Repair the Roof When the Sun Is Shining

Donna Sollenberger, EVP & CEO, UTMB Health SystemPresident John F. Kennedy once said, “The time to repair the roof is when the sun is shining.”

It’s true—most of the time, we don’t go about our day with an expectation that an adverse event will occur. But unfortunately, sometimes there are emergency situations, whether or not we are prepared for them. And sometimes in health care, people make mistakes that result in patient harm, despite having the best intentions when caring for someone. This is why it is so important that at UTMB, we devote ourselves every day to promoting patient safety, environmental safety, proper patient identification, medication safety, infection control and effective communication, whatever our role may be.

For some time now, the Health System has been on high alert, busily preparing for our Joint Commission re-accreditation survey. However, the preparations and safety measures on which we are currently so acutely focused are things we should always be doing to ensure the safety of our patients and staff. Whether it is focusing on prevention, communication, processes, documentation, or ensuring pathways are clear in case of emergency, we must always be alert. Our re-accreditation survey window, which extends through the next two months, has been a great opportunity to reinvigorate our current efforts to ensure we are providing the safest possible care for our patients, families and one another.

Just as achieving high reliability in health care is a daily endeavor, our successful completion of the survey will require the cooperation and support of every provider and staff member. After the survey, our competitors, affiliates, managed care and insurance companies, referring physicians and, most impor­tantly, our patients and their families will be able to read the details of our performance. I believe the results they see will truly reflect that every UTMB faculty member, clinician and employee at every level is committed to providing excellent patient care!

Why is a good accreditation survey so important? The Joint Commission accreditation survey is a nationwide seal of approval indicating that UTMB meets high quality and safety perfor­mance standards. It says we deliver the best care to all of our patients in a safe environment. Therefore, we must remain committed to zero patient harm, a culture of safety, and continual process improvement. Never ignore or tolerate unsafe conditions, behaviors and practices, and when or if we see something that could be unsafe or cause harm, we must communicate clearly and close the loop on conversations with our team. If needed, escalate issues. It’s simply the right thing to do for our patients.

Our success on the survey will require everyone’s familiarity with Joint Commission requirements in their particular area, and I have full confidence in our teams that we will be fully prepared for the survey. Please review the materials provided on UTMB’s Joint Commission website, including readiness checklists and the preparedness handbook. If you are a manager or supervisor, review employee readiness tips with your team when you have your weekly relay meetings, especially handbook sections “How to Participate in the TJC Survey” and “Other Helpful Hints for the Survey” on pages 12-13.

Spanish novelist, poet and playwright Miguel de Cervantes once said, “To be prepared is half the victory.” Perhaps the other half is to remain vigilant!

If you have questions about Joint Commission standards, please contact Janet DuBois, Associate Director of Accreditation. For more information on Joint Commission Accreditation preparedness in your area, please visit

Thank you for your dedication to delivering excellent care and service to our patients and families!

Unless we think together, we will fail to get the best out of one another!

Donna Sollenberger, EVP & CEO, UTMB Health SystemThere once was an executive named Joe, who worked for a medical device company. Joe was very worried about the device that he was working on. He thought that it was too complicated, and he thought that its complexity created margins of error that could really hurt patients.

He wanted to find a way to help, but when he looked around his organization, nobody else seemed to be at all worried. So, he didn’t really want to say anything. After all, maybe they knew something he didn’t. Maybe he’d look stupid. But he kept worrying about it, and he worried about it so much that he got to the point where he thought the only thing he could do was leave a job he loved.

In the end, however, Joe did find a way to raise his concerns. And what happened then is what almost always happens in this situation—it turned out everybody had exactly the same questions and doubts! So now Joe had allies, and everyone on his team was thinking about how to solve the problem together. And yes, there was debate and argument, but that allowed everyone around the table to be creative, to solve the problem, and to change the device.

By speaking up, Joe wasn’t undermining anyone’s work. In fact, he was improving the overall quality of the team’s work and protecting others from harm. Joe had always been passionately devoted to his organization and the higher purposes that the organization served, but he had always feared the conflict that would result from speaking up. When he did finally speak up, he discovered that he had not only contributed much more to the team than he had ever imagined, but his colleagues did not think negatively of him—they thought of him as a leader.

The story above was borrowed from a presentation by Margaret Heffernan, a writer and keynote speaker who frequently presents on how conflict avoidance and selective blindness can lead organizations astray. Fear of conflict is the very thing that leads to communication breakdowns and broken processes, which in turn, result in preventable errors.

We know from the premise of our Culture of Trust that significant safety failures are almost never caused by isolated errors committed by individuals. Rather, they result from multiple, smaller errors in environments with serious underlying system flaws. This is why regular feedback and communication is important.

A couple weeks ago, I shared a story about my own experiences with constructive feedback, and how at times, I have also found it uncomfortable to give and to receive. However, I realize the importance of constructive conversations, and even though they may involve a difference of opinion, they are a very necessary part of conducting safe, effective and successful work for several good reasons:

  1. We don’t always have an internal cue that lets us know that we’re wrong about something until it’s too late.
  2. Without a shared understanding of people’s points of view when it comes to concerns, people might blame problems on other people, and not where it actually should be, like broken or inefficient processes.
  3. Continual two-way feedback allows people to focus on one or two areas for improvement, rather than having to address a much larger problem that has already caused harm or will require significant intervention and time to resolve.

If we truly care about providing the safest care for our patients, we will be committed to speaking up. Continual quality and safety improvement is the right thing to do. As we observed in Joe’s case, speaking up helped the team and the individual to achieve success. That is why we have to be willing to listen to and consider what others are saying to us. Individually, we must keep an open mind and be willing to work through problems strategically. As a team, we know this is important because it will ultimately help us succeed. Unless we think together, we will fail to get the best out of one another!

Whether we have a gut feeling about the condition or functionality of a device, or we feel concerned that a care process may be unsafe, we need to act with safety in mind and speak up. In health care, we are accountable for our own actions and for those of our team. As we go about our important work, let’s be conscious of any system design that may potentially cause harm if we do not identify the flaws and fix them before a patient is affected. Instead of being afraid of conflict, we have to address the issues head-on.

My job is to make sure that you have what you need to be able to take care of our patients. If you don’t, my hope is that you will make your manager aware, and if you are the manager and you cannot get what you need to ensure your team can provide the right care at the right time in the right way for your patients, you will continue to escalate the matter, without fear of consequence, until you get a resolution. This does not mean that the decision will always be exactly what you want or asked for, but you should receive an answer and a resolution that leaves you with a sense of closure.

Remember: “You can blame people who knock things over in the dark or you can begin to light candles. You’re only at fault if you know about the problem and choose to do nothing.” – Paul Hawken

Defining Moments

Donna Sollenberger, EVP & CEO, UTMB Health SystemToday, I couldn’t help but think about how events in history shape and define us. For each generation, there has been a major historical event or time in history that people remember as having irrevocably changed their lives.

For my children’s generation, and for most of us, we remember where we were and what we were doing the morning of September 11, 2001, when two planes flew into the twin towers of the World Trade Center and two others into the Pentagon and a small town in Pennsylvania. It was the single largest loss of life from a foreign attack on American soil and a day we would never forget.

My generation remembers the assassination of President John F. Kennedy. He was a leader who could inspire and motivate people, and we can tell you exactly where we were when we heard the news on November 22, 1963. My parent’s generation remembers Pearl Harbor Day—it was just before eight o’clock in the morning on December 7, 1941, when hundreds of Japanese fighter planes attacked the American naval base at Pearl Harbor near Honolulu, Hawaii. The next day, the U.S. joined World War II. And for my grandparent’s generation, it was the Wall Street Crash of 1929, also known as Black Tuesday. In the aftermath, America and the rest of the industrialized world spiraled into the Great Depression, the deepest and longest-lasting economic downturn in history up to that time.

In all of these instances, the world changed and so did we. But just as our lives can be shaped by world events, we are also shaped by personal life experiences. We are shaped by happy occasions that become memories we hold dear, like the day we met our best friend or spouse, or the birth of a child or a grandchild. We are shaped by events that whisk us down paths we had not anticipated or wanted, like the death of a loved one or a life-changing health diagnosis. We are shaped by temporary events, like recovering from a storm or healing from an injury. Even though we may fully recover, we are yet changed by our experience.

Even witnessing the life events of others can be transformational. Early in my career in hospital administration, I had a defining moment that changed me forever. Since that time, I have approached my work and my outlook on my day in a completely different way. I want to share that experience with you.

It was after seven o’clock one evening, as I was packing up my “homework” in my office. In my mind, it had been a terrible day. I don’t recall what had made it so terrible, but I do remember I was glad it was over. I was in a pretty bad mood. My office was on the second floor, so I took the stairs down one flight to the main lobby. As I pushed open the door, I noticed a young family seated in the lobby. I could see the mother was a cancer patient. She wore a scarf on her head and was surrounded by the tubes connected to her IV pole. A man who appeared to be her husband was seated across from her, and there were three children sitting on the floor around them. They were all smiling and laughing.

I stopped in my tracks. Suddenly, I felt very selfish. Here I was in a bad mood, completely focused on the terrible day that I had, while there was a family sitting before me who had every reason to think and act like they were having a bad day, but they were smiling and enjoying each other’s company. I decided right then and there I was not going to have bad days at work anymore. I realized that my attitude about each day was based only on my perspective, not reality. As long I remembered the reason I came to work each day—to help others take care of our patients in the best possible way—then all of my days would be good days.

I also realized that I had a responsibility to carry myself in a positive way, because our patients were counting on all of us. Winston Churchill once said, “Attitude is a little thing that makes a big difference.” I know from my own experience as a patient that when we are not well, we tend to be more focused on ourselves than we are normally. The same applies to family members preoccupied by concerns about a loved one. That’s why our patients and families need us to stay focused on them, and they want us to be supportive, understanding and compassionate. The interactions they have with us largely determine how they perceive the quality of their experience.

I recently received a letter from a family member that demonstrates how everyone on the care team, from those who deliver care to those in supporting roles, like financial services, makes an impact:

“Thank you for all of your help with my mother-in-law’s account. I have been taking care of the financial needs for my father-in-law since he is taking care of my mother-in-law now until she passes…I want to let you know how appreciative we have all been during this very difficult time. [My mother-in-law] will most likely pass away any day now, and it has been very difficult for my wife and father-in-law, as you could imagine…Everyone that was providing care for her has been absolutely amazing. We could have asked for a better outcome but not better care or service. I will never forget our time in Galveston at the hospital and how impressed I was with the care [she] got. Thank you.”

I know how busy you all are, and I appreciate the work that you do to make sure that we are caring for our patients in the best possible way:

  • For those of you in direct patient care who are having the busiest of days but still take time to lend an ear to a patient in need of support or to share a few words of encouragement, thank you.
  • For those who finish the day having met the needs of your patients only to face an evening of documentation or a long list of emails and MyChart messages, thank you. Please be assured that we have heard your concerns and are working hard to improve our processes and systems so that you will be able to spend more time with your patients and your families.
  • For those who see a colleague in need of assistance and come to their aid, thank you.
  • For those who answer phone calls and do all that you can to help a patient get an appointment scheduled or a question answered, thank you.
  • For every smile you give, or every time you stop to give directions or help a patient or family member to their destination, thank you.

This day of the year reminds us of the fragile and unpredictable nature of life. Thank you to each and every one of you who comes to work each day ready to support our patients and their families, sharing in the joyful moments, as well as the sorrowful ones. We never know when that kind gesture or swift and skillful intervention will be the defining moment in someone’s life.

positive attitude

Create a culture in which excellence can flourish.

Donna Sollenberger, EVP & CEO, UTMB Health System“Whatever you or the public may consider quality to be, this definition is always a safe guide to follow: Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.” ~Will A. Foster

Each New Year is a chance to commit to what we hope to achieve in the future. Last week, we established four areas in which we will focus to be successful this year: continued investments in our people, quantum leaps in quality and safety, transparency with our outcomes, and the wise use of our resources. In this first Friday Flash message of FY16, I’d like to explore our focus on quality.

Quality is defined as the standard of something measured against other things of a similar kind—the degree of excellence of something. It can mean everything from caliber or condition, character or worth, and it can be good or poor. Defining health care quality, however, is a little more technical. In fact, if you conduct an internet search for the words “health care quality” you’ll find a long list of organizations working to promote health care quality in hospitals, and you’ll also see numerous guides on how to improve in areas like patient outcomes, 30-day readmissions, and healthcare-associated infections. You may even find an infographic or two on reimbursement calculations!

To make a long story short, much of what is out there is written by the health care industry for the health care industry—and it is complex! As an industry, we even have had to find a way to state it simply to steady our focus. The Agency for Healthcare Research and Quality (AHRQ), the federal government’s leading agency, defines quality health care as “doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results.”

But what do our patients and their families think “quality” health care means, and what do they expect of us when we say that we are committed to quality? Several years ago, in an issue of the Journal of the American Medical Association (JAMA), Dr. Allan Detsky, an internist and health policy expert at the University of Toronto, identified criteria that patients expect when asked what they really want from health care.

He found, as one would expect, that patients want the best health care—they want to know that their care team is highly qualified and experienced, and they want to know the care they will receive is reliable, based on feedback from people they know, a referring physician, or other patients. This is not to say that patients don’t value statistics—our quality performance is currently publicly reported, so patients can compare us against other providers and know whether or not we are an excellent place to come for health care. It’s simply that they are more focused on whether the treatments they will receive will work in their specific case or condition.

The list of criteria is long, but the following are the most important aspects of care patients identified:

  • Timeliness. Patients desire access to services in a timely fashion.
  • Kindness. Patients want to be treated with kindness, empathy, and with respect for their privacy.
  • Hope and certainty. Even in dire situations, patients want to have hope and be offered options that may help. Patients and families are uncomfortable with uncertainty about diagnoses and prognoses. Therefore, they want to feel well informed, participate in decision making, and prefer active strategies.
  • Continuity, choice, coordination. Patients want continuity of care and choice. They want to build a relationship with a health care professional or team in whom they have confidence and have that same person or team care for them in each episode of a similar illness. They want the members of their health care team to communicate with each other to coordinate their care.
  • Privacy. Patients want to be hospitalized in their own room with their own bathroom and no roommate (this is something we proudly offer our patients at UTMB).
  • Low out-of-pocket costs. Patients want to pay as little as possible from their own pocket at the point of service delivery.
  • Medications and surgery. Patients prefer treatments that they perceive will require little effort on their part. Essentially, they want to feel “well taken care of”.

There is a much more important, patient-focused reason for making quality improvements: it’s the right thing to do. When we safely heal people and they have a positive experience in our care, they are more likely to follow through with their doctor’s advice and manage their disease processes, which leads to better patient outcomes and healthier patients in the future.

So, let’s focus on our patients’ experiences, with the understanding that they already trust us to do the right thing by delivering safe, evidence-based care and they trust us to monitor our own performance, much in the same way that we all trust airlines to make sure the plane is functioning well before takeoff!

Every individual in every role at UTMB impacts the patient experience in one way or another. This is why we must all focus on making the necessary changes to create a culture in which excellence can flourish. Whatever our work entails, we should reflect on the following:

  • Do we work together as a team, and are we committed to a culture of trust and safety, in which we can express our thoughts and concerns and constructively think together?
  • Do we demonstrate integrity by always doing the right thing for our patients and their families?
  • Do we show compassion and respect to all, so we not only work well together, but so that we are able to comfort patients and families during challenging times, or support them so they are motivated to heal? Do we promptly respond to patient and family concerns, whether by phone or the call button? Are we willing to take the time to explain things clearly and answer all of their questions?
  • Do we value diversity so that we can understand patients’ perspectives and preferences and fully engage them and their families in making decisions about their care and treatment?
  • Are we committed to lifelong learning, so that we are able to apply new knowledge and always explore better ways to enhance outcomes while remaining vigilant to assure patients’ safety?

If we are firmly committed to quality, and we practice safety measures the same way, every patient, every time, we will not only improve our performance, but we will be better able to focus on the experience of our patients and their families. At UTMB, we should always be able to look people directly in the eye and say: “The care you will receive at UTMB Health will be the same care I would want my most cherished of loved ones to receive.”

The bad news is time flies. The good news is you’re the pilot.

Donna Sollenberger, EVP & CEO, UTMB Health SystemWhen I was in grade school, time seemed to stand still. The school year seemed to last forever, and it felt like summer would never arrive. The days before Christmas (which my family celebrates) were the longest days imaginable. The hands on the clock seemed to stand still as I waited for my cousin and best friend to come over to play.

I have a vivid memory as a twelve-year-old. I was sitting on the steps of our front porch and thinking about my grandparents, who had recently come to visit. I was worried about getting old like they were—I didn’t want to grow old! However, when I did the math, I realized that they were 62, and I remember promptly feeling much, much better because that was such a long way off!

Now, fast forward to this past December. All of my children and their families were visiting for the holidays. Both of my twin sons and their wives had become parents that year, and they were enjoying introducing their daughter and son to all the members of our family. I remember one evening as we all sat around the living room, one of my sons commented on how quickly time had seemed to pass, “It seems like it was just last week that we were all together for the winter holidays.” I smiled as I wondered how he grew up so fast and was now married with a daughter.

These days, time seems to fly!

It is almost unbelievable to me that this is the last Friday Flash Report of fiscal year 2015, and next week we will publish the last Friday Focus Newsletter of the year. Many of the plans we made when we started this year are now complete. The FY2016 budget is behind us, as are all of the performance evaluations. The 84th legislative session came to a close in June, and we made some additional strides in service to patients through the Correctional Managed Care program. We have also worked hard to integrate the Angleton Danbury Campus into UTMB, and implemented UTMB’s electronic medical record (Epic) throughout the site.

We have made tremendous progress this year! Each day, I’m amazed by the view from my office, as I see the beautiful new Jennie Sealy Hospital nearing completion. I look forward to celebrating its opening next spring. I continue to marvel at UTMB’s growth off the island. From the League City Campus to the Angleton Danbury Campus, to the openings of the Primary and Specialty Care Clinics in Texas City and Alvin, and the new Pediatric Urgent and Primary Care Clinic in Galveston, it has been a year of progress and growth, and these exceptional facilities will help us better serve our patients and train future physicians, nurses and health professionals.

Although the past year was challenging at times, it is anticipated that the Health System will meet its budget on the close of business August 31, 2015. And in addition to all of this, we have achieved many new certifications that speak to the talent, skill and teamwork involved in making sure that our patients receive the very best of care. To all of you who have worked so hard to help UTMB achieve this growth and success, thank you!

We have a lot to look forward to in the upcoming fiscal year. Thinking about all that we aspire to achieve, we realize there will be more hard work ahead of us, and we will surely be met with a few new challenges, as well. But I am certain we will rise to the occasion and succeed by remaining focused on the initiatives that will move our organization forward.

In the coming fiscal year, our focus in the Health System will be to:

  • Make a quantum leap in our quality and safety performance. We already have many strategies in place to address and improve our performance in the quality measurements of value-based purchasing, including patient satisfaction, 30-day readmissions, healthcare-associated infections and hospital-acquired conditions, as well as hand hygiene. While we have seen some improvements in the past year, all other organizations to which we compare ourselves have also improved, and some have improved more quickly than we have. We must achieve greater improvements in quality and safety!
  • Continue investments in our people. We will refer to the results of the upcoming You Count! Pulse Survey to continue to identify and act on improvements you recommend. I am not sure if you know it or not, but Friday Flash Reports began as a result of feedback from Health System employees who asked to hear more from me about where we were headed and how each individual in our organization plays an important role in our future. Many of the new offerings for training in Human Resources have also been resulted from survey feedback.
  • Achieve a $49M improvement in net patient care margin. We have developed action plans which address the needed improvements, and we will need to utilize all of our resources effectively in order to meet this goal.
  • Become more transparent. You will soon be seeing UTMB’s quality information reported publicly on our website. The data will be front and center for our patients and community to easily access. Some of the information will be specific—for example, patient satisfaction responses will be presented at the provider level. Some organizations are already doing this, and we believe it is critical that we share how we are performing in these areas with our community and our patients in a timely and accurate manner.

The future will be here before we know it. If we maintain a laser-like focus on these four areas—the continued investments in our people, quantum leaps in quality and safety, transparency with our outcomes, and using our resources as wisely as possible—the future will be filled with promise.

I always look for inspiration, whether it’s in something I’m reading, a story about one of our employees, or a conversation I have along the way. In his commencement address to the 2005 graduating class at Stanford, Steve Jobs asked the audience if they could remember the last time they had asked themselves why they were doing something, or why it mattered to them. He said, “Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do.”

We are all in health care because we believe in what we do. I love what I do. Although I do not deliver direct patient care, I make an impact and that matters to me. Through my work, I am helping make a difference in people’s lives. I’m able to support those who do work on the front lines of health care. And I believe in delivering excellent patient care. I believe in keeping our patients and families safe and at the heart of everything we do. I believe in offering the very best facilities and services for our employees and those we serve. And I believe that if we remain dedicated and focused, we will be successful in all our endeavors this year.

Happy New Fiscal Year, and thank you each for all you do to make UTMB a great place to receive care and a great place to work!

The bad news is time flies. The good news is you're the pilot.




Inspire others to dream more, learn more, do more and become more

Donna Sollenberger, EVP & CEO, UTMB Health SystemThe other day, my husband and I were talking about what I had learned during my 40-year career in health care. During the conversation, he asked me what I thought had been the best compliment I had ever received over the years. This was a really tough question, because I have worked with so many people who have generously shared their positive thoughts with me. As I thought about this, the story of an associate with whom I had worked early in my career came to mind. She had been one of the managers at the same small medical school in Central Illinois I mentioned last week. I’ll call her Susan.

Susan and I had worked together for nearly ten years, and it was a pleasure working with her. She was older than I, but she didn’t have a lot of experience working with faculty, so there were times when her decisions were not as inclusive as they could have been, or she had made decisions without gathering sufficient input. As I worked with her over the years, I provided feedback to help her improve in those interactions and to fully develop the potential I knew she had. I always appreciated that she listened attentively and made appropriate adjustments in her management style.

Years later at my going away party, I remember talking with Susan. She had been asked to take my position! Although I cannot recall everything she said that evening, I do remember that she said she would miss me, and I had been the only person she’d ever worked with who was willing to take the time to talk to her and give her guidance on ways she could improve. Even though I was giving her corrections, she said she still left the conversations feeling good about her performance and about herself. Without a doubt, that may be one of the best compliments I have received in my career.

I have always found giving constructive feedback to others about their performance to be very difficult. But when I think of Susan, I remember that it not only helped the team succeed, it also helped Susan achieve personal success. I think most people would agree that such conversations can be challenging. As a result, people handle it differently. Some would rather ignore problems to avoid conflict, even if it means the problem will grow. On the other hand, there are individuals who have very little difficulty pointing out what someone did incorrectly, yet they often deliver the message in a way that leaves the person on the receiving end feeling discouraged.

Whether you are a manager or a colleague, delivering your message in just the right way takes thought, skill and practice. I always try to keep in mind that most people come to work because they want to make a difference. So, I like to balance positive feedback with constructive feedback. I try to begin with something positive and complimentary, focusing on what the person is doing well. Then, I give feedback on what they can do to improve. The latter may not mean they are doing something wrong. It may simply be that there are suggestions for ways they can achieve their full potential.

I like to think of providing feedback like coaching. Coaches give feedback in real time, rather than letting things pile up. Regular feedback allows people to focus on one or two areas for improvement, rather than feeling bombarded. At the end of each practice session, the team huddles. After carefully listening to the team, it’s time for the coach to offer some helpful advice. It isn’t the time for negative criticism; rather, constructive criticism is what people need. These conversations should always happen in person (never send constructive feedback via email). This gives both parties—the coach and the team—an opportunity to talk about things in context and share their perspectives. Giving feedback is a conversation!

Suggestions should be complete so people know what they should do, and they should feel encouraged. The best feedback leaves people feeling empowered. It’s also helpful to ask questions, which gives the person receiving feedback a chance to reflect on what they might do differently. I’ve found that most of the time, people feel more motivated to make changes when they’ve realized something on their own. This does not always work, but it is a great place to start.

Meanwhile, asking questions is also an opportunity to discover what I can do to help the person improve. Am I providing clear enough direction? Am I allowing the person to have development opportunities? Am I sufficiently available for discussions? Do I listen well enough? Sometimes, in the course of the conversation, we find ways we can improve, too!

I would be remiss if I didn’t admit that it can sometimes be difficult to receive constructive feedback. However, as recipients, we need to be willing to focus on what is being said and not take it personally. We need to want to improve and to do that, we have to be willing to listen to and consider what others are saying to us. Constructive criticism is a two-way street. For the best results, you need to not only be a skilled coach but also someone who is coachable. In order to effectively communicate, you must be good a listener.

Above all, I believe it is important to remember that people want to feel appreciated for their effort, especially when they were proactive or showed initiative to take on a project or task. Without a sense of appreciation, a motivated employee or colleague may take a step back in the future, finding it safer to stay silent, or preferring to wait to be told what to do instead of taking a hands-on approach.

Tom Peters is an American writer on business management practices, who asserts that leadership is about nurturing and enhancing. Leaders who lift people up get farther than those who push down. Do everything you can to support your employees and colleagues, whether it’s resources, knowledge, information, or thoughtful and constructive advice.

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If you aren’t in over your head, how do you know how tall you are?

Donna Sollenberger, EVP & CEO, UTMB Health SystemEarly in my career, I worked as the administrator in the department of surgery of a small medical school in Central Illinois. It was a wonderful setting to begin my administrative career, because I had the chance to experience many opportunities I wouldn’t have otherwise been given at a much larger medical school.

One of those experiences surfaced around the advent of the personal computer. Our chair of surgery decided he wanted to replace the institutional mainframe with a local area network (LAN) for the whole department. And that would not have been a problem, except for the fact that he wanted the department to manage it, not the chief information officer (CIO) for the school.

The chair assigned one of our researchers, an individual with a great aptitude for computers, to negotiate this change with the CIO. After three months of meetings, however, neither side wanted to budge on who “owned” the network.

At that point, the chair told me that he wanted me to “broker” this deal and get the CIO to concede the management of the network to the department. Because he was my boss, I agreed, but I have to tell you I was reluctant—I knew very little about computers and even less about personal computers and local area networks! The only thing that boosted my confidence was that I generally could get people to come together and reach an agreement, even when they had not been able to before.

At the first meeting, I let the researcher and the CIO do most of the talking. I asked them to tell me, from their perspective, how each envisioned the system would be configured and implemented, and what each thought the barriers were to reaching an agreement. As the talking continued, I remember thinking that the meeting might as well have been in a foreign language, because I was not fluent in half the terminology they used once they got into specifics. I left the meeting wondering what I could ever do to move this discussion along, and I was a little concerned about whether I could actually get these two gentlemen to agree.

Rather than accept defeat, I began reading everything I could about LANs and their configuration, the future of the mainframe in a world evolving to use personal computers, and how others had managed similar implementations. I knew that in order to accomplish the job I’d been assigned, I had to educate myself. Although I was daunted by the learning curve, I was also energized by the possibility of learning about something which was definitely going to change how we worked.

When the project ended two months later, I had successfully brought the researcher and CIO to an agreement. Today, the details of that agreement have faded from memory, but what I do remember is that the CIO agreed to support us in putting the LAN in the department as a pilot for the rest of the medical school, the researcher could define the configuration, and the system would be maintained by the CIO and his team. Meanwhile, I had become the “go to” person in administration for other departments as they each began to implement their own networks.

Albert Einstein once said, “The only source of knowledge is experience.” I had used an opportunity to increase my value to the organization and better prepare myself for a changing future. And, I had helped the departments involved maintain a positive relationship.

I believe that with the right attitude, we can completely reframe the way we experience challenges—we can take advantage of challenging situations to unlock our untapped strengths and abilities. Each time we do this, it will increase our confidence until we begin to see most challenges as opportunities to harness our personal power to an even greater degree.

I am reminded about this story each time we take on something new. We have a choice: we can either resist change or even try to keep the inevitable from happening; or, we can personally take the necessary steps and contribute to making the change a success. If you refuse to let challenges intimidate you or slow you down, you just might inspire and motivate others to do the same when they face obstacles of their own. Anytime you experience personal growth, you help the people around you in some way!

ts eliot

Trust: The Most Essential Ingredient

Donna Sollenberger, EVP & CEO, UTMB Health SystemLast Friday, I began physical therapy to rehabilitate my knee. On my way to the appointment, I was incredibly nervous. I had been told by my doctor that any slight movement could cause the patella to slip, and if it did, I would face the potential of surgery.

As I got myself into the passenger seat of the car, I started worrying about all sorts of things. What if we got into an accident and I injured my knee? What if I started movement of the knee at therapy, and the patella slipped?

Once in the treatment room, my physical therapist, Patrick, began explaining to me that we would start out by “loosening” the knee, seeing how far we could bend it, and we would end the session with trying to ride the stationary bicycle (only using some simple back and forth motions, not full rotations).

To say I was reluctant to let Patrick begin therapy on my knee was an understatement! I am so used to being in control, and at that moment, I was anything but in control. As I halfheartedly let Patrick begin therapy, I realized that in order for this to work, I had to follow his lead and completely trust him with the process. Without trust, this situation was not going to get any better. He was the expert; I was not.

Then, I remembered a quote by Stephen Covey about trust: “Trust is the glue of life. It is the most essential ingredient in effective communication. It is the foundational principle that holds (together) all relationships.”

As I did the exercises over the next hour, I began to think about how many times we are called upon in our lives to trust one another. Why was I so quickly able to trust Patrick in this instance? I trusted him because he had been my therapist four months earlier after a previous surgery, and the results were exceptional. I developed trust in his work, and the outcome of that trust was a well-functioning knee. I remember so many people commented on how well I was walking, they couldn’t even tell that I had surgery.

In many respects, developing trusting relationships is not unlike the work we do at UTMB, particularly in patient care. Our patients trust us to help them and to do the right thing. For that to happen, we must effectively communicate with any number of individuals on the care team. Creating a culture of safety requires trust and respect of all people working together on behalf of the patient.

A culture of safety does not happen when people are afraid to speak up. When people don’t speak up, there is no trust, and that has the potential to be harmful. We all have a responsibility to speak up when we see that shortcuts are being taken, rules are being bent, or that the system or process has the potential to do harm. As a member of the team, we must be ready to graciously welcome the feedback, because we realize that concerns are being voiced purely out of concern for someone’s safety and well-being.

Anytime a person speaks up and they are responded to with disrespect or disregard, trust is eroded, and the person who spoke up will be much less likely to speak up in the future. The person who will be harmed in such a scenario is innocent: the patient. That is not at all what we want.

In a culture of safety, the person who speaks up also has a responsibility to do so in a caring and respectful manner. It is hard to admit one is wrong or about to take a risky shortcut, so if the communication is not handled respectfully and tactfully, a loss of trust is also at stake. It is important not to point blame at the receiver of the message—no one wants to feel blamed; rather, the concern is being voiced in the context that it is helping to avoid a potential mistake.

I recently read an article about why people are reluctant to speak up, and I can relate to each reason:

  • Confronting people is difficult; too many people prefer to avoid conflict rather than respectfully addressing the issue
  • Others feel that speaking up is “not their job”
  • Some are not confident that speaking up will do any good
  • And other obstacles are time and fear of retaliation

My physical therapy has shown me the importance of trust in carrying out my plan of care, but I also feel I have a responsibility to speak up if any of the therapy movements are causing me pain or I do not “feel right”. The saying, “no pain, no gain” may be true in some instances, but it is better that I speak up and let Patrick consider if we should continue or not. If I do not, I am not being a responsible participant in my care.

I hope as we go about our work this week, we will think about our personal responsibility to create a culture of trust and safety by respectfully speaking up, or if we are on the receiving end of the message, to graciously accept our colleague’s message.

Always Trust your Instincts

Donna Sollenberger, EVP & CEO, UTMB Health System“Always, always trust your first gut instincts. If you feel something’s wrong, it usually is.”

It was a Thursday morning three weeks ago, and I had started my morning the way I usually do – I got up, got ready for work, and went into the kitchen to grab my lunch from the refrigerator before leaving the house. As I rounded the corner, I was greeted by small bugs all over my kitchen floor! I immediately grabbed the insect spray and started spraying. The bugs were exterminated, but now the floor was very slick. I knew it was too dangerous to leave it that way, so I grabbed a mop and began cleaning the floor.

With the chore completed, I picked up my keys and briefcase, but I remembered I still had not grabbed my lunch. As I started carefully walking across the kitchen floor, it occurred to me that doing this was probably not a good idea—what if the floor wasn’t completely dry and I slipped, or worse yet, fell? The moment after I had that thought and yet took another step, my left leg slipped forward, my right leg bend backward, and I heard something snap. You guessed it; I broke my leg.

I cannot tell you how many times I have replayed that split second in my mind. Each time I think: “What if I had listened to my gut? I knew better, but I did it anyway!” We all have an internal alarm system that alerts us when a situation feels wrong. I ignored my instincts, and now I am dealing with the consequences.

In many ways, this reminds me of conversations we have had about patient safety and our own efforts at UTMB to create a safer environment for our patients and employees. Our culture of safety demands that we should always speak up and stop what we’re doing if we see or even instinctively feel that something could have the potential to harm a patient.

Last week, the National Patient Safety Foundation released a report entitled, “RCA2: Improving Root Cause Analyses and Actions to Prevent Harm.” The report asks hospitals and health care providers to approach close calls or observed systemic flaws with the same rigor that they do when a major safety event occurs.

The report says that even though the use of the term “culture of safety” is common in health care today, as an industry we have not really made the necessary progress, because creating this culture involves “hard, continuous work and can challenge the status quo.” The report points out that often, safety event reporting systems like our Patient Safety Net (PSN) are used to report what has already happened, not what could have happened, simply based on the system’s design.

As health care providers, we must constantly evaluate the systems in which we are delivering care, and when we are concerned that any system may have flaws, we need to act on those instincts. If we do not, we may be putting our patients at risk.

Once, in a hospital at which I’d worked, a nurse submitted a PSN report to document that the new tubing we had transitioned to for IV delivery was occasionally crimping, thus slowing the delivery of the patient’s medication. Our safety team went to the unit, looked at the new tubing, and realized the nurse was correct. They immediately ordered new tubing, replaced it throughout the hospital, and addressed the problem.

In this instance, the nurse’s instincts were right, and she acted on her instincts. Although we will never know the actual number of patients’ lives that were positively affected by this nurse’s decision to act on her instinct, what we do know is that we were able to correct a system flaw before any patient’s well-being was compromised.

I am certain there are countless stories we could tell of nurses, physicians, residents and other health care staff who have acted on their instincts to keep patients safe. The point is that they acted.

As we go about our important work, let’s be conscious of any system design that may potentially cause harm if we do not identify the flaws and fix them before a patient is affected. Let’s act on our instincts. I certainly wish I had three weeks ago!

Positive Moments, Healing Moments

Donna Sollenberger, EVP & CEO, UTMB Health SystemAlong a patient’s journey, she or he will encounter many different representatives of UTMB. From our website to the access center, from parking attendants to the hospital welcome desk, then on to registration, waiting rooms, nurses, physicians and more. There are so many people and settings making first impressions that can affect a patient’s experience, and the sum of all parts creates their overall impression of UTMB Health.

While the ongoing improvement of our processes will always be an aspect of enhancing the patient experience and improving the quality of care we deliver, there is one simple thing we can all do to help our patients and families feel better—radiate positive energy and compassion.

Patients want to be cared for by a team of caregivers who show an interest in them as individuals. This isn’t only important in terms of what we consider to be the “surveyed” patient experience, either. When patients feel comfortable with their care team and trust them, they are more likely to follow through with care instructions, which means fewer readmissions and an overall improved quality of life for many patients.

As a caregiver, if you walk into the room and appear pre-occupied, in a hurry, and start out by using downbeat comments, you will radiate negativity. If on the other hand, you start out with a smile and a nice compliment directed toward the patient, they will begin to feel comfortable interacting with you and will appreciate having you as their physician, nurse, or tech. Hippocrates said this so well over 2000 years ago: “Where there is love of humanity, there will be love of the profession.”

Do you remember the last time you were sick or injured? Did you feel as though you needed to stay in bed or you were told to stay in bed? To an extent, this is good as we heal, but over a period of time—even days, we might begin to feel depressed, because we are no longer active; or we may begin feeling discouraged, because we miss our regular ability to move around and perform our daily routine.

Have you or a loved one ever been a patient in the hospital? Did you understand everything the clinicians said to you? I have heard many patients and family members express how just a few words of encouragement helped them through a difficult time, or a care team member spent some time listening to the patient, and it made all the difference in that individual’s experience.

When a patient senses a positive and encouraging attitude from their care team, they will feel more motivated to push through challenging times in their recovery. A great example of this came directly from a patient advisor as she recounted her recent experience at UTMB: “My care tech was motivational, positive and cheerful, and that really made me want to get out of bed and get moving so I could get better.”

Beyond a doubt, patients want to be engaged in their care and to understand what procedure is being performed and why; they want to know the identity and role of each individual who enters and exits their room. They want to know what to expect while they are in our care and what they can do to heal better and faster. But they also want to feel as though they are cared about, not just cared for.

Making a positive impression on our patients and families can be achieved in just a few simple ways:

  • Smiles are powerful, so smile!
  • Take a deep breath before entering each patient’s room and exhale slowly if you’ve been rushing about. This allows you to leave the stress at the door and enter the room with a positive attitude.
  • When speaking, try to do so slowly and clearly—research shows that individuals who do so are perceived to sound more credible than those who speak quickly.
  • Allow patients and families the chance to ask questions, listen to their questions and concerns, and ask them to verbalize their care instructions.
  • Maintain a friendly, open and engaged demeanor. This includes your body language as well as your verbal language.
  • Make eye contact. It clearly demonstrates that you are actively listening to the patient, which they will appreciate.
  • Acknowledge others in the room, such as a family member. Be sure to get their name, and shake their hands, if appropriate. This acknowledgment is very important since you want to create a positive impression with the family members—they will play key roles in the patient’s compliance; and keep in mind, the family member is also going back to the community to share their experiences.

I hope you will take a moment to watch the following five-minute video, shared by the Institute for Healthcare Improvement. It is the story shared of Gilbert Salinas, a patient who was inspired to become a patient advocate because of the wonderful care he received almost 20 years ago. It is the story of a nurse holding a hand, a physician pulling up a chair, and a therapist helping a paralyzed man reclaim a life. It is a story full of positive energy – and lessons for students and health care professionals everywhere.

Whatever your role at UTMB, how do you contribute to a better patient experience? How do you want the UTMB Health System to be perceived by our patients and families? The little things we say and do speak volumes, symbolizing our attitude toward patient care and the medical services we offer. Our compassion and the positivity we radiate can make a big impact in someone’s life!