How to kill a hospital

It's best if you can pick a really good hospital to kill. Try to find one that was started by surgeons and physicians for their most complex patients. It helps if the hospital is known nationally for its quality of care and its research facilities. Merge it with another, larger hospital, one in persistent financial difficulties. This sets the stage for a nice, slow, painful death for the better-run hospital.

If you're a member of management, remember: small demoralizations add up over time to a poisonous environment. Try to start small, with something like the laundry service. Contract with a different service provider, one who can guarantee that about 20% of your linens will come back stained, ink-marked, torn, or with melted tape on them. The extra five minutes a day each nurse or aide will spend looking for usable linens really adds up.

Once your employees have gotten used to hoarding clean, untorn sheets, you can merge supply rooms. Be absolutely certain that the research hospital is a minimum of two miles away from the central supply area, and be sure that their stocks of necessities are always just about to run out. The nurses and aides are used to sorting and hoarding linens; hoarding lumbar puncture kits and needles is one easy step beyond.

Don't forget your support staff! It's best if you can plead "budgetary constraints" before you fire all but three or four of your longest-working support people. With the money you save, you can re-fill those positions with people earning just over minimum wage and with few if any benefits. That way, you'll guarantee that the people who keep the hospital clean, who transport the patients, and who cook and serve the food will think of your facility as just a place to come to work, rather than a job that they're proud of.

Try to hire managers who are completely ineffective. It's better if they can be actively harmful to their units, but ineffective is good enough. Encourage them to promote to management positions those who carry on flaming affairs with coworkers, backstab, or are simply too lazy to move from a chair. It might take a while, but you'll find your patience more than repaid in frustrated and demoralized employees. Train your unit managers to respond late if at all to concerns.

If you have employees who are chronically late or absent, or who falsify documentation or who are unsafe practitioners, do your best to keep those employees around. Try to hire and retain people who complain of bullying if their mistakes are pointed out to them. If one or more of those people is sexist or racist, fantastic. Be sure to discipline good employees at the same time you let the others slide--otherwise, your staff might think you're simply incompetent rather than malicious.

Play favorites. It goes *such* a long way toward establishing cliques and employee unhappiness. Remember: little actions count! Leaving one employee out of the annual holiday-candy dump will be noticed and remarked upon.

Don't neglect the small perks that make working at a formerly-good hospital so satisfying. I'd strongly recommend stopping all employee recognition except that which has to be approved by management. Be sure you appreciate hard work, but not too much. If you have a unit secretary who hasn't taken a sick day in fifteen years, a five-dollar gift certificate to a chain restaurant is about the right level of congratulations.

And be sure that you lower the quality and raise the price of the food in the cafeteria. Nothing says "We could give a flying fuck less about you" than a widespread outbreak of E. coli poisoning, especially when the prices for bacteria-laden sandwiches have almost doubled in a year. Sure, some of your employees might go next door for a decent meal, but remember: you can always discipline them for leaving the floor for lunch.

Investment in new technologies is always a fine idea. Before you invest, though, be sure whatever new widget you're rolling out will be several thousand dollars more expensive than you'd expected, be months late in implementation, and be difficult and tricky to use. If the widget is computerized and crashes routinely, so much the better. Bonus points for replacing a trouble-free system with one that dies on the average of twice a week. Triple bonus points if it has something to do with either patient safety or medication administration. Just think: with the money you've spent on this latest boondoggle, you could've hired another pharmacist. As it is, though, you're increasing the pressure on *that* part of the hospital while frustrating nearly everyone else. Good job!

Keep it up for eight to ten months and watch morale and job satisfaction slide! Don't neglect the tiny details, either, like imposing fines in particular parking areas, then changing the rules without notifying your employees. There can never be enough paperwork. There can never be too few people in critical positions.

Give yourself a raise, manager! You've successfully killed another hospital!