SaferPatients

You can’t get to 100% on your core measures.

The usual mantra is to ‘try harder’. Trying harder is impossible when you’re already trying as hard as you can.

But you can always try different.

In addition to my work for LifeWings I also fly an MD-11 for FedEx. We guarantee your package will be there overnight. On time. A 99.99% success rate won’t cut it. If we deliver 7 million packages a day, that means 700 will not make it on time to the right place and right person. These 700 service failures would be honest mistakes, made by smart, dedicated people working as hard as they can.

No matter how hard we try, we wouldn’t do better than 99% on effort alone. So we rely on a system completely different from what most organizations do. Same number of people, same number of hours working, 100% accuracy.

We added teamwork to the mix. The type of teamwork and collaboration wherepeople cross-check one another,  speak up when needed, and catch the inevitable slips, trips, and lapses that humans make - to detect and correct errors before the package is late. Or, before the patient doesn’t get antibiotics on time, or doesn’t get an aspirin on check in.

If it’s not working, harder might not be the answer. Creating a culture of accountability might be.

We hear a lot about disruptive physicians and Disruptive Physician Policies these days.

As Seth Godin points out in his blog, bad behavior and irrational decisions are almost always caused by fear. If you want to change the behavior, address the fear.

I don’t see that approach to changing behavior much.

In my previous work with airline safety systems, I used to lead what we called “Mediated Debriefs” for cockpit crews that had a total meltdown in teamwork and could no longer fly together safely. Usually the meltdown was caused by disruptive behavior - which can be deadly when experienced in a confined metal tube with wings hurtling through the air at 500 MPH.

After scores of sessions with totally dysfunctional crews, I realized most of the bad behavior stemmed from some sort of fear. That discovery transformed my ability to help the crews get to the root cause of the meltdown and, more importantly, plot a way forward to change behavior.

I wish more folks would try that tactic.

Instead, we ban someone, or we put a letter in the permanent file, or put the employee on a performance improvement plan.

Sometimes asking “What are you afraid of?” is the shortcut in understanding what motivates the behavior you are seeing. Fix the fear - change the behavior.

(Note: This post comes from Steve Montague, one of our Vice Presidents at LifeWings.)

In “Turning Doctors into Leaders,” Thomas Lee correctly notes, “team building is a critical competency for physician leaders.”  While this is clearly a necessity, Atul Gawande illuminates the pathway by which physician leaders will learn to lead; by leading a multi-disciplinary team in the OR, ED, ICU, etc.  The distributed competencies present in a modern clinical context will significantly underperform their joint capability if they are lead in an autocratic style, or not lead at all.  Dr. Gawande points out that medicine is wise to borrow from other professions (such as Sullenberger, et al) and there is a ready model for medical schools to emulate if they wish to adequately prepare tomorrow’s physicians to be servant leaders; the U.S. Service Academies. 

The first step is to clearly articulate the expectation that physicians lead.  For example, if you ask an auditorium of freshmen (or plebes) at Annapolis, “Who in this room is a leader?” there will be a sea of hands up in the air in spite of their lowly status.  Conversely, I never get a similar response from medical students, nor even residents.

Once medical students sign on as future leaders, the medical school must provide a curriculum consisting of academics and low cost of failure leadership opportunities using interdisciplinary simulation.  This allows individuals to experiment and find their specific leadership style. 

Finally, leadership must be evaluated and included in any consideration of residency or fellowship.  If it’s measured, it matters.  Whether leading a multi-disciplinary team, or serving as the leader of colleagues, an admiral or a department chair must know how to lead long before assuming the title.

(Steve is a graduate of the U.S. Naval Academy.)

Not long ago I gave a presentation to group of Cardiovascular surgeons assembled for their annual conference. The topic was “How to be a Topgun.” Read more »