Wednesday, August 4, 2010

Best Laid Plans

Posted by Jon Stanger

I’ve always thought that there is great wisdom in the expression, “If you want to hear God (or the gods, or Fate, or your therapist) laugh, tell Him/Her your plans.”

Two years ago, after thirty years in various roles as physician, educator, and ethicist at CCRMC, I was actively planning for my retirement. Sure, like so many of my compatriots, I hoped to continue a few hours per week at the hospital, but only a few. I had a definite plan. First, I would write the medical ethics textbook that had been percolating in my head for the last few years. Then I would move on to penning The Great American Novel, selling the movie rights to Hollywood and paying off my daughters’ sizable student loans. And, along the way, I’d finally find time to refinish the deck and master the fairway bunker shot. I had a plan. Two years, three years max, to accomplish those goals, and after that, well, we’d see. Really, I had a plan.

I can actually remember the precise moment, two years ago this month, that my carefully calculated orbit was knocked off course. I was returning to the hospital after a meeting with my retirement counselor, when I ran into Anna Roth in the parking lot outside the administration offices. Anna and I had worked together on the System Redesign Team and this was the first time we’d seen each other since her return from a year studying at Harvard and the IHI.

Jon: (Intending and expecting only the most superficial of social pleasantries.) “Great to see you, Anna. So, how was your year?”

Anna: (Characteristically restrained and demure.) “Incredible. Amazing. We’ve got a lot of work to do – and ethics has to be at the foundation of it all. Let’s talk. Let’s get started.”

That’s it. That was the beginning of the end of my plan for the next two years. I did, in fact, retire, at least in name. But from her position as COO, and then CEO, Anna recruited – or, more accurately, conscripted – me onto the Operations Team with a stubborn insistence that an “ethics perspective” was critical to the work we had to do at CCRMC.

If over the past year the nature of my role as ethicist on the Ops Team has seemed illusory at times, and if it feels like we are traveling uncharted territory in this venture, I forgive myself this, given that the whole field of organizational ethics for health care is in its infancy. There are even times when I think that our efforts, that the lessons we are learning right here at CCRMC – our innovations, successes, and set-backs – will be of benefit not only to our own system and patients, but have the potential to contribute to the emergence of organizational ethics as a national discipline. And that’s definitely a chapter worth including in my book.

I really do want to get on with my retirement plans – writing and such – but I have no regrets. Recent changes at CCRMC have not been without missteps and trauma. I don’t know where it will all lead or what major problems lie ahead – certainly there will be some. But I think that something very important is going on in our organization, and I’m glad to be a small part of it. In upcoming installments of my guest contributions to this blog I’ll try to get more specific about what that “something very important” might be and what an “ethics perspective” might have to offer for the tough world of running a health care organization.

That ethics textbook hasn’t progressed beyond the outline stage, and the world is going to have to wait a while longer for The Great American Novel. My deck remains unstained. But my 5-iron shot from the fairway bunker is a little better and, well, that will just have to do … for now.

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