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Inland Empire Provider Positioning for Growth in Reform

This article first appeared on March 11, 2013, in California Healthline.
(by Lauren McSherry, California Healthline Regional Correspondent)

SAN BERNARDINO — Marking yet another step in the steady expansion of its reach in the Inland Empire, Loma Linda University Health is planning to construct a medical and educational complex in San Bernardino that could serve up to 250,000 patients each year.

Experts said the expansion is likely part of the health system’s strategy to better position itself for changes to health care reimbursement and hospital patient volume expected as a result of the Affordable Care Act.

In recent years, Loma Linda University Health has undertaken a number of construction projects in San Bernardino County, where its main medical campus is based, and in Riverside County. The health system, which includes the region’s only Level 1 trauma center and children’s hospital, now has more than 1,000 beds in six hospitals in the Inland Empire.

In 2009, the health system opened a 90,000 square-foot outpatient satellite campus in Beaumont. Through partnerships with Beaver Medical Group and Redlands Community Hospital, Loma Linda University Health’s Highland Springs Medical Plaza offers specialty services, such as oncology, cardiology, neurosurgery and orthopedics. Continue reading →

Lessons From My Father

This article first appeared on the PBS affiliated website This Emotional Life.

“Everything in moderation, including moderation.”  –Oscar Wilde, Irish writer and poet

When it comes to understanding what it means to be a man, little boys typically look toward one specific individual, Dear Old Dad.  What is not so consistent, however, is the manner in which a father chooses to undertake his role. Nowhere else is the drive to impart all that he has learned so strong and the possibility of instilling hard-won wisdom so pronounced as when a father looks at his eager young son. And yet, for this very reason the school of fatherhood boasts a subjective curriculum at best, as the competency of the teacher pales in comparison to the ways in which the student will go on to apply these lifelong lessons, many of which have been handed down through generations, whether knowingly or not.

Several thousand years of fiction tell us all we need to know about how tenuous the influence of a mature man upon his children can be.  From King Laios of Thebes (the biological father of Oedipus) to Wilbur Meecham (the tyrannical father of Ben) to Carlisle Cullen (the eternal father who adopted Edward), the most valuable lessons often emanate from the reactions of the son rather than the actions of the father. In truth, a man’s best intentions may fall upon deaf ears or be misinterpreted by a youth struggling to carve the foundations of his own identity, and sometimes the best we can hope for is that a little luck and our unspoken influence through way of example will provide the necessary navigational instincts for our children as they pass through whatever storms may confront them.

The relationship between father and son is always complicated and in each case unique, with every example of success or failure providing a new interpretation on what it means to be a father. If that was not enough, there is never a guarantee that an idyllic father will raise a comparable son, or that the child of an atrocious man will ultimately follow in his ancestor’s malevolent footsteps. This cumulative nature of fatherhood is in many ways for the best, as nearly every boy at one point or another finds himself determined to be anything but his father. Today, however, as I read that rhyming masterpiece of Dr. Seuss, Hop on Pop, to my 10-month old son on what would be my own father’s 75th birthday, I realize that not only am I deep into uncharted territory, but there is no way of knowing what aspects of history might repeat themselves. Without any guidance or source of direction, how will I ever know if I am a good father?

In looking for answers, I find it hard to gather much from my siblings on what it means to be a father, as both my brother and sister learned from the same role model I did. While fiction and history provide a number of cautionary tales, they are blueprints at best, to be relied upon loosely.  But even as I try to learn from the experiences of friends whose opinions I respect on this subject, there remains the ever-present fact that every case is different, from the point of view of both father and son.  Though one friend is in my opinion an exemplary role model for his children, I cannot help but wonder how much of his inspiration stems from his contentious relationship with his own father, the secrets of which are lost on me and my very different experiences growing up. An example in stark contrast does little more than cast an even brighter light on the many different facets that can shape the paternal instinct. Continue reading →

Our Fear of Health Care Reform and the Household Vacuum

“That’s the nice thing about carousels, they always play the same songs.”  -The Catcher in the Rye by J.D. Salinger

This article first appeared on the PBS affiliated website This Emotional Life.

It starts with a vacuum.

The sudden, unfamiliar dissonance signals fear in his little mind, which grows quickly, magnified by the sight of an unexpected entanglement between the woman he trusts most and this monstrous machine. As he turns to run (or crawl), I find myself thankful to be just inches away, in perfect position to catch my 10-month old boy as he does his best to flee the frightful scene. His two outstretched arms secure a tight grip around my neck, while a sad face burrows deep into my chest. For one sharp moment I feel like a hero, a wholly necessary, trustworthy entity whose sole purpose is to be relied upon in times of trouble.

Fear is a formidable foe, and the ways in which we as grown ups react to its presence can often be inconsistent. Regardless of its origin, any meaningful cause for alarm typically signifies a commonality of chaos, to be first understood, and then vanquished. Though my son’s safety was obviously never compromised during his run-in with the vacuum cleaner, his reaction illustrates the fact that in the eyes of an infant the world is full of uncertainties. In the mind of a child, laughter and tears coexist every day, yet we seldom stop to consider how these emotions actually resonate. Rather, we tend to focus on the cause, which with luck might lead us to a solution, as a means to restore the calm and save the day. Indeed, some of the most seasoned parents have an entire cache of remedies upon which to rely when a crisis hits, and they wield them like weapons of precision, each one crafted and selected for just the right moment.

But what about the child in the midst of a trauma?  Continue reading →

Advice from Antiquity

“Life is like riding a bicycle. To keep your balance you must keep moving.”  – Albert Einstein

This article first appeared on the PBS affiliated Website This Emotional Life.

Every so often I stop to reflect upon the seemingly random series of events that have led my life to its current point. In times like these my mind rarely gravitates toward any single individuals who left lasting impressions, positive or negative, but instead remains fixed on the patterns that have emerged over time.  Make no mistake, I still search for a seemingly insignificant or banal event from my past that might offer some magical context to help define the person I have become, especially in light of my newfound fatherhood.  And yet, while I am not holding out for such an epiphany any time soon for myself, such a revelation could do wonders for my son as he crawls faster and faster toward the conclusion of his first year.

At the age of eleven, I read my first Greek myth, and I was hooked. Eleven years later, I graduated from college with a major in classical studies, a discipline I have described as familiarization with an abundance of Greek myths experienced in a written rather than spoken format, in a language that dates back seven to ten thousand years.  From this historical depository of dactylic hexameter and Socratic dialogue, a few key tenets have remained permanently etched in my brain, and it is not uncommon for me to draw upon these scraps of wisdom on any given day. While often overshadowed by the technological advances that largely define our fast-paced modern society, I continually find that those bits of knowledge I learned twenty years ago are more than enough to help me navigate through even the most baffling of days.

Victory comes to men in turns.”

This famous quote from a traditional English translation of Homer’s Iliad is a source of comfort and hope in troubled times as well as a gentle reminder for us all to strive for humility at any stage. Continue reading →

Professional Advice From A Newborn


“The aim of education is the knowledge, not of facts, but of values.”

– William S. Burroughs, American author and poet

This article was first published on the PBS Affiliated Website This Emotional Life.

It has always seemed to me that life is a series of stages. And yet, rarely do we recognize such fleeting moments when one stage ends and another begins. Irrespective of who or what may be behind the impetus for any given change, these significant, transitory periods in life often accompany opportunities to reflect upon individual priorities. Such was recently the case with me, as I found myself on the cusp of not one, but two major life changes, as well as with an unusual amount of free time with which to think.

Although my titles, job descriptions, and central focus may have shifted through the years, health care has always been my industry. For well over a decade my work has involved legal matters, consulting opportunities, hospital management, academia, and creating a foundation in a public benefit enterprise. These two most recent changes, the birth of my first child and my transition from head of a community hospital to the private sector, occurred simultaneously and permeated practically every aspect of my life and touched upon my inner most thoughts and feelings.  Such intensity in transition can be unsettling, and when reliance upon intuition and instinct is called upon to surpass experience and knowledge in utility, there is often not much time to recover from vacillations in self-confidence and pride.

My father instilled in me the notion that professions were not to be seen as mutually exclusive, and he taught me the importance of finding ways to create an individual path whenever possible. In reflecting upon the past sixteen years since completing my academic studies, I would like to think that I succeeded in reaching the appropriate professional autonomy he espoused, even if I existed under his gentle influence and sometimes watchful eye during the first 41 years, 1 month and 16 days of my life.

Parents can play many different roles, and for me the union between my mother and father formed something like a trapeze net that waited to protect my siblings and me should we find ourselves falling as we attempted great heights. Of course my vantage point toward my family changed over the years as I matured and tried new things, and at times my height was such that I could not confirm their existence below. Still, that net has proven quite sturdy even today as my mother holds it alone, nine years after my father’s passing.  My mother’s firm grip still reminds me of the ways in which my parents influenced my many decisions by providing that rock solid foundation, but I was recently surprised to note that it is a newcomer who seems to have the most influence over my security these days. Weighing in at a cool sixteen pounds, I am talking about my son.

When I reached a rather significant crossroads in my career last fall, my son was still nesting safely inside his mother’s womb. At the pinnacle of my professional transition, he was a mere six weeks old. And yet, when I recently looked below to see if anyone was holding the net for me as I prepared to make my next leap, my son stood there by himself, smiling up at me.  This recent lesson from my son is of equal significance to my father’s instructions a decade ago, yet the two sets of truths could not be any more different from each other.

When my position at the hospital came to an end, I redirected my attention to the various job experiences I had gathered over these past 16 years, with the only common denominator being the industry. Under the umbrella of health care, I sought to combine legal, administrative, and literary acumen as I set out to define the next chapter in my existence. Without the security stemming from the job that had been my professional centerpiece for the past nine years, however, I knew this task would be quite challenging, and my frustration grew when I found I could not readily identify the origins of my perceived obstacles. I feared that something had changed within me, so my response was to increase my efforts in even greater directions. This, of course, did not help my focus.

And then it occurred to me what had caused my recent change. All along, I had been blaming this previously undefined shift in personality for preventing me from advancing my career to its next logical stage. And yet, as it turns out, this change did not blunt my focus or energies at all, but rather readjusted my priorities in such a way so that I now find myself proceeding along the path I had been seeking all along.  I have held many positions in my life, but there is one for which I had no experience up until recently, and its impact stands in stark contrast to everything I’ve ever learned in an office or hospital.

Though I may be new at my role as father, the old adage continues to ring true in my ears – timing is everything. For just when I realized that my career was teaching me how to be a better father, I’ve come to learn that my son has improved upon my professional abilities. As it turns out, this is very convenient for both of us, and I cannot wait to see where this partnership will lead.

 

How My Career Taught Me To Be a Better Father

This article first appeared on the PBS affiliated Website This Emotional Life.

“There is no instinct like that of the heart.” Lord George Gordon Byron, British poet

The old adage is true: Timing is everything.  No matter how straight and narrow the road ahead may seem, one must always take into consideration the unexpected, that one, untamable variable that may at any time upset the apple cart and leave us scrambling to regain both composure and apples. For just over 108 months, I was the CEO of a hospital.  For three overlapping months, I was also a father.  The end to one significant stage of my life coincided with the joyous beginning of another.  Timing always rules the day, and, as I have found, it also enjoys irony.

Recently, I made the commitment to pursue certain credentialing and board certifications in health care management, even as my position in this field was in transition.  With a new child at home, a new career to forge, and a new professional distinction in my sights, I dived head first into an unrecognizable abyss, hoping that some yet-to-be-defined synergy (in the form of a very large net) would break my fall. As luck would have it, one of my first assignments was a book by Tom Atchison, Ed.D., which introduced me to “The Synergy Factor.”  As I understand it, this concept is a coalescing of sorts between certain intangible inter-relational ideas and tangible processes within health care administration.  There, in the middle of my matutinal study of the Synergy Factor and health care leadership, my mind started to wander toward my son, and I began to delve into the ways in which I could enhance our relationship in these early stages.

Young children (and many adults as well) exist in the crossroads of the tangible and intangible.  Matters of genetic makeup, demographics, and fiscal stability are common, tangible discussions for many new parents who aspire to provide for their latest family member. More often than not, however, that which is tangible is also hardest to control. The intangible part of parenting, namely the notion of instilling a mutual trust, respect, pride, and joy into the parent-child relationship, also happen to be what Atchison describes as “the source of a sense of purpose and meaningful work as a result of living the mission, values, and vision.” (Atchison, Leadership’s Deeper Dimensions: Building Blocks to Superior Performance, 2005).

Although not necessarily represented in equal proportion, certain factors such as the color of his eyes, the sound of his voice, the bed in which he sleeps and the neighborhood where we reside all share attributes that extend to varying degrees beyond my parental jurisdiction.  But the intangible ways in which I deliver certain messages that speak of and lead to trust, respect, pride, and joy are almost entirely within my control, regardless of those aforementioned tangible realities, as well as any challenges I may face now or in the future as a parent.

Now, as my studies force me to probe deeper into the core of health care management, I constantly find myself reflecting upon my real life lessons learned over the past nine years. No matter what educational background or prior experience a hospital CEO brings to the table, certain on-the-job assignments will necessitate fast, critical thinking.  With such knowledge comes the hope that I myself faced each hospital challenge with a combination of what I learned in school, what I learned from past work-related experiences, and what just felt like the right response. And as I continue to read about tangible and intangible notions in health care management as well as other industry terms and phrases, I begin to realize that I had in fact embraced most of these concepts during my tenure, in deed if not in word as well.

As I reflect upon the past decade with these thinly disguised affirmations from my present studies, I wonder also how I will come to assess my first nine years as a father. At the outset, I am very mindful that this new role differs from the last with respect to the events over which I was ultimately responsible. Now I share the top position with my wife, although to be sure my involvement is shaped by the needs of a newborn and the physical limitations of a father.

Without anything resembling an owner’s manual to follow as I try to build connections with my son while navigating the uncharted waters of new fatherhood, I realize that my instincts will be my second greatest ally, preceded only by those of my wife.  Thanks to the recent validation of these very instincts in hospital management, I am mindful that timing is still everything, and not all variables can be controlled.  Some must be dealt with as they emerge. Certain concepts that previously had no words in health care management may also be unknown terms to me in parenting.  For now, however, I can reassure myself by embracing both the tangible and intangible, and perhaps borrow some of these newly acquired definitions from health care to light my way.  After all, my goal is to build a solid foundation with which to give me footing among these intangibles in preparation for a lifelong journey with my son. In many ways, this is not so different from the way in which I approached the running of a hospital.  This time, however, the stakes are more profound, not to mention precious.

 

Searching for Attachment at Home

This article first appeared on the PBS affiliated Website This Emotional Life. This content is provided in conjunction with This Emotional Life’s Early Moments Matter initiative. Early Moments Matter is dedicated to making sure that every child has the best possible chance at emotional well-being. Find out how to receive the Early Moments Matter tool kit and provide one to a family in need.

“Not until we are lost do we begin to understand ourselves.” –Henry David Thoreau

Yesterday I awoke feeling somewhat uncomfortable. Looking around the room, I checked the facts before me.  Yes, it was my home, my family, my face in the mirror, but something was still missing. Concluding this to be a typical morning sensation, I decided to follow tradition: Make some coffee and read the newspaper.  In recent years, however, the newspaper has been for me little more than a spring and summer luxury within which I can scan baseball box scores and statistics. Still, with nearly 80% of the season left, I thought I should have no problem catching up quickly.

With coffee and toast at the ready, I was soon armed with key baseball facts — the American League only of course — and ready to move on to the Wall Street Journal.   As I thumbed through page after page of news, digesting financial facts and perusing stock market tables from the day before, it suddenly hit me that I could not honestly answer my wife when she asked me why I still received the paper’s print edition. Returning to the local paper one more time, I finally understood what was so unfamiliar with my morning:  I had nothing to do, and I was restless.

It was only the other night that I joined forces with the other nine percent of our nation’s unemployed, but on this first wayward morning my overall sense of detachment proved uninspiring. For nine full years I had headed a community hospital in southern Los Angeles, and I was used to a little drama with my morning meal. The drive to find something new on which to focus had not yet overpowered the need to put out any potential fires that had erupted at the hospital overnight, and my instincts were still primed to react to quick moving scenarios where the balance between life and death hung fast, waiting for a reaction. Today, however, I had no crisis to manage, no dragons to slay, and no urgent phone calls or emails to return. The only real enigma I faced on this first morning was to ask myself why I felt like a stranger in a home where a three-month old infant served as the poster child in support of the very idea behind positive attachment. Warily, I considered my options, and quickly concluded that ignoring this situation until it escalated into something dramatic and life threatening that my health care focused brain could understand was not a healthy way of looking at this first new day. For nine years running I had proven that I could solve almost any problem with which I was presented, and today I was determined to find some attachment.

To my knowledge, there are five permanent “entities” and one guest living in my home, aside from myself, and so I decided to work my way up the ladder in reverse order, in search of attachment. I began with Max, an arrogant but often lovable Pekingese who was unfortunately busy with a mid morning nap.  Then came Amnesia and Segundo, two black cats full of kindness and compassion, who, like Max, were also sleeping, which was not entirely unexpected, as they are cats. I then proceeded to the more animated individuals in the home, those with whom I knew I could communicate, where I believed I would find the attachment I so desperately sought.

Jackpot. My wife and son were feeding, and I thought to myself that symbolically, at least, my quest was now complete.  My mother-in-law was telling what appeared to be a very engaging story, and I smiled to think that this moment reflected the positive domestic light of a home based on solid and secure relationships with free and easy conversation.  Unfortunately for me, however, the tale was told in Russian, and I simply could not follow. Still, I held my ground, and a few minutes later I made my move, scooping up my son to effectuate the necessary post-feeding digestive adjustments, and for a brief moment I was able to bask in the glory of this fleeting victory.

Sadly, my success was short-lived, as not twenty minutes later I was informed that my son, my wife and her mother were late for a class that I had neither business nor interest in attending. So I opted to stay put and lower my sights, still determined to find some attachment with the dog and cats.

But the animals proved fickle, as house pets tend to be, and their desertion had been at least in part expected. What was worse, though, was the fact that the desk in my office, my old battle-mate, brought no relief either. Just last week my computer stood as a portal to another world where healthy, meaningful relationships roamed in great abundance.  Today, however, this connection seemed lost, and I learned a hard lesson about the dangers to be found in errant, virtual attachments. Feeling abandoned and lost, with no point of focus, I left the house to complete some menial tasks, none of which were necessary, all of which proved unfulfilling. After completing every menial errand I could concoct, I returned home with the somewhat forced notion that I deserved to consume a well-earned lunch.

But then I stopped. Let it here be said that we all have fictional boundaries in our lives, boundaries of our own devising, some of which are more accepted and important than others.  For the record, I have many, most of which I break, but there is one hard and fast statute on which I simply will not budge.  I refuse to eat lunch at 10:30 am.

And so, with a grumbling stomach but without much choice, I resigned myself to the couch and watched a pre-recorded episode of the television show House.  As I relaxed and gave myself over to the drama unfolding before me, it hit me that this would be as close as I was going to get to a hospital for the rest of the week.  And just when I thought I had failed in my one and only objective for the day, Max the dog materialized from under a table, jumped on the couch, and rested his head on my leg with one eye fixed on the television. Together, we watched in silence.  Indeed, we bonded.

Still not quite lunchtime, I reflected on why I have had such a difficult time finding my attachment this Monday morning. While it is true that the past few months I have spent transitioning a hospital (with a 24/7 emergency department) between owners have made me a stranger of sorts in my own home, my thoughts have always been primarily with those who rest beneath my roof, and it is to them that I have sought to return. When it comes to my son, I feel at times that I have arrived late to the party, though I marvel at the energy my wife has spent building a safe and secure environment for him. In fact, the bond she has formed with my son during this period in which I was preoccupied is exactly what gives me hope for the free time which now stretches before me. It is in many ways a gift for which no amount of education, experience or desire can prepare me.  The key to any bond rests with time spent together. And I for one cannot wait to begin.

Go to www.earlymomentsmatter.org to learn about attachment and to get an award-winning toolkit that introduces ways in which parents and caregivers can help their children build secure attachments.

 

Bringing the Relationship Back Home

This article first appeared on the PBS affiliated Website This Emotional Life.

“As you get older, it is harder to have heroes, but it is sort of necessary.” — Ernest Hemingway

It starts with lavender.  Then I notice the tiny, neatly folded outfit set aside by the changing table. A dragon in the corner smiles at me, performing ironic double-duty as humidifier and protector, providing respiratory ease rather than spewing the requisite fire so common to his kind.

Through the dim lighting I spot a small bottle waiting to provide the next meal when necessary, along with an array of accoutrements placed strategically throughout the room in anticipation of what the night may bring. And, of course, I hear the alternating tonic and dominant harmony in D flat.  This is my house, and yet I cannot help but ask myself where this room has come from.  It seems to have magically appeared overnight, while I was at the office crunching numbers and doing my best to contain health care-related chaos.

As I have mentioned in earlier articles, the last few months have been interesting for me, for a variety of reasons. Thus far, 2011 has seen fit to grant me a beautiful baby boy as I relinquished ownership of a family hospital handed down to me by my father.  Never before have I seen the Wheel of Life turn so up close and personal than in the last few months, and the combined experience has forced me to take account of the daily minutiae.  Simply put, things are changing, and fast.  The past seems suddenly far behind while the future stretches out before me, full of exciting new events that remind me just how far out of my league I am.  And through it all, the scent of lavender lingers as a reminder of my transition.

With the livelihood of over 400 employees – who I consider extended family members – at stake during the ongoing sale process of a local hospital on which the very community has come to depend for more than 50 years, I am the first to admit that the last two months have not afforded me as much time to spend with my newborn as I would have liked.  Late night phone conferences and early morning briefings have left little time for more than the occasional bottle-feeding or diaper change. That’s what comes to mind as I make my way across this odd little room in the heart of my house and realize just how much work my wife has put into creating a warm, safe haven in which to raise our son.  My lack of familiarity with many of the products on the nightstand only serves to reinforce how much she has learned recently, and put into practice on her own.

While I have been managing to survive my recent professional upheaval with the support of a hospital family nine years in the making, two strong-willed brothers, a handful of professional advisors with over 75 collective years of experience, and plenty of luck, that dragon’s smile stands as a reminder that she alone has borne the brunt of maneuvering through the uncharted waters of first time parenthood.  Any initial feelings of personal guilt as a result of my situation are quickly succeeded by the pride I feel on her behalf as it dawns on me that the foundation she has so gracefully provided exists not just for my son in his first months, but for me as well as I close out an important and emotional chapter in the history of my family tree.

While I was focusing my energies on external responsibilities, it was my wife who kept the home front intact. We never did plan any such allocation of duties, nor could we have anticipated this perfect storm of sorts when her pregnancy was first announced.  Yet somehow during the process, perhaps when I wasn’t even paying attention, Natalya became both anchor and life preserver, in many ways taking care of me in much the same way as she did our son.  In this forum I have had ample opportunity to discuss the many relationships that have formed my understanding of health care and its continued survival throughout innumerable pressures. But I may have been remiss by not making it unmistakably clear that the relationships that form behind the scenes within the family nest are often what make it possible for health care workers to give their best in emergency situations day in and day out. Personally speaking, my support group is an army of one. On behalf of my son, my hospital family, and myself, I am forever grateful to my wife and my hero, Natalya.

As an aside, my mother-in-law recently arrived from Belgium to lend a hand and offer advice.  Her arrival underscores what I am sure the dragon must also be thinking as he watches what transpires in that little room: “A mother’s work is never done.”

The Relationships Behind the Healing

This article first appeared on the PBS affiliated Website This Emotional Life.

In an 1889 essay, The Decay of Lying, Oscar Wilde argued that life often imitates art because “the self-conscious aim of life is to find expression,” and art provides an appropriate release. In many ways the same could be said of the current relationship between those who provide health care to the community and those who draft legislation governing such care. As the debate around health care reform enters its second year, perhaps it is time to stop and consider the full impact of the bill, not just on the health care system as a concept, but on the fate of the local hospital as a living, breathing entity.

The obvious uncertainties brought to life by today’s health care climate have over time become an unfortunate source of anxiety affecting nearly every patient-doctor relationship, as well as giving pause to the hundreds of thousands of health care workers industry-wide. For those on either side of the equation, the future of these relationships is now at a crossroads, in large part because neither professionals nor patients know what may be waiting around the next corner. Sadly, this all too often adds undue pressure to the already difficult task of care for the sick in the event of an emergency.

Next month will mark my nine-year anniversary as CEO of a hospital in Los Angeles County, California, in a role I had honestly never expected. I remember walking into that job on my first day, to face a group of intelligent, dedicated hospital managers who were devastated by the loss of their former leader.  As I addressed this room full of people – some of whom were in tears, some of whom remained stoic, all of whom were scared of what the future might hold – I wondered how I could ever comfort them for the loss they had just endured and assuage their fears of what was to come. The Hospital’s former CEO had died the day before from injuries sustained in a car accident, and it was my job to regain control of the facility and keep things functioning while learning the ropes as I went. There was no question I had some rather large shoes to fill, and but for the fact that the prior CEO had also been my father, I imagine I never would have accepted the challenge.

On the day of that first meeting with my new staff, we did not focus on our need to provide health care to the surrounding community.  Instead, we addressed the obvious issues of how best to continue forward as a team. Even so, no one working that day forgot the primary goal of any hospital, regardless of the surrounding chaos. Notwithstanding, for the next 3,300 consecutive days – almost 80,000 uninterrupted hours – the hospital did exactly as it should, using the network of relationships already in place and building on the new to continue its focus on providing care to the community.  In hindsight, the past nine years under my tenure were in many ways defined by these relationships, and our focus was strong.  As a result, the community received exactly what it had come to expect and deserve — a hospital.

Five months ago I began what would become a new chapter in this story, although initially I had no reason to anticipate the scope of its impact. It had become increasingly clear that the time had come to enter into discussions to sell the hospital to a larger health care group with the resources necessary to continue providing the area with top quality care. Throughout the process, which was long, arduous, and quite emotional for me, our focus was always to ensure that the community received what it deserved — that same hospital it had come to rely on for over fifty years.  Yet even in those moments when my focus waned, I knew I could depend on an extended family nearly 400 strong who made sure that we were well-positioned to deliver medical care to those who needed us. In the end, that’s what health care is all about.

Just the other day I entered that same room, filled with many of the same people from nine years ago.  While there were plenty of new faces as well, most of them had long ago become a part of our family. I explained that I had been preparing for this day for nearly nine years, although what was originally a day to which I had looked forward with anticipation was now one I truly dreaded. This time, I was to deliver a different message – that I would soon be stepping down as their leader. Looking out at the crowd as I gave news, every face reminded me of a lesson taught or learned, a favor asked or granted, or an experience shared.

I’ve heard it said that the whole is greater than the sum of its parts. When it comes to health care in the modern age that is certainly true, be it the correlation between community and hospital, employees and hospital, or even investors and hospital. As different as each of these bonds is from the other, all three survive only by existing together. These past few days I have witnessed first hand the ways in which change can make for a stressful environment.  The staff is nervous, the patients may be confused, and emotions run high. Nine years of consistency will undoubtedly lead to fear and uncertainty for a time, no matter who is waiting in the “on-deck circle”.

But that is what makes a hospital such a special place to work.  As chaos tries to rule the day, something happens, and a wake up call of sorts is given, reminding us all of the reason we have come together in this building on this day. Our dose of reality connects us with the real issue at hand. We remember that our community truly values the support we give in times of need, just as we do the same for one another.  After all, that is what relationships are all about.

If life could really imitate art, or at least the spirit of the law, it would make health care reform a much easier pill to swallow. To succeed in this endeavor, our primary goal should be to remember not just why we are here, but what the underlying purpose of health care in America is really all about.  For me, it has always meant faithfully serving the people who depend on us.  Though we may all sometimes forget why we do what we do, the relationships around us that maintain the hospital infrastructure so that it can operate all day, every day, are too important to ever be taken for granted.  Hopefully those who oversee the nationwide debate will one day come to accept this fact.

Relationships: The Front Line of Health Care

Chaos is the score upon which reality is written.”

– Henry Miller, American novelist and painter

This article first appeared on the PBS affiliated Website This Emotional Life.

As the Chief Executive Officer of a community hospital in the Los Angeles area, I am a big fan of the television drama “House.”  While it may on occasion stretch the boundaries of medical plausibility, it does an excellent job depicting the often tenuous relationship between doctors, nurses, administrators and patients in a hospital setting.  For seven seasons – nearly as long as I have held my current position – I have been a faithful viewer, but tonight I find myself in unfamiliar territory for a number of reasons.  First, there are zombies in this episode, which strikes me as odd for a show based in reality.  Second, there is an infant in my house, screaming as newborns tend to do.  Finally, there are two plates of fish at the table, and I am eating alone.

Working in a hospital, I have come to accept the fact that very few things surprise me anymore, as the unexpected and strange have long since replaced the usual and customary.  At any given day on the job I might observe the miracle of birth or the tragedy of life cut short, and on occasion even the phenomenon of life brought back from the brink. But regardless of whether art imitates life, work supplants home, or zombies magically appear in a medical TV drama, one thing remains constant – it quickly becomes clear to those involved in any emergency that the likelihood of survival rests on the stability of the relationships that are formed in the environment at hand.

As the onscreen events transition from the macabre to the surreal and the baby heads to his first bath ever, I sit eating my salmon while a small Pekingese dog stands on his hind legs, desperately begging for food.  I think of my young son, dependent on my wife to keep him clean.  I think of the dog, dependent on me to keep him fed. I think of patients dependent on House to keep them alive and House dependent on Dr. Lisa Cuddy et al. to keep him employed. And through it all I remember something else important – I really hate fish. Continue reading →

 

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