Sometimes Not Fitting in is Better

November 12th, 2005 by Nick Jacobs 17 comments »

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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Dr. Lee Hood

September 15th, 2005 by Nick Jacobs 126 comments »

There’s a new movie at the theaters entitled "Red Eye."  Some of us lived at least a part of this film last week as we flew to Seattle at 7:00 AM and began our trip back that night, actually the next morning, at 2:30AM.  Ten hours of breathing recirculated air on the way to and from Washington  resulted in an early autumn cold, but, more importantly, and more positively, it may have produced a major, new partnership for Windber. 

Our first stop in the city of Starbucks, Boeing and Microsoft was directly across the street from the Gates Foundation.  As we drove past the infamous home of the Gates Foundation, we were told that, when Mr. Gates wants to visit, ten black Cadillac Escalades come roaring down the street and one peels off into the basement garage of the building while the others go on in every direction.  Then the prized Escalade with the billion dollar cargo on board, Bill Gates, rides an elevator to the floor where his meeting is being held. Fort Knox on software.

Our primary meeting there, however, was with a very famous scientist, Dr. Lee Hood

Hood_3 "Dr. Hood is the founder and Director of the Institute for Systems Biology, a spin-off from his labs at University of Washington (UW). Hood came to UW from UCLA encouraged by aggressive financing from Bill Gates. Hood has been (i.e. first gene sequencing machine) and continues to be one of the leading researchers and thinkers in the genetic engineering and biotechnology revolution. Hood is thinking about the next step: bioinformatics.

"His professional career began at Caltech, where he and colleagues pioneered four instruments that constitute the technological foundation for contemporary molecular biology. One of the instruments has revolutionized genomics by allowing the rapid automated sequencing of DNA. Dr. Hood also was one of the first advocates and is a key player in the Human Genome Project — the quest to decipher the sequence of human DNA.

"Dr. Hood earned an M.D. from Johns Hopkins University in 1964 and a Ph.D. in biochemistry from the California Institute of Technology in 1968. Since then, his research has focused on the study of molecular immunology and biotechnology. Dr. Hood has published more than 500 peer-reviewed papers and co-authored textbooks in biochemistry, immunology, molecular biology and genetics. He also co-edited Code of Codes, a book discussing scientific, social and ethical issues raised by genetic research. Dr. Hood is a member of the National Academy of Sciences, the American Philosophical Society, and the American Association of Arts and Sciences."

Well, Dr. Hood asked us if we would consider having Windber partner with him in his research and entrepreneurial activities.  We hesitated for about  two seconds and said, "Yes."

Our first combined grant application could be for around $100M, a number that is very close to the combined funding that has come to Windber and Walter Reed over the past several years.  Dr. Hood described our science, our collection of human tissue, our bioinformatics capabilities and our partnership with Walter Reed as a valuable, unique and one-of-a-kind opportunity in the world.

Thanks, Dr. Hood.  Maybe soon the rest of the world will "get it" as we press on to make life and science better for everyone.

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From the Outer Banks

August 24th, 2005 by Nick Jacobs 9 comments »

Well, the summer is almost over, and I’m in the middle of my annual trip to the beach.  Once a year for the last quarter century we’ve headed to some beach, usually Duck, North Carolina.  Now, some of you know where the Outer Banks are located, but for those of you who don’t, they’re located a few hours South of Virginia Beach. 

Let me be the first to tell you that I’m not a big beach person.  I’m not crazy about sand, don’t like to have things bite me in the ocean or, for that matter, on the deck, and I"m not thrilled with fishing. I don’t like to get sand in my shoes, and really hate those dumb beach shops where you can buy sea shell ashtrays and five tee shirts for $10 that say things like "I Got My Tan at Duck." I don’t like to sun bathe (boring), gave up golf, don’t care for too much air conditioning, and don’t drink enough to keep me from knowing that I’m there. 

Most of the time I miss my suit and tie. 

The best part of the beach for me is not the seafood, as I’ve been a vegetarian since 1996.  I used to enjoy the human scenery a great deal, but Duck is pretty laid back, not like New Jersey or Maryland.  It’s mostly conservative families, very few tattoos, and hardly any body piercings. 

The best part of the beach trip for me is Beyond Balderdash

Now, I’m not talking about the word balderdash, I’m talking about the game.  After everyone finishes digging crab meat from steamed crabs, and shucking all the things they shuck, the group crowds around the table and begins to play Beyond Balderdash

This game will probably be banned from family use someday by the neoconservatives, but for now, Beyond Balderdash is downright crazy FUN.  As you might imagine, my job/s don’t really lend themselves to crazy FUN.  We deal with serious stuff all day, everyday.  We deal with people’s lives, people’s futures, and people’s loved ones.  So, it’s not often that I can laugh til I cry and hold my stomach from the pleasant pain.  Sometimes I laugh so hard that I can’t breathe, and that’s a good thing. 

This year’s Balderdash group has expanded to include a new family, my son’s in-laws.  They have added another dimension of craziness to the game.  I’ll admit that the drinks sometimes increase the joy for some of the players, but overall, the fun for me is from the pure creative energy that goes into the wonderful, make believe answers that hardly ever stump any of us. They just make us laugh those deep belly laughs that used to be such a regular part of life. The laughs that don’t come at anybody’s expense. The laughs that say, "Heck, it’s just great to be alive today." 

So, I listen to the ocean.  Watch the waves. Read a little. Walk the beach. Call the office three or four times a day.  Check my e-mail a dozen times.  Send some text messages. Eat too many pretzels.  Sleep until 6:30 or 7AM.  Nap in the afternoon, and PLAY Beyond Balderdash

Warning:  This game is not meant for the faint of heart.  People who don’t find humor in The Comedy Channel, David Letterman, or movies like "Old School" will probably have a tough time getting into the crazy, fun Balderdash that we play, but for now, it’s my closest visit to Nirvana! 

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