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We must, indeed, all hang together, or most assuredly, we shall all hang separately. – Benjamin Franklin
Sometimes things go so unexpectedly well that it shakes a few bricks from the hod. Last week over 70 physicians representing Obstetrics/Gynecology, Internal Medicine, Surgery, and Family and Community Medicine gathered to share a meal and conversation around common ground.
Recently many providers have voiced concern that the physical and professional distance between the Duke Street and Women & Babies hospitals has strained both patient care and collegiality. An event was planned to connect, and out of respect for the physician’s time, many advocated for a formal agenda, Power Point presentations and CME credits.
Instead Dr. Beyer acknowledged and celebrated our shared heritage, and Dr. Addis reaffirmed a collective commitment to a system approach to patient care. Dr. Olt spoke eloquently about the challenge -- perhaps curse -- of the Obstetrics discipline, where expectations were uniformly high and anything less risked tragic consequences. When Dr. Riley queried the group, nearly three-quarters of the physicians acknowledged they had birth experiences at LGH/WBH.  It is hard to imagine a more common ground from which all supported moving forward.
Professional distance, even isolation, is not unique to Obstetrics and WBH. With Medical & Dental Staff growth (over 50 percent in 10 years) and increasing specialization, care venues now exist across the referral area, even extending beyond the county. Mario Moussa, in “The Art of Woo,” describes a critical influence zone of 150 feet. Beyond that distance, interaction and dialogue fade.  That was one of the determining factors of placement of the new Medical Staff offices. Despite electronic connections, distance challenges the empathic connection we gain from shared space. 
Specialization and growth also can threaten collegiality. Hospitalists, SNFists, Observationalists, Proceduralists and even Medical Homists contribute to patients’ perceptions of fragmented care and blur the professional line of sight for the care we deliver. In “The Tipping Point,” Malcolm Gladwell also cites the number 150, this time concerning organizational size, informational spread and culture in many industries, even the military. He concludes that groups larger than 150 members lose their cultural ties, fostering division, isolation, even alienation.
Gladwell used Gore & Associates, maker of GORE-TEX® materials, in Newark, Delaware, as an example. Gore maintains an entrepreneurial and innovative culture by structuring its divisions based on the 150 rules: 150 members within an easily accessible, well-defined space. Gore is consistently ranked as one of the best companies to work for, sustaining growth and margins while limiting turnover to one-third the industry average. Laudable and culture driven.
Jon Meacham, in his book “Thomas Jefferson: The Art of Power,” writes about Jefferson’s use of dinner engagements to help soften difficult conversations. At a time when contentious factions debated consolidation and dispersion of power, Jefferson used a shared meal to make disagreements less disagreeable and fostered relationships for future endeavors. We did not shape the nation with last week’s dinner, but there was consensus about future educational events, including care standardization, our relationship with Penn and provider satisfaction. We had begun to close the physical professional distances.
Many believe that performance stems from culture, which in turn reflects leadership. Others believe simple acts and behaviors, shared through stories that stick over time, shape culture and influence leadership. I am not sure after all it was just dinner, but it will be a story I feel privileged to share.


Lee M. Duke II, M.D.
Chief Physician Executive
Progress Notes' Editor-in-Chief


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