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Health Leadership P10

And the third time we will help you find work, and so ten percent of the people that wouldn’t take their shoe off were helped to find work at the neighboring hospitals, and I called them for Windber the gift that just keeps on giving because they’re being mean and nasty at the other hospitals, and people were like, “I don’t want to go back there. She told me I’m a jerk. She yelled at me and she wouldn’t let me –“ So they were gone. Ten percent gone. Then the doctor thing started, right? Well, I mean, I would have been unemployed if I had fired some of those original doctors in the early days, and so consequently it was how do we deal with this? Well, there are contracted doctors, anesthesiology, laboratory, emergency, X-ray, and these doctors typically are part of a larger group that cover multiple hospitals, and typically when you have that, there are at least a third of them who don’t ever want to be at your facility but are forced to because they’re part of the larger group.

And, I remember getting a phone call, like two AM because a husband was outraged because the anesthesiologist had been screaming at his wife because he didn’t want to come in to give her anesthesia to have her baby. Like she could have had any control over when the baby was going to come out. He didn’t want to get up at two o’clock in the morning. And so I met with him, I met with his boss, and I fired the group. They were good. And I went out and got another group, and the same thing happened with a couple of other groups, and after that, the medical executive committee took over, and when a surgeon would throw scalpels at an employee or scream and yell or take a fit or do whatever they did, not just surgeons, any of the docs, the medical executive committee would call them in, and they would say, “This is not the type of hospital that we have here. So you have two choices. One choice is that you can resign right now and go practice somewhere else, or the other choice is that you straighten up. We’ll get you anger management, we’ll do whatever we need to do, but if you do it again, we will take your practicing privileges away from you and we will report you to the national physician data bank.”

How cool was that? They got rid of the bullies, and the people that came there came because they wanted to be in an environment that was not a typical hard, harsh environment. I had an employee that had worked for me – well, not for me, but for the hospital – for twenty some years, and this employee decided to take me on over an issue here, and it was – plain tree is a movement, there are five hundred plain tree hospitals. We were the third one in the United States, and it’s basically a movement that says let’s humanize healthcare. That’s what the movement is, it’s an attitude. It’s give people access to their medical records, allow their loved ones not only to stay but also to become part of a care giving team. It’s twenty four hour visiting, it’s massage, aromatherapy, music, all those things that I wanted to do.

And so this person decided to take me on, and was wired to the board, and I let her go, and at the next board meeting, I had attorneys on my board, it was like I was on trial for murder, and they started just screaming. “You do not have the right to let this person go. This person’s been loyal for twenty-two years. Blah blah blah.” And it was interesting, because there I was with kids in college. I still owed seventy thousand dollars for my education. I had, you know, my wife was in school for her education, and it was like, and I stood up, and I said, “Then you don’t want me as your CEO. That you want to make all the employee decisions, that you decide who works here, who doesn’t, who’s hired, who’s fired, who will take your philosophy forward, who won’t,” and I started for the door.

Then the board chairman came and pulled me back, and we talked our way through it, and that was the last time that ever happened. So understand that this isn’t all painless getting there. Understand that it isn’t without risk, but also understand that if you have a passion and you have belief and you have a desire that you can change it, and you can make things work, and you can make things happen. So I ended up going through actually two, three – it took me three sets of vice presidents. Second group was all young guys full of testosterone fighting with each other over who controlled whom and not sharing and silos of power and whatever, and the third group was primarily women with kid, older men, people who were nurturers, and it was a nurturing environment that I was seeking. Now, if you’re running an ammunition plan, you probably don’t necessarily want a nurturing environment, but you know, it’s interesting, because I had a young woman that was a relative of the family who lived in our home during an internship, and she had gone to Geneva College, and she told me about a factory outside of Meadeville, and this was a steel fabricating shop.

Have any of you ever been into a steel fabricating shop? Yes, right? What are they typically like? They’re noisy. They’re dirty. Smoky. Very loud. So, tough environment. Tough environment. She described this steel fabricating shop. She said, “Floors were painted and spotless. There were cut flowers around in vases. The people were interacting at all times with their bosses. The boss knew every one of their names. He knew their birthdays,” and it’s like the waiting list to get into this place, and there was not a shortage of jobs at the time, the waiting list was two years long of people wanting to work there. Well, what was going on, again, was the Hawthorne effect.

The owner was taking responsibility to allow those employees to know that he cared about them, that he was involved with them, that their success was his success, his success was totally based on their success, and when they left at night, there was no company. They are the company. The employees are the company; it’s not the building. It’s not the CEO. It’s you all that are the company. So what happened? Patients loved it, family loved it, public loved it, media loved it. Most importantly, I loved it, and the greatest compliment I ever got was there was a review by the department of health, three nurses. The one nurse, she was in charge, and she turned to the second nurse at the end of the exit interview. Now, this is where they had gone through the hospital with a fine tooth comb.

They do it every year, making sure that you’re doing everything right so that you can get your license and get your medicare and whatever. She says to the second nurse, “Is there anything you’d like to say to Mr. Jacobs?” And she said, “Yeah.” She said, “This is the thirty second hospital that we have reviewed this year.” Thirty-two. And she said, “I’m from Philadelphia, and I called my husband last night, and I told him that no matter where I am, no matter what happens to me, I want you to bring me to this hospital.” It was the greatest compliment I could have ever gotten, and it’s like, you look at that and say, “Wow. This is a person that does this for a living, and they wanted to come to this hospital.”

And truthfully, I don’t ever want to go to a hospital that wouldn’t be like that. I’ve been to them. You know, you have your heart [inaudible] and they bring you bacon and eggs for breakfast and slap it down in front of you, say, “Well, I just had heart [inaudible], I have heart disease.” Well, so what? Here’s your bacon and eggs. So there were some things that didn’t work because when you take the power away from a bully and that’s their way of life, they become desperate victims. They don’t know anything else, and that happened to me with several people. And this was an old Nigerian saying. Your friends may come, your friends may go, but your enemies accumulate.

These are just some things that happened internally, I won’t go into all the details out of respect for those present, but here’s the thing I think that really, really, really made it fly. We began to celebrate. We had an offstage room where the employees could go to unwind where people didn’t see them feeling frustrated over dealing with some cranky old patient or whatever. We had parties. I was telling this story at a [inaudible] fortune one hundred HR speech, and I said, you know, we had buses to the Pirates games, and somebody put their hand up and said, “Was the for the bad employees? You made them go to the Pirates games?” So the future became a design function. The future became a design function.

Now, what does that mean? It means that we took ideas. What were some of the ideas? What were some of the things? Humanizing healthcare? Can you think of anything? Betty Grable got her thyroid removed. I mean, we took that, right? Can you think of anything we did? Baking bread in the halls. Yeah. Bringing dogs into the hospitals. Yeah. When you think about that, it’s like bringing a dog into the hospital? We did everything that was against conventional wisdom. Fountains. Dogs.  Twenty-four hour visiting. That’s all bad stuff, right? Bad. Terrible.

But we did all that, and what do you see the results? Because the results were not what any of us expected. Our emergency room visits tripled, which also allowed us to do this. We went from three hundred plus employees to seven hundred plus employees, we started doing pay per performance. There were people every year making eight and a half percent raises in the time when the rest of the world was making two percent, three percent because of the work that they were putting forth and the things that they were doing.

The average three year growth and net patient revenue in the state was 4.8. Ours was 21.58 percent. I was at a hospital in Alaska and theirs was about the same, but it’s because of oil. We didn’t have oil. We didn’t even have coal anymore at that time. Our donations over that five year period were over five million dollars in a town where the average income was twenty-two thousand. And there was nearly a hundred million dollars at that point in grants and contracts that eventually became two hundred and fifty million. We split it fifty fifty with Walter Reed to give us credibility of having a strong partner, and so 125 million dollar poured through for breast cancer research. Average Pennsylvania operating margin was .98 percent.

That was the average hospital in Pennsylvania. Ours became 3.36 percent. My last year at Windber, we brought in 2.3 million net in a fifty-seven bed hospital in western Pennsylvania where blue cross control the reimbursement and where our health system decided to pay us twenty percent less than blue cross was paying them, and they kept it kind of a secret for a long time. So that was millions of dollars a year less than other people were receiving. Our HCAP scores were – now, the HCAP scores are an interesting invention. It’s invented by the Federal government, and the concept is you’ve been in the hospital, we’re going to ask you stuff like how was it? Was your doctor good? Did you like your doctor? How about your nurse? Was she good? Was it noisy?

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