"In the end, the CEO's ability to provide the environment in which professionals can perform at their highest level is where the CEO's credit or discredit lies. This is the dynamic that determines the ultimate economic success or failure of the hospital."

Hospital-running education does not end with a university diploma; it begins with the job. The university inculcates the importance of a profitable bottom line, but it cannot possibly teach future CEO's all the ways to get there, and it may not always distinguish those methods that are most compatible with quality service. Furthermore, successful CEO's inevitably find that there is a certain amount of bungee jumping involved, which is also neglected in their academic preparation.

An effective operation of the care delivery process has never been as essential and as difficult as it is today. All the passion and energy reserved for commitment to quality care must be accompanied by an equal, if not more aggressive, commitment to be financial integrity of the institution. A facility that does not sustain itself financially through sound fiscal management will cease to exist, and no one benefits. There must be a surplus, even if the facility is considered non-profit, for the expansion demanded by advancing technology, growing population and changing demographics. Furthermore, one must deliver increasingly better economic results. Achieving the reconciliation of excellent care and profitablity is a daunting responsibility. Most hospital CEO's, as cognizant as they must be of the hospital's need for strong financial management, also place a high value on patient care quality and on the needs of the community. They understand the difference between management and leadership. They want to acquire an insight into healing and understand what they must do differently when the product is service to the sick and injured. They understand that their most valuable resources are the human resources on their staff, and they want to facilitate excellence in these individuals. They would like to have their choice of the best of these professionals, and they would like for professionals to appreciate the importance of bottom line. This book supports those aspirations.

From the foreword: "We can create hospitals that will serve their patients well and at the same time retain the profitability necessary for growth and modernization. This is today's task for health professionals, executives, legislators and community leaders with integrity and courage."

Excerpts from Chapter 10, "Reconciling Power, Profit and Service"

One of the greatest afflictions of some of our hospitals is management from the top-level by intimidation, which naturally compels many CEO's to practice job safety, to avoid risk-taking so vital to success, failing to determine what are appropriate, even essential risks and what are not. Consequently, they themselves do not encourage, indeed they create no opportunities for, nurses and other caregivers to experiment and to demonstrate better methods with greater economic returns.

The courage to remain truly focused on the hospital's mission and to act on principle can be very difficult to muster. Fortunately, there are those for whom the opportunities, resources and power to produce change are so invigorating that the obstacles are welcome challenges.

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Each leader in today's health industry must look into their organization and find that small but crucial group of persons with a little courage. They are the persons with whom you will build the best health care facility at the best cost.