Vocation

Man oh man, I'm getting my butt kicked this week.

I had a 15-hour day on Monday that culminated in a dinner with our endocrinologists at a restaurant in the western suburbs. Despite the fact that I felt I was fighting the stomach flu all day, I knew I couldn't bail. This was my only chance to get administration and these docs around the same table. I needed to sell our idea of getting a nurse practitioner in Diabetes and a fellowship slot for an endocrinologist training program.

I felt terrible Monday night and thought I was going downhill toward Immanent Illness. I woke up Tuesday and felt like death. After my shower, I cocooned myself in a blanket on the couch and plotted my approach to rescheduling the day's meetings. Then I heard my mother's voice in my head...when I was a kid in school and felt icky, she'd tell me to try it and she'd come pick me up if I felt worse. Then she'd say, "Just gut through it- maybe your day will be better than you think."

Darn it all, Mama Bear was right. Tuesday rocked!

I drug myself into work and on a breakfast of M&M's and coffee, started to liven up a bit. The morning meetings were okay. It wasn't my A-game, but it was okay.

Then my life changed forever.

Because I am extremely blessed and weirdly connected in this field, I had my first call with Dr. Bill Nelson, chief ethicist at Dartmouth Medical School. I'm not a name-dropper, but this was BILL NELSON. He's written, like, 900 articles on ethics and is pioneering change in healthcare ethics.

My mentor through ACHE hooked me up with Bill; they're on the AHA board together and just "hang out." I cannot even imagine what it's like to "hang out" with people like this but after 45 minutes of speaking with this distinguished academic on the phone, my head ached. I wondered if I gave myself a brain bleed.

He explained the three primary branches of healthcare ethics: clinical, research, and organizational ethics. Clinical ethics is needed when your grandma and my child both need a ventilator. We have one ventilator and must decide who gets it. Or, perhaps your grandpa wants to leave this earth in peace and your family wants to prolong his life with end-stage renal dialysis. That also requires a clinical ethics approach.

Two is research ethics...how do we align the systems within the hospital to prevent patient safety errors and quality issues in the first place? This approach uses Lean and process improvement methodologies to fix hospital operations for the better because it's what we should do. Keeping our patients safe and providing excellent care is our ethical obligation; it is the fundamental driver of our entire business. Through Lean, you want to prevent the ethical fires that ethics committees and clinical ethics consults extinguish. There isn't much done in this area, as it is too large for a hospital and too small for a state department of public health to deal with...

Three is organizational ethics. This describes how we create healthcare structures to address overarching issues, such as how a Catholic hospital would respond to an abortion scandal. Organizational ethics considers the larger scene.

Cue my brain aneurysm...

I have three hats I wear at work: Hospital operations (getting things done), process improvement (via Lean), and clinical ethics for those ethical fires needing specific action and decision-making. My three hats seem disparate and unrelated. I can weave a little bit of Lean into hospital ops, but it is a tough sell some days.

It dawned on me that my life's vision is to advance Point #2 above, research ethics. It just so happens that my three worlds intersect nicely and ethics serves as the underpinning of everything I do at work. I lead the PI teams because it's the right thing for our patients. I reorganization hospital ops because it positions us to better serve out patients. Our moral values and ethical principles guide everything we do in the hospital walls.

Wow. My head spun. I wanted to shout from the rooftops, that I was finally able to name my life's passion! That one conversation helped me articulate what I've been trying to do for the last three years.

So not only did Bill give me time out of his day, help me articulate my life's passion, and send me three of his most recent articles to peruse at my pleasure, he offered to mentor me in the field of healthcare ethics. People pay this guy to speak at national events and conferences and he has umpteen honorary doctorates and *I* get an hour once a month? Unreal.

He said he was "selfishly wanting to mentor someone, to pass along his info." Fine. Twist my arm!

After I calmed down from that celebration, EVOO came into my office and asked if I would help lead a $3M consolidation effort to streamline the ancillaries so things are better for the patients.

To which I answered, "Bring it on! It's the right thing to do!"