Foreword

Think back to the last time you were really sick. Perhaps you had a high fever and cough, or severe abdominal pain and vomiting, or you were in a car accident. Remember that feeling of vulnerability, of fear, of not being sure what to do or what would happen to you.

At the moments when we are sick, we desperately need a health system that is both competent and caring, that is armed with today’s medical knowledge but that also treats us with kindness and respect. It needs to speak our language, understand our spiritual natures, and respect our family structures.

I remember when I was hit by a car and had a broken leg and spent a day at a fine health center, where I was well treated by the doctors and the nurses, until I hobbled on crutches to where I was to have my pre-op labs. As I walked in the door and smiled at the receptionist, she said in a harsh voice, “You know we are closed 12 to 1 p.m. for lunch.” It was such a trivial thing, but upset by the car accident, fearful of the upcoming surgery, tired from using the crutches, I sat down feeling so sad and defeated in the waiting room.

Of course, everyone needs a lunch break. Were I running that system, I may have suggested staggering lunch breaks, but that really wasn’t the issue: I was just overwhelmed. Had she just said, “I’m so sorry, you will have to sit and wait an hour because the nurses are at lunch,” I would have been fine. But when we are sick or injured, we lack the reserve that buffers us from unkind words at other moments.

That’s why this book is so important. For our healthcare system to meet our needs, we must engage, promote, support, and inspire the frontline workers—the nurses, the doctors, the pharmacists, the phlebotomists, the physician assistants, the receptionists, the aides, the security guards, and the environmental staff—to care for our patients. They are the ones providing the care. They are the ones who know what changes are necessary in order to improve care. Everyone else should be eliciting their ideas and supporting their efforts.

Two major supporters—the unions who represent workers and the administrators of the hospitals—are often mistakenly at odds with one another despite sharing a common goal: high-quality healthcare. This goal can be achieved only though respecting and listening to employees.

I have had the good fortune in the cities where I have worked— San Francisco, Los Angeles, and now New York City—to partner with enlightened labor leaders and hospital administrative colleagues to improve the healthcare for public hospital patients. Although the localities vary, the important ingredients of this work, well-illustrated in this book, consist of engaging frontline workers and collaborating, with an open heart and shared-power paradigm, with labor leaders and others who genuinely care how to make healthcare both competent and kind.

I hope that as you read this book, you will not only learn the successful techniques of engaging and supporting frontline staff but also be inspired to improve healthcare wherever you work.

Mitchell H. Katz, MD
CEO and president, NYC Health + Hospitals

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