PHOENIX— It's possible, Michael Frisina postulated, that when your hospital developed its strategic plan for the coming year, it actually validated a policy that said a certain percentage of your patients will be harmed. If zero errors aren't the goal, Frisina said during a keynote yesterday at the 25th Annual Rural Health Care Leadership Conference, then you're acknowledging that patients will be harmed.


"We say that patient care comes first and the patient is at the center of our care delivery," said Frisina, head of a self-named consulting firm and senior research scholar at The Center for Influential Leadership. "When are we really going to do that?"

Much like Bridget Duffy's presentation the day before, Frisina made the case that all too often our own behaviors stand in the way of us — and our organizations — from achieving more. His most critical assessment was aimed at the C-suite: Leaders set the tone. Their behavior will determine whether an organization strives for high-performance and compassionate care.

Influential leaders, he said, understand why people are doing what they do and whether that behavior can be made more effective to drive performance. He offered this small anecdote: While on assignment at a hospital, he asked a janitor what his job was.

"I take out the trash," said the janitor, who had a learning disability.

"No," Frisina told him, "you don't just take out the trash, you prevent infections."

The janitor happened to be excellent at his job and was eventually given an honor by the new head of environmental services — the first person on staff to receive the award. He was thrilled. It was the first time anyone had recognized him for a job well done. It made a difference, Frisina said.

I think Frisina has a point. As he noted, so many people in health care — really, in any industry — go to work hanging their head. They want to do well, but are overwhelmed by the challenges that lie ahead and feel like they are constantly beating the heads against a wall. It's up to leaders to change that environment; or, as he said, to "align your behavior with your strategy to drive performance."

It's something that Casey Meza, CEO at St. Mary's/Clearwater Valley Hospital and Clinics seems to get. Meza gave a great presentation yesterday on how her facilities are using telemedicine for everything from psychiatry to geriatric care to pharmacy. Sure, the presentation was focused on the technical marvels that they've deployed, but there was another undercurrent — Meza's commitment to ensure that clinicians were put in an environment where they can succeed. It's a blending of behavior/culture and mission.

I'll have a final wrap up of the meeting in tomorrow's blog, including my interview with Tom Morris from the Office of Rural Health Policy.

Matthew Weinstock is senior editor of Hospitals & Health Networks. You can reach him at