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“The Secret” and Improving the Experience of Care (2 of 2)

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In the first blog in this series I shared Robert Frost’s poem “The Secret Sits”

“We dance round in a ring and suppose,
But the Secret sits in the middle and knows.”

I suggested that the “Secret” is the person at the center of care. The patient, their family, and their caregivers. Sitting “in the middle” and knowing what they need and want but lacking effective ways of sharing and the ineffectiveness of provider organizations’ current means of capturing that knowledge.

Here are some ideas for how to improve the usefulness of your data capture to improve your patients’ experience at your institution.

  1. Get clarity about your current state
    • Understand your mandatory survey data like CAHPS (because they don’t seem to be going away) and remember the facts – most hospitals must only obtain at 300 completed HCAHPS surveys over the 12-month reporting period AND your choice of vendor to administer the survey is a “choice”
    • Augment your mandatory (and old) data with real-time, point of service feedback
    • Get out of your office and experience the care environment, listen and look, make your own assessment of your environment, paying attention to the tangible aspects of cleanliness, noise, food service.
    • Listen to your staff by talking with them directly, holding town halls and reviewing your staff surveys.
  2. Get clarity about your future/desired state
    • Craft and cast a vision of the future state
    • Make it measurable – how will you know when you’re on your way and/or there. Don Berwick is quoted as saying “soon is not a time, some is not a number”
  3. Get clear about the gap, the disconnect
    • Why aren’t we achieving the future state?
    • Where are the gaps?
    • Is this an issue of skill or will?
  4. Craft a plan to close the Gap
    • Craft a “Blueprint” to close the gap
    • Define accountability for change (my colleague, Maryann Sullivan, has written a simple review of how to establish this accountability.)
    • Get specific around work flows, resources, roles and responsibilities
    • Establish Service Level Agreements
    • Develop tailored training
    • Provide coaching

The question remains, are you dancing around the ring and supposing, or are you listening to the secret?

Still Naked!

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Five years ago, I wrote my first blog – “The Emperor is Naked! Taking risks to reduce risk…”

The title pretty much gives you a clear idea of the premise of the piece. I invited the reader to consider that the brave little voice in the crowd that points out that the Emperor is in fact naked – while all around them (including the Emporer) have been fooled into believing otherwise – is like the voice that speaks up in healthcare when something (or someone) is not safe, patient centered, or effective.

Five years later I am still convinced that there are many in healthcare leadership roles that are still naked, and worse, they are surrounded by ‘loyal subjects’ that are too afraid to speak up and share this reality with their supervisor, with their ’emperor’.

The questions that I posed in that blog remain relevant:

  • Does your environment promote or inhibit speaking up?
  • Are your co-workers and managers so confident and conceited that they sometimes don’t acknowledge what everyone sees as true?
  • Are people ignoring what the data shows for fear of embarrassment?
  • Do people perpetuate “how” things are done to go along with the “crowd” – or because it’s the way it’s always been done?
  • Are leadership team members willing to take the risks required to speak up and act differently? (to be that little voice in the crowd)
  • What are the risks associated with speaking and acting differently?

What I’ve been reminded of over the past five years is that the driver of not speaking up is fear.

Overcoming fear: of being wrong, of push back, of disagreement, or of embarrassment is the essence of accountable leadership.

The reality though, is that often the fear of acting on our thoughts is misplaced. It’s the fear of the fear that holds us back. We tend to get caught up in mind games of what will people think and how will they react. What if someone finds out that I don’t know as much as I think I know? What if they think less of me? What if I missed something? What if…..

Enough already! If the past five years have taught me nothing else they have taught me that the mind games we play with ourselves are exactly that, mind games. Speaking up, saying out loud what we’re thinking and asking the question that no-one else is willing to ask is not as big a risk as we think it is.

Go ahead, try it. Not doing so creates more of the same, the status quo.

Accountability: Buzzword or Basic?

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We hear a lot about accountability when we work in hospitals.  “We don’t have it.”  “We should have it.” “Why don’t we have it?” Is accountability just a buzzword that gets tossed around? Or is it a fundamental, basic concept that represents a mindset and a set of skills to implement?

So what does it mean to be “accountable”?  The Merriam-Webster dictionary defines it as “answerable”.  Hmmm, not very enlightening in a practical sense.  So here is my personal definition of being accountable for something:

  • There is an objective that needs to be met
  • I am willing to be publicly measured on meeting the objective, the “what”
  • I am willing to be publicly measured on “how” I meet the objective (behaviors employed)
  • I feel empowered to utilize my skills, tools and power to meet the objective

Mix these elements together in a beaker and I can make accountable.

How many things are you accountable for in your organization? Can you list not only the objectives but the measures, tools, skills and decision-making authority?  If not you, does someone else have the authority to meet the objective? If not, then no one is accountable for that objective. Well, maybe the CEO, by default. But how many specific objectives does/can a CEO really manage and run with?

Accountability should be more than a buzzword. Organizations don’t function nor perform well without accountability.

If you are responsibility for a major function in your hospital, start filling up your beaker by:

  • Listing your function’s objectives
  • Putting names by each objective of who is accountable for it
  • Thinking about how to give that named person the elements required to be successful (i.e. measures of success, power and tools to accomplish the objective)
  • Don’t forget to publish the results for all to see

Improving the Experience of Care: “The Secret”

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Robert Frost’s poem “The Secret Sits” is two simple lines of poetry, a couplet:

“We dance round in a ring and suppose,
But the Secret sits in the middle and knows.”

The meaning is left up to the reader. In healthcare, the “Secret” is the person at the center of care. The patient, their family, and their caregivers. They sit in the middle and they know, they just don’t have effective ways of sharing what they know or want, and healthcare is not very good at listening and responding accordingly.

During a recent conversation with a client hospital executive, she shared some findings that shine a light on this disconnect between what patients want and what leaders think patients want.

When she asked her leadership peers to list the priorities to improve the experience of care, they said:

  • New facilities
  • Quiet-time to ensure rest
  • Private rooms
  • Food on demand
  • Interactive bedside computers
  • Eliminate visiting hour restrictions

When the patients of her organization were asked to list the priorities they sought in order to improve the experience of care they receive, they responded:

  • Treat me with more respect
  • Communicate better between each other
  • Listen to my needs / requests / concerns
  • Be more happy
  • Show more empathy

Are you surprised?

The reasons behind this disconnect run deep. For many hospitals, clinics, and doctors’ offices the methodology for capturing the voice of the patient (the data) is broken, the tools are clumsy, and what leaders are doing with the data is not resonating, not effecting change, and not very sophisticated.

If I ran a restaurant in a like manner, it would go something like:

You’re served a cold tasteless entrée, on the menu as a ‘hot delicious special’. You have no opportunity to share your feedback with your server; they’re too busy with other patrons, appear far from approachable, and don’t ask you whether this is what you thought you ordered. When you do muster the courage to say something you’re told that you’ll receive a survey in the mail, and you can provide your feedback there.

Several weeks later the survey arrives in your mail box. You try and remember the meal you’re being asked about and reality kicks in; you’re likely remembering one or two experiences blended together, or you’re still so upset about the meal that you just let the restaurant have it…

The restaurant owner and manager receive the survey, identify the waiter and ask him or her to improve their service…

Without weaving this analogy further, you get the idea, oh and by the way, my restaurant would quickly go out of business if this was how I responded/reacted to such service failures.

The signal, response and desired change feel like they are all disconnected. This is how many hospitals currently “measure” the experience of care, this is the data they use to reward and recognize, and this is the data that they use to “drive change”.

What’s missing is an effective system for better capture of operations data. We need practices that capture feedback as close to real time as possible and that use this information to inform operations. The data should be used to inform where training and education is needed to close the gap between the current state and desired state.

Are you listening to “the secret” or dancing around the ring?

Black Box Enabled Surgical Suites?

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Medical errors are estimated to be the third leading cause of death in America. This is worth repeating – the THIRD leading cause of death in this sophisticated, educated, economic power house of a country is mistakes, errors, mishaps…

Why aren’t we outraged? Why aren’t we paying more attention?

I understand that healthcare, as a “system”, is a complicated, ever changing industry that relies on fallible human beings to work well in complex, difficult to repeat situations each and every day. But, here’s the reality – healthcare is NOT alone! There are industries equally as risk-filled with far better safety records! Why is it that the same level of safety we demand for our automobiles or airline travel is not demanded to protect a life, our’s or a loved one’s, when we enter a hospital?

There are many industries, other than healthcare, that work in complex environments where the actions of one human can impact the life of another. Healthcare leaders need to acknowledge the reality that we have much to learn from other industries. While we cannot mimic others entirely, the same general operating principles (including mindfulness that serves as the overarching organizational spirit) that are the foundation for other high reliability organizations (i.e.: aviation, nuclear power) can work just as well to prevent harm from occurring in health systems.

One example of a safe practice or technology that could shared across industries is the in-flight data recorder found on all commercial airliners. It was because of the in-flight data recorder on board the two Boeing 747s that crashed into one another on the island of Tenerife in 1977 that we learned so much about the decisions and behaviors resulting in that game-changing airline disaster.  The time stamped voice commands of those at the controls were captured in real-time, and provided a blueprint of what “not to do” along with a snapshot of what needed to be changed.

Now envision this: following a surgical procedure, regardless of the outcome, we have the opportunity to review every piece of data related to the procedure.

We currently have the technology by which we can go back and look at thousands of time stamped data points to review and/or recreate events as they transpired in the operating room. We can capture voice, video, blood pressure, oxygen levels, numbers of plasma/blood transfusions. The data would stream from the medical equipment in the room, from the microphones, the cameras, and any other sources that we choose to capture, into a device that allows playback, review and re-enactment.

We could assess team work, learn from the practice of those at the top of their game, and use this data to improve. We could revisit poor outcomes and learn what should be done differently in similar circumstances. This is not a pipe-dream, nor is it my idea; it has been developed and is currently being used and piloted by Dr. Teodor Grantcharov, a general surgeon at St. Michael’s Hospital in Toronto, Canada.

An innovator if ever there was one.

The choice to innovate is not, in fact, a choice – it’s an imperative.

I firmly believe we have the expertise, the intelligence, the resources, and the creativity to make healthcare less costly, more effective, more patient centered, and far better. We need to give ourselves the permission to try, to innovate, to disrupt our environments in ways that lead to safer, more effective and more humane healing environments.