The captain of the Titanic

On the April 14, 1912, at 11:40pm, the Titanic struck an iceberg. Master seaman Edward John Smith was the captain of the Titanic. Smith enjoyed a reputation as the “Millionaires Captain” for his experience commanding some of the world‚s most luxurious ships.

After the collision, Smith’s behavior and decision-making became the subject of history‚s scrutiny. For the next two hours and twenty minutes, he isolated himself on the bridge and became a shadow of his former self. According to eyewitness reports, Smith failed to pass on critical information to his officers and seamen; reacted slowly to reports and rapidly changing circumstances; and gave half-hearted orders, some of which the crew would openly defy.

On April 14, 2005, Michael Griffin was named the new chief of the National Aeronautics and Space Administration (NASA). Griffin inherits an organization rife with infighting and internal politics. After years of bloated bureaucracy, NASA is in need of serious restructuring and refocusing. Many critics say that the problem with NASA isn‚t the lack of money rather it is the lack of organization and mission.

Ironically, budgetary problems may be the new NASA chief’s best friend. Tight budgets and new requirements will give Griffin the excuse he needs to lay off people, fire people, and move things around in ways that NASA’s incestuous culture doesn’t usually permit.

During economic boom times, shutting down unproductive programs and eliminating unnecessary jobs can be hard to accomplish. During economic downturns, necessary reforms may actually be more easily justified, accepted, and achieved.

Last Thursday, the Guam Memorial Hospital Board of Trustees accepted the resignation of embattled chief administrator Bill McMillan. McMillan had been maligned because of his failure to bring GMH to sufficient readiness for national hospital accreditation. In a speech before the Rotary Club, McMillan declared that a “change in culture” would be necessary before GMH could ever attain accreditation standards for patient safety or competent medical care.

McMillan’s observation is correct but perhaps not for reasons he may understand. Under McMillan’s leadership, GMH did not demonstrate a commitment to patient safety. Rather than prioritize payments for medicines, health professionals, and surgical supplies, McMillan continued the foolish GovGuam tradition of prioritizing payments to noncritical administrative personnel; funding questionable travel expenses; and even entering exorbitant marketing contracts.

If you are a hammer, everything looks like a nail. If you are a GovGuam administrator, every challenge looks like a political problem waiting for an administrative answer. If you are a GMH doctor or nurse, you just want to have medicines and equipment to take safely care of your patients.

A culture of safety must replace the culture of political expediency that McMillan and all recent GMH administrators have espoused. Not too long ago, a former GMH administrator defended the utilization of scarce hospital resources to fund unnecessary GovGuam employees as “humanitarian.” The pompous bureaucrat issued his callous pronouncement while at same time forcing Micronesian islanders from here and abroad to suffer with a dirty, impoverished hospital that failed to meet accreditation standards for patient safety or competent medical care.

Like his less pigmentally-challenged predecessors, McMillan failed because of lack of courage and inspiration, not dedication or organization. In addition, McMillan was saddled with a hypocritical medical director who had a penchant for inflaming almost every problem with which he was presented. In not quickly recognizing the icy divisiveness created by the medical director, McMillan’s ultimate failure was to stubbornly provide wayward leadership in the face of rapidly deteriorating morale among hospital personnel.

The solutions to GMH’s problems are clearly looming before island leaders like a titanic iceberg of fiscal proportions. Supply vendors must be paid. Operating facilities must be repaired and maintained. Competent medical staff must be competitively recruited and retained. Unnecessary staff and expenditures must be cut. Oh, and the Retirement Fund must be paid in excess of $15 million in order that hard-working senior employees can finally retire.

Empty promises of hope are no longer tolerable. Pleas for transitional analysis and democracy of pain strategies of hospital administration are falling on deaf ears in the medical community. The governor of Guam finally must accept his Organic Act responsibility to give Guam’s people a hospital that meets American standards for safety and competence.

Vincent T. Akimoto, M.D.
Tamuning, Guam