"The Four Frank Principles"

I have to write this down as it is still fresh on my mind: I greatly enjoyed Prof. Art Frank's keynote speech at the 2015 Imagine Project! What an inspiring and truthful depiction of the challenges in health care, brilliantly set into words by such an accomplished scholar! In his speech, Prof. Frank enumerated 4 principles that I will call "The Four Frank Principles":

1. Responsible response. Take one idea per month and track the progress! (Yes! Who needs 13 organizational goals, each with 6 sub-goals?!). This is how many hospital institutions became huge success stories. Look up the Cincinnati Children's Hospital, Virginia Mason Medical Centre, Jonkoping County in Sweden, Kaiser Permanente. They all 'gold-plated the bolt'.

2. Small and specific demands. Please, do not talk about 'transformational change'...a small change in attitude can have great effects (for example respect patient's time and dignity; establish open charting etc.). Change starts with small steps. And as Hugh MacLeod, the CEO of the Canadian Patient Safety Institute, exclaims: Stop calling healthcare a system!


3. Reciprocal benefit. Healthcare workers are overloaded, we all know it. And they need to be recognized and valued. Patients might think we don't care, but how many can live peacefully when they KNOW they can't do the work they should do..? In our hospitals, patients are not the only ones who are not listened to. Nurses, physicians, front line care providers are frustrated with the same issue and they feel devalued by orders that are forced down through the ranks, pushed upon the front lines.

4. Reiser's Law (might be incorrect name, I couldn't find it?). Teachers should teach resident students they way they want the students to treat the patient. Making staff feel valued is extremely important. Deming was one of the first to stress the fact that it was the workers, not management, who knew what was wrong with the process or system. How many nurses, physicians and front line care providers are asked for input on improving the system...?

Asking patients about their' expectations and involving them in decisions is necessary when talking about patient-family centred care.  But it would be ill-advised, even dangerous, to raise the patients expectations when as a system you are unable to fulfill them. It would lead to the public to lose trust and become even more disappointed with public healthcare. To this I would add an increased number of frustrated healthcare providers who are trying hard to provide high quality and safe care when this is obviously not realistic. Let's be...frank: the question that Prof. Frank raised should be the start of our conversation: "Are we really ready for patient-centered care?"