With all due respect to the Pentagon, humankind has not invented a more complex organization than the modern academic medical center. The combination of high tech and high touch, the Byzantine regulations, the toxic medico-legal environment, the extraordinary pace of change…. Well, you get the idea. But the most daunting challenges stem from ...

One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations? A few moments ago in the on-line version of the New England Journal of Medicine, two of the Biggest Kahunas in the safety and quality worlds – the ...

This is an amazing tale of leadership – by my hospital CEO, our former chancellor, and, most importantly, a remarkable philanthropist. I’ll start with the latter, veer off to describe the former two, and then return, on this special day, to the philanthropist. The first time I met Marc Benioff – in 2007 – he was not a happy guy. A adult relative ...

Paul Levy, the blogging CEO of Boston’s Beth Israel Deaconess Medical Center, found himself in hot water last month over an inappropriate relationship with a female subordinate. While some of the details of the transgression remain sketchy, I think I now know enough to opine on it. To my mind, Paul has been an extraordinary healthcare leader, and ...

I vividly recall attending a faculty meeting at San Francisco General Hospital in the mid-1990s, soon after I joined the UCSF faculty. Our late, great chief of medicine Merle Sande was chronicling all the recent and predicted changes in the healthcare landscape: managed care, more transparency, new regulations, and more. The meeting turned glum; ...

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were ...

One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.” Say ...

One of the great joys of a life in academic medicine is the opportunity to work with lots of very smart people. But one regret is that there is something about academia that tends to homogenize – faculty learn that, when it comes to competing for the next grant or promotion, it pays to be clever but relatively conventional. Sure, innovation is the ...

From Tokyo, I flew on to Singapore, where I had the honor of being visiting professor at the massive (1500-bed) Singapore General Hospital, a guest of Dr. Kheng Hock Lee. Kheng Hock, one of Singapore’s leading family physicians, has been charged with developing Singapore’s hospitalist program. Having last been to Singapore 20 years ago, many ...

In a little over a decade, the field of hospital medicine has achieved most of the milestones that characterize a specialty: the field is the fastest growing specialty in medical history, it has achieved wide recognition and acceptance, and there are textbooks, journals, conferences (including my 13th annual CME conference in SF beginning ...