Over the years, I have observed and experienced events which have undoubtedly influenced my management philosophy. What follows is a litany of concepts that taken as a whole best describes my philosophy of life as much as my philosophy of management. My pride of authorship is in the combination of these concepts or beliefs and not in any one taken by itself.

Agent of Change. In times of corporate difficulty the manager must lead his staff out of the abyss. The manager is the leader who must navigate the path to be followed by the organization as will as the staff.

All Actions Are Decisions. A manager must be aware that he is always being observed. Doing is always seen--not doing is always detected. The nature of management is being observed.

All Things to All People (ATTAP)/Niche. Be very good at something important. Do not waste time and money competing for the given--wait, watch, execute.

Army of Lions Led by a Lamb Never Defeats an Army of Lambs Led by a Lion. Leadership can overcome shortcomings in resources. Confidence in leadership will overcome staff perceptions of inferiority.

Authority/Responsibility. One without the other is a guarantee of failure. The Supreme Court without the confidence and concurrence of the populous would be ineffective--so would any manager.

Blame/Responsibility. One without the other is dishonest. Only hold accountable the one who is.

Buyer Sets Price. In health care as in crime. The reaction of a need to control costs has resulted in price-setting which moves the potential for abuse from the provider to the buyer.

Capacity to Learn is as Valuable as the Knowledge to be Gained. Another way of saying an open mind is the tabernacle of inspired reasoning. Listening is as good a vehicle to learning as reading.

Chapter Heading Knowledge. My buzz phrase for the ultimate con artist who tries to impress with words rather than substance. Always engage in some degree of detail to assure real understanding.

Character by Challenge. The measure of a manager's character is more dependent on the challenges he provides himself rather than the obstacles presented by others.

Committed Cost, Discretionary Cost. Be mindful of what comes with the territory before investing resources. For example, for the operation of a building, there will be certain costs such as insurance, depreciation, etc. and if there are employees there will be fringe benefits and possibly separation pay.

Compensated Absence Day. Does away with the distinction between absences caused by sickness or vacation, it eliminates sick lies. Your chances for reducing non-productive time increase if you shift the risk.

Conflict of Interest/Lack of Interest. Be mindful that some people's interest is solely self-directed no matter how worthy the cause. Do not waste time and effort educating the disinterested.

Cost/Price. There is a difference, and well there should be.

Curing/Caring. Understanding the difference is half the battle. The cure is in the caring not in the discharge.

Customer/Patient/Doctor/Payor. How unfortunate that we have to ask. In modern times commercial issues sometimes intrude into social issues.

Defer/Decide. Anyone can defer, it takes a leader to decide. Deferrals will exponentially increase the number of unnecessary decisions.

Diagnose/Treatment. Do the former before the latter. A balance of one's efforts is necessary in management as in medicine.

Discharge/Revenue-Day/Expense. In healthcare financial management revenue is driven by discharges whereas expense is everywhere.

Exposure/Knowledge. Do not confuse being at the game with playing it. Thirty years experience or one year's experience thirty times.

Fixed/Variable. Not all actions evoke responses and some costs are not subject to activity. How fixed some costs are is directly influenced by the fixation of the manager.

Follow-Up, Follow-Up, Follow-Up, Follow-Up. Attention breeds success.

Franchise. At best what we have is a temporary lease. Recognition that each hospital activity is a potential franchise is important from a cost control standpoint.

Function vs. Responsibility. A leader can tell the difference.

Good News/Bad News. Good news properly communicated will travel as fast as bad news that is not communicated at all.

Horizontal/Vertical. It is less costly to treat an ambulatory patient than an inpatient.

Illness/Wellness. An ounce of prevention is equal to a pound of attention.

Information is Power. In any large organization there exists the desire by the masses to have information. Failure to provide information results in the filling of the "information vacuum" with hearsay, rumor, or other forms of false information.

Isoresources. A unit of measure that is indicative and can be compared.

Job/Career. Do not confuse the battle with the war. The perception that is received is not always the image that one projects.

Lead, Follow, or Get Out of the Way. But whatever you do--decide.

I See it, I Like it, I Own it. The satisfaction of doing not having done.

Maintainor/Innovator. The mechanic or the architect.

Management by Design. Do not leave to chance what can be planned. Planning is a science and proper planning is an art.

Memorable Person. Someone who does not remind you of anyone else.

Occupancy/Vacancy. Is the cup half full or half empty?

Opportunity Cost. The awareness that every decision voids the ability to seek an alternative course of action. Remember not all costs are measured in dollars, some are measured in good sense.

Other People's Money. The best form of investment risk.

Owner/Steward. Every shepard knows his flock.

Past-Future. The present is the future's past memories.

Patient-Days-Discharges. A hospital is more like a restaurant than a hotel--what is needed is turnover not occupancy. Borrow from the experience of other industries.

Perception is Reality. Left alone or uneducated one will draw his own conclusions based on his own ignorance. Always be mindful that everyone is following their own tract--therefore one's reality can be another's perception.

Policy Is Set at the Top. Decisions are made everywhere else.

Power/Authority. Ex. Supreme Court

Problem/Opportunity. One nation's terrorist is another's freedom fighter.

Public Utility. A necessary resource that can not be stored nor deferred for any extended period of time, i.e., health. This definition clearly implies that health is a right not a privilege.

Quality/Quantity. The quality of leadership will always compensate for the lack of quantity of followers but the quantity of followers will never improve the quality of the leader.

Reachability. The principal aspect of goal setting.

Reactive/Proactive. The first mover always sets the stage. Every action evokes a reaction, a proactive manager can keep reactionary responses to minimum.

Reimbursement/Sales. Fact.

Resources/Time/Equipment/Money/People/Policies and Procedures/Space. Each task requires the careful weighing and inventorying of one's assets before the utilization of deployment of those assets. An effective plan will always involve the allocation of resources.

Rex Vini/Master of the Feast. The leader. Many are called and few are chosen, but even fewer serve effectively.

Right/Privilege. To what end does individual freedom extend?

Skill: Ability to Activate Knowledge. Fact. The currency of knowledge is the skill in action.

Spender Has No Financial Ties. In order to control costs expenders must be under control. The age old tradition of a loosely connected organization such as a hospital must succumb to the modern view of cooperation.

Team Concept. All managers are members of the management "team" but like any team there must be a manager and coaches.

Terrorist/Freedom Fighter. A way of saying that every coin has two sides.

Thinkable/Doable. If it's thinkable, it's doable. What man conceives, he can implement.

Third Party Authority. A subordinate's use of his superior's name or office to carry out a directive, example, the boss wants you to ... Third party authority (TPA) is not only dishonest but self-defeating.

Wage/Equity. We all need to own a piece of what we do. Not all ownership is deeded--example, knowledge.