Thursday, June 5, 2014

Tip 36: It’s all about relationships…

It’s all about relationships…

For those of you just joining us, 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 book shows how focusing on what matters most to patients, having the right mind-set and having a common direction can bring two people together to ignite an entire organization.

The following behind-the-scenes conversations between our fictional CEO Jane Carolli and her new, game-changing VPMA, Dr. Jack Martin take place as they begin to focus the culture at Angels of Seattle hospital around what matters most to patients. Our last issue left us with Jane realizing, “I have to think about culture as my main if not only strategy… no matter what changes, it will always be the “be all end all” solution for success. It’s the only thing that will help us to give patients what matters most to them.”

When Jane realized that cultural change was her solution, she needed to dig deeper to better define what evolving culture entails and where to begin. Although she fully trusted Jack and knew they were moving in the right direction, it was still new… still a paradigm shift… and getting a little outside validation wouldn’t hurt.

At their daily meeting…

“Jack,” asked Jane, “I believe in what we’re doing here 100% and a lot of my enthusiasm comes from the success you had in Billings and the small steps we’ve already begun. That said, it would really help for me to get some more info on what this cultural animal really looks like and what we most need to be paying attention to… besides what matters most to our patients?”

“I get it Jane,” answered Jack,” Let me share some insights I’ve gained from an article* I recently read… it’s always nice to hear others validate what we’re doing, not to mention the fact that no matter how much I think I know about anything, there’s always more to learn… you know, skinning the cat and all.”

Jane smiled, “Now you’re really sounding like a Montana guy Jack - please go on.”

“When you think about what culture is all about Jane, you have to begin with relationships - how people communicate and treat each other. Because within this big thing we call our culture is a number of micro-cultures, the occupational cultures within - for example, the fact that a physician views the world differently than a nurse does, or for that matter a pharmacy or lab tech.”

“So you’re saying that we all have to be better acquainted with each other’s jobs so that we better respect what they do?”

“Not just better respect what they do Jane - we need to be open to everyone participating regardless of their title or where they fit in the hierarchy. This article I read shared how an ultrasound tech saved a patient from unnecessary imaging, which saved the patient from an extra trip, more expense, while overall spending was reduced.”

“You mean the doctor actually listened to an ultrasound tech Jack?”

“Yep, an ultrasound tech and in another instance a lab tech. And they both had managers that gave them the green light to proactively share what needed sharing. They were empowered to participate.”

“Obviously Jack, the better all-around communication we have the better for the patient.”

“Yep, this author, Dr. Sinsky put it this way: In health care there is a linear correlation between the degree of relational coordination within an organization and the outcomes the organization achieves.”

Jane responded, “That sounds good Jack, but it depends on us all becoming more knowledgable about how what each of us do as individuals fits together to best reach a desired outcome.”

“You got it Jane, it really is about the relationships within the culture and we need to know as much about the attitudes and behaviors people share and display with each other as we can if we’re ever going to change them.”

“Well then, let’s get started.”

Next time, we’ll sit in while Jack and Jane visit about how to best diagnose their culture to gather the data they need to move forward.

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