Towels as Metaphors of Elitism: Dry Hands for the Execs; Damp Hands for the



     A story.

     There was a business that had moved into a
brand new facility. It was about 10 stories high and included factory space,
clerical pools, a computer floor and the top floor was the executive suite
(isn’t it always).

     A friend was working there and I went to
visit him a few times. He had been with the company for ten years and had
worked his way up to a vice presidency which, in the new building, got him to
the top floor even if not to a corner office.

     As it happens, I had used the restroom on
his floor several times and always found it immaculately clean and well
supplied with soap, toilet paper, facial tissue, hand sanitizer and paper
towels. Of course, there were the obligatory hot air hand dryers, but being
old-fashioned I tended toward soap, water and the paper towels and thought
nothing much of it.

     Recently, I had occasion to visit the other
floors in the building for business purposes. Unlike the restrooms on the top
floor, the ones on the other floors were open to the public. The top floor was
secured with badge entry only and security checkpoints for visitors. The
bathrooms were behind the checkpoints. This was not the case on the other

     After several business visits on the lower
floors, I began to note a strange pattern. The restrooms on the other floors
were not as clean as the ones on floor 10. They frequently had neither tissues
nor paper towels occasionally causing a waiting line for the one hand dryer.
After having observed this on several floors and on multiple appointments, I
raised the question with my friend the vice president.

     “I too have observed this,” he said. I have
chalked it up to the elite attitude of the executives on this floor. I have
noticed the custodial staff always visits our restrooms twice as frequently as those
on the other floors, sometimes coming every hour. They never allow supplies to
dwindle up here. On the other floors it’s a bit of let ‘em eat cake or let ‘em
use hot air. No paper towels for the masses.”

     I pursued this with him.

     “How has it been being a vice president
after all those years in the trenches?” I asked.

     “It’s fine. I can get a great deal done
within my own silo, but when I have to work with another vice president it is a
real challenge. You see the entire 1000-person organization is run by three
people and I am not one of them. The CEO keeps all decisions close to his chest
and trusts only his closest two advisors. He actually expresses some resentment at
times of the very people that allow him to make his big salary, those making
our products. 

“The rest of us in the leadership group usually
find out about things through the grape vine like everyone else. Essentially,
these three execs seem very entitled, and none of them knows a whole lot of
about the manufacturing or sales processes that keep us afloat.”

     This reminded me of a lesson from business

     During the course in Organizational Development
as well as the one in Strategic Planning, the aspects that make for successful
leadership were discussed. One school of thought has it, that a successful CEO
in one business can succeed in any business. 
I never bought it. Another school of thought advocates leadership by
people who really know their business from the ground up.

     This brings us to medicine.

     In most medical institutions, the major
revenue generator is patient care. It would seem then essential, if you favored
the second leadership paradigm as I do, that there ought to be real clinicians
involved in the strategy and operations of any medical entity delivering
patient care. Unfortunately, this is not often the case in academic medicine
with a gene cloning medical school dean (Director of Costs), a bean counting
head of the hospital and clinics (Director of Revenues) and a CEO trying to
guide all of this who may have come from either of the other two camps (Costs
vs. Revenues) or worse is a molecular biologist with an MBA from academia with real-world
expertise in neither cost nor revenue management.

     With such a model, the elite of the medical
organization resemble the elite of my friend’s company. They are powerful,
entitled and often clueless about the very product that gave them the corner
offices, the cool cars and the large salaries.

     How smart is that?

     My tendency is to wash my hands of all of
it, but I can’t find a paper towel in the public restroom that I am allowed to

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