Doing that required being a risk taker, not being risk averse. So here are vignettes about some risks taken over 17 years, some with success, some with failure, and some with mixed results. These examples are from my experience. Recognizing the new health care industry algorithm is more complicated, being a risk-taker is still essential for organizational and professional success.
“A ship in harbor is safe, but that is not what ships are built for.” John Augustus Shedd.
Jersey City Medical Center provides EMS services to Jersey City and paramedic services to Hudson County. In the early 1990’s portable, almost self-operating defibrillators became available so our EMS Director (Mary Beth Ray Simone) proposed that we train our EMTs and paramedics and put defibrillators in each of our EMS trucks. This raised eyebrows at the State Department of Health and litigation by the county’s many volunteer ambulance corps. We persisted and now, of course, defibrillators are pervasive in train and bus stations, sports stadiums and arenas, college campuses….everywhere.
“Only those who dare to fail greatly can ever achieve greatly. “ Robert F. Kennedy
In 1989 Jersey City Medical Center was a second-tier, unaffiliated teaching hospital. The University of Medicine and Dentistry of New Jersey (UMDNJ) had a medical education monopoly in New Jersey with two allopathic and one osteopathic medical schools. There were no other medical schools in the state. The President of UMDNJ (now Rutgers) refused to consider JCMC as an affiliate, rather trying to build a network of referring community hospitals, including the half dozen in Hudson County.
So JCMC became the first hospital in New Jersey with an out-of-state medical school affiliation and became a major teaching affiliate of Mount Sinai School of Medicine. The medical staffs at all three of our hospitals were against it and most Board members underestimated the importance of a first class medical school affiliation to the success of our new hospital.
We had a choice with Mount Sinai of our residency training programs in medicine, pediatrics and obs/gyn being free-standing, affiliated, or sponsored. Sponsored meant the most oversight and control from Mount Sinai and that’s what we chose with every residency program director opposed.
The biggest success story with Mount Sinai was a totally integrated Emergency Room when we opened the new hospital enabling the recruitment of a terrific cadre of Emergency Medicine trained physicians.
“What you have to do and the way you have to do it is incredibly simple. Whether you are willing to do it is another matter.” Peter Drucker
At our two community hospitals being a department chair or division chief was much sought after. Both had a history of the positions going to the “next in line” but to my dismay allowed non board certified physicians to garner these roles. When it was proposed that a system wide standard of board certification be put in place it was successfully opposed by lobbying Board members against it; of course the physicians had leverage as the board members doctors.
“Do one thing every day that scares you.” Eleanor Roosevelt
When we moved from our old facility to our new hospital in 2004 we made the entire campus smoking-free and mandated the smoking-free campuses for our two community hospitals as well. First this was a public health commitment so staff and visitors didn’t have to walk through the blue haze of smoke at entrances. But I had also noticed the same people smoking outside time-after-time, while their colleagues inside were working. Smokers were offered smoking cessation assistance. But the biggest negative reaction was from Board members who smoke and were now prohibited from doing so. Of course now almost all hospitals are totally smoking-free. (There was an interesting discussion about whether or not psychiatric inpatients should be allowed to smoke but that was ended as well.)
“Life is being on the wire, everything else is just waiting.” Karl Wallenda
For many years cardiac cath labs were restricted by the state’s Certificate of Need process. Then there was a “call” which would allow any hospital that met certain standards to apply to open a diagnostic cath lab (not interventional). It didn’t make sense to have a lab at one of our community hospitals but again Board members were pressured and an application was submitted.
In the next year dozens of cath labs opened in NJ, including three in Hudson County including one in our community hospital. Only one survived, not ours, because it was also part of interventional cardiology pilot program that allowed certain types of intervention without onsite cardiac surgery. (Parenthetically we helped get them into the pilot program with the proviso that JCMC would be their referral center. They reneged and sent all their referrals to Newark.)
“Trust your own instinct. Your mistakes might as well be your own, instead of someone else’s.” Billy Wilder
The lane to top tier hospital in New Jersey was cardiac surgery. We had secured a Certificate of Need for cardiac surgery while building the new hospital but it would expire one year after we moved in to the new hospital. Our patient mix 30% commercially insured and 70% Medicaid and Charity Care, not very promising from a reimbursement perspective since CS was expensive to staff and required a massive capital infusion to build the necessary specialized facilities.
Everyone except our Chief Medical Officer was against proceeding including the Chairman of the Board who said to me “Jon, I am against this project but will defer to you as President, but your job is on the line.”
We opened the unit in collaboration with Mount Sinai (there was no way we could start a program on our own) and the game changer was interventional cardiology, whereby according to American College of Cardiology guidelines certain patients had to be transported to hospitals with interventional cardiac cath labs and we had the only one in the county. This led to more cardiac surgery cases and a flip of the cardiac surgery payer mix to 70% commercially insured and 30% Medicaid and Charity Care.
Soon after I left one community hospital was closed, the other sold, and the affiliation with Mount Sinai was terminated, but the cardiac surgery and emergency medicine stayed on a very positive trajectory.
“The biggest risk is not taking any risk… In a world that changing really quickly, the only strategy that is guaranteed to fail is not taking risks.” Mark Zuckerberg