When you have hurt feelings, “clear the air”

Recently, I participated in a staff meeting as two people resolved a personal conflict. The emotions were running high. My role was to moderate the discussion and, I guess, make sure no one was injured.

For the purposes of this posting, the subject matter of the office conflict is not relevant. Ironically, I learned something about myself in this session that I did not know. The instant circumstance we were discussing had many factors, but one was a tendency for one of the two parties to harbor a perceived insult, hang on to it and magnify the hurt. As a consequence of not “clearing the air” at the time of the adverse personal incident, the internalized perception of the incident became malignant and toxic to the morale of the individual with hurt feelings. This only worsened the situation and made it more difficult to come to an amicable resolution of the problem.

As this discussion was taking place, I had one of those “ah hah” moments. A light bulb went on that I, too, am inclined to take in an insult, hold it tight, re-live it, nurture the pain and magnify the hurt feelings until it cannot be held in any longer. It makes me feel silly. Recently, I wrote a letter to a person I hold dear and discharged all of the poison I have been harboring for six years of hurt feelings. In retrospect, I should have resolved the problem six years ago, or at least I should have attempted to resolve the problem sooner. I have done this several times before. These missives are filled with noxious gases and venom. So, in the future, it is my furtive prayer to resolve issues sooner. I also have another alternative . . . act like an adult. We all have our feelings hurt from time to time, and learning to deal with them in a mature manner is well advised.

In 1964 when I was in business school, an old professor of business administration suggested that we never "burn bridges behind us." Apparently I am a slow learner. Holding it in and not working it out in short order is not a good idea. Clear the air as soon as possible and avoid writing letters you will live to regret. Clear air is not just for breathing.

Jan Jennings

Republished with permission from the Hospital News Group

Clamoring for Success

In all the years I have served healthcare organizations, I have always been perplexed by hospitals that thrive against all odds and others that wither with clinical and financial resources that would suggest otherwise.

Recently, I met two relatively young brothers who have been extremely successful in business. They own or are partnered with businesses I can barely understand. Now they have turned their attention to healthcare. I am reluctant to share their names, because one of their many well-established business principles and practices is to maintain a very low profile in general, and with the media in particular. Every time I have met with them or discussed a proposal on the telephone I have come away with a deeper respect for their maturity and mastery of a business philosophy that is breathtaking in its clarity. They are bereft of arrogance or hubris. To the contrary, they are sensitive to the people they work with and honor peoples’ lives with respect and dignity.

From all that I have observed and learned from these two individuals, there is one lesson that stands out as first among equals -- clamor for success. What does that mean? The dictionary describes clamoring as vigorously advocating for a better set of conditions. Clamoring is characterized by fanatical commitment and purpose. As applied to business, it is that energy that drives consistent improvement and fends off the status quo. It is the drive to exceed the expectations of customers, employees and business partners. It is the commitment to never pay more for a unit of production than is necessary. We hear these expressions in hospitals all the time, so why is there a difference? These gentlemen mean it. They live it. They are determined to clamor for success, and they are intense.

As I sit at their feet and learn, I can see the answer to my opening question. Many hospital leaders clamor for success, but some do not. Seeking to exceed customer expectations is either a cliché or a fury of thoughtful energy and action. It is one or the other. It cannot be both.
It is with a little bit of "kidding on the level" that I often describe the plight of many hospital CEOs. They get up at 5:30 a.m. and make their way to the 7:00 a.m. Medical Staff Executive Committee (MSEC) meeting. Sometimes the physicians at the meeting, facing their own practice challenges and often unwittingly, spend two or more hours taking out their frustrations on the CEO. Staggering out of the MSEC, the CEO goes to his or her office to meet with Mrs. Schmedlapp (former patient) who has persistently worked to get on the CEO’s calendar. In very earnest terms she explains some moral outrage that occurred when she was a patient in the hospital. Nurse Sprocket spoke to her in a harsh manner, and it made her feel bad. The CEO takes copious notes and promises to look into the matter. At 10:30 a.m. the CFO arrives with more bad news. Somehow the Medicare labor adjustment for the hospital was misstated in the budget, and the hospital will have to make up $600,000 in this year’s budget . . . somehow . . . some way.

The CEO is very assured that they will find a way to do this. At 11:45 a.m. the CEO leaves the building to make a noon presentation to the local Rotary Club. The CEO is not interested in the presentation, and, as it turns out, the Rotarians are not very interested either. At 2:00 p.m. the CEO returns to the hospital to meet with an eager member of his/her staff. This staff member enthusiastically delivers more problems to the CEO’s desk and gives the CEO every opportunity to do the staff member’s job. From 3:00 to 5:30 p.m. the management team assembles for the weekly staff meeting. Most of the meeting is characterized by not making essential decisions, throwing sand on each other and finding a way to avoid controversy. At 6:00 p.m. the CEO arrives at the local country club to have a dinner meeting with a group of physicians to focus on growing discontent about some ill-defined problem. The essence of the meeting is that the physicians just "don’t feel the love like they once did." At 10:00 p.m. the CEO arrives home. He/she is emotionally and physically exhausted. The entire day can be described as a "bucket full of busy."

The CEO who clamors for success finds an alternate approach. He or she finds a way to make the calendar work for the benefit of all stakeholders. Everyone in the organization is encouraged, even coached, to clamor for success. A new and different kind of energy is infused into the organization. People no longer seek to achieve goals. They clamor to exceed the goals. Teamwork replaces politics. Each person in the organization is given a clear understanding of what it means to be a success. To achieve "clamoring for success" requires a change in the culture. To effect this change requires intelligent effort, patience and time. It cannot happen without the CEO going first. Then the senior management teams needs to go through a process of looking at previous efforts in a fresh and imaginative way. Next the department heads need to be enlisted to clamor for the success of the hospital. In truth, it is the department heads that truly run the hospital and control the culture. It is here that the most intense efforts to modify the culture must take place. It can be done if there is the will, determination, consistency of purpose and dedication of appropriate resources.

This is a very different way to run a hospital. Many hospitals do this now. Many do not. If you are in the "do not" column, take this as encouragement to reconsider the organizational priorities and the manner in which business is conducted. Clamoring for success is organizationally infectious if presented and coached properly. Catch the fever.

Jan Jennings

Republished with permission from the Hospital News Group

American Pharmaceutical Industry: Evil at any Price

Over this weekend we got good news and bad news from the FDA. Two similar regimens to treat HIV and AIDS were tentatively approved.

For the United States, a single pill per day drug was approved. This will replace the drug cocktail that HIV positive and AIDS patients have been forced to take in recent years. Here is the bad news, it will be so expensive the American public, Medicare and Medicaid will pay through the nose for this so-called breakthrough. The Medicare Drug program has a very interesting provision that prohibits the Medicare Program from competitive bidding drug purchases. It is enough to make your head spin. When I was a Purchasing Officer for the United States Air Force Medical Service Corps during the Vietnam War, we competitively bid “garden hoses.”

Here we are in 2006 as the only industrialized country on earth that does not competitively bid its publicly purchased medications. The argument is that the United States has a “big heart” and its citizens have to pay for the research and development for new drugs. What is odd about this argument is that so many of the new U.S. marketed pharmaceuticals were, indeed, developed abroad. Most drug companies are now multi-national corporations. Notwithstanding, they have a stranglehold on the United States Congress and the Executive Branch, regardless of political affiliation.

Further, what is the big deal about the science of this new single-dose drug administration? The true breakthrough was getting Bristol-Myers Squibb Company and Gilead Sciences, Inc., to cooperate in compounding existing medications manufactured by their respective firms -- specifically, Squibb’s Sustiva (efavirenz) and Gilead’s Truvada (emtricitabine tenofovir disoproxil fumarate).

What will this cost the American people, the Medicare and Medicaid program? We will find out soon. At the moment, only God knows how the American public will be fleeced to pay for existing drugs compounded and marketed only inside the United States.

Almost comically, this same weekend, the Voice of America reported that a similar approach to drug compounding has tentative approval from the FDA, but it will require two pills per day. The impact of arresting HIV and slowing down the progress of AIDS is the same. The active ingredients in this “two pills per day” regimen are remarkably similar. The drugs are sold under the trade name of Epivir, Retrovir and Viramune. The drugs are lamivudine, zidovudine and nevirapine.

This compounding will be manufactured by a company that may not “ring a bell” for you. The drug company is Aurobindo Pharma in Hyderabad, India. Following is a direct quote from the Voice of America Press Release, “This is the first time the Food and Drug Administration has approved a product like this under the plan. The decision is a tentative approval. That means the product meets all quality and safety requirements for marketing in the United States. Full approval would mean that the product could be sold in the United States. But that is not possible because of patent protections and marketing agreements.”

Wait a minute. I thought we were in support of a global economy. Why are we being denied these Indian medications? When I need to call and ask a technical question about one of my computers, the Indian engineers and technicians are good enough for me and the rest of the American people. Why can we not have the benefit of their pharmaceutical manufacturing expertise?

How about that, “. . . Cannot be sold in the United States . . . because of patent protections and marketing agreements.” In other words, the fifteen countries desperate for these drugs will receive them at reasonable prices because of the moral outrage that these drugs have largely been withheld from them to date.

Stay tuned for the following. You are going to hear a lot about what a wonderful thing this is that American people suffering from HIV or AIDS will only have to take one pill. The public relations campaign will not have much to say about how expensive the pill will cost.

You can also expect to hear how compassionate we are to make similar drugs available to the third world and reduce suffering among those poor people suffering from HIV or AIDS. You will hear less about the fact that this drug regimen will be quite inexpensive.

P.T. Barnum said, “A sucker is born every minute.” When it comes to the American people and the drug industry, you have a financial circus that would give P.T. Barnum a giggle. Do not expect any moral outrage from Washington. The United States Congress is for sale to the highest bidder. I should be clear. This is my opinion. What is your opinion?

Jan Jennings

Republished with permission with from the Hospital News Group

When do two people love one another?

Love has so many meanings it is challenging to talk about love between two people. Some folks love their dogs, a sunset or certain clothes. I love baseball . . . really, I do. I mingle with people who love to go to church or bowling. My friend loves to garden. One of my colleagues loves to see someone sing . . . I think his name is Dave Mathews. There are those of us who love good food. The use of the word “love” has very wide boundaries.

So, what does it mean when two people love one another? I have a working definition based on loving someone for nearly forty years. For me, love is mutual faithfulness, commitment to each others interests, values and sacrifice even to your partner’s whimsy. My belief in God is deeply rooted in the love I have found in the woman I met on a college campus on March 26, 1967. The joy I have found in this relationship has to be related to a power greater than anything on this earth. She has supported me in good times and in bad. She has made sacrifices for me that no man deserves. I pray each morning and each evening that I can be half the man she deserves. We have found love. We are one. We disagree. We are different people. On some level, however, our lives are so intertwined it is hard to know where her life and my life are different. Trust me. This is not like loving baseball.

I know this description is deficient. The reason is I only have words to describe this love. No one could ever reduce to writing the depth of feeling I feel when I look deep into her eyes and her soul touches mine.

Jan Jennings

Republished with permission from the Hospital News Group