy,

I am a staff nurse at bidmc.
I attended the first town meeting you had.I have never attended a town meeting before and therefore never have had the pleasure of hearing you speak. After the meeting, I phoned my husband at work and said, "wow, this guy really gets it....right down to the lowest wage employees". I think your ability to see the big picture and think outside of the box can only benefit us all in the end. It's wonderful to hear you speak. You have a calmness about you and you even got us laughing and then photographed it. Amazing.

I wish you could become my town manager but I'm afraid you are over qualified for the job.:) Thanks for your leadership and continued support.

Anonymous said...

There is a shift differential salary discrepency between nurses and non-nursing. Nurses make a significant increased dollar amount more than the non-nursing staff. I don't know why since we are all working the same hours, but maybe this should be changed to lower the RN differential.

Kamote said...

I just want to say thank you Paul for being the man that you are. You make me proud to be working at BI and more importantly, having you for my CEO. Thank you. I hope all your efforts and ours will amount to keeping everyone's jobs.

Kristen Drake Farr3 said...

I just want say thank you for all that you have done this institution. I have been working for BIDMC for approx 6 mo now. I have never seen the amount of determination and enthusiasm to find solutions than I have seen in the past few weeks.

I have an idea to have everyone take scheduled time off for a week without pay or ET.

Thank you again look forward to hearing from you.

Kristen Drake. Farr 3

e-Patient Dave said...

How ironic is this:

The SEIU is laying off its own employees, and its union is suing the SEIU itself.

Washington Post article here.

Staff Nurse said...

Dear Paul- I was wondering if anyone has considered looking into investing in our own ALS and BLS ambulances for East to West transfers. I spoke with a few EMT's and they guesstimate $20,000 of use on a slow day, which would be $7,300,000/year. An ALS rig runs for about $100K, and a BLS rig is around $60K. If we could invest in 2 of each and employ our own EMT's and paramedics, it could save millions of dollars each year. Just a thought. I know other hospitals have transitioned to this investment, and thought it would be a great way for us to reach or goal.