When I was little, I lived in a small suburb in western New York with my mom, dad, and little brother. We didn’t have much, but I didn’t really notice. My dad had an adventurous spirit, which lead to weekend drives that led to places unknown, sometimes to the lake for an ice cream, to the local diner where I could play the table jukebox while waiting for our meal, a drive-in movie, down pretty leaf colored two lane roads, and occasionally to Canada, his birthplace, to see the Canadian side of the falls, or to drop in on relatives and fill his tank with imperial gallons of gas, long since replaced by liters. I loved our weekend adventures. My most favorite memories of living in New York, however, were about family. My father’s side was Irish, Catholic, and large. My immediate family was small, with just my parents, brother and I. My uncle had six kids, and their house was full of noise, food, and fun. I loved hanging with “the cousins” as we called them. Once, after a sleepover in their dorm like rooms, we went to breakfast, all seven of us, and loved that one of the patrons thought I was part of the brood, being mostly blue eyed brunettes. We moved south when I was ten, leaving “the cousins” behind, and I longed for those big family gatherings.
In my career, I have managed both large corporate surgery centers, and small independent ones. Not unlike family size, there are good with both. With large centers, there may be a full management team, where challenges can be met about and resolved. There also are corporate initiatives, protocols and processes to assist with governing the center. Governing Boards are often large groups where decisions are made democratically. There may also be, however, less room for autonomy, and more valuable time spent in preparing and reporting to shareholders than in smaller independent centers. Smaller centers often allow a more personalized autonomous approach to leadership, and a more familial feel. There could be little support for things like vacations, sick days, or problem solving within the center. The challenges are the same with both: personnel issues, regulatory compliance, cost containment, and ensuring quality care each and every day.
I learned, from managing both types of centers, that the grass is not always greener. As an adult, having reminisced with “the cousins” about how envious I was not having been part of that big family, they shared that they were envious of us as well. There were few road adventures for them. Feeding a family of eight was difficult enough, much less paying for a meal out on the town. Even putting everyone in that station wagon with wood on the sides and seats that faced each other in the back, although really cool as a kid, meant another tank of gas that may not be in the budget. I used to hate when my brother was on “my side” of the backseat, and can now only imagine having to share seat space with five siblings regularly.
We are all facing similar challenges as we lead our centers each day, and there is the good and not so good with both. With every center, adaptation is key, and learning how to work within the culture, big or small, can be tricky. Though never easy, the good stuff is what gets us through, whether it be the ice cream cones at the end of the two lane road, or the big home cooked family meal.