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

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.”

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!

If you want to run fast, run alone. If you want to run far, run together.

Donna Sollenberger, EVP & CEO, UTMB Health SystemAbout six years ago, my daughter, Shannon, decided she wanted to train for the Houston Marathon. Prior to this, she had never run even a half-marathon, so she knew she would need to start training a year ahead of time in order to be ready. She also asked her husband, who was a dedicated runner, to run alongside her the day of the marathon. When I asked her why she wanted Wes to run with her, she said she wanted him there to encourage her to continue when she reached the point in the race where she would want to quit.

The race went as planned, and about two-thirds of the way into it, she “hit the wall”. At this point, Wes encouraged her to keep going and continued to do so until the finish line of the race was literally in sight. They both finished the race! No records were set that day, but the personal satisfaction of finishing what she started has given Shannon a great sense of personal satisfaction. She later told me that had it not been for Wes, she probably would not have finished the race. Meanwhile, Wes told me the satisfaction he got from helping Shannon meet her personal goal was very satisfying to him, as well. Together, they were able to go far!

UTMB’s Chief Medical Officer, Dr. Selwyn Rogers, recently shared a quote that resonated with me. It’s an African proverb that says, “If you want to run fast, run alone. If you want to run far, run together.” Shannon’s vision to run and finish a marathon was supported by her strategy to surround herself by someone with whom she had a strong relationship and who she knew she could depend on for support during her journey to the finish line. Meanwhile, individual abilities like Wes’s endurance and supporting nature also contributed to their shared success in completing an amazing challenge together.

When we set out on a journey, whether it is in pursuit of something we wish to achieve individually or as a team, it’s easy to start off feeling very ambitious. But it’s also important to realize what will be required to sustain our progress. There are a couple of important things about success that Shannon’s experience illustrated to me: it’s important to prepare for our journey, whatever that may be, and recognize when we will need the help of others; and, if we don’t pace ourselves accordingly or don’t have the right support in place along the way, we may either run out of steam or feel like quitting before we reach our goal.

Discovering what we can accomplish as an individual (that is, our strengths and our talent) is something that we can use to support others on our team and encourage them along. Our own personal gifts can often help everyone go further and make the collective achievement even greater. Success is more than simply defining our goals and then determining how we can most rapidly achieve them with the greatest odds of success. It’s about constantly surrounding ourselves with amazing, talented people and building deep relationships with them along the way to success.

These are keys points to remember as we travel The Road Ahead!

Aloha Spirit, UTMB Spirit

Donna Sollenberger, EVP & CEO, UTMB Health SystemMy husband and I took a vacation earlier this month to unwind and spend some quality time with our son, his wife and their eight-month old daughter, who currently live in California. We traveled to Kauai, the oldest and northernmost of the Hawaiian Islands. Kauai is sometimes called the “Garden Isle,” which is an entirely accurate description. It’s covered by lush, emerald green valleys, rainforests, breathtaking mountains and waterfalls. Aside from the fact that the island is inarguably one of the most beautiful places on Earth, one of the most interesting things I noticed was the very warm and welcoming nature of our interactions with the native Kauaian people.

What stood out to me most was that people from the island almost always made eye contact and greeted us in a way that we felt they were genuinely happy to see us. The pace of life there is also different, in a positive way. Nothing is rushed. Meals, car travel, and the beginning and end of the day were always taken in a relaxed manner. Even when people were working, there seemed to be this underlying attitude that life is not about work—people got their work done, but there was less intensity about it. As the week progressed, I noticed my inclinations to hurry my meals, honk at the slower moving car in front of me, and ensure all of my waking hours were scheduled doing “something productive” subsided. I was truly able to experience what the Hawaiians call “The Aloha Spirit.”

In Hawaii, it is common for people to use the word “Aloha”, which in the Hawaiian language usually means both hello and goodbye. The word Aloha is used in a combination with other words, such as Aloha kakahiaka, which means good morning; Aloha auinala which means good afternoon; and Aloha ahiahi which means good evening. But the literal meaning of Aloha is actually “the presence of breath” or “the breath of life.” It comes from “Alo,” meaning presence (front and face) and “ha,” meaning breath.

Aloha is more than a word. Hawaiian culture believes the word Aloha holds within itself all one needs to know to interact rightfully in the world. It is a beautiful concept that is taught from one generation to the next; it is a way of living and treating each other with love and respect. In the contemplation and presence of Aloha, harmony, pleasantness, and patience are also a part of the “Way of Aloha.” The people of Hawaii try and serve with Aloha at work, speak with Aloha to others, and live Aloha every day. It’s even considered a state law!

Aloha Spirit State Law is defined in Hawaii Revised Statutes as the coordination of mind and heart within each person. Each person must think and emote good feelings to others. Its main purpose as a state law is to serve as a reminder to government officials that while they perform their duties, they should treat people with compassion and respect. By learning and applying this lesson to real life, everyone in the community can contribute to a better world—a world filled with Aloha.

So my question to you today is how can we further the Aloha Spirit at our own organization? Better yet, in what ways can we demonstrate the “UTMB Spirit” each day?

With each and every interaction we have with others, let’s try to live and embrace the UTMB Spirit. Let’s demonstrate our core values and hold their meanings in high regard. Think of the picture we’re painting when we treat others with warmth and sincerity, and demonstrate compassion and respect to others. By being mindful of the life events of others—patients, families, visitors and colleagues alike, we make a difference. When we respect others, we value their feelings, wishes and rights; we recognize that they are human beings, and we care about how we treat them. Just as with our core value of integrity, when we respect others, we do the right thing by them because we know it is what should be done.

This year’s Nurses Week and Health System Week is winding down, but we should remember the theme chosen by our nurses for the week year-round: “It’s all about the patient.” Delivering excellent patient care is our mission in the Health System, but what we should emphasize is that every action and every decision we make must be made with the patient and family at heart. If we always remember this, we will never doubt what the right decision should be.

When we work together to identify and embrace the qualities that appeal most to our patients and families, and when we hold ourselves accountable to those practices daily, we build a culture that delivers a consistently outstanding experience to them and to one another. It is up to us to deliver what every patient, family member and employee deserves—the best possible care and a caring environment. And we are rewarded in turn. As the Hawaiians say, “Life is good when you live doing the right thing.” For all Aloha that is given, Aloha will be received!

I hope each and every one of you will demonstrate the “UTMB Spirit” to our patients, each patient, each encounter, every time.


Honoring our past, embracing our future…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThis week, I was honored to welcome attendees to the 2015 Neuro Nurses’ Day Conference, an opportunity for practicing clinical nurses to share and explore recent advances in Neurology and Neurocritical Care. The daylong event was held in the Ashbel Smith Building, which many of you know affectionately as “Old Red”.

As I approached the front steps of Old Red, I thought about what a perfect setting this was for a conference about innovation and advances in health care, because this is where nearly 125 years ago, 23 students and 13 faculty members began UTMB’s legacy to advance health care education, research and patient care. Just five years later, UTMB’s School of Nursing opened as the first university-affiliated nursing school in the U.S.

UTMB was founded as a center for scientific inquiry, a training ground for the future of medicine, and a catalyst for improving the health of society. Since that time, we have earned a reputation for graduating health care professionals who share a deep commitment to excellence, a desire to blaze new trails, and an unsurpassed willingness to leverage their extraordinary expertise to improve the health and well-being of others. Today, UTMB continues its legacy and builds on its rich history. This made me think of a principle that a former mentor had shared with me: Respect all that is good about the past while looking forward to the future.

As we embark on our journey to increase the value (cost + quality) of patient care, we must ground those advances in the history of UTMB that has served us well over the past 125 years. The work we do for our patients is incredibly diverse and often complex. We care for patients from all backgrounds, ranging from the most critically ill to those who seek routine preventive care to stay healthy.thumb_972D434E3BF7486F824579B8DCD36448

Therefore, the work that we do for our students and trainees is also diverse and complex, and it is why we recognize lifelong learning as one of our core values. Despite the complexity and challenges of an ever-evolving health care landscape, UTMB is continually recognized for its exceptional achievements.

Innovative approaches to education, like online courses, are helping us offer students alternatives to traditional classroom learning. Thinking back, I remember after Hurricane Ike, I was so impressed to learn that almost all of our SOM and SON curricula were placed online so students could continue their studies without having to physically be on campus. Now, we offer educational outreach methods on an ongoing basis, like the UTMB School of Nursing’s RN-BSN program, which allows current registered nurses an opportunity to advance their education by earning a Bachelor of Science in Nursing (BSN) degree in a 30-hour, two-semester online program; these innovative approaches to education continue to blossom.

This year alone, nearly 1,000 total faculty members are preparing a diverse student body of more than 3,000 individuals across the fields of medicine, nursing, health professions and biomedical research for a bright future; more than 1,300 of those future leaders will graduate this year.

As I think about our future at UTMB, regardless of the department in which we work, we all have many opportunities to work together collaboratively to make a difference —not just within our own department, but across the entire organization. We continue to seek ways to provide the highest quality of care in every patient interaction. We embrace lifelong learning to grow professionally and take advantage of special educational programs, just like the 185 attendees at this week’s Neuro Nurses’ Conference. We explore ways to share our knowledge and expertise both with our UTMB colleagues and with others who share our commitment to and passion for exceptional patient care.

As we embrace our value of lifelong learning and spirit of innovation, let’s strive to:

  • Reach our fullest potential, personally and professionally.
  • Be adaptable and flexible in our approach to our work so that innovation is a natural outcome of the way we work.
  • Remain open to new approaches and practices in our work.
  • Value the ideas of others and respond in positive ways—this does not necessarily mean we must embrace every idea we hear, but it does mean that we support a culture where new ideas and innovation are welcomed and freely explored.
  • Commit to putting our patients and families first, so that we advance patient- and family-centered care.

UTMB has an unparalleled legacy of service because of the caliber of its people, and in true UTMB spirit, we are thinking boldly about how we can expand the impact of our excellence nationally and globally. Each of us at UTMB Health can best honor our rich history of accomplishment and service by staying focused on our future. We commit to excellence in all that we do as we work together to work wonders for our patients.

Working Together Is Success

Donna Sollenberger, EVP & CEO, UTMB Health SystemIn my recent post, “Your own resolution to succeed is more important than any other”, we explored how UTMB’s vision for the future forms the basis for our goals moving forward, both in the present year and in the years to come. We also affirmed that the key to our success is working together to be the best academic health center. This week, I’d like to talk about why working together as a team, cooperating and forging relationships, is so important to our future.

There is a line in a poem by John Donne: “No man is an island entire of itself; every man is a piece of the continent, a part of the main.” Many of the great things worth doing probably can’t be achieved in isolation, and working together often allows an organization to achieve something that an individual working alone cannot. At UTMB, we want to become the preferred, integrated health care provider in the region for our patients, partners and referring physicians. Simply put, we want to be the best. Therefore, our goals and strategies must also be integrated in as many ways as possible. Through teamwork, we can achieve higher quality outcomes that are more efficient, thoughtful and effective. By doing so, each individual and team at UTMB can garner great support and achieve a great sense of accomplishment.

Success in the modern health care environment is complex and continually presents new challenges. At UTMB, we’ve been progressive in our work and our goals must be ambitious in order to remain competitive and truly become the best. We have a lot on our plates as we take major strides to improve patient satisfaction, patient and family engagement, and the quality of care, all the while lowering costs and improving efficiency. Our resources are limited, and this means we must find ways to team up and streamline our work. As a health care provider, or even as a business, we are not alone in this—today companies, on average, set six times as many performance requirements as they did more than 50 years ago.

However, challenges also present great opportunities for success. The key lies in how we will respond to the challenges. As we strive to develop more efficient processes and new models of care, improve access to our system, and enhance communication with our patients and families (all of which are multifaceted initiatives), we must create an environment in which our providers and staff can work with one another to develop creative solutions to complex challenges. We must be innovative and adaptive. Our solutions don’t have to be sophisticated or perfect, but they have to create greater value. The solutions must be developed by and integrated among teams who work together and depend on one another.

When people cooperate, they use fewer resources; conversely, when we don’t cooperate we need more time, equipment, systems, teams and resources. Staff must compensate for a lack of cooperation, and often, even safety risks can result. Teamwork involves removing barriers that make us self-sufficient. Sharing resources is a good way to make people more dependent on, and more cooperative with, one another. Without such buffers, our actions have a greater impact on one another’s effectiveness. By creating overlaps, streamlining activities, partnering with our partners and affiliates increases the mutual value of our work.

But teamwork is more complicated than cooperation alone. While cooperation is usually for the sake of a common goal that the entire team is working toward—some measurable outcome, a willingness to cooperate stems from relationships that develop between coworkers and leaders. What are the connections, the interactions, and the synapses? Teamwork cannot exist without relationships, even if the extent of the relationship is minimal. Teamwork does not occur if each person does their own thing separately from their work relationships.

To respond to complexity intelligently, people have to really understand each other’s work: understand how each person on the team contributes to the overall process of accomplishing a goal, the goals and challenges others have to meet, the resources they can draw on, and the constraints under which they operate. People can’t find this kind of information in formal job descriptions; they can learn it only by observing and interacting. Without this shared understanding, people might blame problems on other people, and not where it actually should be, like broken or inefficient processes, for example.

In many cases, understanding what people do by shadowing them will provide insights into where and how cooperation is breaking down. Identify individuals in your work area who are already interacting with multiple stakeholders (patients as well as internal partners). These people can act as integrators, helping the teams obtain from others the cooperation needed to deliver more value.

Finally, bring the best out of one another. Know and recognize the strengths of others in your teams and encourage one another to leverage those strengths. Everyone is empowered to use their judgment and intelligence, and feedback is important so we can all understanding where we are performing well and where improvement is needed. Stay tuned into how your team is performing. Don’t be afraid to speak up when you see something that feels unsafe, if you feel concerned, uncomfortable, or think the team should stop and reevaluate a situation. Reward those who cooperate, and don’t fail to ask for help when you need it!

“Coming together is a beginning; keeping together is progress; working together is success.” —Henry Ford

This entry was based on “Six Simple Rules: How to Manage Complexity without Getting Complicated” by Yves Morieux

Perception is Reality

Last weekend, I had the chance to go to the Georgia Aquarium in Atlanta with my cousin and her grandson. I have always loved going to the aquarium. The vibrant colors in nature, like the intense yellow of the angel fish, amaze me. I enjoy watching the sea otters as they play together and swim through the water. My favorite habitat at the aquarium, though, is that of the penguins. I always laugh at their silly waddle and the way they flop forward onto their belly and then slide right into the water—they’re comical on land, but such fast and graceful swimmers.

11-15-14 seeing thingsAs I watched my cousin’s grandson, Cole, observe these sea animals for the first time, I felt almost like it was my first visit. I watched him as he scrutinized each creature’s movements; he laughed as the otters swirled and glided through the water, and he eagerly pointed out a whale shark as it passed over us in the glass tunnel. I have no doubt there will be many more visits in his future!

Watching Cole carefully examine each creature and point out every detail about them made me realize something—as we become more familiar with our surroundings and activities, we often miss the small details. We end up taking what is in front of us for granted, because it becomes a common experience to us.

This is an actual phenomenon, which psychologists refer to as “habituation”. Simply put, it is a decrease in response to something after repeated presentations—the more often we see something, the less we notice it.

This made me think about health care settings, and the fact that as caregivers and employees, we eventually become accustomed to our patient care environments. We become so used to seeing the same setting every day, we may hardly notice when something is out of place, something has collected a little dust, or that a new, unsightly blemish has appeared on a wall, a piece of equipment or furniture.

Because providers and staff are busy focused on patient care, these small details might be easily overlooked; however, patients are looking. I know from my own experience as a patient, when I’m waiting in an exam room, I usually have enough time to give it a thorough inspection. Small details and first impressions have the potential to create a powerful set of assumptions. If patients see something askew or neglected, it may plant seeds of doubt in their minds about quality of care. As an inpatient, one has even more time to examine the details of a room. If something is not working or doesn’t look clean, it may signal to the patient that we don’t care, which is certainly not the case.

Perception is reality to our patients and their families. That’s why as providers and employees we have to practice seeing every aspect of our interaction with patients from their perspective—it’s more important than most of us think.

In fact, a number of studies link a range of aspects of the physical environment to patient safety, patient and family stress and healing, improved overall health care quality and cost, and even staff stress and effectiveness. The physical environment shapes every patient experience and all health care delivery, including those episodes of care that result in patient harm, according to the Agency for Healthcare Research and Quality (AHRQ). According to the NIH, various studies conducted at ambulatory care centers also show the physical environment has been associated with favorable patient outcomes.

The lists of physical features in care environments that are associated with positive patient experiences can be quite comprehensive, but some of the principle demands are an environment that:

  • Promotes safe behavior by patients, staff and visitors – for example plentiful, visible hand washing and hand disinfection stations.
  • Prevents accidents – for example ensuring spills are promptly cleaned up to prevent slips and falls.
  • Encourages patients and staff to feel reassured – through adequate interior and exterior lighting, visibility of security personnel, and, in the case of inpatient care, secure storage for personal items such as glasses, keys and money.
  • Reduces stress, anxiety and aggression – through the provision of pleasant, comfortable waiting spaces, feedback and communication on waiting times and priorities, attention to ambient temperature, light and noise, etc.

These aspects can be further supported by robust monitoring and reporting, demonstrating a Culture of Trust, and having a sense of personal responsibility and willingness to admit safety concerns and report mistakes, should they occur.

On a regular basis, take an unbiased look at your patient care or service environment. Try seeing it from the patient’s perspective. What would be your first impression of the waiting area? Does furniture or equipment need repair? Is it dirty or scuffed? What does the front desk look like? Is there excessive or old signage? Are patients and family members warmly greeted on arrival? What do the exam rooms and/or inpatient rooms look like? Are ceiling tiles damaged? Is the work area cluttered? Is paint peeling or scuffed?

These are just some examples of things of which we should remain aware. I believe we do a wonderful job at UTMB of providing an excellent care environment, but we should always be vigilant. We need everyone’s help!

  • Report facilities issues that need maintenance; if the problem does not get fixed or you don’t have a response within a week, escalate it to your supervisor
  • Keep clutter out of the hallways
  • Assure all supplies are not expired and that they’re properly stored
  • Check for expired supplies and medications
  • Ensure refrigerator temperature monitoring, proper food labeling, and cleanliness
  • Make sure linens are covered
  • Eliminate dirty, cluttered work areas

It’s very easy to quickly resolve issues that impact patient care by dialing one number: 2-4040. Requests may also be made with each area’s designated Zone Mechanic. Calls will be routed to the UTMB Service Response Center, which has expanded its service to act as the single point of contact for all clinical support services in the following areas: Environmental Service, Pest Control, Food and Nutrition, Clinical Equipment, Nursing Unit Support, Maintenance, Utilities, and In-house Construction.

More information on these topics can also be found on UTMB’s internal web site, The Joint Commission: http://intranet.utmb.edu/qhs/TheJointCommission/default.asp

Thank you for the part you play in keeping UTMB hospitals and clinics beautiful and safe for our patients and our staff!

Safety Doesn’t Happen by Accident

Donna Sollenberger, EVP & CEO, UTMB Health SystemGrowing up, I was somewhat of a rebel. My mother and father were often frustrated with me, because I didn’t want to follow their rules. I couldn’t understand why they got so upset about things like missing curfew, driving outside of town, and having a summer job. I was even more perplexed when they told me they established all of these rules to keep me safe. Really? I thought that sounded a lot like an excuse and not a reason!

But as I became an adult and had children of my own, I experienced what many of us have – I started sounding a lot like my parents when I started creating and enforcing “the rules”. When my kids pushed back, I cringed a little as I heard my own voice echo the words of my mom and dad: “These rules are meant to help you. They’re meant to keep you safe!”

I had to admit, my parents were right—it’s easy to think you’re safe from harm in your own backyard. It’s easy to underestimate that something harmful might happen to us  because the odds seem so small. We sometimes take our safety for granted, not realizing the potential hazards that can be present in our everyday activities. We feel a little overconfident at times, perhaps because we’ve done something so many times before, or we’ve become a little complacent and discount the risks—we think we’re being “safe enough”. However, taking risks and acting hastily are often the very elements that create an environment conducive for an error or accident to occur.

The same is true of safety cultures, and the longer I have worked in health care, the more I have come to appreciate the rules that are in place to keep employees and patients safe. We often emphasize the importance of safety in health care with the patient at the forefront, but the safety of our staff is equally important.

It’s easy to go through the motions of something as common as patient handling, drawing blood, or administering intravenous medications, but these are also some of the most common ways both health care workers and patients can be potentially harmed. Therefore, safety interventions, such as proper hand hygiene and safe lifting techniques, protect not only our patients, but our staff as well. This is why it’s important to practice these safety measures the same way, every time.

A perfect example of a safety intervention in place at UTMB is the barcode medication administration system we recently implemented. This is the system where the nurse scans his or her employee badge, scans the patient’s wrist band, and then scans the medication. Then, the system confirms for the nurse that they have the right patient, the right medication, the right dosage and it’s the right time for administration. Using this system is critical to assuring that we keep the patient as safe as possible. When we follow this process exactly, we almost completely rule out the possibility of a medication error, and that keeps the patient safe!

In areas where we do invasive procedures on patients, rules are in place to assure we are doing the correct procedure. If the procedure is a surgery, for example, the nurse asks the patient to confirm his/her name and birthdate to make sure it is the right patient. Then, the nurse or physician confirms with the patient the procedure they are about to undergo, and they mark the patient’s body on the correct side and specific location where the procedure will be performed. This process is repeated again once the patient is in the procedure room, when the physician calls a “time out”. Here, the physician again confirms the patient’s name and birthdate, the procedure to be performed, and the location. Then, anyone present may speak up to express concerns they have about any aspect of the procedure. These processes are in place to keep the patient safe and to assure that the staff proceed as planned.

If we watch other people on our team for “state to error” risk patterns, every time we see one, it will automatically make us think more about what we are doing. And if what we see is sensational enough, we’ll do more than think about it—we’ll actually react to it. This will not only protect our patients from harm, but we’ll also protect one another.

At UTMB, we work to do everything we can to create a safe and highly-reliable environment for our patients and employees. It is crucial all of our staff remain alert and work together as a team at all times to recognize and avoid potentially unsafe conditions and activities for the safety of all. Remember:

  • Everyone has a part to play in creating a safe and reliable care environment.
  • Slow down. Be methodical and mindful.
  • Support effective safety measures and demonstrate accountability at every step.
  • Report mistakes and system flaws — it is safe and valued.
  • Recognize individuals who act with safety in mind.
  • Speak up when you see something that feels unsafe, if you feel concerned, uncomfortable, or think the team should stop and reevaluate a situation.

Although health care settings are varied and present both common and unique safety issues, interventions to improve safety for patients also improve safety for employees. After all, safety doesn’t happen by accident!

“For safety is not a gadget but a state of mind.”  ~Eleanor Everet