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…
My wife and I recently watched as our eldest child headed off to college for the first time, as he read this letter the night before he left he commented that these were good “life” reminders, I agreed, and so share the letter here:
August 28, 2015
My dear sweet Harrison,
I’ve noticed that the mornings stay darker a little later and that the evenings are drawing in, and I am reminded that this is nature’s nod to the fact that everything has a season, and that everything must end and begin again. Just as I know that the seasons change, I’ve known since the day we brought you home from the hospital, that this season of you being a daily constant in our home and our lives would end and that your new beginning, in college, would start.
The time has come my love – the freedom that has excited you and that you are so ready for is here, and yet this same freedom is one that I have very mixed emotions about.
I have both dreaded this moment and been incredibly excited for it.
I think I’ve privately dreaded this day since I first held you almost nineteen years ago. As a parent you learn the difficult lesson that raising children is in fact to embrace a love that is built on the reality of constantly having to let go of things, of constantly having to let go of you. Letting go of you as your learned to crawl, saying goodbye to your little clothes, dropping you off at pre-school, waving the bus goodbye, watching you go out with your friends, and watching you drive away from the house with your brand new license.
Your mom and I have also learned that the deep love that we have for you has changed us as people. You have added an indescribable richness to who we are as you have grown, challenged, tried, failed, argued, agreed, laughed, cried and blossomed as our “beautiful boy”
And so here we are, on the verge of this next chapter of your life, and as the page turns we are as excited to watch you embrace it, as you are likely to go grab it.
And yet I have this mix of stuff going on… I know you won’t be very far away, but emotionally I’m going to miss having my “little man” around. It’s going to hurt because I know we have to say goodbye to a chapter of our lives that is closing; leaving us with the memories, the mementos, the pictures and the stories; but it is over, it is done, it is closed, it is time.
While I will work hard not to cry tomorrow Harrison, you know me as well as anyone and you know that I’m proud of my emotions and share them unconditionally with you. I will work hard not to cry because this is an exciting happy time (the mix of stuff…) and yet as I write this I have become overwhelmed with tears and the desire to hold you so tightly, to remember all that we did together, the adventures we had, the plans we made and even the things that we never quite got to…
I remember you in the hospital in Beverly, hiding in the dryer in Manchester, building walls in Rockport, sailing up to Maine, treehouses in Amherst, snakes in the kitchen, tongues on lamp-posts, your bravery leaving Amherst, a wooden boat project in the backyard, running in Chicago, and fishing in Ipswich, and I remember laughing, crying, running, playing, learning and living with you as you grew up to be the college bound adult that stands before us, and I miss you Harrison. I miss you so very much.
Watching you learn and grow continues to be one of the greatest blessings and experiences of my life, so as I reflect back on all that you have given us, the lessons you have taught us and the example you will continue to be for all those blessed to be a part of your life, I wanted to share with you some guidance as you navigate this next chapter, some choices and some reminders…
Some choices – remember they’re exactly that, choices:
- Smiling OVER scowling
- Working for it OVER wishing for it
- Optimism OVER pessimism
- Owning it OVER making excuses, blaming others, complaining or gossiping
- Being kind OVER being unkind or rude
- Believing in your abilities OVER believing in your insecurities
- Hugs OVER handshakes
- Loving yourself OVER beating yourself up
- Being your own hero OVER waiting for a hero
- Doing what’s necessary OVER doing what’s easy
- Living for today OVER living for someday
- Being vulnerable OVER being perfect
- Living with purpose OVER sleepwalking through life
- Talking to people OVER talking about people
- Being happy OVER being right
- Have goals and review them
- Use logic and reason AND listen to your gut and your heart
- Admit when you’re wrong
- Praise others – privately and publicly
- Be appreciative – say “thank you”, even better, write “thank you”
- Ask for help, remember that you are a work in progress
- Love life and let it show – be honest with your emotions and bring them with you
- There are no limits to what you can do – remember: “if it is to be it is up to me”
- You are empowered – take a risk, speak up, be brave. It’s OK if your hands shake and your voice quivers. Be brave, speak your heart.
- Take time for you – rest, relax, restore, and exercise
- People and relationships are everything – stay in touch, reach out, lift others up, help people succeed, pick people up
- Be mindful and take action – if you see something, say or do something.
- Strive for purpose, find your passion. Do what you do with love, energy, audacity and proof
- Remember that the small things are the big things
- Above all, remember that you are a work in progress, you are blessed and you are forgiven.
Harrison – you will find your own guides, reflect on your own words of wisdom, and learn your own lessons (you already have many of them under your belt…) and I know you’ll be searching for your own answers along the way at Emmanuel, but please also know that if you ever need help, advice, a shoulder to cry on, or an ear to listen, that I am always, always, always here for you.
What I have shared with you is what guides me. I work hard to live up to it every day, and every day I fall short, but that’s OK. Reaching out for advice, help and inspiration is not a sign of weakness my love, it is a sign of strength.
Time will slip by, the next chapter will end I suspect more quickly than the last.
This time is yours, you’ve earned it, give it as much as it will give you. And remember, as a wiser person than me once shared, “There is no grand prize at the end of your life, no all-expense paid trip to utopia. This is your final destination, this is your life. The prize is here, now, in every breath you take, every new friend you make, every kiss, every hug, every challenge, and every exciting piece of information you discover.”
Godspeed little man! Breathe it in, savor every sip, enjoy every moment! Oh the places you’ll go!
I love you,
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.
“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.
“PEH–cha 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)…
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.
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!
Check out this Pecha Kucha Storify
Leadership lessons from the New England Patriots
On the way home tonight I listened to a recording of last week’s post-game press conference with Tom Brady, Quarterback for the New England Patriots football team. In the spirit of full disclosure; I am a Patriots fan, and Brady and colleagues had just come off a victory that many a pundit predicted they had no hope of pulling off, a win against the favored Denver Bronco’s…
I am a happy fan of the winning team, feeling additionally buoyed by the fact that my team had just beat the team that denied us a berth in last year’s Super Bowl, a good result by anyone’s measure. All this aside, what I heard in the press conference from the captain leader of this team, made me realize that what made this football team successful last Sunday afternoon are the same tenets that make any team successful, regardless of the game being played…
A clear vision
During the comments made about the winning game, it became obvious that the vision for this team was broader and longer term than the afternoon’s victory. The vision of the organization (New England Patriots), is to ultimately win the Super Bowl each year. They are competing every week to win enough games to get to the post season, and ultimately get to the final game of the season, and win. Clarity and single-minded committment to a vision is critical.
Clear, executable goals
Tom Brady reiterated that winning football games is the reason the team goes out on the field every week. There are clear goals related to the execution of everyone’s job, there is clarity about each and everyone’s role, the expectations of each player, and their purpose when they’re out on the field. Role and goal clarity is often glossed over as a nice to have, not for this team, not for the Patriots.
Relationships built on trust
When asked about several remarkable plays, from a one-handed catch, to a stunning interception resulting in a touch-down; Brady spoke to the fact that he and his team mates take time to get to know each other, developing deeply rooted bonds of friendship and building trust with each and every one. Over time they learn how to build on and support each other’s strengths, accommodate each others shortcomings, and provide honest (for anyone who has been naked in a locker room with another team mate you know what this feels like), timely, and candid feedback.
A dose of reality
In the locker room, following the win, the Patriots’ coach Bill Belichick congratulated the team for a well-played game, allowing those that had worked hard for the victory a moment of celebration and appreciation. He then reminded the team that seven wins does not make for a winning season and does not guarantee entry into the post season and will certainly not win a Super Bowl. I was struck by this gracious dose of reality; a little time to enjoy the moment, to savor the win, and then remember why you are here. To achieve the goals and reach the vision. Do not stop working toward your goal.
Hire and retain the right people
It was clear listening to Brady during the press conference that this team was made up of people that really love the game of football. They enjoy working hard to get better through practice every single day of the season. He also spoke to the fact that if this wasn’t how a player was “wired”, then they wouldn’t last very long in the program.
Clear vision, communicated expectations and goals, the trust of those you work with, against a back-drop of reality, and a culture of “player fit”, are tenets of any high performing organization and successful team.
How does your organization or team perform? What would your “post-game press conference” sound like?
Yesterday afternoon the faculty and students at the “Telluride-East” Patient Safety Summer Camp visited Arlington National Cemetery.
As we paused for some reflections from our leaders Paul Levy and Dave Mayer I was overcome by the scale of what presented itself in the form of field upon field of white grave markers.
Poignant words reminded those gathered that we were indeed standing on hallowed ground and that many have given, and continue to give, the ultimate sacrifice. A sobering reality is that there are between 25 and 30 new burials every day at the cemetery.
Following our time of reflection I took a walk to reflect on the sacrifice, loss, and scale of what lay beneath me. 400,000 markers of lives once lived, now at rest.
In a recent piece of research published in the Journal of Patient Safety it is estimated that more than 400,000 hospital deaths are attributed to preventable harm. Put another way, since August 2013 more than 400,000 mothers, fathers, brothers, sisters, sons and daughters are no longer alive as a result of harm that could have been prevented with better designed systems, more situational awareness, and other proven human factors and safety science approaches in health care.
I think these numbers are becoming “noise” for many leaders in healthcare, we have heard the numbers and yet still choose not to make the different decisions and the difficult choices. We disassociate from the difficult reality because we don’t “see” the totality of what we are doing.
The grave markers stopped me in my tracks, a visual reminder of what we are doing every year in healthcare by tolerating variation, blaming people, doing the same things over and over and expecting different outcomes.
My walk took me to the Kennedy family grave site. Off to the side of the eternal flame is a Robert F. Kennedy quote that really resonated with the work we are doing with the faculty and students at Telluride-East:
It is from numberless diverse acts of courage and belief that human history is shaped. Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance.
Robert F. Kennedy, South Africa, 1966
This quote captures what I will leave this time of learning and sharing with, and what I urge the students, residents and faculty to find the courage to continue doing…
- Lean in and keep speaking up to improve safety; these are the “numberless diverse acts of courage”
- Believe in yourself and the difference you can make
- Stand up for what you know is right and stand up for those less brave and courageous than yourself
- Speak up, even when your voice quivers and your hands shake. Speak up for patients, the ones you care for, know and for the one’s you dont…
- Most of all, send forth a “tiny ripple of hope”. These ripples will build to a current. These ripples will make care safer
- By thinking and acting differently, by bravely speaking up and taking a stand we will sweep down what often feels like a mighty wall
I commit to making ripples and I urge my new found colleagues and friends to do the same.
Make ripples. Ripples save lives, ripples make care safer.
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…
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.
I am an optimistic person that believes that there are plethora hospital leaders doing the very difficult work of changing healthcare to make their cultures more effective, healthy, transparent, more reliable and less variable. I witness examples of these heroes every single day.
So before I take a little time to rant, let me explain… I work with healthcare leaders that are committed to learning from the past to improve the future, with data as their driver and compass. It is not easy work, per se (let’s be clear, it’s also not the front line care of patients), but it is work that I absolutely love! My reality is that what I do for work is a calling; and so my personal opinions are inherently woven into the work I do, I cannot unravel them.
I tell you this part as explanation, and part introduction; please know that I will never reveal the names of those I reference and would ask that your assumptions be kept to yourself. Needless to say, I think you’d be surprised…
I am sick and tired of the fact that I see many leaders in health care not being honest with themselves.
Unprofessional behavior is tolerated, expectations remain unclear, variation in practice is permitted, and human error is being allowed to harm patients; all the while telling people that they are the greatest, safest, most efficient healthcare system(s) in the world.
Why this lack of honesty? Is it that we’re afraid, or is it that we don’t know?
Do we not know the answers to safer more reliable, transparent, less costly care?
If we don’t know, are we embarrassed to admit that we lack the knowledge?
Are we afraid that if we stop supporting and promulgating the structures, systems, processes, excuses, and people that result in our current dangerous reality, that this will be an admission of past guilt? Are we afraid of the difficult conversations and actions that will be needed to lead a different organization?
I think it’s a combination of embarrassment, fear and a multitude of other deeply held attributes that many smart, well educated professionals have a difficult time “owning” and acting upon.
Let me be clear, I don’t think this is a knowledge gap. Other industries are way out in front of us with their use of technology, their speed to change long held approaches that no longer work, and their desire and ability to learn from others. Many hospitals have taken the lead and are modeling that you can hire for ‘fit’, support daily safety huddles and commit to a goal of “zero preventable harm”, just as a start.
I think we’re afraid of the reality that if we fess up to the fact that we have tolerated bad behavior, poor performance and mediocrity for so very long; that we will have to be vulnerable, naked, open to criticism, and honest with ourselves that yesterday we tolerated and did things that are no longer OK today…
So I have a challenge for myself and fellow healthcare leaders:
Start taking personal accountability for who and what your hospitals are. The good (great), the bad, and, the ugly. You are culture!
Own up to the fact that you know who your poor performers are…
Own up to the fact that you may not have articulated your expectations clearly…
Own up to the fact that there are voices of expertise within your organization that you are not listening to…
Own up to the fact that your hospitals culture is staring back at you from your bathroom mirror…
Own up to the fact that if you cannot state “zero preventable harm” as a goal – then, by definition, you have agreed to hurt someone’s loved one in a way that could have been prevented…
Own up to the fact that you got into this because you want to make a difference…
Own up to the fact that you’re tired, over worked, stressed, and that you don’t have all the answers…
Get out, go home, hang it up, retire! Your colleagues, caregivers, team, patients, community, all deserve better than your dishonesty.
We are surely complicit if we continue to stand by and watch – mute, deaf and blind.
I met with a senior member of a hospitals quality and safety department last week, he confided in me (after looking over his shoulder to make sure the door was closed) that his very reputable AMC doesn’t have the leadership “strength” to state that ‘zero preventable harm’ is their goal. He’s embarrassed and afraid to challenge his CEO.
I met with a senior management team that wanted me to know (after I’d found trash lying on the floor of their lobby, that they had walked past and ignored, and I suggested they ‘pick up trash’) that they “have people to do that…”
I hear leaders tell me that they know that their high revenue producing, senior position holding, research leading, long tenure physician colleagues are abusive bullies, and yet they are still employed, practicing and getting their annual bonuses…
These are choices, and my challenge is for us to make different choices.
My challenge comes with a promise…
My promise, is to keep asking difficult questions, pushing for the right answers, and encouraging and coaching healthcare leaders to be brave. Brave to ask when we don’t know, brave to admit that we made a mistake, and brave to reach out and request help.
I for one am not afraid. Apprehensive and nervous, for sure. Apprehensive that my comments will be seen as negative, accusatory and blaming, and nervous that this sentiment will be seen as one more heretic in the noisy world of working to improving safety and become more reliable and excellent.
But when I think about who we are harming, who we hurt every day in the spirit of “health” and “care”, I am not afraid. When I hear the stories of burned out, stressed, under resourced care giver friends and colleagues, I am not afraid. I’m buoyed, inspired and deeply moved by the memories of people like Michael Skolnik, Josie King, Lewis Blackman, and Jerod Loeb; people I never knew, but people who deserved so much better from the cultures that surrounded them and that were meant to take better care of them.
I am also encouraged and inspired by the health and care radicals (leaders at all levels of their organizations) that are making a difference and inspiring their colleagues to think differently, act differently, be transparent, have difficult conversations, model different behaviors and deliver on the promise of “Primum non nocere”.
So my promise is to keep asking difficult questions, pushing for the right answers, and encouraging and coaching healthcare leaders to be brave.
I leave you with challenges and inspirations from three very different healthcare leaders whose work I admire, and who model this mindset of personal accountability;
- “Rock the boat, without falling out” Helen Bevan (NHS guru of innovative change)
- “Ignite the fire within, not the fire underneath” Peter Fuda (Aussie based wicked smart PhD)
- “Proceed until apprehended…” Florence Nightingale