Monday, January 18, 2010

What I wouldn't trade with any other CEO

(This was the speech given to employees, friends, and family at the 2009 Ozarks Community Hospital winter party)

Ten years. Part of me wants to use the occasion to follow Bilbo and make a farewell speech. I am immensely fond of you all. Ten years is too short a time to live among such excellent and admirable hobbits. I don’t know half of you half as well as I should like; and I like less than half of you half as well as you deserve. But I regret to announce that—though, as I said, ten years is far too short a time to spend among you—this is the END. I am going. I am leaving NOW. GOOD-BYE! In a few weeks, we will have been in the hospital business ten years. Of course, the history of the organization is deeper than that, but there is something special about a rebirth. On June 28, 1999, the State of Missouri granted a Certificate of Need for a 45 bed osteopathic hospital located at 2828 N. National in Springfield, Missouri. It was my birthday. We spent the next six months in labor giving birth to a hospital—believing we could do it with two million when conventional wisdom said we needed ten. While the rest of the country was obsessed with Y2K, worried that computer systems were all going to crash at midnight on December 31, 1999, we were trying to figure out how to breathe life back into a system that had been given last rites more than a decade earlier. Most of you know the numbers. We opened with fewer than 50 employees. We now employ 850. We began with two employed physicians outside the ER. We now employ 60. Gross revenue has grown from less than $8 million to more than $120 million a year. We now contribute $40 million annually in wages and benefits to the regional economy. Most of you know the mission. More than 80% of our patients have governmental insurance or are self pay. Based on hospital and physician utilization by Medicare beneficiaries, we are the lowest cost healthcare system in the nation. Most of you know the story. Years ago, during one of our many close encounters with financial ruin, I sent a memo to the physician shareholders. On the cover was a picture of the walrus and the carpenter from Alice in Wonderland by Lewis Carroll.

The time has come, the Walrus said,
To talk of many things:
Of shoes--and ships--and sealing-wax--
Of cabbages--and kings--
And why the sea is boiling hot--
And whether pigs have wings.

We rallied the troops, held the wolves at bay, kept the doors open and lived to fight another day. Janet and I used to repeat a ritual at the end of each week. We adapted it from the film, It’s a Wonderful Life. It is the scene about the run on the Bailey Building and Loan. George and Mary use their own money to keep the doors from closing. There are two dollars left at the end of the day. George does a little happy dance and says: “a toast to Momma Dollar and to Poppa Dollar, and if you want to keep this old Building and Loan in business, you better have a family real quick.” A few months later, things were looking up and I sent a second memo to the ownership group. I again referred to the walrus and carpenter poem, asking whether the pig had wings, and I answered with a picture of flying pigs under the Doctors Hospital banner:

No one really believed it would ever happen, but the swine flew. [Karla Myers claims she holds a copyright on that expression as it applies to our hospital.] We have had some years when we made money. There have been years when we lost money. At the end of ten years, the profits and losses have almost exactly balanced each other out. I have not been much of a businessman. Many other health systems have adopted a Wall Street, “greed is good” rationale. They believe the ends justify the means. Since the mission is to take care of sick people and that mission is a good thing, it does not matter how many people they have to screw to do it. I am a complete failure at being that kind of businessman. As an attorney and as your CEO, I could have been suing patients to collect money for the hospital without having to spend money on attorney’s fees. Anyone with half a brain for business would have done it. Yet, in ten years, I haven’t done it once. At OCH, our philosophy has been: do good, do it the right way, and the money is supposed to take care of itself. I would rather go broke believing that, doing it that way, than make money doing it the other way. The thing is, tonight, I don’t want to talk about the numbers, the mission or the story. I’ve got this ring of power in my pocket and the temptation to use it is hard to resist. But I’m not Bilbo. He achieved his quest. He helped slay the dragon. He found the golden treasure. He went there and came back again. He earned the right to fade away and leave the next quest to a younger generation. My successes have been limited to a series of recoveries from defeats. I shovel like a madman to fill holes—some of which I dug myself—but the best I can ever do is get back to level ground. I can’t climb the mountain. I can’t climb it but I know it is there. When the whistle blows at the end of my day, I hear a poem by Emily Dickinson. [I can hear the groans out there: “Oh my God! He is going to recite poetry at a party.” I can’t help it. Blame my liberal arts, Ivy League education. It is sad but true. This poem plays in my head like a tune that won’t stop recycling.]

Success is counted sweetest
By those who ne’er succeed.
Not one of all the purple host
Who took the flag to-day
Can tell the definition,
So clear, of victory!
As he, defeated, dying,
On whose forbidden ear
The distant strains of triumph
Burst agonized and clear!

So, I do not stand here tonight to celebrate success. I count my failures and there are many. It is the fear of failure that drives me. No, tonight is not about me or the numbers or the mission or the story. Tonight is about you. The real strength of this organization has always been the special people dedicated to service and to each other. I used to think that we had an advantage due to our small size. We felt more like family to each other than employees at the other health systems. They were just too big to feel that way. Guess what? We’re not that small anymore; yet, I still see, hear and feel the same everyday expressions of compassion, empathy, dedication and selflessness that have been and remain the unique hallmark of our corporate character. I look out here tonight and I see people I love. Yes, it has been rewarding to see the organization grow, but that pales in comparison to the pride I feel witnessing the personal growth and development of so many long time employees. We are going to recognize some of those employees tonight—those with five and ten years of continuous service time. During the first four years of our organization’s existence, we constantly faced issues that should have forced us to close. I still remember the day that the Director of the Greene County Health Department called me and said he had been told by City Utilities to arrange for the ambulance transfer of all our patients in the hospital because they were going to turn off water, gas and electric. I just laughed at the guy. He said, “What do you know that I don’t know?” I said, “This may be the easiest problem I have to solve today.” Make a difference. People use the phrase so often it has become a cliché. For those employees who worked with us five to ten years ago, it was no cliché. Almost every day, something an employee did that day made the difference between staying open and closing forever. Many organizations claim they were built by the blood, sweat and tears of their employees, but I do not know of any other hospital in the nation during the last decade that was literally built on nothing other than the blood, sweat and tears of the employees. As I like to say, anyone could have done what we did as long as they had enough money. Our employees are the only ones who have managed to do it without any money. Ozarks Community Hospital is the only organization in the world that has employees capable of breathing life back into a derelict, defunct hospital facility no one else wanted, given up for dead for two-and-a-half years, doing so without any money, facing unfair barriers to competition that would strangle a healthy, wealthy company, eventually going broke in the process… and then doing it again. Those of you who have joined us more recently will find it difficult to connect to that emotion or believe in the underlying truth of these words. You have no doubt heard similar words spoken about other organizations. I want you to hear and understand and believe this. Every day, there was one employee or another, usually someone making about eight bucks an hour, who had every reason in the world to give up on the impossible task at hand, call it a day and go home, but who, for some inexplicable reason, did not… did not give up… and because they did not give up there was just enough of something that was needed the next day, the next week, the next month, to get by, to make do. It was a nurse playing the part of a biomed technician because we didn’t have a biomed department back then or it was an ER tech performing an IT service because we didn’t have an IT department or it was a housekeeper becoming the purchasing department by making something work that another hospital had thrown away. It was an employee who, instead of saying “I can’t do my job because I need something we can’t get,” said, “I will figure something out and get it done.” I am the one who gets the pat on the back for being the miracle worker, for pulling rabbits out of my hat, but I know better than anyone who the real miracle workers were. I get to be the wizard but even Gandalf will admit that he can’t burn snow, and if it had not been for a lot of hobbits chopping wood, this fire would have gone out a long time ago. A spark here and there in the actions of a few dozen employees ignited a flame of effort and commitment that still burns today. It infects new employees like a virus. Not everyone catches it. Some are immune, but those who do seem to enjoy work and maybe even life more than those who do not. It is not going to get any easier in the years to come. I have been advocating for some kind of healthcare reform that would level the playing field for providers, insure more lives and make care more affordable, but the fact is that the people and institutions with power in this world use it mostly to hang on to power. It would be naïve to bet against them doing so again. We are not going to win the lottery, receive a large grant or suddenly get paid more for the care we provide. Unlike most health systems focused on profit (and, of course, I include billion dollar charitable organizations in that group), we do not compromise patient care by cutting staff in order to preserve a healthy bottom line. We don’t buy new if we can find it used. Our facilities don’t look like Wall Street board rooms. Our floors may not be as fancy but they are just as clean—in most cases, cleaner. I have been visiting a number of hospitals recently to talk healthcare reform with other CEOs and as I walk around the other guys’ buildings I usually say to myself: “They’re not in the same business we’re in.” We have to get it done, providing the same quality healthcare for less pay, with fewer resources and none of the advantages taken for granted by other health systems. There is not a hospital CEO in the nation who would trade financial statements with me, but I would not trade employees with any of them. Will we get it done? You will. I know you will.