G.H. Lawrence & Associates Blog

I have a colleague who’s been stuck in Europe because of that pesky but massive ash cloud. He’s trying to get home to Raleigh, to return to his family but also to meet some important work deadlines. For a few days now, the ash has not cooperated. He and I currently are working together on a big project, so I have a vested interest in his safe, timely return. He’s trying to fly from Spain. Isn’t that where most of the first flights have started trickling in from? Who knows. I do know that of all the things that could delay a project for one of my favorite and highest-priority clients, I never would have guessed a volcanic ash cloud might be the thing. What a world. One final thought: When I cautioned my client that we might be running a little late, she asked a question I assumed was a joke. “Do you have a backup plan,” she asked, “in case the cloud lingers for a year or more like it did in the 1800s?” Uh no, I hadn’t gotten quite that far, I said. Then I chuckled. She didn’t respond in kind. Like I said, it’s a high-priority client. Come on, man, get on that plane!

I have a friend who like me is a consultant. (Heck, the Triangle is full these days of coffee houses where on any given morning you can’t swing a cat without knocking the latte out of a consultant’s grasp.) My friend does some work helping clients, often health care providers, improve their internal communications and management strategies. He knows I’ve had trouble with my aging bones lately — two knee surgeries in eight months etc. — and sought my assessment of the treatment I received at one particular medical practice. To preface, he told me he’d heard a lot of grumbling about this place, which enjoys a sky-high reputation but also is apparently getting some complaints about customer service. I told him I had one surgery there, but moved elsewhere for the second, more significant procedure because I wasn’t satisfied with, shall we say, certain aspects of my treatment at the first place. Would I write up an anonymous critique about my experiences, he asked? Sure, I said. When I finally started writing, it occurred to me what part of the problem was. Its roots are in a small, local practice founded decades ago. Today, while it’s crawling with excellent doctors and nurses, it also has become big business. Very big. Too big. It has multiple offices in multiple cities. Significantly, a few years ago they bought a failing, small specialty hospital in Durham; tore down the historic building; used the Certificate Of Need required by the state to operate it (too complicated, so don’t ask); and built a new version right next door to their own shiny headquarters across town. So nowadays they diagnose your injury, then literally trot you across the street to perform the surgery. I remember being a kid in Eastern North Carolina and virtually all the local doctors had their offices in small places within quick walking distance of the hospital. Most of these places at one time had been residences — small, modest wood frame houses the docs had rearranged for stitching cut knees, curing poison ivy and setting broken arms. But the location was for convenience; these docs didn’t own the damn hospital. The more I wrote my critique, the more I became angry — and confused. Big business. Bingo. And duh. Now the tough part: Will our new health care reform make it all just that much bigger, adding to the problems I described to my friend the consultant? In some ways, decidedly so. At the same time, of course, some believe reform will do the opposite by, as Bob Dylan might say, simply bringing it all back home. My stance on this issue has muddied considerably. At this stage, I’m embarrassed to say, I guess I’d settle for something in the middle.