"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Friday, September 30, 2011

The Time Has Come

Starting next fall, WMHS will make flu shots mandatory for all employees.  A significant departure from previous years as our rate of employees being vaccinated has been historically low.  The more the issue was discussed and the more we heard from hospitals in Maryland that have made flu shots mandatory, it became obvious that the time had come for WMHS to make flu shots mandatory for our staff.  We will begin next year, but are using this fall as the notification period for our employees.  Hopefully, this will not be a major issue.  If they have a health issue that precludes such a vaccination then, a panel of clinicians will review the matter and provide a ruling.  All such submissions will be assigned a number so, no one is tempted to give favorable consideration based on who the individual may be or what there standing may be in the organization.  We owe it to our patients to provide the safest care while they are entrusted to us.  We also owe it to our families and each other.  I got my flu shot yesterday; join me in getting your flu vaccination today.

Thursday, September 29, 2011

Clinical Quality Council

We had our second meeting of the Clinical Quality Council this week and I am thrilled with the group of physicians serving as members.  They were fully engaged, chomping on the bit to identify issues and projects, asking for ongoing education on clinical integration, penalties associated with potentially preventable complications, information on Maryland's Quality-based Reimbursement Methodology, evidence based guidelines, how to improve documentation and the list goes on.  One day after the meeting, I am hearing of these engaged physicians in the hospital talking about how they can really make a difference in guiding their colleagues toward improved performance and aligned incentives.  Awesome!

Wednesday, September 28, 2011

Health Care Spending

First and foremost, health care spending in the US is unsustainable. Changing how we do business and bending the cost curve are essential in solving this problem.  But, we need to stop comparing the US and what we spend on health care to other nations.  It is not a fair comparison.  Other nations do not have comparable regulatory oversight that we have in the US nor do they practice defensive medicine like physicians feel that they have to do in the US because of an ongoing feeding frenzy by personal injury attorneys.  Most other countries protect their physicians from frivolous lawsuits, but not the US.  Take Maryland, we have  personal injury attorneys who serve as President of the Senate and Chair of the State Senate's Judiciary Committee; tort reform doesn't have a fighting chance in Maryland.  Clearly, this is an argument for the Op Ed page and not the hospital boardroom, but let's compare apples to apples going forward.

Tuesday, September 27, 2011

Horrible Bosses

I have been working since I was 16, so I have had my share of bosses.  I have had some great ones; a few were wonderful mentors to whom I attribute my success as a leader.  I have also had some disasters for bosses.  Some who couldn't make a decision for love nor money.  Some whose leadership style was to concentrate the credit on themselves and distribute the blame among everyone else. I had bosses who lied, cheated and even stole (usually the credit). 

I had a new boss early in my administrative career who told me to take a signage package out of a new parking garage that was under construction.  I informed him that the signs were required by City code.  He said that the garage was for employees and that I misinterpreted the regulations.  He told me to revise the signage package to reflect a scaled down version.  I did and asked that he inform the CEO of the change.  He said that he would.  Shortly before the garage was to open, he and I were summoned to the CEO's office.  I was asked by the CEO why I scaled back the signage package knowing full well of the requirements.  I looked at my boss who was sitting in silence. I looked at him again and asked if he wanted to answer the question.  He said that he didn't know what I was talking about.  I accepted responsibility and said that I would rectify the situation immediately, which I did. That was also the day that I realized that I wouldn't be working for him very long.  After the meeting with the CEO, my boss thanked me for covering for him as he didn't want to look bad in front of the CEO since he was new to the organization and I had an established relationship. I suggested that his lack of support never happen again. It didn't, but there were many other occurrences where he pretty much showed himself to be a horrible boss.

Monday, September 26, 2011

The Cost of Regulatory Compliance

I heard an alarming statistic the other day that the current administration is responsible for an average of ten new Federal regulations per day since the President took office nearly three years ago.  The majority rest with the EPA and the Dept of Energy, but healthcare continues to have its share.  In fact, the cost of regulatory compliance in hospitals and health systems nationwide now averages 26% and some estimate as high as 40%.  In Canada, it is 3% and 10% in the United Kingdom.  Although regulations on both a state and federal level are necessary, that's a heck of a lot of money committed to ensuring compliance with the many regulations that we face each day.  Equaling frustrating is the number of regs that are vague or contradictory and always subject to misinterpretation leading to fines, damages and / or penalties.  It is interesting that regulatory compliance is rarely mentioned as a contributing factor to the high cost of healthcare.

Friday, September 23, 2011

Drug Testing

I just read an article yesterday regarding the State of Florida beginning a drug testing requirement for anyone receiving welfare benefits.  Governor Rick Scott's popularity has increased dramatically under the new law and a recent poll has 71% of Florida voters supporting the new law and 27% opposed.   Lots of challenges will occur in the form of repealing the bill and lawsuits however, Florida is off to a strong start.  Maybe the 28% who are opposed would feel differently after learning what the entitlements amount to for each recipient from both the State and the Federal Government.  I am told in Maryland, that in order to do better than an individual who is receiving the various welfare related entitlements that one would have to make greater than $14 per hour.  Let's see how many more States will follow.

Thursday, September 22, 2011


Coming off of our recent Employee Satisfaction Survey, even though the results aren't fully tallied, one area of focus is routinely, Recognition.  I glance at the book, A Carrot A Day by Gostick and Elton, from time to time as it suggests ways to recognize your employees.  Today's really hit home in that our Executive Management team discussed yesterday a higher level of stress in departments across the Health System of late based on how busy we have been.  The "Carrot" for today suggests that as managers we need to recognize the level of stress and figure out the best stress relievers for the situation.  Whether it's arranging massages through the local college's massage therapy program or stopping at the local Dairy Queen or in our case, the Creamery, for ice cream for the team, a little recognition can go a very long way.

Wednesday, September 21, 2011

Bending the Cost Curve at WMHS

Just what does it mean to say that you are bending the cost curve?  The cost of health care continues to increase for many reasons, but it needs to be reduced.  We have successfully reduced costs at WMHS by capturing the low hanging fruit, the easy stuff.  We have also implemented a Lean / Six Sigma program that has brought process improvement to the organization (and that work continues).  We are now pushing to improve outcomes, enhance quality and provide better access to patients, especially primary care.   Through our new payment system, Total Patient Revenue, we have virtually changed how we do business overnight.  We are reducing admissions,   working to deliver care in the most appropriate setting, reducing variation in how care and services are delivered, working to align incentives with our physicians around cost, quality and outcomes and focusing on wellness among our employees, their families and our community.  There is so much work to be done in addressing the cost curve, but the good news is that we are clearly on the right track and in many circles ahead of the game.

Tuesday, September 20, 2011


Crime continues to rise in Allegany County based a recent Baltimore Sun newspaper article.  Twenty-one of twenty four counties in Maryland have seen a decrease in crime since 1975; unfortunately, Allegany County isn't one of them.  We are experiencing a 10% increase over last year in the overall crime rate. 

Our major issue is property crime to support the ever increasing drug problem that has found its way to Western Maryland.  In addition, Maryland has a much more generous offering of welfare-related entitlements than surrounding states and it is much easier access to such entitlements here as opposed to other parts of the State.  Add to that, three prisons in Allegany County, (two State Prisons and one Federal Prison) with friends and family members following the prisoners to the region, again with easier access to benefits, we are seeing an increase in overall crime.  Prison officials have challenged such thinking in the past and I was on board with that thinking.  Not anymore.  We are seeing an influx of urban criminals who are committing pretty violent crimes.  It is too much for a coincidence.  We also have a struggling economy in Western Maryland adding to the problem.  Do I still feel safe living in Western Maryland?  I do, but I find myself taking more precautions than ever before.

Monday, September 19, 2011

What is 95210?

It is more than just the zip code for Stockton, California.   It also is an innovative formula to help children and teens live a healthier lifestyle.  The 9-5-2-1-0 habits include:  9 hours of sleep per day; 5 servings of fruits and vegetables; 2 hours or less of screen time outside of school; 1 hour of physical activity a day; and 0 sugar-added beverages. 
WMHS is one of many organizations in our community collaborating to support healthy food and beverage choices and encourage physical activity among children and families.   This group, Make Healthy Choices Easy, has a number of other initiatives underway to promote better health.
The best way to teach kids healthy habits is for adults to model safe and healthy choices every day.  We all can serve as role models—and improve our own health, too.

Friday, September 16, 2011

WMHS Golf Tournament

Today, we had the 15th annual Western Maryland Health System Golf Tournament at The Jack Nicklaus Signature Golf Course at Rocky Gap and at the Cumberland Country Club. This event continues to be an overwhelming success even during challenging economic times due to the hard work of a lot of people. Great job everyone and thanks for your dedication to the event, the WMHS Foundation and the Health System.

Thursday, September 15, 2011

The Amazing Effects of Drug Abuse

This morning I was reading an article on a Chicago radio station's website and something caught my eye.  There were a series of before and after mug shots of convicted drug abusers. The change in the appearances of each was unbelievable. Significant weight loss, facial contortions, open facial sores, aging, loss of teeth, wrinkles and hair loss were the most prevalent and in many cases over a very short period of time.  Based on the above, I would assume that crystal meth was the drug of choice with the open sores and loss of teeth.   The photos are amazing in that some of the appearances changed so dramatically in just a few months.  This is idea that health departments, colleges / universities, public safety organizations, middle and high schools, boys and girls clubs and the list goes on should be sharing with both young people and adults.  What a powerful  message!

Wednesday, September 14, 2011


I have written before regarding mentors and their importance in developing staff, primarily up and comers.  Mentors come in all shapes, sizes and ages.  Especially for social media related knowledge, younger people have a vast knowledge.  I would encourage you to seek out a young adult who has the knowledge and expertise in the vast arena of social media.  In addition to my social media savvy daughters, we have added very knowledgeable staff at WMHS who are doing some remarkable things with website development, Facebook, Twitter, creating micro sites and the list goes on.   What these individuals know is amazing and you can learn so much.

Tuesday, September 13, 2011


I just starting reading a new book, "Credibility: How Leaders Gain and Lose It; Why People Demand It" by James Kouzes and Barry Posner.  So far, it is an interesting read.  One item that I found interesting was the piece on Characteristics of Admired Leaders Around the World.  The four characteristics measured were Honesty, Forward Thinking, Inspiration and Competence.  The US ranked honesty first, forward thinking second, inspiration third and competence fourth.  What I found interesting is that the other 14 countries surveyed, three ranked the characteristics the same as the US.   They were Australia, Canada and the United Arab Emirates.  Singapore ranked honesty last with inspiration first.  China, Scandinavia and Turkey had honesty third, with inspiration first for China and Scandinavia and forward thinking first for Turkey. 

Personally, I agree with the US ranking, I might quibble with 3 and 4, but feel that honesty is absolutely critical for any leader.  A leader has to have earned the trust of those who are expected to follow.  In the past, I have fired two executives who were competent, inspiring and forward thinking, but dishonest.  They both would tell me what they thought I wanted to hear versus what was actually happening.  Also, if they were lying to me, then they were lying to everyone and how can anyone follow someone who is dishonest, especially in a values based organization.   I will keep you posted on other aspects of the book, but so far it's a very good read.

Monday, September 12, 2011

Remembering 9/11

I was a mess yesterday.  Every time I turned on the TV or listened to the radio and heard another harrowing account of what happened on September 11, 2001, tears would well up in my eyes and my nose would run.  It is absolutely unbelievable as to what these people had to endure, the police, the firefighters, the Mayor of NYC, the President of the US, the families, the injured and the list goes on.  I pray to God that our country doesn't have to endure another September 11.

Sunday, September 11, 2011

The Impact of September 11, 2001

Here's a rare Sunday blog to commemorate September 11.
So, I am at the gym the other day doing my cardio workout and I am watching TV. There is a story on CNN about a former Boston College Lacrosse player who was working as an equities trader at the World Trade Center on September 11, 2001, when one of the hijacked planes hit. His name was Welles Crowther. Welles was remembered for his heroism and bravery through the red bandanna that he always kept with him since he was a young child. On this particular day, he wore it around his nose and mouth as he rescued person after person. After the plane hit the South Tower, he called his mother to say that he was alright. He then proceeded to take control and he directed people to the stairway helping them the safety. He stayed in the South Tower getting people out until the building collapsed. That story evoked a great deal of emotion in me as I related it to one of my children. All that I could think about was being a parent of such a child with absolute devastation for the loss, but absolute pride for their heroism and bravery. First off, both daughters are fine, thank God. However, right after September 11, 2001, my daughter, Lauren, said that she wanted to do more for her country. At the time, she was a 14 year old who wanted to give back to her country after seeing the coming together of a nation post 9/11. Lauren held onto that desire for the next several years. She went on to apply to the Naval Academy to fulfill that dream of doing something more for her country. She was accepted and graduated after four years in May, 2009. She did a seven month tour to the Middle East almost immediately after graduation and is now preparing for her second tour. I had the opportunity to join her on her ship for the final eight days of her first tour from Pearl Harbor to San Diego. I was permitted to stand watch with her on the Bridge for each of her four to five hour shifts, mornings, evenings and nights. What amazed me was at any given time there was a handful of Navy personnel on the Bridge, a few officers and the rest were sailors of various rank, but all in their twenties. These young men and women have been entrusted with a half of a billion dollar ship and a crew of almost a thousand. On one of those nights standing watch, I asked what was the most harrowing experience during her tour. Most she couldn't discuss, but she said for her personally, was being on the Bridge and being harassed by Iranian gunboats in the Persian Gulf. As one of the officers in charge, you have to determine if they are intending to do harm versus simply harassing you. It is amazing what the young people in the military do for us day in day out that most people don't know or even care to know about. They are in the same category as a Welles Crowther, brave men and women who joined the military knowing that they could be in harm's way at any given time. Yet, they do it for love of country and their fellow Americans. Wow! My heart goes out to Welles Crowther's parents and to all who lost someone on that horrific day in September as well as on days serving our country and each other. We will never forget their sacrifice and the love of country.

Friday, September 9, 2011

Happy Anniversary, Pamela

If you haven't figured it out yet, I am on vacation this week.  I have been blogging more about the personal aspects of my life than work and it's been a nice change.  One of the reasons that I am on vacation is to celebrate my 35th wedding anniversary tomorrow.  I have been truly blessed to have fallen in love with such a wonderful women.  I have said it hundreds of times over the 35 years that she is a gift from God.  Pamela is not only my wife, but she is also my best friend.  You might say does he have anymore clich├ęs to throw in here?  OK, she completes me; she is my world; she is the love of my life.  Pamela is all of the above. 

Has it always been perfect, hell no.  When we were first married we were making minimum wage ($2.80 per hour).  Pamela's father had to co-sign for everything.  We were poor, living in a three-room apartment with a bed being the only piece of furniture for quite some time.  We lived pay check to pay check for years.  We struggled, we argued, but we persevered.    We made it work.  Unlike today, where couples divorce after the slightest challenge to their marriage.  A few weeks ago, we were out with six couples and the years of marriage ranged from a low of 30 to a high of 39.  Pretty cool, but unfortunately a dying breed. 

Anyway, my marriage continues to be a great ride, a wonderful wife and two fabulous daughters.  Pamela, thank you for 35 years that I wouldn't trade for anything.

Thursday, September 8, 2011

America's Best Hospitals

Congratulations to one of my best friends, Lou Shapiro, CEO at the Hospital for Special Surgery in NYC. His hospital was named once again as the No. 1 hospital for Orthopedics in the US (actually the world).   I realize that there is a lot of controversy over how US News and World Report selects its top hospitals, but I have spent enough time in this field and around some of these top hospitals and their leaders to know that they deserve such a ranking.  On the flip side, however, I did find it interesting that one of the criterion in which these hospitals are judged by the magazine is their competence in high stakes situations.  The example used was heart valve replacement in a man in his 90's.  Most hospitals would decline such surgery due to its risks, but not the Top Hospitals.  Maybe, more of the top hospitals should be declining such surgeries going forward.  Possibly, I will feel differently when I am in my nineties.  I guess it's all about the quality of life that one can experience in their nineties.  Anyway, again, congratulations to Lou Shapiro and also to Ron Peterson, CEO at Johns Hopkins, as the nation's top hospital.

Wednesday, September 7, 2011

A Tribute to a Very Special Person

Last evening to commemorate the anniversary of my father-in-law's death, my wife and I toasted his memory with a Rusty Nail (equal parts of Scotch and Drambuie served over ice).  On special occasions, he would end the evening with a Rusty Nail, his drink of choice, so what better way to remember him.

My father-in-law, Donald Walter Totzke, (DW to me) died 15 years ago while vacationing on Cape Cod.  Both he and my mother- in-law would vacation at the Cape the week of Labor Day.  It just so happened that Hurricane Fran was in the Atlantic coming up the East Coast. Although it was a beautiful day on Cape Cod, the ocean was experiencing rip currents.  They were walking in knee deep water, the maximum water depth since my father-in- law had a fear of the water from when he was a young boy.  He witnessed a drowning of another boy as a child and was fearful of the water ever since.  The rip current swept both of my wife's parents out to sea.  A wave brought my mother in law back to safer waters.  There were two vacationing life guards on the beach who then swam out to save him, but it was too late.  He was brought to shore, CPR was initiated and continued as he was airlifted to the hospital.  He was pronounced dead on a beautiful afternoon at a Cape Cod hospital.

DW was everything that is right about America.  He was hard working, strong in his faith, a leader, charming, honest, intelligent, had Kennedy family good looks (although more Conservative in his political leanings), a WWII veteran and was always in great physical condition even at 70 when he died.  He loved his family and the holidays, especially Christmas; he appreciated good Scotch, fine wine, good food, sports, politics, art, woodworking, John Wayne movies, any Western and the list goes on.  He was someone to admire and respect.  He was truly a very special man who I tried to model both my personal and professional lives after.

 Here's to you DW, forever missed, but never forgotten.

Tuesday, September 6, 2011

Labor Day

Yesterday, I celebrated Labor Day as I normally would--relaxing, some shopping with my wife and friends (some decent sales on golf clothes), afternoon beach time, a dinner of a low country boil and college football (Go Terps!).  Labor Day is the only holiday that I really don't think of as a holiday of any recognition.  It is simply a day off. 

I don't come from a union background.  My father was in a union sort of; as a police detective, he was a member of the Police Benevolent Association.  In fact, my earliest experience with a union was when I was early in my career in health care and it wasn't a good one.  The Operating Engineers at the hospital where I worked went on strike and I was the Assistant Director of Materials Management.  Most truck drivers were teamsters and wouldn't cross the picket line.  I had to assemble a team of managers and supervisors to pick up supplies, equipment, blood, drugs, food and bring them across the picket line.  I crossed the picket line numerous times to personal threats, attacks, punctured tires and holes in the radiators of trucks, vans and cars.  I was followed and tracked by union workers from other locals, I was in vehicle chases carrying medical supplies and equipment and I was run off the road.  The strike was over after about two weeks, but it was the longest two weeks of my life.  The strike catapulted my career since the Director of Materials Management was older and had a family.  He wouldn't cross the picket line out of concern for his personal safety and his family's wellbeing.  I was 25 years old, married, but no kids.  He was my mentor and I told him that I would handle it.  However, the CEO was not happy with the Director's lack of commitment and his 9-to-5 work day during the strike when the rest of us were working around the clock.  The Director was told to begin looking for a new job as he had no future at that hospital going forward.  He had a new job that year and I was promoted.  

Anyway, back to Labor Day.  Recognition of workers after the deadly Pullman Strike was with great merit; however, Teamsters boss, James Hoffa, threatening to" take people out"  referring to the GOP and Tea Party members this past Labor Day brings me back to those not-so-memorable days.

Friday, September 2, 2011

The Things Nobody Told Me

Recently, I provided a response to a question (5 Things Nobody Told Me Before I Became CEO) for a national publication.  My answer follows.
What still amazes me is the amount of knowledge a CEO needs to have based on the complexity and ever-changing aspects of the healthcare industry. In addition to the day-to-day requirements of running a health system, a CEO needs to be aware of so many other aspects of the industry. From federal requirements to state regulations; from financial planning to strategic planning; from clinical integration to health information technology; previously the CEO could get away as a generalist, but not anymore.
We recently completed the building of a new hospital. I assigned the administrative oversight responsibilities to a vice president. He did an exceptional job, but for the 35-month construction period, even with a dedicated administrative officer, approximately 60 percent of my work day was consumed by some aspect of the building project. I had to become an expert in yet another aspect of this business. It’s still a job that I love doing in an industry that I have been a part of for more than 36 years.

Thursday, September 1, 2011

Flat Tax

Earlier this week, I wrote about the CEO initiative to stop funding political campaigns until the gridlock in Congress stops.  We need another initiative in this country and that is to entirely revamp the tax code.  I read that the IRS adds over 1000 new regulations per month.  You would think that with the employment of CPAs for life through such regulatory morass, that they would embrace the comprehensiveness of such regulation, but they don't.  The CPAs are tired of just as we are.  Talk about a government that is out of control.   We need to have everyone paying their fair share, including corporations like GE that make billions and pay no taxes and the 47 million Americans who don't any pay taxes.  Too few in the middle and upper middle classes carry the burden for everyone and it needs to change.