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?
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.
The show-stopping line from the Hans Christian Anderson’s 1837 fairy-tale is actually, “But he has nothing on!”
A brave, young, clear thinking boy in the crowd is the only person confident enough to say what he thinks and speak up. Perhaps even more simply, the young voice in the crowd has not had the life experience that often builds (and rewards) the filters of loyalty, flattery and only saying and thinking what we think others want to hear.
The story resonates so much that it has been re-told and re-written in as many different languages as cultures. In Denmark it was The Emperor’s New Clothes, in Sri Lanka it was crafted into The Invisible Silk Robe, in Turkey the story is told as The King’s New Turban, in India, as The King and the Clever Girl and in my homeland, England, we grew up with The Miller and The Golden Thumb.
The languages, settings and details differ; the moral remains the same and is well known, that we shouldn’t believe everything we’re told, especially if the evidence doesn’t support the claim.
Some will tell us that an additional lesson was about making a fool and mockery of the Emperor, but, in fact, he clearly does that to himself. He was a fool for not believing what he knew to be true, which can lead us to conclude that he took his position as Emperor for granted, especially in his belief that as Emperor no one would ever lie to him.
The analogies to our hospitals, departments and clinics are clear and prompt some important questions:
- Have we created an environment that promotes or inhibits speaking up?
- Have we become so confident and conceited due to our names and rank that we sometimes don’t acknowledge what we know is true?
- Are we ignoring what the data is telling us for fear of embarrassment?
- Are we doing something just because it’s the way the “crowd” does it, or the way we have always done it?
- Are we willing, as leaders, to take the risks required to speak up and act differently? (to be that little voice in the crowd)
- What are the risks associated with speaking and acting differently?
By any report, our hospitals, healthcare systems and practices are still unsafe and not as patient and family centered as they could be. As leaders of these organizations we must be willing to take, and reward, the risks associated with speaking up, with acting differently, with finding alternate solutions.
The risk of not doing this is too great – it’s more of the same.