Beth Israel Deaconess Medical Center CEO Paul Levy is not a traditional manager.
“In March, we discovered we would be $20 million in the hole on this fiscal year’s budget (ending September 30th),” Levy says today. “I could have laid off 600, but thought there had to be a better way to reduce costs without having to lay off people. I sent out an e-mail note explaining the situation, holding town meetings, asking for suggestions, (to) protect the low income workers. It was a multi-faceted adventure; e-mails. town meetings, chat rooms and blogs.”
Most CEOs would look at how they could cut staff to meet the budget shortfall. They would focus on budget issues with their CFO, and maybe a few other C-level managers. They would come to a decision or a plan on how to deal with this crisis and then would let the medical center staff know of their decision. This is the typical way these issues are dealt with, and they often pit the staff against management, when it might be better to have both groups working for the same goal.
Beth Israel’s budget shortfall would mean the layoff of almost 600 people in a normal hospital, but Levy believed there might be a better way and he sent out an e-mail note to everyone in the hospital explaining the situation and asking for their help. He was both transparent and public about the problem. He held town meetings (300 people meeting face-to-face) and asked for suggestions that might help protect low-income workers. He also supported chat rooms and people blogging about their feelings, frustrations and solutions.
Participation was spectacular. More than 2000 people showed up at the town hall meetings, and there were over 2700 suggestions, including some on Facebook.
A Huge Undertaking
As the teaching hospital for the Harvard Medical School, Beth Israel is one of the world’s leading medical teaching institutions. The facility spans 3 million square feet and deals with 40,000 in-patients, 40,000 emergency room visits and 500,000 out-patients each year. There is a staff of 6,000 full-time employees and an additional 800 doctors who are not employees.
Levy is much more transparent than most of his Baby-Boomer contemporaries. In August, 2006, he started an external blog about “Running a Hospital” (http://runningahospital.blogspot.com/). He started writing about some of the process improvement work at the hospital and actually ended up publishing clinical data.
One of the things Levy soon found out about being so transparent on a blog, was that the blog was a very good internal management tool. Many of the key people at Beth Israel were reading the blog, and the staff also had some pride in not only that the blog was public, but also in the data that was published, as it served to hold them more accountable for their process improvements.
Levy then started to use the hospital Website (www.bidmc.org/) in a similar way. He started writing blogs about patient safety and quality of treatment. He seriously discussed the problem of eliminating harm to patients. (People dying in hospitals is the fourth-highest ranked public health hazard in U.S.) By doing this, Levy was allowing the world to see where Beth Israel stood relative to its goals and targets on these issues for the whole hospital.
Levy sent out a second e-mail and got 800 more suggestions. The third and final e-mail was sent out with the new budget plan, and even that got 100 more responses. The hospital ended up implementing many of the suggestions, and in the end only laid off 70 people instead of 600.
“In March, we discovered we would be $20 million in the hole on this fiscal year’s budget (ending September 30th),” Levy says today. “I could have laid off 600, but thought there had to be a better way to reduce costs without having to lay off people. I sent out an e-mail note explaining the situation, holding town meetings, suggestions, and protect the low income workers. It was a multi-faceted adventure, e-mails, town meetings (f2F-300 people at a time), chat rooms and blog.”
Participation was spectacular. On April 3 of this year, there was a blog about PBS covering this story. Two thousand employees showed up at town meetings. Levy received 2700 suggestions (including on Facebook). After his second e-mail, he received 800 more suggestions. The final e-mail — which included a new budget plan — received 100 more responses.
Past, Future Technologies
Before Levy started blogging, the hospital used pretty traditional Web 1.0 technologies including Microsoft Outlook/Exchange. But it didn’t use instant messaging, Web conferencing or online team spaces — although some of the recent residents (doctors in training) did set up an online community site for themselves, but it is not something the hospital monitors or moderates.
Levy, at the top of the organization, championed these technologies, which are fairly simple and low cost (only people time, no real capital outlays for software). There was some time involved for people to evaluate some of the suggestions (ideas) for their legality and practicality, and there was some administrative work done with the Human Resources Department, but those were the only costs.
The overall goal was to avoid layoffs and find a better solution to the budget problem. The process was experimental, but it worked out so well that Levy is not sure he would do anything differently if he had to do it again. The initiative has started to expand, especially inside the hospital, and was supported by CIO John Holomka, so that there are now regular online chats with doctors. The hospital also is considering deploying some of these technologies outside the firewall to the hospital value network (suppliers, patients and regulatory agencies).
Other hospitals are beginning to follow Levy’s lead. The Mayo Clinic has started a program to reach out online to its patients and prospective patients and creating a social network where patients can not only talk with other patients, but also with the clinic doctors and other medical staff.