Tip 25: Upgraded to Team-Based Care

Q: A nursing executive from the audience shares…”our team is doing so many things these days to transition to value based care, improve quality and the patient experience. But, the simple errors keep on coming, the hand-offs are questionable at best and we’re getting slower than expected improvements. Please tell me that it’s not just our team?” A: Overwhelmed… Inefficient and Fragmented are the three words that might best summarize how we often feel as a leadership team as we take on initiative after initiative. One benefit to traveling (besides the free hybrid upgrade) the country from system to system is observing the shared experiences and patterns. I assured  her that she is not alone…we’re all fighting the same fight, and while some organizations are making real strides in error reduction, improving hand-offs, etc.; as an industry the numbers aren’t budging much and change is not coming quick enough. To move metrics in patient safety, experience, and quality, and gain efficiencies required in this reform era, we must become effective at delivering coordinated team based care. The hot topic of conversation at the opening keynote session of U.S. News & World Report's Hospital of Tomorrow conference mirrors what’s not only on my mind, but on the minds of more and more leaders as we warm-up to realizing the root cause of the problem… Donna Shalala, Ph.D., president of University of Miami and former U.S. Secretary of Health and Human Services said, “ [We need] physician assistants and nurses and pharmacists and other care providers working as a team… we’ve got to get over the hierarchy, we have to take on the scope-of-practice rules, state by state if necessary, because that's what restrains us from creating these teams.” Adding to the mix, former Senate Majority Leader Bill Frist shared, “Our professional ethics is not to be team-based. We like to say that it is… but that's not the way doctors are trained.” Which led to the closing speaker Gregory Sorensen, M.D., CEO of Siemens Healthcare North America.  He spoke of the importance of moving toward a coordinated, team-based healthcare model, and its inherent challenges, saying, "It will be a mindset change. There's a definite hierarchy, and those hierarchies get in the way… and  people have learned that you can build a system that delivers consistent high quality if you can build teams." Consensus builds…but what’s the solution? How to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care? I’ll assume we all agree that healthcare is the “ultimate” team sport. But, what are we doing to make it so? Let me ask this question: “What’s your role? (Not your job. Your role.) This simple question and the responses we get can teach us a lot about why we struggle to deliver team-based care and how to create it. The coming New Year is a great time for leaders to set a new context for yourself and for your team. Feel free to reach out if you’d like to hear how other executives and physician leaders I’m working with are leveraging this question to build more Patient-Accountable Cultures. See you in the New Year. In The News... A Patient Dies. A Hospital Heals By Bill Santamour H&HN Managing Editor A fictional account of a tragedy and how a hospital changes for the better. A patient dies after surgery despite the fact that checklists and other cutting-edge policies are in place to prevent such a tragedy. The clinical staff become defensive. Physicians close ranks to deflect blame. Nurses know that if somebody has to take the fall, it will, no doubt, be one of them. The hospital CEO understands that the fault lies not with individuals or policies, but with a staff too focused on their own task-filled workdays to see the bigger picture and too cynical to believe that things can ever fundamentally change. And the CEO herself is so overwhelmed by putting out everyday fires that she has no time to think about long-term solutions. That’s the set-up of Heroes Need Not Apply, Brian D. Wong’s fictional account of Angels Hospital and the aftermath of a patient’s death, a death that could and should have been prevented. Wong, an M.D. and founder of The Bedside Trust, paints a familiar picture of today’s hospital staff, in which the sincere goal of putting the patient at the center of everything they do can get lost in the crush of workloads, silos, egos, long-standing hierarchies, skepticism and plain fear. His vivid cast of characters includes a brilliant but intransigent surgeon, a young doctor with conflicting loyalties, an outspoken nurse, a new CEO and the person she brings in to help change the culture. OK, I can see you rolling your eyes at the term “change the culture.” But by getting inside each individual’s mind and allowing us to listen in on their thoughts and conversations, Wong avoids consultant jargon and preachiness. He presents a true-to-life scenario of personality conflicts common to all hospital staff and the endemic skepticism that often straitjackets any leader’s efforts to foster meaningful change. And he shows how a hospital CEO can overcome those obstacles to, as the book’s subtitle puts it, “build a patient-accountable culture without putting more on your plate.” The crux of that culture change is eliminating the chain-of-command structure and moving to one in which listening and respect across job titles and individuals can lead to true team care. As someone at Angels Hospital says, “No one person, no matter how smart, was nearly as smart as a roomful of people.” In his introduction, AHA President and CEO Rich Umbdenstock writes that Wong’s story “brings a human element to the equation and underscores the importance of making patients and their families full partners in the care process." Heroes Need Not Apply is an excellent resource for you and your physicians, nurses, C-suite and board members. Might even make a good stocking stuffer. For more information, click here. The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association. H&HN Daily, December 10, 2013 Heroes Need Not Apply... now on eBook Improved care coordination is essential to gaining the efficiencies required in this healthcare reform era. To move metrics in patient safety, experience, and quality, we must become effective at delivering coordinated team based care. In his new book, Heroes Need Not Apply, Brian Wong MD, uncovers the reasons why many of us experience spotty improvements in patient safety, episodic service excellence, and insufficient engagement and accountability. To make sustainable improvements, we need to know how to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care. The purpose of Heroes Need Not Apply is to give healthcare organizations a template for creating a strong foundation for effective coordinated care.  This “how-to” book gives every executive, physician, nurse, and clinical team member the tools to make specific changes at the local level, and uses relatable characters to showcase effective patient-centered skills to improve efficiency, decrease costs, and improve the patient experience. If your hospital is looking to accelerate improvements in care coordination and improve team care,Heroes Need Not Apply is a timely resource designed to equip your organization with the practical skills required for improved care coordination. The book has already caught the attention of many top physicians, nurses, and executives as an innovative resource to lead our industry into a new era of value based healthcare that is both cost effective and accountable to patients.  Dr. Wong's Heroes Need Not Apply is receiving praise by noted physician leaders and industry experts throughout the country... “Heroes Need Not Apply examines the root causes of healthcare’s most pressing safety and quality challenges. It offers practical strategies to improve communication among staff, dismantle silos, and build high-performing teams.” — Richard J. Umbdenstock, President and CEO of the American Hospital Association “I believe this book will help save lives, improve quality, and recommit healthcare providers and patients to new levels of trust.” — Sue Collier, MSN, RN, FABC - Performance Improvement Specialist, Patient-Family Engagement, NC Quality Center/NC Hospital Association “Dr. Wong’s book “Heroes Need Not Apply” breaks new ground as a field manual for what WE can all do on the front lines to be leaders as opposed to “reactors’ of healthcare transformation.” — Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University Hospitals "...[Dr. Wong] speaks the truth of what we must become as leaders in health care." — Jeff Selberg, EVP and Chief Operating Officer, Institute for Healthcare Improvement. “Amazing! Timely, accurate, stunning, motivating, frightening. More than reading, I consumed the book. What a wonderful story of cold truth.” — Jack Cochran, MD, Executive Director, The Permanente Federation, LLC “On the journey to team-based and patient-centric care the evolving healthcare system is indeed a place to which Heroes Need Not Apply." — Joseph S. Bujak, MD, FACP “Dr. Wong draws the reader into the world of the hospital and an understanding of the cultural barriers that contribute so much to preventable medical error.” — Gordon R. Clark, President and CEO of iProtean On Sale Now! To order your copy today and/or get quantity discounts for your organization visit: A portion of the profits from the sale of Heroes Need Not Apply goes to support the Josie King Foundation. To learn more about Heroes Need Not Apply, and/or schedule an author’s interview for your organization please Click here>> Share Forward to Friend Tweet Share +1 Facebook Website

A fictional account of a tragedy and how a hospital changes for the better.

A Patient Dies. A Hospital Heals
By Bill Santamour H&HN Managing Editor	December 10, 2013
A fictional account of a tragedy and how a hospital changes for the better.

A patient dies after surgery despite the fact that checklists and other cutting-edge policies are in place to prevent such a tragedy. The clinical staff become defensive. Physicians close ranks to deflect blame. Nurses know that if somebody has to take the fall, it will, no doubt, be one of them. The hospital CEO understands that the fault lies not with individuals or policies, but with a staff too focused on their own task-filled workdays to see the bigger picture and too cynical to believe that things can ever fundamentally change. And the CEO herself is so overwhelmed by putting out everyday fires that she has no time to think about long-term solutions.

That’s the set-up of Heroes Need Not Apply, Brian D. Wong’s fictional account of Angels Hospital and the aftermath of a patient’s death, a death that could and should have been prevented. Wong, an M.D. and founder of The Bedside Trust, paints a familiar picture of today’s hospital staff, in which the sincere goal of putting the patient at the center of everything they do can get lost in the crush of workloads, silos, egos, long-standing hierarchies, skepticism and plain fear. His vivid cast of characters includes a brilliant but intransigent surgeon, a young doctor with conflicting loyalties, an outspoken nurse, a new CEO and the person she brings in to help change the culture.

OK, I can see you rolling your eyes at the term “change the culture.” But by getting inside each individual’s mind and allowing us to listen in on their thoughts and conversations, Wong avoids consultant jargon and preachiness. He presents a true-to-life scenario of personality conflicts common to all hospital staff and the endemic skepticism that often straitjackets any leader’s efforts to foster meaningful change. And he shows how a hospital CEO can overcome those obstacles to, as the book’s subtitle puts it, “build a patient-accountable culture without putting more on your plate.”

The crux of that culture change is eliminating the chain-of-command structure and moving to one in which listening and respect across job titles and individuals can lead to true team care. As someone at Angels Hospital says, “No one person, no matter how smart, was nearly as smart as a roomful of people.”

In his introduction, AHA President and CEO Rich Umbdenstock writes that Wong’s story “brings a human element to the equation and underscores the importance of making patients and their families full partners in the care process."

Heroes Need Not Apply is an excellent resource for you and your physicians, nurses, C-suite and board members. Might even make a good stocking stuffer. For more information,  click here.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=2970005137&utm_source=Daily&utm_medium=email&utm_campaign=general

Heroes Need Not Apply... now on eBook

To order your copy today and/or get quantity discounts for your organization visit: A portion of the profits from the sale of Heroes Need Not Apply goes to support the Josie King Foundation. To learn more about Heroes Need Not Apply, and/or schedule an author’s interview for your organization please Click here>>

Tip 24: Think Global… Act Local

Think Global… Act Local Q: While doing a book tour event at a health system, I recently had the opportunity to chat with a few physicians before the program began. One commented, “I'm just one guy at this hospital… I’m not sure what I can really do to change anything around here.” A: I told him, “It's not about changing this ‘place’ or about waiting for some big transformation to hit us over the head, it’s about every team member taking small steps to influence your very own local culture.” We went on to discuss that to make big shifts in organizational culture, we have to think small. Sustainable progress toward improving team care, patient communication, and removing medical hierarchy, won't come from top-down cultural transformation initiatives. Progress begins with becoming more familiar with the role we all play on behalf of patients… on the local level. While this was just one guy asking "What I can really do to change this place?" Many of us are asking ourselves the same question - we all want to have more personal impact on improving what we do individually and as organizations. Most physicians I know are not formal leaders in their organization, but all of them are informal leaders. While it's important to have senior leadership setting the correct tone for organizational culture, it takes a combined effort with the informal leaders within an organization to actually influence sustainable changes in organizational culture. Again, think small, think local. Every interaction matters to the patient.

Heroes Need Not Apply... now on eBook

Improved care coordination is essential to gaining the efficiencies required in this healthcare reform era. To move metrics in patient safety, experience, and quality, we must become effective at delivering coordinated team based care. In his new book, Heroes Need Not Apply, Brian Wong MD, uncovers the reasons why many of us experience spotty improvements in patient safety, episodic service excellence, and insufficient engagement and accountability. To make sustainable improvements, we need to know how to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care. The purpose of Heroes Need Not Apply is to give healthcare organizations a template for creating a strong foundation for effective coordinated care.  This “how-to” book gives every executive, physician, nurse, and clinical team member the tools to make specific changes at the local level, and uses relatable characters to showcase effective patient-centered skills to improve efficiency, decrease costs, and improve the patient experience. If your hospital is looking to accelerate improvements in care coordination and improve team care,Heroes Need Not Apply is a timely resource designed to equip your organization with the practical skills required for improved care coordination. The book has already caught the attention of many top physicians, nurses, and executives as an innovative resource to lead our industry into a new era of value based healthcare that is both cost effective and accountable to patients.

Dr. Wong's Heroes Need Not Apply is receiving praise by noted physician leaders and industry experts throughout the country...

“Heroes Need Not Apply examines the root causes of healthcare’s most pressing safety and quality challenges. It offers practical strategies to improve communication among staff, dismantle silos, and build high-performing teams.” — Richard J. Umbdenstock, President and CEO of the American Hospital Association “I believe this book will help save lives, improve quality, and recommit healthcare providers and patients to new levels of trust.” — Sue Collier, MSN, RN, FABC - Performance Improvement Specialist, Patient-Family Engagement, NC Quality Center/NC Hospital Association “Dr. Wong’s book “Heroes Need Not Apply” breaks new ground as a field manual for what WE can all do on the front lines to be leaders as opposed to “reactors’ of healthcare transformation.” — Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University Hospitals "...[Dr. Wong] speaks the truth of what we must become as leaders in health care." — Jeff Selberg, EVP and Chief Operating Officer, Institute for Healthcare Improvement. “Amazing! Timely, accurate, stunning, motivating, frightening. More than reading, I consumed the book. What a wonderful story of cold truth.” — Jack Cochran, MD, Executive Director, The Permanente Federation, LLC “On the journey to team-based and patient-centric care the evolving healthcare system is indeed a place to which Heroes Need Not Apply." — Joseph S. Bujak, MD, FACP “Dr. Wong draws the reader into the world of the hospital and an understanding of the cultural barriers that contribute so much to preventable medical error.” — Gordon R. Clark, President and CEO of iProtean

On Sale Now!

To order your copy today and/or get quantity discounts for your organization visit:

A portion of the profits from the sale of Heroes Need Not Apply goes to support the Josie King Foundation.

To learn more about Heroes Need Not Apply, and/or schedule an author’s interview for your organization please Click here>>

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Tip 23: We are where we are today, because we’ve been trained to be this way

The corporate world is evolving based on the demands and intricacies of a new social era. Business people are having to be more attuned to cultural elements rather than their inherent prime directive, to keep focused on profit above all else. Students of business schools, along with the self-made successes, were and are inherently trained to be less inclusive when it comes to how they run their companies. They’re trained to be profit exclusive. But the paradigm of the new social era demands inclusion and the dismantling of the single-minded (think “silo”) approach to getting things done. Sound familiar? In healthcare, we too are being held back by our silo based cultures. And like the business world, it’s because we’ve been taught to act this way... starting in medical school. The “most difficult” people we deal with act poorly for various reasons, including the heady nature of the profession, the fact that some people are just that way,  and, because our current hierarchical paradigm has been validated (in their eyes) since their first day of med school. And although some people will never change, others will. The most “difficult” character in my soon to be released book, Heroes Need Not Apply,” is Dr. Ethan Lang. After thirty years, Lang might has well had “My Way or the Highway” tattooed on his forehead. And throughout his career, he’s had a tremendous influence on young Docs navigating their way through the system - not to mention his ability to bully his bosses. But Dr. Ben Waller is different. Although he felt had fallen under Langs’ spell for a couple of years, he began to recognize an alternative way of thinking. Here’s a couple of scenes from the book that take place when Ben starts finding his own voice, and the CEO, Jane Carolli, coincidentally finds hers: From Chapter Forty-six         He’d (Ben Waller) been living in a fear driven world that he created himself, and he’d lost the ability to trust. With retrospect, it all made sense. Pre-med was nothing if not competitive, and med school, internship, and residency were all about leaving your fellow students in the dust and doing whatever it took to best position yourself.         When he started at Angels, he believed that success would only come if he played along with Ethan Lang and the MEC’s unspoken rules, and maybe it still does, but not if it’s going to cost one more life, or Mel.         The night before, when Mel asked him when he last thought of Edie, it was like a slap in the face. He hadn’t thought about her at all lately. That wouldn’t happen again.         He didn’t even see or hear Lang when he walked into the locker room.         “Waller.”         Again. “Waller, are you sleepwalking or what?”         “Sorry Dr. Lang, just lost in thought.” Darn, he thought, he’d have to stop taking such an apologetic tone.         “I was just thinking about Edie. When’s the last time you gave her some thought?”         “Who the hell is Edie?”         “The reason we’re having these Never Events meetings. The person we let down.”         With a little Groucho in his tone, Lang snapped,“Waller, why don’t you bore a hole in yourself and let the sap run out. If you let every little set-back slow you down, you won’t last in this business. Do I wish she didn’t die? Of course. But it happens.”         “But we caused it. We could have kept it from happening.”         “Bull.”         “No disrespect Dr. Lang, but if Dr. Hartley had listened to his transcriptionist or you gave Julie the OR nurse five seconds to check out the scan, Edie would probably be fine.”         “Who the hell do you think you’re talking to?”         “I guess I’m still trying to figure that out. Please, indulge me for a moment.”         Lang started to head for the door, “Give me one reason why I should.”         “Because I’ve been a good referrer, I’ve done everything you’ve ever asked of me, and I’m a fellow physician that is asking for your help.”         “Is that you asking for someone’s help, by pointing fingers at them?”         “You’re right. That was the wrong approach. But can you tell me that I was completely wrong?”         “It’s more complicated than that Waller. I can’t possibly know about the dynamics between Hartley and his staff, and I’ve been going by his and other physicians notes and corresponding body markings for thirty years. And this never happened before. It was an anomaly, nothing more.”         “I have to disagree. It may be a first for you. But it was still a fatal decision for Edie and her family. Isn’t it true that you didn’t look at the scan because Julie is just a young nurse and you don’t trust her?”         “Why the hell should I trust her, you or anyone around here? If I want something done right, I know I’d better do it myself.”         “But what if we all did respect each other a little bit more? You may have looked at the scan.”         “What’s gotten into you? Have you been drinking Jack Martin’s Kool Aid? That guy may have had some success in backwater Montana, but this is the real world. We don’t have time to stand in a circle and sing together every time we need to make a quick decision.”         “But what if we just took ten seconds before we made a decision, especially one that holds a life in the balance? And isn’t group decision making just other words for teamwork?”         Ethan Lang just stared at him for a few seconds (talk about irony) and then said, “I know that third NEI is coming up in a day or two. Do you know something I don’t? Because it sounds like you’re looking to make Hartley and I the scapegoats here.”         “No Dr. Lang. It’s bigger than the two of you and all of us in this meeting. It’s systemic. I just think we should look at this as an opportunity to work together better, to improve.”         He turned his back and walked through the door while saying, “You’ve used enough of my time.” From Chapter Forty-seven         Ethan Lang bee-lined it straight to Jane Carolli’s office to see if Waller’s line of questioning came from his chronic naiveté, or was a result of some kind of ploy to put that girl’s death on the doctors.         He was a little taken aback that Waller not only attacked him, but that the kid actually stood up to him. Maybe he had balls after all. But balls or not, there’s a hierarchy around here and physicians have to look after each other. You would think he’d have figured it out by now.         Lang bullied his way through Carolli’s outer office and pushed open the inner office door without acknowledging her secretary’s presence, much less her questions.         On her way out, Jane collided with Lang, nearly lost her balance, and just caught herself before hitting the deck.         “What the hell Dr. Lang, haven’t you heard of knocking, or for that matter checking in with my secretary instead of nearly taking me out?”         “Sorry about that, I’m going to be late for rounds and I needed a minute of your time beforehand.”         She was about to say that she was headed for rounds too, but caught herself before getting stuck with the task of trying to justify what she was doing to her “Grinchiest” surgeon.         “Well Ethan, you’re aptly blocking my escape route, so what can I do for you?”         “Look, I’m not blind Jane, I know that you brought Jack Martin in to stir things up here, but I didn’t realize how much until I just got reamed out from Ben Waller.”         Jane could barely contain her excitement at the thought of another ally onboard! Calmly she continued, “Reamed out, what do you mean?”         “He practically blamed Dr. Hartley and I for that girl’s death, and gave me the impression that you’d be pointing the finger at us during the next NEI meeting.”         “I can assure you Dr. Lang, that’s not the case... ”         He interrupted, “It better not be, because I can tell you right now, although I don’t want to get confrontational, if I feel like I’m being attacked, I will respond with the entire MEC  at my side.”         Pause Jane, pause, she said to herself.         In the kindest possible tone she could manage, ”I really don’t believe Dr. Waller was threatening you at all. Threats are very uncomfortable for me, and I wouldn’t, or I should say, won’t let them become a tactic around here. Do we understand each other?”         Before he could answer she continued, “Drs. Waller, Martin, and myself, are putting our heads together to improve how we all work together around here. I’ve decided to try to make something good come out of these NEI meetings. To use them as an opportunity to find some common ground and figure out a way for Edie’s loss to bring about some positive change.”         He began to talk and she cut him off, “And we want you and everyone at that meeting to work with us. That’s what the next meeting will cover. It’s not about you, Hartley, or any one person, but about why things happened and how we can move forward to get doctors, nurses, and administrators on the same page working together. We need to learn to listen and respect each other or the patients will never be able trust us.”         Ethan Lang didn’t know how to respond. For the second time in an hour, someone he confronted didn’t back down. And for some reason he wasn’t sure of yet, he couldn’t really argue with what either one of them said. As long as they weren’t pointing the finger at him or Simon Hartley, he really didn’t have a lot of ground to stand on. But he also knew that he wouldn’t be taking the word of a wet behind the ears nurse over his own instincts. This Edie person was a tragedy, but an anomaly for sure. Never happened before and never will again. At least not to him.         Fine, he thought to himself, I’ll let them play with their ideas, but if one hint of blame comes our way at the meeting, she’ll learn the meaning of “No Confidence,” and be out the door before she even knows it hit her on the ass.         “Okay Jane, I believe you. You do whatever you want to and as long as I don’t see it as a threat, I’ll hold my tongue.”         “I’d rather have you joining in Ethan. You’re the most experienced and skilled physician we have, it would mean a lot to the process if we had your buy-in.”         “Just enjoy the fact that I’m not fighting you on this one Jane, and do your little experimenting. As long as it doesn’t affect me, like I said, I’ll leave you to it.”         And he was out the door as quickly as he barged in. As I penned these pages, I had to get inside of Ben Waller’s head and heart and try to determine what pushes a person over the line so that they feel comfortable enough to speak truth to power. What would make Ben put his career on the line? When you read the story, you’ll learn of his relationship with Nurse Melanie Swift, and the influence she has on him... but that was just a piece of the rationalization puzzle. As I sat over my keyboard, living in Ben’s head, I realized that real paradigm shifts cannot be done for the sake of another. In the end, we have to all look deep with in our belief system and choose the right path, a path we can live with and feel good about. For Ben, the path became clear. Not just because he was part of a mistake that led to a preventable death, but because he hadn’t lost sight of why he went to medical school in the first place... above all, first do no harm. And to become accountable to patients above all else, he realized that we have to dismantle silos, rid ourselves of the hierarchy mentality, and base all of our decisions on what matters most to patients.

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WHAT'S NEW @ THE BEDSIDE TRUST Dr. Brian Wong's new book is receiving praise from healthcare leaders throughout the country... "Amazing! Timely, accurate, stunning, motivating, frightening. More than reading, I consumed the book. What a wonderful story of cold truth." — Jack Cochran, MD, Executive Director, The Permanente Federation, LLC "Heroes Need Not Apply examines the root causes of hospitals' most pressing safety and quality challenges. It offers practical strategies to improve communication among staff, dismantle silos, and build high-performing teams." — Richard J. Umbdenstock, President and CEO of the American Hospital Association CLICK HERE for a more information and a "Sneak Peek" of Heroes Need Not Apply.

Heroes Need Not Apply

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