risk is bad . . . long live risk

I recall my father attempting to teach me the difference between courage and stupidity.

Courage, according to my father, was standing up to a bully at school. Stupidity was jumping off the roof of our garage. Both involve taking a risk. Both make your heart beat fast. Both could result in a

For a while I believed that, based on those examples, no one could possibly confuse a risk that involves courage with a risk that involves stupidity. However, that was before bungee jumping, hang gliding, parachuting, and high-stakes poker entered my consciousness. While I would not do any of these myself, neither would I unilaterally categorize them as stupid. (OK, maybe bungee jumping.)

More ambiguous still would be a situation like this: A reporter at a local newspaper asks to interview you about the process your hospital uses to set its prices, especially for self-pay patients. Is it stupid to try to explain a complex process that might alienate the community and get the attention of the state attorney general, or is it courageous to reach out to the community to gain their understanding of why the healthcare system works the way it does?

This issue of hfm focuses on risk. In the health administration vernacular, risk generally is somethingto be "managed." What I like about the collection of risks addressed in this issue is that while all are things that need managing, frequently they also require courage.

Consider the list of risks identified in our cover story, "What's Keeping You Up at Night?" Increased demands for transparency in pricing and quality. Gainsharing and joint ventures. Excess capital spending that may leave some providers overleveraged. New workforce challenges.

All are risks that require vision, brains, and courage to address. Take price transparency. One CFO beautifully captures the need for courage in that area: "The day is over when we can say, 'They don't understand,' and not take responsibility for doing something about the fact that they don't understand. It's our job. We have to make it our job."

Also in this issue is a profile of HFMA's new chairman, Joe Fifer, as well as Joe's first column. Joe's theme as HFMA chairman is Courage in Leadership. Joe's middle name could be "Taking Risks for the Right Reasons," although it wouldn't fit on his business card. Here's what Joe says about pricing: "It's a complicated story to tell, but we need the courage to put our pricing in order and then stand up and tell that story."

What strikes me most about those quotes is their energy-the sense that these are people who thrive on taking risks in a good cause.

I hope this issue ofhfm will help you assess a wide variety of risks you face every day, give you tools to cope with those risks, and most of all help you stand tall when the risks require the courage to do the right thing. And if you like bungee jumping-well, I won't say that's stupid, but you're on your own.