Monday, October 6, 2014

Tip 44: Pay me now or pay me later…

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.

As they zero in on survey questions for the assessment tool, Jane found herself struggling with the issue of physician accessibility in light of a study she stumbled across.

As Jack came through the door of Jane’s office, she was so immersed in the data she found that she skipped the pleasantries, getting right to work…

“Jack, I’ve been wrestling with the validity of asking whether or not our physicians and staff are accessible to patients because I’m not sure if we can have much of an affect on the issue in general, regardless of the data we receive.”

“Well hello to you too Jane. What makes you think that?”

Jane looked up for the first time since Jack entered, “Sorry Jack, it’s just such a huge issue, it seems overwhelming. I’m reading about some finding from the Survey of American Physicians that says that 44 percent of physicians plan to reduce patient access to their services by any number of steps, such as reducing the number of patients they see, not accepting new patients, working part-time or moving to a non-clinical job. And, just 19 percent of physicians said they have time to see more patients. How are we going to have any affect on such a systemic problem?”

Jack thought for a few seconds before replying, “You know Jane, you’re right. If you look at it at such a macro level, it’s a huge undertaking. But when I think about accessibility to physicians by patients, I’m thinking about the micro level…”

“Meaning what exactly?” asked Jane.

“Meaning how patients see physician accessibility at the moment of care - at the bedside. Don’t you think we can influence that here at Angels of Seattle?”

Jane shook her head, “I guess there are two heads to the accessibility coin and I’ve only been looking at the macro side. I need to frame this issue from what accessibility really looks like from the patients’ point of view. This article stresses issues arising from the amount of time docs have for their patients, when I know from my rounding experience, that patients aren’t looking at the clock, they just want a more personal experience. Mostly, they just want to be heard.”

Jack knew better than to chime in when he saw Jane connecting the dots in real time. He waited patiently until she continued.

“You know Jack, when I was rounding yesterday, I asked patients about how much time they spent with their docs and how they felt about it, and none of them spoke in terms of quantity. They all said that it wasn’t about minutes spent, but how the minutes were spent. One woman shared that her physician never once looked her in the eye when they met, he never sat down, much less touched her. She said that she didn’t feel that she was treated as a human being.”

“It’s crazy Jane, here we are in the most human of businesses where we see people in their most vulnerable state, and we can’t even take a few seconds to show interest and actually connect with our patients?  You know, earlier in my career I would often look down as I walked the halls so that nobody looked at me, because I was afraid they were going to engage me, and it seemed less threatening to keep them at arms length. I can’t believe that was even me when I think back on it.”

“Don’t be hard on yourself - you didn’t know any better at the time. So what can we do about it this problem in the here and now Jack?”

“Where do we always start Jane?”

Smiling, “With what matters most to patients of course. And we both know what they want. The interaction should have the full attention of the person you’re talking with… they want to be heard and treated like a person, not a patient.”

“Exactly Jane, we don’t have to tackle the big issue of physician time management, we just have to work with our staff to improve the quality of the interactions they’re already having — even if its only five minutes. By listening and learning from our patients, we’ll not only pick up the most accurate diagnosis, we’ll have the opportunity to raise patient experience metrics no matter how much time (or how little) we have.”

Jane beamed, “Like everything else we’ve been talking about, this is a cultural problem with a cultural solution. I had the incorrect assumption that accessibility was only about time. It’s not at all… at least from the patients’ point of view. Many of the great docs I know only have a few minutes for a patient visit and still manage to assure the patient by truly listening and build a trusting relationship.”

“Absolutely Jane. When we take the time to build a relationship up front, it not only dramatically improves the patient experience, it saves us time, expense and in some cases lives.”

“Yep,” said Jane. “Our docs that don’t take the time to give patients the human interactions that they need up front might think that they’re saving themselves time - but they’ll end up putting more time in anyway, when their patients come back in.”

“Pay me now or pay me later Jane… but you are going to pay me one way or the other.”

“And at Angels Jack, we have the ability to do something about this… and we will.”

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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