I have worked nights in lonely ERs as the only doc on duty for miles, resuscitated babies, stared down homicidal drunks, drained pus from abscesses hidden where the sun does not shine and worse. But that all seems pretty tame by comparison to being a hospital CEO. I’ve suspected that for years, but when I became one a few weeks ago it was still a shock to discover that being the boss is a sphincter-tightening job second to none.
Being a CEO seems pretty easy from a distance; just order people around, make “nice-nice” with important people, look good in a suit and serious when someone brings you their problem, run too many meetings, then collect the big bucks and play golf frequently. But looks are deceiving; hospital CEO is a job for which you better wear your big boy (or girl) panties full time.
To start with, everything that goes wrong in your hospital is your responsibility. Yours is the name on the door, the buck’s final destination, and the kitchen where the big heat is. You take every flaw in the place personally, and you should, whether it’s a wrong leg amputated or a meal delivered cold. That helps drive you every darn minute of every darn day to make it a better hospital. If it doesn’t, you are in the wrong job.
When you walk around and talk to staff, you realize that every one of them is counting on you to do your job well so they can do theirs well. If the CEO messes up, someone down the line pays for that mistake, and that someone might be a patient because your company takes care of people and not widgets. When you sit in that office trying to figure out how to keep the bottom line in the black, you also realize those staff are counting on you for their jobs, their health insurance and for food on their families’ tables.
You may look good in that suit, but if the OR does not hum like a watch, the ER does not have enough nurses at night, and the bottom line is not positive at the end of the year, you are just a cheap suit not worth the corner office you occupy.
The CEO’s job is to be the organizational SOB when that needs doing, no matter how much you like anyone you work with. Therein lies one of the great paradoxes of being a CEO; you work with great people because that’s who works in hospitals, but you are paid not to put anyone’s interests above the interests of your hospital. The difference from my job as a physician — to put the interests of a single person above all else — could not be more jarring.
And those are just some of the responsibilities you have for people inside the hospital’s walls. Outside those walls, hospitals in rural Maine now employ most of the primary care providers who care for thousands of patients in the communities around each hospital. They employ many of the EMTs and paramedics who show up without fail when you call 911. They employ home health nurses and other crucial pieces of the rural health care delivery systems that keep Mainers alive and as healthy as possible. That all means if a Maine hospital goes under now it can take health care for thousands down with it.
I will get a lot of great help in this new job and could not do it alone, but when I think about all of this responsibility I might as well just shave my head in order to save my remaining hairs the work of falling out on their own. Then I remember what a great thing a hospital is for a rural community, how much life and hope and TLC and talent and human emotion are wrapped up in one small pile of bricks and wood, and what a great privilege it is to be able to lead one. And if the CEO job stresses me out too much, I can just tuck my stethoscope in my pocket, and go work in the ER with the pus and the babies in order to relax.
Dr. Erik Steele is interim CEO of Blue Hill Memorial Hospital and vice president and chief medical officer of Eastern Maine Healthcare Systems.