My epiphany came at seven o’clock on a hectic November evening in 1996. I was the attending physician in the intensive care unit at Duke Children’s Hospital (DCH) in Durham, North Carolina. A six-month-old named Alex lay in a crib in the ICU with a stiff plastic tube in her throat. Awake and moving after heart surgery, the tiny girl was ready to come off the ventilator. As Alex squirmed and tried to breathe, the ventilator forced more air into her lungs. Her exhausted parents grew distraught. “Why can’t she come off the ventilator?” her mother asked. “Because we’ve had to cut back on night staff,” replied the busy nurse. “There’s no respiratory therapist available.” Alex was uncomfortable. She received medication to help her sleep and to keep her from fighting the ventilator until the therapist arrived in the morning. But her parents didn’t sleep; they were too confused and upset.
Saving Money, Saving Lives
A noble mission doesn’t guarantee financial solvency. That’s why the chief medical director at one hospital needed to find a way to keep the mission lofty and the bottom line healthy. His tools: reams of data, a fresh approach to teamwork, a sense of humor—and the balanced scorecard.
A version of this article appeared in the November–December 2000 issue of Harvard Business Review.