Neurosurgeons are all leaders. As leaders, we can learn something from Rudolph Giuliani’s experiences as mayor of New York. To assume that this book was produced as a result of Sept. 11 is not correct because much of it already had been written. Nevertheless, the mayor’s experiences of September 2001 certainly make his advice more compelling and have sent this book to the top of the bestseller lists.
Giuliani’s eight years as mayor of this country’s largest city produced, without question, a dramatic transformation. In September 1990, Time Magazine featured a cover with a broken heart and the headline “The Rotting of the Big Apple.” Ten years later, Time described New York as the safest large city in America. This metamorphosis from a crime-ridden catastrophe to a tourist mecca with safe streets yields a lesson which we in healthcare cannot ignore.
Giuliani introduced accountability into city government. The centerpiece in his strategy to reduce crime was called COMPSTAT. It is a system for the daily documentation of crime statistics and performance indicators. Obviously, one of the key factors was to collect appropriate data. COMPSTAT was successful because it was flexible and because it was timely.
Once accountability was modeled in the police department, the model was applied throughout the city’s agencies and departments. It was called the Citywide Accountability Program, and each agency created its own program which had to meet the following four criteria: regular collection of data (usually daily); 20-40 performance indicators; regular review meetings (at least weekly); and publication of representative performance indicators on the city’s Web site.
The mayor’s strong belief in frequency of meetings is best exemplified by a daily 8 a.m. meeting of all department heads. The meetings were brief, well-orchestrated and mandatory. It not only kept everyone on the same page, but fostered communication between departments. Giuliani set an incredibly high standard for working long hours and was able to surround himself with wonderfully committed people.
The author does not mince words in his advice about leadership. He includes chapters entitled “Bribe Only Those Who Will Stay Bribed” and “Stand Up to Bullies.” He has subtitled sections “Do What’s Possible, Try What’s Not,” “Don’t Exceed the Pig Factor,” and “Be Ready to Pull the Trigger When Time Is Short.”
Everyone who reads this book is anxious to learn about the events of Sept. 11. Although the author’s account is dramatic, he appropriately points out that his administration had for seven years laid the groundwork that enabled his administration to manage the catastrophe. No one who lived through the events of Sept. 11 will ever be the same. Mayor Giuliani is of the impression that his whole life, and particularly the previous seven years as mayor, prepared him for that day. He became a better mayor and a better person on that day. As a result, we all have something to learn from him. Read this book.
Gary Vander Ark, MD, is director of the Neurosurgery Residency Program at the University of Colorado and past president of the Colorado Medical Society. He is the recipient of the 2001 AANS Humanitarian Award.