The Privilege of Leadership
When Michael Polifka and I were planning our practice together, we had many discussions about the “privilege” of practicing medicine. That’s what it’s called when you get “permission” to practice in a hospital — “privileges” to practice. In those long discussions about what we wanted out of our careers, we spoke about the intimacy involved in the conversations and plans we made with patients around their deepest fears and the uncertainties of prognosis, especially with serious disease. 
It is a privilege to have that degree of trust placed on the doctor-patient relationship.
As I reflect on the last few months, and the gravity of the situation that now faces our hospital, that same word “privilege” jumped into my head today as I rode my bicycle on some gorgeous back roads among these green mountains. This week I announced to the organization and the public that our financial performance is significantly worse than expected. I spent the day Thursday and Friday interacting with managers, medical staff leaders, employed physicians, and staff. These conversations led me to a feeling of privilege. That may seem odd in the face of such an “uncertain prognosis”, but it is based upon the reaction of the people who work in this wonderful institution.
While people are extraordinarily somber, the themes that are emerging are quite hopeful. Of course there is anger about how we got here. However, most folks are looking forward. And the remarkable thing is that everyone wants to help. I am sure there are those who wonder if they should continue working here in all this uncertainty. Most of those talking with me, however, want to learn the lessons of the past, and are looking forward to a better future.
At medical executive committee, physicians began to think about how they could participate by better medical record documentation to support charge capture and our revenue cycle. They also spoke about our culture that is still too “provider centric.” Are we really the most patient centered place we could be? Do we fit in patients who really want to be seen today? Has our competition learned how to serve patients in a more timely manner than we have? Physician leaders are concerned about losing patients to other health systems, and want to understand how we can maximize loyalty to our own medical staff and hospital.
The managers in our organization see wasted time and processes that require “rework.” They decry the poor budgeting tools that have left them with inadequate financial reporting tools to manage their areas of responsibility. They look forward to better understanding our organization through improved financial reporting.
The SVMC medical group has been challenged by Dr. Westergan to improve productivity and reduce costs. Physicians responded positively and already working on plans to accomplish these goals. Improved productivity in the medical group would have substantial “downstream” impact on the rest of the health system, because each patient seen in a physician’s office may need other diagnostic and therapeutic interventions.
After briefing by managers, staff has begun to react to the news of our financial situation. While there is substantial fear of changing benefits, threats to our future pay, and even our staffing levels; I am very moved by the recognition of the core values of our institution, and the professionalism of our staff, and how important those values are to our fiscal recovery. One e-mail sent to me the day the results were shared represents recognition of who we are.
This employee brought her mother in to the hospital recently. She was impressed with the “caring professionalism we have always taken pride in.” Then she went on to say:
“And you know, as I sat waiting, and looking around, my first thought that came to mind, and I know this may sound stupid, was, business as usual… I mean, despite the depressing financial issues, I saw people doing their job, being professional and friendly, from those in the SDS registration, to those in the radiology department. I still saw cleanliness in the hallways, and I still saw people with friendly demeanor. It was so reassuring, business as usual.
From my point of view, tremendous credit needs to be given to all individuals involved in the management of this great institution, and for the initiative shown to keep us a great organization, and for the genuine concerns for all. We are fortunate, and I, for one, thank you.”
This is the spirit in our organization that will bring us out of our uncertain prognosis. It is not me that deserves the thanks- it is all the people managing to put aside their worries and behave as this employee experienced – professional, caring, and patient focused. We are going to be just fine. I feel privileged to lead such caring professionals.
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