Viewing America’s health care system microcosmically - a ‘good news’ vignette

A few months ago I switched my health care insurance from a “one stop” Health Maintenance Organization, Kaiser Permanente, to “Care First” a more traditional insurance provider. Care First offered greater flexibility, which I needed, but the switch was not made without trepidation. Friends who were Care First clients warned of opaque, legalistic documentation, difficult-to-negotiate procedures and bureaucratic, indifferent staff. These warnings were amply confirmed. Staff members of the outstanding internist I located and the fine surgeon that he recommended informed me, when I made my first inquiries, that problems with Care First had lead them to disaffiliate as “preferred providers.” One had a poster communicating this information prominently displayed for viewing by potential clients. Waiting-room anecdotes advised me never to trust information from Care First customer service staff received over the phone - to insist on written communications, via email, for anything of importance and, even then, to be prepared for interminably protracted negotiations in which I would be treated as an adversary.

But once I accepted the reality that dealing with Care First would require all the skills I had learned as scion of a family of lawyers, plus years of negotiating experience with developing-nation and academic bureaucracies, things began to improve. Yes, health care would be more expensive and battles with my “insurers” would have to be fought. But I have discovered health care professionals - from modestly compensated office and hospital staff to physicians - who genuinely care about serving patients in a manner that is only skilled and efficient but compassionate.

My experience with Washington DC’s Sibley Hospital, completing an in-and-out abdominal surgical procedure provides the case in point that has motivated me to write. Once my surgical appointment had been made - and my surgeon’s organization (Foxhall Surgical Associates) would make another good news vignette - I received two follow up calls from hospital staff just as promised. The voicemail message from the appointments nurse was among the most cheerful and courteous I have ever received - I told her so. When I arrived at the hospital I was immediately impressed with the efficient congeniality of staff members greeting me and pride they expressed in Sibley. Everyone with whom I met seemed to have been employed there for twenty years or more.

Waiting times at each stage of a fairly complex check-in process, with many documents to sign, were brief. There was no sullenness or resentment when I asked to read documents before I signed them. When I called attention to a small inaccuracy, the response was immediate, forthcoming and apologetic. Staff members wore name tags, with first and last names prominently displayed in easily read block letters. They seemed pleased when I introduced myself, asked their names and used them in our interactions. When I asked how long they had worked at Sibley all seemed to have time to share a professional experience and a bit of personal information. When an emergency delayed my procedure, a nurse provided an immediate explanation and asked what she could do to ease my waiting. In my six-plus hours at Sibley, meeting with numerous staff - professional and non professional - every single one communicated congeniality, professionalism, efficiency, pride on their work and pride and their organization.

In leading two very different programs at American University, each for a decade, I always emphasized the importance of generating “Good Karma.” I defined this has the ability to have every individual who has any interaction with our organizations come away feeling good about the organizations and themselves. Good Karma, I always emphasized, accumulates (Buddhists believe this) and is infectious. Good Karma, I believe is the most important leadership/management principle that should guide customer service organizations. In hospitals, when customers (patients) often feel at their most vulnerable and disempowered, communicating Good Karma is particularly important and, sadly, all too rarely encountered. The good news vignette I have experienced - and shared - suggests that Sibley Hospital’s leader/managers have discovered the secret of delivering efficient, high-quality health care that embodies Good Karma. It is a secret that should be shared, They have my deep gratitude - and my deep respect

CTE'S goal: a culture that is both results oriented and affirming

At the begining of the fall and spring semesters, The Center for Teaching Excellence (CTE) publishes a four page newsletter that is distributed to faculty and staff. My column, "From the Director" appears on the front page. Recent titles have included 'AU's New President: Grounds for Optimism from a Compelling Book' (Jim Colllins, 'Good to Great') and 'Winning the Battle for Brainpower.' My column for the spring semester number follows.

Each August, a new cadre of part-time staff members join CTE. At orientation, we discuss seven principles entitled ‘Serving the AU Community and relating to one another.’ I believe the most important principle is this:

In CTE, every staff member, from the Director to our most junior hourly worker, is expected to do what needs to be done, when it needs to be done, irrespective of their job descriptions. Even more, CTE staff members are expected to proactively and creatively seek out what needs to be done, without waiting to be told. How can I make a difference? How can I strengthen the results we produce? How can I improve the quality of work life and the quality of human relationships in CTE? How can I create positive Karma? These are questions we must ask ourselves every hour of every working day.

Not long ago, I shared our principles statement with Traci Fenton, a charismatic former AU graduate student. Traci is founder and CEO of WorldBlu an organization whose mission is to promote and celebrate ‘organizational democracy’ particularly in the private sector. WorldBlu’s research has shown that democratic organizations are often more efficient and profitable than their competitors.

In return, Traci sent an article ‘Engines of Democracy’ from the management journal, Fast Company (#29 – Oct. 1999, pp. 174, ff.). It described the achievements of GE’s jet engine assembly plant in Durham, North Carolina. This 170 employee facility leads not only GE but the world in the efficiency and quality of its work. It has the lowest defect rate and best record of on-time delivery. It has reduced production costs by 30% in ten years. It was selected as the sole source provider of engines for the new Boeing 777. Its employee turnover rate is the lowest in the business.

GE Durham embodies the principles of Organizational Democracy that WorldBlu promotes. There is only one boss, the plant manager “which means that on a day-to-basis, the people who work there …essentially run themselves.” A “culture of continuous improvement” is pervasive. GE Durham employees, “have challenging jobs that matter, they have a degree of control over their work that is almost unprecedented, they adhere to demanding performance standards, they receive the training and support they need to do the best work they can – and, as a result, they do just that.”

Traci shared “Engines of Democracy,” she told me, because my description of CTE reminded her of the GE Durham plant. All of us were gratified by her complement. CTE has a long way to go before matching GE Durham’s world-class performance standard and affirming culture. But we are working on it.