The Infrastructure Chronicles

 Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. He blogs about his
experiences at, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

Longwood+Bridge-1A recent Boston Globe story
by Stephanie Ebbert about squabbling between two state agencies
involved in the rehabilitation of a local bridge has prompted me to
start a new occasional series on this blog. People who don't know about
my lives before health care may not know that I am an infrastructure
junkie. For reasons my daughters consider very odd, I love roads,
bridges, sewage treatment plants, electricity cables, and the like. If
you are not interested in this topic, stop reading, but from time to
time, I'm going to relate stories to you about this field, but mainly
positive ones, where creative public officials and others have made the
fabric of urban life better for the public — in ways that never, ever
make the newspapers.

Here's the first. Back in 1999 or so, I was
Administrative Dean at Harvard Medical School. Connie Cepko, one of our
faculty members, called one day. Her complaint: Riding to work on her
bicycle every day, she noticed that the Longwood Avenue bridge over the
Muddy River and the MBTA tracks was full of dangerous potholes. What
could I do about this, she wondered.

Actually, I knew that I
could do nothing, at least within a normal human lifespan. That bridge
is a jurisdictional nightmare. It is at the border of two
municipalities (Boston and Brookline), spans a transit line (MBTA), and
also goes over a state park (owned at that time by the Metropolitan
District Commission). Just figuring out who would be responsible for
the road paving would take decades, much less getting the right person
to order a repair.

So, I called Rick Shea, who was the President of MASCO,
our non-profit planning and service entity for the schools and
hospitals in the Longwood Area. The next day, Connie called to thank me
for getting the potholes filled and a new, smooth surface on the
bridge. "My pleasure," I replied, wondering what happened.

called Rick and he said, "I knew it would be impossible to find someone
of authority to make this repair, so I just hired an asphalt firm and
had the work done. Each jurisdiction — if they noticed — probably
thought it was the responsibility of another. Therefore, no complaints.
Job accomplished. Happy to help."

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8 replies »

  1. I smell something very similar to b-s. There’s no way someone picked up the cost of paving an entire bridge’s road surface on a whim and in a day’s time. Filling potholes? Sure, that takes 10 minutes and two guys. But the paving part is just silly.
    It makes for a good story. But it also makes me wonder that if you stretch the truth on a story like this, what might you also stretch the truth on…?

  2. Imagine my surprise to find myself first in this thread to marvel at the depth of Rick Shea’s (or MASCO’s) pockets – paving a bridge’s potholes on a whim, that very day no less! He’s a veritable Mr. Rogers of government services. Only in Massachusetts!

  3. Great story! In the middle of my high tech career and education I spent one summer as a construction project engineer and when it came time to place a piece of rubber on some temporary scaffolding (carpenters and laborers)so they could install a piece of pipe (pipe fitters and electricians) while they were lowering (fun to watch so crane operators, federal inspectors, my boss)a huge boiler (think nuclear power plant size so every white hat on the project was there) through the ceiling over a 12 hour time period it became apparent that none of the craft was responsible for the movement of rubber. not me not me who could it be. Is there a rubber union?
    I had everyone (over 100 people) turn their backs to me and I crawled into a concrete tunnel and “accidentally” did it myself during their lunch while inspecting the tunnel. Is that what started me on the path to became a nationally recognized consumer advocate for health IT? No but it did teach me the importance of having a more collaborative approach to problem solving and to find simple inexpensive solutions.

  4. For a healthcare IT perspective, I recommend you also follow John Halamka’s blog “Life as a Healthcare CIO” [http://geekdoctor.blogspot.com/%5D. It’s well worth the time to read.
    John is CIO of the CareGroup Health System, Chief Information Officer and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician.
    John is also on the editorial advisory board for Health Management Technology magazine (www.healthmgttech.com).

  5. I conceptualize the leadership issue slightly differently. Often employees are uninterested or unwilling (out of fear of negative consequences) to point out problems, let alone try to solve them on their own. Current systems (or lack thereof) often penalize people for exceeding their “job requirements.” I agree though, because this brings us back to leadership.
    If leadership does not use systems thinking to manage the system, things don’t function in a systematic way (surprise!). Unfortunately, “systems thinking” hasn’t become mainstream, particularly in health care.
    My biggest fear is that we will fill the existing potholes with sand (or maybe coffee grinds?). I love the people who fill potholes, but I’m hoping we take a systemic approach to creating a decent health care system. It would be a bummer to end up leaving craters for the next generation.

  6. Thanks Paul, that was a nice diversion from this X12 5010 document I am creating. It is certainly good to hear of something actually getting done, be it in health care or other realms (government being one of the few places I can think of where things are about as messed up as they are in general health care). As Kathleen said, we need people that are not afraid to stick their necks out to do the right thing. Maybe, just maybe, one day we will have more leaders that are willing to do the right thing and not so much the popular thing.

  7. Let’s call Rick Shea and tell him about the EMR mess. Maybe he can get it fixed!
    Your article point out the importance of leadership and courage for solving problems. Most of us are too concerned about doing the wrong thing or bad press. We need leaders willing to stick their neck out, at the risk of getting them cut off, to repair these long-standing problems with the healthcare infrastructure.
    Great post. Thank you.