Posts Tagged ‘Hospital’

Sometimes it’s Better to Punch a Bear in the Face

March 27th, 2011

I’ve tried to avoid controversy, but since my reading audience has dropped by a few thousand readers after departing my previous CEO position a few years back, I doubt that this will cause me any more problems as a consultant than I’ve already caused by expressing my opinions in previous posts. So, for those of you who are still dependent upon me for financial support, I apologize.

This morning, I read an article in the Pittsburgh Post Gazette by John Hayes entitled “Meet Your Neighbors: The Bears,” about black bears living in Pennsylvania. The essence of the piece is that there are about 18,000 bears living among the 12,000,000 citizens of Pennsylvania, yet there are only about 1,200 bear-related complaints to authorities a year. The bigger issue, however, is that there have been no reported deaths caused by black bears. They don’t eat people.

During this same period of time, I read a post by my friend and fellow patient advocate, Dale Ann Micalizzi, referencing an article about the former president of Beth Israel Deaconess Medical Center (BIDMC) in Boston, Paul Levy,  another nontraditional hospital CEO who espouses transparency. “Admiting Harm Protects Patients” is the article appearing in today’s Las Vegas Sun. In my book, Taking the Hell out of Healthcare, which Paul graciously endorsed on the cover page, we talk about patient rights, patient advocacy, and the need to have someone with you during your hospital stay to ensure that you are not going to become a statistic. In today’s article, Paul is recognized for the work that he did with his blog — a blog which I encouraged him to write and to keep writing — in which he challenged the hospitals of Boston to reveal their mistakes, to stop keeping the infection rates and other problem statistics secret.

Because he was trained as an economist and a city planner, Paul Levy was considered an outsider by his peers when he took over the troubled Deaconess hospital, but as he quickly turned it around, he did so through the eyes of an outsider. In December 2006, he published his hospital’s monthly rates of infection associated with central-line catheters, which are inserted deep into the body to rapidly administer drugs or withdraw blood. These central line infections, which can be caused by nonsterile insertion of the catheter or not removing it soon enough, are preventable. The Centers for Disease Control and Prevention estimate 250,000 central-line infections occur annually, costing $25,000 each and claiming the lives of one in four infected patients.

Dale Ann Micalizzi (L) and Paul F. Levy (R)  - Healing Hospitals - F. Nicholas Jacobs, FACHEHe then challenged the other Boston hospitals to do the same. He was accused of self-aggrandizement, egomania, and numerous other witchcraft-like things, but the bottom line was that the number of infections went down, and they went down because the staff and employees wanted to do better and wanted them to go down.

What else happened at Beth Israel Deaconess?

• Hospital mortality of 2.5 percent, which translates to one fewer death per 40 intensive-care patients.

• Cases of ventilator-associated pneumonia, from 10-24  per month in early 2006, to zero in as many months by mid-2006.

• Total days patients spent on ventilators from 350-475 per month in early 2006 to approx. 300 by mid-2007.

• The length of an average intensive care stay from 2005 through 2009, the average stay was reduced by a day to about 3 1/2 days.

(See my previous post on outrageous claims at my prior place of employment.)

Well, in today’s article about the bears, I read that “when bear attacks occur they are generally very brief, and injuries can include scratches and bites.”  Here’s the part I had not anticipated from the bear conservation officer: “Fight back, don’t play dead.  Unlike other North American Bears, black bears don’t consider people to be food.  When it realizes what you are, or gets a painful punch in the face, it is likely to go away.” I believe it’s a useful metaphor.

If you or your organization would like to hear a CEO or two speak about patient advocacy (and way better healthcare), I’m sure I know a former teacher/musician and a former city planner who would welcome the invitation.

Patient advocacy is in your hands!

Health 2.0 Leadership (1 of 2) from Nick Jacobs, FACHE on Vimeo.


Excerpts and Opinions on “What Makes a Hospital Great?”

March 17th, 2011

Dr. Pauline W. Chen’s March 17th New York Times article answers the question, “What Makes a Hospital Great?” In this article, Dr. Chen finds:

Dr. Pauline W. Chen - surgeon & New York Times contributor - Nick Jacobs, FACHE

Pauline W. Chen, MD | Blog:

“Hospitals have long vied for the greatest clinical reputation. Recent efforts to increase public accountability by publishing hospital results have added a statistical dimension to this battle of the health care titans. Information from most hospitals on mortality rates, readmissions and patient satisfaction is readily available on the Internet. A quick click of the green ‘compare’ button on the ‘Hospital Compare’ Web site operated by the Department of Health and Human Services gives any potential patient, or competitor, side-by-side lists of statistics from rival institutions that leaves little to the imagination. The upside of such transparency is that hospitals all over the country are eager to improve their patient outcomes. The downside is that no one really knows how.”

I’ve written often about the failed promise of technology alone, and this is reaffirmed in Dr. Chen’s findings:

“…hospitals have made huge investments in the latest and greatest in clinical care — efficient electronic medical records systems, ‘superstar’ physicians and world-class rehabilitation services. Nonetheless, large discrepancies persist between the highest and lowest-performing institutions, even with one of the starkest of the available statistics: patient deaths from heart attacks.”

As she asks why this is,  the answers have become relatively clear from a study that was released in the Annals of Internal Medicine this very week. This research indicated that it was not the expensive equipment, the evidence-based protocols, or the beautiful Ritz Carlton-like buildings. It was, instead, the culture of the organization.

Hosptials in both the top and bottom five  percent in heart attack mortality rates were queried by the study team. One hundred fifty interviews with administrators, doctors and other health care workers found that the key to good (or bad) care was “a cohesive organizational vision that focused on communication and support of all efforts to improve care.”

Elizabeth H. Bradley, Phd, Yale School of Public Health

Elizabeth H. Bradley, Phd, Yale Global Health Leadership Institute

“It’s how people communicate, the level of support and the organizational culture that trump any single intervention or any single strategy that hospitals frequently adopt,” said Elizabeth H. Bradley, Senior Author and Faculty Director of Yale University’s Global Health Leadership Institute.

So, it wasn’t the affiliation with an academic medical center, whether patients were wealthy or indigent, bed size, or rural vs. urban settings that mattered in hospital mortality rates. Rather, it was the way that patient care issues were challenged that made the difference. The physicians and leaders at top-performing hospitals aggressively go after errors. They acknowledge them, and do not criticize each other. Instead, they work together to identify the sources of problems, and to fix them.

One of the most telling findings in this study was that relationships inside the hospital are primary, and the physicians and staff must be committed to making things work. Dr. Bradley said. “It isn’t expensive and it isn’t rocket science, but it requires a real commitment from everyone.”

So, the next time that you select a hospital, look up its statistics, and I guarantee you that you will be surprised. When it comes to outcomes, to nurturing or even competent care, the biggest is not always the best.

Learn More:


Along the Way…Things Became Very Interesting

January 31st, 2011

Two years ago I began this new journey, but not until a few months ago did my work in consulting really begin to take shape in a way that could never have been predicted.

As the challenges of our present economic times have become increasingly daunting, my personal and professional journey has become even more dedicated to innovation and creativity. One goal has been to provide new alternatives to past practices that will create value for patients. This means making a contribution to saving and transforming lives, while producing cost savings and financial stability, and developing new markets to enable provider growth in their missions.

Olympic National Park, Port Angeles, WA - Nick Jacobs, FACHE - Healing Hospitals - SunStone Consulting

The driving force behind my exploration began with asking how we can begin to control those out of control expenses that are currently blurring the lines between continued care for our population, and rationing or elimination of services?  But, the answer(s) must enable us to continue to add healing opportunities for our patients at every turn.

Because my creative energies have always been focused on producing more ways to generate new monies for whatever organizations I have personally represented,  it seemed somewhat foreign to me to spend more time on fiscal issues than creative alternatives.  However, with literally millions of Baby Boomers coming of age each year, it was obvious that our entire culture is at risk both fiscally and socially. Consequently, after listening carefully to my peers, several opportunities presented themselves that would address all levels of these concerns.

Through the combination of their proprietary software and dozens of years of combined knowledge in the healthcare finance field, SunStone Consulting, LLC, spends each and every working day addressing the challenges of finding monies that should already have been captured by hospitals and physician practices, while also creating new opportunities that have heretofore not been explored. That’s where SunStone Management Resources comes into play.

SunStone Consulting - Nick Jacobs, FACHE

We have identified new companies, new entrepreneurs and new creatives who can not only improve healthcare, but also significantly improve the bottom line of those organizations willing to embrace their programs. One such company with whom we are partnering can increase Emergency Room productivity by as much as 35 to 50%.  They can also help do the same for cancer centers and operating rooms. They utilize robotic systems that communicate patient needs and simultaneously seek out the appropriate medical services required as soon as the patient is triaged. The patient’s condition and potential requirements are communicated to every individual who will or should have contact with them throughout their hospital stay.

We have also identified what I refer to as “no brainer” opportunities. By making otherwise locked fiscal percentages  a commodity, even small and medium sized organizations can save huge dollar amounts. How? By changing out only the electronic reading devices used hospital-wide. This simple change has resulted in huge fiscal savings for clients.

Add to examples like those above the introduction of  a new invention that, in the right hands, can help to extend some types of Stage 3B and Stage IV cancer patients’ lives from months to years through a relatively simple post-surgical procedure. Also consider the invention of new materials that would support bone growth, while virtually eliminating the need for casts or even slings. Imagine a series of protocols that have brought over 40 people out of deep, irreversible comas. Then, on a completely different path, consider having access to  the cumulative knowledge garnered from over a hundred million dollar investment in breast cancer care.  (This is about to be made available to small and medium sized hospitals across the world.)

These are but a sampling of  just some of the opportunities currently driving my passion in this new healthcare world order.

You may want to make a simple inquiry into what’s behind the innovative, practical, and incredible creations of the brilliant people doing this work.  It’s not just so many words on a page.  It is the future, and the future for you and your organization could be now.


Is Saint Vincent’s Just the Beginning?

November 9th, 2010

In an article in New York magazine by Mark Levine entitled, “St. Vincent’s Is the Lehman Brothers of Hospitals,” we are taken on an extremely in-depth and comprehensive review of the sickness and death of one of New York City’s oldest hospitals. It is not my intent to re-create or completely paraphrase this incredible article, but only to select a few of the most poignant facts that literally jumped off the pages and painted a reality for me that was not restricted to the hospitals of New York City.

Photo Credit: Associated Press via

A worker removes signage from now-closed St. Vincent's Hospital.

Mr. Levine’s research revealed that “In 2008, local hospitals spent $3 billion more delivering care than they took in.” He also found that New York hospitals carried twice as much debt in relation to net assets as hospitals around the country, and that, — this is no surprise, as various New York City hospitals close, “the health of low-income and minority residents will be most affected.”

In this commentary, he listed a myriad reasons why these facts represent reality. Included is the $600 per square foot construction costs, outrageous malpractice premiums that are double the national average, 15% higher staffing levels than in other areas, CEO salaries that in some cases have reached nearly $10M per year, daunting demographic challenges, a lack of private physicians living in most communities, lengths of stay that, once again, are at least a day longer than other U.S. hospitals, the 1.4 million New Yorkers who have no health insurance, decreasing Medicaid rates, and a private insurance network that makes considerably more on its New York hospitals than is the case in other geographic areas.

Interestingly enough, as we forged our way through this comprehensive history of how the City system has devolved over the past thirty or so years, we were taken on a journey that is not unfamiliar to many of us in hospital administration. As government swung from socialized (as Mr. Levine states…with a small “s”) medicine to shock-therapy free market, to increased costs in competition, physician recruitment, technology build-up (a build-up that he referred appropriately to as the “medical arms race“), and more movement toward outpatient care, it is very clear that New York City’s hospitals crisis is just one view of a dysfunctional healthcare system that is clearly on a path that could eventually lead to collapse for not only the system, but also for the economy of the country as well.

New York City’s hospitals crisis is just one view of a dysfunctional healthcare system that is clearly on a path that could eventually lead to collapse for not only the system, but also for the economy of the country as well.

This paragraph is one of the most telling paragraphs in the article, “The way forward seems perfectly, if brutally, clear. With private insurers under pressure to cover more patients yet not hike premiums, with federal and state governments facing record deficits, and in a local industry climate with free-market survivalism, many New York (substitute U.S.) hospitals won’t be able to generate sufficient revenue to restore themselves to financial health.”

Image Credit: - Nick Jacobs, FACHE -

Interestingly enough, the conclusions reached regarding survival embrace numerous ways of doing business that were not entirely foreign to many hospitals. Included were such concepts as: moving more toward outpatient care in less expensive locations, more follow-up care to keep patients from returning, reduction of unnecessary testing, employment of and profit sharing with physicians, and additional methods of dealing with “the tyranny of insurance companies.

Steps such as measuring nursing hours, housekeepers per square foot, food service people per meals delivered, and embracing the entire model of industrial efficiency were all suggested contributors to the bottom line.

Mr. Levine also granted partial sainthood to a profoundly bullying management style of one CEO who cut services that didn’t make profits, eliminated catering to the poor and “told doctors where to go.”

All of this plays perfectly into the story that I had lived and am currently telling across these United States and beyond; that dignity, prevention and wellness, attention to human and humane detail, the removal of autocratic leadership, and patient and employee-centered care — all enveloped in a spirit of entrepreneurship — can prevail.

That integrative and holistic medicine practices will contribute to taking us out of the current crisis and into a health care delivery system that will be the design for this century and beyond. Of course, we need malpractice reform; we need more control over big pharma and most importantly, we need to provide some type of safety net for those without coverage, but the path to survival is not simply one of a “business model.” It is a path to a humane model, a creative model that embraces people, embraces wellness, embraces humanness in creative, meaningful ways.

Perhaps hospitals are not being killed, but rather are committing slow suicide by following their “Calf Paths” from the past.


The Obligation is Real

September 21st, 2010

On Saturday night a group of people will gather at a restaurant  for a celebration of life since graduation from high school. I won’t be there. Neither will Joe, Butch, Tommy and half a dozen others,  but their absence is for a very different reason: they have passed away. I, on the other hand, will just be passing. So, why not go this year?

Nick Jacobs, FACHE at the beach with his grandchildrenWell, it’s a kid thing. You see, part of my birthday present to each of my kids was an overnight stay at a resort with their spouses, and, low and behold, there is no one to watch three of the grandkids and the brand new chocolate lab; no one, that is, but me. Why would I sacrifice the opportunity to hang with my old buddies for the chance to change diapers, mop up housebreaking accidents, and argue over bathing and bedtime issues?  Why?  Because it was part of the commitment, that kid commitment.  They will be my kids until either I die or they do, and with that come certain obligations that are real.

Why bother you with all of this personal blog stuff?  It’s about obligations.

The other day, a bright young man met with me at lunch to ask me questions about the American Healthcare System. Interestingly enough, I don’t believe that  my answers were what he had expected. You see, we have certain beliefs about our rights to generate, earn, and receive money in this country. What is missing, however, is a realistic reward system that aligns the appropriate reimbursements with the actual needs of the country. When he asked me how many hospitals would invest in purchasing his product, one that might help to eliminate hospital infections, my response was “Not many.”

You see, with obligatory bottom line orientations, many of the hospital CEO’s and CFO’s are not anxious to spend money on a  product that might work.  More importantly, with a lack of transparency, the public exposure that most organizations have relative to this infection problem is still somewhat limited.  It was easy to explain that if “St. Elsewhere” was exposed for having a 24% infection rate, not unlike a five star hotel having bed bugs, you can darn well bet that something would be done and done quickly, but the issue is not so pressing when it is under the basket.

Over the last few years, I have lost some wonderful friends who have had fantastic surgeries at highly respected hospitals.  These surgeries would have been impossible to have in a “normal” hospital, but, having said that, two of them died and one lingered near death for two years due to the infections they acquired there.

If this was widely publicized public knowledge, might he be able to sell more product?  The question was rhetorical and the answer is absolutely, positively, yes. So, back to obligations. Why is it that we must be exposed in order to become aggressive about serious problems in our systems?  The answer is simple: It costs money, and resource allocation is the number one challenge of most hospitals.  Hence my point about our financial incentives.  If we were reimbursed, rewarded and paid, not in an unconnected, cottage industry manner, our treatment regimes and protocols would change.  If we knew that it would be our financial responsibility to amputate limbs for advanced diabetes, would we be more eager to spend money on wellness initiatives?

Truthfully, it’s our obligation, and, as our fellow human beings suffer, we are currently seeing a movement toward political groups intent upon repealing reform measures. That is a backward view of an already complex challenge. It is our obligation to help our fellow man. “Do unto others …or pray you don’t lose your health insurance.”


Planetree or Bust!

October 4th, 2009

Those who have worked with me know that I have been unequivocally one of the most loyal supporters of the Planetree Philosophy of care in the world.

My former place of employment was the third Planetree hospital in the country, after Planetree’s headquarters moved to Griffin (Derby, CT.)  We were the first Planetree hospital in Pennsylvania, and that hospital, Windber Medical Center, is now one of the top ten Planetree-designated sites internationally.  After having served on the Board of Directors of Planetree for nearly eight years, having written literally dozens of blog posts and articles about Planetree,  having taught numerous online seminars for them, contributed a chapter to their latest book, and served on the Planetree Speaker’s Bureau for half a dozen years, I’m back once again with a presentation this Tuesday at the Planetree 2009 conference.  It’s called: Take Care of Your Employees and They Will Take Care of Your Patients.


Although I was encouraged to retire from the board in order to give newer members their opportunity to participate, and am no longer a part of the Speaker’s Bureau, with no formal ties to the organization anymore, I want to assure you that my experience, passion, and commitment to humanizing healthcare, transparency, creating a nurturing environment for patients and their families could not be stronger.

Since my transition from formally running hospitals full time,  I have immersed myself deeply into the world of  helping hospitals through my consulting practice to achieve the patient, employee, and family satisfaction ratings that ensure top scores in HCHAPS which, in turn, will result in increased business, increased revenue, and increased growth for any organization.

Nick Jacobs, FACHE
Nick Jacobs, FACHE

I am including one of my lastest articles on Integrative Health written for Hospital News.  Remember, if I can help, just call, e-mail or or comment:

Integrative Medicine

Massage, Flower Essences, Spiritual Healing, Drumming, Reiki, Acupuncture, Music, Aroma, Humor, Pet, and Art Therapy; all of these healing practices were formerly referred to as Alternative or Complementary Medicine.  They deserve, however, to be referred to as Integrative Medicine. Because, when we integrate these various disciplines with other contemporary healing methodologies, the results can be amazing.

As a hospital CEO, it brought me great satisfaction to introduce all of these treatments to the healing environment of the hospital.  Many times they came amid intense resistance from both the medical staff, and some members of leadership.  In fact, after nearly 10 years of offering comprehensive exposure to Integrative Medicine, we still had a smattering of nonbelievers.  The only thing questionable about these therapies for a healthcare administrator is that the typical insurance companies don’t cover the costs of all of them and cash payments come into play.

The number of patients coming to our facility had tripled through the emergency room alone as did the overall budget of the entire organization during that time period.  Those “Forest for the Trees” practical leaders still could not bring themselves to give credit to one of the major contributing factors involved in that surge of the hospital’s popularity.  Yes, of course, we also encouraged 24 hour, seven day a week visiting, had guest beds in many patient’s rooms, and served meals to the families on the medical floor where their loved one was a patient. Did all of this combine to the create a healing environment?  Of course it did, but Integrative Medicine was the heart and soul of the difference.

Their skepticism seems to fit into the cycle of questioning the validity of wellness and prevention, two comprehensively established methodologies for improving general health and well-being, proven over centuries of unofficial clinical trials.  Wellness and Prevention works, but because the insurance companies have not yet fully embraced these philosophies, then some still say that they are not valid.  Treating sickness can be as comprehensive as ensuring wellness.  For whatever reason, some of our medical and administrative leaders often confuse reimbursements with healing, and forget to add new patients and additional income from related disciplines like PT and OT to the equation.

As a nonmedical, nonscientist, it was easy for me to understand why the various integrative arts worked so well for our patients and their families.  From the old song, “All You Need is Love,” you could easily enjoy the looks on the faces of those patients and family members who used these treatments to receive sorely needed relief from whatever pain or loneliness they were experiencing.  It doesn’t matter if you’re eighty minutes or eighty years old; touch, nurturing, and love all remain critical in our lives.  Have you seen the statistics on how much better people do with pets than without, or how many babies died in orphanages due to the “failure to thrive?”

None of these ancient arts were created because the scientific method produced FDA approved results in trials of 200,000 or more.  They evolved into centuries old healing arts because they provided relief and help in a time when leeches, bleedings, and a lack of hand washing were the accepted medical treatments.  The tribal shaman, medicine man, healers, and other spiritual leaders all knew what the subtle and not so subtle impact of their work meant to their fellow human beings.

We have casually observed the use of these healing modalities on patients who have experienced restored feelings to otherwise numb feet.

We have seen them relieved from debilitating back pain, healed from hopeless wounds, saved from surgeries due to the opening of blocked intestines through acupuncture.  We have observed psychological breakthroughs from drumming that had never been reached by traditional therapy.  Truthfully, I didn’t care exactly what made our patients better, just that they were better, and the results were dramatic, with an infection rate of 1% or less, a 3.4 day length of stay, a low readmission rate, and the lowest mortality rate for adjusted morbidity in the region.

Remember, “All You Need is Love.”


Interesting Words to Think About

September 25th, 2009

The time has come to realize that the old habits, the old arguments, are irrelevant to the challenges faced by our people. They lead nations to act in opposition to the very goals that they claim to pursue — and to vote, often in this body, against the interests of their own people.  They build up walls between us and the future that our people seek, and the time has come for those walls to come down.  Together, we must build new coalitions that bridge old divides — coalitions of different faiths and creeds; of north and south, east, west, black, white, and brown.

The choice is ours.  We can be remembered as a generation that chose to drag the arguments of the 20th century into the 21st; that put off hard choices, refused to look ahead, failed to keep pace because we defined ourselves by what we were against instead of what we were for.  Or we can be a generation that chooses to see the shoreline beyond the rough waters ahead; that comes together to serve the common interests of human beings, and finally gives meaning to the promise embedded in the name given to this institution:  the United Nations. (President Barack Obama’s Speech to the United Nations)

Obama Speech UN 2009

Interestingly enough, there were 22 years in a row when I could have made the same speech (Okay, it would not have been rendered  as eloquently as the President’s, but the content would have been similar.)  The most disconcerting thing about this statement is that I was referring to the internal stakeholders of many hospitals.  One of my favorite statements during those years because of all of the infighting was that “We are not the enemy.”

An enormous amount of energy is expended in almost every healthcare organization on internal power struggles.  In many cases these struggles revolve around issues relating to money.  Questions like “Should the radiologist or the cardiologist be permitted to perform one particular test?”  Turf battles over procedures always seem to be part of the equation.  Other struggles revolve around perceived power relating to whatever positions are held because someone wants more control of larger pieces of the budget.

Power, control, greed?  All of these traits are part of the human experience, but when an organization expends much of its energy on these issues, the result is wasted time, wasted resources, wasted anguish, and, in many cases, lower quality outcomes.

Watching old movies of workers in factories during World War II have always fascinated me because we, as a country, had found a common enemy toward which we could focus our angst.  The fact that health care never seemed to be able to embrace illness as the common enemy always created intrigue for me. Yes, we would rally and work together when emergencies hit, but the other daily activities became somewhat mundane and boring, and our instinct seemed to be to revert to power, control, and greed.

Maybe, just maybe, we could find a way to marshal the medical staff, employees, and administration, the volunteers, and patient families to work together every day in every way to create an actual healing environment where patients can be surrounded with the energy of love, kindness, respect, dignity, and healing.  Maybe this environment could be the goal of every hospital executive, and they could begin and end each day by focusing on setting the example for the creation of a healing environment.


Loyalty and The Life of a CEO

August 9th, 2009

Since stepping back from my CEO role, I have had time to reflect upon the toll that a position like that can take on any individual regardless of the thickness of their epidermis. I have come to realize that anyone who is completely in charge of an organization faces many of the same challenges.

CEO_scales256As a young man, I had serious delusions about what it would be like to be in the role of President. It was kind of a Superman fantasy: Yes, I would be kind, understanding, and fair. It would be my further commitment to be honest, forthright, and ethical in every way. My obligation would be to the people and the patients at all levels. My motto would be “Truth, justice, and the American way.”

Then the big day came, and my tenure began. It took about an hour to realize that it was now my personal responsibility to do everything necessary to generate all of the money needed to make payroll for the employees. In an area with a disappearing population base, that was an extremely challenging task, and as the Sisters of Mercy used to say, “No money; no mission.”

During the money quest, the issues of loyalty and fairness were always rearing their ugly heads. Could you, in this very self-centered culture, ever really expect people to be loyal no matter what your commitment had been to them? I would minimally try to play the role of a benevolent, servant-leader.

I was the guy who would reach out to people who needed a break and then provide them with that break; sometimes against the conventional wisdom. What did I expect in return from them?  Simple loyalty. Time and time again, however, those same people who might never have had the opportunity that they were given would turn on me. It became almost predictable.

It took them a long time to believe that they were capable of doing the job that I had personally selected them to take, but usually as soon as they reached their comfort zone they would begin to turn away. Maybe it is just human nature, but even Mighty Mouse would have been disillusioned by this recurring situation.

The other CEO reality is that fairness is situational and so subject to interpretation that it becomes impossible to please or satisfy everyone. The nature of our new collective employee psyches seems to be one of “If it’s not done directly for me, then it’s not fair.” The list of individuals who were brought to the leadership stage over my 22 years in healthcare was voluminous. Dozens of people were given consideration for their education, salaries, promotions, and advancements, yet if one other person was recognized in a similar way, the hue and cry was often, “It’s not fair.”


So, looking back over two decades of running hospitals, foundations, a research institute, and several other spin-off companies, an appropriate summary for any future leader is to “go with your gut.” With that in mind:

You are not now and will never be a superhero.

You are a human being with human frailties.

You cannot right the world or repair dysfunctional childhoods, marriages, or lifestyles through your benevolence.


You can do what you believe will result in the most good for the most people.

You can respect the fact that your efforts could help to continue payrolls for hundreds or even thousands of families.

You can embrace the fact that the vast majority of your mistakes will not be fatal to anyone, but you also need to learn to cut your losses and deal with the disloyal.

One of my mentors used to pull me aside periodically and say, “Nick, you’re doing a great job, but you need to lighten up. We only pass through here once. So, try to enjoy yourself, my friend.”

Now that was good advice.


The List

July 25th, 2009

Okay, so if you are in healthcare administration and you have any interest in what’s going on in my world, just take a quick read of this descriptive list of services from various organizations with whom I have become aligned.


In terms of creating value for any of you, the first organization that I obviously believe should be on your list is SunStone Consulting.  In order to help explain our work, think of the following list:  Transfer DRGs, Worker’s Comp, Compliance and RAC readiness assessments.  These represent just a few of the professional services in which SunStone specializes for hospitals.

What about the rest of the list?

  1. Virtual elimination of  “accounts receivable.”
  2. The building of software bridges to anywhere.
  3. Expertise in telemedicine delivery.
  4. Business flow software systems, like Legos, that can be added for any business unit.
  5. Research software that delivers, white papers, proteomic and genomic research results, and pharmaceutical tie-ins through its unique search engine.
  6. Marketing research for any occasions.
  7. Business development and lobbying services.
  8. Food services.
  9. Environmental savings and income solutions.
  10. Educational training in all aspects of management expertise.
  11. Biofeedback systems for stress management.
  12. Hazardous waste disposal.
  13. Response systems for data breaches, i.e, notification mailings and call centers.
  14. REIT-type investment and building solutions for expansion projects.
  15. Searches for all executive and executive medical and PhD leadership positions.
  16. HR software to ensure objective  employee evaluations for quality improvement.
  17. 24 hour translation services for hospitals and physician office practices.
  18. Comprehensive  proteomic lab services for sophisticated oncology/cancer testing.
  19. Electronic Medical Records
  20. Physician office billing systems.
  21. Strategic planning expertise for hospital medical staffs.
  22. Physician practice diagnosis and “repair.”
  23. Grant writing and fund raising for all aspects of healthcare: residencies, research, job training, nursing schools, and so much more.

If you need to find funds, are looking to have money returned to you that you have rightfully earned, want to improve your business quality and efficiency, are in need of comprehensive analysis to help you start, improve, or garner maximum profitability from a business unit, or just want to improve your bottom line, follow the money . . .

Check out SunStone Consulting’s Global Solutions, and give me a call.  It’s what we do.  (This was not a paid announcement.  Rather, I just wanted to let you know what I’m up to besides board, administrative, and personal consulting and assistance.)


April 2nd, 2009

Let me open this blog with a little housekeeping chore. Because I’ve retired from being a hospital president (Yes, they replaced me with two great people, count ‘em, two.) , I’d like to change the name of this thing. It’s not that I’ve established a P-Diddy-type Twitter following where 100,000 human beings are waiting with baited breath to see what my next move will be, it just doesn’t seem right to keep calling myself a hospital president. We know who reads this thing, and we are grateful to our loyal, talented, and brilliant followers. We also know that we can link the old blog names to get you here. So, regardless of what you typed, or what gets Googled, our genius social media maven & webmaster, Michael Russell, can help to bring you home to this site.

Okay, so as a transformational advisor, a broker of sorts, most people with whom we have consulted have described me as a person who can fix things that are broken before they actually break. Maybe we should call it the “Break it if it’s not already fixed” blog. I’d love it if it was a name that would generate millions of hits and companies would fight to advertise on it.

My first thought was to use nickjacobs in the title because there is a Nick Jacobs on Facebook who teaches Aboriginal people in Australia, and he seems popular. There is another Nick Jacobs who is a professional organist, and one who is an athlete. There’s a Nick Jacobs who is a consultant and another a paramedic in London, one who had a blog who is a yachtsman, there’s my son, the commercial real estate broker, and finally, there’s a Nick Jacobs who does pornographic movies who is not my son. Actually, that Nick Jacobs’ followers would probably be the most disappointed by this blog.

Since the .com version of nick jacobs was already taken by some guy in England, we captured, and that will work for right now.

If you have any ideas, however, that you think would really rock the blogspere, let us know and we’ll check with our domain registrar to see if it is available. In fact, if you are the winner of a Name Nick’s Blog Contest, I’d be happy to consult for free BY PHONE for at least one hour of brainstorming with you about the topic of your choice: music, healthcare, proteomics, teaching, PR/Marketing, the travel business, or even physician recruitment.

Remember, Hospital Impact is already taken, and, because my last three consulting jobs have been with a newspaper, a nonprofit arts oragnization, and a chain of hotels, we don’t want to think too restrictively. Gotta earn a little money, too.

When we ran the breast center, we found that the website got more hits than anyone could imagine. The problem was that the readers were mostly thirteen-year-old boys who probably weren’t too interested in running a hospital. After Miss America had visited us, the hits went up exponentially when those two searches were combined. Somehow, I don’t think that Nick Jacobs’ Breast Center for Miss America would probably get me the type of following I’m currently hoping to attract. On the other hand?

A very good friend recently asked me to write a brief bio about what my new life is like, and it struck me that it is very much like my old life but without any restrictions. This is what I wrote:

While teaching junior high school instrumental music in the early 1970’s, Nick Jacobs made an extraordinary discovery. He learned that, by empowering his students and surrounding them with positive influences, he no longer was providing a service or even an experience for them.

What this entirely unique teaching style resulted in was a method for helping to transform students. By providing with both passion and commitment the tools needed by them to undertake their journey, his involvement with the students became a means of dramatically helping them to make whatever positive life changes they were seeking.

It was during that early period in his career that he also discovered that this formula could work to positively change lives in almost any aspect of living as he ran an arts organization, a convention bureau, and finally a hospital and research institute.

Since that time he has dedicated his personal work to helping others make their lives better, and that is exactly what he is doing in his position as an international executive consultant with SunStone Consulting, LLC.

Maybe that will give you something to chew on? Okay, something on which to chew.

SunStone Consulting. With more than 20 years experience in executive hospital leadership, Nick has an acknowledged reputation for innovation and patient-centered care approaches to health and healing.