Coalitions in Healthcare: The Super Power of Pathways

"…then a nurse was telling me how they encountered a problem and how they fixed it…and I said 'No! Don’t do that way!'"* 

These are the words of Paul Levy, former CEO of Beth Israel Deaconess Medical Centre in Boston. His leadership style during the restructuring of BIDMC is studied in organizational behavior courses in postgraduate schools to illustrate decision-making and change management skills. But why would he be against local, grass-root level implementation of changes?

Caregiver Becomes Patient: 3 Arguments for QI

I consider myself lucky. Until lately, I did not need any surgeries or extensive medical care. But this suddenly changed and I had my first experience as a patient. I joked that I wanted to actually see first hand how the healthcare system works…but my smile was tentative and my apprehension surpassed my curiosity. Now, after being at the receiving end of medical care, I would like to ask my healthcare colleagues: 

Are you able - and willing - to better your care for the patient?

Your Input Matters: Improving Opinion Surveys

If you work in an organization - any organization - you probably received periodical emails with links to opinion surveys. The email message would say something like "your opinion is valued" or "your input matters" and kindly asks you to take few minutes of your day to complete a survey. So what do you do? Click on the survey link? Postpone to action on it? Or simply ignore- or even delete the email?

Learning to Change

How do you feel about learning? 

Do you remember your school years as an exciting time, or do you just recall exam anxiety? 

Whatever the answer, it is OK. 

A recent presentation on adult learning on #rebeljam15 started with "Have an open mind". As adult learners, we might be conditioned by past behaviours but we can also approach learning in a novel, productive way (if we choose to). That is because the learning science also followed an incredible evolution and has become accessible, fun and rewarding, and more than ever- necessary.

There is no question about why we need to be life long learners (LLL). Here are some of the many benefits of LLL:

Questions on Quality: Sail or Sink?

Quality in healthcare: we talk about it, debate about definitions, wonder if we can and if we do measure it. For some of us, it’s an intricate concept that feels like it could make your head explode. For others, it’s common sense: to give the best care, to the right patient, at the right time. 

If it is true that all good things (i.e. Danish-sounding ice-cream) come in small packages…can we at least hope that quality in healthcare comes in cargo loads? Or are we bound to provide healthcare on islands of excellence in a sea of mediocrity?

I will not use this space to expand on the "quality" etymology or on matters of semantics. Instead, I would like to focus on 3 areas related to quality that I came across in discussions and readings this week:

Healthcare Worker's Search for Meaning

"The last of human freedoms- the ability to choose one's attitude in a given set of circumstances" 
Viktor Frankl

When you are a healthcare worker there is one thing you never want to hear: a fatal error leads to patient death. Sadly, today was one of those days. This terrible event is mentally and physically painful to grasp and reminds us all of our inherent and human ability to fail. The pain of the family is extremely raw and the society’s response is intensely broadcasted, and for good reason. Today though, just for once, I will talk about the pain of the provider, the one entrusted with your safety.

The Challenges of Change Agents

 

I don’t know about others, but when I think of my own improvement attempts on my unit, I usually recall challenges, resistance, hitting walls. Yes, I was told it will be difficult, and once you realize that you are not alone in your passion, it is even harder to get back to the daily whirlwind. It is discouraging, and some days are worse than others. And then I am thinking: for sure others have the same challenges, but does it make a difference if you would be in a formal position of authority rather than front-line staff? Would you be able to influence and leverage more for your ideas?

New Year: Let's Talk About Resolutions!

It's that time of the year again: you can barely find a parking spot at the gym or a corner to spread your yoga mat in a studio, the produce section at the grocery store is suddenly the busiest place in town, and everyone has a (sometimes manic) glitter of determination in their eyes. If you are one of the people who make New Year resolutions (nothing wrong with that!),  research actually says that you have an 8% chance to stick to it. Yes. Eight Per Cent. Sorry to be a downer, but I am also quite unhappy with the fact that in healthcare up to 70% of change initiatives fail! And for the amount of opportunities for improvement, this is discouraging.

Why do we fail to change? Just like in self-improvement, workplace improvement fails from the very same reasons: competing priorities, the daily whirlwind of activity that makes it difficult to keep on our plan, and choosing far too many goals to reach. But beware! There is that 8% of people who succeed, just like those 25% of change initiatives that prove there is hope! I am clinging on to this rope of hope (ha!) and wonder what can we do to succeed?

Shifting Culture in Healthcare

It is a fascinating idea, and it is (and will be) proved to be successful: implementing a new way to achieve better healthcare. From Tommy Douglas to Lean, Saskatchewan ran already a multitude of processes to improve healthcare (listen to podcast here). There is also debate on implementing Lean in healthcare, and many are also skeptical on the results. So how do we shift culture in healthcare?

People have to look at the processes from a patient's perspective, and whether you call it Lean, 4Dx or something else, this will not change the basic idea, that the ultimate person of interest is the patient (and not the physician). Removing waste, removing what is of no value and shift your viewpoint will ultimately make a difference. Sadly, leadership and healthcare management want to 'kill the mosquitoes' , without 'draining the swamp'. That means assigning a person to 'do the improvement work', and come back and report (while being held accountable for failures). But the data out there- and the examples from many Lean organizations- prove that improvement without senior management involvement is difficult, if not impossible to achieve long term.

My opinion on culture shifting: start talking about improvement, talk about tools and what is being done out there. Make nurses aware that they have power to improve their workplaces, and encourage involvement. Healthcare improvement happens everywhere in the world, and it is a real movement, not a fad. We can slow it down, but we can't stop it. So you are either be prepared, or find yourself on a burning platform!