I do not care who you are, where you went to school, which union represents you, how smart you are, or how smart you think you are — executive, doctor, nurse — you are not entitled  to work in a hospital.

privilegeTo run a hospital, or to take care of patients who trust us to help make them better is a privilege, not a right or just a job.

This entitlement attitude — an issue I am hearing more about from CEOs and other executives across the nation — is one of the many factors in our struggles to improve quality and safety.  In addition, it contributes to poor productivity, waste and other inefficiencies that must be eliminated from our business model.

I am not saying that we should ignore basic business management principles in how we staff and operate hospitals. Hospitals must be profitable and be able to produce retained earnings to cover the cost of capital for facility improvements, patient care redesign and new technology, and to support those who work there.  Rather, I believe leaders should give more emphasis to the idea that hospitals are places of employment for special people who can, when they walk through the door, place their own personal needs and problems in the background and focus on the work at hand.  As I have written here in the past, from the housekeeper, cooks in the kitchen, the technicians in labs and radiology, to the nurses, aides and technicians on the floor, everyone should clean the room, cook the meal or care for every patient as if they were a beloved relative who deserves our  deepest compassion and our very best effort.

Somewhere, over the last 50 years, I fear we have lost our way in terms of reaffirming our values and our passion for our patients.

Several years ago I led a search for a hospital seeking a Chief Human Resource Officer.  This hospital was in the midst of a comprehensive turnaround.  The culture smacked of entitlement.  Union and non-union workers alike demonstrated a strong sense of entitlement for their jobs. The hospital was struggling financially, in clinical quality (no surprise there) and a very dysfunctional work environment. The CEO realized that without a competent strategic partner in HR, the chances of achieving and sustaining change were not encouraging.  Things were so bad that I even thought about declining the engagement.

The CEO changed my mind.  He recognized that the culture, the deep-seated entitlement attitude of the employees, had become part of the daily habits of working there. He told me that altering those bad habits would be essential for a sustainable change. His passion to lead a cultural transformation won me over.

Here are some of the steps he took:

  1. He recognized that his plan had to have two parts.  The previous CHRO was weak and ineffective. He and his team tended to recruit and hire weak and ineffective people.  The CEO realized that had to stop.  The second part, the more difficult challenge, was to wage war against the ingrained bad habits that were reinforced by the employment entitlement attitude.
  2. He sacked the CHRO and the senior recruiter.  He recorded a short video presentation clearly outlining the organization’s mission, vision and values. Job applicants were required to watch the video before their application was accepted. The message was specific and clear: if you cannot buy in to these values, you cannot work here.  Recruiters were told that their performance review would include an assessment of the quality of their work and the people they recruited.
  3. He instituted multiple daily rounding — some scheduled, some unannounced.  Representatives of his executive team would always accompany him, even when those rounds were unannounced — say 3:30 AM on a Saturday morning.
  4. Members of the leadership team were required to make patient rounds, speaking with the patients and family members to learn what was working and what was broken.  The executives were empowered to rectify the issue immediately if at all possible.

To be honest, I had never seen nor heard about a CEO making such a massive commitment to rounding.  His message was always clear:  these are our values, this is what we believe.  There was no room for negotiation or ambivalence.

The unions initially pushed back as did some of the local politicians and board members until they realized, of course, that their opposition to this new accountability put them in a very bad place, politically speaking, in the face of the CEO’s unfailing passion  and commitment to achieving change.

What drove that now retired CEO?  His passion, his belief that “there can be no greater honor or reward in life than to serve patients,” he said time and again.

Working in a healthcare organization, taking care of patients, is a privilege. “Those that do not share that value, need not apply,” he said.