Thursday, May 8, 2014

Tip 43: When you don’t know what to measure, you measure everything

When you don’t know what to measure, you measure everything

Greetings, we’re in the midst of an 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 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, the right mind-set and a common direction can bring two people together to ignite an entire organization.

Some of the most powerful scenes in the book are strategic conversations between our fictional CEO Jane Carolli and her new, game-changing VPMA from Montana, Dr. Jack Martin. In the last issue, Jack and Jane agreed that they wanted to build their culture around what matters most to patients… and we left off talking about how that happens…

Q: In our attempts to fix everything, we track just about everything - what do we do with all the data?

A: Jack had a few minutes before rounds so he dropped by Jane’s office to check in and offer support. Although he knew that Jane was 100% on board for the new direction they were taking Angels of Seattle, developing a common direction to become more patient-accountable was definitely a paradigm shift for her, and he wanted her to feel he was by her side for the long haul.

As he walked into her open door he could see she was wound pretty tight, “Morning Jane, how are you this am?”

“Glad to see you Jack - in all candor, I’ve been here for two hours and I’m ready to jump on a plane to anywhere. I’m staring at a dashboard overflowing with a multitude of diverse metrics that I’m suppose to improve, and piles of data I’ve collected and don’t know how to utilize. I have no idea about what drives what.”

Jack waited, knowing she had more…

“We don’t know what to measure - so we measure everything. And the funny thing is, I’m trying to find solutions to an endless number of metric challenges and I don’t even know where to begin. I’m just running around in circles. And none of this data (pointing to a pile on her desk) seems relevant to what’s going on at the bedside.”

“Jane, do you think all the items on your “everything under the sun” list need specific answers?”

“That’s just it Jack - all the so-called answers I’ve been coming up with are band-aids at best. I need to find out the root cause of this mess and I know that it’s more about attitudes and behaviors… but I don’t know if we can measure that.”

“Let’s go back to what we’ve been working on Jane. Where does everything begin?”

Jane shot back, “With what matters most to patients.”

Jack smiled, “Then that’s where we start… where we measure.”

Jane replied, “Well that would be great, but can we do that?”

“You tell me. Think of a question that would elicit the data you need.”

“Well I’d like to know what kind of behaviors are compromising team performance. If I could figure that out, It would solve a good number of these problems in front of me.”

“Great idea Jane, so let’s ask them.”

Jane sat thunderstruck and slapped her forehead.  “I never even thought about that.  Imagine asking questions based on what matters most to patients - questions that assess the degree of teamwork and respect and listening and feeling safe from patients as well as from staff.  Eureka, I have found it!”

Once Jane realized she could track the behavioral and attitudinal data necessary to literally evolve the culture, the discussion moved toward determining the questions necessary to really change what’s going on at the bedside.

In the next issue, join Jack and Jane while they begin to build out an assessment tool aimed at ferreting out the few root causes of the many challenges that every leader faces.

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

Kindle  iBookstore   Nook
Dr. Brian WongImproved 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!
Kindle  iBookstore   Nook
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.
Dr. Brian Wong
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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