Before embarking on my path to hospital administration, I was a teacher.  Many of you know that several of my former students are now working with us.  The names and faces of hundreds of these kids float through my conscious and subconscious mind every day and night.  It is not unusual to think about the opposite ends of the bell shaped curve, the great ones and the ones who needed the most attention and help.  Three of my former students have written to me recently, all three phenomenal people with amazing talents, and all have gone on to do wonderful things with their lives. They were the top of the curve.

The first is from one of my favorite students of all time.  She was trying to explain the challenges that I would face on a potential visit to Australia:

Did you know that it is the HOTTEST, DRIEST, FLATTEST, and MOST INHOSPITABLE place of all the inhabited continents?  Yes…I’m talking NO WATER, NO SHOWERS!  It’s DIRTY, DUSTY, and INFERTILE. The so-called Romantic Outback, is just a VAST, REMOTE, BAKING, BOUNDLESS VOID, teeming with all manner of POISONOUS ANIMALS that want to eat each other AND Y-O-U!

If you’re not bitten by one of the world’s 10 most DEADLY SNAKES, you could be bitten by a funnel web spider. This baby has massive fangs that are large and powerful enough to easily penetrate YOUR fingernails and cripple your writing hand! OR… you could be bitten by one of the other hundreds of poisonous insects or arachnids that inhabit Australia.

Take a walk outside to get a breath of fresh air and you may be kicked in the head by a deranged kangaroo or trip over a dehydrated wallaby.  Go too close to water and you may receive a fatal chomping from a man eating “protected” crocodile, or die a slow, painful death from the sting of a box jelly fish. Oh yeah…they  also have that Opera House thingy…big deal.

And the next one was from another of my FAVORITE students . . .

	Mr. Jacobs Meets Maynard Ferguson

I can’t ‘not’ call you “Mr. Jacobs” because that’s how I remember my time in Junior High School, playing in the marching band, the orchestra, and the most fun of all, Stage Band.  It was the mid-70’s, and I thought you were the greatest band director on the face of the earth

.

All I ever wanted to do was sing and play my instrument. Fast forward 30-some years, and I’m the CEO of a hospital.

It’s not a surprise to me that you ended up where you did.  How different is managing a hospital than it is to be in the middle of nearly 200 junior high school kids, all with their own levels of talent, all self-absorbed, crisis-prone, gossip-focused, crashing into one another verbally and emotionally.  Wait, are we talking about the band here, or staff in general?

Your November 9th blog says it all. You might as well title it, “How Do You Know What You Don’t Know” (or what no one bothers to tell you).  And it usually hits you in the areas (of the hospital of course) that you think are humming along.  People you trust are doing wonderful things, just like you thought they were, until you figure out you’ve been had.

A million policies and procedures can never safeguard you against the people who look like adults, sound like adults and dress like adults, but who are sometimes as emotional as 12 years old with not much common sense.

Much of the time I walk around going, “How did this happen?”  “What was he/she thinking?” “When was anybody going to tell me about this?”

It’s . . . often a scary feeling of, “Is this real? Did that person just actually say that?”

If you’re a CEO, or in any significant management position, you had better be micro-managing daily…and it had better be your communications process.  I’m convinced communication either makes or breaks an organization, and for the CEO, fueling that effort never ends.

It’s not enough that you’re in charge of people’s lives, and the people who take care of them 24 hours a day, 7 days a week.  You have to be all over the information generated from every area, all the time.  And be prepared to understand that there are many sides to every story, and even then, it might not be entirely in focus.

I loved you as a band leader, and I would love to visit your hospital and see some of the things you’ve done to make it less institutional.

Glamorous? Yep, that’s how some people see my life, glamorous. Heck, I’ve been to Bosnia, Nigeria and now, Serbia. The day started at 5:00 AM as I walked up to the ticket counter for my 6:45 flight. It was a short hop to New York, but this particular day would be very long. Typical trans-continental flights leave at around seven or so at night and land at about seven or so in the morning. Six or more hours magically disappear as you fly into the future. During that flight it is not unusual to be waited on a half dozen times with food and beverages, that fact alone keeps even those with sleep eye masks and ear plugs from sleeping for more than a few hours at a time.

Upon landing, a greeting party consisting of the physician in charge of the conference and a representative from the hotel met us at the exit door from the airplane’s walkway, they escorted us through Passport security and took us to the hotel where they informed us that lunch will be served in 20 minutes. Following lunch, we had about 20 more minutes before my presentation and then the opening ceremonies. Approximately 900 physicians were in attendance at this three and a half day event. Present at the opening were the His Royal Highness, Alexander, Prince of Serbia, the Minister of Health, the general in charge of military medicine and numerous other dignitaries and prominent physicians.

The following day was filled with lectures and workshops, but we were on a mission to visit a rehabilitation hospital and spa. It was a three and a half hour trip each way, but our driver had amazing driving skills, and we made in two and a half hours each way without being arrested or killed. (Other drivers that we had over the three days were arrested twice for speeding and one had an accident and parked the car on a streetcar track.) The visit to the spa was amazing, the physicians were amazing, and the concept was amazing, one level beyond even our current span of modalities.

We returned to the hotel in time to jump in another car and meet personally with HRH Alexander, the Crown Prince of Serbia, a friendly man who was born and raised in England and the United States. His great grandmother was one of the Queens of England. His wife was a Greek Princess and immediately began to talk to us about her knowledge of Johnstown and her visits to Pittsburgh to assist in encouraging U.S. Steel in their successful efforts to purchase a plant in Belgrade.

The next morning we met with the Minister of Health in a private meeting, spent time at the conference and toured Belgrade. Later that afternoon we returned for the major dinner of the conference. It was during that event that we experienced a truly amazing celebration of Serbian heritage. There was an ox, sheep, and pig roast (not a good day to be a vegetarian); the country’s winning ethnic, brass band and presentations and awards for everyone, including yours truly.

At 8:30 AM the following morning we had a private meeting with the general in charge of military medicine at the country’s version of Walter Reed Army Medical Center, a one-thousand bed hospital that specialized in every aspect of care including transplant surgery.

We returned to the city for lunch, went back to our rooms to pack, had a quiet dinner and left for the airport at approximately 11:30 PM Wednesday evening, 5:30 AM Belgrade time. For the next 24 hours we were in transit from Belgrade to Paris, Paris to NYC, New York to Pittsburgh and then drove from Pittsburgh to home. Truthfully, it was a nice break. Our organization’s pins are now firmly planted on lapels throughout the Balkans, and only time will tell what the future will bring. We met with several medical students who are interested in doing research with us, several physicians who have vowed to visit us from as far away as Korea and as near as the Cleveland Clinic and have made new friends from Bosnia, Slovenia, Russia, Greece, Italy, France, England, and Montenegro, to name a few.

Our work continues to be heard, discovered and embraced internationally, and our desire to make Windber an international center of excellence continues to move forward. It once again reinforces the fact that we really are all one world and that a child in Serbia has the same hopes and dreams as a child anywhere. So do his parents.

It’s about 11:30 AM on Saturday, 10/12/07, and I’m on my way to Kennedy.  That’s JFK Airport in New York City.  This will be a very long day as I wait until 7:00 PM for a connecting flight to Paris, and then run for 45 minutes through that airport to make my next fight to Belgrade. Once in Serbia, we will deplane and almost immediately make a speech to the participants of the World Health Congress on Cardiology.

I’m not exactly sure what we will be finding there, but, not unlike my trips to Nigeria and Bosnia, the one thing that I am sure that I will find will be wonderful, friendly people.  In fact, my brother, Charlie and a Serbian-born friend, Steve, will be there with me.

We will be meeting with the Minister of Health, the Head of Military Medicine and a Health Spa.  Then we will head home on Thursday.  It will be lots and lots of travel, lots and lots of talking, and not much sleep, but next weekend will give me plenty of time for that.

So, hang on to  your hats.  I’ll try to connect from Serbia, but, since getting Serbian dollars at the exchange here has not been possible, we’ll just see  how things go. 

The adventure begins.

Nick’s note: Our dog, Brody, died today, and so, with permission from myself, here is an updated version of a blog that I wrote a few weeks ago for another website:

I am writing this as a health care provider, a hospital CEO, and a concerned citizen.  In the past we have talked almost incessantly about the 47 million uninsured in our nation, and the lack of funding for domestic issues ranging from education to infrastructure.  The Pittsburgh Tribune-Revue last week wrote about the absurdity of suggesting increases in cigarette taxes in order to provide health care for poor children as a very bad idea because this tax plan would have a negative impact on the poor as well?  That logic escapes me as the pieces of the backwards thinking rings in my head.  Getting people to stop smoking, be they rich or poor, is a very good thing.

An article in the New York Times by Sarah Kershaw opened with this pertinent piece of information,

“The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.”

At our hospital, the decision to treat or not to treat will remain the same: We will treat.

The Washington Post’s Christopher Lee wrote recently that,

“If anything looked like a sure thing in the new Congress, it was that lawmakers would renew, and probably expand, the popular, decade-old State Children’s Health Insurance Program before it expires this year.”

This surely seems like a dream come true for any politician, something that creates a health care safety insurance program for children who otherwise might not have the coverage or financial wherewithal to pay for this care.  What politician would even consider vetoing an already established program that offers health insurance for kids?

Interestingly, President Bush did veto it.  It’s important to note that his veto was not because he is concerned that this program doesn’t work. He has acknowledged that S-CHIP works very well.  He has also indicated that he would not veto it because it is fiscally irresponsible. In fact, this plan is, overall, a very reasonable expenditure. Yes, he objects to any expansion of the plan, but, it appears that this was not the only reason for his veto.

It seems that Mr. Bush’s decision to take this stand is ideological.

The program is diametrically opposed to his philosophy of government.  If you take care of kids, and that plan works, then you can take care of adults, too.  Expansion of government is not something that this president embraces.  But the administration clearly continues to embrace the Iraq war, and that costs money, lots of money.

  From The New York Times, January 17, 2007 by David Leonhardt:

“…For starters, $1.2 trillion would pay for an unprecedented public health campaign” a doubling of cancer research funding, treatment for every American whose diabetes or heart disease is now going unmanaged and a global immunization campaign to save millions of children’s lives.

Combined, the cost of running those programs for a decade wouldn’t use up even half our money pot. So we could then turn to poverty and education, starting with universal preschool for every 3- and 4-year-old child across the country. The city of New Orleans could also receive a huge increase in reconstruction funds…”

It truly is all a matter of ideology?

This evening as I was looking through the web for some inspiration for a Hospital Impact blog, I came across a description of a wonderful health care experience.  It was so much fun that I wanted to share it locally, too.

It was a beautiful, spring morning, and I had just "Gotten My Fix on Route 56" . . . (Well, it was actually a Chai tea from Eat n Park), but, nevertheless, my 90,000+ mile Jeep at that time was less than five minutes from work, just past the cell phone dead zone that I lovingly refer to as Radio Free Windber, when it rang.  On that particular Treo, my first of five, the caller’s personalized ring was a jazz piece that I had down loaded from the web.  Because of the jazz ditty, I Immediately knew that it was Zane, the 78 (now 80) year old, former Publicist for the Pittsburgh Symphony. Zane was living in Columbia, South Carolina, and his first words to me at 7:15 that morning were, "Hey, why aren’t you blogging?" 

To this day he denies ever calling or saying this to me, but that’s how it happened.  You can’t begin to make these kinds of things up.

Now don’t get me wrong, I knew a little bit about blogging from listening to the grand kid’s Ya Ya saying very bad things every time she watched television and her personal favorite politicians didn’t come on, didn’t win a debate or didn’t give the correct answer when it came to the economy, funding the war or world diplomacy.  She actually had informed me about the popularity of some Blogs/weblogs, currently being written about, you guessed it, politics. 

"Why?"  I said to Zane.  "I don’t know why.  Sounds like a great idea.  I’ll do it." 

A few minutes later I was on the phone with "Web Man, my personal super web hero," a professional webmaster with whom I had been working for the past half dozen years or so, Mike Russell.  Mike was responsible for helping us create a website or three, and, if anyone knew about blogging, it would be Mike.

Later that weekend, I started a hospital blog.  It was called Windberblog, but Mike also named it "Nick’s Blog."  In fact, it was the first hospital blog written by a CEO in the world.  If you’re reading this for the first time, don’t be shocked.  Hospital dudes are generally not real fond of risk taking, at least the 3,573 others with whom I have networked at one time or another.  Leading the pack in innovation is usually not a great love of theirs. 

When I tell you that this blog was hospital based, it was.  When I say it was board endorsed?  Well, that’s another story.  That didn’t happen.  In fact, it never really officially happened.  Some of my board members discovered it and liked it, but, for the most part, it’s an older group, that doesn’t hang out much online. Sometimes, it’s just better to ask for forgiveness than permission.

It actually wasn’t until I started writing funny and controversial things that it became internally well known.  Once after spending an entire week-end composing a very objective description of an upcoming major decision making process, my board chair received a call from a business leader suggesting that he fire me before I was sued, but, thank goodness, nothing was on that blog that made me particularly sue-able.  Yes, it was transparent, but that’s the part I love about this new world order. 

So, there is some little risk to this adventure.

After several months, a young Cornell grad by the name of Tony Chen, sent me an e-mail and invited me to become a guest blogger on his Hospital Impact blog at hospitalimpact.org.  At that time Tony was a very erudite young employee of HFMA, and the blog was intended to reach out to hospital leaders in order to give them hints on "how to be the best run hospital in the world."  That blog became my national philosophy soapbox.  It also gave me a chance to spout off about "Planetree," an international organization dedicated to the demystification of health care.  We actually considered calling it Windbercare at Windber, and, in fact, that is now what we do call it  . . . currently under the Planetree umbrella.

It was almost a year later that Mike Russell suggested something called "YouTube."  After about one weekend of exploring that site, we began transferring our advertisements, videos and speeches there.  That went on until we had approximately 15 or so samples of our work under the moniker of Windbercare.  (Is moniker a word?)

It was about the same time that Toby Bloomberg from Diva Marketing contacted me via e-mail for an interview that she ran on her blog, then Bob Coffield’s Health law blog, Trusted MD, HIStalk and several other bloggers linked to us and began to recognize our work and interact with us.  We were invited to speak in Washington, Las Vegas and now Chicago regarding blogging, and word of our work began to spread in other directions as well with podcasts from HealthLeaders and others. 

A new, local weekly newspaper invited me to write a comedy column for them.  Yes, it was gratis, but they let me tag it with our windberblog info, and hits on Windbercare and Nick’s Blog, began to grow as my popularity soared as a local folk hero for these fun, baby boomer, kid-raising, memories at ourtownonline.biz under Nick Jacobs.

That, of course led to some of my blogs being picked up by Blue H News, an industry newspaper that goes to every hospital, except ours . . . but I’m sure it’s an oversight.  George Page, the editor liked my stuff and only rejects about 50% of what I write.  Hospital News of Western PA, Atlanta, Chicago and South Florida began accepting my submissions and I became a regular contributor there.  The Johnstown Tribune Democrat  has begun to print my weekly business-oriented articles, and Tony got me a gig writing for the Worldhealthcareblog.org website that is managed by Hylton and Francois. That’s my international soapbox. 

Two weeks ago Tony also got me hooked on Facebook.com.  That’s been just for fun . . . so far.

Long story long?  This stuff works.  Although it would be misleading to give full and complete credit to the blog, it sure has helped to elevate knowledge about our organization.  Paul Levy of Beth Deaconess does his own blog now and is a CEO.  The difference between Paul and me is that it is his personal blog, and he is living in a big city, my continuous fantasy. 

Someday, maybe someone will pay me to write this stuff, or we’ll get sponsors, but it has been a real trip into Web 2.0, social networking.  I haven’t felt this good about myself since I played trumpet for a living.  As they used to say back in the 60’s,"It’’s hip to be cool." 

Quote from Imelda Marcos: “Doesn’t the fight for survival also justify swindle and theft? In self defense, anything goes.”

Quote from Nick Jacobs: "Gosh, I hope not!"

So much of what we are experiencing everyday feels a little uncomfortable . . .

This is not a political blog.  It is not intended to be.  It is intended, however, to encourage you to explore the real vs. the perceived.  It is intended to point out things that have been bothering me for quite some time as a human being. 

Windber is a Planetree facility.  That means that we embrace the concept of body, mind and spirit; the demystification of healthcare; the concept of not leaving your dignity at the door.  We call it WindbercareTM. Some of our competitors would have you believe that whatever they say they do creates a special center for healing.  We say: come here, then go somewhere else, and feel the difference.

We have a multiple slice PET/CT scanner.  If you’re a lay person, that probably means almost nothing to you.  It’s technical. a PET scanner is one diagnostic machine, and a CAT scanner is another piece of diagnostic  equipment. Combined, they become an extremely powerful tool.  As an FYI, a multiple-slice CT scanner is not the same tool as a PET/CT.  At least for now, Windber Medical Center is the only PET/CT available for many miles around.

How about a three-Tesla MRI?  What is that?  It is a magnet for an MRI that is twice as powerful as any magnet in this area.  Twice as powerful. Here numbers really do count.  So who cares?  Anyone who needs an MRI scan should care.  It is twice as dynamic as a 1.5 T magnet, the standard magnet available in this area.  Brain scans and breast scans are phenomenal on this piece of equipment.  In fact, we have brain surgeons from Pittsburgh and physicians from Johns Hopkins in Maryland who send their patients to Windber.  The University of Pittsburgh has two magnets like this, West Virginia University has one… and the only other one in this part of the country is here in Windber.

On that same note, what is an open MRI?  It is a piece of equipment that has been developed for people who are anxious, obese or who want an examination of small parts of the body.  The major difference for the patient is that there is no tunnel, the device does not surround the patient being tested. By comparison, even a large bore MRI is NOT open.  To my knowledge, the closest open MRI in this area is in Indiana, PA.

Our infection rate at Windber Medical Center is less than 1%. Try that on for size. If you come to Windber for surgery, there is better than a 99% chance that you won’t get a hospital borne infection. Ask our competitors what their infection rates are. Then make a decision. Your life could depend on it.

Finally, the physician who says to you, "We can only do this surgery at ANOTHER hospital because they are the only ones with the equipment necessary for me to do this work," often times is not telling you, the patient, the entire truth.  There are only a small percentage of procedures that cannot be done at Windber Medical Center.  As is the case in most hospitals, if need be, the factory representatives will actually bring equipment directly to us for specific specialty surgeries, but most of the time when we track back that physician excuse, we find out that all of the equipment was already here. 

The real excuse is "If I don’t do a certain number of surgeries at a competitive hospital, I will no longer have a block of time for my other surgeries. It is a use it or lose it philosophy imposed upon them by larger facilities. Consequently, the physician says, "I’ll tell you that they don’t have the proper equipment," and what he doesn’t say is, "I’ll do that in order to preserve my block elsewhere."

The little secret seems to be… "In self defense, anything goes.”  So, ask, and don’t always assume that the answer is not just better for your health. Because, sometimes, it’s just better for their business.

Okay, I feel a little better now that you know.

Sir Winston Churchill said, "There is something about the outside of a horse that is good for the inside of a man."   

This week-end something wonderful happened . . . the coming together of people from all geographies, all walks of life, all areas of interest.  They came together for one wonderful thing, to help Windber Regional Hospice.  Now, some of you may be wondering what they did, but back up a few lines and read Sir Winston’s quote.  It was the horse show, you know…Pole Bending, Box Keyhole, 50 Yard Dash, Flag Race, Hay Bale Tunnel, Dollar Bareback.

The Greater Johnstown Saddle Club and Golden Star Horse Farm came together once again to raise money for the patients cared for in our palliative care unit and hospice.  The cumulative sum needed each year to cover the costs of the efforts in these two areas is generally over $300,000 and this weekend, thousands of dollars were raised toward this need. Thanks to efforts like this one, neither those who can or those who can’t afford it will ever know the difference in their care and treatment.

As in the movie "Casablanca," our own Frankie Bock and her team generated the list of usual suspects to make this all happen. The list went something like this: our donors, sponsors, patrons, show participants, friends, staff of both the Hospice and Medical Center, businesses, and the greatest volunteers anywhere.  If you have no idea who is represented by this list, simply stop by any function touched by the hospice and you will see these faces, hundreds of faces, who make up that list of volunteers, supporters, and sponsors.  It’s a wonderful list of truly amazing people, all geared toward one goal, helping families who need hospice care.

One of our non-hospice employees walked up to me with a pretty, fifteen year old girl and said, "Nick, I would like you to meet Lori, her mom passed away in hospice. I just wanted to bring her here today."  That’s what we’re dealing with: people who care about their fellow human beings.

As my grandson walked up to the show area to look at the horses, a non-Windber physician came up to me with the tallest horse I’d ever seen and said, "If he’d like a ride, I’d be happy to let him ride my horse for the judging."  He, along with a few dozen other kids, won a trophy, and that trophy never left his hand the rest of the day.  People taking care of people.  People reaching out, sharing, working to help other people.

There was food, plenty of food. There was plenty of great food, prepared, sold and served by this group of wonderful volunteers.  There were children’s games and activities, a Chinese auction and drawings. It was people caring for people: feeding them, nurturing them, watching out for their human, physical needs.

One of the baskets that was being raffled was called a kid’s basket and in it was grooming equipment; brushes, oils and other wonderful accoutrements for grooming horses; for teaching care and nurturing at a very young age.  Groom a horse, love one of the creatures of the universe, and the universe will teach you to pass that love onto others.

It’s all about kindness.  It’s all about giving because in giving we receive. Saint Francis of Assisi once said, "Preach the gospel at all times. When necessary, use words.”   This group of usual suspects live those words as they care for each others, for their patients, their friends, their loved ones.  Hospice is amazing, and unless or until this country understands completely the beauty of this program, we will continue to suffer death in hospital rooms crowded together without support, without nurturing, without love.

From our Hospice physician, Dr. Kelly Warshal…

"So now, after a few days with us, I am sending the patient home on nothing, no drugs, nothing but our own hospice blend of flower essences like angel’s trumpet to help to prepare him for the transition into the spiritual world. He is talking, blowing us kisses, and eating pudding.  I LOVE MY JOB!”

Become a Windber Hospice volunteer. You’ll love your job, too.

“Everybody wants to go to heaven, but no body wants to die.”  That’s what Jim’s dad, Carl, used to say on Thursdays in the 1970’s when we looked to him for his wisdom and advice.  Actually, he used to say it when we were complaining about how hard it was to accomplish something.  It’s funny, but applies to so many areas of our life.

Creating the future, or at least creating a positive future, is something that everyone wants, but when it’s time to step out and make it happen, it’s a good idea not to stop and look behind you, because, usually, there’s a very short line of risk takers standing there with you.

John F. Kennedy used to refer to the Irish writer, Frank O’Connor, who wrote about his childhood and about the early formation of his risk taking philosophy by saying, “He and his friends would make their way across the countryside and when they came to an orchard wall that seemed too high, too doubtful to try and too difficult to permit their voyage to continue, they took off their hats and tossed them over the wall, and then they had no choice but to follow them.”

It was Henry Ford who said, “If you think you can, you’re right.  If you think you can’t, you’re right.”

As an organization, we are facing our future head on.  We must re-invent ourselves on a daily, weekly and monthly basis.  Business as usual will not cut it here anymore.

Only through our creativity, our persistence, our desire to succeed . . . only through throwing our hats over the wall, putting a stake in the ground, taking a stand and being there for our patients, our physicians, our partners and our loved ones can we be successful.

Dream our future as an International Center of Excellence, and dream individually of our new centers of excellence, the ones that you will work to create.  Then, create and support them.

We’re only in a competition with ourselves, and we are not the enemy.  Let’s start each morning by saying, “If we think we can, we’re right,” because, as Ralph Waldo Emerson said, “A Hero is no braver than an ordinary man, but he is braver five minutes longer.”

Be brave.  Focus on a positive future and it will be ours!