SaferPatients

Typically, it takes about six to nine months for a hospital to decide if it wants to do training to improve the communications between its physicians and nurses. Nine months from the time the executive team and Board of Trustees has decided that it can not  allow any more sentinel events in its hospital.

One hospital I worked with had a series of several serious wrong surgeries. After the third one, and in desperation they called me, asking for an immediate call back. They knew their culture was broken. They knew their checklists weren’t being used correctly, if at all.

It took over 24 months for them to decide to take the steps to fix it.

You don’t need more time, you just need to decide.

Read the history of the original Mac and you’ll be amazed at just how fast it got done. Willie Nelson wrote three hit songs in one day. To save the first brand Seth Godin was responsible for, he redesigned five products in less than a day. Seth says It takes a team of six people at Lays potato chips a year to do one product redesign.

The urgent dynamic in patient safety is to ask for signoffs from your executive team and to push forward, relentlessly.

Keep telling your leaders, “I can make this happen. I’ve got it.”

Seth Godin, one of the best project innovators out there says you can feel this relentless move forward happening when you’re around it. “It’s a special sort of teamwork, a confident desperation… not the desperation of hopelessness, but the desperate effort that comes from being hopeful.”

Your patients are hopeful that you are relentlessly improving how you provide care. Are you?

What’s happening in your unit?

If you go to any meeting about patient safety or quality and say nothing, it would have been better if you hadn’t gone at all.

If you go to work and do only what you’re told, and never look for a way to do what you do better, you’re not being negative, but the lack of initiative you demonstrate costs the entire unit, because you’re using a slot that could have been filled by someone who would have added more value.

It’s tempting to work quietly, comply, and rationalize that at least you’re not doing anything negative to hurt your patients. But the opportunity cost to your hospital that must compete in a new world of safety data transparency, and ever more dangerous world of high-tech medicine complexity is significant.

Not adding value in patient safety is the same as taking it away. What will you do today to be more reliable, have less variability, and ensure things don’t fall through the cracks?

On the bottom of the World Health Organization Safe Surgery Checklist are these two sentences: “This checklist is not intended to be comprehensive. Modifications to fit local practice are encouraged.”

This item on the checklist is the most important because ignorance of this advice from the WHO is the source of almost 90% of checklist implementation failures. Successful checklists are created by the physicians, nurses, and staff that actually use them. Ineffective checklists are imposed from above by administrators without regard to local practice or input from end-users.

For example, at the University of California, San Francisco Medical Center, the Neurosurgery unit just created its own Time Out checklist.  Because of its proven record in reducing surgical morbidity and mortality, relative ease of use, and focus on improving interdisciplinary team communication practices, the WHO Surgical Safety Checklist was used as a major point of reference in the design of their checklist.

An interdisciplinary taskforce modified the checklist and inserted neurosurgery-specific language and concerns to make the WHO Surgical Safety Checklist and its communication practices more applicable to neurosurgical procedures in their institution. In addition, the taskforce consolidated the timeouts before induction of anesthesia and before skin incision on the WHO checklist for 2 reasons.

1. It is often challenging to have all multidisciplinary operating room team members congregate on 2 separate occasions to conduct 2 timeout checks.
2. Moreover, the WHO checklist before the induction of anesthesia places heavy emphasis on addressing airway concerns and verifying the functionality of equipment. Anesthesiologists at UCSF institution already routinely perform their own separate equipment checks and assess the patient’s airway prior to anesthesia induction.

These are two great examples of the type of modifications that must be done to create a checklist that staff will actually use in a sustainable way.

To view a video of the completed checklist at UCSF, use these links. Click here to view with Media Player. Click here to view with Quicktime.

I love Steve Pressfield’s book, Do the Work. It’s a short, simple, incredibly motivating manual on how to overcome the resistance that all great improvement projects meet. Here is a short excerpt on his comments about passion - and passion’s role in overcoming resistance.

“Picasso painted with passion, Mozart composed with it. A child plays with it all day long.

You may think that you’ve lost your passion, or that you can’t identify it, or that you have so much of it, it threatens to overwhelm you. None of these is true.

Fear saps passion.

When we conquer our fears, we discover a boundless, bottomless, inexhaustible well of passion.”

Want to find a way to energize your patient safety or quality improvement program? Find a way to tap into the passion of your staff to heal patients. Isn’t that why they got into health care to begin with?

Nothing is as ever as persuasive to your staff- not your logic, not your cogent arguments, not the peer-reviewed data -  as when your passion for the project connects to their passion for caring for people.

You know you will meet resistance whenever you are trying to effect change. When you meet it, and find yourself hesitant, ask yourself, “What, exactly, would I do here if I wasn’t afraid?” Whatever the answer is - do it. When you conquer your fear of what others will say and do, you’ll find your passion for the task will grow. Others will see it and tap into it. Then you’ll have some momentum.

Go find your passion.

Overcoming Organizational Resistance

When  inspiration, then success, then recognition and reward for the improvements we have made have come and gone, who will still love you—and whom do you love?

Only two things will remain with us when we cross to the other side: the creative genius (yes, genius) with which our Creator endowed us, and the hearts of those we love.

In other words, what we do with the abilities we have been given and those for whom we do it.

Each of us is unique -  equipped for this moment and our role in health care reform with a set of work skills, life experiences, and passions. Are we doing the most we can for this mission with what we have?

When resistance comes, and it surely will, remember why you are doing what you are doing, and for whom you are doing it.

Don’t let yourself be stopped.

Overcoming Organizational Resistance

My favorite quote, one we use in every Leadership Development Institute with health care leaders, is from Calvin Coolidge:

“Nothing in the world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent.”

In 11 years of helping health care organizations all over the world, I have worked with all kinds of leadership teams with all kinds (or not) of resources -  world-famous academic medical centers; giant world-class metropolitan hospitals; prestigious, rich, profitable, money-is-no-object institutions; simple, very rural, out-of-the way 10-bed facilities; poor inner-city clinics. Some have been wildly successful changing their culture and dramatically improved patient care, others not so much.

One thing I know beyond a shadow of a doubt. You cannot predict success on the basis of education, talent, or resources. I agree completely with President Coolidge, “Persistence and determination alone are omnipotent.” It is the only predictor of success.

Be Stubbornly Persistent

Once you commit to action with a change initiative, the worst thing you can do is to stop.

What will keep you from stopping? Plain old stubbornness.

I like the idea of stubbornness because it’s less lofty than “tenacity” or “perseverance.” You don’t have to be a hero to be stubborn. You can just be a pain in the butt.

When you’re stubborn, there’s no quit in you.

You’re in until the finish.

You will sink your junkyard-dog teeth into Resistance’s butt and not let go, no matter how hard he kicks.

You will be successful.

When you start a new safety or quality initiative you are going to get resistance. It’s a fact of life. Why are you surprised when you get it?

When you do get it, when Dr. ‘Big Producer’ or Nurse ‘I’ve-Been-Here-30-Year’ says “That will never work,” or, “We don’t do it that way here,” - don’t take it personally.

This is tough advice. Are you supposed to take it like a filing cabinet would take it?

Sometimes it seems as though the only way to take it is personally. That physician who doesn’t like your protocol (your best work) or that nurse who has been your friend for 20 years who doesn’t want to run with you any longer…It’s never personal. It’s never about you. How could it be? That person doesn’t truly know you, understand what you want for the organization or hear the conversation you have in your head about the right thing for your patients.

All they know is themselves and what they think.

When someone fights you and your project, when they refuse to listen to evidence, or even badmouths you or your work, it’s not personal about you. It’s personal about them. Their agenda, their decisions, their story.

Do your work, the best way you know how. It’s the right thing for your patients.

Is there any other option?