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Health Leadership P8

Does anybody know what they are? What are trans fats? Does anybody know? They are manufactured. They are genetically manufactured. They are changed – I don’t know about genetically, but chemically changed, altered, to increase the shelf life of food. So as a manufacturer, if you make bread, it will last longer if you use trans fats. And that seems like a good thing for whom? The manufacturer. I remember as a kid, “Don’t eat butter, eat margarine!” And you could put the margarine in the middle of your table and not refrigerate it, and it would lay there for a week, you know, and it’s like, you could still eat the margarine.

I had a college professor once that went to a fast food restaurant, bought a milk shake at the beginning of the semester, put it on top of his book case behind his desk. At the end of the semester, brought it down and drank it to prove that it had not spoiled. There are hot dogs in landfills that are sixty years old, still completely intact. So we can make food cheaper, but what is it doing to us? Because now, instead of 9% on our healthcare, we’re at 18%. Instead of 18% of our food, we’re at 9%. So here we are in this geography, and one of the main engines of the geography was ripped out. And what happens? And how do we sustain this?

If we want to stay here, if we want to have a future here, if we want our children to grow up here, what are we going to have to do individually and collectively to make this work? We’re going to have to pick up the slack. And how do you pick up the slack of someone who is essentially a cardinal, you know, at the American Vatican called Washington DC? How do you pick that slack up? You don’t do what you’ve been doing. You don’t just keep doing business as usual. You can’t. You can’t afford to. You can’t afford to. Windber Medical Center was gone.

Gone. Gone. I had a couple kids in college, you know? I had some big bills to pay. It didn’t meet my needs to have it go away. It didn’t meet my needs to have to relocate. And so I said, “Let’s do it differently. Let’s make the best of a hospital, the best of a spa, the best of a hotel. Let’s found a research institute. Let’s not be the flea that’s banging your head against the top of that lid.” And you know what, I could spend four hours telling you all the things that went wrong and how hard it was, but that’s not the point. The point is everything makes sense in a large enough context. And you need to sense what is happening and let it happen and be alert to your changing environmental conditions, reframe your limitations to become opportunities.

I mean, where could I have had a better opportunity than a hospital that was going out of business? Nowhere. Nowhere. No one would have given me that power. They wouldn’t have done it, and [inaudible] I look back at what I really was impacted by there, I walked into there [inaudible] care unit, their hospice. It was the first rural hospice in the United States. It was started by a visionary CEO who I believe either worked at the Mayo or the Cleveland Clinic and was killed in a car wreck about a year into his tenure. But he had this idea, and he worked with a doctor, and they opened the first rural hospice in the United States in Windber in 1977 before anybody would pay anything for it.

And I walked into this hospice for the very first time, and you know what I saw there? I saw people being treated with dignity. I saw people being treated in a manner that grabbed my heart. There was a guy with his loved ones, and it was after eight o’clock at night. I thought wow, that’s pretty wild. Visiting hours are over at eight because that’s the calf path we follow. I went to the next room, and there were a bunch of people, and they were singing. And I thought wow, they’re singing, this is after hours. It’s supposed to be quiet here. It was nine o’clock. I went to the next room, and the guy’s dog was in the room with him because he was dying and he wanted to see his dog. And I went to the next room and I heard someone say, “Yes sir, yes, we’re going to have the van out here tomorrow.”

His last wish was to go fishing one more time, and the nurses loaded him up and took him fishing. And I thought, “Why do we have to die to be able to be treated like this? Why do we have to be dying before people give you permission to treat other human beings as human beings? To nurture them? To care for them? To hold them? To feel for them?” And so that’s the premise upon which I made my statement. You love the hospice? Let’s do what you do in a hospice. That’s where it came from. So then I went to the employees, and Rod may or may not remember this, but I met every single employee in that hospital in my office the first two or three weeks I worked there.

Everybody came in. They had seven minutes. Five to seven minutes. Me and them. A chair, a chair. That’s where my house is. If you need to kill me, you know where to find me, you know? My door is always going to be open to you. Tell me about your family. Tell me about your dreams. Tell me about this place now. Trade seats with me, and tell me if you were the president of this organization, what would you do to make it better? And I took copious notes, and when I retired, I found that folder with all those notes in it, and we implemented hundreds of those ideas. And we learned more in that two week period than we would have learned in ten years. We know who was sleeping with whom, who took what parking place. We knew who was stealing, we know who was drunk, we knew who – it was just an unbelievable education. If you ever get a chance to be the head of something, take the time, take five minutes, and spend it with each employee, and you’ll hear stuff that’ll blow your mind.

But it’ll also educate you. I got more education in that amount of time than I could have ever gotten in ten years. And then we talked about the fact that we’re going to have to change, and we’re going to have to change in nontraditional ways, and so we had town hall meetings around the clock, and we had something called pizza with the president. For their birthdays, they got invited to come in, they could ask me anything they wanted and I had to answer it. It was their birthday present. So we were transparent. We showed them our financials. And sometimes it wasn’t a good thing for them, because sometimes it was very painful, and they were very scared, just like me. But you know what? At least they knew what was going on. They didn’t have to go home at night and make up all the bad stuff like we all have to do usually, because we don’t know what’s going on. So we get all paranoid. We go home at night, we say, “Oh, the sky’s falling, the sky’s falling and little black ghosts are coming and pulling us into the sewer.”

And so we were open, and we were transparent. And we started with the twenty-four hour visiting, and loved ones were invited to stay over. I mean, I have to tell you, when I said we were going to invite loved ones to stay over, you would have thought that I said to nursing, “Okay, ladies, gentlemen, here’s the deal. Bring your firstborn child in, stand him in front of the hospital, and I’m going to kill him.” I mean, that’s the way that was received. Resistant to change is an understatement. When we decided to change the walls from pink, doctors were coming into my office saying, “If you do that I’ll take my patients to Memorial and to [inaudible] and I won’t come here anymore,” because we’re painting the walls.

Resistance to change. The good news is I was on my honeymoon, and so they weren’t going to fire me in the first six months because they’d have to pay my contract. We asked for double beds in the OB suite. I went to [inaudible], the bed manufacturer, and I said, “I want double beds in the OB suites.” They said, “No. We don’t do double beds. Nobody does double beds.” I said, “You know, they made a baby together. Would you mind if they slept together after the baby’s born?” “Well, we’d  have to make special beds. Blah, blah, blah.” We got double beds. Guess what? Everybody used them. They liked them. Duh. You know? We could sleep a family of four in a palliative care unit with balconies and special bathrooms and a private kitchen where you could go, and if your loved one wanted brownies one last time before he left or she left, you could go make brownies. You could lace them if you wanted to. I didn’t care.

So the first [inaudible] came from the palliative care unit, and initially, the board and the management team and the medical staff verbally supported the concept. “Yes, we love our hospice. Yes, this is a great idea. Yes, let’s do it, let’s do it, let’s do it.” Within about eighteen months, this is what they realized I had done. The power went from them to the patients and their families. Now, understand I had one group of physicians who were primarily Windber [inaudible] guys and no ladies, and then I had a group that were from the Philippines. There were two power bases, and periodically, the heads of each group would come into my office and say, “If you don’t do what I tell you to do, we’re going to close this place down.”

I mean, if I could play that recording back for you, the number of times I heard it, you’d all just fall asleep because it’d be so boring. Over and over and over and over and over. And how are these people trained? They were trained like House. They were trained to be what? Do you know what the great description would be for that? It’s a real popular word right now. Anybody know what it would be? Bullies. They were trained to be bullies. In fact, a lot of them had probably been bullied in junior high school, and now it’s like revenge of the nerds, you know? It’s like they were trained to be bullies in medical school, and so it’s like if you don’t do it my way, I will take my ball and go home, and you will be out of work and I’ll close this place down.

That’s what I was up against. That’s the kind of push back, irrational push back, resistant to change. The paint was the first major one, then one time – we had something called spiritual touch. Any of you ever hear of spiritual touch? I had never heard of it. I didn’t know what it was. Spiritual touch does not involve touch. It should be called spiritual not touch. You know, the patient’s laying here, and someone who’s been trained to do this basically stands over the patient, closes their eyes, and kind of does this. Now, for some people, this has a huge, unbelievable impact on them. I don’t know what it is, and I don’t care what it is, because their whole thing is they’re moving energy fields and they’re moving, you know, the chakras and all that stuff.

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Health Leadership P7

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Any of you ever get a chance to look into a big time microscope? Like, a really good one, not necessarily like what we had in high school labs, but like an electron microscope or anything like that? If you look into a really good microscope and you put a drop of water in there, do you have any idea what you see when you look into a really high powered, incredible microscope at a drop of water? What do you think it’s like? It’s an entire universe. I mean, it is a wild, wild experience. You see all these amoebas, like, driving to the laundry and going shopping, and I mean, it’s just all kinds of stuff going on in that drop of water. It’s wild. It’s fun. It’s like a whole civilization. A single cell civilization, but it’s a civilization. There’s all this movement going on.

It’s really, when you think about it, this is a drop of water. It’s infinite, what’s going on in that drop of water. And then if you look into, like, the Hubble telescope, and you’ve seen pictures from the Hubble telescope and you realize that whatever the number is, I’m going to make this up, two hundred billion, two hundred billion stars the size of our sun. Two hundred billion. Think about the sand at the seashore. Two hundred billion stars the size of our sun. It’s endless. It’s endless. And so you look at the universe out there and you look at that microscope down there, and you say, well, what are our limitations? What are the limitations? Because there are endless possibilities when you think of things in that scope.

Now, let me ask you this. When you’re flying around the world, outside, you know, the earth’s atmosphere, in a spaceship, and you’re looking down, what do you see? Blue. What else? White. And if it’s night time, lights. You see blue, you see white, you see lights. Do you ever see the [inaudible] county line? The border? No. Do you ever see the [inaudible] town city line from outerspace? No. Unless it’s a river, you know? What color is this? What do you think? Alright. So three people say this is red. Anybody disagree with that? It could be burgundy, it could be maroon, but we’ve got three people saying it’s red. Now, is it red, or is it something that we agreed to call red?

It is, right? We agreed that this is red, and what color is that top you’re wearing? We agree to call it white. This might be chartreuse in some other realm of reality, but we’ve agreed that that’s white, and we’ve agreed that this is red, and we’ve agreed that there is a boundary where when you’re speeding from one state to the next, the hats will be different on the policemen that write you tickets. Right? It’s going to be you’re crossing from Pennsylvania to Ohio, do you really know that? Do you see a line? No. These are things that we have agreed to, and sometimes we’ve agreed to it over millions of gallons of blood, because we’ve fought and killed and done whatever to get land, right? And to say that that’s our border and that we own that, but do we really?

And what, really, are the boundaries, and what are the limitations? The limitations that you all face in your life are by and large self-imposed. By and large, they’re self-imposed. You are limiting yourself, thinking this is red. It’s like limiting ourself to thinking about just one dimension. I mean, if you read the work of Albert Einstein and you start to understand time and space and relativity and different dimensions, it’s like all of a sudden, your opportunity to be more open broadens, because in that description of time and space and where we are and how we fit in, there are other opportunities out there. We are just familiar with this one, and this is the one that we embrace.

But this is also the way we put limitations on ourselves. This is where the calf paths come in. We take – it’s black and it’s white. Nothing against accounting. But that’s your world. It either is or it isn’t. The money is either in the bank and we can count it, or it’s not in the bank and we can’t count it, and I don’t care what you tell me about where it is in the pipeline, it’s not in the bank, so that is either black or white. Am I right? And so many of us come from professions where you either make the sale or you don’t make the sale. You either got the check or you didn’t get the check, and there’s no in between. But that is what we impose upon ourself, so when you’re creating and you begin to realize that nothing has to be the way that it is and that we can either invent, we can take that shoe off, or we can prevent our futures, we can prevent it by never taking our shoe off ever.

Don’t take it off, don’t participate, don’t think outside that box. I met a guy once who met a guy who trained fleas for a flea circus. I said [inaudible], how do you train fleas for a flea circus? He said, “It’s pretty simple. You put the fleas in a box, you put a lid on the box. The fleas jump up and down and hit their little head on the lid. And they do it a thousand times. They just keep jumping, hit their head, hit their head, hit their head, hit their head, hit their head, fall down on the bottom.” He says, “Then you take the lid off, and guess what happens.” What do you think happens? They never jump higher than the lid was. They’re trained. Don’t ever do that because you might hit your head again. That’s how we’re trained, too. You know, you hit your head, you hit your head, you hit your head, you said, “I’m not going to even try it, because I might hid my head. I quit.

I’m not going to reach out beyond my comfort zone, I’m not going to take my shoe off, I’m not going to allow myself to be challenged in a way I’m not comfortable with, I am not going to bother to grow because I don’t need to. I’ll work within those boundaries, those township lines, those county lines, those city lines that are in my mind, and I will live there and I will stay there.” That’s what we do. That’s what we do. So there are no boundaries, and all the limitations that you have are self-imposed because the universe is really one connected fabric. Whether you’re religious, whether you’re not religious, whether you believe, whether you don’t believe, none of that matters.

It’s all tied together somehow. I don’t know how necessarily, but you know they can get a moon rock and find qualities in that moon rock that you’re going to find in man. You know that there are, somehow there’s a web that ties us all together. You know. I don’t know. I’m not here to tell you one religion or another. I’m not here to tell you one articulation of one holy book versus the other. All I’m here to tell you is that somehow it’s connected. So here’s this universe that’s connected, and there’s  a fabric that connects it all, and then the issue becomes what is the vision for your own future? Because you have the ability to create a new world order. You, personally. You.

Remember the old thing, it’s like, you know, one man, one person has the ability to change. Like Tiananmen Square. There’s a great little quick video I call the power of one. Did you ever hear of it or see it or know anything about it? And it shows how individual people in this humankind, in this spectrum of life, how individuals stood up to something or invented something or stopped something or created something, individual people, because of their passion, because of their belief, because of their commitment, because of their ability to jump beyond the top of the flea box.

Because of their ability to see things just a little differently than your peers, than the people around you. Because, by and large, we are surrounded by ho hummers. Ho hum. Another day. I used to have a college roommate that was a 4.0. Graduated top in his class, and he’d walk in from class every day, and he’d go, “Another day. Another A.” I hated him. So we have the ability to do it, and once we’ve totally accepted it, we can change it. Now, why is this so critical to us right now? Why is it so critical to you right now? I’m in Pittsburg. You’re in [inaudible]. What one major significant thing has happened here in the last nine or ten months that absolutely will change the fabric of this area without a doubt? What’s the most significant thing that’s happened? Can anybody think of anything?

Pardon me? Mr. [Inaudible] died. I think he was killed, but that’s a whole other story. I do. I think if they had taken the mask off, it would have been Dick Chaney and [inaudible] doing the surgeries. I’m not sure, but you don’t die from what he died from, but that’s a whole other discussion. So Mr. [inaudible] died. How could that change things at [inaudible] group? There it is. There it is. How could it impact current technology? Absolutely. How about [inaudible]? They’re not investing here. That’s right. What about JWF? Yes you do. Yeah. What about Memorial Medical Center? Less patients. Less need for employees. UCP. Yeah. Less consumers. High market blue cross. Less customers, less consumers.

Barnes and Sally. Okay. So this is a common theme we have going on here, isn’t it? So now you’re in a situation where you’re saying, “Okay, he’s dead. He’s gone. He was great for the area. He created thirty thousand jobs. He helped us in so many ways. Where do we go from here? Do we pack up our tent? Do we put our house for sale? Do we just keep letting things deteriorate?” I grew up in Fayette county. They used to call it Fayettnam. It just kept getting worse and worse and worse. It was the [inaudible] and coke capital of the world during World War II.

I mean, as a kid, I can remember my parents would take me for a drive, and all you saw were empty coke oven where they made coke from melting steel. Thousands and thousands and thousands of them. And then the process changed. The demand changed. The geography changed. And then every member standing in line in the supermarket behind everybody who weighed 350 pounds was on food stamps. It’s interesting. About nine months ago I had bronchitis, and I couldn’t sleep, and I turned on the TV, and Oprah came on. I had never watched Oprah. I had heard a lot about her; never watched her. And she had a guy on that just wrote a book, and the book that he wrote was about food, and he said, “You know, in 1960,” that would have been my era, “in 1960, we didn’t eat out a lot.”

And I always thought it was because we were cheap, but he said it was because food for a family in 1960 cost you eighteen percent of your family income to buy food and make it yourself. Eighteen percent of your family income. Ironically, healthcare in 1960 was only 9% of your family income. Guess what it is now. Food is now 9% of your family income, and healthcare is 18%. So we can make cheap food, but don’t try to live on whatever. Big Macs the rest of your life. You’ve seen that show, too. So you start to look at this and say oh, yeah, we can make cheap food, but you know, something that takes water and flour and sugar all of a sudden now has a list of chemicals this long to make the shelf life last longer. I remember walking beside a scientist, and he said, “The greatest experiment ever perpetrated on mankind without his permission was trans fatty acids.”

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Health Leadership P6

So I wrote a grant and we got our first monies and we opened up clinics in both places and shared employees back and forth between Walter Reed and Windber. Anyone ever heard of Windber? They go “Windber?” I remember Dr. [inaudible] saying, “What do you want from me?” I said, “I want you to take the question mark away from the word Windber.” Now, where did this come from in my mind? Well, in 1992 when a nun said, “You’re out of here,” I had a job interview. It was in Omaha, Nebraska. I could tell my wife cried the whole way out and the whole way back. So I knew I wasn’t going to get to move there unless I got divorced. I mean, that’s where it was. But I get out there, and there’s this little hospital in the middle of Omaha.

Now, the difference between the look of that hospital and the look of Windber hospital was in the parking lot, everybody had clubs on their steering wheels to keep their cars from being stolen. In Windber we had guns. So you walk into this place, and here is this hundred bed hospital in the middle of Omaha, and on the top of the building it says, “National Research Hospital.” And I’m going, “Oh, yeah. There’s some real serious ego stuff going on in this place. It’s a hundred bed hospital. It’s not associated with a university. It’s not associated with the NIH. It’s just a little hundred bed hospital.”

And I walk in, and I meet this feisty little [inaudible] priest, and he happens to be the head of a place that some of you may have heard of called Boys Town. Did you ever heard of Boys Town? It’s kind of like Hershey. It was started back in the 30s for kids who were poor and their parents died, and to help them get through that. Well, this guy, this priest says to me – I said, “What’s the deal with this national research hospital?” He said, “You know what the deal is? I got this idea, and I hired three PhDs, and I hired three more, and I hired three more.” He says, “I have 38 PhDs in 1992, and we are a genome center.” And I thought that’s the guys who made the cookies. I didn’t know what genome center was in 1992. And he says, “And we’re going to crack childhood deafness and blindness through the study of genomics.”

Whoa. That’s a pretty big deal. And it stuck with me. I get the job at Windber. I go down to the Arcadia theater, and I’m on the board, and this little old bald guy comes up to me. He’s probably my age now, but at that time, a little old bald guy, which I almost am. Bald. I’m old. But anyway, he walks up to me, and he says, “You know, you know, I used to head up the radiology school at Windber.” And I’m going, “There was a radiology school at Windber?” He says, “Yeah.” He says, “We removed Betty Grable’s thyroid.”

Now, for those of you who have never heard of Betty Grable, she was this really hot movie star in the 40s and 50s. She was, I think, the very first person who ever had her legs insured by [inaudible] of London for a million dollars in 1940 whatever, because she was the pinup that all the army guys and the Navy and the Marines and the Airforce – she was a hotty, okay? He said, “Yeah. She came to Windber to have her thyroid removed.” And I’m going, “Are you kidding me? How did she even get here? We didn’t even have a Fisher Price airport in those days. How would you get from Hollywood to Windber to get your thyroid removed? And why? Why would you do that?” He said, “Well, we did Arthur Godfrey’s, too.”

Well, Arthur Godfrey was a famous TV star from the 50s and 60s, played the ukulele and sang. He said, “He came up at 10:45 at night knowing [inaudible] was there, took his thyroid out, and he went home.” He said, “We did Jenny Woolworth.” That would be the equivalent to the Dollar Store now. It was Woolworth Five and Dime. And I’m going, “Jenny Woolworth, Betty Grable, and Arthur Godfrey came to Windber? What? What?”

So I started to look into it, and I found out that two of the surgeons that worked there were very progressive surgeons, and when the [inaudible] company started that hospital, one of the Bowen brothers said, “I want this to be a cutting edge, leading edge hospital.” In the 20s. And these guys studied in Austria with an Austrian surgeon, and they were in class with two other people whose names you might recognize. They were in class with the Mayo brothers. That’s not that jet pilot thing. Mayo clinic, okay? So the Mayo brothers were in class with these [inaudible] guys from Windber, and they’re learning to do thyroid surgery where they do an internal stitch and a very tiny external stitch, and guess what happens when they’re done? There’s no big scar. You don’t look like the bride of Frankenstein.

Now, why would Jenny Woolworth and Betty Grable and Arthur Godfrey want to do that? Well, they didn’t want to look like they had thyroid cancer or whatever. And why else would they want to do that? They found out that these guys worked periodically out at Johns Hopkins. Now, they could have gone to Johns Hopkins and had it done, but who hangs around big cities? Reporters. Paparazzi. What happens? They find out you’re there. You’re Betty Grable, and all of a sudden it’s the front of the National Inquirer that you have thyroid cancer, and you’re like, “Naw, we were seeing Michael Douglas. He’s dying. He’s dead. He’s gone, and now she’s pregnant again.” It’s like that kind of stuff that’s going on. I made that up. I don’t know if that’s true. He says he’s not. And she says she’s not.

But having said that, it’s like okay, let me think about this. Where is Rochester, Minnesota? Anybody ever heard of it or been there? Rochester, Minnesota is where the Mayo Clinic is. It’s nowhere. It’s nowhere. And before the Mayo Clinic became the Mayo Clinic, it was kind of Windber. And how about the [inaudible] health system? Any of you ever hear of the [inaudible] health system? Anybody know where it is? Anybody know? Danville. Any of you ever been to Danville? There’s a Red Roof Inn and a Burger King and a bunch of houses that look like Windber, because it was a logging town, and in this 4.5 billion dollar health system.

So it’s like, huh. Genome center. Mayo brothers. Danville, Rochester, Windber. And we had something that they didn’t have: connectivity. I mean, this is the only time in the history of this world that you could be sitting here and somebody riding on a camel on the [inaudible] could be texting you on his satellite phone saying, “Hey, how’s it going, Michelle?” Right? Am I right? Somebody in the Himalayas could be contacting you right now and say, “Did you remember to get milk?” I mean, my son in law was deployed for a year in Iraq, and two or three times a week we’d sit and watch him and talk to him on Skype. We’re connected. For the first time ever, probably since Adam and Eve, worldwide we’re connected.

And what’s going on because of that, it scares people that don’t want to take their shoes off and wave them. It scares them desperately, which is why there’s this ultra conservative movement going on internationally. There’s an ultra-conservative movement to pull it back, take us back. Not ten years, not twenty years, not thirty years. Take us as far back as you can when it was safe because we don’t know what this all means right now, and it scares us.

I heard an anthropologist talk about the fact that all the tattoos, there are 50 million people in the United States with tattoos now. I mean, my daughter came home from college and she had a little daisy on her back, and I said, “You know, that could eventually turn into a sunflower.” You have to worry about stuff like that, right? So the tattoos, the piercings, it’s tribal. This is all tribal. It’s like, let’s preserve something that we’re familiar with and let’s associate in that manner.

So you look at that and say, “Okay. Change is happening. Why couldn’t it happen here?” Well, we have the internet, and we were the first place in this area to have OC48 dark fiber lines, which meant, it was like the equivalent of having a telephone line that covers Washington to Baltimore and Windber.

So why couldn’t it happen here? You don’t have to be sitting in the middle of a library somewhere to communicate with somebody with ideas. So what I found was if you work half the time in areas that you don’t know like genomics and proteomics and whatever I ended up being thrown into and half the time somewhere else, you’ll grow from it.

Well, this young colonel walks into my office because I’d written a grant for breast cancer research and was denied on the grant, and I rewrote it and resubmitted it next year, and we got 7.5 million dollars. And this colonel walks into my office and he says, “Well, Mr. Jacobs, you’ve got 7.5 million dollars coming from the army to study something dealing with breast cancer. What do you want to do? What do you want to do?” And I said, “I want to be the genome center for breast cancer for the United States military.” And he said, “Well, as long as we’re doing genomics, we probably should do proteomics, too.” And I said, “We might as well, because I really don’t know what either one of them are.”

And that’s how it started. We were literally standing in a gravel floor beneath a hospice at Windber with nothing there yet, and I said, “So what do I do now?” He said, “Form a corporation, a research institute. Non-profit research. I’ll recruit the beginning of the PhDs. I’ll get that started for you. But you need to have a research institute.”

So I went to my boss and I said, “I want to start a research institute.” And he said, “You idiot,” and he laughed and scoffed and said, “Get the heck out of here.” He didn’t really say heck. So I go to my board chair, and I said, “Well, I tried to get him to start a research institute with me and he said I was nuts.” He said, “Good, we’ll start it separate. We’ll do our own.”

So we started a separate non-profit corporation called the Windber Research Institute, and the first three scientists they recruited were from the University of Maryland, and these guys and lady walked into Windber Medical Center, the new Windber Medical Center at that point – and this isn’t an advertiser for Windber. I’m detoxed. I’m not there anymore. I don’t care if you ever go there. But my point is they walk into this place, and there’s bread baking, and there are golden retriever therapy dogs, and there are guitar players and harpists and violinists, and there’s popcorn in the lobby, and there’s 24 hour visiting, and there are double beds in the OB suites, and there’s a workout facility in a town of 4700 people that has 1350 members allowing us to deduct the money every month from their checking account, and they walked through this place, and they go, “Man, if you can do this, you can do a research institute. We’re moving here.”

That’s how it started. And we ended up with 50 scientists. But it started from an idea, from designing a future, from some luck, and from having big dreams. That’s what started it. I’d like to talk about a ten minute break and come on back. Thanks.

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Health Leadership P5

I don’t know why, but I can tell you I’m walking beside the protein scientist. And remember, the proteins are the guys that are really wreaking havoc in your body. It’s the proteins. There’s thirty thousand genes. There’s three hundred thousand proteins, and the genes say to the proteins, “Give the guy heart disease, spread it around a little bit, do your thing,” and they’re out partying, doing their thing. So it’s the proteins that are causing the problem. So I said to the proteomic scientist, I said, “You know, I’m a musician, first. I’m a musician. Can you talk to be about music and genomics and proteomics?” And the gene scientist said, “Well, it’s the same. Like, it’s letters. The genetic code is letters, and the way those letters are placed and the order of those letters are like the chords in music.” And they are. Some are colored, some are basic. Some of them make impact that changes things dramatically, and others don’t. They’re just part of the core feel for what’s going on. And I said, “What about the protein thing?” And he says, “Well, I’ll tell you about the protein thing. The proteins actually move and fold and vibrate with music and sound.” “Really? Do we know what they do when they move and fold and vibrate?” “No, we don’t.”

The indigenous man, maybe he did. Maybe that’s the placebo effect. Maybe what’s happening is that certain combination of notes, that certain series of sounds is causing cures or placebos or whatever to kick off endorphins to make you feel better. I mean, we started baking bread in the hallways. Every day, bread machines all through the place. Why would we bake bread in the hallways of a hospital? Do you have any idea? What do you think? What do you think of when you smell bread? Do you like the smell of bread? What’s it remind you of, Michelle? Yeah, or somebody’s home. Grandma, aunt. Comfortable. And they always tell you – is there anybody in real estate here? Probably nobody left in real estate. They always tell you that when you’re selling your house, bake bread, right? Right? And put flowers out and whatever. It releases endorphins. The smell of fresh baking bread releases endorphins. It makes you feel better. It makes you better.

And I did that, and the state department health [inaudible] said, “You can’t do that.” And I said, “Well, why not?” “Well, I don’t know. You can’t bake bread.” I said, “Well, why can’t we bake bread?” “Well, no one’s ever baked bread before. And you can’t have these decorative fountains in here.” “Why?” “Well, they’ll cause legionnaire’s disease.” I said, “Well, we clean them.” “We’ve never seen that before.” That’s the kind of stuff we were up against.

The other thing we needed to do was become the employer of choice. How does one become the employer of choice when you have three big beasty hospitals cleaning your clock? How do you do that? How is it that you go from being the lowest, lowest, lowest dog on that totem pole to being the employer of choice? I have a two hour program I could answer that question with, but the reality is – how many of you have ever heard of the Hawthorne effect in business school? Any of you ever heard of the Hawthorne effect? So the Hawthorne effect was back in the early 1900s, the industrial revolution, people walk in and the look at all the people working in a factory, sitting at a sewing machine or doing whatever it was, and the Hawthorne effect was let’s do something to show that we’re paying attention to those people. And so they dimmed the lights, and the people worked harder. And then they thought, “Well, dimming lights worked. I wonder if raising the lights would work.”

And they went in and they raised the lights, and they worked harder. And it’s like, wait a minute. Was it really about the lights going dimmer or the lights going brighter, or was it the fact that people saw that we were paying attention to them? That we were noticing them? That we were caring about them? That we were investing intellectually and emotionally in their wellbeing?

And so to become the employer of choice, all of you, as leaders, have to realize the incredible impact that’s available to you by paying attention to the people with whom you work. And so we started to pay attention to them. And it took me a while, because we didn’t have the money to pay attention the way they wanted to be paid attention to, but we eventually started getting enough money in that we could pay more and more attention and do things that were really impactful. But before that, going through the place with the vice presidents and a push cart giving out smiley cookies on a rough day, like turn the lights up, turn the lights down. Sundae carts, going through, making sundaes, giving people sundaes, just saying, “Thanks for your hard work. We care about what you’re doing. You made a difference here for us.”

So we have the power to change the reality, and we have the ability to make things be some other way, and we definitely have the capacity for self-design. We definitely have that capacity, and we have the ability to modify our environment. All those things are built in to us, and you’ve all done it at some point in your life, whether it’s just within your own families, whether it’s in class, whether it’s in a club, whether it’s with a sports team, whatever, we have the ability to change things. And so we have to decide what kind of future it is that we want to occupy, and then we have the ability to design that future.

And one of the things I learned, okay, so I’m in the hospital and I’m working, and I’m doing some crazy stuff. You know, bread and dogs and fountains and crazy stuff. And Mr. [inaudible] decides that it’s fun. He came out and visited. He said, “This is nuts. This is great. It’s fun. I like this.” And I’m sitting beside him one day at dinner, and I didn’t – I knew him, but I didn’t know him. I didn’t know what he did. I knew he was a congressman, but I didn’t know what that meant. And I was on a special program for heart disease at the time, and I was supposedly eating vegetarian food, but the woman that had the dinner didn’t know what to give me, so she gave me this great big white plate with two egg whites on it.

So here’s this place that’s about this big with two little egg whites in the middle, just egg whites, so they’re not even looking up at me, and I’m sitting beside congressman [inaudible], and he looks at me, and he says, “What the hell’s wrong with you?” He’s got this plate all piled up with mean and good stuff, and I’m eating these two little egg whites. And I explained to him that I had just come from a program where I met 23 people who were basically given six months to live twenty years ago, and I had seen their pet scans where they had reversed their heart disease.

It’s kind of like I cut myself a couple weeks ago, I hit the counter of my kitchen and I tore my arm, and I watched that day by day by day. What does it do? It gets better. It heals. And nobody ever thought we had the capacity to get rid of heart disease. Like once you got it you got it, you’re now a victim of heart disease. You’re going to live with this your whole life, then you’ll die. Right? You might get open heart and get some stints and get this and get that, but you have heart disease, and that’s it.

Now, one of the reasons that this theory that was put into place was not embraced by the physicians was because they themselves could not project themselves into doing this stuff because what did it require? It required human behavioral, what’s the key word here? Change. They couldn’t imagine themselves taking time each day to do a little bit of stress management. They couldn’t imagine themselves not eating ribs and chicken wings. They couldn’t imagine themselves exercising, which is why our physicians typically die ten years before we do. Before their patients. And so they couldn’t endorse something that they didn’t believe would work, but I’m sitting beside the congressman, and I’m eating my two little egg whites, and he says, “You know, we’re spending a billion dollars a year on heart disease, a billion dollars a year on heart disease in the military.”

And that was in 1998 or 99. A billion dollars a year. And that was before Iraq won – no it wasn’t, it was after Iraq won. It was after Iraq two. It was before we started sending all the national guard over who were ten years older who all had heart disease pretty much, because they were overweight, they weren’t in shape. They were flying more people to [inaudible] Germany for stints and bypasses than they were for wounds. And he said, “So, if you can find somebody down at [inaudible] or at [inaudible] that might work with you, I might be able to help you.”

I didn’t know what those words meant. I didn’t know what “I might be able to help you” meant. I didn’t know that. So I went to the Navy first, because he was a Marine, and they were really nice to me, and they threw me out. But they were nice. They were very polite about it. They said, “Get the hell out.”

So I go over to Walter Reed in a taxi cab, because I’d never been there, and I’m driving in the cab, looking out the window, watching people selling each other crack and doing all this stuff, and I walk into Walter Reed – any of you ever been into Walter Reed Army Medical Center? I walk into Walter Reed, and there are probably 550 doctors that rotate through there from all over the world. I didn’t have an appointment with anybody. I didn’t know anybody in the whole place, but I had a goal, and I had a vision, and my goal was to redesign the future of that little facility out there.

So I walk in and the first white coat I see could have been anything. Could have been a laboratory doctor, could have been an EKG tech, could have been anything. It was a doctor. Didn’t know him. Never met him. Walked up to him and said, “Doc, my name’s Nick Jacobs from this little town in south central Pennsylvania. I have this congressman that said if I could find somebody down here that would work with me, maybe he’d be able to help us, and I had this idea about heart disease.” And he goes, “Well, who’s the congressman?” I said, “Well, a guy named Jack Murphy.” He said, “Follow me.”

He was the only doctor ever in that organization to have ever gotten money to do research, and he got it from Senator Stevens from Alaska to study prostate cancer. So talk about serendipity. Talk about fate. Talk about God and the heavens. Whatever – Obi-Wan Kenobi – I don’t care what your belief is. I walk into the only guy in that entire facility that could have made a difference in our lives here in this area. And he took me right to the cardiologist office, and on her desk was the book written by the guy I’d studied from in California, Dr. Dean [inaudible], and her mother and father had both had open heart surgery within two years, and she was a candidate herself. And she said, “I’m very interested.”

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Mindy & Max From Singapore | Patient Review

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Health Leadership P4

You know, you say to your mom, “Hey, I want to go for my master’s degree.” She goes, “Are you kidding me? You couldn’t even pass math in junior high school.” Whatever it is, we have that stuff that tags us, that tears at us. We have the ability to get there. I remember walking down the hall, we founded this research institute, and I had a genomic scientist on one side and I had a proteomic scientist on the other side, one doing genes, one doing proteins, and I said, “Okay, well, explain this to me. So, like, I’m the general, and I tell the protein what to do, and the protein’s the foot soldier, and he goes out and does it. So if I say okay, we’ve got breast cancer, you go spread it, then the protein goes out and does that.” And I said, “Well, what if we find a way to stop that communication between you two?” And he says, “It won’t work.” And I said, “Why?” And he said, “Well, it’s just like us. We can always find a way to get around it.” And so when people say to me, “Did you ever play in B?” I did. And a C, and a D, and an E, and an F, and a G. You don’t stop having other plans, other ways to get there. You set your goal, you go for your goal. You can get there. You can do it. Sometimes it’s not pretty; it’s kind of like making sausage, but you can get there.

And so the future becomes a [inaudible] function. Now one of the interesting things which he also pointed out, which I really believe, is that a lot of discovery comes from fiction. I was reading a magazine – I don’t know what it was, People, I don’t know what it was – some light thing. I’m sitting in an airport or in a doctor’s office or somewhere, and they were talking about, I don’t know if it was CSI or one of those shows were there’s this big clear board in front of you, you see the moving things across the board. Nobody had invented that. That was science fiction when they started using that thing. It didn’t exist. And then a computer manufacturing genius saw this thing and said, “Why not?”

And if you read Jules Verne’s Twenty Thousand Leagues Under the Sea, or if you read all these – I remember as a kid seeing these little rocket ships blasting off on television that, like, they were so fake it was unbelievable. It was like a little firecracker sticking out of the bottom. These little things would fall over, whatever. We didn’t have rocketships when I saw those. But guess what? We got them, and they pretty much looked like the ones someone had dreamed up who weren’t scientists. They weren’t scientists, and so the future discovery a lot of time comes from not only fiction, but also from fantasy.

And the question becomes what are the limitations that you personally accept on yourself? What are your limitations? What are the little black ghost limitations that you’re dealing with? I’m not going to embarrass you and ask you, but you’ve got them. You all have to have them. What are the things that are holding you back? What are the things that you believe about yourself because people have told you them over and over and over? What are they?

I mean, if somebody had told me that in 1997 I would get a job in a place that was all pink with indoor outdoor carpeting and duct tape and three or four computers and that we would get 250 million dollars in grants and create an international research institute with proteomic and genomic scientists and collect 57 thousand donated breast tissue with 800 fields of demographic information on each woman, and that the National Cancer Institute, two months ago, would have come here and taken those samples to map the breast cancer genome for the world, I would have asked you what drugs you were on. None of those things were in my mind. They weren’t possible. I was not a scientist. I was not a doctor. I had no background in this stuff.

So how does this happen? And how far can you reach? How far can you look out there and say, “I can do that” and not be delusional? Because it does happen little by little. And it’s interesting, what I found was the bigger the dream, the easier it is to get the money.

You know, I look at your Stealers shirt, and truthfully, when the Stealers are winning, we all know what we’re like. We’re euphoric. It’s like great, oh my gosh, it’s so great to be with the winners, and I don’t care if he messed around with that girl, he’s a great quarterback, and it’s like we forget everything. It’s kind of like just so our Stealers win. Well, people love to be associated with winners. They love that.

People hate to be associated with losers. I was walking into a situation where there were four hospitals in that town, in this town. This was the loser. This had the least amount of money, the dimmest future, the least chance for survival. We had very, very, very intelligent, good employees who left as soon as they could. It was like a revolving door, because they said, “There’s no way. There’s no way that [inaudible] will live, and we will go down, and Mercy will go down. No way.” Right? There’s no way it could happen.

So that’s what we were faced with. That’s what we were faced with. So then you have to ask yourself would you rather live in a world that is or help to design the world that will be? It’s idealism versus realism, and you have to understand, just like the genomics and proteomics guy. Nothing has to be the way it is. No one way is the only right way to get it done. As a musician I look at these guitar players that never, ever took a lesson who are making millions and millions of dollars a year singing country western or whatever it is, playing everything the wrong way. But it works and it sounds great and they’re successful at it. You tracking me here?

So the stuff that holds us back is what’s in our calf paths. It’s what’s in our brain. It’s between these ears. That’s what holds us back. That’s what keeps us from making the impact that we could in our life and doing the things that we want to do and really would dream about. So the baby boomer in me said what do baby boomers like? We like to be pampered. We like nice things. And we like competency. So let’s be the best of a hotel, the best of a spa, and the best of a hospital. Let’s do it all. Let’s bring that all to bear. And one of the first people I hired was a manager of hotels.

Now, why would I do that? Why would I bring an outsider in? He’s not in healthcare. Didn’t know anything about healthcare. Didn’t know about the rules, didn’t know about the restrictions, didn’t know about the 47 regulatory agencies or the 42 regulatory agencies or whatever the number is. Why would I bring – give me thoughts why I would bring somebody in. Different perspective. Exactly. All that. That’s not what they were trained to do. They were trained to cut the money. Okay? So here we have a situation where this guy comes into the place, and he says, “Jeez, it’s ugly in here.” I go, “I know. We got these pink walls and we got these white walls and we got these white sheets and these white bedspreads and these white separators.” It’s ugly. It’s stark. Oh, and everywhere in the stairwells there’s I color I think that came from mental institutions called foam green. Have you ever seen those in hospitals? It kind of goes with the green jello. So you’ve got the green jello thing going on, and you’ve got the foam green walls, and you’re going, okay, how do we make this look more appealing? How do we lighten this up so that people walk in and go, “Wow. Okay.”

And what we found is it’s just as expensive to buy the white as it is to buy color. It’s just as expensive for the wood as it is for the nonwood. So it wasn’t extra money. It was the way we looked at it. And I let them loose. I just let them run wild. I said, “Okay, borders up here, and let’s change this, and go do your thing.” I remember walking through the new addition with my boss the very first time after it was completed, and I said, “How many decisions do you think I made in this connecting corridor about the way it was going to look?” And he said, “Hundreds.” And I said, “Zero.” When you get a butterfly, you let him fly. When you get somebody that understands it, don’t get in their way.

So I made zero decisions on that connecting corridor and on that building up there, but what we built in were fountains and staircases and wooden everything, and it’s gorgeous. It’s just gorgeous. It was like a hotel. Why did we do that? Because when people walked into what, before, was foam green with indoor outdoor carpeting and tape and they see all of a sudden it’s like – and it was cosmetic for the most part. It didn’t just break what little I had in the bank. And they look at that and they go, “Wow. It doesn’t look like a hospital.”

And this was fourteen years ago, so put that in perspective. Some of you were eight years old, you know? Fourteen years ago we were coming up with these ideas. So it’s like, okay, let’s do that. Now, let’s add the best of a spa. Well, what’s the best of a spa? It’s massage, it’s aroma therapy, it’s [inaudible], it’s music therapy. So we added all that stuff. We had pets that came in. Here’s the good thing about not being in healthcare. Here’s the good thing about not being a medical guy. Here’s the good thing about not being a scientist. I didn’t care what made you better. So if a golden retriever jumping into bed with you made you get better, that’s okay with me. Just get better.

It’s funny, the word placebo became a really derogatory term about twenty-five, thirty years ago. And it’s like, do you really care what made you get better, if it was a fake pill or the real pill? If the fake pill made you get better, does it really, deeply matter to you that you were taking a fake pill? I don’t think it should, because it did what it needed to do to make you get better. Now, if you took the fake pill and you died, that’s not a good thing.

But literally, when you think about placebos, what makes this work? I mean, indigenous man knew a long, long time ago, in every one of their treatments, what did they use? Any time you see the medicine man and the witch doctor, what’s going on there? What one thing is kind of in common, besides, like, the big [inaudible]? What’s going on? Music. Am I right? Music. It’s always drums, and they’re beating the drums, and they’re doing their thing. Do we know why?

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Invisalign Treatment | Dr. Vinograd’s Patient

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Health Leadership P3

Your brain’s full of these things. And work away from sun to sun to do what other men have done. They follow in the beaten track, and out, and in, and forth, and back, and still their devious course pursue to keep the path that others do. But how the wise old wood gods laugh who saw that first primeval calf. Ah, many things this tale might teach, but I am not ordained to preach.

That’s what’s going on. Precedent. We have precedent, and we follow that precedent to the death. We follows those paths, the paths that make no sense at all. We follow those paths over and over and over again, and I have to tell you, if you think that change is scary, wait ‘til you experience obsolescence. I can remember being called into the office in January of 1992, and the boss said, “Well, the sisters decided to sell the hospital. It’ll take place within the next three months. Look for work. It’s over. It’s over.” No matter how hard you worked, no matter what you did, it’s over. You are now obsolete in this position.

And I had a binder three months later, I swear to you, it was this thick with 253 rejection letters for jobs. Okay? So take your shoe off. Wave it around once in a while and experience what’s going on, and then understand that those people who refuse to take their shoe off when you are trying to lead a change in your organization, they’ll probably never take their shoe off. Ever. And that’s what we’re going to talk about.

So down here in the bottom, this would be me. I was trying to escape. Those are my cousins. I’m still trying to escape from them. But that was me whenever I was whatever, eighteen months, two years, I don’t know. And in healthcare, I was trying to do the same thing. I was trying to escape from the calf paths. Why did it have to be that way?

I remember meeting the president of an eight billion dollar health system. I walked in, sat down, and he knew I was a hospital president, and he started off by saying, “I just want to tell you,” this is his opening statement, “I just want to tell you I don’t like hospital presidents.” That was the opening statement. And I said, “You know, I have a rough time with them myself.” Because they’re following these calf paths. How do we change it? How do we move on?

And so what the leaders do, what’s your job? Your job is to create a vision and a direction for the organization, and then to mobilize to accomplish that vision and direction. That’s a great combination of words. It’s a great combination of words. But the key up here is to mobilize, to get people to do it. I mean, you can tell, I could tell those three vice presidents, “I’m going to introduce massage therapy.” That was one of my first statements. “I am going to introduce massage therapy into a hospital.” And I knew why I wanted to do it. If you read all the literature that was out there, the American public was spending billions of dollars a year to get massages. But they weren’t getting them in hospitals. So it’s like, if they’re going to spend the money on it, and we need money, why not have them spend it on it at a hospital? That was the logic behind it.

But the calf path was, well, massage therapists didn’t go to medical school. They don’t have a four year degree usually. They’re not advanced, certified, yadda, yadda, yadda. People will think that we are – okay? And so the resistance was it’s not what we do in hospitals. We can’t do that in a hospital. We cannot add that. So we will give you lip service and we will tell you that we agree with you, we will tell you that we’re going to do it, but we will find every possible road block we can find to keep that from occurring. Have you experienced this? Have any of you ever experienced this in your lives? Have you caused it? I don’t know. I mean, I’m asking, right?

So I had a young administrative fellow from the University of Pennsylvania who was on a full scholarship, and this guy maintained that he was not bright. Full scholarship, UPenn. He said, “I’m not bright, I just can’t forget anything. So when I read something or hear something, I remember it my whole life.” And I’m thinking, “Yeah, that works. You may not think you’re bright, but that’ll work for you.” And so he talked to me about what’s going to be our goal. And I said, “I don’t want to do what people will like. I want to do what people will love.”

Now, I’m a baby boomer, and I have to tell you, he have been a total pain the whole way through. I mean, the boomers have messed up your life in so many ways you can’t even imagine. You just can’t even dream of all the things we’ve done to you. And we’ll continue to do until we ride off into the sunset. I remember walking into the house one day after having bought a pair of blue jeans that were clearly the wrong size, but they fit me, and I was on cloud nine. It was kind of like a Jerry Seinfeld bit. I had on this – it has been a long time ago since I even saw these numbers – but I had on these 32 waist blue jeans, and I should have clearly been in 34s, but they fit, and I’m like, “Yeah!” I’m walking in, kind of doing this, “Check it out.” My jeans on, and my wife took NewsWeek and slid it across the counter. On the front cover of NewsWeek was a guy standing there in blue jeans, and it says, “Levis changes the shape of their jeans to pear shaped to fit the baby boomers.”

We changed your blue jeans, we changed the way you do credit cards, we changed the stock market. We’ve screwed up a lot of stuff. We changed sex. We changed drugs and rock and roll. Now, here I am, a baby boomer, thinking okay, my mom and dad went to the doctor. The doctor literally can say to them, “Okay, I would like you to go out in the parking lot and lay down, and I’m going to drive over you just to see your resistance to my tired.” They go, “Yes, Doctor. I’ll do whatever you tell me.” Right? They were like that. It was like, you tell me what you want me to do, I’m there.

But the boomers, and you all, I go to the doctor, and he says, “Well, I think you should do this.” And I reach down and I pull out this many printouts from my computer and say, “Well, you know, there’s a different theory on this, and there’s this philosophy is different than the one that – and maybe we should talk about this.” Am I right? It’s a whole different approach. It’s just different.

And so I’m looking at these boomers, and I’m looking at my peers, and I’m thinking, “We’re demanding. We’re obnoxious. We’re over the top. We expect a lot, and our kids are worse.” That’s a lot of you. They want it now. We work our whole life to get our half a million dollar house, and they get it the first job. So it’s like, what do we do here that will make them love us? That was the goal.

Now, this is where it gets interesting for you. There’s a guy by the name of Dr. Leiland Kaiser, and he’s a [inaudible] graduate. He’s probably close to 140 years old now. He’s like Yoda. When you listen to him it’s like listening to a Buddhist monk up on a mountain with clouds around him. He’s a brilliant guy, but Dr. Kaiser did a lecture on this once, and I got to hear the lecture, and it’s stuck with me my whole life. The future is a design function. It’s up to you to design your future. You, individually, to design your future.

I had a friend who was a 4.0 all through college, IQ of 150 plus, and could have been a brain surgeon, a rocket scientist, could have been a novelist, a whatever. A diplomat. President of the United States. But kept going from lousy job to lousy job her whole life. And I said, “What’s your deal?” And she says, “You know, did you ever see the astrological sign for Pisces?” She said, “You know, we kind of just go where the water takes us. We’re just floating around.”

Well, my whole thing was you don’t have to go where the water takes you. You can design your future, and that was his philosophy, as well. Interestingly enough, again, back in the 90s, every time a CEO in healthcare went to a conference, they would give us a binder, but it was real leather. Thousands and thousands of animals were sacrificed for our conferences. I had a shelf that I was unpacking when I retired a couple of years ago, and that shelf was filled with leather binders, most of which I hadn’t used because I had so many of them, and I pulled one out that literally I had not opened since 1992. And when I opened that binder, it said Nick’s Goals, and it listed them.

And it was like, go back to Carnegie [inaudible], get your second master’s, go to Harvard, get this, do this, get your fellowship, double your salary, lose twenty pounds – I did that and gained it back – but they’re all there. All these goals were listed, and I’m going, wow. I did them all. I designed my future. And when I looked at that, it was like how did that work? Well, I still believe that one of the reasons that it worked was because nobody else knew my goals, so they really couldn’t stop be from accomplishing my goals. Does that make sense to you?

Did you ever see the movie Ghosts with those little black things come out of the sewers and pull you down into the sewers? We’re surrounded by those little things. Look to your left. Look to your right. Look in front of you. Look behind you. Look at your family. Look at your neighbors. There’s always someone saying, “You know, she’s cuter than you,” or “You know, you’re stupid.”

I remember as a kid once I was sitting at dinner. I was about ten or eleven, and I knocked my milk over. And my dad said, “You are the clumsiest kid I have ever seen in my life!” He only had two kids. But I’m thinking, man, I must be really clumsy if I’m the clumsiest kid he ever saw, and so that started out as a cobweb in my head. Oh, boy, I’m clumsy. I’m a clumsy kid. Are you tracking me on this? The calf path. And by the time I was in junior high and I’m tripping and not catching a ball all the time, which all junior high kids pretty much do, I’m thinking man, I’m exceptionally clumsy here. And it’s, like, preying on me. I go bowling, and I’m like, should I start out with the left foot or the right foot? Because I’m clumsy. Am I going to trip and drop the – so the cobweb becomes a rope, the rope becomes a chain, the chain becomes these big steel cables that wrap around us. All of us. We all have these things in our brain that are our creation, that stem back to junior high. They do. And we let those things get in our way. We let those little ghosts come up and pull you down.

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Health Leadership P2

And it’s like, why does it have to be that way? Why do they give you outfits where your butt sticks out? Why do they do things where it’s parent to child, where they’re talking down? And so I went to this board, and I said, “Alright, I want to make a change.” Now, the only thing that you will find in life that is consistent is change. It’s the only thing. Count on that. And if you haven’t figured that out yet, learn it today. It’s the only thing that is consistent. We spend our whole life trying not to deal with change, in many ways. Do the same thing every morning, brush our teeth a certain way, do this, do that, do this. We try not to deal with change, but the reality is change is always with us. It’s always going to be with us. It’s what makes it all work. We are always going to have change.

And there’s a book called Change or Die, and the book was interesting because it said when you confront people with the opportunity to correct something in their life to the point of where it will save their life, ninety percent of people will choose death rather than change. Human behavior change is a very, very difficult thing to get to happen, and as leaders in your organizations, when you have to bring change into the organization, a lot of times, the change agent becomes the sacrificial lamb. A lot of times you’re the person that has to sell that change, but the reality is you can’t live there afterwards because people are so unhappy with change.

So the challenge was very, very interesting to me, but when you look at what happened to the saddle makers when automobiles came out and the watchmakers when the quartz watch was invented and newspapers and music and movies, when you look at those people, what is happening and has happened to them is this world is digitizing and as we went from horses to cars, they became obsolete. And so my suggestion is enjoy the ride, because if energy stands still, we’ll all be dead. I mean, it’s all about motion. It’s all about forward motions. The right brain attributes. Artistry, empathy, taking the long view, pursuing the inspirational.

I had this drawn for a friend of mine. I ended up speaking in Alaska a couple weeks ago. Try to imagine I’m in a room ten times bigger than this. Behind me is all windows. Outside the windows – so I’m standing in front of the windows – outside the windows are snowcapped mountains, and in between them are glaciers feeding a glacier lake that is right behind me. Have any of you ever been to Alaska before? So I’m standing in Homer where Tom Bodett is from, the guy that does Motel Six. And I’m talking, and I notice that all of a sudden, none of the eyes, hundreds of eyes, none of the eyes in the room are on me or the screen anymore. They’re looking right past me, and I’m thinking, “Something’s going on out there.”

So I turned, and a seal had come up out of this glacier lake with a halibut the size of a Volkswagon hood. I mean it was, honest to God, it was this big. And bald eagles were dive bombing the seal, taking bites from the halibut. I was living a Disney movie. I’m not kidding you. It was just an amazing thing, and after we left that speech, we were driving down the road, bald eagles were sitting on light posts and [inaudible] and there’s a group of twenty-five of them on the ground with crows and things behind them trying to get what drops out of their mouth. I mean, it’s pretty amazing. Pretty amazing sight.

But having said that, when I started in this job – and Rod, you don’t have to shake your head on this one – when I started in this job, I had three vice presidents who were great professionals. They were terrific in the business, they understood the business, they were long-time experts in the business. In fact, one of them had been the interim president two or three or I don’t know how many times as they were selecting new presidents. I came in there, and I said, “Okay, we’re going to change, because we’re going to go out of business.” And every meeting, when the four of us sat together, they all shook their head. Absolutely. Great idea. I love it, man. Great idea.

In fact, one used to hug me all the time. She’d say, “Great idea! Let’s go do it. Let’s go do it.” And then we’d go to Rod’s former boss’s office and they would meet in there, and they would say, “To hell with this guy. He’s nuts. We are not going to cooperate.” So that picture depicted my first year on the job. That would be me, the lead dog, being choked, and that’s them digging their paws in behind. And that happens all the time in leadership. It happens all the time.

And I will tell you something that a wise man that [inaudible] used to hire told me, and he said that ten percent of people, no matter what, ten percent of people, no matter what, will never, ever, ever make the change. And sometimes it’s better to deal with that ten percent right up front, because they’re just not going to do it. They refuse to do it. I was just at a conference a couple weeks ago, and the guy that invented was talking about web 2.0, and he was talking about social media and what’s going all with all the different – LinkedIn and Facebook – and he said to everybody in the room – I would say it to you right now, but you’re not awake enough to do this yet – he said, “Everybody here in the room,” there were a thousand people, “take off your right shoe and hold it in the air.” And all these shoes went up in the air, and he says, “Okay, make [inaudible] with that shoe.” [Inaudible], shaking their shoes around, and these are all adult healthcare executives, right? And he does this for about five minutes. He says, “Okay, put your shoes down.” Then he goes, “You never put your shoe in the air. Why not? And you, you didn’t put your shoe in the air. You, you didn’t put your shoe in the air. Why didn’t you put your shoe in the air?” And he got answers like, “Well, you know, I didn’t feel comfortable doing it,” and blah blah blah.

And he said, “You know what? Find a new job.” That’s what he said. Now, what was he really saying? Resistant to change. Afraid. Didn’t want to participate in this thing. There are five hundred million people on Facebook. No. Yes. Five hundred million. It’s the fourth largest country in the world now. Facebook is the fourth largest country in the world. Five hundred million people. If you don’t think that social media is here, you didn’t take your shoe off. You’re missing it. It’s going past you so fast. And his point was it’s there. You may not want to participate. You may not think it’s something that’s important to you. You may not think it’ll help your company. You may not think that it’s going to be good in any way for you, but the reality is, phew!

Two years ago, I was hired to make a series of speeches at a newspaper company that knew they were going out of business. They knew it. It’s all gone digital. Couldn’t get enough money for putting it on the internet. They’d just laid off half their reporters. They know – they could see the future. The future is here. It’s now. What will the new world order look like? They don’t know. And so my presentations to them were on how do you take the assets that you have and deal with the change you need to make? And that’s really what this all comes down to. Because things change so fast, and they change, sometimes, very dramatically. Overnight. It’s interesting, because you see things happening, and it’s like nah, no, it’s not going to happen. It’s not going to catch on. Well, it catches on. I hate to do this, but I’m going to read this to you. The only reason I hate to is I hate to read and have things on the screen, so if you want to look down, you don’t have to look at it. But I’ll read this to you, because I think this is really important.

One day, through the primeval wood, a calf walked home, as good calves should, and made a trail all bent askew, a crooked trail, as all calves do. So you’ve got this little calf, and he’s out for a walk. And he’s a calf. And he’s not an intellectual calf, he’s not a philosophically based calf. He’s a calf. He’s just like, doing his thing. He’s walking home and he’s walking through the woods. Since then, two hundred years have fled, and I infer this calf is dead. But still, he left behind his trail, and thereby hangs his moral tale. The trail was taken up next day by a lone dog that passed that way. So he had the calf, went for a walk, pushed down the grass, made some headway through the woods. The dog sees a path.

Again, the dog is not committed to analyzing the shortest distance between two points. The dog follows the calf. You got me? You going with me on this okay? Everybody’s good. And then a wise bell weather sheep pursued the trail or [inaudible] and steep, and drew the flock behind him, too, as good bell weathers always do. So we have a calf, we have a dog, and now we have a whole flock of sheep, and they’re following this original path. And from that day, o’er hill and glade, through those old woods a path was made, and many men wound in and out and dodged and turned and bent about and uttered words of righteous wrath.

So we have, now, men following the calf, the dog, the sheep, and they’re cursing, and they’re saying, “What the heck? Look at this. This is crazy.” But they’re still following it. You got me? Because some of you live on roads like this; I know you do. It’s funny.

I was in Iowa two weeks ago, and I said I had a boss from Iowa once, and he said there was a difference between going off the road in Iowa and going off the road in Pennsylvania. If you go off the road in Iowa, you either hit corn or soybeans and you’re okay. If you go off the road in Pennsylvania, you’re going to die. So we got these calf paths that are made into roads. And still they follow, do not laugh, the first migrations of that calf. And through this winding wood way stocked because he wobbled when he walked, this forest path became a lane that bent and turned and turned again. This crooked lane became a road where many a poor horse with his load toiled on beneath the burning sun and traveled some three miles in one. And thus a century and a half they trod the footsteps of that calf. The years passed on, and swift as fleet, the road became a village street, and this, before men were aware, a city’s crowded thoroughfare, and soon the central street was this of a renowned metropolis, and men two centuries and a half trod in the footsteps of that calf. Each day, a hundred thousand route follow the zig zag calf about, and where his crooked journey went the traffic of a continent. A hundred thousand men were led by one calf near three centuries dead. They followed, still, his crooked way, and lost one hundred years a day, for thus such reverence is lent to well established precedent. A moral lesson this might teach were I ordained and called the priest, for men are prone to go it blind along the calf paths of the mind.

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Study Shows Periodontal Disease Can Affect Newborn’s Health

Pregnant BellyOnce believed to be a sterile part of the uterine environment, the placenta actually contains a multitude of bacteria that may impact pregnancy and influence an infant’s health via the bacterial structure of the gut, according to the results of a new study.

This research is one part of a wider scientific attempt to investigate the microbiome, which consists of trillions of viruses, bacteria and fungi that are part of the body.  The human microbiome plays a critical role in digestion and metabolism, and may also play a role in obesity, diabetes and many other conditions.

Researcher think that having the wrong bacteria in the placenta, or not having the right bacteria, may contribute to premature birth.  Research is still preliminary, but it is thought that this could explain why women with periodontal disease, urinary tract infections and other infections during pregnancy have increased risk of premature delivery.  This link suggests that more studies are needed into the use of antibiotics during pregnancy.

This study indicates that normal gut bacteria in infants may come from the placenta.  If confirmed, this is good news for women who undergo cesarean sections, as it was previously believed that infant gut bacteria came from exposure to bacteria in the birth canal.  “I think women can be reassured that they have not doomed their infant’s microbiome for the rest of its life,” said Dr. Kjersti Aagaard, author of the study published in Science Translational Medicine. Further studies are needed into the effects of surgical birth on the infant microbiome.

Studies have already been done on bacteria in the mouth, skin, intestines and vagina, but until now little attention has been paid to the placenta.  The fetal life support system, the placenta supplies nutrients and oxygen to the developing baby, while removing waste and secreting hormones.

“People are intrigued by the role of the placenta,” said Dr. Aagaard, an associate professor of obstetrics and gynecology at the Baylor College of Medicine and Texas Children’s Hospital in Houston. “There’s no other time in life that we acquire a totally new organ. And then we get rid of it.”

Dr. Aagaard started to wonder about the placenta when they realized that the microbes most prevalent in the birth canal did not match the population found in the intestines of newborns.  It was assumed that bacterial makeup would be similar in babies born vaginally, as they were thought to acquire bacteria during the birth process.

“It didn’t make a whole lot of sense to us,” she said. “It’s not like babies are hanging out in the vagina. They come shooting out pretty fast.” She added that vernix, the waxy coating babies are born with, may help prevent baby from picking up the bacteria.

The researchers wondered whether some of the intestinal bacteria could begin to populate the infant’s intestines prior to birth.

The researchers examined the placentas from 320 women, mostly black and Hispanic, who had vaginal deliveries at term, though some had cesareans and some of the deliveries were premature.

The scientists removed the outermost layer of each placenta and tested samples from the inside for bacterial DNA.

“The placenta is not teeming with bacteria, but we can find them, and we can find them without looking too hard,” Dr. Aagaard said.

They found that the placentas were about 90% placental tissue and 10% bacteria, similar to the bacterial density of the eye or the deeper layers of skin, but significantly different from the intestine, in which those numbers are reversed.

About 300 different kinds of bacteria were found, most of them benign.  The team found that the bacterial makeup of the placenta most closely match the bacteria found in the babies’ mouths.  As it turns out, at birth the bacteria in the mouth is very similar to what is found in the babies’ intestines.

Dr. David A. Relman, a microbiome expert at Stanford, said that his lab has also found bacterial DNA in the amniotic fluid that appears to come directly from the mother’s mouth, gut and vagina.

Dr. Aagaard theorized that bacteria from the mother’s mouth gets into the bloodstream where it then travels to the placenta, where it settles and eventually makes its way to the fetus.  While this is simply one theory, it is supported by animal research.  Oral bacteria injected into veins in mice were later found in the placenta.

This theory is supported by the long-standing observation that women with periodontal disease are more likely to have premature babies or babies with low birth weight, and treating the disease during pregnancy does not seem to mitigate the risk.  Preventing the disease or treating it before pregnancy are much more effective.

This particular study did not offer any evidence about periodontal disease because only one of the participants had it.

Women who had urinary tract infections during early pregnancy, even when the infections were treated, the bacteria was still found in the placenta and increased the incidence of premature birth.

Researchers also found that the bacterial makeup of women who delivered at term differed from those who delivered early.  Dr. Aagard said it was unclear whether the bacteria actually contributed to prematurity, or whether bacterial makeup normally changes over the course of pregnancy.

Dr. Martin J. Blaser, director of the human microbiome program at NYU Langone Medical Center, and the author of the book, “Missing Microbes,” said that Dr. Aagaard’s study was important, but argues that it is preliminary, and does not provide information useful for treating pregnant women.

“I’m intrigued by the findings about the mouth and also the relationship with preterm labor, which is a really important clinical question,” Dr. Blaser said. “Will this be a productive lead, or will it fizzle out? Time will tell us.”

He argued that pregnant women are frequently given antibiotics for a variety of reasons.  Doctors once thought that antibiotics wouldn’t affect the growing fetus because the placenta was thought to be sterile.  If the placenta is not sterile, but is instead a pathway for bacteria to travel from mother to baby, what affect to antibiotics have on the baby?

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