Tip 33: The Cultural Toolbox

The Cultural Toolbox

This past year, my book Heroes Need Not Apply, “How to build a patient-accountable culture without putting more on your plate,” hit the shelves. It’s the story of how a small town physician from Montana teamed with a CEO to transform the culture of a large Seattle hospital. The book shows how focusing on what matters most to patients and, the right mind-set and a common direction can bring two people together to ignite an entire organization.

Like any book, especially one designed to create a specific paradigm shift, there are always back stories and deeper conversations readers would love to hear. When I speak with my audience and they share what parts of the book affected them, most people ask me questions about the characters, their motivations and what tools characters Dr. Jack Martin and CEO Jane Carolli count on to spread cultural change throughout the fictional hospital, “Angels of Seattle.”

Which led me to begin a series of Coach+Leaders to share some of my tools and findings by using the characters of my book to give you a glimpse ahead by looking back. I’ll share a few excerpts from the book in the following weeks, and some of the conversations you didn’t hear…

Let’s begin with what many an organizational leader has asked me:

Q: From reading your book, I know where I want our culture to go, but where do I begin? What should we build our culture around?

A: We have to build our cultures around what matters most to our patients… patient accountable cultures. But before we do that, we need to provide our staffs with a common direction to become more patient-centered.

Early in my book, Dr. Jack Martin and CEO Jane Carolli were having some of their first conversations defining how Jane needs to show up as a leader to move the process forward and engage her management staff. Part of their conversation included Jack saying,

“What do you think when I say your role as a coach is or should be, a primary leadership competency... it should be the foundation for how you lead?”

“Jack, you’re saying that coaching is the most important thing I can do?”

“Yes Jane, and if we all want to truly be patient-centered... to build patient-centered relationships, we have to be coaches, and teach others to do the same. In Billings, things changed when my boss started coaching his leadership team, and eventually his medical staff.”

At this point, Dr. Martin and Jane Carolli began the first phase of their eventual transformation that clearly began with the two of them. Jane accepted the process, but she also wanted to know a little about the big picture… where would it go next. What you didn’t hear were Jane’s big picture questions about moving forward…

“Jack, knowing that this starts with the two of us, how is this going to move forward with the entire medical staff?”

Jack replied, “Jane, we really have to begin with our small nucleus and gain engagement slowly… but that doesn’t mean we can’t prepare for what’s coming around the corner. We certainly don't just need more data Jane, we need more context. All the changes we’re working on and have talked about are relational, not operational. If we focus on the handful of actions and behaviors that matter most to patients, we"ll be in a better position to do more than merely meet the needs of patients, we’ll have to opportunity become a true patient-centered organization.”

Jane shot back, “That’s a no-brainer Jack, I can list those behaviors and actions in a heartbeat.”

“And I’m sure you’d come close. But we need to go right to the source with an assessment tool. We need to hear from everyone and not just once. We need a tool specifically aimed toward building a patient-accountable culture… and one that continually measures our progress.”

“That sound great, but where do we start? What kind of questions do we need to ask?”

Jack settled back in his chair, “Questions specific to our goal.”

"Don't we want a culture that makes patients safer, a culture produces clinical quality, a culture that supports coordination of care, a culture that offers respect to everyone?"

Jane smiled, “Sounds like the right place to start Jack.”

Our next coach leader will go further into the book and deeper into their discussion to share the insights that drive organizations to become more patient-centered. With Jack’s guidance, Jane will see how to measure and design a culture around what matters most to patients.

Is your culture aligned to what matters most to patients?... 

Click here to take the poll 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

Tip 32: The Forgettable Experience: Part 2 — Quality Interactions Not Empty Transactions

The Forgettable Experience: Part 2 — Quality Interactions Not Empty Transactions

Our last issue identified how many patients feel like their interactions with physicians feel more like transactions with a bank teller. It also spoke of how our cultures have been molded by a hierarchical legacy reaching all the way back to medical training.

Q: So how do we migrate organizations from their current state of providing inconsistent, episodic service excellence to a true patient-centered system?

A: By establishing that patient-accountability is everyone’s role. Everyone becomes responsible for transforming the culture. Leaders just need to know how to take the guesswork out of it, so everyone participates.

Being patient-accountable isn’t about creating a “kumbaya”, feel-good attitude, it’s about providing all staff with a common direction to guide quality interactions - the building blocks of a patient-centered system.

If there is a single defining characteristic for patient-accountability, it’s this: It begins at the top and permeates through the entire organization. It must be built into the organization’s mission statement and reflected in every team member’s role description.

Leaders must create the right organizational structures, and repeatedly underscore the organization's commitment to what matters most to patients using culture cues like this card. Every employee, whether they deal directly with a patient or not, needs to understand how his or her every day actions affect everyone who works with patients and the patients themselves.

We know the quality of our interactions impacts culture, team-performance and patient outcomes. Start by focusing less on the speed of the transaction. When you talk to people, are you focused on the transaction or your interaction?

During a transactional encounter you’ll focus so much on the task at hand you’ll be inclined to block out everything else in order to get the job done.  A true interaction depends on really listening and staying in the moment with the patient/team member in front of you. It’s not difficult to be aware of the difference. After all, if you were the patient (or if your mother was the patient) what would matter most to you?

For example, consider the average medication explanation. Physicians are notorious for rapidly downloading medication information with medical jargon and running out the door to the next patient without verifying this information has been properly transmitted and understood. The research shows we think we do a good job at communicating, but many leave confused and require follow-up. The bottom-line is that we’re not providing quality interactions and these empty transactions have a profound impact on patient experience and trust. Besides, they cost us a fortune.

To become more self-aware about how you handle conversations, ask yourself: Are you focusing on how the patient is assimilating the information you’re giving? Do you follow up to ask if your instructions are understood… do they even make sense? Do you ask for their feedback and try to help them become part of the decision making process?

If you are focused on the transaction when communicating with staff, there can be a tendency to treat the conversation in a matter-of-fact, Sergeant Friday approach: "Just the facts Ma'am." The implied message behind the message can be interpreted as I don't have time for you or what is important to you."

So take a look at the quality of conversations you're having. Are they transactional or interactional? While training yourself to be more self-aware, ask yourself, “If this were my mother, how would I explain it? All of our patients need that personal approach and relationship if we want to earn their trust. As you begin to have more quality interactions with patients and/or staff, I'm confident that you'll begin to see how each interaction you have sets the tone for your culture.

Is your culture aligned to what matters most to patients?...

Click here to take the poll 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