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“True” Life and Death Decision Making – More Complex Than You Think

Date: Mar 24, 2020 @ 05:00 AM

As commercial finance professionals, we are adept at providing millions, and sometimes billions, of dollars of financing to borrowers of all types and sizes. Our industry is comprised of wicked smart and successful people who are at the top of their professions.
 
That same constituency somewhat naively believes that the decisions they make are as important as life and death decisions. To an extent that may be true, but from a more realistic perspective, keep in mind that we are talking about financial transactions. Such perspectives about financial transactions may change when a person has been exposed to a true life or death situation – where decisions need to be made in a split second, and the outcomes have could have dramatic and far reaching impacts – truly life or death consequences.

For the past fourteen months I have been the interim Chief Financial Officer at the largest safety net hospital in Washington, DC. Late in January 2020, while city workers were doing work on the street outside the hospital, they accidently ruptured a gas line. The smell of gas was permeating the entire building.

You could feel the tension starting to rise inside the hospital. Within minutes, the hospital’s Emergency Team was assembled at the Command Center under a “Code Red” … yes, there really is such a thing as a Code Red. This included leaders of the Clinical Teams, Security, Hospital Administration, University Administration, and Public Relations and Communications.

All in, there were approximately 1,000 people that needed to be accounted for, including 160 patients, their families and visitors, hospital staff, medical student residents, employees, lab technicians and many more. Some of the most critical issues to address in this crisis included:

  • Has everyone been accounted for?
  • Have the elevators been cleared?
  • Where should the patients be moved to?
  • Are security personnel positioned at all entrances? Given the prominence of social media, pictures are not to be taken because pictures and postings of misinformation could create obvious and unwanted chaos. Keeping control of the media is also very important.
  • Have all pharmaceuticals been accounted for and locked down?
  • Where is the central point for communications? In our case it was the Security Commander.
  • And much more!

Ultimately, the focus in such situations must be on two critical issues:

  • Preserving all lives, and
  • Being prepared to evacuate the hospital and checking with other hospitals for available bed capacity, just in case, as the ultimate preventive measure. On a lighter note, the definition of “evacuate” has much different meanings to Clinical People compared to everyone else.

Closing or winding down a hospital for financial reasons can be done in a planned and organized manner, but under a Code Red, no such time exists.

Amazing Similarities Between the Clinical and Finance Worlds

While it isn’t quite the same, sometimes the finance world presents amazing similarities to what I have outline above.

Say a company is running out of or hemorrhaging cash. The entity has some amazing prospects and you need a team to believe in its value and “story.” The stakeholders have met with a litany of lenders – all having passed on the opportunity so save the company, except for one. The enterprise and its stakeholders are working diligently to interest or persuade the lender that it’s worth taking the chance on them. Stakeholders are also working to persuade the existing lender that the lender doesn’t want to be part of the reason hundreds or thousands of jobs could be lost in the community where the institution is fulfilling a mission critical community service. In its own way, a life and death situation with its own sustainable or non-sustainable pressures.

Enormous Pride, Passion and Preparation

What I find consistent in both cases is the enormous pride the parties possess. At the hospital each morning there is a “Safety Huddle” to prepare for just such emergencies. And in both cases working around the clock is not unheard of. Also, the enormous passion that the participants and leaders bring – doing everything in their power to ensure the best possible results and consider all the possibilities of their decisions.

As I participated as one of the executives at the Command Center during this crisis, one of the things that stood out the most was the humility of the players. Empathy goes without saying especially in mission-driven organizations such as hospitals. The humility demonstrated by the personnel and how they conducted themselves throughout the process and crisis was something that left a lasting impression on me and many others as we learned from numerous patients and regulatory organizations in the debriefing that occurred subsequent to the crisis.

Although we were well prepared for an evacuation, fortunately the hospital received the best words it could hear in a situation like this: “all clear” and ultimately evacuation was not necessary. In less than two hours, an outsider would have never realized anything was out of the ordinary. Again, a tribute to all the employees of the hospital.

A Final Thought

Pressures and stresses of everybody’s responsibilities are always all relative. In one of his books, Dale Carnegie described worrying as a self-fulfilling prophecy where one believes or worries that everyone is watching them or focusing on their actions, when the truth is, others are actually focused on their own issues and don’t care much about “you” or anything else. A common theme for the real world.

Having been in the middle of a true potential life and death crisis, and one that was thankfully well planned for and avoided, provides a deeper perspective into what is truly important and urgent, and redefines the definition of emergency and humility.
___________

Robert D. Katz, CTP, CPA, MBA
Managing Director | EisnerAmper LLP
Robert D. Katz, CTP, CPA, MBA is a Managing Director with EisnerAmper LLP in its Bankruptcy, Restructuring and Insolvency Group specializing in performance and cash flow improvement. He currently serves as the Interim Chief Financial Officer at a Washington, DC, Hospital and an Adjunct Professor at Temple University. He can be reached at Robert.Katz@eisneramper.com or (215) 738 – 5542.
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