One Reason Hospitals Squander Millions of Dollars

Resistance to Change
The human impulses related to change are probably as old as our knuckle dragging ancestors. Presented only as English literature, there is an interesting 2,000 year old story in the New Testament Book of Mathew. The setting for this story is the village of Gadarenes. Theologians only agree that the town was on the eastern coast of the Sea of Galilee. Because the villagers were herding pigs, it is thought the villagers were Greek, or possibly Roman. As Jesus entered the town, he was threatened by two mentally disturbed men. The response of Jesus was to heal the two men of their mental illness. It seems like good news; maybe not. Jesus was promptly asked to get out of town. Yes, the status quo had been altered. The villagers had accommodated themselves to their mentally ill villagers. People hate change; resist information that will lead to change; even when that change might lead to a new and more favorable set of conditions. In two thousand years, nothing has changed.

Our firm had a short misadventure representing a nationally recognized group purchasing organization (GPO) in a small geographic territory. What a waste of time, money and effort.

Yes, we went from hospital to hospital proclaiming the good news. We were evangelists for cost savings. We did not ask our audience to accept our message by faith. We were armed with eighth grade math. The numbers used are only an example:

• GPO # 1 – 32,000 items times an Average Cost of X = Total Supply Spend = $ 37,342,334

• GPO # 2 – 32,000 items times an Average Cost of Y = Total Supply Spend = $ 32,123,654

• St. Smithers by the Swamp Medical Center Savings . . . . . . . . . . . . . . . . . . . . $ 5,218,680
=========

Yes, we represented GPO # 2. The message was largely unwelcome. The most interesting, if frightening example was a female supply chain executive who reviewed the “facts and figures” and came out of her office screaming at the top of her lungs, “We are not interested in changing GPO’s, I don’t care what the savings are, get out of our hospital.” She was “bug-eyed”, her face was red as a tomato and we estimated her blood pressure at 200 over 120 (stroke range).

Most stories were less interesting. One CEO said they were not going to change GPO’s because his hospital system makes decisions based on “facts and figures” and that was the basis of his discriminating determination. We found this to be an odd response. One step in the process the CEO scrupulously avoided was the review of the “facts and figures.” Go figure. As it turns out, this CEO was ingratiating himself to his staff by supporting their recalcitrance.

One of the executives related to GPO # 2 provided me with a window into one understandable reason to resist switching GPO’s. There is a one time cost in time and effort, however small, to switch from one GPO to another.

There are other reasons not to change:

• The supply chain executive is generally not given any incentive to recommend a change that would lead to thousands or millions of dollars of hospital savings. It just sounds like a lot of extra work. Further, it may be well understood internally that the CEO is “drinking the “Kool-Aid” from the resident GPO.

• The hospital “supply chain” operations are, perhaps, the least intensely managed department of the American hospital. This is rooted in a deep tradition of not wanting to be tagged with the responsibility.

• GPO’s are extraordinarily solicitous of their existing customer base to lock in undeserved loyalty. Strategies and tactics include meetings (away from the hospital grind) with outside speakers, golf, tennis, tickets to professional sports events, lavish luncheons and dinners and on and on. In 1970, folk rocker Stephen Stills captured this phenomenon best with his song, “Love the One You’re With.”

• Notwithstanding my eight grade math example, GPO’s morph in ways that make them somewhat difficult to compare. Difficult but not impossible. More work with no reward for the effort. Each GPO is laden with bells and whistles that are intended to differentiate themselves from alternate GPO’s or obfuscate meaningful comparisons.

It would be disingenuous not to acknowledge that our firm may not be very good evangelists for change. We speak truth to power. There are many hospitals that do seek meaningful solutions to existing challenges. There is little time to suffer hospital leaders willing to squander scarce hospital resources for all the wrong reasons. Yes, some things never change.

The Best Healthcare Executive I Have Ever Known

Nicholas Jacobs, President and CEO, Windber Medical Center



Over the past thirty-five years I have met so many great healthcare leaders. I will avoid mentioning twenty or thirty of them because I would be neglecting twenty or thirty others. Some of these great leaders have been close working partners; others have been ruthless competitors. Some have been dear friends; others have been nominal acquaintances. I never thought I would know one healthcare executive that stood tall above the rest. That has changed.

In 1999 I attended a family gathering in a little hamlet outside of Johnstown, Pennsylvania. At the time I was working as a healthcare consultant. I was introduced to a fellow by the name of Nick Jacobs and was told he was the CEO of a rural hospital in the area: Windber Medical Center. I never heard of it. We talked about his activities and his hopes and dreams for his 80 bed rural hospital. Some of what he said was so “fantastic” I wondered if he was completely bolted down. There was no bragging or horn blowing; he just talked about his quest to make healthcare better than it had ever been before.

Several years later I had the opportunity to serve Jefferson Regional Medical Center in Pittsburgh as President and CEO. The culture of Jefferson Regional Medical Center was strikingly like every hospital I had ever served. It was all about diagnosis, treatment, throughput, science, new technology, finances and quality management. It was not the best hospital I had ever served and it was far from the worst. Like most hospitals, it was decidedly “vanilla.” There was one program referred to as the “Spiritual Life Department” that was truly special. It reminded me of my year’s earlier discussion with Nick Jacobs.

I was motivated to pick up the telephone and call Mr. Jacobs for an onsite appointment at the Windber Medical Center. I was unprepared for what I found. While Nick Jacobs is committed to the humanities, he embraces the medical sciences in every conceivable way. How many rural hospitals have the following?

• The Windber Medical Center owns and controls a research facility that is at the cutting edge of genetics research in affiliation with the Walter Reed Army Medical Center and the Genome Project. Dozens of scientists at the M.D. and/or Ph.D. level have been recruited to a facility larger than the hospital to advance genetics research and improve the future of diagnosis and treatment. Of the 126 U.S. academic medical centers in the United States, there are few that have research facilities on a par with those supported by the Windber Medical Center.


• In a separate building is a Breast Care Center designed by and for women. The center has every conceivable technological advantage available to women. More interesting is the attention to detail to the humanities. The dedication to privacy and the emotional health of the patients is striking. The facilities are breathtaking. Over its short history, Windber Medical Center has amassed the largest inventory of breast tissue through biopsy in the United States enabling the potential to advance diagnosis and treatment of breast disease more rapidly than any facility on the face of the earth.

• Mr. Jacobs became concerned about the conditions that confound patients and family at the time or near the time of death. He appealed to the citizens of the little coal town of Windber and the money was raised to build a seven suite inpatient hospice with facilities that would rival any Ritz Carlton or Four Seasons Resort.

• Concerned about the quality of life in Windber, Mr. Jacobs spearheaded the construction of a building that houses one of the most beautiful fitness centers in the United States. There is an integrated pool for therapies best suited for water therapy and a Dean Ornish Program designed to reverse coronary artery disease. The success stories from the Dean Ornish Program would bring tears to your eyes.

• Windber is a coal town, but has little coal. The population is largely elderly and the community is economically challenged. The elderly residents previously congregated in a worn and sad senior citizens center. Through a real estate and financial transaction that would make your head spin, Nick Jacobs found a way to build a new senior citizens center with the best facilities that money can buy and make it available with free parking to all senior citizens of the area.

• By the way, the Windber Medical Center has an eighty bed hospital. You will not be surprised that they have a 16 slice PET/CT, a 3.0 Tesla MRI, 4D Ultrasound, hotel styled hospital rooms and other technologies rarely found in a rural hospital.

More remarkable than the technical mumbo-jumbo, the Windber Medical Center lifts your spirits the moment you walk in the door. The hospital was one of the early affiliates of Planetree, an organization committed to introduce the humanities into the hospital and its surrounds.

Here are a few of the accomplishments of the Windber Medical Center. Volunteers bake bread on the nursing units and serve it to the staff and patients. There is a sense of “home” when you stroll through the hospital. On an entirely optional basis, patients and staff have access to the following:

• Stress reduction programs
• Aromatherapy
• Massage Therapy
• Yoga
• Pet Therapy with the “Golden Girl Retrievers”
• 24 hour visitation hours
• Musicians perform in the hospital on a regularly scheduled basis funded by the Pennsylvania Council of the Arts
• Yamaha music programs (every nursing unit has a piano)
• Acupuncture
• Double Beds in the OB Suites for overnight stay by the spouse
• Meditation Garden Behind the Breast Center
• Walking trails on the hillsides
• Birdfeeders in view of each hospice guest
• The kitchen is “trans-fat free”
• Numerous fountains inside and outside the hospital
• An Inter-faith Spiritual Healing and Meditation Program
• A Greenhouse for patients and visitors

My editor worries when my articles are too long. This is but a small window into the soul of the Windber Medical Center.

I will stop. Before I close, I want to make sure I stay in touch with reality. Nick Jacobs has faced challenges and adversity, both personally and professionally. But when you meet with Nick Jacobs you know you have stood in the presence of humility and greatness. You will not be surprised to learn that FierceHealthcare recently honored the Windber Medical Center with the “2007 Hospital Innovators Award.” FierceHealthcare is an internationally renowned digital daily newsletter published by FierceMarkets: www.fiercemarkets.com.

The greatest miracle is that his Board of Directors has been able to keep Nick Jacobs in Windber, Pennsylvania and the search firms of the United States have not been able to turn his head with money or fame. Nick, God Bless You.

Jan Jennings

Reprinted with permission of Western Pennsylvania News

What is the prescription for a confused healthcare executive?

Why do two-thirds of American Hospitals Lose Money or Barely Break Even at the Operating Line?

Through my long career I have observed the divergence of American hospitals into the prosperous and the “have not’s.” Why? On occasion it is clear. There are two subsets of hospital failure easy to understand. Some hospitals simply should not be open. When the St. Francis Hospital of Pittsburgh closed in 2002 . . . it was barely mentioned in the local newspaper. At one time it was the largest hospital in Pittsburgh with over 1,000 beds. It simply worked itself out of being needed. It was sad, but inevitable. And, of course, there are those hospitals in communities that are very poor and, yet the hospital is desperately needed. Many of these hospitals are rural and their loss would be devastating to a needy community. What about the remaining hospitals that fail to thrive?

The answer to the puzzling question of hospital failure is becoming clear. Many hospital board members and hospital executives reach into the jaws of victory and find failure with fundamentally poor judgment and decision making.

I have made my own share of terrible decisions in my career, but have normally been supported by boards of directors to avoid disaster through good oversight and internal controls. It turns out that all hospitals are not as fortunate.

Recently, I received a phone call from a young lady in our research department and advised that she had stumbled upon a small multi-hospital system blowing approximately $4,000,000 per annum right out the window through a simple error that could be easily corrected by making a small change. As it turned out, I happened to nominally know the CEO of the hospital system. I called him on the phone and suggested we meet. At my own expense and time, I flew 1,100 miles, rented a car and drove to a restaurant to meet him. He was absolutely delighted at this revelation. His little system is suffering seven figure operating losses on a monthly basis. Four million dollars would go a long way. He was going to rush back to the hospital and share this great news with his flagship hospital CEO.

I will admit that my motivations were not derived entirely from the cup that holds the milk of human kindness. In healthcare consulting, sometimes if you do something “good” for a hospital or health system, it will be remembered when consulting services are needed.

Well, what happened in this situation? Finally a phone call came and it went something like this: “Jan, I checked in with my Hospital CEO and he does not want to make this change at this time and I support my people.” I was more than a little surprised. I said, “But Fred (name changed for obvious reasons), there is no cost, the numbers are not in dispute and your hospital system will lose $4,000,000 on a recurring annual basis. How could you possibly not do this, there is no downside and you receive four million dollars annually without any pain?” His reply went like this, “Well, my style is to show my people support by supporting their decisions . . . even when they are wrong.” My colleagues, this kind of “decision making” takes your breath away.

I am reminded of the American novel, The Grapes of Wrath, by John Steinbeck. In a novel that documented the tragedy of drought and famine in America’s heartland in the 1930’s, there is an exchange between the agent of The Shawnee Land and Cattle Company and a farmer who is having his farm repossessed. The farmer, Muley, said to the agent, “Do you know who owns The Shawnee Land and Cattle Company?” The agent said, “It ain’t nobody. It’s a company.”
The farmer’s son said, “They got a President, ain’t they?” The agent said, “Oh son, it ain’t his fault, because the bank tells him what to do.”

This kind of circular reasoning leads to decisions that are not in the best interests of America’s hospitals, and other organizations for that matter.

In another circumstance we offered a 10:1 ROI to a struggling hospital in the Pacific Northwest. Yes, it sounds too good to be true. So, to demonstrate confidence, we offered a money back guarantee. The hospital CFO thought it was too expensive. Wait a minute. How could it be too expensive if there is a money back guarantee and a 10:1 return on investment? How could that be too expensive? You know what is coming. The CEO told me he supports his people and they really appreciate his support. My opinion is they REALLY appreciate his support.

Facing a similar dilemma some twenty years ago at the Millard Fillmore Health System in Buffalo, New York, I shared with a group of board members that I wanted to support my management team, but I just could not stomach a recommendation being forwarded to me for an affirmative decision. The former Chairman and CEO of the Dunlop Tire and Rubber Company put his arm around me and whispered these words in my ear. “Jan, you are running a university affiliated hospital with lots of research laboratories. Would you turn the laboratories over to the monkeys? Sometimes you have to grab the steering wheel and follow your best experience and instincts. There is no upside in blindly supporting stupid decisions.” It is a lesson many hospital leaders and hospital board members need to learn.

These are only two data points in hospital and health system decision making. Notwithstanding, there is an indisputable pattern of poor decision making in many of America’s hospitals. The rules of the road, reimbursement methodologies (public and private) are so similar and yet the results among hospitals and health systems are so different. Success is rooted in good decision making. Failure is rooted in poor decision making. I have a keen perception of the obvious.

Jan Jennings

Republished with permission of Atlanta Hospital News

UPMC Jet's

Hubris Seems to be Flying High at UPMC


The Trib reported last Sunday (May 6, 2007) that the University of Pittsburgh Medical Center has leased a second corporate jet. The second jet is a Bombardier Global Express valued at between $30 million and $50 million with a monthly lease payment estimated at $280,000.

A UPMC spokesman said it is needed because it "can carry more people and avoid refueling." The jets are going to be used to take staff to UPMC operations in four foreign countries -- a high-profile hospital in Italy, cancer centers in Ireland and England and an emergency care center in Qatar.

The Trib also offered a tortured detailing of how much it would cost to fly commercially to all of these foreign locales. The bottom line was not convincing that a corporate jet is necessary, appropriate or cost-justified.

UPMC now is the largest private employer in Pennsylvania. And when it came time to gather quotes from the business and civic community about this issue, it seemed like knees went to jelly. Cliff Shannon, president of SMC Business Council, said he would question the use only if the physicians and workers are being transported to engage in activities that aren't related to patient care. Shannon continued: "If there are patients at the other end who need their timely attention, I don't know that I could criticize that." Cliff Shannon has been vocal on issues that affect health-care costs and affordability of health insurance.

Please spare us this nonsense. When the Trib queried three other academic medical centers with care centers abroad -- Mayo Clinic, John Hopkins International and M.D. Anderson Center -- it was learned that all of their physician and executive officials fly on commercial aircraft. Anyone with a wit of understanding regarding the needs for moving academic physician and executive personnel around the world knows that commercial aviation is quite satisfactory.

When former President Clinton was asked why he got involved entertaining the sexual ministrations of Monica Lewinsky in the Oval Office of the White House, he gave one of the clearest answers possible: I did it for the most arrogant of all reasons -- because I could.

You cannot blame UPMC President and CEO Jeffrey Romoff for these excesses; this sort of thing has to be approved by the board of directors. Indeed, the genesis of this idea to lease $30 million to $50 million jets may have originated somewhere else in the organization. It was done for the most arrogant of all reasons: They could.
When Mr. Romoff survived moving a $10 million book of advertising business out of Pittsburgh and giving the contract to a company in which his brother serves as a principal, it was obvious that there was nothing the board of directors would not do to keep Romoff happy.

The Trib article stated the following:

"Private jet firms say leased and chartered jets are popular among business executives who want to avoid the hassles of flying commercial. Travelers can take off on relatively short notice, avoid long security lines and have room to conduct meetings or sleep, said Dan Stainer, director of marketing for Voyager Jet Center, a West Mifflin-based firm. 'You arrive at your destination refreshed,' Stainer said. 'You can go to a meeting, and we can have you back in time for dinner at home.'"

God forbid that anyone at UPMC would have to endure the same indignities that the consuming Pittsburgh public faces daily at Pittsburgh International Airport.
I wish I could think of a word more apt than absurd. I cannot. Here are three reasons UPMC should not be leasing corporate jets:

1. UPMC is a community treasure. Romoff and his mentor, Dr. Thomas Detre, are both strategic geniuses. They took UPMC and the affiliated medical school from obscurity to national prominence. One of their greatest assets in achieving these great heights was the tax-exempt status available to them to serve the eleemosynary requirements of a grateful community. Sen. Charles Grassley has been fishing for a good reason to take away the tax-exempt status of hospitals; this is the "poster child" of abuse that he has been looking for and it was so avoidable.

2. There is a dubious mathematical and financial equation for determining whether or not a corporate jet is justified. Let's just assume UPMC passed this test. Pittsburgh is still a conservative town with people who will never understand why the gentry of UPMC need a jet to squire them around the world. Those who are inside the industry know that there is no "patient care" justification for corporate jets. In mathematical terms, this is hubris squared.

3. What kind of message does this send to "Joe Six-pack" who cannot afford health insurance or can barely meet his co-insurance and deductibles for medications and visits to his primary care physician? It demonstrates a lack of judgment and sensitivity to the people who pay the bills that have turned UPMC into a corporate giant. It might benefit the consciousness of Jeff Romoff and his minions if they flew commercial and sat next to their customers and sought their advice and counsel with respect to the issues that worry the consuming public.
Do not expect this situation to change. According to the Trib article, some models of the Bombardier Global Express "can seat 19 passengers and feature personal DVD players, a separate conference area and plush leather seats that can be converted to beds."

Tonight when UPMC officials streak across the Atlantic like Greek epicureans opening bottles of champagne and the attendants serve gourmet cuisine, many of Pittsburgh's citizens will be going through the drive-thru at Wendy's picking up a small chili without cheese and a small Diet Coke trying to cut corners to face their co-pays at the Eckerd pharmacy later in the evening.

There will be a day of reckoning. This is the kind of excess that the "average Joe" can understand. He may not be able to do anything about it but someone in a position to do so will. It cannot come a day too soon.

Have you ever had that sick, sinking feeling when you are embarrassed for someone else because he does not have the good sense to be embarrassed for himself? Well, when we look up in the sky and see UPMC officials disappear into the sunset in their Bombardier Global Express, many of us will be embarrassed for them; for they do not seem to have the self-awareness to be embarrassed for themselves.

Jan Jennings

Republished with Permission from the Pittsburgh Tribune-Review

Well-Seasoned Consultants: Caveat Emptor – Buyer Beware

Picking a “Well Seasoned Consultant” May be More Dangerous than “Eating Beef Jerky”

This month our firm celebrates its third anniversary. We have had a lot of fun, grown rapidly, made a few mistakes and have enjoyed remarkable success.

It is always risky commenting on the consulting skill of other firms. So, at the outset I should disclose that we have several dozen consulting partner firms from whom we have benefited greatly from their instructiveness, sound leadership and commanding knowledge. They are often in a position to offer expertise that is not within the spectrum of services offered by American Healthcare Solutions. Further, we have enormous respect for many of our competitors with whom we have no relationship. There probably has never been a deeper and richer pool of consulting talent in the healthcare industry.

We do, however, still bump into consulting firms that bill themselves as “well-seasoned.” This term of art is often a euphemism for tired and old approaches to solving new problems in healthcare. “Well-seasoned” is, however, a nicer term than “old goat.” “Old” today is less related to the age of the consultant than is the freshness of thought within their minds and hearts.

Originally used to describe food, “well-seasoned” draws my attention to “beef jerky” and “Virginia ham.” Both are rather expensive, loaded with more chemicals than a waste disposal system and heavily laden with fat and salt. The routine consumption of these food items is not generally considered good for your health; directly related to hypertension, as a minimum.

One should look carefully at the ingredients of a “well-seasoned” consultant; the following characteristics are bad signs:

• If your consultant thinks advanced computer skill is in some way related to e-mail . . . you may have a “well seasoned” consultant.

• If your consultant gets glassy eyes when you request a multi-variant predictive algorithm utilized in productivity management . . . you may have a “well seasoned” consultant.

• If your consultant thinks supply chain management is picking the right GPO . . . you may have a “well-seasoned” consultant.

• If your consultant cannot tell you every link in the revenue cycle from the doctor scheduling the operating room from his office to the investment of cash receipts from net patient care . . . . you may have a “well-seasoned” consultant.

• If the pictures of the consultants on their website (if they have one) looks like the bulletin board introduction photos of clients in a local nursing home . . . you may have “well-seasoned” consultants.

• Seriously, while there are endless lists of indicators, if you open the invoice from your consultant and the dollars charged take your breath away . . . you may have a “well-seasoned” consultant. Stated somewhat alternatively, if the invoice challenges your “gut” regarding the value received for the dollars charged . . . you may have a “well-seasoned” consultant.

As a practical matter, a consultant should only be retained against the same criteria generally utilized for hiring a new member of an executive team:

1. They can do something you do not have time to do.

2. They offer expertise that is needed and otherwise unavailable within the organization.

It is this latter category of consulting where “well-seasoned” consultants tend to struggle. The “well-seasoned” consultant that has skills garnered in the 1970’s or 1980’s is frequently missing an entire body of knowledge that has emerged in healthcare administration in the last generation. Certainly experience is an important factor in selecting a consulting firm but is the firm at the cutting edge of quantitative and qualitative analytical technologies and knowledge?

The best “well-seasoned” consultant I know is a fellow in his mid 70’s by the name of Paul Long. He is semi-retired, was a senior leader in the former Hunter Group and has an extraordinary pedigree of finance related accomplishments in some of the best hospitals in the United States. He stays current with the latest developments in healthcare administration and healthcare finance, in particular, and has penetrating judgment and integrity. His conclusions are based on deep data analysis, a balance of competing forces within an organization, and a commitment to deliver value to the client. We wish we could secure his services on a full-time basis. I do not have his permission to use his name in this missive . . . so I am likely to take a finger-wagging for telling the truth about him.

We also see young people coming into the field with remarkable skills and abilities typically over the pay grade of the generally available “well-seasoned” consultant. These young people own the future of healthcare consulting. Integrating their knowledge and analytical skill with more senior, but competent, talent is the trick for obtaining best value in healthcare consulting.

So, there you have it. When you retain a healthcare consultant, be careful. These dollars should be spent judicially. If your consultant cannot exceed your expectations and raise the performance bar for your organization, you may have purchased the “beef jerky” and “Virginia ham” of healthcare consulting . . . well-seasoned. On the one hand your feet should not swell, but your blood pressure may rise.

Jan Jennings

Republished with permission from the Hospital News Group

Valentine's Message from an Anonymous Nurse

It was a busy morning, approximately 8:30 AM, when an elderly gentleman, in his 80's, arrived to have stitches removed from his thumb. He stated that he was in a hurry as he had an appointment at 9:00 AM.


I took his vital signs and had him take a seat, knowing it would be over an hour before someone would be able to see him. I saw him looking at his watch and decided, since I was not busy with another patient, I would evaluate his wound. On exam it was well healed, so I talked to one of the doctors and obtained the needed supplies to remove his sutures and redress his wound. While taking care of his wound, we began to engage in conversation.


I asked him if he had another appointment this morning, since he was in such a hurry. The gentleman told me that he needed to go to the nursing home to eat breakfast with his wife. I then inquired about her health. He told me that she had been there for awhile and that she was a victim of Alzheimer’s disease.


As we talked, and I finished dressing his wound, I asked if she would be worried if he was a bit late. He replied that she no longer knew who he was and that she had not recognized him in five years. I was surprised, and asked him, "And you still go every morning, even though she doesn't know who you are?" He smiled as he patted my hand and said, "She doesn't know me, but I still know who she is." I had to hold back tears as he left. I had goose bumps on my arm, and I thought, "That is the kind of love I want in my life." True love is neither physical nor romantic. True love is an acceptance of all that is, has been, will be, and will not be.


The happiest of people don't necessarily have the best of everything; they just make the best of everything that comes their way.


An Anonymous Nurse

When we harm a patient, should we apologize?

We certainly would not send them a bill for poor care...or would we?

Last year I was visiting with a friend, a highly recognizable name in healthcare. He conveyed a personal story of a surgery performed that went horribly wrong, leaving his vision in one eye forever damaged. When the surgical mistake was “diagnosed,” it was the surgeon himself that brought to light his shortcomings. In a glib tone, he admitted his “hand slipped” and that this issue was detailed in the consent form. He promptly sent a bill to the appropriate health insurance company as well as to the patient for the co-pay expenses. As a result, the hospital where the surgical error occurred took a negotiated discount from charges as payment in full for the procedure.

The Hospital CEO -- well, he thought the surgical outcome was really “unfortunate.” The surgeon was disappointed; he said this case was one of only three times in his career he had permanently damaged a patient’s vision. No one thought an apology was in order. Both men are extremely well educated and trained, mannerly and respected in their professions. Both men would even apologize if they accidentally bumped into a little old lady in the grocery store. Permanently damage a man’s vision, and no apology is in sight -- no pun intended.

In October, 2006, Newsweek published ten case studies directed toward fixing America’s healthcare system. The first case study was “Facing Up to Mistakes.” A patient of Boston’s Brigham and Women’s Hospital relayed her nightmare of enduring a cardiac arrest when an anesthesiologist injected a routine nerve block and everything went wrong. The patient intuitively knew that something horrible had happened and felt betrayed by the hospital for not being candid with her about her adverse medical event. The anesthesiologist wrote the patient, accepted responsibility for the mistake, and apologized. As a result, the hospital developed a new system of patient safety. The patient offered her forgiveness to the doctor and, more importantly, said, “I felt like I had my life back.”

Not everyone gets their entire life back, even when they survive poor care. In December, I received a letter from a woman who read an article I had previously written and published with regard to hospital-acquired infections.

Mrs. Johnson offered the following story pertaining to her husband’s care (Mr. Johnson) following a laparoscopic colon resection at Alamo General Hospital. Forgive me for changing the patient’s name and the hospital name. Aside from all of the legal problems such a disclosure would unleash, it would also detract from making this central point: Patients are routinely injured or killed in American hospitals; no one apologizes; the hospital, physicians and surgeons bill the insurance company, and, if necessary, the patient or family is sent a bill for co-pay obligations. It is not possible to make up this stuff.

Mr. Johnson opted for a laparoscopic colon resection because the risk of infection was lower. The surgeon informed Mr. and Mrs. Johnson that the surgical procedure was a “success.”

Notwithstanding, Mrs. Johnson was concerned. With no training in medical or hospital care, she perceived the nurses were understaffed and overworked. “There were simply not enough “hands” to cover the surgical floor most of the time.” All hospital personnel were courteous but frazzled.

There were hand sanitizers in Mr. Johnson’s room, and Mrs. Johnson noticed that nurses and physicians frequently washed their hands. They did not always wash their hands; but after all, they frequently washed their hands. Aside from observed hand washing irregularities, Mrs. Johnson noted numerous unsanitary practices; most caused by the sense of chaos on this surgical nursing floor.


Here are several direct quotes from Mrs. Johnson. “In a matter of a few days, there was something not quite right going on in the area of his incision. As his discomfort grew, he began complaining of pain and nausea and was eventually given some medicines allowing him to be able to rest. Since it was evening, I went home for the night. Little did I know that the next day would prove to be the real beginning of the nightmare.”

"By the time I arrived at Alamo General the next morning, my husband was in severe pain and fighting a spiking temperature. Since it was the Easter weekend, staff was really limited. Eventually, the nurse and I had a talk, and I demanded that a doctor look at my husband. I was not going to allow this to go unchecked.”

"The doctor who finally came to check in on my husband (at the nurse's insistence) barely looked at the wound site. He was nice, but he was not as concerned as the nurse and I. He tried to assure me that there was nothing unusual about the situation. He did not convince me.”

"My husband continued telling the nurses of his concerns that evening and throughout the night; but upon standing up from his bed the next morning to go to into the bathroom, he felt that his gown was wet. When he looked down, he watched as a bloody pool formed on the floor at his feet. A nurse who was passing by his door saw what was going on and quickly attended to him.”

"Shortly thereafter, three doctors were in my husband's room, the young doctor from the day before being one of them. With scissors and nothing to numb the wound site, they proceeded to reopen the wound which produced more puss and fluids than they were able to contain with the handfuls of gauze they had brought along. Right there, on the hospital bed, in a very non-sterile setting, my husband's very infected wound was treated. It almost caused him to lose consciousness and almost caused me to completely lose my temper.”

"I became the one who had to pack the wound, administer the medication and change the dressing for the next month.”

"The health care professions are demanding, indeed. But when there are not enough nurses and nursing assistants on every shift, there simply is not time to employ the proper procedures for fighting infections. The visitors to the patient rooms must also be involved and educated on the prevention of spreading germs to the patient. It cannot be left entirely to the nurses and the physicians."

Mr. and Mrs. Johnson finally left the hospital. As Mrs. Johnson started to drive her husband home, they both noted a banner hanging on the front of the hospital proclaiming that the hospital was one of the top 100 hospitals in the nation or words to that effect.

In closing, Mrs. Johnson said, “My husband recovered, though he still suffers with pain occasionally. As he likes to say, "I had to get out of that hospital before they killed me!" His sense of humor is still intact.”

Indeed, Mr. Johnson might be that one unlucky hospital patient in twenty that acquires an infection as a consequence of being admitted to a hospital. Here are several pertinent facts. Mr. Johnson was otherwise healthy when he arrived at the hospital. He did not have an infection when he arrived at the hospital. He acquired a life threatening infection while in the hospital. No one apologized or even offered a single word of regret. All hospital bills were submitted for payment with dispatch. Mr. and Mrs. Johnson have never contacted an attorney and do not intend to sue anyone. They are just thankful that Mr. Johnson is still alive.

Having conducted interviews with several dozen hospital CEO’s (not very scientific or statistically reliable), they think Alamo General Hospital is the norm and that Boston’s Brigham and Women’s Hospital is the outlier. Among other things, they point to the advice and counsel from the hospital attorneys. Admit nothing. In 1970 there was a memorable movie by the name of Love Story. Torturing the most famous line from the film, “Providing poor patient care is never having to say you are sorry.” The American hospital may not always be able to provide the best care. One element of reform that Newsweek had right is we need to be able to face up to our mistakes. While it is easier said than done, it still should be done. If we are to maintain the reservoir of goodwill that the “Johnson” families of America extend to us, we will need to face up to our mistakes sooner rather than later.

Jan Jennings