Grassroots Change + Personal Accountability in Healthcare

Change and personal accountability in health and care!

Standing on the shoulders of the rebels, the crazy ones, the trouble makers and the boat rockers – these are the folks that I am blessed to call my friends and my colleagues; these are the people that push the envelope for change, that embrace the hard work and the ones I love!

Here’s to Colin Hung, Linda Galindo, Helen Bevan, Tracy Granzyk, Dave Mayer, Michael Bennick, Paul Westbrook,  Paul LevyKaty SchulerSteve Farber, Jake Poore, Diana Christiansen, Jason Wolf, Coleen Sweeney, Carol Santalcuia, Jason Gottlieb, Chris McCarthy, Kip Durney, Jim Rawson, Debra Barrath, and many, many more.

Changing the culture of healthcare takes a village of the committed, personally accountable, energetic, loving and audacious. I love these change agents!

Please join us on March 24th 20:30 EST (8:30 pm) on Twitter for a tweetchat #hcldr

Grassroots Change + Personal Accountability in Healthcare.

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Culture and Love – Safety Leadership Lessons from a Supermarket Chain

Culture and Love – a story from 2014

As 2014 drew to a close last week many a news outlet spent time reflecting back on the highs and the lows of the past year. Whether framed as a “top 10 list” or presented more as the best and the worst, here in northeastern Massachusetts one particular story caught my ear.

This was the Market Basket Story, a tale of unparalleled employee unity and pride, and living proof that a small group of committed people can in fact make a difference.

If you’re unfamiliar with this particular tale, there was a real cast of characters; long-time feuding, wealthy family members, unfairly (some would argue) fired senior executives, passionate, committed employees, and deeply loyal customers.

Bottom line: local grocery-store chain CEO fired by cousin (hate each other) board member, employees (loyal is an understatement) outraged and walk off the job, stand-off ensues, employees rally for the fired CEO to be reinstated, customers stay away at the request of employees (and there are no supplies on the shelves) and eventually the fired CEO buys enough shares to take control of the company and is reinstated – celebrations all around and bonus checks for employees!

The news story that I heard a few days ago was celebrating the fact that the entire body of employees has been recognized as the Boston Globe’s “2014 Business Person of the Year”, and reflecting on the leadership of Arthur T. Demoulas, the reinstated CEO, making the statement “… he was reinstated along with his culture of generosity, kindness and caring.”

I love this statement! His Culture!

Think about the words, his culture. This is not an abstract, difficult to grasp concept – this is his, the way he leads, the way he works.

In our work to improve safety in healthcare the word ‘culture’ gets tossed around all too easily. It’s easy to blame the culture, almost as if doing so excuses the behavior. It rolls off the tongue as part of our standard vernacular, and is often the response to much of what ails us:

Q: “Why are some of your operating rooms using surgical checklists and others not?”

A: “That’s just the way we do things here, it’s our culture…”

Q: “What stopped you from speaking up when you saw your senior colleague acting in that rude, disrespectful manner?”

A: “That’s the culture on this team, keep your mouth shut and your head down…”

It strikes me that we cite or state culture as the root-cause of the problem because it creates the impression that fixing or changing it is nigh on impossible. That to tackle, change or create a new culture is a myth so complicated that we best not even try…

The Market Basket story annihilates this myth.

Health and care leaders listen up

Culture is the way we act as leaders. It is the tone we set, the expectations we communicate, and the behavior, language and performance that we tolerate.

Culture is the way we (you and I) do things. Do you want a communicative, fair, safe culture? Then communicate openly about the good, the bad and the ugly. Be fair with the people that choose to work in your organization, and with the way you make decisions (don’t interpret as treating everyone the same…), and model an environment where speaking up about your mistakes and owning them is celebrated not frowned upon.

Remember, if it is to be it is up to me.

His culture!

“His culture of generosity, caring and kindness.” The reporter goes on to interview Arthur T. (reinstated CEO) and he describes some additional tenets by which he runs his company, with fairness, justice, and connection to the human soul.

They’re running supermarkets people, and he’s talking about connecting to the human soul…

He nails it when he shares that the secret to this incredible story is to remember that they are, “… in the people business first, and the food business second.”

Health and care safety in 2015

People business first, medicine business second.

People is where our focus needs to be. Caring and healing our patients and their families, absolutely, it’s the calling that many of us responded to that finds us doing the work we do. But it needs to be more than this…

I propose that in 2015 we need our focus to be more on the people that provide this care – as leaders we need to make these people ‘the business that we are in.’ They will take care of their patients.

Commit to being in the people business first. The care givers; the nurses, the technicians, the physicians, the patient care attendants, the unit secretaries, the managers, the supervisors, the housekeepers, the pharmacists, the social workers and each other.

Provide the generosity, kindness, love, fairness and justice that connects them to their purpose, reminds them of their calling, and creates a safe environment for them to deliver the best care possible.

 

The reporter for the piece on Market Basket closed out the segment by suggesting that the Market Basket employee’s actions have presented other companies throughout the Commonwealth and around the world with a challenge of sorts – loyalty is one thing, these folks though clearly love where they work, and who they work for…

From loyalty to love!

Perhaps for 2016…

 


Pecha Kucha comes to IHI 26 Forum

Pecha Kucha!

“Bless you!” were the first words out of my mouth when I heard someone say peachakoocha during this week’s 26th annual Institute for Healthcare Improvement (IHI) Forum in Orlando, FL. On hearing the word, my 12-year-old daughter thinks it sounds like the name of a Pokemon character…

Weird word = wonderful experience
In a conference environment that can be all too often filled with long-winded PowerPoint presentations with presenters reading slides, this was an energizing and welcome change.801t

“PEHcha KOO-cha,’’ is the English pronunciation, of what appears to be a rough translation of the Japanese word(s) for “chit chat’’. Picture an event akin to a poetry slam. A Pecha Kucha is where subject matter experts get together to share their work, opinions and beliefs, and get to hear from others. A fast paced opportunity to share, learn and be inspired.

Pecha Kucha started in 2003 in Tokyo and has since migrated to almost every country in the world. Originally designed to share ideas in design, architecture and photography, it has apparently now come to healthcare. There are now Pecha Kucha ‘nights’ in more than 300 cities around the world.

How does this work?

The Pecha Kucha at this weeks IHI meeting was hosted by Helen Bevan, Chief Transformation Officer for NHS Horizons Group (UK) who acted as host and ‘race marshal’. She explained to the audience what would happen, then welcomed each presenter to the podium, and then asked, “are you ready?”, setting their slides running for the ensuing sub seven minute presentation (6 minutes, 40 seconds)…640

Presenters — there were 8 of them at the IHI — shared and narrated 20 slides for 20 seconds that “auto-ran”, meaning the presenter had no control over slide advancement, the slides roll…

The 20 x 20 format is at the core of a Pecha Kucha. The emphasis here is on speed! Can’t keep up, then you’re likely not ready for this rapid fire onslaught of ideas and inspiration.Pecha Kucha 2014

What we witnessed at the IHI Forum was a Pecha Kucha focused on the theme of “my hope for the future of healthcare”. These were inspiring stories of why each presenter had been called to make a difference in healthcare and provided insights into specific projects that each of them were working on. Beautifully inspiring, brave, personal stories of commitments to lean in and make health and care safer, more accessible and more relationship driven; the triple aim is alive, well and thriving!

A refreshing change at a terrific conference. I commend Helen for leading this and congratulate the IHI for welcoming this imitation of a clearly different approach to sharing, learning and inspiring.

I’m a Pecha Kucha fan!

pechakucha2nobanner

Check out this Pecha Kucha Storify


You promote what you permit

I recently spent a day with a number of senior clinicians all working in an environment that is permitting pockets of disruptive, unprofessional, and quite frankly dangerous behavior amongst caregivers. The last conversation of the day ended with a chilling reminder that we still have much to do, “The problem is that for too long, to be successful in academic medicine, you haven’t needed to be polite, professional and well mannered…”

Last night I read a headline that really grabbed my attention…

Why disruptive docs may not be so bad after all

Here was my reply:

I will start by saying that there is, in my mind, absolutely no place whatsoever for a disruptive (rude, hostile, ill-mannered, bad tempered) anyone in a safe, efficient, patient centered, healthy, just healthcare environment. Let’s not limit this to physicians…

I am sick and tired of hearing that being a technically excellent clinician and being a decent, respectful, polite human being are somehow mutually exclusive. They are not, and to suggest otherwise is disrespectful to the enormous number that are.
Please don’t suggest that organizations committed to improving the experience of those they serve are “getting rid of disruptive docs…” as an approach because they now have dollars tied to HCAHPS performance. This is a gross over simplification.

I’d offer that any healthcare organization that hires and retains mean, disruptive physicians (or anyone else) is complicit in creating a dangerous, un-just, unreliable work environment, not simply a less than ideal patient experience.

We need to start changing the conversation, raising our standards and expectations, and demanding more of one another. A world class, safe, reliable, effective experience is within our reach, but only if we stop confusing experience with “nice” and start holding ourselves and our colleagues to not only the highest technical standards but also high behavior standards.

 

I understand that we need to be mindful of the words we use, and am enthusiastically open to the idea that we need to lead with more “healthy innovative disruption” as we work to improve the safety and delivery of health and care. (Note the great work done by Helen Bevan and colleagues at the NHS with the notion of being a rebellious health and care change agent). But to suggest that disruptive behavior, in the way this article does, is somehow OK, and furthermore actually has a place in our healthcare environment, is reprehensible.

I’d love to hear your thoughts.