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Airline CEO’s Philosophy Flew in the Face of Convention

About once a year for several years now, I have done eulogies for some psychiatrists who had died over the year. This time I’d like to do one for a business administrator. Given that our field has become more and more like a business, the connection should be relevant. This eulogy is for Herb Kelleher, who was CEO of Southwest Airlines from 1982 until 2001, and was then chairman until 2008. He died on Jan. 3 at the age of 87. Southwest Airlines became a unique airline. It sparked the availability of low-cost flights. It was so successful that it reported profits for each of the past 45 years. The norm for other airlines has been boom and/or bust. What was the secret to this success? According to the obituary in this past weekend’s Wall Street Journal, titled “Southwest CEO’s Quirky Style Yielded Steady Profits”, Mr. Kelleher insisted it was putting employees first. He made employees feel valued. In most businesses, “customers come first” has been the mantra. Translate that into behavioral healthcare and psychiatry, and it is that patents come first. Indeed, in my profession’s ethical principles, patients come “first and foremost,, whereas colleagues are of secondary priority. I’m with Kelleher, though. When I was fortunate to win the Administrative Psychiatry Award from the American Psychiatric Association in 2016, without knowing of the emphasis at Southwest, in my award lecture I said that whatever success I had was from putting staff and colleagues first, not patients. That felt like heresy, but I believed that loving staff in a caring way, with reasonable expectations, was the key to quality of patient care. The documented decrease in patient outcomes when clinicians are burning out due to system dis-empowerment confirms that point. Now that we are in an age of burning out in epidemic rates, not only in caregivers, but it seems administrators too, it is ever more important that the well-being of staff and colleagues is prioritized. If we don’t, not only will they suffer, but so will our patients. The bonus if we do so is also likely to be better financial performance.

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