Chicago Med fic: Redemption (2/8)
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
-o-
Getting settled was a nice idea, but when Will entered the hospital fully, he realized it was a bit of a fantasy. Will couldn’t get settled here -- because here wasn’t settled in the first place. Will had been in a lot of hospitals during his career, but this one was by far the least organized and well presented he’d ever seen. There was almost sheer chaos in the ED, and it wasn’t clear who was doing what. Patients seemed to be stuck in random corners of the hallway, and discarded equipment was stashed behind the desk. EDs could always feel a little grim just by default, but the poor lighting and drab decor were enough to make the place seem like one step up from a mortuary.
The rest of the hospital wasn’t much better. Mikayla took him the long way, in her words, allowing him to briefly tour each floor and department. The floor that looked the most like a hospital was the ICU and surgical wards, but those areas were so small that it hardly seemed to make a different. Poor staffing numbers, overcrowded exam areas, outdated equipment, crumbling infrastructure -- Will had read the file.
The file didn’t do it justice.
By the time they got to his office, Will was already feeling somewhat discouraged. Mikayla had a desk right outside, though it was nothing more than the end of a hallway.
His office, even by comparison, was unimpressive.
The area didn’t look like an office. It looked a bit more like a glorified closet. Small and cramped, there was a desk with a chair sitting in front of a dingy window. The view overlooked an alley and nothing more. There were two pairs of filing cabinets crowded on the back wall, and a small bookshelf near the door was flanked by a pair of actual folding chairs for guests.
The worst part was that this was the office for the chief of staff. If this was the best the hospital had to offer, then Will had sorely underestimated just how bad the situation on the ground here was.
Of course, Will could just be dramatic about this. Yes, it wasn’t an overly encouraging sign, but the value of a hospital wasn’t in superficial measures. The size of his office didn’t even matter. What mattered was how well they were treating patients.
And, to a lesser extent, if they were staying solvent.
He still had a few hours before his meetings were slated to begin, so Will started in on his more detailed assessment of the hospital’s finances and turnover rate -- for patients and staff. There was a computer, but Mikayla said that his electronic credentials hadn’t been updated yet. Besides, she told him helpfully, everything he would need was in the filing cabinets already.
Will turned to the cabinets.
A paper trail.
It seemed rather quaint after all his time using advanced technology.
Quaint could still be effective.
Or so he hoped as he opened the first drawer and got to work.
-o-
The good news was that the files were in order. In fact, they were surprisingly well organized for the state of disarray he’d seen throughout the facility in his short time there.
The bad news was that what they showed wasn’t any more encouraging than the numbers he’d skimmed when he took the offer. Their operations were underwater on every level, with the ED burning through half of the hospital’s budget in a month.
Worse, the need for updates was everywhere. He’d read the hospital’s specs when he’d taken the position, but he found that those were optimistic assessments. Sure, the hospital had two MRI machines, but only one was working. The other one required so much electricity that it could only be run every other day.
The story was much the same in every category.
This hospital wasn’t just a lost cause.
This hospital was the most lost cause he’d ever seen. If Dr. Wexler and Dr. Ho had seen the actual performance numbers in real time, they would have likely shut it down on the spot. And what was Will’s purpose here? To drive a sinking ship into the ground? To pilot the Titanic straight into an iceberg?
It was sobering, to say the least, but Will tried to comfort himself with the fact that good medicine didn’t always coincide with cutting edge technology or posh facilities. He’d worked at a rundown hospital with Adam and a state of the art one with Dr. Dunst. Despite the differences, both hospitals had been vibrant and effective.
Things could still be salvaged if the staff was on board.
He held his optimistic view for as long as he could.
Until he started to actually interact with the staff.
Then he realized just how daunting this task was.
The plan had been to meet with each department head in a personal, one-on-one session. Will would get to know them and their specialty, and then he would get an accurate assessment of their department’s position and needs.
Each of them came in, one after another, and told him the same story.
They were overworked, they were understaffed. They didn’t have time, money, equipment, training -- you name it. They didn’t have anything they needed for success. Two of them started crying, right then and there. One tried to tender his resignation. Other departments just didn’t exist, and the head of pediatrics all but laughed at him when he said it would be a pleasure to work with him.
“Sure,” the man said as he simpered roundly. “We’ll see if you last the month.”
So, needless to say, things were off to a stellar start.
-o-
Will was feeling more than a little discouraged, needless to say. But then, Mikayla poked her head in. “We have one more,” she said. “You think you’re up for it?”
Will felt like he’d been beaten up and shot -- again.
But this was the job.
He sighed.
“Sure,” he said. “Who is it this time?”
Mikayla glanced at her notes. “Dr. Helena Barringer,” she said. “Head of Surgery.”
“Okay, then,” he said, rocking back in his chair and steeling himself. “Send her in.”
-o-
Compared to the rest of his makeshift senior staff, Helena Barringer looked moderately put together. She had long dirty blonde hair that was thick with texture. It didn’t quite curl, but it had had an unruly flair to it. She seemed to cope by binding it back in a ponytail, which had the effect of making her look just slightly girlish.
For a brief second, she didn’t look experienced enough to be the head of his surgical department, but she comported herself with a ready confidence that quickly dissuaded him of that notion. In fact, from a simple greeting, he could quickly tell that Dr. Barringer was the most self possessed and competent member of his staff.
It was a purely superficial assessment, of course. He knew that.
But it was up to her to prove him wrong.
“Dr. Barringer,” he said, standing up and reaching his hand out. “Head of Surgery, right?”
She shook his hand. “Yes,” she said, and her accent was heavily British. “And you’re Dr.--?”
“Halstead,” he supplied for her, and they both sat down in tandem. “Will Halstead.”
She made a small sound of acknowledgement, but she offered no other pleasantries.
It made for awkward conversation, but Will was the boss here, so it fell to him to rectify it. “It’s my first day, so I’ve been getting the lay of the land, meeting the department heads.”
At this, she smiled, but the movement was a little cynical. “I’m sure that’s been a fun time,” she said.
So she wasn’t one for undue displays of deference. There was a part of him that respected that, but he wondered if it was going to be a problem. “Every hospital is unique,” he replied, going for a diplomatic return instead. “But for now, I’d just like to talk about you and your department.”
Getting to the point seemed to please her a little. She sat back with a small nod. “I know you don’t know me yet, so don’t think I’m prone to bragging, but you don’t have to worry about the surgical department.”
“Oh?” Will said. He glimpsed down at the file. He’d studied them all earlier, but it was worth a refresher. “How’s that?”
“We have the highest staff retention rate, and we’re the only department currently in the black,” she said. She pointed to the file on his desk knowingly. “Also, you can check your numbers, but we also have the highest success rate for patients. More better outcomes on a consistent basis, even when you control for other relevant factors.”
All of that jived with what he’d already known, but hearing her say it was something else. She was proud -- but it was more than that. She was confident -- in a way Will used to be.
He wasn’t sure if he envied her or pitied her.
“That’s all very impressive,” he said. “So I guess you won’t have anything to request when I start putting together my reforms--”
She sat up, startled by this. “Hey, I didn’t say that,” she said, suddenly taking things much more seriously.
“But if your department is the best--”
“Then we’ve earned the perks,” she said, somewhat forcefully now. “I mean, how do you think we got here? Not because I sat back and let other people take what was mine.”
Will thought she might have a point, but it was different when you were looking at it holistically. He’d probably never appreciated that before.
No, there was no probably.
He’d definitely never appreciated the big picture before until he was solely responsible for it.
He tapped the rest of the files. “You forgot to mention that you put in for more monetary requests than every other department combined,” he said. “While every other budget in the hospital has shrank, somehow yours keeps growing.”
“Because success yields success,” she said. She shook her head, moderately offended. “I’m not going to apologize for what I’ve built here.”
“And I’m not asking you to,” he said. “But I am going to be realistic about how I allocate resources. This hospital can’t operate with just one successful department. They’ve all got to stay afloat.”
She sat back again, her lips pursed. “I think you’re misunderstanding what I’m saying,” she said, and she herself seemed to have retreated to a posture of diplomacy. “I am more than ready to work with you and the rest of my colleagues to see widespread success across the hospital. In fact, I may have some relevant insights to share that you can apply to other departments. In particular, the ED.”
“The ED will be covered,” Will told her quickly.
“How?” she asked. “That position has been vacant for -- I don’t even know how long.”
“Yes, and I will be serving as Chief of the ED,” Will said.
Her face wrinkled, clearly confused. “But you’re Chief of Staff.”
“And the Chief of the ED,” he said again, to clarify her confusion.
It didn’t seem to help. “But how?” she asked. “I mean, you’re both Chief of Staff and ED Chief?”
Will nodded, not sure why this was such a hard point to follow. “Yes. Both positions were open. I agreed to do both.”
That answer seemed insufficient to her. “But that’s two full time jobs in one,” she said. “They don’t pay you enough to do that.”
He sat back, a little surprised by that particular accusation. “You don’t know my salary.”
She laughed, short and incredulous, as if she had forgotten -- or simply didn’t care -- that he was her boss now. “I don’t care what your salary is. They couldn’t pay anyone enough to do that,” she said. “And besides, it’s too much work. You could never do both jobs -- at least not well.”
“Well,” Will said, closing her file preemptively to make a point. “I’m pretty dedicated.”
She continued to be unimpressed by him. “You’d have to have no social life whatsoever. Your tolerance for stress would have to be unparalleled. I mean, you’d basically have to live in this hospital.”
She said that like it was an impossibility. He wasn’t sure why that riled him, why suddenly he wanted to prove her wrong. “If that’s what’s necessary.”
Now, Dr. Barriger looked him up and down, mouth hanging just a little open.
He found the scrutiny too much. “What?” he asked, exasperation seeping into his tone.
“It’s just that you don’t look naive,” she said. She narrowed her eyes and shook her head as she grappled with the notion. “And I read your file, too. You don’t sound like someone who is green behind the ears.”
A lack of experience wasn’t the problem. The lack of good experience might be a more relevant consideration, but not one he was admitting to her on his first day on the job. “I know what I’m doing.”
She looked somewhat bemused now. “I actually doubt that, but I will give you credit,” she said, and despite the humor in her voice, she sounded impressed. “You have the gumption to try.”
He turned his nose up a little. “Gumption?”
She rolled her eyes. “Let’s forgo semantics. Did you know that I’ve been here two years?”
“I did,” Will said. “It’s in your file along with everything else we’ve discussed.”
“Then you’ll also know that I am the second longest tenured member of this staff,” she said. “Outpaced only by Dr. Duvernay.”
“Pediatrics,” Will said. “Lovely guy.”
“He’s been here five years,” Dr. Barringer said. “Whatever he does, he’s earned the right to do it.”
“He seems a little, I don’t know,” Will said. He shrugged, looking for an apt description.
“Crazy?” she said. “Yes. You have to be crazy to last here. There is no equipment. We don’t have supplies. We are always overworked, and we get no time off. And the paychecks? Will bounce several times a year. Always around Christmas.”
None of that was in the file, and yet, Will didn’t find himself surprised. “You stayed, though,” he said. “Two years? What’s your story?”
“Well, me, I like a challenge,” she said with a dismissive shrug.
“And they didn’t offer you this job?” Will asked.
“Oh, they did. They offered it to everyone, but none of us are stupid enough to take it,” Dr. Barringer said. “Which is why I can’t figure how they got you -- their poster boy -- to sign on. To a failing hospital, no less.”
“Maybe because I’ve known enough failure in my life,” Will said. “Maybe I can help avoid it here.”
She raised her eyebrows. “And if you can’t?”
“Then at least I’ll know it didn’t fail on account of me,” Will said.
It was an answer that surprised her, but after a moment of consideration, it was also an answer she clearly liked. “You are either the most idealistic person I’ve ever met or the most insanely proud one.”
“I’m just here to do the job, as best I can for as long as I can,” Will told her.
“And you want me to buy that line?” she asked.
He tilted his head. “Is that how you always talked to your boss?”
She lifted up her hands a little. “No offense intended,” she said. “But I’ve gone through a lot of bosses in my two years.
“Look,” Will said. “Dr. Barringer, I don’t care if you buy my line or not. The real question is, will you continue to do the work?”
She sat back with cool consideration. “I guess that is the reason why I’m here, aren’t I?”
“Exactly,” Will said. “So you just keep doing your job, and I’ll keep doing mine. We’ll see where it goes from there.”
“Okay,” she said. “Did you have any other questions?”
“No,” he said. “I’m still getting settled, but I’ll let you know.”
She got him, smiling a little. It was almost coy, and just a little smug. “I will say this much,” she told him. “However this turns out, I’m quite looking forward to seeing you work, Dr. Halstead.”
In truth, he had no idea if it was a compliment or not. Now that he was the boss, though, setting the tone was his call.
There was nowhere for the blame to hide.
“Thanks,” he said, going for gracious. But still skeptical. “I guess.”
She beamed at him. “It’s a good thing,” she told him on her way out. “Trust me.”
He wasn’t sure if he trusted her, but he sort of thought he might like her.
-o-
Dr. Barringer was a perplexing case, to be sure, but Will had a whole hospital of perplexing cases, many more pressing than his Chief of Surgery.
In fact, some were so much more pressing that he didn’t really have time to dwell on Helena Barringer at all. During his first week, the local power grid went down, and their backup generators failed in several departments. This left them scrambling to provide critical care, and Will was forced to close the ER for several hours, costing them dearly.
Then, two ED nurses quit, and he had an attending in pediatrics quit in a public rant that had him escorted out by security much to Will’s horror and dismay.
Several patients turned up in the ICU without valid patient files, suggesting either a huge lapse in protocol or a huge mistake in paperwork. Will had to call the water company to negotiate a late payment contract that didn’t shut off their complete water supply, and there was a portion of the ceiling that literally fell down in one of the exam rooms in the ED.
So, things were literally falling apart.
And Will was at a loss to figure out why -- and how to fix it. In his previous posting, he’d been saddled with a plethora of problems, but the solutions had been immediate and short-term. He’d been working within an existing framework, implementing the best case scenario.
This, though?
There was no framework.
He had to make it.
And he wasn’t really sure what the hell he was supposed to do with that.
Ignorance was a luxury, however. He’d signed on to do a job, and this was the job. He had to set the tone. He was the one responsible for sorting out the mess. It was on him if this project excelled or sunk.
The task, on its face, was obviously overwhelming, so Will broke it down into more manageable parts. He started by trying to pinpoint the actual problem.
Or, in the case of this particular hospital, problems.
There were plenty of opinions on this matter. Frustrated discussion and callous criticism ran rampant through the gossip mill. People ranted in the locker room, and complaints were the topic of conversation during surgery. Will had to sort through that to separate the normal workplace complaints from the problems with actionable solutions.
To do this, he started in the most orderly fashion he could. Which was easier said than done. But he didn’t come here for the easy out. If he had to do this the hard way, he would.
He started by interviewing the department heads. After talking to them each, one on one, he had them document their complaints. Then, he worked long hours -- often well into the night -- collating the responses, looking for crossover and similarities. It required some creative interpretation, but Will came up with a ranked list, which he presented to a joint meeting of all the department heads.
“These are the problems,” he said, handing out the list to each one. “Now, I asked you here to start thinking of solutions.”
They looked at him. Some of them looked blank. One or two simply looked dumbfounded. Dr. Barringer was smiling, almost inexplicably.
Will couldn’t be deterred by that, any of it. He pressed on.
“We all know the problems, but we can’t sit around and keep pretending like they can’t be fixed,” he said. “We have to actually fix them if we want to save this hospital.”
Dr. Duvernay from pediatrics looked like he might be falling asleep. His neurology head squinted at him like he might have grown horns. No one said anything.
The risk of being frustrated was real, but Will couldn’t give into it.
“Just look down the list. Pick a problem,” Will said, pacing across the front of the room. “There are no wrong answers right now. We have to start somewhere -- anywhere.”
He was trying to inspire, yes.
But he was rapidly being reduced to imploring.
When no one said anything -- no one could even look at him now -- Will felt desperation start to rise. If he couldn’t do this, then it would all fail. If he could save these department heads, then he couldn’t save this hospital. If he couldn’t save this hospital, then he couldn’t salvage his own failed career.
“We’re here to save lives, I know that,” Will said. He pointed at his own sheet of paper. “But this is how we do it. If we can’t fix these problems, then we can’t fix patients. Come on. Anything.”
And he was losing it. He was losing everything. Maybe it was time to quit. Maybe it was time to walk away. Maybe he could leave right now, get a plane ticket anywhere and just go. He was foolish to think he could do this.
His heart was thrumming loudly in his chest, and he could feel the beat as it thundered in his head. He was starting to sweat, from his palms and down his back, and the familiar sensation of his throat closing up indicated that he was just on the cusp of panicking.
Then, from the middle of the room, Dr. Barringer, his Chief of Surgery, raised her hand.
Will nodded at her, not trusting himself to speak.
“Most of these problems, when you break them down, start with communication lapses,” she said, making a gesture to her sheet. “I mean, look us here now. We can’t even talk to each other. So of course nothing else works, either.”
At first, Will was just so relieved that someone had spoke that he didn’t much listen to what Dr. Barringer said. But, as the numbness receded from his cognitive processes, he slowly understood what she was saying. They had all lodged their complaints; Will had made a list; she had boiled it down to something simple.
“Okay, communication,” Will said. “I’m the new guy here, so I’m not going to have the best insights on this issue. How long would you say this has been going on?”
Dr. Barringer raised her eyebrows. “How long hasn’t it been going on?” she said. “I’m one of the most tenured staff members her, and it’s been like this since I got here.”
“Okay,” Will said, glancing from her to the rest of the group. “Then, let’s take Dr. Barringer’s comments to heart. Let’s talk.”
Dr. Barringer looked willing, but the rest of his department heads looked uncomfortable.
Will pushed forward, cajoling them more carefully now. “This isn’t a punishment. It’s not an indictment,” he said. “Let’s just back things up. Look at the list. What one speaks to you most? Which point worries you more than the rest?”
There was another moment of punctuation silence. Dr. Barringer bit her lip as she looked at her colleagues, and Will’s blood pressure threatened to rise once more. But then, from the front of the room, another doctor raised his hand.
Will nodded eagerly at his Chief of Cardiology.
The man drew a breath and almost reluctantly began to speak. “The inconsistent application of protocols is one that gets me,” he said. “If the standard cardiology protocols were followed, we could make sure that patients are treated faster and more efficiently. Right now, too many patients are slipping through the cracks while the cardiology ward is flooded with patients where the cardiac function is a secondary concern.”
A few other doctors were nodding along. “It also messes up our distribution of resources,” the neurology chief chimed in. “We have all our equipment distributed unevenly. I know that we’re working with less than a normal hospital, which is why everything needs to be targeted. I can’t wait for hours for a repeat MRI -- it backs up the OR and limits patient outcomes. But we still have limited access because of distribution models that no longer apply.”
From that comment, two more staff members had raised their hands.
The conversation was building now, as productive discussions finally ensued. Will moderated it with relative success, and he couldn’t help but spare a grateful nod at Dr. Barringer, for helping him get this far.
-o-
The meeting was progress, Will had no doubt about that. But, he wasn’t naive. The problems wouldn’t be fixed with mere conversation.
No, Will needed to take action.
Now that he had a better grasp of the problems, he had to form targeted responses that addressed these multifaceted problems. Plus, he had to do it on a short timeframe with limited resources. In short, he was expected to work miracles.
It was a tall order, and failure was likely.
Will knew he had to try anyway.
To start, he decided to build on the conversation. The first session with his department heads had been fruitful, and he decided to make it a weekly event. He coupled that with periodic department meetings, including as many doctors, nurses and techs as possible. From there, he established one-on-one meetings with each department head as well, to really start getting the trust built.
From these wide ranging meetings, Will was able to start building more impressive and widespread plans to address the systemic problems facing the hospital. He first went after allocation, taking precise inventory of what each department had and what each department needed. By shifting some of the supplies and equipment, he was able to provide better support where it was needed most.
Then, to complement the allocation of supplies, Will streamlined acquisition requests. This made it easier for departments to indicate what they needed, and it promoted interdepartmental sharing to a higher level. It didn’t eliminate shortages, but it did help address some of the biggest lapses, and the quality of care provided across the board was immediately evident.
From there, Will tackled more ambitious projects. The hospital was barely paying its bills, and the threat of losing access to water, gas and electricity was actually quite real. With some research, he found that the hospital’s systems were so old that they were prone to failure -- they were also costing them a fortune. The problem was, of course, that updated those system was going to be expensive -- and the thing the hospital didn’t have was money.
It was a quandary -- and it was one that Will had no means to solve on his own.
So he didn’t.
He took the issue up directly with the utility providers, discussing the terms and conditions of their agreements. With some sympathetic finagling, Will was able to pitch the upgrades as an investment in the future of the community, and by signing elongated deal, Will was able to secure upgrades at a reduced rate. He even talked the issues up through the city channels, leveraging a contact of Mr. Alawe of all people. With Mr. Alawe’s recommendation and endorsement, Will was able to convince the city to extend the power grid to the hospital.
It took several days on the phone, and a flurry of emails, but Will had the situation with their utilities improved over the course of a week.
From there, Will knew he needed to address some of the issues within the staff. The high turnover rate would have a multifaceted cause, and he knew that, but that couldn’t be fixed with supply reallocation and a better power grid. No, Will had to be more targeted in these fixes.
He took feedback from the nurses most seriously. He knew very well from his time at Med that having the backing of the nurses could make all the difference. The fact that Maggie had considered him family had been a crucial part of his success there -- even though it hadn’t been enough to save him from himself in the end.
Still, if he wanted to improve staff morale, he had to go after the nurses. From departmental meetings, Will quickly noted a few consistent concerns from the nursing staff. Some of the factors were abstract, having to do with a lack of funding issues that Will was already addressing, but others had to do with something far more universal: scheduling.
With a short-staffed nursing network, the current nurses were being asked to work long hours, inconsistent shifts, and last minute schedules. In other words, they were being asked to put the hospital first in front of their families, social lives and other personal pursuits. With those kind of demands -- and the lack of pay or positive work environment to back it up -- it was no wonder his nurses were leaving in droves.
The only problem was that the nursing shortage made a reduction of hours almost impossible. Will didn’t have the money to hire new nurses -- yet -- but the scheduling system in place was still programmed to predict more nurses than they had on staff. Will needed to reprogram the system to account for a lower number of nurses in the first place. Then, by extending shifts to the maximum legal time, Will could create a more standardized schedule. Nurses wouldn’t be working less, necessarily, but they could at least trust that their hours were be consistent from week to week.
That fix was relatively painless, and it went over well with the nurses.
Then, it was time to make some harder calls.
So far, most of his changes had been working with what he had already. The cost savings from the energy fixes were the most significant, but even those were more negligible than he might want to admit. The real gain there had been reliability.
No, the hospital was still working at a bad deficit, and Will couldn’t pretend otherwise. Even with all this, the hospital was still going to go under unless Will started making more drastic cuts.
The problem was where -- and how.
And, probably, if he were honest, who.
There was no way to reduce the nursing staff. Techs were already overworked. They were operating with the bare minimum of residents and attendings. Which essentially led Will to one simple conclusion.
They didn’t have enough resources to support all the departments. They didn’t have the money, the staffing, the space -- any of it. They were overextended in their offerings. By simply reducing the departments, they could scale back on the overhead, streamline staffing issues -- all of it.
It was the obvious solution, clearly.
That didn’t make it an easy one.
After all, eliminating a full department was a dramatic change. It affected everyone in the department -- and it could limit their offerings as a hospital. It made them less widely competitive, but they couldn’t pretend like the system was working. Will couldn’t pretend to do everything well. He had to pick and choose the best things to excel at.
He worked his way around back to that conclusion every single time, and he knew he was right. He even floated the idea past Adam, and he consulted official organization policy with Dr. Wexler, and they both agreed. This was the critical solution needed to buy the hospital more time. In essence, he had the right to do this. He had high level administrative support.
But that didn’t mean it was going to go over well with the staff. Over the last few weeks, he’d built up a sense of hope and enthusiasm -- but it was tentative at best. He was not eager to shake the boat in his manner, even if he saw no feasible way around.
Feeling anxious about making the final decision, Will decided to pull in someone with a little more insight to the staff. He had a good working relationship with all his department heads, but he needed someone who he trusted to speak out, someone who shared his vision, someone with established credentials.
Dr. Barringer obligingly showed up in his office for her weekly one-on-one. She was usually in good humor when she arrived, and though she discussed matters professionally, she was the first of all his staff to seem truly at ease with him. She trusted him, and he found that he trusted her.
So he didn’t mince words.
She already knew the issues they were facing. She had already been part of the solution. When he posed the idea of consolidating departments, she sat there and stared at him. Then, she laughed. “You’re actually asking me?”
“Yes,” he said.
Incredulous, she gawked. “You’re actually asking me what I think of cutting departments? As a department head, you don’t think maybe I’m biased?”
“Not biased, invested,” Will said. “And I’m not talking about cutting. I’m talking about combining. By consolidating departments, we lose virtually no staff and we would allocate our resources better.”
“No staff?” Dr. Barringer asked tautly. “What about the department heads? You can’t just force a neurosurgeon to practice pediatrics all of a sudden.”
“Some of the specialties are more pliable than others. It’s not a perfect thing, I know that, but neither is the system we have in place now,” Will said. “I’ve been over the numbers and our output too many times. We simply can’t support the departments that we have.”
She scoffed. “We are already operating at the bottom of the barrel,” she said. “If you cut more departments, then we are shooting ourselves in the foot. We need whatever prestige we can find.”
“But we don’t have prestige,” Will countered. “People come here as a last resort, and we both know it. We have to be honest. Do you think people come through our doors because we have a pediatrics department?”
Her jaw dropped. “Wait, you want to cut Duvernay? The guy who has been here longer than anyone?”
Will shook his head, feeling a pang of frustration. “I’m not cutting Duvernay,” he said. “Honestly, with Duvernay’s background and experience, I was thinking he was a natural fit for your surgical staff. He spends more time in OR than most other department heads, and that is where 80 percent of our peds cases end up once they get out of the ED.”
“Right, so you’re not going to fire him. You’re just going to demote him,” she said with wry skepticism.
“I looked at the numbers. By combining budgets and reducing redundancy, I can still afford to pay everyone the same,” he said. “His pay would be untouched -- and so would his benefits.”
“But the title--”
She was set to protest, but Will stared back at her hard. “You think this guy has stayed in a place like this for five years because of a title?” he asked, and he watched her shift back in her chair, crossing her arms over her chest with a touch of petulance. Then, he continued. “I’m not saying these are perfect solutions, but they are solutions to problems that have gone on for too long. We have to think outside the box or the whole thing is going to collapse we we’re all out on our asses.”
He was being honest with her, and she knew that -- and there was a part of her that respected it, even if she clearly didn’t want it. Her posture eased, though, even if just a little. “So, why are you talking to me? It sounds like you’ve already figured this out.”
“Well, I’ve gone over this at a high level, but it’s not going to work without buy-in,” he said. “You’ve been one of the more forward thinking members on staff. I thought gauging your reaction would help me figure this out.”
She shook her head, smiling with disbelief. “No, you just wanted to get me on board,” she said. “You thought if you could sell me on it, I could help you sell everyone else.”
He lifted one shoulder, but didn’t bother to deny it. “It wouldn't hurt,” he said. “And I’m serious about Duvernay. I want him to feel good about the change. I want him to feel comfortable in his new team.”
“His new team with me,” she said gruffly. “You want me to make nice and make Duvernay feel like it’s not a demotion.”
“I just want to know if you think you can make this feel like a team effort,” he reasoned. “Surgery is your department. Do you have a place for someone like Duvernay?”
She slunk back again, crossing her arms once more. “You’ve got some nerve, Halstead.”
“I have to,” he posited. He pushed the budget sheet across to her, followed by a new one. “Look at our current budget and tell me how long we’d be open. The second sheet is the improvements that come from consolidation.”
Eyeing him with some suspicion, Dr. Barringer sat forward and took the papers. She studied them quietly for a moment, before shaking her head. “I’ve seen these numbers hundreds of times,” she said, putting the budget sheet back. She held onto the other one, nodding at it. “But this? All these years, and no one has come up with a plan like this. It’s like we’ve all been bailing water so long that I’ve forgotten what staying afloat looks like.”
She was starting to get it at least. Will had taken a week to process his denial and frustration, only to get him here. He was presenting it to her to process in one single meeting. “I’m just trying to keep the doors open,” he said. “If we don’t make changes, we all lose our jobs.”
Dr. Barringer put the second sheet down with a sigh. She pursed her lips, looking at him plainly. “Duvernay is crazy. You do know that, right?”
At that, Will tilted his head at her. “You’re saying that you’re not up for the challenge? I thought you liked challenges.”
“Oh, I see what you’re doing,” she said, sitting back and tossing her head to the side. “I am personally offended that you think you can play me like that.”
Her statement was definitive on its face, but there was something more. Expectantly, Will raised his brows. “But?”
She seemed to ease into the ease more now, concession visible in the set of her posture. “But your point is taken,” she said. “And, for the record, I will prove you and your smug little ass wrong.”
Will’s jaw dropped, surprised by the force and weight of her candor. “Careful, Dr. Barringer. I called you in here as a courtesy. I am still your boss.”
At this point, Dr. Barringer was smirking out right. “Whatever, Halstead,” she said. Then she casually shrugged. “And you can call me Helena.”
In some ways, the invitation didn’t surprise him. Her faithful candor, her ready attitude -- she had been the closest thing he’d had to a friend since starting here.
But he hadn’t been looking for friends.
He hadn’t even had time.
He’d been focused on strictly professional things, but here was a smart, vivacious and attractive woman, giving him first-name access.
It was surreal, for some reason.
“Helena,” he repeated, not sure what else to say, what else to do. All his ideas, and he was fresh out of them now. Somehow, his brain had effectively stopped working.
Across from him, Helena arched her brows. “And?” she asked, clearly expectant.
Will blinked back at her dumbly. “What?”
Now, she was exasperated. “If I’m doing you this favor -- and it is a significant favor, just to be clear -- then I should at least get a first name invitation back, shouldn’t I?”
The preponderance of professional behavior screamed in the back of his mind, but she was sitting there, looking at him, and all he could do was stare back with an air of awe and wonder. “Will,” he said without thinking about it. “You can call me Will.”
It might have been the wrong thing to do, but Helena’s smile made it impossible to see it that way. Brilliantly, she nodded at him. “Will,” she said, sounding wholly satisfied now. “You have yourself a deal, Will.”
-o-
Here was the thing.
After all his thinking and planning, after all his fretting and anxiety, it worked.
Against all odds, his last ditch hail Mary plan actually worked.
Expenses were tightened. Staffing issues were resolved. Productivity increased. The bottom line started to look more black than red.
And then, the turnover rate started to slow down. Patient satisfaction was skyrocketing. There were no lapses in service, and it was working. The improvements weren’t impressive by the standards of the other hospitals Will had worked at, but given where he’d started here, he couldn’t help but be pleased.
He was taking the best of what Adam had taught him, the best of what Dr. Dunst had taught him -- and he had applied it. He had applied it well and comprehensively, and the whole damn thing was actually working.
With the day to day activities moving along at such a good clip, Will had been rightly focused on the here and now. Keeping his head down, he hadn’t allowed himself to get distracted by outside issues. The outside issues, however, had other plans.
At least this time it wasn’t gang violence. At least this time there was no rise of a terrorist cell.
No, this time, something even more terrifying happened.
Will got notice from Dr. Ho that he was coming for a personal tour of the facility, and he wanted to sit down with Will one-on-one to discuss the current situation.
On its face, there was nothing particularly damning about the request. There was no active hint of accusation, and Will could not detect any trace of concern except from the presence of the request itself. Why would Dr. Ho need to come there? Why would an unscheduled review be warranted?
Will had been in contact with the board as his position warranted, and he had been thorough in clearing his decisions with all necessary parties. He’d been going out of his way to be utterly by the book in all this, and he knew that while they were impressed with his past work, he’d taken on a position that didn’t have much wiggle room.
What if he hadn’t done enough?
What if he’d done too much?
How was he going to justify his choices? How was he going to substantiate the outcomes so far?
When he expressed his doubts to Jay over a video chat, his brother rolled his eyes. “You’re overthinking this.”
“Am I?” Will asked. “I don’t have a great track record.”
“Actually, you do,” Jay said. “Or have you not noticed how everyone over there loves you?”
Will shook his head, feeling miserable at the impending meeting the next morning. “They don’t know me,” he said. “What I’ve done.”
“Pretty sure at this point it doesn’t matter,” Jay said. “We’re more than our worst mistakes, right?”
“Says the guy who still brings up me moving away to college like it was a personal affront,” Will muttered.
Jay sighed with that, and he nodded. “You know, you’re right?”
Will frowned, surprised. That had not been the answer he was expecting or even looking for. “What?”
“You’re right,” he said. “I resented the hell out of you for years, and I gave you a hard time about some of your choices. And I’m not going to sit here and pretend like you didn’t do everything right, but it’s also not fair to sit here and pretend like you did everything wrong. I wasn’t fair to you. And that only made it harder for you to come back. I know that, and I’m sorry for it.”
Will stared at the screen, not sure what to say. All these years he’d gotten used to playing the bad brother, and Jay was sitting there, offering absolution.
“Don’t be weird about it,” Jay said, scowling at him over the video. “You’re still a crappy brother more often than not, but you’re not all bad. I just don’t want me to be part of the reason you stay away, like you think you’re not good enough of something, because that BS in a very big way.”
“Thanks, Jay,” Will said. “I mean, that means a lot.”
Jay shook his head, now perturbed by the emotion. “So anyway, if that asshole comes in and gives you a hard time, don’t be afraid to stand up for yourself.”
“I don’t have much of a leg to stand on,” Will said. He bit the inside of his lip. “The hospital’s doing better, but it’s a long way from being solvent.”
“You’ll get there,” Jay said, with a total confidence Will would never understand. “You’ll get there.”
And Will was pretty sure they weren’t just talking about hospital administration anymore.
-o-
The conversation with Jay had made Will feel better, but it did not alleviate the practical anxieties he felt. On a high level, he knew that he had done nothing wrong. When it came to living it out, however, Will was still paralyzed by the same fear that had overwhelmed him in Ms. Goodwin’s office all those months ago. It was a hard feeling to shake, but it wasn’t one he could indulge.
Not with Dr. Ho arriving promptly at nine.
Will made sure to meet him personally, going out of his way to clear his schedule and dress his best for the part. He made grandiose small talk that he would have no memory of later, and he made every effort to make Dr. Ho feel welcomed -- and, more so, that the hospital was a legitimate, functioning place for medicine.
Clearly, Dr. Ho had been there before, but he still accepted Will’s invitation for an informational tour. And he moved around with the alacrity of an awestruck child, wide-eyed and open-jawed. He seemed more impressed with each department, and by the time they got back to Will’s office, Dr. Ho was nothing short of gobsmacked.
“I admit, when I read your reports, I thought they were fanciful,” Dr. Ho said, pacing back and forth across the small, undecorated space.
Will frowned in concern. He’d hoped that inviting Dr. Ho to his own office would be less nerve-wracking, but he still found the whole process to be unsettling. “I tried to be truthful and thorough in my reports.”
Dr. Ho turned to him in surprised dismay. “Yes, of course!” he said. “And you were! But that is what I find so remarkable! If anything, your reports do not do this justice.”
Will was perched on the edge of his desk, arms crossed tenuously over his chest. “This?”
“The transformation is the closest thing I have seen to a miracle in all my years of medicine,” Dr. Ho said. “I mean, clearly, there is still work to be done, but for the first time since I have been in charge of monitoring this facility, I feel like there is actually hope.”
Will wasn’t sure what to say. “Well, I do have plans for continued improvement, but they’ll take time and money--”
“Both of which you will get, I assure you,” Dr. Ho told him promptly. He started pacing again, shaking his head as if in disbelief. “The other board members will not believe the progress that I report here. To see how well things are functioning. To see the productivity of the staff.”
“We’re still working on retaining the talent, and cashflow continues to be an issue,” Will said, hoping to damper the expectations.
“We all thought this hospital would be shut down by now,” Dr. Ho said. He stopped and turned back to Will. “We had a buyer on the line, just waiting for the word to put in a bid.”
This one made Will pause. “You allowed me to come to a hospital you were going to sell?”
Dr. Ho shrugged, starting up his walk again. “We did try to discourage you from it, and that is largely why,” he said. “But Dr. Wexler was convinced you deserved a shot at any hospital you chose, and her faith was clearly not misplaced.”
Will was the one slack-jawed now.
Dr. Ho stopped once more to smile at him. “You have had many remarkable feats this year, but I would venture that this, right here, is your most impressive one yet,” he said. “This is excellent progress, Dr. Halstead. Excellent, indeed.”
Will’s instincts were to talk back the praise, but somehow talking back to his boss just didn’t sit right with him either. Instead, he managed to smile. “I’m...just doing what I can.”
Dr. Ho gave him a proud nod. “And I assure you. It is more than enough.”
That just proved, as far as Will was concerned, that there was a first for everything.
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
-o-
Getting settled was a nice idea, but when Will entered the hospital fully, he realized it was a bit of a fantasy. Will couldn’t get settled here -- because here wasn’t settled in the first place. Will had been in a lot of hospitals during his career, but this one was by far the least organized and well presented he’d ever seen. There was almost sheer chaos in the ED, and it wasn’t clear who was doing what. Patients seemed to be stuck in random corners of the hallway, and discarded equipment was stashed behind the desk. EDs could always feel a little grim just by default, but the poor lighting and drab decor were enough to make the place seem like one step up from a mortuary.
The rest of the hospital wasn’t much better. Mikayla took him the long way, in her words, allowing him to briefly tour each floor and department. The floor that looked the most like a hospital was the ICU and surgical wards, but those areas were so small that it hardly seemed to make a different. Poor staffing numbers, overcrowded exam areas, outdated equipment, crumbling infrastructure -- Will had read the file.
The file didn’t do it justice.
By the time they got to his office, Will was already feeling somewhat discouraged. Mikayla had a desk right outside, though it was nothing more than the end of a hallway.
His office, even by comparison, was unimpressive.
The area didn’t look like an office. It looked a bit more like a glorified closet. Small and cramped, there was a desk with a chair sitting in front of a dingy window. The view overlooked an alley and nothing more. There were two pairs of filing cabinets crowded on the back wall, and a small bookshelf near the door was flanked by a pair of actual folding chairs for guests.
The worst part was that this was the office for the chief of staff. If this was the best the hospital had to offer, then Will had sorely underestimated just how bad the situation on the ground here was.
Of course, Will could just be dramatic about this. Yes, it wasn’t an overly encouraging sign, but the value of a hospital wasn’t in superficial measures. The size of his office didn’t even matter. What mattered was how well they were treating patients.
And, to a lesser extent, if they were staying solvent.
He still had a few hours before his meetings were slated to begin, so Will started in on his more detailed assessment of the hospital’s finances and turnover rate -- for patients and staff. There was a computer, but Mikayla said that his electronic credentials hadn’t been updated yet. Besides, she told him helpfully, everything he would need was in the filing cabinets already.
Will turned to the cabinets.
A paper trail.
It seemed rather quaint after all his time using advanced technology.
Quaint could still be effective.
Or so he hoped as he opened the first drawer and got to work.
-o-
The good news was that the files were in order. In fact, they were surprisingly well organized for the state of disarray he’d seen throughout the facility in his short time there.
The bad news was that what they showed wasn’t any more encouraging than the numbers he’d skimmed when he took the offer. Their operations were underwater on every level, with the ED burning through half of the hospital’s budget in a month.
Worse, the need for updates was everywhere. He’d read the hospital’s specs when he’d taken the position, but he found that those were optimistic assessments. Sure, the hospital had two MRI machines, but only one was working. The other one required so much electricity that it could only be run every other day.
The story was much the same in every category.
This hospital wasn’t just a lost cause.
This hospital was the most lost cause he’d ever seen. If Dr. Wexler and Dr. Ho had seen the actual performance numbers in real time, they would have likely shut it down on the spot. And what was Will’s purpose here? To drive a sinking ship into the ground? To pilot the Titanic straight into an iceberg?
It was sobering, to say the least, but Will tried to comfort himself with the fact that good medicine didn’t always coincide with cutting edge technology or posh facilities. He’d worked at a rundown hospital with Adam and a state of the art one with Dr. Dunst. Despite the differences, both hospitals had been vibrant and effective.
Things could still be salvaged if the staff was on board.
He held his optimistic view for as long as he could.
Until he started to actually interact with the staff.
Then he realized just how daunting this task was.
The plan had been to meet with each department head in a personal, one-on-one session. Will would get to know them and their specialty, and then he would get an accurate assessment of their department’s position and needs.
Each of them came in, one after another, and told him the same story.
They were overworked, they were understaffed. They didn’t have time, money, equipment, training -- you name it. They didn’t have anything they needed for success. Two of them started crying, right then and there. One tried to tender his resignation. Other departments just didn’t exist, and the head of pediatrics all but laughed at him when he said it would be a pleasure to work with him.
“Sure,” the man said as he simpered roundly. “We’ll see if you last the month.”
So, needless to say, things were off to a stellar start.
-o-
Will was feeling more than a little discouraged, needless to say. But then, Mikayla poked her head in. “We have one more,” she said. “You think you’re up for it?”
Will felt like he’d been beaten up and shot -- again.
But this was the job.
He sighed.
“Sure,” he said. “Who is it this time?”
Mikayla glanced at her notes. “Dr. Helena Barringer,” she said. “Head of Surgery.”
“Okay, then,” he said, rocking back in his chair and steeling himself. “Send her in.”
-o-
Compared to the rest of his makeshift senior staff, Helena Barringer looked moderately put together. She had long dirty blonde hair that was thick with texture. It didn’t quite curl, but it had had an unruly flair to it. She seemed to cope by binding it back in a ponytail, which had the effect of making her look just slightly girlish.
For a brief second, she didn’t look experienced enough to be the head of his surgical department, but she comported herself with a ready confidence that quickly dissuaded him of that notion. In fact, from a simple greeting, he could quickly tell that Dr. Barringer was the most self possessed and competent member of his staff.
It was a purely superficial assessment, of course. He knew that.
But it was up to her to prove him wrong.
“Dr. Barringer,” he said, standing up and reaching his hand out. “Head of Surgery, right?”
She shook his hand. “Yes,” she said, and her accent was heavily British. “And you’re Dr.--?”
“Halstead,” he supplied for her, and they both sat down in tandem. “Will Halstead.”
She made a small sound of acknowledgement, but she offered no other pleasantries.
It made for awkward conversation, but Will was the boss here, so it fell to him to rectify it. “It’s my first day, so I’ve been getting the lay of the land, meeting the department heads.”
At this, she smiled, but the movement was a little cynical. “I’m sure that’s been a fun time,” she said.
So she wasn’t one for undue displays of deference. There was a part of him that respected that, but he wondered if it was going to be a problem. “Every hospital is unique,” he replied, going for a diplomatic return instead. “But for now, I’d just like to talk about you and your department.”
Getting to the point seemed to please her a little. She sat back with a small nod. “I know you don’t know me yet, so don’t think I’m prone to bragging, but you don’t have to worry about the surgical department.”
“Oh?” Will said. He glimpsed down at the file. He’d studied them all earlier, but it was worth a refresher. “How’s that?”
“We have the highest staff retention rate, and we’re the only department currently in the black,” she said. She pointed to the file on his desk knowingly. “Also, you can check your numbers, but we also have the highest success rate for patients. More better outcomes on a consistent basis, even when you control for other relevant factors.”
All of that jived with what he’d already known, but hearing her say it was something else. She was proud -- but it was more than that. She was confident -- in a way Will used to be.
He wasn’t sure if he envied her or pitied her.
“That’s all very impressive,” he said. “So I guess you won’t have anything to request when I start putting together my reforms--”
She sat up, startled by this. “Hey, I didn’t say that,” she said, suddenly taking things much more seriously.
“But if your department is the best--”
“Then we’ve earned the perks,” she said, somewhat forcefully now. “I mean, how do you think we got here? Not because I sat back and let other people take what was mine.”
Will thought she might have a point, but it was different when you were looking at it holistically. He’d probably never appreciated that before.
No, there was no probably.
He’d definitely never appreciated the big picture before until he was solely responsible for it.
He tapped the rest of the files. “You forgot to mention that you put in for more monetary requests than every other department combined,” he said. “While every other budget in the hospital has shrank, somehow yours keeps growing.”
“Because success yields success,” she said. She shook her head, moderately offended. “I’m not going to apologize for what I’ve built here.”
“And I’m not asking you to,” he said. “But I am going to be realistic about how I allocate resources. This hospital can’t operate with just one successful department. They’ve all got to stay afloat.”
She sat back again, her lips pursed. “I think you’re misunderstanding what I’m saying,” she said, and she herself seemed to have retreated to a posture of diplomacy. “I am more than ready to work with you and the rest of my colleagues to see widespread success across the hospital. In fact, I may have some relevant insights to share that you can apply to other departments. In particular, the ED.”
“The ED will be covered,” Will told her quickly.
“How?” she asked. “That position has been vacant for -- I don’t even know how long.”
“Yes, and I will be serving as Chief of the ED,” Will said.
Her face wrinkled, clearly confused. “But you’re Chief of Staff.”
“And the Chief of the ED,” he said again, to clarify her confusion.
It didn’t seem to help. “But how?” she asked. “I mean, you’re both Chief of Staff and ED Chief?”
Will nodded, not sure why this was such a hard point to follow. “Yes. Both positions were open. I agreed to do both.”
That answer seemed insufficient to her. “But that’s two full time jobs in one,” she said. “They don’t pay you enough to do that.”
He sat back, a little surprised by that particular accusation. “You don’t know my salary.”
She laughed, short and incredulous, as if she had forgotten -- or simply didn’t care -- that he was her boss now. “I don’t care what your salary is. They couldn’t pay anyone enough to do that,” she said. “And besides, it’s too much work. You could never do both jobs -- at least not well.”
“Well,” Will said, closing her file preemptively to make a point. “I’m pretty dedicated.”
She continued to be unimpressed by him. “You’d have to have no social life whatsoever. Your tolerance for stress would have to be unparalleled. I mean, you’d basically have to live in this hospital.”
She said that like it was an impossibility. He wasn’t sure why that riled him, why suddenly he wanted to prove her wrong. “If that’s what’s necessary.”
Now, Dr. Barriger looked him up and down, mouth hanging just a little open.
He found the scrutiny too much. “What?” he asked, exasperation seeping into his tone.
“It’s just that you don’t look naive,” she said. She narrowed her eyes and shook her head as she grappled with the notion. “And I read your file, too. You don’t sound like someone who is green behind the ears.”
A lack of experience wasn’t the problem. The lack of good experience might be a more relevant consideration, but not one he was admitting to her on his first day on the job. “I know what I’m doing.”
She looked somewhat bemused now. “I actually doubt that, but I will give you credit,” she said, and despite the humor in her voice, she sounded impressed. “You have the gumption to try.”
He turned his nose up a little. “Gumption?”
She rolled her eyes. “Let’s forgo semantics. Did you know that I’ve been here two years?”
“I did,” Will said. “It’s in your file along with everything else we’ve discussed.”
“Then you’ll also know that I am the second longest tenured member of this staff,” she said. “Outpaced only by Dr. Duvernay.”
“Pediatrics,” Will said. “Lovely guy.”
“He’s been here five years,” Dr. Barringer said. “Whatever he does, he’s earned the right to do it.”
“He seems a little, I don’t know,” Will said. He shrugged, looking for an apt description.
“Crazy?” she said. “Yes. You have to be crazy to last here. There is no equipment. We don’t have supplies. We are always overworked, and we get no time off. And the paychecks? Will bounce several times a year. Always around Christmas.”
None of that was in the file, and yet, Will didn’t find himself surprised. “You stayed, though,” he said. “Two years? What’s your story?”
“Well, me, I like a challenge,” she said with a dismissive shrug.
“And they didn’t offer you this job?” Will asked.
“Oh, they did. They offered it to everyone, but none of us are stupid enough to take it,” Dr. Barringer said. “Which is why I can’t figure how they got you -- their poster boy -- to sign on. To a failing hospital, no less.”
“Maybe because I’ve known enough failure in my life,” Will said. “Maybe I can help avoid it here.”
She raised her eyebrows. “And if you can’t?”
“Then at least I’ll know it didn’t fail on account of me,” Will said.
It was an answer that surprised her, but after a moment of consideration, it was also an answer she clearly liked. “You are either the most idealistic person I’ve ever met or the most insanely proud one.”
“I’m just here to do the job, as best I can for as long as I can,” Will told her.
“And you want me to buy that line?” she asked.
He tilted his head. “Is that how you always talked to your boss?”
She lifted up her hands a little. “No offense intended,” she said. “But I’ve gone through a lot of bosses in my two years.
“Look,” Will said. “Dr. Barringer, I don’t care if you buy my line or not. The real question is, will you continue to do the work?”
She sat back with cool consideration. “I guess that is the reason why I’m here, aren’t I?”
“Exactly,” Will said. “So you just keep doing your job, and I’ll keep doing mine. We’ll see where it goes from there.”
“Okay,” she said. “Did you have any other questions?”
“No,” he said. “I’m still getting settled, but I’ll let you know.”
She got him, smiling a little. It was almost coy, and just a little smug. “I will say this much,” she told him. “However this turns out, I’m quite looking forward to seeing you work, Dr. Halstead.”
In truth, he had no idea if it was a compliment or not. Now that he was the boss, though, setting the tone was his call.
There was nowhere for the blame to hide.
“Thanks,” he said, going for gracious. But still skeptical. “I guess.”
She beamed at him. “It’s a good thing,” she told him on her way out. “Trust me.”
He wasn’t sure if he trusted her, but he sort of thought he might like her.
-o-
Dr. Barringer was a perplexing case, to be sure, but Will had a whole hospital of perplexing cases, many more pressing than his Chief of Surgery.
In fact, some were so much more pressing that he didn’t really have time to dwell on Helena Barringer at all. During his first week, the local power grid went down, and their backup generators failed in several departments. This left them scrambling to provide critical care, and Will was forced to close the ER for several hours, costing them dearly.
Then, two ED nurses quit, and he had an attending in pediatrics quit in a public rant that had him escorted out by security much to Will’s horror and dismay.
Several patients turned up in the ICU without valid patient files, suggesting either a huge lapse in protocol or a huge mistake in paperwork. Will had to call the water company to negotiate a late payment contract that didn’t shut off their complete water supply, and there was a portion of the ceiling that literally fell down in one of the exam rooms in the ED.
So, things were literally falling apart.
And Will was at a loss to figure out why -- and how to fix it. In his previous posting, he’d been saddled with a plethora of problems, but the solutions had been immediate and short-term. He’d been working within an existing framework, implementing the best case scenario.
This, though?
There was no framework.
He had to make it.
And he wasn’t really sure what the hell he was supposed to do with that.
Ignorance was a luxury, however. He’d signed on to do a job, and this was the job. He had to set the tone. He was the one responsible for sorting out the mess. It was on him if this project excelled or sunk.
The task, on its face, was obviously overwhelming, so Will broke it down into more manageable parts. He started by trying to pinpoint the actual problem.
Or, in the case of this particular hospital, problems.
There were plenty of opinions on this matter. Frustrated discussion and callous criticism ran rampant through the gossip mill. People ranted in the locker room, and complaints were the topic of conversation during surgery. Will had to sort through that to separate the normal workplace complaints from the problems with actionable solutions.
To do this, he started in the most orderly fashion he could. Which was easier said than done. But he didn’t come here for the easy out. If he had to do this the hard way, he would.
He started by interviewing the department heads. After talking to them each, one on one, he had them document their complaints. Then, he worked long hours -- often well into the night -- collating the responses, looking for crossover and similarities. It required some creative interpretation, but Will came up with a ranked list, which he presented to a joint meeting of all the department heads.
“These are the problems,” he said, handing out the list to each one. “Now, I asked you here to start thinking of solutions.”
They looked at him. Some of them looked blank. One or two simply looked dumbfounded. Dr. Barringer was smiling, almost inexplicably.
Will couldn’t be deterred by that, any of it. He pressed on.
“We all know the problems, but we can’t sit around and keep pretending like they can’t be fixed,” he said. “We have to actually fix them if we want to save this hospital.”
Dr. Duvernay from pediatrics looked like he might be falling asleep. His neurology head squinted at him like he might have grown horns. No one said anything.
The risk of being frustrated was real, but Will couldn’t give into it.
“Just look down the list. Pick a problem,” Will said, pacing across the front of the room. “There are no wrong answers right now. We have to start somewhere -- anywhere.”
He was trying to inspire, yes.
But he was rapidly being reduced to imploring.
When no one said anything -- no one could even look at him now -- Will felt desperation start to rise. If he couldn’t do this, then it would all fail. If he could save these department heads, then he couldn’t save this hospital. If he couldn’t save this hospital, then he couldn’t salvage his own failed career.
“We’re here to save lives, I know that,” Will said. He pointed at his own sheet of paper. “But this is how we do it. If we can’t fix these problems, then we can’t fix patients. Come on. Anything.”
And he was losing it. He was losing everything. Maybe it was time to quit. Maybe it was time to walk away. Maybe he could leave right now, get a plane ticket anywhere and just go. He was foolish to think he could do this.
His heart was thrumming loudly in his chest, and he could feel the beat as it thundered in his head. He was starting to sweat, from his palms and down his back, and the familiar sensation of his throat closing up indicated that he was just on the cusp of panicking.
Then, from the middle of the room, Dr. Barringer, his Chief of Surgery, raised her hand.
Will nodded at her, not trusting himself to speak.
“Most of these problems, when you break them down, start with communication lapses,” she said, making a gesture to her sheet. “I mean, look us here now. We can’t even talk to each other. So of course nothing else works, either.”
At first, Will was just so relieved that someone had spoke that he didn’t much listen to what Dr. Barringer said. But, as the numbness receded from his cognitive processes, he slowly understood what she was saying. They had all lodged their complaints; Will had made a list; she had boiled it down to something simple.
“Okay, communication,” Will said. “I’m the new guy here, so I’m not going to have the best insights on this issue. How long would you say this has been going on?”
Dr. Barringer raised her eyebrows. “How long hasn’t it been going on?” she said. “I’m one of the most tenured staff members her, and it’s been like this since I got here.”
“Okay,” Will said, glancing from her to the rest of the group. “Then, let’s take Dr. Barringer’s comments to heart. Let’s talk.”
Dr. Barringer looked willing, but the rest of his department heads looked uncomfortable.
Will pushed forward, cajoling them more carefully now. “This isn’t a punishment. It’s not an indictment,” he said. “Let’s just back things up. Look at the list. What one speaks to you most? Which point worries you more than the rest?”
There was another moment of punctuation silence. Dr. Barringer bit her lip as she looked at her colleagues, and Will’s blood pressure threatened to rise once more. But then, from the front of the room, another doctor raised his hand.
Will nodded eagerly at his Chief of Cardiology.
The man drew a breath and almost reluctantly began to speak. “The inconsistent application of protocols is one that gets me,” he said. “If the standard cardiology protocols were followed, we could make sure that patients are treated faster and more efficiently. Right now, too many patients are slipping through the cracks while the cardiology ward is flooded with patients where the cardiac function is a secondary concern.”
A few other doctors were nodding along. “It also messes up our distribution of resources,” the neurology chief chimed in. “We have all our equipment distributed unevenly. I know that we’re working with less than a normal hospital, which is why everything needs to be targeted. I can’t wait for hours for a repeat MRI -- it backs up the OR and limits patient outcomes. But we still have limited access because of distribution models that no longer apply.”
From that comment, two more staff members had raised their hands.
The conversation was building now, as productive discussions finally ensued. Will moderated it with relative success, and he couldn’t help but spare a grateful nod at Dr. Barringer, for helping him get this far.
-o-
The meeting was progress, Will had no doubt about that. But, he wasn’t naive. The problems wouldn’t be fixed with mere conversation.
No, Will needed to take action.
Now that he had a better grasp of the problems, he had to form targeted responses that addressed these multifaceted problems. Plus, he had to do it on a short timeframe with limited resources. In short, he was expected to work miracles.
It was a tall order, and failure was likely.
Will knew he had to try anyway.
To start, he decided to build on the conversation. The first session with his department heads had been fruitful, and he decided to make it a weekly event. He coupled that with periodic department meetings, including as many doctors, nurses and techs as possible. From there, he established one-on-one meetings with each department head as well, to really start getting the trust built.
From these wide ranging meetings, Will was able to start building more impressive and widespread plans to address the systemic problems facing the hospital. He first went after allocation, taking precise inventory of what each department had and what each department needed. By shifting some of the supplies and equipment, he was able to provide better support where it was needed most.
Then, to complement the allocation of supplies, Will streamlined acquisition requests. This made it easier for departments to indicate what they needed, and it promoted interdepartmental sharing to a higher level. It didn’t eliminate shortages, but it did help address some of the biggest lapses, and the quality of care provided across the board was immediately evident.
From there, Will tackled more ambitious projects. The hospital was barely paying its bills, and the threat of losing access to water, gas and electricity was actually quite real. With some research, he found that the hospital’s systems were so old that they were prone to failure -- they were also costing them a fortune. The problem was, of course, that updated those system was going to be expensive -- and the thing the hospital didn’t have was money.
It was a quandary -- and it was one that Will had no means to solve on his own.
So he didn’t.
He took the issue up directly with the utility providers, discussing the terms and conditions of their agreements. With some sympathetic finagling, Will was able to pitch the upgrades as an investment in the future of the community, and by signing elongated deal, Will was able to secure upgrades at a reduced rate. He even talked the issues up through the city channels, leveraging a contact of Mr. Alawe of all people. With Mr. Alawe’s recommendation and endorsement, Will was able to convince the city to extend the power grid to the hospital.
It took several days on the phone, and a flurry of emails, but Will had the situation with their utilities improved over the course of a week.
From there, Will knew he needed to address some of the issues within the staff. The high turnover rate would have a multifaceted cause, and he knew that, but that couldn’t be fixed with supply reallocation and a better power grid. No, Will had to be more targeted in these fixes.
He took feedback from the nurses most seriously. He knew very well from his time at Med that having the backing of the nurses could make all the difference. The fact that Maggie had considered him family had been a crucial part of his success there -- even though it hadn’t been enough to save him from himself in the end.
Still, if he wanted to improve staff morale, he had to go after the nurses. From departmental meetings, Will quickly noted a few consistent concerns from the nursing staff. Some of the factors were abstract, having to do with a lack of funding issues that Will was already addressing, but others had to do with something far more universal: scheduling.
With a short-staffed nursing network, the current nurses were being asked to work long hours, inconsistent shifts, and last minute schedules. In other words, they were being asked to put the hospital first in front of their families, social lives and other personal pursuits. With those kind of demands -- and the lack of pay or positive work environment to back it up -- it was no wonder his nurses were leaving in droves.
The only problem was that the nursing shortage made a reduction of hours almost impossible. Will didn’t have the money to hire new nurses -- yet -- but the scheduling system in place was still programmed to predict more nurses than they had on staff. Will needed to reprogram the system to account for a lower number of nurses in the first place. Then, by extending shifts to the maximum legal time, Will could create a more standardized schedule. Nurses wouldn’t be working less, necessarily, but they could at least trust that their hours were be consistent from week to week.
That fix was relatively painless, and it went over well with the nurses.
Then, it was time to make some harder calls.
So far, most of his changes had been working with what he had already. The cost savings from the energy fixes were the most significant, but even those were more negligible than he might want to admit. The real gain there had been reliability.
No, the hospital was still working at a bad deficit, and Will couldn’t pretend otherwise. Even with all this, the hospital was still going to go under unless Will started making more drastic cuts.
The problem was where -- and how.
And, probably, if he were honest, who.
There was no way to reduce the nursing staff. Techs were already overworked. They were operating with the bare minimum of residents and attendings. Which essentially led Will to one simple conclusion.
They didn’t have enough resources to support all the departments. They didn’t have the money, the staffing, the space -- any of it. They were overextended in their offerings. By simply reducing the departments, they could scale back on the overhead, streamline staffing issues -- all of it.
It was the obvious solution, clearly.
That didn’t make it an easy one.
After all, eliminating a full department was a dramatic change. It affected everyone in the department -- and it could limit their offerings as a hospital. It made them less widely competitive, but they couldn’t pretend like the system was working. Will couldn’t pretend to do everything well. He had to pick and choose the best things to excel at.
He worked his way around back to that conclusion every single time, and he knew he was right. He even floated the idea past Adam, and he consulted official organization policy with Dr. Wexler, and they both agreed. This was the critical solution needed to buy the hospital more time. In essence, he had the right to do this. He had high level administrative support.
But that didn’t mean it was going to go over well with the staff. Over the last few weeks, he’d built up a sense of hope and enthusiasm -- but it was tentative at best. He was not eager to shake the boat in his manner, even if he saw no feasible way around.
Feeling anxious about making the final decision, Will decided to pull in someone with a little more insight to the staff. He had a good working relationship with all his department heads, but he needed someone who he trusted to speak out, someone who shared his vision, someone with established credentials.
Dr. Barringer obligingly showed up in his office for her weekly one-on-one. She was usually in good humor when she arrived, and though she discussed matters professionally, she was the first of all his staff to seem truly at ease with him. She trusted him, and he found that he trusted her.
So he didn’t mince words.
She already knew the issues they were facing. She had already been part of the solution. When he posed the idea of consolidating departments, she sat there and stared at him. Then, she laughed. “You’re actually asking me?”
“Yes,” he said.
Incredulous, she gawked. “You’re actually asking me what I think of cutting departments? As a department head, you don’t think maybe I’m biased?”
“Not biased, invested,” Will said. “And I’m not talking about cutting. I’m talking about combining. By consolidating departments, we lose virtually no staff and we would allocate our resources better.”
“No staff?” Dr. Barringer asked tautly. “What about the department heads? You can’t just force a neurosurgeon to practice pediatrics all of a sudden.”
“Some of the specialties are more pliable than others. It’s not a perfect thing, I know that, but neither is the system we have in place now,” Will said. “I’ve been over the numbers and our output too many times. We simply can’t support the departments that we have.”
She scoffed. “We are already operating at the bottom of the barrel,” she said. “If you cut more departments, then we are shooting ourselves in the foot. We need whatever prestige we can find.”
“But we don’t have prestige,” Will countered. “People come here as a last resort, and we both know it. We have to be honest. Do you think people come through our doors because we have a pediatrics department?”
Her jaw dropped. “Wait, you want to cut Duvernay? The guy who has been here longer than anyone?”
Will shook his head, feeling a pang of frustration. “I’m not cutting Duvernay,” he said. “Honestly, with Duvernay’s background and experience, I was thinking he was a natural fit for your surgical staff. He spends more time in OR than most other department heads, and that is where 80 percent of our peds cases end up once they get out of the ED.”
“Right, so you’re not going to fire him. You’re just going to demote him,” she said with wry skepticism.
“I looked at the numbers. By combining budgets and reducing redundancy, I can still afford to pay everyone the same,” he said. “His pay would be untouched -- and so would his benefits.”
“But the title--”
She was set to protest, but Will stared back at her hard. “You think this guy has stayed in a place like this for five years because of a title?” he asked, and he watched her shift back in her chair, crossing her arms over her chest with a touch of petulance. Then, he continued. “I’m not saying these are perfect solutions, but they are solutions to problems that have gone on for too long. We have to think outside the box or the whole thing is going to collapse we we’re all out on our asses.”
He was being honest with her, and she knew that -- and there was a part of her that respected it, even if she clearly didn’t want it. Her posture eased, though, even if just a little. “So, why are you talking to me? It sounds like you’ve already figured this out.”
“Well, I’ve gone over this at a high level, but it’s not going to work without buy-in,” he said. “You’ve been one of the more forward thinking members on staff. I thought gauging your reaction would help me figure this out.”
She shook her head, smiling with disbelief. “No, you just wanted to get me on board,” she said. “You thought if you could sell me on it, I could help you sell everyone else.”
He lifted one shoulder, but didn’t bother to deny it. “It wouldn't hurt,” he said. “And I’m serious about Duvernay. I want him to feel good about the change. I want him to feel comfortable in his new team.”
“His new team with me,” she said gruffly. “You want me to make nice and make Duvernay feel like it’s not a demotion.”
“I just want to know if you think you can make this feel like a team effort,” he reasoned. “Surgery is your department. Do you have a place for someone like Duvernay?”
She slunk back again, crossing her arms once more. “You’ve got some nerve, Halstead.”
“I have to,” he posited. He pushed the budget sheet across to her, followed by a new one. “Look at our current budget and tell me how long we’d be open. The second sheet is the improvements that come from consolidation.”
Eyeing him with some suspicion, Dr. Barringer sat forward and took the papers. She studied them quietly for a moment, before shaking her head. “I’ve seen these numbers hundreds of times,” she said, putting the budget sheet back. She held onto the other one, nodding at it. “But this? All these years, and no one has come up with a plan like this. It’s like we’ve all been bailing water so long that I’ve forgotten what staying afloat looks like.”
She was starting to get it at least. Will had taken a week to process his denial and frustration, only to get him here. He was presenting it to her to process in one single meeting. “I’m just trying to keep the doors open,” he said. “If we don’t make changes, we all lose our jobs.”
Dr. Barringer put the second sheet down with a sigh. She pursed her lips, looking at him plainly. “Duvernay is crazy. You do know that, right?”
At that, Will tilted his head at her. “You’re saying that you’re not up for the challenge? I thought you liked challenges.”
“Oh, I see what you’re doing,” she said, sitting back and tossing her head to the side. “I am personally offended that you think you can play me like that.”
Her statement was definitive on its face, but there was something more. Expectantly, Will raised his brows. “But?”
She seemed to ease into the ease more now, concession visible in the set of her posture. “But your point is taken,” she said. “And, for the record, I will prove you and your smug little ass wrong.”
Will’s jaw dropped, surprised by the force and weight of her candor. “Careful, Dr. Barringer. I called you in here as a courtesy. I am still your boss.”
At this point, Dr. Barringer was smirking out right. “Whatever, Halstead,” she said. Then she casually shrugged. “And you can call me Helena.”
In some ways, the invitation didn’t surprise him. Her faithful candor, her ready attitude -- she had been the closest thing he’d had to a friend since starting here.
But he hadn’t been looking for friends.
He hadn’t even had time.
He’d been focused on strictly professional things, but here was a smart, vivacious and attractive woman, giving him first-name access.
It was surreal, for some reason.
“Helena,” he repeated, not sure what else to say, what else to do. All his ideas, and he was fresh out of them now. Somehow, his brain had effectively stopped working.
Across from him, Helena arched her brows. “And?” she asked, clearly expectant.
Will blinked back at her dumbly. “What?”
Now, she was exasperated. “If I’m doing you this favor -- and it is a significant favor, just to be clear -- then I should at least get a first name invitation back, shouldn’t I?”
The preponderance of professional behavior screamed in the back of his mind, but she was sitting there, looking at him, and all he could do was stare back with an air of awe and wonder. “Will,” he said without thinking about it. “You can call me Will.”
It might have been the wrong thing to do, but Helena’s smile made it impossible to see it that way. Brilliantly, she nodded at him. “Will,” she said, sounding wholly satisfied now. “You have yourself a deal, Will.”
-o-
Here was the thing.
After all his thinking and planning, after all his fretting and anxiety, it worked.
Against all odds, his last ditch hail Mary plan actually worked.
Expenses were tightened. Staffing issues were resolved. Productivity increased. The bottom line started to look more black than red.
And then, the turnover rate started to slow down. Patient satisfaction was skyrocketing. There were no lapses in service, and it was working. The improvements weren’t impressive by the standards of the other hospitals Will had worked at, but given where he’d started here, he couldn’t help but be pleased.
He was taking the best of what Adam had taught him, the best of what Dr. Dunst had taught him -- and he had applied it. He had applied it well and comprehensively, and the whole damn thing was actually working.
With the day to day activities moving along at such a good clip, Will had been rightly focused on the here and now. Keeping his head down, he hadn’t allowed himself to get distracted by outside issues. The outside issues, however, had other plans.
At least this time it wasn’t gang violence. At least this time there was no rise of a terrorist cell.
No, this time, something even more terrifying happened.
Will got notice from Dr. Ho that he was coming for a personal tour of the facility, and he wanted to sit down with Will one-on-one to discuss the current situation.
On its face, there was nothing particularly damning about the request. There was no active hint of accusation, and Will could not detect any trace of concern except from the presence of the request itself. Why would Dr. Ho need to come there? Why would an unscheduled review be warranted?
Will had been in contact with the board as his position warranted, and he had been thorough in clearing his decisions with all necessary parties. He’d been going out of his way to be utterly by the book in all this, and he knew that while they were impressed with his past work, he’d taken on a position that didn’t have much wiggle room.
What if he hadn’t done enough?
What if he’d done too much?
How was he going to justify his choices? How was he going to substantiate the outcomes so far?
When he expressed his doubts to Jay over a video chat, his brother rolled his eyes. “You’re overthinking this.”
“Am I?” Will asked. “I don’t have a great track record.”
“Actually, you do,” Jay said. “Or have you not noticed how everyone over there loves you?”
Will shook his head, feeling miserable at the impending meeting the next morning. “They don’t know me,” he said. “What I’ve done.”
“Pretty sure at this point it doesn’t matter,” Jay said. “We’re more than our worst mistakes, right?”
“Says the guy who still brings up me moving away to college like it was a personal affront,” Will muttered.
Jay sighed with that, and he nodded. “You know, you’re right?”
Will frowned, surprised. That had not been the answer he was expecting or even looking for. “What?”
“You’re right,” he said. “I resented the hell out of you for years, and I gave you a hard time about some of your choices. And I’m not going to sit here and pretend like you didn’t do everything right, but it’s also not fair to sit here and pretend like you did everything wrong. I wasn’t fair to you. And that only made it harder for you to come back. I know that, and I’m sorry for it.”
Will stared at the screen, not sure what to say. All these years he’d gotten used to playing the bad brother, and Jay was sitting there, offering absolution.
“Don’t be weird about it,” Jay said, scowling at him over the video. “You’re still a crappy brother more often than not, but you’re not all bad. I just don’t want me to be part of the reason you stay away, like you think you’re not good enough of something, because that BS in a very big way.”
“Thanks, Jay,” Will said. “I mean, that means a lot.”
Jay shook his head, now perturbed by the emotion. “So anyway, if that asshole comes in and gives you a hard time, don’t be afraid to stand up for yourself.”
“I don’t have much of a leg to stand on,” Will said. He bit the inside of his lip. “The hospital’s doing better, but it’s a long way from being solvent.”
“You’ll get there,” Jay said, with a total confidence Will would never understand. “You’ll get there.”
And Will was pretty sure they weren’t just talking about hospital administration anymore.
-o-
The conversation with Jay had made Will feel better, but it did not alleviate the practical anxieties he felt. On a high level, he knew that he had done nothing wrong. When it came to living it out, however, Will was still paralyzed by the same fear that had overwhelmed him in Ms. Goodwin’s office all those months ago. It was a hard feeling to shake, but it wasn’t one he could indulge.
Not with Dr. Ho arriving promptly at nine.
Will made sure to meet him personally, going out of his way to clear his schedule and dress his best for the part. He made grandiose small talk that he would have no memory of later, and he made every effort to make Dr. Ho feel welcomed -- and, more so, that the hospital was a legitimate, functioning place for medicine.
Clearly, Dr. Ho had been there before, but he still accepted Will’s invitation for an informational tour. And he moved around with the alacrity of an awestruck child, wide-eyed and open-jawed. He seemed more impressed with each department, and by the time they got back to Will’s office, Dr. Ho was nothing short of gobsmacked.
“I admit, when I read your reports, I thought they were fanciful,” Dr. Ho said, pacing back and forth across the small, undecorated space.
Will frowned in concern. He’d hoped that inviting Dr. Ho to his own office would be less nerve-wracking, but he still found the whole process to be unsettling. “I tried to be truthful and thorough in my reports.”
Dr. Ho turned to him in surprised dismay. “Yes, of course!” he said. “And you were! But that is what I find so remarkable! If anything, your reports do not do this justice.”
Will was perched on the edge of his desk, arms crossed tenuously over his chest. “This?”
“The transformation is the closest thing I have seen to a miracle in all my years of medicine,” Dr. Ho said. “I mean, clearly, there is still work to be done, but for the first time since I have been in charge of monitoring this facility, I feel like there is actually hope.”
Will wasn’t sure what to say. “Well, I do have plans for continued improvement, but they’ll take time and money--”
“Both of which you will get, I assure you,” Dr. Ho told him promptly. He started pacing again, shaking his head as if in disbelief. “The other board members will not believe the progress that I report here. To see how well things are functioning. To see the productivity of the staff.”
“We’re still working on retaining the talent, and cashflow continues to be an issue,” Will said, hoping to damper the expectations.
“We all thought this hospital would be shut down by now,” Dr. Ho said. He stopped and turned back to Will. “We had a buyer on the line, just waiting for the word to put in a bid.”
This one made Will pause. “You allowed me to come to a hospital you were going to sell?”
Dr. Ho shrugged, starting up his walk again. “We did try to discourage you from it, and that is largely why,” he said. “But Dr. Wexler was convinced you deserved a shot at any hospital you chose, and her faith was clearly not misplaced.”
Will was the one slack-jawed now.
Dr. Ho stopped once more to smile at him. “You have had many remarkable feats this year, but I would venture that this, right here, is your most impressive one yet,” he said. “This is excellent progress, Dr. Halstead. Excellent, indeed.”
Will’s instincts were to talk back the praise, but somehow talking back to his boss just didn’t sit right with him either. Instead, he managed to smile. “I’m...just doing what I can.”
Dr. Ho gave him a proud nod. “And I assure you. It is more than enough.”
That just proved, as far as Will was concerned, that there was a first for everything.