Healthcare Reform

Who says rainy days and Mondays can get you down? It's Monday and raining, and I'm on top of the world! On Saturday I got engaged, on Sunday we found a house that we're going to bid on this coming weekend, today is the first day of my promotion to executive assistant to the chief executive officer (CEO), and this coming Saturday I'm graduating, having completed my bachelors at the University of Phoenix. Oh yeah! "Let it pour," I yell to myself as I pull into the hospital's parking lot.

In fact, rain is good! Why do they always call anything but sunshine "bad weather"? After such a long dry spell, we need the moisture. It helps the crops grow, cleans the air, and fills the lakes. So, all the eaters, breathers, and water drinkers--that should cover us all--can't live without it. Bad weather? What kind of thinking is that? Uh, oh! My thinking is bouncing around like the waves of the puddle I just stepped in.

Greetings and best wishes surround me as I make my way to the executive offices--my new place of employment. I discover my office to be a single desk in space shared with the CEO's administrative assistant (AA). No problem! The AA is a great person, with a positive attitude, a good thinker, and very efficient. We'll work well together.

"Good morning. Your new business cards are on your desk; here's a writing pad, and the boss wants to see you in the executive meeting room ASAP," shoots out of the AA's mouth as if from an automatic weapon. I throw my attachй case "on" my office--the desk--grab one of my new business cards, and hustle to the meeting room. I take a quick look at my card. There it is: Chris Smith, Executive Assistant, Faith Community Hospital.

As I reach for the door handle, it seems unusually low. I must be walking above the clouds. My moment of pride is cut short by the incredible panoramic view of our beautiful valley--that view, the clouds with their infinite variety of geometric patterns and shades of white and gray, rolling through the sky.

"Good morning, Chris," my new boss greets me. "Welcome aboard," Pat offers, more as an obligatory greeting than a real welcome. "These rainy days and Mondays really get me down. Have a seat." As I sit down, Pat continues by commenting, "I understand you're about to get your degree."

"I am almost done! This Saturday is graduation," I answer, with a sense of pride and relief and somewhat nostalgically.

"Far from done; you've only just begun," the CEO clarifies. "But, before we go on with the task at hand, tell me: which courses did you enjoy the most?" Just as I begin to answer, Pat quickly adds, "Let me change that question: in which courses did you learn the most?"

I think, 'Which ones do you want to hear?' but I answer, "Management, Public Speaking, Organizational Behavior, Ethics, and, of course, Critical Thinking."

"Great," answers the CEO, "because you're going to need every one of those and more with the first assignment I'm about to give you. Are you ready to apply your newly developed skills?"

"Let the rain fall down on me," I respond, hoping Pat has a sense of humor.

"Oh it will, and I hope it doesn't dissolve you." Yes, Pat does have sense of humor.

"I see you have your business card. Turn it over, please. Just in case you don't have the mission statement memorized, you can always read it, right there on the back of the card.

"With the foundation and commitment of our spiritual heritage and values, our mission is to promote the health and well-being of the people in the communities we serve through a comprehensive continuum of services provided in collaboration with the partners who share the same vision and values."

"What do you think?" asks Pat.

"I do believe it and I'll certainly try hard to live by it. Plus, by having it on the back of our cards, we're doing a great job at keeping it in front of everybody, so to speak," I chuckle.

"Nice play on words, Chris. Unfortunately, few Faith Community members and partners seem to be flipping for it lately," responds the CEO. We've got some interesting interpretations of the mission statement being made in all of our stakeholder groups. Very patchy, I must say. Chris, do you have any idea what's going on out there?"

"It's pouring," I respond bluntly.

"Yes it is!" Pat confirms. "It's falling from every direction, and coming in all over the place. Here's some of what I'm thinking about.

"Let's start with this morning's news headline that medical errors cause tens of thousands of deaths each year, close to 100,000 in hospitals alone. With that as the external panoramic view, let me paint the picture for you, from the inside out.

"I report directly to the Board of Directors of the Faith Foundation. Its diversity alone represents a kaleidoscope of thinking and decision-making. The grand point of commonality among the Board members is their support of the purpose, values, and survival of Faith Hospital. The entire community knows of our religious heritage and our commitment to the public. That openness attracts a wide variety of believers--Board of Directors, staff, patients and their families, as well as others--each with infinite influences on his or her own thinking. I'm not sure how many of our stakeholders realize or understand the differences between ethics, laws, beliefs, oaths, etc. If they do understand, how many accept the fact that we draw our value lines at diverse junctures when it comes to applying these ground rules?

"On one hand, we have particular patients who refuse to take certain medical services, and on the other hand, particular staff members who refuse to provide certain services. In both cases, they feel that medical intervention can go too far into conflict with their religious beliefs or personal moral convictions. We have a case in our Neo-Natal Ward, where Child Protective Services is in the process of taking custody of the baby and threatening to file charges against us because of the way we provided services or, as they allege, failed to provide services. All this trouble, despite our actions being in agreement with the parents' wishes. Last week, three staff members in the ICU initiated Do Not Resuscitate (DNR) directives. The only problem was that no written orders to that effect existed. At the same time, I have some