I got a call from a hospital “leader” some years back.
Effusive praise for a service I provided to a member of the community had gotten back to him. It seems they went to the same elite country club and he wanted to share these kind words with me. I welcomed it. I appreciated it. Except there was something that bothered me about the call . . . something that ate at me to my core. It was something he said about why he joined this particular club.
“Dr. Profeta, one of the first things I did when I moved to this city was join this country club because I felt I needed to be close to the people we care for, get a feeling as to what kind of job we were doing.”
I remembered back to the days of my youth when, as a Jew, my family would not be welcomed at such a club. Also coming from lower middle class roots, we certainly did not have the means to join that type of club anyway. The closest I ever got to it as a child would be as a trespasser as my mom pulled her car alongside one of the roads abutting the fairway and we’d crawl through the thickets and hedges to watch “their” fireworks on the Fourth of July.
Certainly, the social and cultural times have changed and I imagine the cash of people who pray like me would be more than welcomed. But I am still keenly aware the vast majority of people we care for in our Emergency Department are far more likely to be the 'me' of the 1960s and 70s or today's laborers and waiters of that very club.
You see, my partners and I care for a magical menagerie of the homeless and middle class, single moms and nursing home residents, gang members, children of immigrants with parents just trying to master a few basic words of English to be able to say “pain . . . hurt . . . stomach.” They are barbers and plumbers and teachers and nurses and truck drivers and farmers, battered women and abused children with just a faint sprinkle of some “golf buddies” and “tennis wives” tossed in on those days their concierge doctors are unavailable.
“The people we care for . . .” Really? You’d think he’d know that, wouldn’t you?
No doubt that what slipped out was “I need to be close to the people who really matter—people who serve on our boards, who lend legitimacy to the decisions we will make. People like us who recline on chairs and type on keys far from where others coughed up mountains of blood-tinged sputum while you reused masks and wondered to yourselves if today is the day you might fall ill and die.”
There were many heroes in hospital administration during the Covid-19 pandemic, people who rose to the challenge. I highlighted some in a piece a while back (Top Five Hospital Administrators During Covid-19). It was a sampling of some of the best hospital administrators singled out by the ER docs who knew them. It celebrated their response and preparedness to this pandemic and touted their accessibility and willingness to listen. I did this in part because my inbox was sadly being flooded by nurses and doctors all over America asking me for help, wanting me to leverage my social media following to “out” some of those administrators who absolutely failed, whose actions were literally causing death and an apocalyptic collapse of morale just like the ones I’m describing. All these communiques seemed to expose a common trend: those who failed hid from sight. They governed by Zoom and left the critical decisions to accountants, HR, and legal instead of the doctors and nurses at the bedside. In their wake of destruction, they left us to pick up the pieces, cover shifts, and absorb crushing workloads when we already had been taxed to the bone. What was clear was they were far more concerned about the perception of damage in the public sphere than the actual damage they were causing on the ground.
But this evolution of healthcare leadership was not just a simple outgrowth of Covid-19. It was a leadership style that was being cultivated and encouraged far before a Wuhan bat coughed in the face of one of its handlers.
These leaders are simply no longer home-grown parts of the community, a process that is absolutely calculated. The trend in health care is to lure administrative carpetbaggers with big paydays and promises of lucrative bonuses, have them stride into town from some hospital, a bit smaller, two states away, make a few tough and uncomfortable financial decisions, and move them on before anyone notices. The only thing left is a series of LinkedIn posts with their headshots touting their performance and their ratings on Becker's, promoting them as some up-and-coming leader. But we in the trenches know the real truth—some of these pressed and cuff-link-clad headshots had a profound negative impact on the provision of health care in our communities at a time when it was needed the most.
We all bear some responsibility because we have allowed them to operate openly and freely, with little attention paid to the damage—both emotional and physical—they have inflicted on our friends and neighbors. They did this not out of malicious intent, but because they simply were not engaged. Their only true mission is that of fiscal responsibility and profitability with little concern for the dedicated nurses and physicians who came to your aid when the world was collapsing around you.
Quality healthcare leadership is so much different than any other type of leadership. You have to be at the bedside to understand the issues. When you are not engaged, when you think the country club is your client base, when you don’t really know who lies on your cots, when you don’t know the people in your charge, it’s easy to allow some clueless, number-blind accountant to usurp your role and convince you that these are the tough decisions needed to “keep the lights on.”
You forget who you serve.
In an ideal world, we would be having 9/11-type hearings tomorrow investigating the abject failures of this type of leader. We’d scrutinize the hospitals and their multistate overlords asking the key questions. Why did hospitals have supply, nursing, and other staffing shortages at the same time they were spending countless millions of dollars building hospital extensions and investing hundreds of millions of dollars in profits in hedge funds, corporate-run staffing agencies, and other long-term investments?
Why were our nurses leaving, why weren’t we paying them what was needed in order to keep them on the job?
Why did they furlough staff of non-critical areas when Covid censuses fell? To save a few bucks? Are you kidding me? We at the bedside knew, all across America, that there was a real chance they might be needed as this pandemic went on. Did they not think for even one second that the message they were sending out was “YOU DO NOT MATTER”? Did you honestly think that bullshit about the mission would be enough for them to just stay home and wait to see if their job might remain when this all was over?
Why were they so short-sighted and reactionary so as to create a cultural environment that made it not only easy but imperative for nurses and techs with countless years of experience and immense intellectual and clinical capital to flee a few states away in the middle of a pandemic? This lack of insight and planning will go down as one of the most egregious failures in the history of health care leadership and one that none of them should be able to hide from.
From administrators in the early days saying we should “rein those doctors in” who insisted on wearing masks for fear they would spark panic in patients, to one such hospital administrator in charge of nursing who actually felt emboldened enough to proclaim on a recorded Zoom call that “maybe you just go somewhere else” when legitimate concerns about pay, staffing, hours, workload, and burnout in the midst of the pandemic were brought to light by some of the dedicated nurses who chose to stay. The same nurses who were FaceTiming loved ones as they pleaded “Daddy . . . Daddy, I love you, please hold on . . . please hold on.”
Accounts like these could be told for five years straight and you still wouldn’t get through them all. Is there any doubt this attitude found purchase in country club bars and backroom Zoom conferences far from where doctors and nurses were collapsing against walls from exhaustion and despair.
“The people we care for . . .” Really?
Simply put, the leaders of many of the hospitals that allowed this to happen should be fired tomorrow. They have got to be held responsible. Medical staff members need to come together and initiate votes of no confidence on every last one of them, and our nurses across this land need to come together and say “enough.”
We in health care and those who care about their community need to put an end to this and insist we get back to a time where our health care leaders did far more than simply tout that we are open, post cardboard letters of support on manicured yards, or toss an occasional pizza and car wash coupon to their staff as if they were training a labradoodle.
Covid-19 exposed for all to see that health systems across this country is led far too often by people such as this who, while having the skills, the smooth voices, and soft smiles needed to sell widgets and gadgets and cell towers in far-off lands, have absolutely no business being involved in the delivery of healthcare—a service that at its core is not only about national welfare and security but about the welfare and well-being of the people on the ground. Health care is so much more than platitudes and advertisements on backstops and standards holding up a basketball rim or birds or hearts or triangles or letters emblazoned on the floor of some arena floor or accompanying scoreboard.
A million Americans died.
Their voices need to be heard. Covid-19 is responsible for most of them, but the failure of hospital leadership on our own soil is also responsible for some of these deaths. We in the trenches saw this with our own eyes.
I will say it again, there is plenty of praise to go around. Some of our administrators like the ones I highlighted in earlier articles were absolute heroes, but we need to know the failures too. You need to know the role some of your local hospital system leaders played in causing nursing shortages, a collapse of morale, burnout, and a massive exodus of experience and intellectual capital which will never be recovered. Know why some of your loved ones died in small rural hospitals because they could not be transferred to major high tech hospitals due to staffing shortages. Realize why they lost any chance to perhaps survive their illness. It wasn’t because we had no beds . . . It was because we had nobody to provide care to the bodies that would occupy those beds.
The public, the media, local and national legislators, it's time you did your job and started asking the tough questions of these community health care “leaders.” Perhaps approach them as they take their lunches at the golf course bar, or exercise an option on corporate-sponsored suite tickets, or floor-level seats (seats that probably should have gone to our hospital housekeepers anyway).
If they are found wanting, then it’s time for you to quit their boards, drop off their foundations, end this charade of offering them legitimacy. There are better places for you to spend your money than by giving it to major medical centers with a billion dollars in their coffers. Ask us, those in the trenches, we’ll tell you where to send it. But in the meantime, be aware.
Some of the worst hospital administrators may be living in your city and pulling the strings of healthcare delivery to your community.
Isn’t it time you knew that?
Dr. Louis M. Profeta is an emergency physician practicing in Indianapolis and a member of the Indianapolis Forensic Services Board. He is a national award-winning writer, public speaker and one of LinkedIn's Top Voices and the author of the critically acclaimed book, The Patient in Room Nine Says He's God. Feedback at firstname.lastname@example.org is welcomed. For other publications and for speaking dates, go to louisprofeta.com. For college speaking inquiries, contact email@example.com.
Dr Louis M. Profeta is an emergency physician practicing in Indianapolis. He is one of LinkedIn's Top Voices and the author of the critically acclaimed book, The Patient in Room Nine Says He's God. Dr Louis holds a medical degree from the Indiana University Bloomington.