14 Ways To Know Whether You Are Failing As A Hospital Administrator

Failure

I’ve been an administrator.

I’ve seen hospitals in which a strong leadership team has improved the hospital’s market share and I’ve seen hospitals that have closed and that are struggling to stay open due to a failed administrative team. Here are some common traits I’ve seen in the failures:

1. You don’t know the names of the people who work in your corporation. You aren’t fooling anyone when you walk the halls without addressing people by their names. All this shows is that you don’t care to take the time to know them. If you don’t take the time to get to know them, why should they care about your corporation?

2. You spend a lot of time and effort seeking feedback about your employees’ performance, but you spend little or no time seeking feedback about your own performance. All this shows is that you are a hypocrite. People hate hypocrites.

3. Your hospital has a high employee turnover rate. This isn’t an issue with employees, it is a clear and unequivocal issue with management. People don’t leave their jobs, they leave their bosses. If your hospital has a high turnover in one department and you aren’t seriously evaluating that department manager’s work, you have no business running a hospital.

4. Your “help wanted” listings go unfilled. In an economy with high unemployment, the fact that people would choose to stay unemployed rather than work for you and your organization is a good reflection of the public opinion about the business you are running.

5. Your employees leave the room when you walk in or they try to avoid you in the hallways. When no one wants to be around you in your workplace, it isn’t a sign of respect, it’s a sign of disgust. Keep that in mind the next time you see someone duck into a stairwell when they see you walking down the hall.

6. You don’t show up at holiday parties for your employees. If you feel uncomfortable mingling with your employees at a party, you shouldn’t be trying to lead them. The good thing is that if you feel uncomfortable attending an employee party, your employees probably won’t want you there, anyway.

7. You don’t participate in charity events for employees or employee family members. Your failure to support your employees in their times of need will only drive everyone to dislike you even more.

8. You don’t support employees who have been injured. Or worse yet, you try to terminate employees who have been injured. News of these types of actions spreads quickly through the hospital. Again, if you don’t have their backs, what makes you think that they’ll have yours?

9. You care more about your bottom line than you care about your patients’ or your employees’ bottom lines. When you create policies to increase your bonuses, you employees will know and they will resent you for it. They may even make passive aggressive attempts to keep you from reaching your goals.

10. You spend more time criticizing your employees than you do complimenting your employees. Worse yet – you don’t compliment your employees at all.

11. You display favoritism. If you allow anyone to drop your name or to use their relationship with you to gain an advantage at work, your employees will quickly grow to resent you and your clique.

12. You discourage constructive criticism of your organization from within. If you think everything is going just fine in your facility, you’re out of touch and you’re wrong.

13. You don’t act on employee concerns. Your failure to follow up on an employee concern not only shows that you’re unreliable, but it also may serve as a basis for legal action if something related to that concern goes wrong.

14. You don’t visit the departments in your hospital on a regular basis. If it’s been more than a week since you’ve visited any department in your hospital, you have lost a great opportunity to compliment your employees on the job that they are doing. You have also lost the ability to uncover and address small problems before they become big problems.

Healthcare Update Satellite – 06-08-2015

To increase access to medical for our nation’s veterans, the Veteran’s Choice Act authorized the VA to pay for more medical provided to veterans from community health providers. How did the VA save money in that scenario? It either “lost” claims in which providers had proof of submission or it just delayed paying the claims so that veterans would be billed for the treatment. Now providers are refusing to contract with the VA due to all of the hassles. The VA said that it was making interest payments to providers who received delayed payments, but none of the people testifying to a Senate subcommittee had received such payments.
And this is the type of system that we’re all hoping to adopt for our nation’s healthcare?

Thought provoking article in American Thinker where a physician compares defensive medicine to defensive policing. Both professions can involve life-or-death decisions in which not all information is always available. Physicians may respond by ordering more tests “just to be sure.” Police may respond by ignoring criminal activity or by delaying a response to a crime to avoid any conflicts.
“The natural response is to avoid the high-risk situations. Stop accepting new patients, particularly sick patients with a greater chance of complications. Order extra tests to avoid missing a diagnosis, however unlikely. For police, just look the other way. Take your time responding to a distress call. Don’t make the arrest. And watch the crime rate climb.”

Palm microbes

How grubby are children’s hands? This mom put her 8 year old’s hand on an agar plate after he had been playing outside. What grew on the plate appears remarkable on its face, but many microbiologists who commented on the project said the agar would probably have grown out the same material even if the kid had washed his hands before putting it on the agar plate. Still a pretty cool picture.

Speaking about bacteria, a recent study from the University of Iowa shows that chronic exposure to Staph aureus superantigens in rabbits causes type 2 diabetes. According to this article in Science Daily, the researchers are now working on a vaccine to the superantigens and also doing studies to determine whether topical antibiotic gels may affect glucose levels.

Stay off of the internet while you’re working in the hospital … unless you’re trying to game the system to improve the hospital’s ratings on Yelp, HealthGrades, ZocDoc, and other web sites. Hospitals are now hiring “reputation managers” whose job it is to improve the hospitals’ online reputations.

Wait. Patients can die from Z-Paks? Who would have imagined? NY Times Wellness Blog tells story of a patient who underwent surgery to fix a broken arm, got postoperative antibiotics to prevent a wound infection, then developed a recurrent Clostridium difficile infection and died. As the article notes, C. difficile causes almost 500,000 infections per year and more than 29,000 deaths per year.
The expert interviewed for the article noted that “most antibiotics ‘are being used inappropriately, for things like upper respiratory infections that are caused by viruses.’ And eating yogurt or taking commercially available probiotics while on an antibiotic have not proved protective, he said. However, in England, where a program of more judicious use of antibiotics was put into effect, C. diff. infections have declined.

Doing genetic testing for diseases? Be careful about relying upon the results. Not all genetic testing is created equal.

Nonurgent cases account for 80 percent of all emergency department visits in Jeddah, Saudi Arabia. Private health department director notes that “this rush also adds to patients waiting a long time to get treatment and their negative effects on doctors and on other patients whose health conditions are critical.”

Is nitrofurantoin effective for use in patients with reduced kidney function? The simple answer is “yes”, but other antibiotics such as Cipro and Bactrim had half as many treatment failures (6.5% versus 13.8%) in women with a low estimated GFR (average 38 ml/min/1.73m2).

OK, this isn’t medicine, but it is science. And dammit, I wish I knew about it a couple of years ago. How do you get the smell of skunk out of a dog’s fur? Tomato juice? Peanut butter? Nope. Mix a quarter cup of baking soda and a couple of teaspoons of liquid soap into a quart of 3% hydrogen peroxide and wash your dog down with it. The dog might turn blonde, but the smell will disappear.

Survey

Quick request …

If you haven’t taken this short survey, it would be much appreciated. Looking to publish the results in a future journal article. Many thanks for your help.

http://www.esurveyspro.com/Survey.aspx?id=8ee4bd68-04a7-4b43-b07b-652af4088ddd

Rodent Control

Urinal
A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure.

We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin, some captopril, and he even got Lasix just to spite all of the #FOAMed wonks.

About 45 minutes later, the patient needs to go to the bathroom. We didn’t want him walking since he didn’t appear to be the steadiest on his feet, so he got a urinal. He grabbed the urinal and the nurse walked out of the room to give him some privacy.
A minute later, the patient starts screaming.
“Aaaaah! There’s a RAT biting my PECKER!”
The nurse went back into the room and slowly pulled back the covers. She looked around and didn’t see anything. She looked at the patient.
“Do you still feel something?”
“Nah. It’s gone.”
She walked back out of the room. Sure enough, 30 seconds later he’s screaming again.
“OOOOOW! It’s biting me AGAIN! OOOOOOW!

The nurse picked the covers up from the corner, screamed, and flung them off the bed, thinking that there may have been a rat from the nursing home in his clothing or something. Nothing there. Of course, after hearing the nurse scream, I went in the room to see what was going on.
“There’s something biting my pecker!”
I thought to myself … just when he tries to use the urinal, though? I looked at the urinal. Nothing inside.

“OK, let me see if I can catch it.”
He put his business back in the urinal and tried to go.
“Aaaah!” He yelled, making me jump.
“Where did it get you?” I asked.
“Underneath. Here,” he said, pointing to the area where his woo-hoo was resting on the urinal.
Then I looked at the urinal a little closer. There was a sharp point to the plastic on the edge of the urinal. I showed it to the nurse. Then I got a couple of pieces of tape and taped over it. I gave the urinal back to the patient.
“Better?”
“Yeah. That’s better. Did you catch it?”
“Yep. I’m sending him home with the nurse.”
The patient laughed.
I tossed the roll of tape to the nurse as I walked out the door and said with a wink …
“Make sure to order some rat traps from Central Supply, will ya? I hear those things can be pretty vicious.”

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room please e-mail me.

Rodent Control

Urinal
A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure.

We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin, some captopril, and he even got Lasix just to spite all of the #FOAMed wonks.

About 45 minutes later, the patient needs to go to the bathroom. We didn’t want him walking since he didn’t appear to be the steadiest on his feet, so he got a urinal. He grabbed the urinal and the nurse walked out of the room to give him some privacy.
A minute later, the patient starts screaming.
“Aaaaah! There’s a RAT biting my PECKER!”
The nurse went back into the room and slowly pulled back the covers. She looked around and didn’t see anything. She looked at the patient.
“Do you still feel something?”
“Nah. It’s gone.”
She walked back out of the room. Sure enough, 30 seconds later he’s screaming again.
“OOOOOW! It’s biting me AGAIN! OOOOOOW!

The nurse picked the covers up from the corner, screamed, and flung them off the bed, thinking that there may have been a rat from the nursing home in his clothing or something. Nothing there. Of course, after hearing the nurse scream, I went in the room to see what was going on.
“There’s something biting my pecker!”
I thought to myself … just when he tries to use the urinal, though? I looked at the urinal. Nothing inside.

“OK, let me see if I can catch it.”
He put his business back in the urinal and tried to go.
“Aaaah!” He yelled, making me jump.
“Where did it get you?” I asked.
“Underneath. Here,” he said, pointing to the area where his woo-hoo was resting on the urinal.
Then I looked at the urinal a little closer. There was a sharp point to the plastic on the edge of the urinal. I showed it to the nurse. Then I got a couple of pieces of tape and taped over it. I gave the urinal back to the patient.
“Better?”
“Yeah. That’s better. Did you catch it?”
“Yep. I’m sending him home with the nurse.”
The patient laughed.
I tossed the roll of tape to the nurse as I walked out the door and said with a wink …
“Make sure to order some rat traps from Central Supply, will ya? I hear those things can be pretty vicious.”

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room please e-mail me.

Memories …

Juicy FruitA sweet little lady was brought to the emergency department by her caregiver after having difficulty breathing at home. She got a few breathing treatments and some steroids and was doing much better an hour or so later.

When I went back in the room to evaluate her, several family members were present.
“Oooh. You got the good doctor. No wonder you’re doing better.”

I thanked them because … obviously they were right … but I mentioned that I didn’t recall seeing their mother in the emergency department before.
“She hasn’t been here in a long time. You took care of our father.”
“Oh. I see. How is he doing?”
“He died a little more than a year ago.”
One of the family members could obviously see the confusion in my face.
“He was dying from cancer and he came to the emergency department many times before he died. One of the last times he was here, he was having trouble swallowing and his mouth was dry. You started the IV on him and gave him some fluids. Got him feeling better. He kept saying that all he wanted was some Juicy Fruit gum. So you went to the vending machine and got him a pack of Juicy Fruit gum. That was all he talked about after that day … how his doctor in the ER went and got him some gum when his mouth was dry.”

At that point, I realized several things.
First, it showed me that patient opinions of medical care can be arbitrary. I was judged as being a “good” doctor because I did something nice for a patient, not because of the medical care I provided. This interaction just reinforces my belief that our current means of rating medical care is woefully inadequate and inappropriate.
Second, this family’s story showed me how small acts of kindness can have a tremendous ripple effect. Something I had long forgotten had made a lasting impact on the patient which in turn made a lasting impact on the family and will probably continue to be a story that is always associated with our emergency department.
Finally, this interaction reiterates a quote from Maya Angelou that I frequently paraphrase when talking to residents and even in some of my lectures: Patients may not remember your medical knowledge and they may not remember your diagnostic acumen, but they will ALWAYS remember how you made them feel.

Pretty good returns for an investment of a 35-cent pack of gum …