Amy Gets It Right

I am not an avid reader of Dear Amy in the newspaper; however, I found today's column to be very appropriate for what we are trying to accomplish in health care today.  A woman wrote that her father, who is 91 and suffering from dementia, gave his son a living will a few years ago.  Under the circumstances, the son wants to fulfill his father's wishes by exercising the no heroic measures component of the Living Will.  The daughter wants to fulfill her mother's wishes, as she would like any measure necessary to resuscitate her father be exercised because the mother, who is of sound mind, will miss her husband terribly.  Amy's response was right on target; fulfill the wishes of the individual.  Why put someone through those heroic measures when they have no chance of any quality of life? 

Recently, my family experienced the same issue with a out-of-state distant relative who made his peace and said that he was ready to die. Unfortunately, the family hadn't conveyed his wishes to the staff.  Once he went into cardiac arrest and since he hadn't completed a do-not-resuscitate order, he was resuscitated.  Fortunately, his family finally got it and conveyed his wishes.  He died shortly thereafter.  

I just wish the family had that same "a ha" moment when their father was first hospitalized after a fall.  He was eventually transferred to a skilled nursing facility (SNF) from the hospital with two pretty significant pressure ulcers that only worsened at the SNF along with the addition of several other ulcers.  There was very little attention paid to the pressure ulcers with little care, treatment or wound therapy.   In addition, he was rarely ambulated by the staff.  The staff was pleased with themselves when they got him to sit in the chair.  When the family was asked about why they weren't more adamant about the care of their father, they said that the staff are working so hard as it is.  Yikes!  I can't imagine letting someone deteriorate right before your very eyes and not advocate for your loved one.  Between the pressure ulcers, the lack of ambulation and the meds that he was on, the entire scenario can be described in one word: iatrogenic.  His condition and subsequent deterioration were the direct result of an inadvertent lack of care brought on by medical professionals since his goal was to walk out of the hospital after that April fall.  It is so very sad in that there were so many who could have advocated for this man but didn't.

Backing Into a Solution for Improved Public Health

In the most recent issue of Health Affairs, there is an article, "Civil Unrest, Police Use of Force, And The Public's Health" by Jessica Bylander.  I read the article with great interest from several perspectives--a health system CEO working to champion value-based care delivery in my community and beyond, the son of a former police detective, and a holder of two degrees in Criminal Justice.  The article was well written and directed toward the considerable challenges facing the African American community.

Based on my upbringing and didactical training, I continue to take issue with the demonization of law enforcement.  It has become extremely popular to do so, but too many fail to take into account what police officers are subjected to as they try to enforce the laws and protect the citizenry.  I was taught to respect the police and comply with what they asked.  Have I been disrespected by the police?  Sure, but I have had to swallow my pride and do what I was told to do.   It appears that once a young man or young woman in the African American community feels disrespected by the police, they have to challenge that authority and there are times that such challenges end badly.  

Unfortunately, the breakdown of the traditional family has led to many of the problems in poorer communities, both black and white, with rarely anyone there to teach, guide, shape or mentor.  The article talks about an eight-year-old receiving health education in school who says that he didn't need to hear about heart disease or STDs.  Both of his brothers had died before their 16th birthdays and he didn't see himself most likely living much longer.  That to me is heartbreaking.  What a failure of family, community and government.  The political leadership in Baltimore and other cities in the US should be embarrassed as to what has become of their inner cities.  

So, what can health care do about it?  There is a very thought provoking statement in the article related to health care. Joseph Betancourt, associate professor of medicine at Harvard, said, "The mistrust that people have for the police force in these communities mirrors the mistrust that the same people feel for the health care system."  

Until now, I have looked at health care as we are all here to help you no matter what your race or socioeconomic status and you should work with us and be grateful.  The mistrust concept is disconcerting but should serve as a starting point for those of us in health care who are trying to restore public health options to the inner cities as well as the poorer communities that we all serve.  

In Maryland, and certainly Baltimore, the recipients of our services should benefit from our industry's transition to value-based care delivery.  With the goals to care for people in the most appropriate setting and work with them to keep them out of the hospital, health systems are bringing care to the community in record numbers.  Primary care, chronic care, dental care, ancillary testing and health education are now being extended to housing complexes, barber shops, churches, schools, neighborhood centers, outreach clinics and the list goes on.  We are engaging community health workers with diverse backgrounds.  We are trying to best serve residents who are the sickest of the sick, the high utilizers of services, the non-compliant patients, and even the next generation of the sickest.  

There is a lot of work to be done related to these many challenges, but Maryland health care is off to a great start.  We are addressing some of the past inequalities through a conscious effort to improve the health status of the communities that we serve.

Conflict Resolution

I read an article in the most recent issue of Success magazine last evening.  The article was entitled "How to Resolve Conflicts Between Employees" by Emma Johnson.  The article offers 11 tips on how to resolve, better yet, stave off such conflicts.  

The tips are as follows:

1. Recognize that disputes can't be avoided.
2. Step in early.
3. Don't just tell people to get over it.
4. Make each person acknowledge the other.
5. Focus on expectations.
6. Tell them to come up with a solution.
7. Assist them is articulating a plan.
8. Skirt instincts to separate the warring parties. (Force them to work together on a project.)
9. Unite them in solving a crisis bigger than their argument.
10. Invest in personality assessments such as Myers Briggs.  (Actually, this can work.)
11. Create a process for dealing with the conflict.

Very useful information.  Actually, there is another option depending on what level in the organization the warring parties may work.  The alternate approach is one that was taken by the first hospital CEO with whom I worked. There were two warring Assistant Administrators, aka VPs, who had offices next to each other.  One was young, easy going and certainly an up-and-comer in the organization.  The other was older, retired military and much more autocratic in his approach with everyone.  The two were constantly arguing about pretty much everything......they were like oil and water.  

Finally, the CEO called them both into his office and told them that he had no time and little patience for their constant feuding.  He told them, "If the two of you can't solve this problem, I will. If you can't figure how to work together, I will summarily fire one of you and the other will not be far behind."  The feuding continued and a week after the CEO warned them, he fired the older one and told the up-and-comer to begin looking for another job.  The CEO told them both, "If I have to deal with this problem, it will end badly for the both of you."  Damn, if it didn't.  

In the article, there are three case examples of how three CEOs dealt with conflicts involving their employees. The information is useful and the strategies taken appear to be beneficial; however, I still like my first CEO's approach.  There is little time in one's day to have to deal with conflict resolution.  We are adults; figure out how to deal with each other to get the job done.  If your boss has to constantly play referee, I can assure you that the situation will eventually end badly for the warring parties.

Supporting Medical Marijuana

Below is a blog that I wrote back in February 2015.  At that time, I wasn't able to publish since Peak Harvest wasn't ready to announce their intentions to locate their medical marijuana manufacturing facility in Cumberland, Maryland.  Since I wrote that blog, much has happened leading up to yesterday's announcement.  I have continued to have meetings with the principals associated with Peak Harvest; and, if anything, my impressions of each of them have only strengthened.  

This is a first-rate group of business people with whom I would be honored to be associated.  In June, I, along with three other business leaders, visited their medical marijuana growing facility in Connecticut.  Their facility is state of the art with its growing, harvesting and production capabilities, along with exceptional security that far exceeds most banks.  Most recently, I have provided them with a memorandum of understanding on behalf of WMHS to work with them on the clinical aspects of medical marijuana.  Peak Harvest will continue to have my full support and I expressed that at the launch last evening.  

For those of you reading this blog, I will answer in advance the burning question of how much I personally have invested in Peak Harvest, and the answer is zero.  Although I was asked and feel very strongly that it would be a very good investment, I do not want my support for medical marijuana and the clinical role that WMHS may play to be in any way tainted by my personal gain.

February 5, 2015   Medical Marijuana

On Tuesday, I had my second meeting with md / phh, a company that is hoping to be awarded one of the 15 licenses to begin the manufacturing of medical marijuana in Maryland.  This company is looking to locate in western Maryland.  The City of Cumberland initially reached out to me for economic development purposes, but the meetings have now advanced to the potential for partnering on clinical trials in the future.  

Some may be surprised to learn of my support of medical marijuana since I am vehemently opposed to legalization of recreational use marijuana.  (Just look at Colorado and the mess that exists there.  Although their tax revenues are through the roof, they have significant challenges with increases in crime, public health issues as well as social issues.)   I have classified medical marijuana as another tool in the clinician's toolbox, if you will.  With the out-of-control use of opiates in Cumberland, Maryland and across the US, medical marijuana could be a wonderful option for patients whose pain is no longer effectively controlled by Oxycodone or other similar opiate derivative drugs.  It could also provide loved ones who are in their final days the ability to have quality time with their family rather than in a morphine-induced coma because of the severity of their pain.  It certainly has a place in many areas of health care and needs to be used.

I am most encouraged by the founding leadership of md / phh, who are clearly in this for all of the right reasons.  They have licenses in Connecticut and Minnesota and their description of their operations is just short of amazing.   These are very credible individuals who are extremely interesting and have a wealth of knowledge on the subject.   At yesterday's meeting, I invited Dr. Goldstein, WMHS's Chief Medical Officer; Nancy Adams, Chief Operating Officer and Chief Nurse Executive and Kevin Turley, our Vice President for Marketing, Planning and New Business Development.  That meeting was only an hour due to constraints with other meetings, but it could have lasted for three or four hours.  We are all intrigued by the science associated with medical marijuana and what this company is looking to accomplish.  

It would be of great benefit to the western Maryland region to have a company locate here and bring 50 to 150 new jobs with the economic impact of revenues from $50 to $75 million.  In addition, Western Maryland Health System and our patients would have another dimension for their care.  Medical marijuana also fits nicely into our value-based care delivery model by caring for patients in the most appropriate location and keeping them healthier and out of the hospital.  

I will be keeping everyone apprised of md / phh's progress over the next several months, but I thought that it was necessary to give you a prospective on such a new and different company and concept that will hopefully be coming to Cumberland.

CEO Fathers, Daughters and Corporate Social Responsibility

An interesting article came across my desk this AM entitled, "Those with Daughters Make Better CEOs, Study Finds."  Two researchers studied over 400 CEOs with a total of 1000 children.  They found that having a daughter, especially if the daughter was first born, directly affects a CEO's social responsibility.  

The corporate social responsibility was far better in companies / organizations run by CEOs with a daughter. Male CEOs with daughters were almost a third more likely to make social responsibility decisions similar to female CEOs.  CEOs with daughters show a much greater connection to society in general and a greater concern for the well being of those connected to the organization.  

So that leads one to ask what about CEOs with sons; not even close with the results according to Erin Marshall, the author of the article.  CEOs with sons were not linked to the same results nor corporate social responsibility behaviors.  

I am not sure that my commitment to social responsibility has much to do with my first born daughter, Jessica, who strangely enough handles corporate social responsibility for Boeing in Charleston, SC, or even my second born daughter, Lauren.  Both are wonderfully successful in their own right and recognize the importance of social responsibility in their personal as well as professional lives.   

For me, as I reflect back, I think the strongest influence has been my wife over the many years that I have been a CEO; Pamela is very pointed in her kindness and generosity to ensure that the greatest impact will be felt by as many as possible.  She has influenced me accordingly.  

I have also been positively impacted by the predominantly female workforce at WMHS (81%); this is a group who are so giving professionally in their service to our patients and to each other as well as in their personal lives to their families, their churches, their communities and the list goes on.  Over the last five years or so, I have been especially influenced by those women in executive leadership positions at WMHS: Nancy Adams, Chief Operating Officer & Chief Nurse Executive, is always mission and values focused and has an amazing knack at transforming ideas into action; Kim Repac, Chief Financial Officer, who, when she feels committed to a cause or issue, can be the most generous person that I know; Jo Wilson, VP, Operations, lives and breathes social responsibility and recognizes it's criticality to those whom we serve both inside and outside the organization; Michele Martz, VP, Physician Enterprise, displays a wonderful interest in people and ensuring that we do always the right thing for those whom we serve; Kathy Rogers, Director of Community Relations, serves as the organization's conscience, as well as mine, by always bringing that commitment of responsibility to our many decisions and Karen Johnson, Foundation Executive, is very much attuned to the social needs of our organization and our community and in many cases she knows how to fund them.


I continue to be blessed with the many female influences in my life--from my wife to my daughters to the staff, especially those many wonderful advisors from whom I seek counsel  each day.   Oh yeah, I am also blessed to have the many male influences in my life who truly get it when it comes to social responsibility.  I bet they too are wonderfully influenced by the women in their lives.

Family and Friends Basket Auction

On Thursday and Friday of last week, our Foundation held its fourth annual Family and Friends Basket Auction.  When we first started, the auction was associated with our golf tournament; however, since there is so much work that goes into both events, we began to  separate them.  

Last week's auction was the best yet. There were 21 baskets donated by departments and individuals, 126 silent auction packages and 37 Chinese auction packages / items, and they raised over $11,000 for WMHS Foundation scholarships. By the way, the Foundation just passed the $1 million mark in scholarships awarded, WOW!  

Obviously, there is a great deal of work that goes into the auction and some photos are attached.  Karen Johnson, Dawn Martz, Jamie Perrin, Lisa Hout and Katie Gattens did an exceptional job in making this happen. Over the two days, there was a total of 239 bidders, with some of the bidding wars occurring up to the final minutes of the auction. The $11,300 raised was 70% of the total value of the baskets, packages and items donated.  Way to go, everyone, on a job so very well done.