“It is fine to celebrate success, but it is more important to heed the lessons of failure.” – Bill Gates
Back in the day…
One summer Friday late afternoon I was in my car heading off for the weekend when the Commissioner of Health found me and told me he was closing the JCMC Trauma Center for failure to get renewed State approval.
Our new Trauma Service Director had told me that we were at risk for non-approval so we should have an American College of Surgeons consultation visit before the ACS certification, a prerequisite for State approval. But apparently he did not know that State approval had an absolute re-approval date of three years no matter what preparatory steps we chose to take.
The call was on the re-approval deadline date so the Commissioner shut the TC down but the radio stations said the ER was shut down, making the matter even worse.
To make a long story short, we got approval to reopen the TC on Monday after an early morning compliance visit by the State, and three months to get re-approval. Which we did with no contingencies, conditions or recommendations.
“Failure is only the opportunity to begin again, only this time more wisely.” – Henry Ford
Bariatric Surgery was the rage and our new Chairman of Surgery said we had to be in the game. So he recruited a team of bariatric surgeons to branch out to Jersey City Medical Center, and spent time at their home base training to be an Assistant Bariatric Surgeon (and thus able to bill for this role).
We staffed up, lots of prospective patients came to orientations, but no cases were ever done. Why? The prospective patients were mostly our own employees who “chose”, we were told, to have the surgery at the team’s home base for “privacy concerns.” So we not only paid for the programs fixed costs but also for the insurance impact when our employees had the surgery elsewhere.
“There are no secrets to success. It is the result of preparation, hard work and learning from failure.” – Colin Powell
Each of our three hospitals had different protocols to avoid “wrong site/ wrong side” surgery (e.g., wrong kidney removal). Some surgeons operated at 2 or 3 of our hospitals (as well as at other non-system hospitals) and thus had to navigate the different protocols. We called a meeting to establish one standard protocol for our system, to be approved by each hospital’s medical staff.
Only to find out months later that our two community hospital medical staffs amended the protocol rather than simply adopt it. So as CEO of all three hospitals I mandated the standard protocol, it rose to the level of the Boards of Trustees, but common sense prevailed.
“A person who never made a mistake never tried anything new.” – Albert Einstein
Three full time Chairmen told me they were in the final stages of building a free-standing surgi-center a half mile away from the hospital, and that the previous President had promised to buy it. Nothing in writing. I demurred. So they partnered with two competing hospitals. One Wednesday morning I went to a Chamber of Commerce showcase event only to find the three Chairman at their surgi-center booth. All three ran residency training programs and Wednesday was Grand Rounds for all three. They told me they were using vacation time. I said that was not appropriate. They said it was none of my business. I told each of them they had a choice, either sell their shares of the surgi-center or be fired. Two sold, one “left” and took his residents with him to one of the competing hospitals.
“You build on failure. You use it as a stepping stone. Close the door on the past. You don’t try to forget the mistakes, but you don’t dwell on it. You don’t let it have any of your energy, or any of your time, or any of your space.” Johnny Cash
The Mystery of the Hospital CLAUSTROPHOBIA CLUSTER
Our Teaching Hospital (TH) had just acquired a new state-of-the-art MRI. One of our Community Hospitals(CH) was only a little over a mile away, there was an MRI transfer protocol in place, and we ran a robust county-wide EMS transport system.
But almost every insured patient at CH who needed an MRI was referred to a “private” free-standing Imaging Center due to CLAUSTROPHOBIA. Somehow, also mysteriously, Medicaid patients and the uninsured made it to TH.
The problem was compounded by the fact that we were under a DRG reimbursement system where we got reimbursed an all-inclusive rate for every diagnosis, and had to pay for “outside” MRIs out of that bundled payment. These very expensive outside MRIs often meant that CH and the system lost money on many of these patients.
Since 1989 Federal Law “Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation),…
Whichever entity provides the service tacks on a Facilities Fee to the professional fee charged, for example, by a radiologist.
This raises the question of whether self-referral is a purely clinical recommendation or might “ownership” and the Facilities Fee be an influence.
We never solved the CLAUSTROPHOBIA CLUSTER mystery but the Cluster disappeared very quickly after we focused on it.