A Microcosm of Leveraging Knowledge - Highly Reliable Organizations

Yesterday, I met with other Ascension Health ministries to discuss our High Reliability platform on our journey towards Healing Without Harm by 2014. This represents a commitment to an unending destination in quality, safety and experience for patients, associates, volunteers, physicians and leaders. In short, High Reliability Organizations in one that delivers on what it intends to and we all have dedicated ourselves to this endeavor.

We discussed 5 principles associated with delivering highly reliable care, each and every time. Yes, these are obvious - the consistent delivery of care and the leverage of knowledge will make our healthcare systems better across the nation. It starts with Engagement - engaged associates, volunteers, physicians, patients and families who participate and support in the care provided.

Our group yesterday served as just a small microcosm of sharing and leveraging knowledge across 70 hospitals. That is how we will all change our care delivery in a more effective way - truly sharing best practices.

At the end of the day the key is utilizing these High Reliability Principles as a guide to deliver on what you intended to to. The principles include:

1. Preoccupation with Failure

- Predict and eliminate harm

2. Reluctance to Simplify

- Acknowledge full range of opportunities for error

3. Sensitivity to Operations

- Recognize and address anomalies and potential errors by providing holistic patient care

4. Resilience

- Requires teamwork to adopt and respond quickly

5. Deference to Expertise

- Encourage teamwork by de-emphasizing hierarchy to allow people with the appropriate knowledge relevant to an issue to be included in decision making.

Again, things we know. It will be those systems who deliver these principles most consistently who will serve as the highly reliable organizations.

Don't Ask, Don't Tell

A local hospital recently added a 'don't ask, don't tell' policy for all employees. It seemed they felt they could provide safer, more effective care if officials and co-workers of the organization were oblivious to facts about their associates. When asked what the healthcare system expected to accomplish, officials stated the "don't ask, don't tell policy" should help the organization advance their quality agenda, improve their relationships with key physicians and insurance companies, improve their patient satisfaction and associate engagement and drive stronger financial margins...

In these day where we need to provide more transparent leadership, how will the public respond to the tactics from the healthcare system above?

The same should hold true for our military. According to the Washington Post, House lawmakers on Wednesday again approved a bill to repeal the "don't ask, don't tell" law, delivering renewed momentum to the years-long campaign to end the ban on gays in the military ahead of a possible Senate vote next week.

As you probably imagined, the healthcare organization above is a made up story. There are many things we are far behind with in healthcare but the "don't ask, don't tell policy" is not one of them.

The nation needs continued transparency in all we do so we could make the most effective decisions based on our collective input.

Sleigh Bells Ringing on my 7th Cranial Nerve

The holidays are filled with lots of bells...Christmas bells, sleigh bells, jingle bell's, Salvation Army bells. And last Wednesday, the holiday brought me partial Bell's Palsy (also known as 7th cranial nerve paralysis).

Certainly, it was scary at first as I thought I noticed signs of a Stroke. I quickly called one of our physicians and headed into see him. After an MRI and other testing, I was cleared of a Stroke concern and put on proper medications. Times like this definitely get you to step back and think what led up to this. Looks like I had a "perfect storm" of possibilities including physical stress on the body with a marathon, less sleep, more travel and medicine that may have lowered my immune system over the past 3 weeks. Now, with a patch over my left eye for the next few weeks to keep it closed, it really provides me the chance to slow down (or smash into things) and watch my activities more carefully. Please note that I have appreciated all the offers to sign, decorate, add bling and bedazzle my patch. We could leave that contest for another day. I have also received several praises from kids today, complimenting me on my cool eye patch.

"Ahh, the joys of physical activity have caught up to you." as many have shared with me. "This is your body telling you to slow down." I suggested that a simple pep talk would have worked for me. During this evaluation phase it truly brought to light my key priorities and interests.

I do not take this situation lightly though and do appreciate the chance to reflect on key focus areas and priorities. This morning, our senior team discussed that very point...how do we slow down and make sure we address our key priorities, ensuring that we move forward and involve the key people to implement any changes with more success. It led to a deeper discussion about shared leadership vs. one person making all the decisions. Sue C., a former boss of mine at the Rehabilitation Institute of Chicago once put it well with our team around her. She said, "most of our decisions could and will be made through our shared and collaborative leadership. There will be times that a final decision needs to be made and I realize that I sit in that seat." I really enjoyed that lesson of collaboration balanced with accountability. To have this balance, it is important to involve key stakeholders and also identify who "sits in that final decision seat."

Oh, and did you know (according to the world wide web) many famous people have had Bell's Palsy including George Clooney. Perhaps the healthcare bloggers could start choosing those actors/actresses who will play us in the future movie entitled, The Impact of Blogging on Healthcare Reform.

I look forward to hearing from you.

Is it About the Money?

A couple fo days ago, the Kansas City Star posted an aritcle entitled, Area doctors get pharmaceutical money for talks about drugs .


The articlew by Alan Bavley with The Kansas City Star stated:

A prominent cardiologist who’s written a diet book. A urologist who’s part of a booming group practice. A family practice doctor, two psychiatrists and two specialists in pain and rehabilitation.

They are area members of the $100,000-plus club — physicians paid six-figure sums by drug companies.

For their paychecks, the doctors give promotional talks to other doctors about the drugs the companies make. They lead forums. They serve as industry consultants.

More than 100 area doctors are taking money from drug companies for speaking gigs and other work, according to data from the nonprofit journalism organization ProPublica. From the beginning of last year through the first half of this year, area doctors have received at least $2.2 million.

The drug industry and the doctors themselves said they were doing an important job by teaching colleagues how to use medications and giving them the benefit of their experience dealing with patients.

Critics said education is not the only reason — or even the primary reason — why drug companies paid so much to doctors. They say it’s all about promoting the companies’ products.

And, critics said, the practice could lead to doctors prescribing drugs too often; prescribing problematic drugs; and writing prescriptions for more-expensive medications when cheaper ones would do.

Payments to physicians by drug companies is an issue that has simmered for years in the medical community.

The Association of American Medical Colleges and the Institute of Medicine have questioned whether doctors should participate in speakers’ bureaus for drug companies.

Certainly their are mixed reviews I have heard across the hospital and in the community. There is not necessarily a wrong or right answer, of course.

Overall, our healthcare system is trying to provide the highest quality care and help improve the health of our population, improve the patient experiences and lower the cost of providing our services.

So, what's your opinion on the physician fees received?

Brown Mackie via Satellite

Last night, I presented to the Occupational Therapy Assistant students with Brown Mackie College in Phoenix. They have a fantastic school and curriculum for these students. We had a chance to meet via videoconference while I stayed in Kansas City.

The students had some great questions regarding the future career opportunities and the impact of healthcare reform on the country. A couple of their tough questions included:

1. What it the most challenging part of providing care to the patient from the time they are admitted until they are discharged. That, of course, reflects the entire experience and it almost always comes down to how we treat our patients and each other and how well we coordinate their care through the process.

2. How do we provide the best care to our patients and advocate for all the necessary resources since many organizations "seem' bottom line driven. Another great question. As organizations need a bottom line, it has to start with Quality. If we need additional resources, we should request them. If we can not get additional resources, we must ask ourselves, "how can we still provide safe and effective care today?" If we can't provide safe and effective care, my vote is to get the patient to a place where they could get safer and more effective care. We have limited resources in healthcare and need constant communication to understand our priorities and back-up plans if we do not have all the resources we need.

Anyway, we had a lot of fun with the presentation. They told me this was their first video presentation so I made sure to take a picture...I could only capture a few in the class.

The End of the Line...We Should Talk

Tonight I had a chance to see my kids perform in a holiday charity event for Operation Breakthrough. It was an enjoyable way to end the evening after a day of following patients and observing several process improvement activities.

I started out this morning "In Your Shoes" with the preoperative staff before patients went to surgery. I had a chance to serve as a Patient Representative and follow Dr. Scott and Dr. Norm's patients through surgery, into Recovery and then paid them a visit once they were settled on the inpatient unit. I did try to go incognito, with scrubs and a badge with just my first name showing. Word got around fast - a family member asked if I was the CEO...they still agreed to let me observe the surgical flow process for the patient. Thank you to Lois, Sean and Dr. Norm for explaining things throughout the surgery.

Every step of the way, critical steps were followed with constant communication across all parties like a well conducted symphony. Of course, that is a key element when things go well and a key breakdown when things don't go smoothly.

Talking about the right communication needed, let me take you back for a minute to to the charity event with my kids. I parked the car and met my wife at the end of the line. She then took our kids to the back to get them ready. I noticed several people giving what I considered evil stares. After a few minutes, I was still at the end of the line with no one behind me and my son asked if he could walk around. He said since we were at the end it would be easy to regain our spot. Just then it hit me like the end of The Usual Suspects with Kevin Spacey...I went back and found the glares were still on me and, you guessed it, the "end" of the line was actually the front of the line. I confirmed with the person now behind me who had probably camped out since last night. Yes, my son and I headed to the real back of the line.

The point being, sometimes processes are not so obvious and we all need to speak with each other more freely to ensure we don't miss anything. As we enter these next few years, we are not only challenged with the changes with healthcare reform but with the overall new world as we now realize. We must continue to provide incredible care and an exceptional patient experience at a lower cost than we provide today. That will come from constant communication with each other and standardizing processes where we can. In addition, those process improvement competencies will be more critical than ever before.

Check out this initial flow chart for getting a patient from the emergency department to the inpatient floor. By involving the right people around the table, the new process will probably take out 40-50% of steps, getting patients to the most appropriate level of care in a very timely manner.

If you had the time and opportunity to improve 2-3 processes in your organization or in your daily activities, what would you change?

Safety Matters

Enjoy our Safety Matters video.

The video shows various safety tips and CH's own version of Dancing with the Stars. There was great participation in the making of the video, and while it's entertaining, it also carries serious reminders about the importance being safe in the care we provide to our patients. It is played to Men Without Hats popular 80's song, Safety Dance. Thank you Stefan!