Tuesday, October 21, 2014

Tip 45: Avoid em' like the plague...

Avoid em' like the plague...

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.

In our last issue, Jack and Jane were talking about accessibility, and more specifically, how the issue can be viewed from both a system and patient perspective. More specifically, how the macro view of physician time management is not the way patients see the subject of accessibility - on the micro level, patients see accessibility as the quality of the interaction they have with their physician.

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

The conversation continues…

In the cafeteria:

“Jack, on this accessibility issue, I’m having a hard time dealing with the fact that we can give our patients what they need the most by just improving the time spent with them… this issue spotlights one of healthcare’s biggest challenges, yet one of the easiest to remedy… and I need to understand it better if I’m going to ask our physicians and staff to begin working differently.

Jack replied, “You know Jane, first off, I suggest you don’t just think of this as a healthcare issue, this is a challenge you can see everywhere if we look close enough. For instance, I'm reminded of something I once heard from Freddie Couples a professional golfer, he said that when he was home, he just didn't answer the telephone because he was afraid that there might be someone else on the other end.”

Jane smiled, “Are you saying that his avoidance behaviors are similar to the ones impacting the patient experience here at Angels?”

“Absolutely. You’re the one who told me about some of the docs around here who make rounds at 2 am when their patients are sleeping… how more avoidant can we be?”

Jane got it, but didn’t know how to reply, when Jack continued with, “Let me tell you what John Blanchard once told me - he’s a primary care doc I used to work with in Billings. John had a woman come in that he had been seeing for years. In every past visit, she was enthusiastic, very articulate and downright bubbly. But when she came in on a routine visit, something just wasn’t right .

He noticed right off that her speech patterns were slightly different than they’s always been… just slightly. In fact, he told me that anyone else who hadn’t spent some time getting to know her would have never made the pick up because she had no complaints and was unaware of the minimal changes as they were so subtle. He did a neurological exam and nothing showed up.

So he ordered a brain MRI, regardless of the fact that her insurer refused because she had no specific indications with an otherwise normal history and examination. He refused to give up and called them back multiple times until the insurer finally relented. The MRI showed a benign meningioma – treatable and probably curable.”

Jane added, “Your buddy only figured it out because he knew his patient. He had invested his previous time with her listening intently and getting to know her.”

“Right Jane - and it’s not like he spent an inordinate amount of time with her in the past, he just spent good quality time to understand the patient."

“He may have healed her, not from some miracle diagnosis  or new wonder drug… but from taking a moment to listen and observe his patient. This isn’t rocket science Jack - it’s a pretty simple concept.”

“Agreed - but here’s another story I heard recently… it illustrates the same thing from a different perspective. A friend of mine took his mom to the cardiologist last week. After the cardiologist spent some time getting to know her and really listening to her, he believed he'd hit upon what was causing the problem… and a solution, which happily did not involve a drug or surgery but behavior modification. He told her he'd call her internist who she has been seeing for many many years to tell him about the discussion.

His mother waved her hand dismissively and said, "He doesn't know me. In fact, you know more about me after this short visit than he ever has… and I’ve been seeing him for over 20 years!" The cardiologist looked surprised and a little confused but he understood. His mother was saying that her internist had not spent time listening to her and getting to know her unique situation like this cardiologist had done.

She went on to say that her internist was always in a hurry and never treated her like the cardiologist did. She said that she had only known him for a short while but already trusted him more than her primary care doc.”

Jane chimed in, “ There’s obviously both good and bad to that story Jack. We just need to get the moral of this story out to every physician and clinical team in this hospital. This patient view of accessibility is one we can influence. We need to help our colleagues start looking at  everything we do from a patient’s perspective. That will begin to shift the culture around here… and I’ll tell you what Jack… at first, when we began talking about changing up the culture, it sounded huge and unfathomable. But this accessibility issue really illustrates that culture is simply the degree and frequency of quality interactions… this is a conversation we need to share.”

“Simple to grasp, yes Jane… simple to implement… well, we’ll see. It’s a paradigm shift - and encouraging change is a slow process… but definitely doable.”

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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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