Wednesday, June 18, 2014

Tip 37: Are you listening?

Are you listening?

For those of you just joining us, welcome to our 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.

Come meet our fictional characters CEO Jane Carolli and her new, game-changing VPMA, Dr. Jack Martin as they focus the culture at Angels of Seattle hospital around what matters most to patients. Our last issue left us with Jane and Jack visiting about the relationship between better all around communication for patients to get them what they really need, while helping organizations achieve their goals at the same time.

If you want to improve your culture, you must start by focusing on building trusting relationships. But how do we do that when physicians and staff don’t trust each other and a growing number of patients I speak to don’t trust their primary care physicians?

Listen to what Jack and Jane had to say about trust at Angels of Seattle…

Jane was a little miffed. She and Jack had started the process of healing the culture at Angels of Seattle at the top, one person at a time. Most of the management team was onboard, but a few couldn’t let go of the command and control system they’d been living by the last 25-30 years, and a few, probably never would. Jane was particularly annoyed at how one of her best doctors just wouldn’t budge. When Jack came through her office door, she jumped right into her thoughts…

“Jack, I’m going crazy here - Dr. Lambert, Mike Lambert is one of the best doctors we have and I can’t get him to talk to, much less build a relationship with his colleagues, never mind someone he considers below him like a nurse.”

‘Well good morning to you too Jane. I’m guessing you’ve been stewing on this a while and my timing is precipitous if anything.”

“Sorry Jack, I just hit a speed bump…”

“No worries - okay Jane, first off, what do you mean by Lambert is one of my best doctors?”

“This guy has an incredible record Jack. He’s probably the best neurosurgeon in the city, and a month doesn’t go by where someone doesn’t try to poach him. His clinical ability is known internationally and brings in some of the most high profile cases out there.”

Jack paused. “Okay, so you’re saying the best doc is the best clinician… right?

“Well yes… I mean no… I mean, come on Jack. You know this guy… and we both know if someone had to cut into our brain, we’d choose him.”

“Fair enough Jane. But let’s put him aside for a second and look at the forest, not just one super special tree. All of our doctors are really good clinicians. We have an exemplary staff when it comes to training, education, clinical abilities… but we still have all these problems that you and I are trying to fix… why is that?”

Jane smiled. “It’s easy to forget Jack. With all the skills in the world, if they can’t connect with their colleagues, much less a nurse, all they are doing is keeping us from giving patients what matters most to them.”

“And Jane, let’s be the patient for a minute. When you sit down to meet your primary care physician, what do you want the most?”

“Easy enough, you want someone to talk to you in a language you can understand, then, most important… you want them to listen without interrupting you.” She took a beat. “ You know Jack, you,re the one that told me that 90% of the time the patient will give you the diagnosis if you just let them talk.”

“Yeah Jane, but the problem is, most docs won’t let a patient talk for more than 10-20 seconds without interrupting. And the thing is, if they would just listen a little longer, they’ll end up getting it right the first time.”

“Which potentially means less visits back here.”

“Right Jane, but it also gives the doc a better chance at finding the root cause of the problem. When a doc doesn’t have the entire picture…”

Jane interrupted, “ By not listening… as I interrupt you.”

“Funny… So when the doc doesn’t have the full picture he’s most likely to prescribe symptomatic relief, and we’re more likely to see the patient again in the near future. But when they fully listen to their patients, they not only have a better chance of solving the problem, they truly gain the trust of the patient.”

Jack continued, “So that brings me back to the dilemma you were suffering through when I walked through the door. Mike Lambert.”

“Right, thanks. Yes, Mike has great skills, but he’s missing the kind of skills we need to change things around here.”

“So tell me Jane, what does Dr. Lambert need more than anything?”

“He needs to learn how to listen. But how do I teach him that?”

“How did I teach you Jane?”

“Duh. You coached me. You asked me the right questions and you gave me the time to answer them. You asked questions which set me up to come up with answers that illustrated the critical importance of listening. And there’s nothing more powerful than coming up with your own answers…”

“That’s how I began to build trust with you. And that’s what you need to do with Mike Lambert. It may or may not work, but if Mike can’t learn to communicate better and trust the people he works with, then he’s only going to slow us down as we work to build a culture that’s accountable to patients.” 

Get some data and read more about building trust in the article: “Do you trust your primary care physician?" by STEPHEN C. SCHIMPFF, MD at:

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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