I feel uncomfortable in the space between the tried-and-true way something has been historically done, and the risk and uncertainty associated with finding a better way to do it…
The conversations about what is not working, knowledge of the outcomes that are not being achieved and the belief that there is a better way (that is often already being practiced or imagined by a small number of courageous souls) is exciting and full of possibility and potential… I am naturally drawn to what is on the horizon, the potential of a brighter future…
And it is unsettling and downright scary as I put at risk the “way I’ve always done it” and lean into something that is uncertain, unclear and without guarantee.
It is uncomfortable to both yearn for something better and deal with the private tension that not changing is often easier and less risky than changing… And yet I know, deep down in my bones and from my own life experiences, that much of what I enjoy today is because I took a risk to walk away from the past, took a risk to try something new and let go of something that wasn’t working based on a promise or a belief of a better, brighter more value/principle aligned future…
The phrase “the tension of the and” comes to mind in this uncomfortable space. Easy enough words to say, and yet, for me, uncomfortable to practice and bring to life both personally and professionally.
A mentor of mine reminds me that unless I now have elastic arms… I need to let go of what I am holding onto to reach what I’m trying to grab…
A crude analogy perhaps but the root of my discomfort is the uncertainty in the space between these two states… the known and the unknown.
The actions associated with change are uncomfortable.
And, knowing and sharing this does not make it any easier but it does make the journey more enjoyable.
It is more enjoyable because it is easier for me to articulate what is happening, easier to recognize and appreciate the feelings (my own and those around me), easier in some ways to craft and share the narrative of the why behind the change and the hope for a better future and easier to seek out support, advice and help from those around me as we journey forward and change.
I’m comfortable being uncomfortable.
I had a routine GI procedure three weeks ago. You know the drill; “after the prep, the procedure is a piece of cake…”
I had a great experience. The results were clean and benign! The staff were friendly, the center was clean, the nurses were kind and professional and explained everything well. The doctor was personable and had an appropriate (enjoyable for me) sense of humor. Everything ran on time and my ‘competent adult’ escort got me home before lunch time – I was starving!
Life quickly returned to its ‘pre-prep’ normalcy and the procedure was a distant memory. Or so I thought…
This morning a 37-question paper survey arrived in our mail box, asking me to share my “thoughts and feelings”.
My immediate reaction of wanting to recycle this piece of ‘junk mail’ was curtailed by my morbid curiosity to re-examine this antiquated and ineffective means of gathering feedback.
Do our hospital and health system leaders really believe that this is an effective way to gather feedback about my experience of the care that I received? I can’t remember what I had for breakfast this morning and you’re asking me to rate the “Attractiveness of the Surgery Center” from three weeks ago.
This is absurd on so many levels!
I really don’t recall how attractive the surgery center was, nor do I really care.
I care that your staff were kind, compassionate and didn’t keep me waiting. I care that you knew who I was and did the correct procedure on me. I care that you explained what you were doing to me and that you all seem to know what each other was doing, apparently enjoyed working together, had the equipment to do your jobs safely and effectively and seemed to be committed to taking care of me as a priority.
Listen. If you really want my feedback, if you really want to know my thoughts and feelings, do what our vet does after my dogs have a visit; call me that night or the next morning. If I’m not available chat with my wife (she was the competent adult that picked me up…), trust me, she will know whether my experience with you, your facility and your caregivers was anything other than stellar.
This would also allow you to determine whether I was suffering any post-procedure discomfort or pain. That call would also be an appropriate time to ask me whether I had any questions about the procedure and you could remind me about any follow up that I needed to remember.
If you can’t afford the time for a person to make a call, then send me a text or an email with half a dozen quick questions. In fact, that might be better, then you’d have the real time data to inform any changes to your operations or any service recovery for your patients.
The 80’s called, they would like their survey back!
We can do better than this, our patients and caregivers deserve better than this!
P.s. send the pager and fax machine back too…
It’s been more than five years since I dipped my toe into the world of blogging when I wrote – “The Emperor is Naked! Taking risks to reduce risk…”
The title was a clumsy headline intended to grab your attention.
The point then is the same as it is today so here’s a reprise – Still Naked
The fear of speaking up and being vulnerable is getting in the way of delivering safe and effective healthcare. The fear of speaking up is paralyzing leaders and their teams.
Coming over that fear requires bravery and as my friend and mentor Steve Farber (author of the Radical Leap) would say, vulnerability:
“Vulnerability aids human connection, and connection is the conduit for energy. Pretense of invincibility builds walls and creates distance between human hearts.”
Time to close this distance. Time to speak up. Time to get naked…
In the first blog in this series I shared Robert Frost’s poem “The Secret Sits”
“We dance round in a ring and suppose,
But the Secret sits in the middle and knows.”
I suggested that the “Secret” is the person at the center of care. The patient, their family, and their caregivers are sitting “in the middle” and knowing what they need and want but they lack effective ways of sharing this, and provider organizations’ currently have ineffective means of capturing this feedback.
In the second and final part of this series, “The Secret” and Improving the Experience of Care, I offer some ideas for how leaders in healthcare can improve the usefulness of data capture to improve the patient experience.
I’d really appreciate any comments, feedback and other ideas that this post prompts.
The question remains, are you dancing around the ring and supposing, or are you listening to the secret?
I recently used Robert Frost’s poem “The Secret Sits” as a blog writing prompt…
“We dance round in a ring and suppose,
But the Secret sits in the middle and knows.”
In the blog I suggest that much of what we do as leaders in healthcare (the dance) and what we measure in healthcare are disconnected from what our patients and staff really want and need (the secret sitting in the middle).
I was recently in a hospital conference room preparing for a leadership meeting; the walls were papered from floor to ceiling with graphs, tables and charts… a “loud” visual statement that a myriad aspect of operations was being measured and reported. During our meetings I dug a little deeper, listened to the leaders, caregivers and patients, and then looked a little closer at the “scores” on the walls.
Outcomes, as measured and reported, apparently hadn’t changed much over the past two-years… It was not lost on me either that this conference room that is billed as the “control-center” of operations felt lifeless and soulless… For an organization committed to ‘health’ and ‘care’, this felt like a disconnect.
And I’ve seen hospitals that are listening to the “secret”. They are measuring, reacting and acting differently. They are breathing life into their data and working on ways to make it as real-time as the work and care that it is intended to measure. Outcomes are improving, care is safer and the experience of those caring and being cared for is markedly improved; so I am optimistic and incredibly hopeful that we can rethink what we measure and how we act. How we lead.
Check out my blog “Improving the Experience of Care” (first in a two-part series) on our company’s site. I’d love your thoughts, comments and ideas:
- Are we measuring the right things in healthcare?
- Is chasing an improved CAHPS score, or a better CMS Star Rating, the right way to drive change?
- Can we measure everything that matters?
- How do you measure a healthy, effective and respectful culture?
- What’s the secret that you’re dancing around?
The language we use and the hierarchy that this supports is at the core of creating, leading, and sustaining a safe culture.
The words we use
Listening to the faculty and the future (students) at the Academy for Emerging Leaders in Patient Safety (#AELPS11) over the past three days, I have heard several comments and engaged in more than one conversation regarding hierarchy, ego, and language as barriers to safe care.
During some of these discussions I heard myself and others say things like, “Communicate down to the housekeeper” and “escalate this up to the board”. While I think these comments are made with no malicious intent, and often find myself thinking and saying these things, I firmly believe that we need to be more mindful of what this “directional” language promotes.
When I listen to this language, I hear us unintentionally reinforce professional elitism. The language implies that the housekeeper is at “the bottom” of our organization and that the board member is at “the top”. Perhaps I’m reading too much into this but having served in both roles, and having been on the receiving end of these conversations for many years, I believe that this language promotes the belief that the housekeeper is at the bottom of the hierarchy and not an equal voice or participant on the care team. The more we think and speak like this, I believe, we are at risk of discounting the input of those at the lower end of the equation, as well as elevating opinions and ideas of those “at the top”, often at the expense of safe care to patients.
Listening to the team
One story we heard here was the tragic story of Lewis Blackman – a poignant reminder of the aforementioned point was the nutritionist recognizing that Lewis had not touched his food, and yet nutrition orders never changed. Did the nutritionist notice, and wonder why? Was he or she empowered to voice concern, and what might have happened had that been the case?
The care team in healthcare is made up of everyone that interacts, communicates and cares for the patient and their family. The professionals serving in the housekeeping department may spend more time in a patient’s room than many of the clinically trained team on any given day. Ensuring that these team members are engaged, respected, and listened to as valuable team members is a critical component of safe care.
Perhaps it is time that we re-think the structure and hierarchy of traditional healthcare environments
The need for a structure and redesign
I acknowledge that we need some organizing structure to run our teams and organize [lead] our organizations. That said, what we presently have in many healthcare organizations seems to be getting in the way of supporting an innovative, just, safe, learning culture.
In the words of Malcolm Gladwell from his book, What the Dog Saw, “If everyone had to think outside the box, maybe it was the box that needed fixing”. I am also reminded about the words of Don Berwick regarding system design, “Every system is perfectly designed to get the outcomes it is achieving”
It is fair to say that our current healthcare system, if designed to get the outcomes we’re getting (estimated 400,000 lives lost a year from preventable error) needs to be redesigned.
A different approach
I recently read about an alternate approach to organizing an organization, the idea is called Holacracy and was coined by Brian Robertson. This is an alternate way of running an organization, modeled on some concepts that are being adopted more and more by innovative, forward thinking leaders. For example, peer-to-peer business models have changed how we get from A to B (Uber) and have revolutionized finding a place to stay while on vacation (Airbnb). These “disruptive” companies have started re-thinking their internal structures and have abandoned traditional top-down hierarchies, controls and processes. This approach to running an organization removes power from a management hierarchy and distributes it across clear roles, which can then be executed autonomously, without a micromanaging supervisor.
What’s interesting is that instead of the anarchy and chaos that one might expect, the work is actually more structured than in a conventional company, it just looks much different. With Holacracy, there is still a clear set of rules and processes for how a team breaks up its work and defines its roles with clear responsibilities and expectations.
David Allen, the author of Getting Things Done, summarizes adoption of this approach like this: “Holacracy is not a panacea: it won’t resolve all an organizations tensions and dilemmas. But, in my experience, it does provide the most stable ground from which to recognize, frame and address them.”
Perhaps we’re ready for a different way to organize and deliver healthcare. Perhaps we’re ready to rethink our hierarchies, controls and processes.
Perhaps healthcare is ready for a little Holacracy.
Reflecting on our first day of the Academy for Emerging Leaders in Patient Safety and I am feeling blessed for the insights, the lessons and for the reminders.
Yesterday morning we watched the Lewis Blackman Story – we were fortunate to have Helen Haskell with us, Lewis’ mother, who graciously and bravely answered our questions, provided more insights and shared the reminder that this November marks the fifteen-year anniversary of the death of Lewis.
I’ve seen this video more than a few times and to be honest was thinking to myself that there was not much more to “learn”. How wrong was I?
Re-watching this emotional story I was abruptly reminded that the stories of communication failure, mis-diagnosis and poor communication are as real and relevant today as they were fifteen years ago, and that being reminded of the work ahead is critical to this effort of making patient care safer, more just, and more transparent.
I watched the video again, took new notes, re-read those notes, and listened to the story and the discussion. I heard things I hadn’t heard before, heard perspectives that I hadn’t paid attention to in the past, learned new lessons, and was left with a re-galvanized commitment to this difficult, rewarding, and necessary work.
In the work that I do with healthcare leaders to change culture, I hear and see a lot of conversations, interactions and exchanges. Having the ability to reflect on what I have heard or seen, either from reading my own notes, re-remembering my experiences, or having the story interpreted by someone with a different perspective, provides me renewed energy, fresh insights and ideas about alternate solutions.
Day 1 reminded me that re-visiting the stories, notes, videos, conversations and perspectives are some of the most powerful reminders of the work still ahead to change the world of patient safety.
Thank you Helen for the reminder.
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 Levy, Katy Schuler, Steve 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
Last speaker of the day
Several years ago I found myself in the audience of a quality and safety conference at Harvard University. The last speaker of the day took the podium with little fanfare and no slides. What a welcome change…
With his very generous permission I’d like to share my memories and notes from that day, the lessons and leadership “keys” he shared then, ring true now, and continue to resonate with me.
And now for something completely different…
Mike Dowling is the President and CEO of the North Shore-Long Island Jewish Health System (NSLIJHS). Prior to becoming president and CEO on January 1, 2002, Dowling was the health system’s executive vice president and chief operating officer.
Mike served in New York State government for 12 years, including seven years as state director of Health, Education and Human Services and deputy secretary to former governor Mario Cuomo. He was also commissioner of the New York State Department of Social Services. Before his public service career, Dowling was a professor of social policy and assistant dean at the Fordham University Graduate School of Social Services and director of the Fordham campus in Westchester County.
Mike presented at the Eleventh Quality and Safety Colloquium (Cambridge MA – August 14-16, 2012) – my notes summarize his comments. Without any slides, Mike shared “7 Keys” to creating a “Premiere Healthcare Organization” by stating, “NSLIJ is not there yet, but we are on a journey toward this, and I’d like to share it with you…
Have a coherent idea of where you want to end up – a clear VISION
- Not just the “what” but the “why”
- You must be able to engage EVERYONE’S head and heart in the VISION – in the “why…”
Have a positive attitude
- Be optimistic and believe that it is possible – a “can do” attitude
- Be responsible for outcomes and model personal accountability – “if it is to be it is up to me”
Have a complete commitment to transformation
- Be ready to think differently – we CANNOT be risk averse
- Be open minded – healthcare is NOT unique – exceptional, high-quality organizations are NOT industry specific
Engage and develop EVERYONE
- Lead a continuous culture of learning
- Be mindful of who you hire, who you promote, who you let go
- Remember: People + Values + Behaviors = SUCCESS
- Use simulation
- Make a core part of your curriculum mandatory
- Break down silos and train people across disciplines
- Manage your board and medical staff
- Change how we do medical school training
Become deeply consumer focused
- Everyone you serve is more educated and informed than ever
- Expectations are constantly changing
- Constant communication of the “why” from #1
- Top down, bottom up, side to side
- Face to face, electronic, multi-media, print, etc. etc.
- You CANNOT over-communicate
Most of all – remember that:
- we do great work every day in healthcare!
- we have much to be proud of!
- we do make a difference!
Mike closed his remarks with the words of Sir Winston Churchill, “Success is going from failure to failure without losing enthusiasm…”
Thank you Mike, you continue to inspire and encourage!
An Impressive Group
Full disclosure here – this is a story about my son, this is the guy that pushed his father to run a marathon this past fall, this is my little boy that is growing up, and (if all goes to plan) is headed off to college this fall. This is his story and I have to admit, my wife and I are bursting with pride!
This is a story of love, commitment, leadership and humility.
Our son has been bitten by a bug so to speak. Not the bug of lethargy and complacency, that I think I feared might befall a high school senior, nor the bug of curfew breaking, and late night calls that could have accompanied a spirited, strong-willed eighteen year old. No, this is the bug of hard work, service, and a deep commitment to the welfare and happiness of others.
This however is not just his story, in fact, this is the remarkable part; this is the story of a group of high school aged “kids” that belong to the youth group at our church. Last summer, as they have in the past, this group gathered together (with support from the church and the community), to head to a place that was in need. Real need.
Fifteen strong, with adult chaperones, they boarded a flight to Glendora, Mississippi.
With each person’s luggage being kept to a minimum (carry-ons only), this allowed their checked bags to be filled with needed supplies: clothes, books, tools, dry foods and toys.
They committed to a deeply held belief that they are the accountable entities, and that if change was going to happen, they would have to act differently.
A Small Group
A small group of citizens, making a difference.
This, I figure, is living proof that Margaret Mead got it right when she stated “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”
These children left their hometown of Ipswich, MA with a view of the world that likely didn’t stray far from three square meals a day, a warm bed at night, a school packed with supplies and resources, and summer vacations spent at the local beach.
They came home changed.
They came home sad, thoughtful, melancholy, inspired, committed and well and truly changed for the better.
They came home believing that with privilege comes responsibility, they came home with a strong commitment to want to use their talents to help those with less, they came home committed to go back!
This is a community with very few of the amenities and services that we take for granted. This is a community where the median household income is about $17,000 a year. Many of the children of Glendora found it difficult to believe that these 17 and 18 year olds were not parents and had not yet been incarcerated.
As our son told me, “Dad, I need to work with these people, alongside them, so that we learn from each other and share what we can. We have so much to share Dad, I don’t need all this, and I have to give back…”
This group spent a week building playgrounds, setting-up a library for local children, and crafted a summer camp curriculum that lives on. They spent their down-time walking the one-road town picking up trash, they cleaned up a neighborhood that remains grateful to this day.
They are living proof that change only happens when we embody it, act differently, and lead by example.
So this is their story, and they want to go back and do more. They believe in the power of a small group of committed citizens. They do not have the resources from their church or town and yet they remain committed to going back to their friends in Glendora, who believe in them.
I believe in them, we believe in our son.
Thank you for considering and supporting their efforts to raise funds for this trip. Herewith a link to their story and their fund raising effort.