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.”
These talented medical students may have a career in show business if the whole medicine thing doesn’t work out in the end. This group is from the David Geffen School of Medicine at UCLA, but search YouTube for “medical student parody” and you will find medical humor set to tunes from Frozen to “What Does the Fox Say?” to “Call Me Maybe” and this group’s choice, “Royals” by Lorde. Have a great weekend!
For those who have not had the chance to hear JK Rowling’s 2008 Harvard commencement address on “The Fringe Benefits of Failure and the Importance of Imagination,” see the YouTube video below. She addresses the Harvard graduates with humility, wisdom and gratitude, as well as humor, and teaches all that the power of imagination reaches far beyond creativity, innovation and invention–it allows us to empathize with anyone, no matter where they come from or who they are. What an excellent reminder as we strive for more patient centered care!
Though I personally will defend the value of bedtime stories to my last gasp, I have learned to value imagination in a much broader sense. Imagination is not only the uniquely human capacity to envision that which is not, and therefore the fount of all invention and innovation. In its arguably most transformative and revelatory capacity, it is the power that enables us to empathise with humans whose experiences we have never shared.
As the Telluride Patient Safety Summer Camp 2014 Sessions come to a close, we are buoyed by our ever-expanding network of young and enthusiastic health care providers in-training, turning patient safety into a creative science. The Telluride Summer Camp blog continues to receive comments and posts from alumni, and is increasing evidence of a positive healthcare culture on the rise. Mindfulness, a just and learning culture, open and honest communication and patient centered care are all foundational messaging of the Telluride curriculum, and keys to true culture change in healthcare. Colin Flood, an M2 from Rush Medical College in Chicago attended this year’s Telluride East Camp, and recently posted the following reminder that patient safety lessons exist all around us, especially when we are mindful and focused on the end goal of keeping patients safe.
Thanks Colin, for continuing the patient safety conversation:
On the way to the hospital this morning, I heard a report from NPR’s Dan Charnas about mise-en-place, the chef’s philosophy and discipline for organizing and managing a hectic commercial kitchen. The piece was a great reminder that many of the challenges we face in healthcare are shared by others. Chefs standardize their procedures, prepare meticulously for each workday, and read back instructions from their colleagues to keep orders straight in the hectic kitchen. They also “work clean” and practice “clean as you go” to keep their workspaces organized and their food safe. When something’s not right, the chef “slows down to speed up” by taking time to correct any problems before a dish reaches a customer. A few weeks after Telluride it was a great reminder that we can get inspiration and motivation for patient safety practices anywhere!
To hear the NPR story, click here.
A tribute to a gifted storytelling talent and teacher.
Terry Heick, teacher and blogger, gives additional tribute to Williams, and to teachers who inspire selflessly in, That the powerful play goes on, and you may contribute a verse. To quote:
He whispered to students in a sing-song, melancholy, and haunting tone on behalf of those that had come before. It was never about him, but about the ultimate invitation–inviting a potential learner to something worth understanding.
To me, that’s teaching.
As far as his character in DPS (Dead Poets Society), it wasn’t so much the quotes and themes (carpe diem) as it was his devotion to something greater than himself–and his ability to see his limited role in that fragile process. Students deserved to understand literature–that seemed to be his position. So I took those ideas, and formed what I thought about teaching.
What can I do to help students climb over and around me?
To not need me?
To trust themselves enough to reach out and take something?
Who were the teachers you remember? We talk about educating the young and the need to rework medical education in a way that addresses the needs of today’s healthcare, yet change comes slowly. Where are the “John Keatings” and “Terry Heicks” of medical education?