Monday, December 2, 2013

Part One of an interview series with Gedy Barnes

July 2013

An interview with Gedy Barnes, Director, Creative Medical Advisory Office, Our Lady of Rejected Saints Hospital

It’s cooler today than it has been the past few. The respite is palpable. This afternoon I’m interviewing Gedy Barnes, the Director of the Creative Medical Advisory Office (CMAO) at Our Lady of Rejected Saints Hospital in Northcrest, Texas.

Q: Gedy Barnes, author, administrator, and father of what is considered in many circles to be the future of medical service delivery, welcome!
GB: It’s good to be here, Quatro.
Q: So nice to see you again. One note, my name is Quarto, not quatro.
GB: Did you change it?
Q: Do you remember that kid named Quarto that you insisted on calling “quatro” all through junior high?
GB: Of course, I wonder what came of that fellow-- so dour.
Q: So, Mr. Barnes: Creative Medical Advisory, what is it?
GB: It’s an experiment, first and foremost. I've always had a keen interest in hospital administration. Yes, the hospital provides health care, but it’s also a business. My intent in this project was to bring a synergy to the two. I was thrilled when, three years ago, OLoRS accepted my proposal and I opened the Creative Medical Advisory Office on campus. 
Q: What does the synergy of business and medicine mean to you?
GB: It’s easy to see the institution, brick and mortar, monolithic. A person gets sick, is admitted, gets well, or not, then receives a bill for experience; but it’s more nuanced than all that. 
Q: Sure, looking at the bill I received from the hospital after my daughter was born, it’s obviously more nuanced that that, but where’s the synergy?
GB: Okay, there’s a tendency to think of it as a revenue generating, profit creating machine. Let me correct that perception and say this, and it’s very important, the CMAO was never about maximizing profits for the business concerns of the hospital. The CMAO was about looking at individual cases, patients if you will, and maximizing their opportunity for care through the CMAO programs.
Q: Okay, can you walk me through a case?
GB: There are certain patient confidentiality issues that preclude those specific discussions, but let’s take one of our programs, “Smiles for the Terminal Miles”. Through “Smiles” as we liked to call it, the hospital was able to offer orthodontic and cosmetic dental procedures to a range of non-traditional patients.
Imagine for a moment, you wake from a ten year coma to find your children grown, your wife remarried, and your body an atrophied wreck. But hold on a minute! As you’re being rolled onto your side by an orderly for yet another humiliating sponge bath, you catch your reflection in the mirror, and BAM!, two rows of gleaming pearly whites, straightened and veneered, just waiting to share your next adventure.
A simple example, but before CMAO, it was an impossible example. You can see the win-win right there. Of course we aren't advocating a coma for a stubborn bicuspid that just won’t turn-- but if the opportunity is there?
Q: I want to move on a little and explore your role as director of the CMAO. Can you give us a snapshot?
GB: When you really drill down on the point, I’m an idea guy. My degrees are in social science, not medicine, but I always saw that as an advantage. The hospital is filled with physicians, what I do is bring that outside perspective to maximize those opportunities for patients to receive the care they deserve. My pen cuts on a different angle from a surgeon’s scalpel.
More to your point though, my day usually begins with a review of the previous night’s developments… intakes, evolution of current cases. I like to get ahead of things, so I’m always thinking down-line, which gets us back to the core of what I do anyway.  On Mondays and Fridays, I buy coffee for my staff and we just relax and talk about anything except work. It’s gotten to be something of a tradition and one of those little things we all look forward to. 
Q: A few times you mentioned that you see yourself as an idea guy. What does that look like in practice?
GB: So often it’s the convergence of circumstances that creates new doors. I’m the one who recognizes those and tries the knob.
Q: Can you elaborate on that a little bit? Maybe take us through a particular, inception to implementation?
GB: Of course! Let’s step back a few years to the beginning of the project. Like many older facilities, OLoRS was designed to house two patients per room, with these assignments generally made ad hoc. Well, prima facie, it seemed that we could put a finer point on that and add some value to the operation, but we were all stymied and put it aside.
Well, a year later, I was out on rounds supervising a group of foreign interns when we walked through the doorway of room 638. That was the first act in a revolution in the way we delivered patient care.
[Barnes pauses for a moment and looks out of the window. There’s a mockingbird frolicking in a concrete birdbath. Even though the heat has abated, the freshly coated asphalt is too warm for the tiny bird’s delicate feet]
GB: That sums it up, right there!
[Barnes nods toward the window]
GB: In room 638 I found a patient, let’s call him Ted. Ted was suffering from some sort of kidney failure. A few feet away lay a man recovering, as nearly as I could discern, from some type of head injury-- recovering with a complete set of veneers I’ll add. The staff had nicknamed him “Chompers” because he kept biting his feeding tube in half. No one could get near his head without risking a finger, so they finally came up with the idea to… I’m getting off point here.
So there I was, standing between a rapidly yellowing Ted and old Chompers, when it hit me. Ted needs some dialysis and Chompers could use some company. Boom! The “Gemini Healing” concept was born.
Q: How did that work out exactly?
GB: Well, the medical esotery would bore, and frankly, it’s none of my business, but in this case, old Chompers had a skull full of mush and some spare capacity in the old renal system, so I said, “Let’s get these two together on something.”
Like I said earlier, it’s a convergence of circumstances and taking that brave step. All the rest is just tubes and wires to me.  I don’t practice medicine; I just provide creative advisement to our health care system.
Q: Looking back, what’s been CMAO’s biggest challenge?
GB: Tough question! You know, in the moment, everything new carries that “most” quality, especially when you take the temporality out of things and look at them on a plane. I think when I first proposed the idea that we take a more plastic view of death than what was traditionally accepted, it took us right to the brink. It’s a tough concept to embrace medically, but from a business perspective, it’s just right there. There’s that synergy I mentioned earlier.
Q: Let’s flesh that out a little bit. I’m familiar with your work and I know you've refused to name this program out respect for its gravitas, but I wonder if you could…
[I know I’m walking a fine line here. Asking Barnes to explain here could set the wrong tone, so I use the hum of vagary and a begging gesture to elicit a response.]
GB: I want to be precise in the concept but vague in the details. What I’m about to describe is the foundation of our institutional practice. But first, let me ask you this, “What is death?” Did you imagine a clinical sort of death, cessation of breathing, heartbeat, brain activity? What if you were running a business? If a person stopped doing business with your company, wouldn't you consider that relationship dead? If the business collapsed, bankrupt, isn't it dead?
I’m asking you to consider these questions because their answers are essential to understanding this point. The synergy between medicine and business lies directly in the intersections of your answers to these questions. We've taken the brave step and applied those answers.
We have both a doctor/patient relationship and business/client relationship with each case in our facility. Each side of that relationship supports the other. There’s a balance there, of course, we explore the limits of that balance. That’s what I mean by a plastic definition of death-- how far can one side lean to support the other. I think to carry that out further would be flirting with vulgarity.
Q: Well… the hour grows late. I hope your schedule doesn't preclude another meeting. I've read your journal article, “Abbreviated Digestion, a Solution for Institutional Foodservice”. It would make a fascinating roundtable discussion.

[Barnes is clearly exhausted. He nods, and we stand to shake hands. I stood for several minutes after he left studying the little mockingbird bathing outside the window. If it doesn't rain soon, even that water will be too hot for its delicate feet.]

After this interview, Mr. Barnes contacted me with a request. He asked that I hold off on publishing the interview for a few months. The fact that he gave no reason for this request piqued my interest. I didn't make any further inquiries and indulged us both with the delay in publication.

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