Have You Asked Your Patient About Their Needs, Values, Preferences and Goals Today?

Mom had a total knee replacement surgery on Friday, and I’m happy to report she is doing great. She trained for surgery, doing as much pre-surgical physical therapy in the pool and on the bike as her body could tolerate. She is an engaged and determined patient, and she has an engaged family and patient advocate by her side, asking questions she may not know she needs to ask, not being intimately involved in healthcare herself. I’m confident the surgeon was technically skilled, the pain service was attentive and on a schedule for pain management, nurses came in roughly every 4 hours for vitals in the first 48 hours and were kind, always asking her to rate her pain level, and while nutrition services started off like the worst take out order imaginable, they pulled it together over the next couple days. Mom rolled with all of it — no complaints, as she usually does with everything in life.

White_Board_Patient_Generic_v2As someone intimately involved in the delivery of healthcare, I now understand just how many moving parts are involved in a successful hospital stay, and I am also more critical of the care being delivered. I also know it is the greatest gift to care for patients in their time of need, and that as we do this, we are also delivering a costly service that the patient is paying for–one way or another. As such, we need to step up and design and deliver care that addresses the patient’s needs, values, preferences and goals from the outset. While the flow of Mom’s care seemed to even out nicely over the course of her stay, and on a weekend no less, I still saw a number of ways that care could have been more patient-centered. Here are a few:

  1. The white board in the room had a place for Patient Goals but those were never addressed until I wrote her wishes to be woken up for pain medication on the board.
  2. Each member of the care team came in separately–the patient or family was not included in a meaningful way in any of the rounds or handoffs.
  3. The surgeon only did surgeries on Fridays–a nightmare for anyone savvy to the potential hazards of night and weekend care in hospitals.
  4. Mom was being given instructions while on narcotic pain medication, fresh out of surgery and over the course of the next two days.
  5. We had to ask the questions, and were not invited into the conversation in a meaningful way as part of the care team.

So the first procedure-related hurdles appear to have been cleared. She’s alive and well, and heading home today. As I remain mindful of the potential for an infection lurking beneath her bandage, or a fall once she’s home, she remains positive and upbeat, ready to do the other knee next year. She has had a positive experience of care, and reports feeling very informed about her procedure and what is to follow, and I’m grateful for the care she received. I can’t help but wonder, however, about the other patients I saw with similar bandages, who may not have been referred to their surgeon by one of his own work colleagues, or did not have a cadre of family and extra ears present to listen in as the pain medication kept them comfortable–I hope their experience was equally as positive. It also reminded me just how resilient we are all are–that despite care not quite as patient-centered as I might have liked, Mom is happy and so far, healing nicely.

John Harbaugh, Don Berwick, Lance Secretan and the Principles of New Leadership

Having moved to Baltimore about a year ago, I couldn’t help but enjoy watching last Sunday’s AFC Championship game. While the Chicago Bears will always be my number one football team, I have enjoyed following the Baltimore Ravens through their relatively short NFL history because like the Bears, the Ravens have a “blue collar” work ethic–built on strong, physical defenses led by all-pro middle line-backers.  Plus my wife’s family is from Baltimore so our Sundays have always had some element of purple to them–even while living in Chicago.

What really struck me though was the trophy presentation and interviews in the Baltimore locker room after the game. Winning teams always talk about the “great chemistry” the team shares–players and coaches expressing admiration for each other–but this locker room was different. It felt different from the 1985 Super Bowl-winning Chicago Bears, different from last year’s New York Giants’ press coverage. I could feel something more powerful coming through the Ravens players’ interviews. From the owner, to the coaches and down through the players, they all talked about the love and respect they had for each other, and how they always had one another’s back–in good times and bad. It was different…

John Harbaugh and Danny

John Harbaugh and brother-in-law, Dan Crouse and family

Having had the opportunity to meet and talk with John Harbaugh, the Ravens coach, at a fundraiser right after moving to Baltimore, it was clear he is the “real deal”. Coming from a family of great football coaches (John will face brother Jim and his 49er’s en route to a Superbowl championship in what sports pundits are calling the Harbowl or Superbaugh), one could easily tell that being an NFL coach was his true “calling” in life, and what he loved doing most. But it was more than just coaching–it was clear his passion was leading from the heart and serving as a role-model and mentor to the young men on his team. He was humble, caring, and passionate about football–and by the smile on his face when he told stories about his players, you could tell he really loved them. He had no ego, a wonderful sense of humor, and repeatedly poked fun at himself and his own weaknesses. By the end of that evening, I could see why the Ravens players also loved and respected him, and took to his leadership style. It was clear he could be a great leader at any Fortune 500 company.

The Ravens post-game locker room celebration this weekend reminded me of my encounter with John Harbaugh, and about my recent discussions on 21st century healthcare leadership. As in football, it starts with higher ground leadership qualities, and the increasing call for leadership from the heart that inspires others to greatness, and in so doing, brings joy and meaning back into the patient care environment. Those of us that have attended any of the annual Institute for Healthcare Improvement (IHI) meetings over the last 10-12 years understand the power of these John Harbaugh-like qualities each time Don Berwick takes the stage for a keynote talk. Be it his Escape Fire story, or the year he shared his wife’s personal health experience, he was and remains, a consummate storyteller who leads from the heart, knows his calling and inspires all of us to reach a higher level in patient care (see Leadership and Love). His talks elevate others, making everyone in the audience feel as though their work has more meaning after listening to him speak. He is truly one of the multipliers that Darrell Kirch referred to in his keynote at last years AAMC meeting, and as discussed in our recent post, #AAMC12 Calls for New Vision of Leadership. Many safety experts believe high quality, low risk patient care cannot be accomplished unless more leaders possessing these qualities join the healthcare improvement journey.

We have been discussing Lance Secretan, an executive leadership coach who believes it is the following eleven concepts that people are now searching for in those that lead organizations. His philosophy is based on leading from the heart, and his “Higher Ground Leadership” program is based on these concepts. More of his work can be found at: www.secretan.com, and I agree that it is these principles, and the examples set by the John Harbaughs, the Don Berwicks and the Lucian Leapes of the world, that we should strive to emulate when we are given the gift of leading others.

  1. Leadership. Many of us are yearning for an alternative to business-as-war and leaders-as-warriors. We yearn for spirit in the workplace and for servant-leaders—people who lead with their hearts as well as their heads and wills.
  2. Values. Business has more opportunity to influence the future than any other institution in the world. New Story Leaders choose to make business an instrument for positive change.
  3. The End of Competition. The root meaning of ‘compete’ is to strive together—exactly the opposite of its usual meaning. The New Story Leader respects our interdependence—our oneness—and sees how it opens opportunities for growth, both within the organization and out in the marketplace.
  4. The Cause. People want to work for a Cause that inspires the soul. A Cause acts as a magnet for passion. It articulates the higher purpose of an organization, it describes how we serve.
  5. The New Customer. The New Story Leader devotes even greater attention to meeting the needs of employees as they do for customers. This goes beyond the usual incentive and reward systems —to practices that awaken passion and satisfy the soul. The result is a dramatic improvement in profitability.
  6. Integration. The New Story Leader creates an environment in which “work” and “life” are not just “balanced,” but blended into an integrated, seamless whole.
  7. The Calling. People are looking for more than a paycheck. They seek joy, meaning and fulfillment from their work. A Calling results in work that engages, nourishes and expresses our souls. The leader’s mission is to enable each follower to find, grow and excel in her or his Calling.
  8. Soulspace. We ask people to contribute to the highest standards of which they are capable while putting them in the dreariest, most uncreative environments in their lives. Imagine the extraordinary work that could flow from sacred workspaces designed to inspire the soul.
  9. Technology. The Internet, as an example—can be a medium for the web of human consciousness, described by Pierre Teilhard de Chardin as the noosphere. New Story Leaders will reinvent their organizations within this context.
  10. Learning. The most important ‘fringe benefit’ is no longer healthcare or a pension; it is the right to learn. Learning inoculates against irrelevance and positively feeds the soul.
  11. Inspiration. The role of the New Story Leader is to inspire others. This ability grows organically from one’s own inspiration.

The New Leaders of Healthcare

Healthcare in the US is rapidly changing. We might not know exactly what healthcare will look like in 5-10 years but it definitely will be quite different from the model we have today. A good friend likes to say the “fee-for-service” model is a zombie…while it is still walking around, it is really dead and will be gone in the not so distant future. Quality, wellness and value are the terms we hear today and shareholders are now either battling or partnering to “acquire” as many patients as they can to ensure their survival and a seat at the table. This appears to be a good thing since the current care provision model has not been ideal.

With all this change going on around us, it begs the question, “What type of leadership is needed for success in these changing times?”  Peter Pronovost’s wonderful post, Leadership qualities for a patient safety turn-around, called for a new type of healthcare leader – one that leads from the heart with love.  Peter’s call reminded me of the time I spent with Lance Secretan and learning about his Higher Ground Leadership philosophies (see Healthcare Leadership of the Future Is About Inspiration) . Similar to Peter’s call, Secretan shares that:

great leadership is not a formula or a program, it is a human activity that comes from the heart and considers the hearts of others. It is an attitude, not a routine…

In Secretan’s new book entitled, The Spark, The Flame, and The Torch, he continues his call for leaders that inspire versus motivate. As he astutely points out the definition of motivation is “to provide a motive to induce, incite or impel”.  Motivational leadership moves people toward a goal set by the motivator.  Secretan states that this is the “old story leader” – something we all have seen many times before.  Yet the definition of inspiration comes from the Latin term “spirare” meaning spirit, to breathe or give life to. To be inspired means to love what we are doing and to be inspirational leaders, all of us must first find our own “Destiny, Character and Calling” – something that relies on leaders first finding our own personal true North Star and deciding what we want our lives to be about.

There seems to be more of this “new leader” talk in healthcare today. Dr. Robert (Bob) Rosen, the founder of Healthy Companies (http://healthycompanies.com/) and his team partner with CEOs and executive teams in helping build high-performing organizations. Over the years, Healthy Companies has interviewed or worked with more than 250 CEOs from 34 countries, including AT&T, Booz Allen Hamilton, ING Group, Macy’s, MedStar Health, New York Life, Northrop Grumman, Singapore Airlines, Toyota and more. They have built an extensive knowledge base of leadership best practices through research in the characteristics of successful CEOs and healthy companies.

At a recent leadership development session, Bob shared his thoughts on leadership for the 21st century, challenging all of us around the premise of “Who you are drives what you do”. As Rosen and colleagues teach, healthy leaders of the 21st century will be “mindful” leaders that incorporate two important qualities in all their work:

  1. Open mindsets around self-awareness, broad-minded thinking, win/win mentality, we-centric
  2. Positive emotions based on hope, empathy, trust, gratitude

Open mindsets and positive emotions such as self-awareness, hope, empathy, trust and gratitude are qualities I believe inspire, versus motivate, people. I found Rosen’s thoughts similar to Secretan’s philosophies on Destiny, Character and Calling. Both Secretan and Rosen talk about a passion leaders must have for their work. Funny, this is also what Lucian Leape, the father of patient safety, has been telling us the last few years…healthcare leaders need to bring joy and meaning back into the workplace. The qualities Lucian talks about – being respected, supported and appreciated – are qualities that come through inspirational leadership, not motivational leadership. Four great scholars – Pronovost, Secretan, Rosen and Leape – all sharing similar thoughts on what type of leaders are now needed today – those that are driven by a higher calling, value all individuals in an organization, lead from the heart, and inspire all of us to do the healing work we came into healthcare to do.

Healthcare is definitely changing. Maybe the successful healthcare leader of the 21st century will also be changing. Maybe we are moving away from leaders who were driven by financial metrics and the volume of care provided while ignoring the quality and safety of the care provided. Hopefully that old leadership model will also be the zombie of the future.

More On Storytelling: How Well Do You Know Your Characters?

Ah, Twitter–again! And it happened so quickly I can’t even send out a proper thank you to the originator, except to have faith that the sharing of good ideas is the only recognition many of us on Twitter really seek. Today, it was a link to the Fast Company article, 3 Storytelling Tips From “Breaking Bad” Creator Vince Gilligin, that took me back into the creative space and my ETY series on Storytelling, with the reminder that the ability to craft believable characters within our stories is best left up to the characters themselves. Gilligin’s 3 storytelling tips are: 1) Keep getting to know your characters; 2) Make it your mission to surprise, and; 3) Embrace curveballs. I’ll let you read the article to get the details, but I want to focus on “getting to know your characters” for this post.

For anyone who has ever written fiction, the process of surrendering to the characters is one of the purest forms of escaping into another’s reality. For example, knowing something as seemingly simple as why your character chose the clothes he or she put on that morning is important. This simple choice speaks volumes about the character coming to life on the page. Is she a fashionista? Is he trying too hard? Is she from the wrong side of the tracks? Is he trying to fit in a world he doesn’t belong? Allowing the character to then tell you, as the writer, where the story will go next takes a leap of faith, especially if it contradicts the story outline you have already created.

In the following video, the prolific Joyce Carol Oates talks about her fascination with people and their personalities. Knowing a few of her characters and how they leap off the page, I believe it is her study of human nature that feeds the richness of the characters she creates. She also instructs her students to let characters find their own voice:

In a screenwriting class I took years ago, we were instructed to write 8 page bios for each of the 2-3 main characters, answering a list of 114 questions about these characters, such as: 1) What did his Dad do for a living? 2) Does he like chocolate? 3) Did she finish high school? Go to college? Grad school? Medical School? Art school? Perhaps more importantly–why?  By answering these questions about your character, a human being comes to life–one that allows the writer flexibility and versatility as the story unfolds.

The best writers understand and study human nature in-depth–in ways others do not. As a caregiver and healer, wouldn’t it be wonderful to understand human nature, and the behavioral pieces of the health puzzle, that much better? Learning more about characters–real and imagined, can add to the growing toolbox of skills needed to connect with the whole patient successfully.

Entrepreneurial Learning

How do you constantly look around you, all the time, for news ways, new resources to learn new things?
John Seely Brown

As a follow-up to last week’s post,  A New Culture of Learning by John Seely Brown (JSB), I wanted to share a short ~10 minute video which contains highlights from his keynote address at the Digital Media and Learning Conference last spring. I do so in hopes that this new way of thinking about learning will catch fire in medicine in its own way for so many reasons, as he points out, “the half-life of most skills = 5 years.”

In the video, Brown shares that the use of new technology is the easy piece in creating learning environments designed to meet the needs of the digital age, however it will be the social practices and related institutional structures themselves that will present the greater challenge. How will medical education shift, and how quickly, to meet the opportunities in front of all learners today? Better yet, how will medicine help shape the learning environments of the future? Please weigh in!

A New Culture of Learning by John Seely Brown

If you want to succeed, double your failure rate.
Thomas Watson, Founder–IBM

John Seely Brown:New Culture of LearningJohn Seely Brown, often referred to as JSB and former Chief Scientist at Xerox and Director of the Palo Alto Research Center (PARC), co-authored  A New Culture of Learning: Cultivating the Imagination for a World of Constant ChangeIn the book, JSB and Douglas Thomas, associate professor at the Annenberg School for Communication at the University of Southern California, discuss the need for learning in this century and beyond to be collaborative, welcoming questions, and challenging what we “know” to be answers. From the book:

…in the new culture of learning the point is to embrace what we don’t know, come up with better questions about it, and continue asking those questions in order to learn more and more, both incrementally and exponentially. The goal is for each of us to take the world in and make it part of ourselves. In doing so, it turns out, we can re-create it.

The authors also talk about the need to embrace change, “looking forward to what comes next and viewing the future as a new set of possibilities, rather than something that forces us to adjust.” We don’t have to look very far to see the world changing much more quickly around us. The technology being developed is so intuitive, kids 5- and under can easily pick up an iPad or smart phone and navigate their way through the latest version of Angry Birds. JSB and Thomas provide examples of the 70 years it took from the discovery of a color TV signal in 1929 by Bell Labs to color TVs becoming ubiquitous in American homes, versus the exponentially faster adoption of internet technology (18% of households with internet access in 1997 to 73% in 2008). The tools we use in all business sectors, especially healthcare, are now more capable of harnessing large amounts of data that can drive solutions to questions that years ago may have seemed ridiculous, too “far out”, or even crazy.

So how does this all fit in medicine and medical education? The quote that led this post–“If you want to succeed, double your failure rate,” has no place at the bedside. But now, more than ever before, healthcare has a real need to solve the problems that are burying the industry with new thinking that comes from new learning. Simulation training and redesign of curriculum are two ways to address the needs not currently being met in medical education. But it goes deeper than that–as so many have said, the culture of medicine needs to shift. Medical students and residents have not only been bullied in their training by know-it-all mentors creating a learning environment that not only kills creativity, but the spirit as well. With all the discovery yet to be made in the sciences, how could one person think they “know” all the answers–wouldn’t it be best to view what is known as a starting place, and use it as a springboard to invite other intelligent, knowledgeable people into the conversation to take that baseline knowledge further?

In my maybe not-so-humble opinion, learning should embrace the not-knowing as well as the knowing. How we accomplish that in healthcare will take a shift–not only in thinking but in long-held beliefs as well. We don’t have the luxury of waiting for those afraid of change to leave medicine, and we don’t want to continue a stilted learning process that has proven to limit options. This change needs to be embraced today, and John Seely Brown’s book is both a lifeline and a roadmap. Please take a look at his keynote at Indiana University below, or pick up the book–I barely scratched the surface of the wealth of content contained within.

Healthcare Leadership of the Future Is About Inspiration

Leadership is not so much about technique and methods as it is about opening the heart…about inspiration–of oneself and of others. Great leadership is about human experiences, not processes…is not a formula or a program, it is a human activity that comes from the heart and considers the hearts of others. It is an attitude, not a routine.

Lance Secretan

Many years ago, I was able to spend two days with Lance Secretan, a truly amazing human being and leadership scholar (www.secretan.com). The company I worked for at the time was a big believer in leadership development as a critical component of sustaining long-term greatness. Our CEO believed that leadership was a skill similar to that of golf or tennis, and that to be a great leader, one needed to invest significant time in continuously improving leadership skills through training. Lance was one of a number of leadership “gurus” I was fortunate to meet during my own leadership training while with this organization, and I found the messages contained in his “Higher Ground Leadership” experience truly inspirational. One of the biggest takeaways was that while great leadership of the past was built around philosophies of “winning at all costs” and using power and fear to drive results, successful leaders of the 21st century would be leading from the heart versus the fist, and they would be working to create “win-win” outcomes.  This new-age leadership relied on leaders inspiring their workers to connect with their own inner values in helping achieve organizational greatness.

There is no doubt this leadership training shaped my career, leaving a lasting impression. While each of my “classmates” were on their own personal leadership journey, we were guided to reflect and connect with our “authentic self”, as well as one another. Throughout the experience, Secretan encouraged all of us to honor the part of our authentic selves that would be truly inspirational to others, instead of creating elaborate motivational “schemes” to convince others to do things they weren’t meant to do. Secretan teaches his leaders-in-training to recognize the value of connecting with the “authentic selves” of those we lead, and how inspirational that connection can be to both parties. His short video below outlines the difference between motivation and inspiration:

Secretan’s teachings are based on the core principle of connecting the soul with what was formerly known of as work–the two becoming intertwined in a way that redefines “work-life” balance, and is truly fulfilling. He espouses that even the environment we work in should reflect and honor the creative spaces of the soul. Think of the healing that could occur not only in our healthcare workforce, but in our patients, if we created healthcare environments that were truly places that nurtured the soul? Whether you are a student or have been involved in healthcare for longer than you care to admit, reclaiming your values and identifying your strengths, will allow you to solidify a foundation for your own leadership style today–regardless of position.

In a recent post, Leadership and Love, I talked about what I believe the best leaders in healthcare do to inspire those around them. When the foundation of any relationship is built upon love and mutual respect good things happen.  I also believe that good leaders surround themselves with smart, passionate people and then get out of their way–checking in to inspire or be inspired, and to make sure each individual has what they need to further their goals and the goals of the team. Each of us wants to be valued, our contributions to a higher purpose given room to grow, and the tools to move our ideas forward available. When leaders create work environments that clear a path for all to honor their own passion and talent, an amazing transformation has the chance to take place. The joy and meaning at work that Lucian Leape often speaks of now has an opportunity to breathe new life into organizations.

What resonates with you from this post? Why? What have you observed in good leaders around you? Share your thoughts as we continue a series on leadership!

In closing, I share another quote from Lance Secretan:

“If there is one thing a leader can do to connect with followers at a human, or better still a spiritual level, it is to become engaged with them fully, to share experiences and emotions, and to set aside the processes of leadership we have learned by rote.”

Sharing of ‘Good Ideas’ Vital to Solve Healthcare Challenges in 2013

Thanks yet again to Twitter, I recently came across an article on the Robert Wood Johnson Foundation (RWJF) site, Young Leaders Transform the Future. The article provides a brief outline of the projects designed by RWJF’s first 10 Young Leader Award recipients. The projects, and those who designed them, are so impressive that I felt obligated to share them in hopes they may add additional spark to an idea percolating within a reader, inspire a new collaboration, or be used as a solution to an existing healthcare challenge. Following are three of the award-winning Young Leaders, and a description of their projects as food for thought. Follow the link above to RWJF site for a description of all 10 projects, and more on the work being done to generate new healthcare solutions:

Ruben Amarasingham, MD, MBA
An algorithm developed by Amarasingham’s group spots patients whose social conditions put them at high risk for relapse after discharge from the hospital. Using this breakthrough technology, Parkland Hospital in Dallas has cut its 30-day readmission rate among Medicare heart-failure patients by a stunning 40 percent, a $500,000 savings that has sparked nationwide interest in Amarasingham’s technology.

Naa Oyo Kwate, PhD
With startling comprehensiveness and originality, Kwate video-documents urban neighborhoods to capture and analyze the ubiquity of racist symptoms and messaging. Lately, she has begun to talk back to the urban environment via billboard messages that lay bare—and hopefully defuse—racism’s destructiveness to human health.

Raina Merchant, MD, MS
Blending social media and tournament theory with an emergency physician’s passion to save lives, Merchant mapped the location of every defibrillator in Philadelphia. Next she wants manufacturers to install a GPS chip in defibrillators worldwide so your cell phone will automatically lead you to the nearest one.

The sharing of these Young Leader’s projects is in the spirit of Stephen Johnson, whose TED Talk is included below, and who believes that good ideas take time and input from others to truly take shape and become reality. If more writers, storytellers, documentarians, healthcare providers, entrepreneurs, tech-savvy creatives, patient advocates and others share their experience and stories perhaps we can jump-start the natural evolutionary process of idea formation to action in order to solve healthcare challenges sooner vs. later.