Thursday, July 18, 2013

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

Work THis WayThe 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.
        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.”
        “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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Heroes Need Not ApplyDr. 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

Heroes Need Not Apply
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