The people in the lobby

It was winter in the north country.  The temperature was in the low teens, the wind was blowing 20 MPH and the heavy snow was flying horizontally.  When I walked into the lobby of the hospital it was full of Mennonites.  They had come from their milking barns to the hospital and they were waiting for the business office to open so they could pay on their bills.  You see, Mennonites pay their bills – in full – in cash.  They will spend the rest of their lives paying their obligations.  I went on to the administrative suite where ridiculous debate was occurring that made me furious.  The administration was discussing sub-optimizing for the private benefit of Dr. Huff-and-Puff while the Mennonites were lining up to pay the hospital not from their excess but from their necessity.  I am very lucky I did not get fired for suggesting that Catholics in a Catholic hospital were engaging in decision making somewhere between magic eight ball and Ouija board.  I had no idea that Catholics did not like Ouija boards and I had no idea what it meant to get reamed out by a nun but I soon found out.

A couple of years later, I was invited to South Georgia Medical Center to be interviewed for the purpose of a potential interim engagement.  As I walked through the lobby, I was nearly overcome.  South Georgia has a large lobby and little space elsewhere for waiting.  The lobby almost always has people.  They are south Georgia people.  They are easy to identify by their dress and their speech.  They sit and sit in the lobby keeping vigil for their loved ones.  They wait and they pray.  They pray that their loved ones will be healed and that those of us that are responsible for their care will get it right for their family.

These people do not know who we are or what we do.  Many of them would not understand what we did if we explained it.  Shucks, some of us don’t know what we are doing most of the time.  ‘Still and yet’ (as the girl from WVA used to say), the people in the lobby wait, pray and hold vigil.  I have told my family that if I am in a hospital, I do not want anyone holding vigil over me, there is nothing they can do.

Has this ever occurred to you?  When you are making decisions that are going to impact care and allocation of resources to provide care do you think about the people in the lobby?  Do you see to it that to the best of your ability to exercise control or influence that not one cent of the hospital’s resources are wasted?  Do you demonstrate this ethic by your living?  Are people around you inspired to be better by the example of leadership you are setting?

One of my favorite one-liners is the euphoria we get from drinking at our own still.  How often are we wasting time in an administrative suite waxing eloquently about how great we are while simple people are sitting a few yards away from us praying as hard as they can that somehow we will get it right for them and their loved ones in spite of ourselves?  Anyone that does not labor daily under the stress of this burden or awaken in the middle of the night worried about this does not deserve to serve in a hospital.

Just this week, I told some voluntary hospital trustees how much respect I have for them and their service to insure to the best of their ability that the hospitals they represent meet the needs of the communities they serve.  Talk about an awesome, bone chilling responsibility.  When you are in the presence of these people, you have the incredible experience of being in the same room with the giants of humanity among us.

I have at times in the past experienced fear for my job.  I meet regularly with people who have fear for their job.  One of the benefits of being in interim services and a late career executive is that I no longer have fear for a job.  I am a lot more afraid of the people in the lobby and the Board of Trustees.  Will I reach my potential to deliver what the sick, wounded and downtrodden need?  Will the blessing of intelligence and understanding of numbers and complicated governance and leadership concepts I have be enough to meet the needs of so many that are so utterly dependent upon me?  Will my ability to  get an organization functioning as efficiently as possible be sufficient to meet the needs of the people that depend upon the hospital?

One of the many unique features of a hospital is that not one of its customers (patients) with the possible exception of healthy women bearing healthy children want to be there.  Virtually every other patient would just as soon be anywhere else doing anything other than subjecting themselves voluntarily or involuntarily to medical interventions that in many cases only prolong their agony.   I have yet to meet the person that was glad they were diagnosed with cancer so they could spend days in an infusion room.  I have yet to have the marketing department introduce me to a patient that saw a billboard and woke up the next morning saying that they should spend the day in the emergency room.  Where is the first patent that drank their morning coffee from a hospital logo cup and decided as a result to come in for a MRI?  The people that we serve know very little about disease process or clinical process.  Even those among us who work around hospitals are rendered impudent when we find ourselves on our backs at the mercy of people we do not know doing things to us we never envisioned or understand.  The last time I faced surgery, the day before I had no idea that before a day had passed that I would be in an operating room as a patient.  Actually, I had some other plans that were more important in my mind.  A sharp ache and the next thing I knew, my life was turned totally upside down and out of my control.

I heard the Chairman of a Board that had undergone heart surgery say that he literally watched the seconds of his life ticking away on a wall clock in the cath lab as he was told he was going straight to a heart room.  The question that was in the front of his mind was whether or not the hosptial had what it needed to provide the care he was going to require?  He mused to himself about whether or not as a Board Chairman had he done enough because if he had not, it was a little late to start focusing on the need.

This is what we do and why it is important.  We do not know who will need our services, when or why.  The reason we are leaders in healthcare organizations or organizations providing service and support to healthcare providers is to be there for EVERYONE that needs our services in their hour of need.  The better we do our jobs, the better enabled our organizations will be to meet the vision of their missions.  If we fall short of our potential or what the organization needs, the friends and family of the people in the lobby will suffer.  Sleep with that a few nights.  Sometimes, I wonder if I should have stuck with my original career aspiration; wrecker operator.

And so I come back to familiar questions.  Are you up to the challenge?  Are you leading from the front by example?  Are you an example of what the organization aspires to become or what it needs to rid itself of?  Are you spending time, money and energy in ongoing education to improve your potential to meet the increasingly complex challenges of running a complicated healthcare organization these days?  Is your area of responsibility meeting the needs of the organization?  Have you made it better or is it impeding the ability of the organization to move forward?  Are you and your area of responsibility rising to your full potential or is new leadership needed to reach the next level?

Get off your ass, take a walk.  Go into the waiting rooms.  Look at the people there.  Speak to them.  Engage them.  Shake their hands.  Introduce yourself.  Tell them what you do.  Tell them that you are seeing to it that they or their loved ones are getting the best the organization is capable of delivering.  Give them a card and tell them to call you ON YOUR CELL PHONE if they have a problem, question or concern about how things are going.  Demonstrate interest and compassion.  Engage your patients and family you would like to be engaged if you tomorrow found yourself sitting in the lobby of a strange hospital in a strange town with no idea of what is happening.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the US, I might have an idea or two that might be valuable to you.  I can also help with career transitions or career planning.
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This is original work.  Copyright is claimed by me with reproduction prohibited without prior permission.  I note and  provide links to supporting documentation for non-original material.

If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com. I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.

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