Tuesday, August 12, 2014

Tip 40: Dead On Arrival


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.

Jack knew from previous experience that he needed a strategy for improving culture. So he and Jane set about at developing a cultural assessment tool that not only took the temperature of their culture… it could be used as an ongoing tool to measure change and progress.

The first question they developed for the tool, “Does our organization’s culture make patients safer?” connected the dots between patient safety and having a safe, trusting culture. They confirmed that “Culture is no longer about the soft side of business. Without the "right" culture, the best-laid operational plans will stagnate.

Which led them to their second assessment tool question…

Jane was looking over her notes from her last meeting with Jack when he sauntered in with a couple of Tall Starbucks cups. Engrossed in thought, she barely noticed him when he said, “Earth to Jane - you look pretty deep into something… what are you thinking about?”

“Oh Hi Jack, ooh, double non-fat latte?”

Jack smiling, “Of course.”

Jane continued, “Well the conclusions we came to last time had me connecting the dots all the way around.”

“What do you mean?”

“Well, when we talked about how patient safety is compromised by a lack of trust and communication between staff members, it set me to thinking about the next question on the survey, and how the patient safety conclusions relate to it.”

Jack prodded her on, “You have my attention.”

“Well, I wanted to talk about care coordination… more specifically, how does our culture contribute to improving care coordination.”

Jane hesitated, then continued, “Look, we have the best systems in place here at Angels… cutting edge EHR, checklists in place… you know the drill. But we’re still not doing a great job with handoffs, amongst other things…”

“Jane, I see what you mean by connecting the dots. Obviously, having all of these great assets and processes is great and necessary, but if we don’t have the right culture in place, the prospects of improving care coordination is dead on arrival.”

“I hear you Jack. When I was completing patient rounds the other day, I talked to a patient who was recently transferred. All her records got here in one piece, but nobody handed her off properly and the hospitalist didn’t take the time to talk with her primary care physician. She was scared to death that no one called her doctor. This internist left his phone number with a nurse two days ago. A successful handoff requires constant communication and respect.”

“You mean we need to make sure we treat people like the humans that they are, right?”

“Exactly. Doctors, nurses, therapists, pharmacists… whoever is involved needs to follow through all the way down the line.“

“You know Jane, I can’t remember the guys name, but a rocket scientist once said that it was his job to get the rocket into the air, not to worry about where it’s going to come down. That’s what we’re talking about here. We’ve got to get everyone involved with our patients to hold themselves accountable to what matters most to patients… again, they just want to trust that everyone is on the same page when it comes to their treatment.”

“It’s crazy Jack, here we are in the most human of businesses, but we don’t treat each other like humans… it’s just another transaction.”

Jack thought a minute and replied, “Jane, as long as our culture has a silo mentality, patients won’t get a better standard of care, period. We need to change the paradigm around here…”

Jane interrupted, “Exactly Jack. Because at the end of the day, with all the great systems we have in place, the only thing that will curatively change how we care for patients is improving how we work together.”

“You’re right Jane. With everything we’re in the process of doing here, job one is to start changing the mindset of the staff. We have to get people to realize that if people don’t feel safe about sharing and working together… like you said, care coordination is dead on arrival.”

See you next time. 

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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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