Children's Hospital at Erlanger Chief Medical Officer Dr. Alan Kohrt signs the wall during a Topping Out ceremony at the Children's Outpatient Center at Erlanger on Thursday, Nov. 9, 2017 in Chattanooga, Tenn. The Topping Out ceremony is a traditional builder's milestone, signifying that the final beam is put into place. The outpatient center is set to open in December 2018.

I'm not sure most patients can name the new CEO of Erlanger Health System.

Or the old one.

Or even really care.

If you're being rushed to surgery or delivery or emergency rooms — or your loved one is — then you have other things on your mind.

Is this hospital clean? And safe?

Is my nurse compassionate and prepared? Is my doctor rested and supported?

Or are they exhausted, ignored and frustrated?

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David Cook

During moments like that, Erlanger's executive offices and board rooms may as well be a million miles away.

It is the bedside — not the board room-side — that matters most.

Perhaps that's why former CEO Kevin Spiegel's gone.

Erlanger seemed to have become two hospitals.

A hospital for salaried executives.

And another hospital for patients, nurses and doctors.

Not long ago, it was easier to understand Erlanger. It took about seven words.

Erlanger was losing money. Tons of it.

Between 2011 and 2013, the hospital lost some $32 million.

Then came Kevin Spiegel, the dynamic CEO from Memphis.

Erlanger grew into the nation's 10th largest public hospital system, fourth largest stroke program and seventh busiest emergency department.

The hospital began making money while becoming the largest employer in the city. Erlanger East expanded. A campaign began to build a new children's hospital.

Marketing campaigns rebranded Erlanger away from its moral obligation to help the indigent poor into a powerhouse hospital known nationally.

So what went wrong?

Apparently, as Erlanger stopped losing money, it began losing something else.




In May, top hospital physicians declared a "no confidence" vote in the "structure of the current Executive Leadership."

"Despite over 3 years of complaints and concerns by patients and physicians, hospital management has been ineffective in addressing these issues. There exists a lack of accountability in senior management who are either unable or unwilling to effect necessary changes to insure patient safety," members of the Medical Executive Committee wrote to the board.

Soon after that, the hospital's vice president of patient safety and quality resigned.

This suggests a two-hospital disconnect. While physicians were pleading for more attention to patient safety, the board was making Spiegel the Million Dollar Man, literally — his salary was more than $900,000.

"It crushes team spirit and is completely disheartening for the nurses and other foot soldiers to hear about his big fat bonus in the years when times are too tight for us to get any raise at all," one nurse said to me last week.

See? Two hospitals.

One at the executive level.

Another on the ground floor.

On Wednesday, the board selected a new CEO — Dr. William Jackson, the hospital's chief medical officer — only a week after Spiegel's departure. A week. Kidney stones take longer to pass.

Realistically, Jackson won't be here that long. The board gave him a one-year contract, but even if they extend it, national research shows that the average tenure for hospital CEOs is around five years.

Theoretically, Jackson will be gone by 2024.

And all this will start over again.

Last week, I heard from a friend who's a well-known doctor in Chattanooga.

He has some advice for the new CEO.

"Lock the doors," he wrote.

Once a week, lock all the executive office doors. Don't spend your day there. For the next 10 hours, walk through patient rooms. Shadow nurses. Observe doctors. Get to know the people who keep Erlanger alive.

Listen to them.

Support them.

"The knowledge of any institution resides on the shop floor," he writes.

What is the emotional state of your nursing staff? Do they feel supported by administration? Are they overworked and underpaid?

"The nurse or physician watching this unfold on television has to wonder why these individuals, some with 7 figure salaries, who never stand at a patient bedside, continue to preside over rudderless ships with discontented crew members," he wrote.

He mentioned studies that suggest if nurses and doctors are tired and poorly supported — if their emotional state is exasperated — then, despite best efforts, such frustration can translate into reduced patient care. How could it not?

"Actively work to cultivate a culture of gratitude," the doctor wrote.

As the new CEO, Jackson should return to the hospital's roots, which is always the intimate and crucial moment of care between patient and nurse, technicians and doctors. Bedside. Not board-side.

What if Erlanger's new announced goal was the most supported nursing staff in the nation? Or the safest hospital? Or a model of open communication — and, when needed, criticism — between doctors and executives?

"This I suggest would serve as the basis of a deep well out of which could flow the cool waters of healing," this doctor said, "benefiting the well-being of all Hamilton County residents."

David Cook writes a Sunday column and can be reached at