Welcome to our ongoing series based on the characters created in my book, Heroes Need Not Apply, “How to build a Patient-Accountable Culture without putting more on your plate.” The book shows how focusing on what matters most to patients, having the right mind-set and a common direction can bring people together to ignite an entire organization.
My characters, CEO Jane Carolli and VPMA Dr. Jack Martin continue to craft a strategy to improve their culture by developing a cultural assessment tool to help drive change.
In our last issue, Jack and Jane were talking about accessibility, and more specifically, how the issue can be viewed from both a system and patient perspective. More specifically, how the macro view of physician time management is not the way patients see the subject of accessibility - on the micro level, patients see accessibility as the quality of the interaction they have with their physician.
As Jane said toward the end of the last issue, “Our docs who don’t take the time to give patients the human interactions that they need up front might think they’re saving themselves time - but they’ll end up putting more time in anyway, when their patients come back in.”
The conversation continues…
In the cafeteria:
“Jack, on this accessibility issue, I’m having a hard time dealing with the fact that we can give our patients what they need the most by just improving the time spent with them… this issue spotlights one of healthcare’s biggest challenges, yet one of the easiest to remedy… and I need to understand it better if I’m going to ask our physicians and staff to begin working differently.
Jack replied, “You know Jane, first off, I suggest you don’t just think of this as a healthcare issue, this is a challenge you can see everywhere if we look close enough. For instance, I'm reminded of something I once heard from Freddie Couples a professional golfer, he said that when he was home, he just didn't answer the telephone because he was afraid that there might be someone else on the other end.”
Jane smiled, “Are you saying that his avoidance behaviors are similar to the ones impacting the patient experience here at Angels?”
“Absolutely. You’re the one who told me about some of the docs around here who make rounds at 2 am when their patients are sleeping… how more avoidant can we be?”
Jane got it, but didn’t know how to reply, when Jack continued with, “Let me tell you what John Blanchard once told me - he’s a primary care doc I used to work with in Billings. John had a woman come in that he had been seeing for years. In every past visit, she was enthusiastic, very articulate and downright bubbly. But when she came in on a routine visit, something just wasn’t right .
He noticed right off that her speech patterns were slightly different than they’s always been… just slightly. In fact, he told me that anyone else who hadn’t spent some time getting to know her would have never made the pick up because she had no complaints and was unaware of the minimal changes as they were so subtle. He did a neurological exam and nothing showed up.
So he ordered a brain MRI, regardless of the fact that her insurer refused because she had no specific indications with an otherwise normal history and examination. He refused to give up and called them back multiple times until the insurer finally relented. The MRI showed a benign meningioma – treatable and probably curable.”
Jane added, “Your buddy only figured it out because he knew his patient. He had invested his previous time with her listening intently and getting to know her.”
“Right Jane - and it’s not like he spent an inordinate amount of time with her in the past, he just spent good quality time to understand the patient."
“He may have healed her, not from some miracle diagnosis or new wonder drug… but from taking a moment to listen and observe his patient. This isn’t rocket science Jack - it’s a pretty simple concept.”
“Agreed - but here’s another story I heard recently… it illustrates the same thing from a different perspective. A friend of mine took his mom to the cardiologist last week. After the cardiologist spent some time getting to know her and really listening to her, he believed he'd hit upon what was causing the problem… and a solution, which happily did not involve a drug or surgery but behavior modification. He told her he'd call her internist who she has been seeing for many many years to tell him about the discussion.
His mother waved her hand dismissively and said, "He doesn't know me. In fact, you know more about me after this short visit than he ever has… and I’ve been seeing him for over 20 years!" The cardiologist looked surprised and a little confused but he understood. His mother was saying that her internist had not spent time listening to her and getting to know her unique situation like this cardiologist had done.
She went on to say that her internist was always in a hurry and never treated her like the cardiologist did. She said that she had only known him for a short while but already trusted him more than her primary care doc.”
Jane chimed in, “ There’s obviously both good and bad to that story Jack. We just need to get the moral of this story out to every physician and clinical team in this hospital. This patient view of accessibility is one we can influence. We need to help our colleagues start looking at everything we do from a patient’s perspective. That will begin to shift the culture around here… and I’ll tell you what Jack… at first, when we began talking about changing up the culture, it sounded huge and unfathomable. But this accessibility issue really illustrates that culture is simply the degree and frequency of quality interactions… this is a conversation we need to share.”
“Simple to grasp, yes Jane… simple to implement… well, we’ll see. It’s a paradigm shift - and encouraging change is a slow process… but definitely doable.”
Is your culture aligned to what matters most to patients?...