Immersion Day-A Truly Fabulous Idea for Boards and Executive Leaders

Immersion Day-A Truly
Fabulous Idea for Boards and Executive Leaders

By

Leonard Zwelling

         In the March 31 issue of the New England Journal of Medicine, Drs. Richard Bock and Ronald
Paulus describe an action they took at the Mission Health system in Ashville,
NC to educate their board about what it is doctors actually do. They put the
board in scrubs and took them into the OR. What a concept!

http://www.nejm.org/doi/full/10.1056/NEJMp1600068

         Since 2013, they have led a group of board members and now
legislators upon whom their system depends, into the real world of medical
care, on hospital floors, emergency departments, operating rooms, and
encounters with real patients and with the electronic medical record. This is
an idea whose time has come for all health care provision institutions.

         As a prior faculty member, physician, basic researcher,
research administrator, congressional staffer, and chief medical officer at a
federally-qualified health clinic, I was always impressed with how much I
didn’t know about an activity I had claimed previously to understand. Every
time I took on a new task, usually one that I had observed being done at a
distance before it was mine to do, I was shocked how ignorant I was about the
day-to-day activities of the new job I had thought I understood from my
previous vantage point.

         When I was a clinician, I couldn’t imagine what those lab
jockeys did all day. Once I had my own lab and funding became critical, I
learned what grant writing was all about.

As
a new research administrator, I had many faculty members graciously teaching me
about the difficulties in performing clinical research. They greatly influenced
my decisions and the construct of the processes my office devised to try to
meet their everyday needs while staying in compliance with federal code.

         When I got to Capitol Hill, I rapidly learned that all that
nonsense they taught us in Civics class about how the government works was
indeed nonsense and that I had entered into a full contact battlefield of
political heavyweights. My survival depended on staying out of the way of the
career staffers who would kill one another over the language of an amendment in
a bill. I got out of there fast and remarkably in one piece. My book is proof
that I lived to tell about it—barely.

         When I got to Legacy, I learned fairly quickly that the
problems I thought I had escaped by leaving academia were rampant in the community
and government sectors as well. Leaders had no idea what the doctors did and
could not care less about it. Their focus was the bottom line. Sound familiar?

         That’s why Immersion Day is such a good idea. This is not a
“walkabout” where a President visits a clinic and dishes out attaboys and
attagirls to the staff. This is getting right in the face of cancer and
cancer’s trail of blood, grief, and death. I think the Pickens crowd, the Board
of Visitors, the Board of Regents, and especially the non-physician Chancellor
ought to don scrubs and spend a day or two with the MD Anderson faculty. Then
reassess. What a concept!

         What they will find is an even more dedicated group of
faculty than they imagined, coping with processes and systems built by folks
who have no idea what it is they are trying to do and have expressed no
interest in learning either.

If
the Chancellor and the Board of Regents do indeed find what I suspect they
will, the onus must then shift to them to make the appropriate adjustments. And
they cannot say they didn’t know any longer! And if the Board of Visitors
continues to settle for the annual dog and pony show as a substitute for
Immersion Day, then shame on them. If they don’t stand for something, they will
fall for anything. Thus far, they have.