As the Ebola virus lands closer to home, it has been disappointing to watch the hype, inaccuracies and blame circulating in various media on what continues as a yet-to-be controlled humanitarian and health crisis in West Africa. Those who have been aware of this evolving issue, such as many well-trained, conscientious infection prevention professionals around the country, know this disease has been threatening the West African countries of Liberia, Sierra Leone and Guinea with increasing magnitude since March of this year, taking the lives of far too many West Africans over the last 7+ months. As a result, Ebola abroad, and now for the first time in the US, is also a very dynamic situation, like much in healthcare. As such, responsible healthcare journalists, weekend warrior bloggers or persons with a Twitter account might want to take into account that as more is learned, protocols and best practices will, as expected, evolve.
An excellent Infectious Disease (ID) blog sharing good information about Ebola is Controversies in Hospital Infection Prevention, hosted by three ID physicians from the University of Iowa: Mike Edmond MD, MPH, MPA, Chief Quality Officer, Eli Perencevich MD, and Dan Diekema MD, Director, Infectious Disease. In July, Edmond (@Mike_Edmond) posted, Ebola Hemorrhagic Fever: A Primer, which contains foundational information about the virus, much of which is based on CDC Ebola interim guidances, that are also evolving. And to put Ebola in a more realistic perspective and take away some of its horror film power, it is a very slow-moving infectious disease per Eli Perencevich MD (@eliowa), who writes in an October 9th post, Traveling with Ebola is not traveling with influenza:
The…most important difference between the current Ebola outbreak and the 2009 H1N1 pandemic is that Ebola is very slow-moving….the first case of Ebola is thought to have occurred 307 days ago on December 6th in a two-year old boy. Since that time there have been an estimated 8,032 cases …If you compare a similar 307-day period for 2009 H1N1, April 12, 2009 to February 12, 2010 CDC estimated between 42 million and 86 million cases occurred in the US with a mid-level estimate of 59 million people infected…7300 times more cases of H1N1 using the mid-level estimate
Fast Company staff writer, Rebecca Greenfield (@rzgreenfield), in Ebola Deeply is the Only Place You Should Be Getting Ebola News, directs those in search of Ebola related content without the hype, turn to the single source news website, Ebola Deeply, started by Lara Setrakian (@Lara) a former ABC News and Bloomberg reporter. After clicking onto the site, readers are immediately drawn to the NYTimes video story by video journalist, Ben C Solomon, also embedded below. The story shows what life is like on the streets of Monrovia for Gordon, a Liberian Ebola ambulance driver, separated from his family as a safety precaution for over five months. What he describes sounds like going to war against an invisible opponent, with limited armor and safe harbors. Certainly in a resource rich country like ours, we should be able to handle what courageous true front line Ebola warriors are fighting with much less.
While healthy critique of those charged to create solutions in the US provides a good check and balance, it’s disappointing to watch the finger pointing that rears up in such a well-resourced, educated country, especially as those in West Africa have far less time to discuss and instead are using that energy to improvise and stay alive while caring for their thousands of ill patients vs our limited number of cases to date. In fact, more people died in the last week due to all medical harm in the US than to an outlier of an infectious disease like Ebola. To add even greater perspective, a recent New York Times article by Elisabeth Rosenthal MD, For Ebola Health Workers Risks and Duty Collide, closes with the following:
…Meanwhile, Dr. Cooke said she has tremendous admiration for the doctors in West Africa: “It’s been inspiring to hear African health care workers saying ‘I’m a doctor, these are my people. There’s no choice.’ It’s a fundamental reminder of what it means to be an M.D.”
And with the arrival and death of an infected patient to a Dallas hospital, and the subsequent infection of two nurses who treated him, many of the existing cracks in our healthcare system are being exposed by the media on the larger stage that is now practicing medicine. In an interview on the Today Show last Thursday, a nurse working at the hospital spoke with Matt Lauer, sharing the need to come forward knowing full well she might lose her job. Not knowing the full story, the fact that this could happen comes as no surprise to those working in healthcare. However, it is important to note we still have one of, if not the, very best systems in the world–cracks and all. A safe healthcare system has a just culture, and when a nurse “voices concern” about his/her own safety, as well as that of patients and colleagues, he/she is heard, even thanked, by those who can fix and address those concerns. Many healthcare organizations across the US are creating environments that welcome this voice, yet others are still far from adopting this culture. While not at all familiar with the culture at this particular hospital, nor the institution’s side of the story, it appears from the Today Show interview this nurse voiced concerns that initially went unaddressed. To this end, we see how failure to embrace elements of a just culture could affect patient and provider safety in real-time. This could be an unfortunate example of a long existing need for greater urgency around culture change in healthcare.
And despite the “he said, she said” or “they should of…” thinking, there are many looking for solutions to stop the outbreak in Africa. In a recent @FastCoExist article, Can Better Design Stop Ebola? How Creative Minds Can Help, Jessica Leber writes:
…On just one day’s notice, almost 200 people crowded an auditorium at Columbia University’s engineering school on a Thursday evening in early October. Engineers, designers, and public health researchers were there to learn and brainstorm, and do so quickly…Columbia isn’t the only institution interested in applying design thinking to the health and humanitarian disaster. On October 9, USAID, partnered with the innovation platform OpenIDEO, the CDC, the Department of Defense and the White House, announced its sixth in a series of “grand challenges for development” focused on crowdsourcing ideas for better tools to fight the virus. Anyone can contribute to the brainstorm, and the government hopes to begin funding the strongest ideas in a more formal challenge competition “in a matter of weeks.”…
Getting to the other side of this real-time test of our infection prevention and containment abilities at home, the hope is that we will rise to the challenge and become that much stronger as a national healthcare system for having gone through the experience. As Edmond writes in a Controversies in Hospital Infection Prevention post on October 14th, Ebola: The Questions Keep Coming:
…the Ebola crisis is challenging us in many ways and will likely continue to do so for quite some time. But perhaps we’ll emerge from this with a more thoughtful approach to patient care that improves safety without sacrificing quality.
Over the course of history, many young entrepreneurs have changed the world. Be it in the technology arena like Bill Gates, the social media world like Mark Zuckerberg or the newest Nobel Peace Prize co-winner, Malala Yousafzai–real change has been created by young leaders who envisioned a better way. These creative thinking young entrepreneurs are also leading change in healthcare. While their vision and action as patient safety advocates and role models may not send financial ripples across Wall Street, or redefine how we communicate with one another just yet, their efforts will save patient lives.
Over the last two years, ETY followers have read many stories about quality and safety projects being led by resident physician and health science student entrepreneurs, many Telluride Patient Safety Scholars and alumni. The attached video highlights another example of these young leaders in action, role-modeling the use of resilience tools that will make care safer for our patients. Daliha Aqbal, Telluride alumna and a medical student at the Georgetown School of Medicine, role models two resilience tools to over 300 faculty caregivers–the use of Safety Moments, and an example of “Stopping the Line” to validate and verify information when something doesn’t feel right. While many of these young leaders may not win a Nobel Peace Prize, they are truly helping change our safety culture as they lead by example.
No introduction necessary, though I did have to watch it twice to get the entire message because I was too taken in by the sad yellow lab.
Director Nino Kirtadze had no idea the patient education tool she created in the somewhat engineered documentary film, Don’t Breathe–a film intended as a study in the fragility of human nature. From my seat, however, the story she captured only further illuminates how in-the-dark many patients remain when it comes to their own health, and the care they receive. While the trailer alone tells the story many intimate to healthcare live each day, discussion after the film revealed the team had no intention of using it to educate patients–even as the gentle main character traveled from one doctor to another, enduring professional and unprofessional examinations, his diagnosis becoming more and more ridiculous, almost comical, and all too close to reality in many circles of care. Almost comical that is, if you ignore the fact this man was experiencing in “real life,” the fear which accompanies any suggestion by a healthcare professional that one might need surgery, have heart disease or worse.
How can this story, or even simply the film trailer, be used to educate patients on the need to speak up and ask questions about what their healthcare professional may or may not be telling them?
And as a related aside, I give the Toronto International Film Festival (TIFF), and Toronto, 5 glowing stars. The line-up of film premieres, number of A-List attendees, quality of venues and restaurants all within walking distance, and the ability to see the top films, were unmatched by past experiences at Sundance or the Chicago Film Festivals. Next year will be TIFF’s 50th Anniversary, and I look forward to returning. On the bucket list next, Cannes!
Breakout sessions at last week’s Lucian Leape Forum included Dr. Lucian Leape himself, Paul O’Neill, Former Chairman and CEO, Alcoa, 72nd Secretary of the US Treasury and more. I had the long-awaited pleasure of hearing Paul O’Neill speak in person, during his breakout session entitled, Operationalizing, Disseminating and Implementing Joy & Meaning In Work and Workforce Safety, along with Julie Morath, RN, MS, President & CEO, Hospital Quality Institute of California. O’Neill’s unwavering standards and expectations in business, and for healthcare, have been an inspiration for many. Therefore, it came as no surprise that he seemed irritated with our progress to date, pulling no punches when asking the group how many of us in the room knew the real-time facts about injury to the people who do the work in our hospitals, and, did a system currently exist to provide that information with a 24-hour lapse? No one in the room raised a hand, and he shared that only 6/100 in a recent audience responded affirmatively to the same questions.
“We’re too far away from this type of excellence,” he said, following with a story that while at Alcoa, the company’s screen saver included real-time safety data. When a particularly concerning near miss appeared on his screen one day, O’Neill picked up the phone and called the team in Russia where it had occurred, asking for more information about what had happened. The personal attention to this near miss resonated throughout the organization, furthering the culture and behaviors that make organizations stronger. It’s this type of response and awareness to healthcare professional harm, as well as patient harm, that will move us to where we need to be.
“Why can’t we do this (in healthcare)?” was O’Neill’s resounding and animated challenge, many in the room knowing full well why we have not. Healthcare culture, leadership that says one thing but fails to support the necessary changes at pivotal moments, inertia–all of these however, are choices made by leadership. Either you’re in or you’re out.
Much of O’Neill’s breakout session was based on the LLI white paper, Through the Eyes of the Workforce, a must read for anyone serious about improving the quality and safety of care. Key takeaways from this breakout, as well as the summary session that followed, include:
- It will be very challenging to protect patients if we first can’t protect our own.
- The physical and psychological safety of our healthcare workforce is pivotal to ever improving the quality and safety of care.
- Real leadership is enabling not controlling.
- A leader’s first responsibility is to his/her people.
- Safety is not negotiable – it’s not a trade-off. You figure out how to pay for it. A pre-condition is that people who work ‘here’ will not get hurt.
- Habitually excellent organizations don’t “report” – they share information and act in a timely way when things go wrong.
- The response is key when people do share information. You can shut down a reporting culture in a heartbeat if you criticize someone for what/how/where they shared information.
- How would your healthcare workforce answer O’Neill’s 3 Questions: 1) Am I treated with dignity and respect by everyone each day? 2) Do I have what I need so I can make a contribution that gives meaning to my life? 3) Am I recognized and thanked for what I do?
We were reminded that it is hard to make a business case for healthcare professional safety, but data also shows that unhappy, un-empathetic, uninspired or unrecognized healthcare professionals directly impact the safety of patients, which directly impacts the “business case” in immeasurable ways. Too often, many in healthcare have observed our colleagues defend or excuse sub-optimal results, or continue to look the other way when observing behaviors that clearly are not in the best interest of colleagues or patients. O’Neill’s unwillingness to compromise standards or expectations is not only inspiring, those values created a company in Alcoa with a safety record that set the bar for his industry, as well as other high-risk industries. O’Neill left the group with many pearls, but following is one that particularly resonated along with advice from the world of storytelling:
“Organizations are either habitually excellent or they’re not – there’s no in between,” said O’Neill.
“Do or not do, there is no try,” fictional sage Yoda advises via the story world of Star Wars.
It is time for healthcare to do differently.
The 7th Annual National Patient Safety Foundation and Lucian Leape Institute Forum and Gala was held last week in Boston, gathering patient safety leaders together to share knowledge, recharge and re-energize their efforts in making care safer for healthcare professionals and patients. The opening keynote, Using Informal Influence to Drive Positive Change in Healthcare, was given by Andrew Knight, PhD. Assistant Professor, Organizational Behavior, Olin Business School, Washington University. Knight has studied innovation implementation, leadership and teams in high risk environments, such as the surgical suite, ICUs, Emergency Departments and the military.
Knight’s talk provided a number of take home tools for healthcare leaders to approach internal change with new power. He supplied a different lens through which to view company politics, one that allows for consideration of “the other” versus leaving a footprint on even your mother’s forehead to reach the top. He shared insight into the influence skills and the collaboration across teams necessary to move quality and safety initiatives forward. And, he stressed that data alone has not been the sole catalyst for the large-scale adoption of change needed to make the healthcare workplace as safe as we need it to be, using the tragic story of Ignac Semmelweis as evidence. Many are familiar with Semmelweis’ story–the doctor who discovered hand washing as a “cure” for the high number of deaths related to childbirth in Vienna clinics. His findings at the time went against the medical community’s thinking of the day, with physicians even taking offense at the request to wash their hands before caring for a patient. Unable to convince, or influence, others of his findings during his lifetime, Semmelweis was ultimately committed to a psychiatric hospital at the age of 47, and beaten by guards two weeks after his arrival. As the story goes, Semmelweis died shortly after from the same infection he was trying to protect patients from through hand washing. This simple, cost-effective step in the delivery of care at the desired 100% adoption rate still eludes health systems today.
Additional takeaways from Knight’s talk include the following. He is an excellent speaker and the topic couldn’t be more timely for healthcare.
- When it comes to navigating the waters of company politics, do you consider yourself an innocent lamb, a straight shooter, a survivalist, company politician or Machiavellian? Knight asked the group to respond via a text message survey. Results showed a normal distribution, the majority claiming to be survivalists with one Machiavellian in the group, prompting Knight to tongue-in-cheek, warn all to watch their backs.
- A more realistic view of company politics was offered, such as: Instead of considering what tactics might be used to influence someone, walk a mile in their shoes to understand exactly how what you offer might affect another. Or, instead of kissing up to those in power, feel free to compliment those you admire!
- Driving positive change is hard work! A 2005 study showed more than 50% of attempts to implement innovations end in failure, and that over $500 Billion is wasted annually on new technology implementations, according to Morgan Stanley
- To implement change, groups outside one’s direct circle of influence need to buy-in, collaborate, support, and supply resources to be successful. Influence skills can help gain the buy-in!
- Informal influence at all levels of the organization is what makes for the successful adoption of new initiatives.
- A numeric equation to map the political landscape related to change was provided, quantifying the amount of current support for any given project, by any given stakeholder, indicating likelihood of success.
- “For most change initiatives we need commitment. Compliance is rarely enough.”