Why am I here?

As I approach blog post number 2000, it is time for reflection. For those who remember the 1992 Presidential campaign, this is a bit like Admiral James Stockdale's comment, "Who am I? Why am I here?" (But, I hope with a more successful result!)

I'm going to skip the first question and go right to the second.

I joined BIDMC in 2002 to carry out a public service, to save a great academic medical center that had fallen on hard times. That done, we proceeded to develop strategic plans for our clinical, research, and educational missions. Those have been successfully implemented, with growth in market share and clinical affiliations, expansion of a world-class research program, and enhancement of both undergraduate medical education and residency programs.

The next phase was an intense focus on quality and safety improvement, combined with a level of transparency unprecedented for an academic medical center. The arrival of Mark Zeidel as our Chief of Medicine set the stage for this, as his is the largest department, and because he has a rabid enthusiasm for the proposition that hospitals should not harm patients. I personally took his objective a step further, by publishing real-time clinical data on this blog, on the theory that transparency would help us hold ourselves accountable to the standard we say we want to meet. The incumbent Chiefs of Service and others recruited after Mark enthusiastically jumped in. With our Board's involvement, we adopted an audacious goal of eliminating preventable harm over a four year period, and we are on track to reach that goal.

Meanwhile, we decided that the only way to excel as an institution was to engage front-line staff in all job categories in a sustained and respectful program of process improvement. We tested this out with BIDMC SPIRIT and then moved to full-fledged implementation of the Lean process improvement philosophy.

Most recently, we "discovered" that patients and their families need to be part of the planning and management of the hospital. If our purpose is to deliver the kind of care we would want for members of our own family, incorporating the unique perspective of patients and their families is the only way we can achieve that purpose.

So, from the institutional perspective, that's why I have been here. It is engaging and worthwhile to be the coach and cheerleader for a fine organization like ours as we make progress in carrying out our mission. If you had come to me in 2002, 2005, or 2008, that's the answer I would have given. But I have gone through an evolution as to why I am here as a person.

My answer now is that I am here to be with people like Tom (below and also seen here with his friends.) Tom was very sick. When he recovered, he asked me to help as he devoted himself to helping other current and potential patients. I am also here to be with people like Mary, who feel comfortable enough with me to share very personal observations of things going wrong -- hoping that it will lead us to change practices, reduce pain, and save lives. I am also here, from time to time, to join patients who are dying and to have open and heart-warming conversations about things that really matter.

In short, I have learned to be here to be emotionally present as part of the human condition. There is no more dramatic place in the world than a hospital. There is pathos, humor, pain, and relief. I have allowed myself to be open to the possibility that the CEO can play a role that is totally separate from the business aspects of the hospital. People choose to invite me into their lives to a degree that is truly humbling. They offer me the blessing that my presence is helpful to them and others. I am ever grateful for that.