Sometimes Not Fitting in is Better

November 12th, 2005 by Nick Jacobs Leave a reply »

It’s been nearly six decades since this personal journey began.

It all started at the age of eight with my paper route. Each day the three paperboys from Dickerson Run, Howard, Roy and Nick would sit in front of my aunt’s grocery store and wait for the Pittsburgh Press paper delivery truck.

Usually the Uniontown papers arrived early . . . I’d count the papers carefully to make sure that they didn’t short change me . . . then I’d count again to see if they gave me any extra papers to try to sell to make additional money (my profit was $.015 for the Pittsburgh Press and $.02 for the Uniontown paper.) My profits were about $1.00 a day . . . and $2.50 on Sunday when I delivered 50 papers from a red metal wagon. This was big money for a kid from Dickerson Run.

At least six of my customers tried to stiff me every week when I had to collect my $.42. They owed me $.07 per day, and would hide when I came to collect the 42 cents that they owed me. It was great practice for my future.

I really liked most of my customers, they were sweet people. Some people weren’t, but I’ve met them over and over in my life, the good and the bad.

It used to take me 1.5 hours to deliver about 45 papers every day.

It was during these very important years that I developed the discipline to live on a schedule. I used to go home in the afternoon, practice my drums or trumpet, take a nap, do homework, practice more and then stay up to watch the Tonight Show alone.

Well, this paper route has taken me down several roads, some that were less traveled than others.

The view from the paper route was not always clear. It was cluttered with complications, and, as I went from drums to trumpet to band director to arts center director to tourism president to hospital administrator to founder of a research institute, those days on the streets of my youth have served me well.

When my tenure began as a hospital Vice President, it was clear from day one that we were not in the hotel business. The sheets were not 700-thread count. In fact, they were practically see-through. The curtains were oftentimes spattered with blood, as were the ceilings. There were dust bunnies in every corner. The furniture was scratched, and the chairs were similar to those used in a prison. If you wanted to sleep, you slept on the prison chair. As it became clear that this was the biz my heart sank. Each day my walks through the hospital, a.k.a., rounds, were peppered with discoveries of dirty corners in the halls, abandoned cigarette butts on the stairs that literally stayed there for weeks at a time, filthy walls, entrance mats, and windows.

The food was regularly delivered cold, tasteless, and colorless. The most courteous messages ever delivered were “Sit over there and wait,” and “Don’t worry, honey, someone will be with you.” (What wasn’t said was the rest of the phrase that was “sometime this week.”)

The hospitals of the 80’s were not exactly user friendly, and the CEO’s were not exactly interested in the soft side of care. They were interested in reimbursements, unions, recruiting physicians, keeping budgets on target, and many other business considerations. It was and still is a tough career.

My initial thoughts were to apply the concepts learned from the hospitality industry, one of my previous careers, to healthcare. My dream was to bring chefs, hotel managers, and housekeeping professionals to the hospital. Of course, this concept was unheard of and rejected for all of the institutional reasons. It was the same set of criteria that probably dictated that the walls were to be painted white or that awful shade of institutional green. It was the same criteria that collected school, prison and hospital administrators in a pool called superintendents.

We couldn’t have chefs because they were “too expensive.” In fact, they weren’t too expensive. They were plentiful, creative, and competent. There were culinary schools all around us, and the chefs were employable for nearly the same amount as the hospital cooks.

We absolutely could never have a hotel manager because hotel managers “don’t understand the hospital business.” True, but it’s absolutely also true that hospitals didn’t understand the hospitality industry. In fact, when, as a hospital president, we hired our first hotel manager, it changed hospitals forever. His approach was fresh, exciting, and virtually unparalleled in the conservative hospital business.

Ritz Carlton logo Now, housekeeping was a problem. Fortunately, the only thing that we had to do was orient our housekeepers to the hotel business, and we did this through training and orientation at Ritz Carlton Hotels. They got it very quickly. We also began to overstaff. Recommended staffing was approximately six in our little hospital, we had 12. The brass began to shine. The floors began to sparkle. The infection rate dropped off the charts. Most months it was below one percent. The national average was 7.5 percent.

What in the world was it about? It was about transforming a hospital into the best of a hotel and the best of a spa. Our philosophy was not just to create something that people would like. We, in fact, were interested only in creating something that people would absolutely love.

What did that mean? As a patient, it is typical that you must leave your dignity at the door of the hospital. You are entering a world that is foreign to most of us. It is filled with scientists who typically deal in life and death issues. Hence, when they make a mistake, it can be serious enough to end a life or damage a human being forever. This phenomenal responsibility dramatically changes lives, personalities, and interactions.

Patients very quickly move into a world of fear, confusion sometimes filled with employee coldness and apathy. The employees many times develop an edginess that is matched only in a federal agency. Some of it is protection from emotional involvement. Some of it is boredom, lack of communication and years and years of pent up anger coming from being managed by great technicians or nurses who many times have no real training in management. This many times represents the Peter Principle at its very best.

The other major issue with which these employees must deal is dysfunctional physicians. Now, believe me, there are hundreds in fact thousands of physicians who are not dysfunctional, but the ones who are are maddening. Sometimes they are physicians who were directed into those behind the scenes specialties like radiology, anesthesiology and pathology where patient contact is limited, but their interaction with employees is not. If hospitals were not so dependent on these usually very skilled, highly educated men and women, life but maybe not health, would be better for everyone.

In our facility, we took a very aggressive stand toward dysfunctional physicians, and, although we’ve canceled contracts, discontinued relationships, and cancelled privileges, there are still some interesting challenges created by exceptionally talented physicians who are critical to the care of our patients but brutal toward our employees. There are those who would also like to kill every hospital administrator regardless of the facts, but that’s another chapter or book.

So, what are the answers? The answers are all based upon one universal belief, love. Love can be produced through empowerment, through trust, through humanness, through nurturing; through the very best that mankind has to offer. The reality of love will cut through every one of the concerns listed above. So, love your neighbor as you would yourself . . .

Finally, speaking of love, Nina was born this week. She weighed 8 lbs 5 ozs and has beautiful blue eyes. Thanks to our daughter for Jude’s sister, grand baby number two.

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