Tip 43: Better safe than sorry

Welcome Back.

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 a common direction can bring people together to ignite an entire organization.

My characters, CEO Jane Carolli and VPMA Dr. Jack Martin continue to craft a strategy to improve their culture by developing a cultural assessment tool to help drive change.

Building a patient accountable culture doesn't happen over night. As with any long-term endeavor, data continually flows in… which not only stimulates more ideas to work with, but validates the direction Jack and Jane are going… always a good thing…

Jack asked Jane to meet him for a beer “off campus,” thinking that they’d both been buried in work, and although it would be a “working beer,” they both would benefit from a change of venue. When Jane slid onto the bar stool alongside of Jack, he could sense her frustration.

He gently prodded her, “Long day huh?”

“Aren’t they all - this was a great idea Jack, I don’t remember the last time I’ve sat in front of a cold pint…”

He went a little further, “So, come clean, what’s on your mind?”

“Something is definitely bothering me, but we can talk about it later… we need to get back to the assessment.”

“Jane, whatever you’re troubled about will tie into what we’re doing. And either way, you look like you need to get something off of your chest.”

“It’s the ED Jack - we’re seeing a significant percentage of patients returning unnecessarily because they are anxious about their symptoms and are not getting the assurance they need.  It’s costing us and them a bundle, and we’ve got to do something about it.”

Staying true to the coach he is Jack said, “Why do you think this is happening?”

“When this data was brought to me last month, I tasked our staff to further assess why we had so many patients returning shortly after discharge. What they saw was frightening— we found that their decision to return was fueled by uncertainty regarding medical conditions as well as a perception that the ED and our employed primary care physicians were not responsive to their needs. In addition to expected insurance challenges, these patients were generally dissatisfied with their primary care physician, and noted the lack of trust they have in their primary physician. Needless to say, I did some rounding myself and found similar themes.”

”Tell me more Jane.”

“Many patients suggested that nobody really listened to them. One woman shared that her doctor was in the room with her for ten minutes and never once looked at her as he was typing on the computer… another said that he watched several doctors walk by his room for hours. He told me he thought the doctors went out of their way to avoid him. One woman had seen her physician three times and she didn’t even know his name.”

“What’s more important than being reassured when you’re the patient?”

“Jane this reminds me…several years ago, I worked at a hospital, that had actually built a hidden stairway system so that the docs could move about without having to interact with staff and patients in the hallways.”

Jane sighed, “Why doesn’t that surprise me.”

“So what’s your plan Jane?”

“We just have to figure out how to help our clinical teams to understand that spending a small amount to time reassure a patient, explain a medication or a diagnosis can do us and our patients a world of good. Oh yeah, and that treating people like humans, not cattle will be a complete game changer.”

Jack added, “ I think the only way to do that is to make them all become patients… just kidding… but I’m not. They need to remember what it feels like to be vulnerable and ignored. But that’s another discussion. What we can do now is get back to the assessment. Because everything you’ve told me validates that this is the same cultural challenge we see all over this hospital… and we need to deal with the root cause of all of it.”

“You’re right… so let’s get back to it. I already have some assessment question ideas in mind because of this conversation .”

“Do share.”

“How about something like whether or not physicians at our organization are accessible to patients and that are our physicians approachable? What do you think?”

“I think that questions like those just might make these docs think… and that’s a start.”

Jack added, “We should add similar questions for leaders, nurses and staff.”

“Agreed Jack, this is about reminding everyone that for us to improve care we all must become accountable to what matters most to patients.”

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 42: A Culture of Silos and Silence

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 a common direction can bring people together to ignite an entire organization.

My characters, CEO Jane Carolli and VPMA Dr. Jack Martin continue to craft a strategy to improve their culture by developing a cultural assessment tool to help drive change. 

As they build the tool, certain constants continue to surface, with importance of collaborative communication leading the list…

When Jane met Jack in the cafeteria for lunch, Jack was so engrossed in reading an note from a friend, she had to literally give him a nudge on the shoulder to get his attention.

“Earth to Jack, are you in there?”

“Sorry Jane, I just can’t get over this message I got from a physician colleague… it hits so close to home in so many ways.”

“What do you mean?”

“Well,” said Jack, “He almost lost his 91 year old mother to preventable errors a physician made, and more importantly, a number of staff members enabled his mistake to almost go critical by not holding him accountable.”

Jane grimaced, “I know what you’ve been going through with your mom Jack - there’s nothing easy about switching roles with a parent when they can no longer take care of themselves.”

“You’re right Jane, my mom immediately came into mind, but I feel very good about where she is… and honestly, I just can’t believe things like this are still happening… I mean, I know our industry is plagued by siloed cultures, but this is just ridiculous.”

“Clue me in Jack.”

“Well, this doc’s mother-in-law who lives in an Alzheimer unit almost died from an iatrogenic C. Difficile infection. Her doc lazily diagnosed her with possible bronchitis or pneumonia based on a history of cough, weakness and increasing cognitive impairment.”

Jane broke in, “What about his examination? Didn’t he take a sputum culture/gram stain or take an X-ray?”

“He didn’t even examine her. He phoned in a prescription of Augmentin and then waited a week to see her cough improve, only to have her develop abdominal pain, a fever and loose stools.”

“Surely then, he performed a comprehensive exam.”

“Nope,” said Jack, “ He just guessed again, and called in another antibiotic.”

“Okay Jack, I get it. We’ve got a burnt out doc here. Unfortunately it’s just getting worse - luckily we’re doing more every day to prevent this here at Angels.”

“It’s much more than a burnt out doc Jane… it’s how everyone else contributed to the situation… by not contributing at all. For instance, the family was told that the staff were well aware that their mother wasn’t given appropriate care and was prescribed antibiotics without complete or even minimal evaluations. They even suggested that my friend find a new doctor.”

Jane asked, “Surely someone reported the guy?”

“That’s the deal, nobody said anything - nobody held the guy accountable.

“Nobody wants to be accountable for anything,” said Jane in disgust.

“Right Jane, as my friend put it: “Active errors by a single individual at the frontline are seldom sufficient to cause an adverse outcome.  It is when they are supported by a wealth of enabling passive systemic errors throughout the organization that the active errors result in potential harm.”

He continued, “This story reminds me of some research findings from a critical care nurse and physician survey. The study found that 84 percent of physicians witnessed co-workers taking dangerous short cuts and 88 percent of physicians witnessed co-workers making poor clinical judgments.  Yet, 88 percent of nurses and a remarkable 99 percent of physicians were unwilling to confront a co- worker providing sub-standard care.”

Jane sighed, “And we wonder why we’re surrounded by cultures of silos and silence. We know that medical errors are going to happen, but without any cultural accountability in place, nothing’s going to change.”

“Well that’s why we’re doing what we’re doing Jane. We have to build a culture that starts with being more accountable to patients, and the only way to do that, is to continually assess what skills and behaviors need changing…and I can’t help thinking we need to continue to make this a priority.”

“Then we better get back to it Jack.”

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