Tip 39: Can an organization’s culture make patients safer?

Welcome Back…

The following Coach Leader is part of 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.

Our last issue left Jack and Jane discussing that the quickest way to build patient trust is to ask the right questions and then truly listen. It turns out, the same strategy works for increasing trust between staff members.

Jack knew from previous experience that to improve an organization’s culture, you first have to improve the quality of interactions people are having with each other. To measure change and progress, Jack and Jane set out to develop a tool that would help everyone in the organization contribute to improving the quality of their interactions. We join Jack and Jane after Jack just broached the subject of building a tool to help them advance their culture...

“Jack,” said Jane, “Are you sure this is the right way to go… the last thing we need is another survey that provides us with a bunch of data we can’t do anything with.”

“I agree wholeheartedly Jane. We can design a tool that not only helps us get clarity on what’s going on in the trenches…  it gives us cues on a regular basis that forces us to examine if our culture is contributing to or hindering care… and it brings culture to the forefront of our conversations rather than leaving them to lurk in the hallways.”

“You mean, we can develop questions that will get them all talking amongst themselves?”

Jack smiled, “Exactly. Every physician, nurse and staff member in this hospital has strong feelings about this organizations culture even though we may not directly address the issue. We'll make culture become part of everyone’s daily conversation just like everything else around here. This is how we clarify what culture is and how to change it. This is our cultural strategy".

“Got it,” said Jane. “ We need to set a little context for what our culture should and can look like. When it comes to patient safety, all of our people believe checklists are a tangible way they can contribute to improving safety… but with culture, they don’t know what to look for or what they can actually do to change things.”

Jack said, “ Patient Safety is a great example Jane. What if the first question we asked was something like: Does our organization’s culture make patients safer?”

“I love it. They might not be able to define what culture is yet…”

Jack interrupted,”Or how we see our culture becoming…”

“Yep. But we all have perspective to share when it comes to if our culture is positively or negatively influencing patent safety.”

“Exactly. The insights we’ll collect will be beneficial, but what's even more important  to me is that we are helping everyone begin to see how our culture can impact things as important as patient safety."

“Yeah Jack, there is a lot going on out there and most of us forget to see that our culture either drives or hinders safety. For instance, maybe… hopefully not… but maybe we find that certain departments feel that safety is sometimes compromised because of the way people interact with each other… but they have no idea what to do about it.”

Jack added on, “It’s not a stretch to say that many of us have just come to accept these types of interactions as business as usual.”

“But that’s about to change. This tool will bring quality interactions to the forefront of everyone’s mind and let them know how they can contribute to changing things around here.”

“And as you said earlier Jane, it begins with us helping everyone to see how we can all play a role in improving culture. As leaders we can instigate bottom-up change by setting needed context...this will give them the tools to make changes on a local level. I just read an article titled: Reinventing Healthcare: 5 Strategies for Successfully Leading Change. And the author actually defined culture as a business imperative - let me read you this one part:  “Culture no longer is about the soft side of business. Without the "right" culture, the best-laid operational plans will stagnate in the vertical hierarchy or fail from poor execution.”

“It’s good to know we’re not the only people going down this path,” said Jane, “Culture is finally being recognized for what it is… the most important factor in making our hospital more patient centered.”

Jack and Jane continued on with the survey working to determine what they really need to know on an ongoing basis. Join us next time as they continue to shape their cultural assessment tool. 

Here’s the link to the article quoted in their conversation:
http://www.beckershospitalreview.com/leadership-management/reinventing-healthcare-5-strategies-for-successfully-leading-change.html

See you next time. 

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 38: From the horses mouth…

From the horses mouth…

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.

If you’re just joining us, 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 talking about one of Angel’s most proficient physicians who lacked a skill that was more impactful on patient care than any of his clinical skills… his ability to listen… to anyone.

From diagnosing a patient to working on a surgical team, his inability to listen to who he considered subordinate, cost him the ability to run a team… costing his patients even more. We left the conversation with Jane’s realization that the path to improve communication and developing productive relationships depends on establishing trust, which begins with improving your ability to listen.

As Jack and Jane continued drilling down on the trust building process and shared the importance of team listening, Jack asked Jane about what she was learning during her patient rounds.

Note: In the book, Jack introduced Jane to the importance of regularly getting to the bedside to talk to patients. Since they determined that all of their efforts were based on giving patients what matters most to them, it only made sense to regularly check in on what they had to say…

“So Jane,” said Jack, “What have you been hearing from our patients?”

“It’s a mixed bag Jack - and it really through me for a loop because I really feel like we’re turning a corner, but some of the comments I got yesterday made me pretty upset.”

“Jane, there are hundreds of doctors and nurses on staff and we haven’t reach even a quarter of them yet… we’ll get there… so what did you hear?”

Jane picked up her notebook and began to read.

“This 59 year old female was in the cardiac unit and said: “I’m glad I’m getting released because I feel just like another number here - I don‟t remember being called by my name in the six days I was here. My name was listed on the board, but they didn’t use it.”

Jane continued,” Can you believe that Jack, six days and nobody took the time to call her by her proper name.”

“Unfortunately I do Jane.”

“What’s interesting Jack, is that I heard things that made my skin crawl, like when a woman was complaining about having had an epidural and being scared because she couldn't feel her legs, and the nurse just said, ‘Relax and enjoy that your pain is relieved.’  That just burned my chaps, and I’m in the process of tracking that nurse down… but what really gets me is the simple statement a young man shared - he said that he felt like he was interrupting them when he asked for help.”

Jack paused for a minute to let Jane sit in it and asked, “So what do you want to do about it?”

She thought. “Well, we’re moving in the right direction, but its just not spreading fast enough. A large part of the staff are lacking the most basic of skills.”

Jack asked, “What kind of skills Jane?”

“That’s a big list Jack - but to start with, how about how to give patients your full attention, how to listen to everything a patient has to say before responding, how to make eye contact… like I said,these are basic and there are a ton of them.”

“Interesting,” said Jack, “The patients are saying the same things about our staff that our staff  says about each other… “

“Yeah, you’re right Jack. The last assessment we took pretty much mirrored my patient comments. So I guess we just have to keep plugging away with teaching them all how to ask the right questions and truly listen to the answers.”

“And Jack, the next time I hear a patient tell me that they feel that asking a question is like interrupting, I’ ll remind them that that we want them to ask us questions, and that we are receptive and responsive to the questions… that it’s the only way to build stronger relationships. And if anyone makes them feel bad about it, they’ll have me to deal with.”

“I like it Jane. But be prepared for the naysayers who are skeptical about listening - they’ll say they don’t have time, they're too busy… you know the drill.”

Jane smiled, “I know Jack, I’ll just remind them about the high cost of not listening -  delay in diagnosis, incorrect diagnosis, poor patient experience, not to mention avoidable patient harm amongst others.”

“Hey Jane, its just like that old Fram Oil Filter commercial, “You can pay me now or you can pay me later.”

“You’re dating yourself Jack, but you’re right - they can listen now, or they can spend a ton of effort and resources later. Their choice.”

Listening is the fastest way into the shoes of our patients. Although we have to treat patients as intelligent partners, we also have to recognize that they’re in a foreign, often scary environment that creates feelings of helplessness, fear and anxiety.

So how do we give them confidence and build trust? We ask the right questions and listen. That may mean repeating what my patient has asked me to ensure my understanding of their question, explaining what I am saying slowly and in small doses, giving my patient adequate time to process the information and ask more questions, and assisting my patients to be true partners in their care by giving them access to information about their disease process. Whatever it takes to build a trusting relationship.

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