February 4, 2013

A Physician (and Psychologist) share personal perspectives

  More on healthcare, leadership and culture...

Today  there was an interview in the Boston Globe with a Physician whose mother died. He felt there were errors made and wanted to speak out to help prevent these things from occurring.  http://bostonglobe.com/lifestyle/health-wellness/2013/02/04/jonathan-welch/YDxG225lt80x7i4UG0MJbL/story.html  

His answer to this question stuck out for me:

Q. Do you think smaller hospitals, like the one in Wisconsin that treated your mother, make more errors than big, teaching hospitals?

A. I don’t know if size necessarily has a lot to do with it. What I think really matters at the end of the day is culture. I think you need [hospital] leadership to say: “This is important to us. We’re not going to have people die unnecessarily on our watch, and we’re going to listen to patients and families.” 

So, my thoughts....What will it take to ensure every hospital creates a culture that emphasizes listening to patients and families? What leadership is required?

This resonated with a personal experience I had many years ago.  My first husband died of metastatic melanoma as a young man. He received excellent care, by many providers and more than one hospital over many years; but the disease did eventually take his life. 

Despite this good quality care, he had one experience that almost led to a preventable early death. As his wife, by his side constantly, I could see things that were going wrong. He was misdiagnosed. He was being "observed" and not receiving active treatment in part because it was the weekend, the hospital was understaffed and they were waiting for the full array of hospital staff ("experts") to arrive on Monday morning. 

But that may have been too late. 

I was forced to  confront a resident who was over her head and not willing to get the help needed. I became pushy, persevered; no longer concerned with politeness, I raised my voice. I demanded a specialist. I demanded a CT scan. I insisted they get someone in who could deal with the situation. [At that point, I am pretty sure she was offended, but I no longer cared...we were talking life or death here].

Later in the day, when it was confirmed that he had been misdiagnosed, (he had a brain tumor that was causing swelling, delirium and eventually a seizure) and the situation was stabilized, I was commended by the medical staff for "catching" the problem before it was too late.

The point is not that I know more about medicine, I don't. The point is: I knew more about my husband. I knew what he was like "well" and I knew he was deteriorating.

I agree with this physician--Hospital leadership needs to set the expectation that staff listen to patients and families. It needs to be a core value. It needs to be supported. It may prevent unnecessary deaths, and it also will lead to an overall much better hospital environment.

February 1, 2013

The human side of healthcare transformation

I just attended the Mid-Winter Leadership Forum co-sponsored by the Massachusetts Hospital Association (MHA)  and the American College of Healthcare Executives (ACHE)- Massachusetts chapter. It was quite interesting and it is exciting to be in Massachusetts where there are many innovative initiatives underway.

The title of the conference:"Making Connections: Crafting a New Healthcare System", was clearly meant to highlight Collaboration and Transformation. There were presentations of several innovative Massachusetts-based collaborative initiatives in which payors and providers have come together to provide better quality, cost effective solutions.

I was a little surprised, however, at the few references to the human aspect of transformation throughout the conference day, especially given the title "Making Connections". For example, what is effective leadership in these initiatives? How do leaders in healthcare organizations contribute to, or hinder, these transformations? What is the role of the physician leaders, healthcare executives, nurse managers and other leaders in ensuring the successful transition throughout these massive changes? What about those on the front lines?
Peter Straley, President & CEO, of Health New England, Inc. came closest to addressing the personal side of change by noting that what was really needed was to change the culture in which we grew up. YES!  A new vision...a new way of viewing and operating in a healthcare system within which we have been living.

Transforming healthcare is not about new technologies or new payor systems ALONE. Yes, those are critical, as are needed structural and systemic changes for delivering high quality care, more efficiently, effectively and at a lower cost. But, transformation requires personal change. It is about changing the culture. It requires collaboration, communication and compromise. It requires a new way of thinking. In essence, it is about changing behavior. And this is often the most difficult change of all.