Wednesday, June 12, 2013

Tip 22: The Era Of Old-Fashioned Modern Medicine

Over the past year, every Coach Leader I've written, regardless of its specific emphasis, always reiterates the importance of beginning every discussion with, "What matters most to patients?" The CEO of an organization I just began working with recently asked me how I first made that determination, and how I continually remind myself of the importance of that question as a foundational starting point for everything I/we do. When I answered, "Improving organizational culture begins by talking with patients," my client responded saying that his schedule pinned him behind a desk most everyday, and wasn't sure where rounding on patients fit would in to his overloaded to do list. When I told him that all my clients perform rounds a few times a week, he wasn't sure what to say or where to start.

To best illustrate my point, I gave him the following excerpt from my soon-to-be-published book, Heroes Need Not Apply. It helped him to immediately see the merits of these actions, how it actually plays out and the positive impact it can have on patients and staff.

In the scene below, you'll meet CEO Jane Carolli (who started her career as a nurse) and her new VPMA Dr. Jack Martin. Jane brought Jack aboard to help her build a more collaborative workforce like he did in the Montana hospital clinic he came from. Even though Jane brought Jack aboard, it took awhile to build the relationship to this point:

    "Don't you go on rounds, Jane?"
    "Well I used to as a nurse of course, and I know some managers have. But besides the fact that I don't have time for it, I'm not sure what to say. Funny enough, after half of a lifetime working with patients, it's a little out of my comfort zone."
    "All that I can tell you Jane, is that everything we're talking about began with performing rounds in Billings when I didn't have any patients. At first, I started asking them what kind of improvement they'd like to see - big mistake. I already knew the answer and every conversation started off negatively. Then, I asked them what was really important to them, and I got an entirely new perspective, something I could really use. Although patients framed their answers differently, they all essentially said the same thing."
    "They were saying that they wanted to trust their caregivers?"
    "Not in those specific terms, but yes, they were all alluding to something relational instead of physical. They all had their own hierarchy of concerns, and everything funneled down to trusting that we were all truly listening to them and hiding nothing from them. Like you just said, they want to feel engaged in a team effort to make them better."
    Jane smiled, "So basically, the patients are looking for the same things we need from each other, the ability to put all of our past stuff aside and work together."
    "In fact Jane, once I figured it out, and things began to improve, I looked forward to rounding more than anything else. When the improved workforce started taking shape, the patients started raving about the care. I realized that if I needed a pat on the back, I'd get it from rounding. Sold yet?"
    As she rose and headed for the door she said, "Call my office and set it up."

    "Jack, before we go in, I'm not sure what I should talk about."
    "First off, it's more about asking something and spending most of the time listening. If we're going to give these patients what they need the most, we have to listen."
Saying it almost to herself, "Sounds like making a basic diagnosis."
    "So what do you think you should ask Jane?"
    "Well what if I ask them how we could improve their stay?"
    "You tell me Jane, is that something that you don't already know? Will that yield you deeper insights into what we're trying to validate?"
    Jack let her think for a moment and then said, "You mentioned making a basic diagnosis. This is a lot like that. Because the only way to really get to a more patient-centered approach is knowing how to ask the right questions. What do you want to know from them?"
    "I guess I want to know what's most important to them - what really matters to them."
    "There you go."

    They continued on toward the room and Jack shared, "We're visiting Bill Meyers, a 56 year old male scheduled for a coronary angioplasty first thing tomorrow morning."
    They walked into the room and Bill Meyers was facing the TV, but you could tell he really wasn't paying any attention to it. He almost snapped to attention when a new physician and a suit entered the room.
    "Hi, what's going on, is anything wrong?"
Jane jumped right in, "No Mr. Meyers, we're just stopping by for a visit. I'm Jane Carolli, I kind of run things around here, and this is Dr. Jack Martin, he's in charge of Medical Affairs. We just wanted to check in and see how you're doing."
    "Wow, is this SOP? Oh, excuse the acronym, you can take the man out of the Marines, but not the other way around... is this standard operating procedure?"
    "Well yes and no," Jane answered. "We like to get out and visit with as many people as we can, when time permits."
    "What can I help you with Miss...?"
    "Jane. It's the other way around Mr. Meyers. You're the one who can help us. I just want to know more about what everyone's thinking around here. Tell me, what's the most important thing on your mind right now?"
    "You mean besides getting out of here in one piece?"
    "I mean, is there anything in particular that you're thinking about? Anything that would reassure you that you'll get out of here in one piece?"
    "Well, there are a lot of people going in and out of here and I can't help wondering if they're even talking to each other. It seems like twenty different bodies ask me the same question all day long, like one hand doesn't know what the other's doing. I mean no disrespect, but you hear about people getting the wrong meds and such, and it sure would be nice to know that everyone's on the same page, that people are actually talking to each other about me. Having my heart worked on is stressful enough if you know what I mean."
    "I do," said Jane, "is there something you'd specifically like to see or hear?"
    "I don't know." He stared right through the TV again for a minute. "I guess seeing more interaction would be nice... but I also realize there's probably all of that going on behind the curtain and I'm just not seeing it. I just want to believe it is. It would be nice to feel more confident about everything. I mean, not about my doc, or each of the nurses, just about everyone combined."
    "This is why I'm here Mr. Meyers..."
    "Bill. I need to hear this from you so that I can figure new ways of making sure you get the peace of mind you deserve."
    "Or at least some peace of mind," he countered, "until they've been in and out of my arteries, it's hard to relax. But it sure would help if it felt like all of these people were on some kind of team."
    "Let me see what I can do about that," Jane glanced back at Jack, "and I'll stop by tomorrow after your procedure and check in. I'll also stop by the nurses' station right now, and double check everything for you. I was a nurse and nurse manager, and I know there is a lot going on behind the curtain, as you said, but I also know that you shouldn't have to wonder about these kinds of things."
    "Thank you."
    "My pleasure Bill. See you in the morning."

Coach Leader Tip 22: It's the old-fashioned tools patients value most

After reading this excerpt, my CEO colleague looked at me and exclaimed, "You sure you didn't use my hospital as the back drop for your book Brian? This lack of communication goes on every day, but we rarely put it into context as to how it immediately and directly affects our patients until something goes south."

This excerpt and tip is much more than a lesson in rounding. It reminds us that modern medicine is in danger of losing powerful, old-fashioned tools that have the most impact on our one-to-one relationships with our patients - human touch and listening. In his 2011 TED talk, physician and best-selling author Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam. He emphasizes the importance of touching and the trust and impact our hands can have on strengthening relationships with our patients. Abraham reflects on how quickly and readily we physicians interrupt our patients and the effect impersonal communication has on our ability to care for them. Having spoken to hundreds of physicians about this very issue, it's clear what is driving these ineffective interactions. Many physicians tell me that if they ask open ended questions like " Is there anything in particular your concerned about?", the patient will ask for more than we can give. They assume that their response will take up more time and put them further behind. We know from experience this is simply not the case and a very costly assumption. Abraham and the physician leaders I work with know that patient experience and outcomes are only as good as our clinical team's ability to touch, listen, and ask patient-centric questions. For a patient, nothing inspires confidence more than trusting that every physician and nurse entering your room takes the time to ask the right questions, to listen to your answers and to ensure that the entire team is focused and dedicated in providing what matters most to you.