Health Leadership

watch the video at http://vimeo.com/20400332

Good morning everybody. I always like to start off with a few stories. Some of you may or may not know, but I was a teacher, and I started out, I have a master’s degree in trumpet and played professionally for about twenty years, but taught for ten years. I remember sitting in a teacher’s lounge once at one of the elementary schools because I taught elementary, junior high, and senior high, and one of the fourth grade teachers came in, and she said, “I just had a great class.” She said, “I had my kids working on reading about leaders and then making a little speech about.” These were fourth graders. And she said, “And one little boy, [inaudible] got up in front of the class, and he said, ‘I read about Julius Caesar. He was a leader. He made long speeches. They killed him.’” So I’m hoping that’s not the outcome from today.

So basically, what you’re going to hear about is what I call permanent white water. You’re going to hear about a journey through a time that, I believe, was a pretty difficult time, and a difficult time for this area. But the other thing is that it impacted me very much personally, and so I usually like to add a few personal stories, and one was that my daughter and son, when they were about six and eight years old, and I went to the old Richland mall, which many of you didn’t even know there was one, and we were standing in a book store way in the back, and my daughter was looking for books on the pony books, Pretty Ponies, what were those pony books? Anyway, she was looking for – what is it? My Little Pony. And my son was looking for Incredible Hulk magazines, and they were back in the kid’s section, and all of the sudden, in the front of the store, I saw this really big guy. Real long hair, big boots, and one  of those wallets with the chain that wraps around your waist so you don’t lose it when you’re on your motorcycle. And he locked eyes with me, and he started coming through the store at me at a high rate of speed, and I thought, “This can’t be good.” And he’s working his way up through that store, just totally focused on me. He gets up to me, and my kids are like standing there looking at him. He throws his arms around me, and he says, “Mr. Jacobs, I had you as a teacher. You changed my life.” And he turned and started to walk away, and my son said, “If he hadn’t had you as a teacher, might he have had a neck tie on?” Probably so.

So I’m hoping that I could help change your life a little bit in a positive way. Part of this story, part of this challenge is one of how do we get there, were did we go, how did we deal with it, and what I think you’ll hear this morning is that a lot of our challenges exist between these two cartilages here on the sides of our head. They’re inside our own brain, and so what I hope to do is take you on a journey that will point some of that out.

So I became the president of [inaudible] medical center in 1997. And I have a witness here today, so I will look to him periodically to shake his head like this and to agree with me. Rod, will you do that? See, he did it. So that’s good. And so basically, we were in a situation where we had just merged with the [inaudible] health system, and they brought Ernestine Young in, the accounting firm, and Ernestine Young did a study of the organization and came into my office and said, basically, fundamentally, it’s over. You are at about fifteen percent penetration of what at that was called managed care, and within the next three to five years, it’ll be at about thirty-five to thirty-seven percent. You can’t possibly sustain the organization. There’s virtually no hope for the hospital’s survival, and we should start making plans to transition it and close it down. That was my first month on the job. Shake your head. Okay, thanks.

So basically, we were kind of up against it, and I will describe the building in 1997. It was all pink inside. The whole building was pink. I had indoor outdoor carpeting in my, no, I had shag carpeting in my office that was about this deep and kind of dirty, and Brady Bunch furniture, like different colors of oranges and greens and reds and whatever, and I had a cardboard desk. I mean, it was pressed paper. And we had indoor outdoor carpeting in the OB suite with duct tape. And there were three computers in the building. So it wasn’t exactly a wealthy situation. They didn’t have a lot of money in the bank. I think it was a total of about six million dollars, and interestingly enough, this pronouncement is what kicks off this whole journey. Because it basically put me in a situation that I did not foresee, and it gave me power that I did not ever assume that I would have.

I reported to the board of directors out there, and that board of directors passionately wanted to keep their facility open, but we were just given this decree here that life was going to end as we knew it. And so what ended up happening is when I went to the board, who were looking at me as someone who was going to make this work, I said, “Look, here’s the deal. [Inaudible] declared it’s over. We can go out to [inaudible] lumber, we can buy plywood and deliver it one sheet at a time and start to board our buildings up. Or you can let me try some of these ideas that I’ve had for the past many, many years.”

And these ideas that I had came from the fact that I taught for ten years, I ran an art center in [inaudible] for five years, I ran a convention bureau in [inaudible] for four years, and got into healthcare when I was forty years old. And when I made that transition into healthcare, I have to tell you that it was a very, it was a very difficult transition for me. I remember the very first day on the job at the old mercy hospital. The elevator doors opened and the elevator was filled with people in scrubs who were coming from surgery to the cafeteria, and I remember hearing them talking about T and A, and I thought, “Oh, this is a pretty cool group of people. They had just come from hearing the musical [inaudible] chorus line.” That’s a song; you can look it up and find out what that stood for, but they were talking about tonsils and adenoids.

And I realized, at that point, that here I was, primarily a right-brained, creative kind of guy, in a left brain world. I was in a world where these people had really done well in science, and in doing well in science – they had raised the bunnies and fed them certain diets, and then they’d kill them and cut them open to see what happened to them. And I could never do the kill them and cut them open part. And so here I was coming out of a world of education, the arts, tourism, the convention bureau business, having worked with about 123 different hotels, motels, convention centers, and wondering to myself, “Why do they do it like this? Why do they treat people this way?” And I looked at where they were coming from, what their training was, and I looked at where I was coming from, where my training was, and I’d been doing a lot of flying. I just did Denver, Alaska, Iowa, all over the place. Florida.

And when I get on that plane, I really don’t know if the pilot is sober or competent. I’m hoping that the rules that company has are strong enough that they’re both sober and competent. I absolutely don’t know how the engines work. I know that sometimes it smells really, really bad if a bird gets in one of them, but I don’t know how they go, why that works. I don’t understand what makes the plane get up in the air in terms of the actual science of it all. But I know if the flight attendant or the [inaudible] is nice, I know if the plane is clean, I know if they’re polite, I know if their boarding process is good. When I put the tray down, if it’s dirty, it scares me, because if they didn’t take care of that tray, what are they doing to that engine?

Well, try to imagine – and you can imagine because you probably all experienced this – walking into a hospital. You hope that whoever’s running the place has the right equipment there and that it’s good equipment, and you pray that the people that are running that equipment are at least certified and know how to do it and have competencies in that area. But you don’t know. You really don’t about any of those things, and so what can you judge it on? You can judge it on how people treat you, how you feel about the experience, how people address you, how they work with you. And so my whole thing coming into healthcare was why do you treat people like lab rats? Well, because they were trained to work with lab rats.

And so how can you change? How can we marry these two worlds together? How could you take some of this right brain, creative, sensitive, emotional stuff and bring it in more with the left brain world? And I could tell you when the TV series House began winning all of their – what do they win, Emmys? Daytime Emmys, nighttime Emmys – it really was disturbing to me, because that is the [inaudible], that is the person who is praised for being brilliant, but he can be ignorant and mean to people. It’s the diva mentality, and that’s where I saw things not working well in healthcare. It’s like when I went to music school, you could go down one track and you could be a soloist, or you could go down another track and you could be a solo player that worked in ensembles and worked with people. And on the solo track, the world revolved around you. It’s like the old joke, how many neurosurgeons does it take to change a light bulb? One. You hold it in their ear and the world revolves around it.

And so you’re trained to be a soloist and you’re trained to be a diva, and if any of you have ever worked anywhere in any capacity where a star comes to town, and they send a contract along, it’s things like, I remember when Bob Hope came to town. I have to have all feather pillows, the windows have to open in the hotel, I have to have a double suite, I have to have a massage at midnight, I have to have – I mean, the riders that go with these divas are pretty crazy. Well, what happened in hospitals is it evolved out of warfare, so all the training was triage warfare, hierarchical training. It was all Socratic where people literally were screamed and yelled at if they didn’t perfect things.  And then they would do the same to the people beneath them. They were trained a certain way, and they treated everybody else that way. So by having this interesting situation, we had an opportunity to make things work.

And so creative thinking, creative ideas, creative approaches, creative relationships, but it all boiled down – I mean, solutions – but it all boiled down to relationships. It all boiled down to what is happening between you and your customer, you and your client, you and your peers, you and your boss. That’s what it really boiled down to. How do we get it through to these employees and to the physicians and to everybody there that this may be your 475^th tumor, but it’s their first one? How do we get through to them that all of us spend our whole life trying to preserve a little bit of dignity, trying to be okay with ourselves, and the first thing you do when you walk in a hospital, someone says, “Okay, take off your clothes, stand on your head, I’ll get to you into forty-five minutes or whenever I get to you.”