Monday, September 13, 2010

Why am I here?

As I approach blog post number 2000, it is time for reflection. For those who remember the 1992 Presidential campaign, this is a bit like Admiral James Stockdale's comment, "Who am I? Why am I here?" (But, I hope with a more successful result!)

I'm going to skip the first question and go right to the second.

I joined BIDMC in 2002 to carry out a public service, to save a great academic medical center that had fallen on hard times. That done, we proceeded to develop strategic plans for our clinical, research, and educational missions. Those have been successfully implemented, with growth in market share and clinical affiliations, expansion of a world-class research program, and enhancement of both undergraduate medical education and residency programs.

The next phase was an intense focus on quality and safety improvement, combined with a level of transparency unprecedented for an academic medical center. The arrival of Mark Zeidel as our Chief of Medicine set the stage for this, as his is the largest department, and because he has a rabid enthusiasm for the proposition that hospitals should not harm patients. I personally took his objective a step further, by publishing real-time clinical data on this blog, on the theory that transparency would help us hold ourselves accountable to the standard we say we want to meet. The incumbent Chiefs of Service and others recruited after Mark enthusiastically jumped in. With our Board's involvement, we adopted an audacious goal of eliminating preventable harm over a four year period, and we are on track to reach that goal.

Meanwhile, we decided that the only way to excel as an institution was to engage front-line staff in all job categories in a sustained and respectful program of process improvement. We tested this out with BIDMC SPIRIT and then moved to full-fledged implementation of the Lean process improvement philosophy.

Most recently, we "discovered" that patients and their families need to be part of the planning and management of the hospital. If our purpose is to deliver the kind of care we would want for members of our own family, incorporating the unique perspective of patients and their families is the only way we can achieve that purpose.

So, from the institutional perspective, that's why I have been here. It is engaging and worthwhile to be the coach and cheerleader for a fine organization like ours as we make progress in carrying out our mission. If you had come to me in 2002, 2005, or 2008, that's the answer I would have given. But I have gone through an evolution as to why I am here as a person.

My answer now is that I am here to be with people like Tom (below and also seen here with his friends.) Tom was very sick. When he recovered, he asked me to help as he devoted himself to helping other current and potential patients. I am also here to be with people like Mary, who feel comfortable enough with me to share very personal observations of things going wrong -- hoping that it will lead us to change practices, reduce pain, and save lives. I am also here, from time to time, to join patients who are dying and to have open and heart-warming conversations about things that really matter.

In short, I have learned to be here to be emotionally present as part of the human condition. There is no more dramatic place in the world than a hospital. There is pathos, humor, pain, and relief. I have allowed myself to be open to the possibility that the CEO can play a role that is totally separate from the business aspects of the hospital. People choose to invite me into their lives to a degree that is truly humbling. They offer me the blessing that my presence is helpful to them and others. I am ever grateful for that.


Anonymous said...

I have always felt the essence of a hospital is most movingly captured walking down its darkened corridors in the middle of a snowy night. All may be chaos outside, but inside there is a sense of another world of security and caring despite pain and sickness. There can be no more sacred place to work, Paul.


mikroenjeksiyon said...

A very emotional conversation. But good.

BIDMC MD said...

I am glad you feel the same passion for the pathos and joy of working with patients as we as docs do.

Barbara said...

To quote Winston Churchill:

"We make a living by what we get, but we make a life by what we give".

Keith said...

I very much like your approach and you have done a great job at working to make your instituion stronger with a focus on quality. It is unfortunate that more institutions have not done the same, and many now seemed too narrowly focused on fulfilling Medicare quality improvement criteria instead of improving the whole process of health care. Your approach stands out as unique.

What I find puzzling is the fact that leaders such as yourself want to motivate your employees to do better, but time and again, what I see is no tangible reward for the employees who do the hard work of instituting the plan and huge bonuses for those who think up the plan. I guess the guys at the top get the big bucks for figuring out ways to motivate employees without it costing them anything monetarily, and then they get to keep the extra cash for doing so! How do your employees get compensated for their efforts? Does it bother you when you and your administrative team get large bonuses and they get told they are lucky to keep their jobs let alone get a raise?

Unknown said...

Leaders lead. Leaders have a long term vision Thats what its really about. Thanks to Paul and others this is an organization dedicated to Transparency and Safety. Our Safety culture in the OR's is testimony to that top down involvement. It was difficult at first but we got there!
Hospitals are wonderful places to work and make a difference. However the healthcare process is still very complex and bewildering to most people. "Keeping it simple" should be our next goal. As Robert Frost wrote..."I have miles to go before I sleep...."

Bob said...

Beautifully articulated. Thank you.

Anonymous said...

Hi Keith;

I know nothing about BIDMC, but in my hospitals it's the consultants who get the big bucks. (:

nonlocal MD

Anonymous said...


There are many incorrect aspects in how you have characterized things surrounding motivation and compensation, but that topic is better left for another day.

Keith said...


This topic always seems to be hidden from view, although hopefully new IRS requirements will solve some of this. But it always seems to be a topic not easily reconciled with the ongoing lobbying of hospitals for more funding. I would very much appreciate it if you will explain it all to us at some point in your blog.

Keith said...

Nonlocal MD,

I don't know to which consultants you refer, but one pet peeve of mine is the immense amount of money that health care execs spend on these consultants when presumably we are paying them handsomely for their extreme insight and wisdom.