From Grey's Anatomy to E.R., we have all likely been exposed at some point in our entertainment experience to the dramatic and cinematic potential of hospital drama. Blogger Paul's blog is not exactly ready for a close-up anytime soon. This former CEO of a major teaching hospital is more focused on quality medical care than on love from the cameras. His blog provides an insider's understanding of how America's medical facilities run, from the inside out.
Hear me. Do you know me?
It isn't often that I can report that I was honored to see a play, but such was the case recently when I was invited to view the showing of a short four-person drama at West Gippsland Hospital in Warragul and especially because I was permitted to attend the staff discussion that followed the performance. Here's the background:The Australian Institute for Patient and Family Centred Care was established a few years ago by Catherine Crock and colleagues to promote just what its name implies. As noted:We aim to to transform people’s experience of healthcare through a three-fold approach:Develop partnerships between patients, their families and health professionalsCreate a culture that is both supportive and effectiveImprove healthcare environments through high-quality integrated art, architecture and design.One medium used by the AIPFCC is to commission short plays on key themes in health care delivery and present them, upon invitation, to hospitals throughout the country. The hospital plays a small fee for the show, and the balance of the cost is covered by donations to the Institute. The plays have now been seen in dozens of health care institutions by thousands of people.Two plays are offered, Hear me and "Do you know me? The first deals with medical error, disclosure, apology, and communication. The second deals with care of the aging population.We viewed the latter play in Warragul. It was organized and supported by CEO Dan Weeks. The audience of doctors, nurses, and trainees were deeply affected by the performance and the themes raised. Afterwards, Dr. Crock facilitated a discussion, and the honesty and vulnerability displayed in the comments was truly extraordinary.The actors had permitted people to reach into their experiences--whether with their own family members or with patients--and share observations that will help bring a better sense of clinical teamwork in the hospital and empathy with patients and families.I was particularly pleased to see that medical students and more advanced trainees were permitted time away from their ward-based clinical activities and were invited to attend. They, too, were active participants in the discussion and clearly benefitted from the experience.Meanwhile, the actors stayed and listened, no doubt enhancing their own ability to offer even more engaging performances in the future.
Towards zero on the roads in Oz
In America, drivers don't try to kill other drivers. In Australia, drivers try not to kill other drivers.After almost three months here, I've decided that this difference in attitudes is the biggest thing that separates these two cultures.America was built on a culture of individualism, sometimes called "rugged individualism." In Australia, society is characterized by a much greater degree of communitarianism.The place of traffic fatalities in the two countries provides a nice example.There are about 32,000 traffic-related fatalities in the US per year, about 10 per 100,000 population. I think if you were to ask most American drivers about this figure, they would probably answer, "These things happen." There is virtually no concern in the general population about these deaths, and there is certainly little or no evidence that road dangers influence the manner in which people drive.In Australia, there are about 1200 deaths per year, or about 5 per 100,000 population.A two-fold difference is pretty significant, and Australia would certainly be entitled to rest on its laurels. But folks here understand that there is no virtue in benchmarking yourself to a substandard norm. Instead, as illustrated by the a program of the Victorian Transport Accident Commission, they've set an objective of zero. The agency explains:At the heart of Towards Zero is the belief that human health is paramount to all else. It acknowledges that, as people, we all make mistakes. However, when mistakes happen on our roads they can cost us our lives or cause serious injury. That's because our bodies aren't made to absorb the forces of high impact speeds. We are fragile, and there's only so much physical force we can withstand and this is why we need to build a safer road system. Improving the safety of our roads, our speeds, our vehicles and our people will improve safety for everyone. The move Towards Zero is a collaborative effort between everyone in the community. Together, we can build a safer road system and help change road safety for the better.A campaign is just a campaign if it does not take hold in the minds and behavior of the target audience. I'm here to report that as I drive on the highways and streets of Victoria, I see it in action. When you are on the highway, and the speed limit is 100 km/hour, people go at 100 km/hour. In the US, when the speed limit is 60 mph, the expectation is that you will go above that. In Victoria, you don't see people engaged in a "Grand Prix" form of driving, weaving in and out of lanes to pull ahead of cars in front of you. As a result, automobile travel is a lot less stressful and more comfortable, not to mention safer.In talking with friends here, they acknowledge that very strict enforcement of the speed laws--and high penalties--keeps your mind on doing the right thing. But they also follow up by saying that they are pleased that such is the case. Why, they say, should people die when they don't have to.In the US, if we think about the issue at all, we tend view those who might die as "somebody else," and we feel no sense of responsibility towards those potential victims. In Australia, when they think about the issue, they view those who might die as a member of their community, and they feel a great sense of responsibility in minimizing the potential for harm.In a future column, I will explore whether this communitarian view of Australian society carries over into health care--whether there is a comparable commitment "towards zero" with regard to preventable harm in hospitals.
When I was growing up, ultimate (originally known as ultimate frisbee) had not yet been invented. While we played with frisbees, it was mainly just a lot of tossing them around. Since then, the sport has developed and highly skilled players and teams compete worldwide.I've had a forced sabbatical from playing soccer here in Melbourne (no one plays during the summer apparently), but have been lucky to be invited to join a local co-ed division three ultimate team. It's been great fun to play a sport which in which the rules are self-enforced, i.e., without referees, and where the "spirit of the game" is the dominant culture.Nonethless, there remains a role for a team leader, often a player-coach, and in this case we are blessed to have Michelle Phillips, a world class player, as ours. Off the field, she and I have traded stories about leadership, and I've also had a chance to watch her skills in that regard during games and her post-game advisories ot the team. The latest one strick me as having lessons well beyond the playing field. Here's an excerpt:There's a tendency in teams (whether sporting or otherwise) to try to 'fix' everything, to try to have the strategy perfect, to try to get everything absolutely right. It's not possible. More importantly, trying to do this is actually detrimental to the overall performance of a team. Let's have a look at why, and at what we can do instead. When we try to correct every non-perfect action out on field, we crowd our minds with more information than we can process. What that looks like is multiple voices in the circle, talking about strategic points while we're on the line, and tacking extra pieces of information onto the main message. Doing this means that not only do we not remember all the little things we've been told to do, but we forget the most important things that we started with. There's a direct parallel between these points and about achieving process improvement in hospitals and other organizations. Improvement in efficiency, quality, safety, and customer satisfaction occurs one small step at a time, within an overall strategy. If you try to change too many things at once, the effort usually fails, and because you've changed too many things, you don't know how to analyze the cause of the failure.Now, let's get back to Michelle's summary as she discusses a leadership (and the followship) issue:A leader's job is not to fix everything. A leader's job is to filter all the information they receive, decide what is most important for the team, and direct the focus there. If you're leading (and we all do, at different times) you need to be able to give your team one clear set of directions out of the hundreds of possible actions that could be taken. If you've passed information onto a leader and they haven't acted on it, realise that they have made a decision not that it isn't valuable, or true, but that it isn't the message that the team needs in that moment. Trust that they are storing it away, and when the time is right it will be packaged up and delivered.Finally, we return to the relative importance of strategy versus implementation:And let me tell you a secret. It's way less about the strategy than we think. If it was all about strategy, the underdogs would never win. If it was all about strategy, team sport results would be far more predictable than they are. If it was all about strategy, the state of your athlete's wouldn't matter - only the state of your coach. Games are won by the team that controls the mood.I don't think people think much about this concept of mood in a hospital or an industrial or service organization, but it is key. We might use another word, like "morale." Having now visited thousands of places, I can usually tell within 15 minutes whether a place is a true learning organization--one described by my late friend and colleague Donald Schön (1973), as one that is “capable of bringing about its own transformation." You can see it in the faces and demeanor of staff as they walk down the corridors. You can feel it in how they interact with one another on the front line. Call it mood, morale, or a shared sense of purpose and mutual support. I described this in my book Goal Play!The girls who play soccer in our town’s league in Eastern Massachusetts are among the luckiest kids in the world. They get to go out and play a beautiful game with their friends in a safe environment with terrific coaches and parents who support them. But there is an additional bit of magic that occurs during a game.As the girls play, they unconsciously adapt to one another’s strengths and weaknesses, creating a seamless web of teamwork. As a coach, when you see this happen, all you can do is smile. You know you had something to do with it, but you also know that something has happened among the girls themselves. It is a marvelous thing. They will remember it all their lives, but they may not entirely understand what they are remembering. They will think their fond memories of the season had something to do with friendships or other social relationships or new skills acquired or the team’s exceptional record. But there is something even more important that made the season so memorable. It is an elemental statement about the human condition: We are born to work and play together in teams. Many people do not get to experience that sense of ensemble, which requires giving enough of ourselves to let the filaments connect. That the girls discover it for themselves is very, very special. They are, indeed, the luckiest kids in the world, and we are likewise blessed in being able to share this time with them.
- Feb 22, 2016 Ultimate advice
- Feb 17, 2016 Sea spurge, compacts, and other descendants of Wipe off 5
- Feb 14, 2016 Correlation ≠ cause and effect
- Feb 11, 2016 "A good way for doctors to let patients know they are antiquated and unfriendly"
- Feb 09, 2016 Ask, instead, why they would want to leave
- Feb 09, 2016 In memoriam: The Boston Courant
- Feb 08, 2016 Cruelty and enlightenment
- Feb 07, 2016 There is no Holy Grail, just small chalices
- Feb 04, 2016 There is no billing code for compassion
- Feb 03, 2016 Plus ça change
- Jan 31, 2016 Mind the step!
- Jan 27, 2016 A canary in the coal mine?
- Jan 26, 2016 Fostering a non-negotiable safety mindset
- Jan 25, 2016 Nominative determinism
- Jan 24, 2016 One person's costs is another person's income
- Jan 23, 2016 When is a doctor like a bull ant?
- Jan 23, 2016 Bullying, a multi-legged problem
- Jan 20, 2016 No worries? Not so good.
- Jan 19, 2016 Negotiating in Geelong
- Jan 16, 2016 Facebook: Killing the goose?
- Jan 15, 2016 Too quick to judge, Jerry.
- Jan 13, 2016 How do you pronounce Djerriwarrh?
- Jan 12, 2016 Quizzify doesn't hurt!
- Jan 09, 2016 Is this any way to run a transit system? You bet!
- Jan 08, 2016 The paradox of unanimity: When intuition is badly informed