The Secret Sits

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?

 

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Improving the Experience of Care – let’s start with our words.

Words

I recently re-read the words of broadcast journalist Walter Cronkite, “America’s healthcare system is neither healthy, caring, nor a system.”

This sad and yet truthful reflection, combined with the reality that our founding partner, mentor, friend, student of the classics, and therefore a natural etymologist – Tim Sullivan –  had me thinking about the origination of the words we use in healthcare.

Two words in particular; hospital and patient.

A quick scan of history reveals that in the middle ages hospitals were in fact almshouses for the poor, or hostels for pilgrims. The word ‘hospital’ comes from the Latin word hospes, meaning an entertainer, host, a visitor, a guest, a friend bound by the ties of hospitality.

Another noun derived from this is hospitum which came to mean hospitality, or the relationship between guest and shelterer. Hospes is also the root of the English word host.

In my travels, I have witnessed many hospital leaders who have lost sight of the fact that our roots go back to providing shelter for the poor, a resting place for those on pilgrimage, and completely lost sight of the tenets of welcoming patients as guest or friend.

The English noun ‘patient’ comes from the Latin word patiens, the present participle of the verb, patior, meaning ‘I am suffering’.

The hospital should be a place of respite for the friend that is suffering.

I think it is fair to say that if you’re leading in a hospital (regardless of size) you’re contributing to the running of one of the oldest aspects of the “service industry”. Yet at many hospitals, we seem to have left the consistent delivery of this ‘service’ completely up to chance or in the care of those without the training and skills necessary to deliver upon the promise.

Service – from the old English meaning religious devotion or a form of liturgy, from old French servise or Latin servitium ‘slavery,’ from servus ‘slave.’ The early sense of the verb (mid-19th century) was ‘be of service to’, or ‘to provide with a service.’

What service is your institution providing those who are suffering that come to your hospital for care and cure?

Do you insist on telling your patients and communities why they should be satisfied with your ‘service’ because of how safe you are, what good ratings you get, or how qualified your staff are?

Or are you listening to those you are called to serve in order that you might better deliver the service(s) they need?

Your patients want to feel welcome, be treated kindly, understood, healed, cured, communicated with (not to), and they don’t want their time to be wasted.

The rest (the safety, the expertise and the qualifications) are a prerequisite – foundational and non-negotiable.

healthcare service

Are you listening to those you serve?


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.


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.