A Letter to the Administration of Providence Southfield and Providence Park Hospitals in Novi, MI and Dr. Lago/PSJ Anesthesia:

Your jobs are complex and I believe that you, like the rest of us, want to do a good job. The affordable care act has admittedly made us all a little crazy as we look for new ways to address bottomline vulnerabilities created by the shift to value based healthcare. But nationwide, in an attempt to not financially sink the ship, it appears that far too many healthcare organizations, including yours, have repeatedly dropped the same balls in the name of effective fiscal leadership.

Fear and intimidation

There is evidence that effective communication and engagement can create a culture of change and innovation among workers. Unfortunately, “my way or the highway,” continues to be the mantra of the leader with a myopic and underdeveloped personal philosophy. The main leadership strategy for this individual is fear and intimidation. While initially successful as a tactic, two conditions must be in place for it to be sustainable in maintaining the status quo. The first is isolation of people through censorship and the banning of social media. And second, encouraging the belief that there is nothing anyone can do, thereby reinforcing the age old phenomena of learned helplessness.

By now, many are aware of the social media firestorm created on professional platforms in response to the less than stellar roll out of the plan to outsource anesthesia services at Providence and Providence Park hospitals in Michigan. Altogether, 68 of 74 certified registered nurse anesthetists (CRNAs) stood together in rejecting the contract. Knowing only one side of the story, I question, but cannot confirm, that this plan is necessary for the financial optimization of the organization. It appears though, that because of the low expectations you and your team set for the CRNAs (a.k.a. #Michigan 68, #MI68), your surprise deal backfired. What is even more obvious is that you underestimated how quickly 68 astute CRNA’s could mobilize and garner attention and financial support for their cause from around the country. So here we all are. A 68 CRNA problem has become a 15,000+ CRNA problem.

Costs are everywhere

The hidden costs of poor leadership are many, with results that inversly correlate with low HCAHPS scores. In the clinical, as well as the administrative setting, it is false to assume that a set of rules, a script, and in your case, a contract can substitute for communication. In healthcare, dispensing with the old way of leading that blindly puts profit before people is necessary if we are to move forward and stop the race to the bottom.

Some years ago I had a medical director tell me that as a CRNA, I should know that I have no power. I was in shock and didn’t have 68 powerful CRNA’s backing me when I lost my contract at that time. I resolved, however, to educate myself as a leader so that if I ever came across this commoditization of myself or any of my colleagues again I would not be silent.

So as you strategize, consider that the CRNAs and other frontline workers represent more than just an expenditure or a line item on a P&L statement. Their care and development will strengthen your bottomline in ways you may never have imagined. Value based leadership leads to value based healthcare. You can undo the damage of low expectations and poor leadership in this case by getting in front of this story and leading with courage. We are all watching.


Meryl Williamson, CRNA