by Nick Jacobs

Tony asked me what I would miss as a hospital CEO? Let me begin by saying that I left teaching at age 31, and thirty years later I still very much miss the interaction with the students. Just yesterday, I received another E-mail from a 50ish year old IT executive telling me that my teaching had been one of the greatest influences on his life. That was the third similar E-mail that I had received in the last five months from that work of 30 years ago.

From teaching I miss helping the students find themselves, teaching them to fly, and saving those borderline kids who were hanging by a thread. My life as a teacher was completely built around being a care-giver and a mentor.

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by Nick Jacobs

Penn and Teller, magician-comedians, have a cable TV show that basically explores all aspects of life in America with the intention of exposing those areas that are not valid. I'm not sure why the noble bull has suffered this indignity of their show's title, but, when it comes to making fun of the nontraditional, these magic men hold nothing back. They look at topics like integrative medicine, snake charming, and sensitivity training through their sarcastic, unprofessionally trained eyes and do all that they can to rebuke the topics being explored.

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by Nick Jacobs

After 20 years as a non medical observer in a health care setting, some of my greatest observations regarding personal change have come through my own interpretation of the results of brushes with mortality. It’s interesting how the human mind works, the depth of denial that we persuade ourselves to embrace and the creation of sometimes self-created turmoil that helps us avoid the daily realities that are occasionally too emotionally unforgiving to acknowledge.

Typically, we go on until we hit the well-known, proverbial brick wall that causes us to stop, rethink our future and make decisions as to how we should attempt to proceed.

The most extreme outcome resulting from these near death, life threatening and often life changing experiences, has been my observation as a lay medical person of primal change. So many times people have entered my life with a terminal or near terminal diagnosis, survived that illness and come back to a life that even they had never imagined. This brush with death made them realize that they were either lucky or, in fact, selected to stay a while longer and potentially make a difference. This is what I refer to as the sickness epiphany.

Don’t get me wrong. There are still plenty of us who hit the wall and happily return to the life that brought us to that event. What is that quote that is attributed to Benjamin Franklin? You know, the one that I used to think of when I practiced my trumpet for four hours a day, “The definition of insanity is doing the same thing over and over and expecting different results."

On the other hand, we have all seen the heart attack victim who, after smoking heavily for 45 years, stops cold turkey without hesitation and then tells every smoker he knows how awful the habit is for them. It is has also not been uncommon to begin a discussion with someone who had a physical scare, and then decided to quit their job or change their marital status. Finally, we have met those individuals who were barely hanging on to a spiritual thread when they faced death and found their faith. It’s the epiphany. "It came to him in an epiphany what his life's work was to be!"

Some people decide that their new found life should be spent more at home, in church or at play. We have all heard the well worn expression, “No one on their deathbed ever says I wish I had worked longer hours.” On the other hand some survivors become passionate toward causes, i.e., helping similar patients face the same situation that they survived. Still others have decided that they will take the time they have left and work to literally change the world.

It is this type of purpose driven existence that can have a phenomenal impact on all of us.

A little over three years ago, I faced death. When I realized what many people have embraced for decades, that each day was truly a gift, my initial response was, “Why me? Why was I saved?” As I searched for that why, it came to me that at least one purpose for still being here was to change the way health care is being delivered.

Co-incidentally or maybe serendipitously, another individual from a completely different background met with me today to discuss the fact that his life had taken a similar health twist. His passion, as described by him, was literally to change the way that health care is delivered.

We only have about 4500 more hospital to change in order to make this transition.

by Christopher Cornue

As many of our readers know, I’m usually not short on words, but this posting is very direct and few words are needed. We spend a great deal of time discussing ways to make our healthcare system better in the States and this is an absolutely essential discussion that needs to occur, and it will continue. However, I do want to take a step back, prompted (I’m sure) by a recent hospital stay in November and other recent activities. Medicine is so amazing and our society is able to do so much to improve the health of individuals. The progress made over the past few decades (and centuries, for that matter) is remarkable and our possibilities to improve are endless. The ability to affect the lives of individuals, whether you are a front-line caregiver, physician, administrator, office worker, etc. is a rewarding and awesome responsibility. I’m so proud to be a part of this industry and to be an active contributor to these efforts.

So, with that brief pause and reflection on our industry, I look forward to our future discussions, collaboration and solutions to, as Tony puts it, make “our hospitals the best run organizations on the face of the planet” and improve the delivery of healthcare!

by Nick Jacobs

Denise Grady wrote a great Op Ed for the New York Times today about her sister's fight with cancer. In this opinion column she discusses empathy toward vulnerability. Interestingly, she quotes Dr. James A. Tulsky, director of the Center for Palliative Care at Duke University Medical Center whose study published in the Journal of Clinical Oncology found that doctors and patients weren't communicating all that well about emotions. She quoted the study as having revealed that male doctors were less than 50% as empathetic as female doctors in their responses to patients.

Ms. Grady made a point of indicating that it was not necessarily critical for the physicians to engage in long dialogue with the patients where they became psychological counselors. In fact, according to Tulsky, "Brief, empathetic responses will suffice."

A few days ago, I ended a post by quoting Maya Angelou who said, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."

So much of our life is spent looking for emotional support in some way, shape or form. The management schools teach us that "It's not all about the money." The attorneys tell us that "If we are kind and explain ourselves to the patients, our chances of being sued drop exponentially."

This morning we dealt with an employee complaint. It wasn't about time, money, or benefits. The complaint was that the employee was not treated with compassion, respect or dignity. It was about how one of her peers made her feel.

There are very difficult emotional challenges that come with being a chemotherapy or, for that matter, any type of cancer patient. After all, this disease can very clearly make us deal with our own mortality in a very direct, uncaring, matter of fact way. It is or it isn't. We are or we aren't; and one of the examples that we use is that "It may be your 543 rd Leukemia or melanoma or lymphoma, but it is the patient's first."

We are not indicating that our world must be one of mamby pamby, warm fuzzies that never deal with the truth. We are indicating that the people with whom we deal are human beings. I heard a comedian say last night that he had just gone through a tough divorce and lost weight. He then said, "I think I lost about 30 pounds. That's how much a soul weighs, right?"

So, as we move about in our world every day, remember Denise Grady, remember her sister, and remember that warmth, concern, compassion, and empathy are NOT bad things. The day that we found out that my father's cancer had metastasized, the doc told him not to worry. He told him that everything was okay. Then he turned to my mother and winked. That day will forever be burned in my memory. His was the wink of death.

Just remember that, "Wherever there is a human being, there is an opportunity for kindness."

by Nick Jacobs

My life has taken me to different countries, different continents, different cultures: Italy, Bosnia, Serbia, England, Nigeria, The Netherlands et al. During those travels, it is always exciting to me when my view of life is shaken by fundamental realizations that challenge my day to day beliefs.

For example, during my first trip to Europe, we crossed so many borders into so many different countries pre Euro, that money became so confusing to me that my mind locked up. 123,000 Lire, 5 Francs, £3 Sterling? What did it mean? It was during those multiple country, multiple currency visits that it hit me, at the tender age of 22, that money was just one way to get what you needed.

Nearly twenty years later, as we deplaned at the airport in Rome, we were swamped by Italians leaving for their month long holiday, and, of course, for those businesses that remained open, there will always be the break from 3:00 to 5:00 PM and those leisurely, wonderful, evening meals.

What struck me is that we, as Americans, too often see the things that happen to us on our way to our next meeting or destination as an unessential distraction. While, to those Europeans, be it in Serbia, Bosnia, France, Italy or Spain, those interruptions are life. They stop and talk. They enjoy the trip. Because the journey, not the destination, is life.

A friend of mine recently forwarded me a letter from a business associate that described the secret to being a successful leader. To paraphrase his thoughts: a successful leader has the uncanny ability to embrace both philosophies. Great leaders most often have disciplined themselves to get huge amounts of work done in very short amount of time.

They also, however, have learned to hold onto the moment, to remain receptive to those with whom they have come in contact, to keep their minds open for positive interaction and to take advantage of the serendipity that surrounds each and every one of us every day. It has been my experience that by keeping open to every possibility, we often times find solutions to our most challenging problems. So, carpe diem. As Maya Angelou said, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."

by Tony Chen

All this talk about health care policy, healthcare blogging, and hospitalk, sometimes it's easy to forget that we are talking about real people, real sons, daughters, fathers, mothers, wives, husbands, and loved ones.

Yes, we have to run tight ships financially to ensure the long-term sustainability and advancement of our hospitals. Yes, we need to learn the business of healthcare. Yes, we have to think aggregate in numbers. But let's always remember that we are serving individual people, many who are in the most scaring, vulnerable moments in their lives.

I ran across this story at Blog, MD about Derek Madsen, a 10-year patient who had a rare childhood cancer. Please take a moment today and go through these 20 gripping Pulitzer prize photos of his journey.

Also, we've collected a few other patient stories here.

by Nick Jacobs

Back in 1963 my philosophy professor challenged me to prepare an analysis of intrinsic (taking) versus altruistic (giving) behavior. My conclusion at that time was that there clearly was no such thing as altruism. No one did anything unless it was good for them. Even those individuals who so generously gave of their time, money or wisdom, did it because it made THEM feel a little better about themselves.

Interestingly enough, that sophomoric knowledge (I was a sophomore.) did not keep me from embracing a life in not for profit management. Throughout my career in the various nonprofit organizations with whom I have worked; education, arts, economic development, and healthcare, it has been clear to me that there are two types of people who volunteer, the givers and the takers.

When questions are raised regarding how much is personally too much to those individuals who are the takers, the answer is obvious, “You can never have too much.” But when the same question is posed to the givers, the answer is entirely the opposite, “We enter with nothing, and we should leave with nothing. We are here to serve mankind.”

Well, over the last thirty plus years, it has also become clear to me that controls are necessary in order to keep the takers in tow because, many of them have no boundaries in regards to their material needs, and not for profit organizations are not the appropriate setting for pursuing those endless needs.

After Enron there appeared to be a glimmer of hope relating to controlling these takers, and there also appeared to be a strong movement toward a Sarbanes-Oxley-type legislation for nonprofit's. That proposal has now evolved into a new proposal called the Nonprofit Accountability Bill. Unfortunately, it does not yet have enough teeth to be really meaningful.

Let’s examine carefully the rolls of our nonprofit board members and simply track back the amount of business done by their companies within the nonprofit corporation for which they volunteer. Then check to see if bids were solicited, if influence was not placed on executives in charge through board compensation committees and if the business/member excused him or herself from the meetings when these issues were being decided. The Nonprofit Accountability Bill proposed certain limitations regarding the amount of business that actually constituted a conflict of interest, but, it is relatively clear that those numbers have also not been activated.

Bottom line? Ask questions about your nonprofit boards. Thankfully, for the past ten years I have worked for a board that is free of conflict, but this clearly is not the norm.

The difficult proposal that requires you to buy board member products, embrace their services, and use their consultants in order to ensure that they will be good board members is not acceptable behavior in a world that needs our help.

by Nick Jacobs

Why 2034? It’s actually the date that my actuarial has indicated that my individual involvement in this discussion should no longer have any viability. In other words it’s the projected date of my passing, but, believe me, there will be tens of thousands of we boomers contributing to this discussion until then.

A few years ago, during a scientific mission to Boston for a conference at MIT, it was my privilege to participate in a conference directed toward the challenge of keeping our senior citizens viable, active and out of long term care for as long as possible. We met with several health care professionals, engineers, and scientists who had taken on the challenge of miniaturizing every known type of monitoring system for the human body.

They had begun the effort to successfully decrease the size of these devices to the diameter of a nickel, the relative thickness of a potato chip and a cost of about twenty five cents each. We saw demonstrations of some of these miniaturized devices in actual use. They were adapting systems for monitoring the heart, blood pressure, brain function and respiratory system. With all of the flexibility that wireless communication can deliver, the unencumbered participants would be literally, wired for sound, as they moved freely through the special apartment that had been constructed for this research.

Each and every movement could be monitored all day, every day. The signals generated from the participants various organs were sent directly to a computer that was housed at a physician’s office where any missed beat could be reported through an alarm system that immediately notified the physician in charge.

Think of it. Pappy gets up from his chair, feels a little dizzy, sits back down, and the videophone rings with a healthcare professional checking to see if all is well.

Because of the 1984 feeling that some of we 1960’s free spirits might feel from this “Big Brother” type monitoring, it was suggested that the grandparent might also like to have her sibling monitored as well, thus giving the affect that they are indeed checking on each other.

Think of it. This system could very well keep us out of some offensive, under staffed, insufficiently reimbursed nursing home for at least an additional year or two.

In closing, however, I did receive an e-mail the other day with this suggestion. If you like to cruise, it would be more fun to live on the Pacific Princess for the rest of your life than in the Sunset Valley Nursing Center. The cost is similar, and when you trip and break your hip, they will upgrade you to a suite and deliver meals to your room.

by Nick Jacobs

Having been an observer of scientific research projects for the past seven years, I have recently made an observation that undoubtedly proves irrefutably that parallel universes do exist. On a recent beach trip, six young mom's in our family and our extended family decided to send their hunters off to deep sea fish for Father's Day, leaving two grandfathers and a four year old boy behind to protect the house.

Because he was not included in the fishing trip, the boy would have been crushed, but the old dudes bailed out his dad and mom by inviting him to go fishing with us. Neither of us had been fishing since we were young dads, about thirty years ago, so the day was already predetermined to be interesting. We strapped the little guy into his car seat and left in search of a fishing pier. It took us about forty minutes and fifty four dollars for gasoline, a bottle of Superman apple juice, some Halloween candy corn and a piece of beef jerky.

When we arrived at the fishing pier and entered the main building, it was like a time warp. In a large glass case there sat a talking humanoid Pirate that told fortunes. Then we passed 70 different pinball, video, basketball and bowling machines. When we finally arrived at the cashier's corner, eight more bucks lighter; we saw reality in a completely different light. Renting two poles with sinkers and hooks required an $80 deposit. Miscellaneous fishing fees were $48, and that included a bag of blood worms. Our wrists were then stamped, and we went out onto the pier and into the blazing, morning sun.

We were instructed to cut the blood worm which contained what seemed to be about a pint of blood. The little boy became very quiet, looked at me and said, "You're killing him." At that point I taught him about regeneration. Then we launched the baited hooks into the Atlantic Ocean and five minutes later caught a four inch fish which we promptly threw back into the sea. After about 90 seconds more, the little guy looked up and said, "Poppa, I want to go home now." He turned and started walking toward the exit.

On the way home he cried out for a toy, we stopped and bought him a little pirate, armed to the teeth, and a motorcycle for a grand total of $5.34. When we walked into the beach house, he opened his motorcycle and the wheel fell off. He stopped crying 20 minutes later when his mom convinced him that it would go to the broken toy hospital and be fixed.

If you're wondering about my introduction to parallel universes, it should be perfectly clear to you by now that this trip was exactly like scientific research. You start out not knowing where you're going; spend lots of money trying to get there; have great expectations; end up with much less than you or anyone had anticipated; have to throw it back in, and too many times, the wheels fall of.

Parallel universes.