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.”

Staying the Course

Donna Sollenberger, EVP & CEO, UTMB Health SystemAbout two months ago, I underwent knee surgery. Today I am still in the process of recovering, but doing very well. The day I was finally off my crutches was an exciting day, and not long after that, I was able to walk completely on my own again. I still see my physical therapists, Patrick and Lindsay, here at UTMB on a regular basis. During a recent therapy session, Patrick told me that I am indeed making great progress, but now I needed to begin working on my gait.

I thought, “My gait? This is how I’ve walked my entire life!” He explained that because I was recovering from surgery, I had naturally compensated for my recovering knee by leaning a little to one side as I walked—I now needed to focus on centering my body more evenly above my hips, think about the amount of weight I put on each leg as I walked, and I should push off from my big toes. There were many instructions!

As I tried to remember each correction, I realized I actually had to concentrate to walk with proper posture and gait. Although I’m not entirely certain how I’ll change these long-time habits, I know I have to stay the course to improve so I can be in the best physical condition. It’s going to take time and effort!

After my therapy session, I attended a special presentation by Dr. David Henderson, primary author of the Society for Healthcare Epidemiology of America Guidelines, who presented valuable information on the prevention and treatment of bloodborne pathogen exposures.

After the lecture, I walked back to my office from Levin Hall Auditorium, and I decided to stop in the cafeteria and quickly grab something for lunch. There, I saw Karen Chapman, director of Rehabilitation Services. I took the opportunity of our chance meeting to tell her that I could never have recovered so quickly without the help of all the wonderful physical therapy staff members, and that I am very grateful for the excellent care I have received.

Karen told me that she was very pleased I had a good experience, but she had noticed as she walked behind me after the lecture that my knee might be better, but now it was time to work on my gait. “Seriously?” I thought. “Why is everyone so interested in my gait?”

Back at my desk, I thought about my morning appointment and the conversation I had with Karen, and it reminded me that it is much harder to learn to undo something you’re used to than it is to learn something new. It is also easy to slide back into the old way of doing something if we don’t maintain our focus. For example, I noticed that when I concentrate only on walking properly, I can walk as I am supposed to walk; but as soon as I am distracted, I slide right back into my old gait.

In health care, we have so many changes hitting us all at once. No wonder people feel stressed and overworked. The pace of change is unlike any I have seen before. It makes sense that we have a hard time making real and sustained change. However, I know that if we prioritize our work and stay focused on the highest priorities, we will eventually reach the point where we will have real and sustained change. This is why everyone in the Health System is working very hard right now to narrow the list of new priorities for the coming year so we can remain focused on opening the new Jennie Sealy Hospital, making the new League City Hospital a success, and most of all, taking great care of our patients.

It is truly amazing to see how much progress we’ve made just in the last few years, and it is very exciting to know we’ll soon be caring for and supporting our patients and their families in these amazing new facilities. I remember when we first began planning for our new future, the many projects at hand seemed daunting. At the time, opening day of the new buildings seemed far away in the future.

From that point forward, everyone at UTMB understood that we would have to stay focused, and we had to remind ourselves regularly that achievements of this magnitude could only be made by taking the process one day at a time. And here we are today–it’s the first day of May 2015 and we are starting the move into the new Clinical Services Wing, preparing to open the new League City Hospital early this fall, and by next year at this time, we’ll be in the new Jennie Sealy Hospital.

While it seems that new initiatives arise just as previous initiatives are completed, there is something I can say with certainty: our accomplishments are remarkable. Every single individual at UTMB Health has played an important role in that success and should be proud of their contributions.

There is a quote by author Marabel Morgan: “Persistence is the twin sister of excellence. One is a matter of quality; the other, a matter of time.” With steady focus and determination, new changes not only get easier with time, but before we know it, we have reached our goal, and we are better and stronger than before we began!

Teamwork and Trust

Donna Sollenberger, EVP & CEO, UTMB Health SystemContinuing with last week’s theme of college basketball (and in honor of March Madness), I thought it would be interesting to talk about some of the different aspects of basketball that foster teamwork and trust. It is fascinating to me that a group of individuals can join together as a team, and even though many of the team members may have never played together in the past, they can become good enough over the course of two to four years that they can always count on one another to be at a particular place on the court during a set point in a specific play.

Practice after practice, the team drills the offensive and defensive plays developed by their coach to become consistent, and through this intense practice and repetition, the plays become second nature—the team develops an intense trust of one another and their coach, and decisions about passing and shooting become instinctive.

The one move that amazes me most is the blind pass, which occurs when the player with the ball looks in one direction but passes in another. This is done to confuse the opposing team’s defense. It is not an easy move, and it is definitely risky, but when it happens and works, it is truly remarkable. I remember the first player I ever saw do this with any regularity was Pistol Pete Maravich, but other greats such as Isaiah Thomas, Magic Johnson, Larry Bird, Steve Nash and Michael Jordan all also used this pass with some regularity. And most of the time, this type of pass successfully caught the other team off guard, resulting in points scored.

I would imagine in order to effectively carry off the blind pass, each member of the team must understand everyone’s roles well, knowing they can count on one another to be where they should be at a specific moment and time, doing their defined job; they also have to believe their teammates are sufficiently capable. This is really the only way any team can optimally perform!

In many respects, we have our own blind passes in health care. For example, think about how important it is for each member of the team in the emergency department to know their own role as well as that of others on their team. They must trust and have confidence in one another. When seconds matter, as they often do in the ER, being able to act deliberately, consistently and predictably can mean the difference between life and death. And, it is the same in the operating room and on the inpatient units when acting decisively is critical to the outcome for the patient.

In the clinics, the pressure of time may not be as intense, but when a patient needs an appointment or calls with an issue they need to discuss with us, it is important for each member on our team to know their role and perform predictably. If not, we ultimately let the patient down, and our lack of responsiveness could mean we have lost the opportunity to intervene during a time when we could help prevent the patient from becoming increasingly ill and/or having to be admitted to the hospital.

Finally, a good blind pass requires great communication on the court—and, so it is with health care. As we work in teams, being able to be open and forthright with each other regarding the care of each patient is essential. It is critical that every member of the team respects one another and encourages each other to speak up when they are concerned about any aspect of the patient’s plan of care. After all, it is only in an environment of mutual respect and explicit trust that people feel comfortable speaking up. A team is not a group of people who merely work together; a team is a group of people who trust each other.

Phil Jackson is an American professional basketball executive, former coach and former player, who currently serves as president of the New York Knicks in the NBA. He says, “Good teams become great ones, when the members trust each other enough to surrender the ‘me’ for the ‘we’”.

So, how will WE work together to work wonders for our patients and their families today?

An Act of Kindness Allows a Man to See Daughter Graduate

Donna Sollenberger, EVP & CEO, UTMB Health SystemI hope you all are familiar with the Health System’s Friday Focus Newsletter. The Health System publishes the newsletter for our employees each month to share exciting accomplishments and important news within and across the Health System. UTMB employees are always invited to suggest topics for the newsletter or to submit their own stories.

Last month, Dennis Santa Ana, patient care facilitator of Unit J9A CT Surgery/Vascular Surgery, also known as UTMB’s Dedicated Cardiac Care Unit, sent in a story about how his team came together to help a patient enjoy a special moment with his daughter. Upon reading the story, I thought it was so touching that I decided to save it for this Friday’s message!

The Dedicated Cardiac Care Unit is unique in that it is much more than a regular hospital patient unit. It is equipped with specialized monitoring devices like those found in an ICU, such as electrocardiogram (EKG) and atrial electrocardiogram (AEG). It is designed for patients who require specialized cardiac care, such as individuals who have recently undergone a heart transplant or have had a Ventricular Assist Device (VAD) implanted.

The comprehensive care the unit team fosters close relationships with patients. Dennis Santa Ana says, “Patients feel like we’re family and they know they can call any of us individually any time to get help. We’re here for them. We become more than health care providers; we are counselors and friends. We become their support system.”

That’s what Santa Ana’s story is all about…

An Act of Kindness Allows a Man to See Daughter Graduate
by Dennis Santa Ana

Recently, UTMB’s Dedicated Cardiac Unit (J9A) admitted a patient with advanced congestive heart failure, a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body’s other organs.

After a right-side heart catheterization, the primary care team determined the patient needed to be started on intravenous cardiac inotropic drugs, which would help improve his heart function by helping his heart beat more strongly. The team hoped this combination of therapies would allow him to be discharged home once he achieved hemodynamic stability (normal blood pressure or adequate cardiac output).

Despite these interventions, the cardiac drips only minimally improved his heart function, and after the results of additional diagnostic tests were received, the primary team concluded that a heart transplant would be his only hope for survival. The patient’s medical condition had deteriorated to the point that it would not be safe for him to wait at home for the heart transplant, and he would need to remain as an inpatient during the waiting period. From this point on, his life had changed—his prognosis was uncertain.

One day while receiving treatment, the patient told his nurses his greatest wish was to see his daughter graduate from college that month, but he feared this may only be wishful thinking, because he understood he was in no condition to leave the hospital for the ceremony.

His nurse shared his wish with the other members of the nursing staff during one of their informal discussions. The team began brainstorming for different ideas to help the patient and decided they could use the internet to Skype or FaceTime during the graduation ceremony. Several of the nurses coordinated with the family regarding the plan, and one of the nurses obtained the university’s website where the graduation would be streamed live.

On the day of the graduation, the nursing staff set up their conference room so they could stream the ceremony onto the large projector screen. One of the nurses even served popcorn for the occasion. The patient was able to watch the entire graduation ceremony, and thoroughly enjoyed it—he was happy and proud to see his daughter receive her college diploma. The patient was very grateful to the nursing staff in J9A for giving him this rare opportunity to witness a once-in-a-lifetime event.

Excellent patient care is treating the whole person, mind, body and spirit. It’s more than providing the best medical care possible for our patients. It is also about providing that care in an atmosphere of kindness and compassion. I’d like to thank Dennis Santa Ana for taking the time to share his team’s story and to give special thanks to the nurses of J9A for exemplifying excellence, compassion, teamwork, advocacy, critical thinking and patient- and family-focus!

“Love and kindness are never wasted. They always make a difference. They bless the one who receives them, and they bless you, the giver.” —Barbara de Angelis


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!

Plate Spinner Extraordinaire!

Donna Sollenberger, EVP & CEO, UTMB Health SystemThere is an old episode of the Ed Sullivan Show I’ve thought of often, lately. It features a man who may quite possibly be the most famous and skilled multitasker that ever graced the show—a man from Austria, Erich Brenn—plate spinner extraordinaire.

Brenn was a master at the art of plate spinning. His routine consisted of spinning five glass bowls on four foot-long sticks all while spinning eight plates on the same tables. Intermittently, he also managed to balance a tray carrying glasses and eggs and in one swoop would remove one of the trays causing an egg to fall into each glass.

He would also carry a separate tray lined with glasses and spoons in front of them. With a simple flip, every spoon would magically fall into a glass. All of this, of course, was done while keeping those glass bowls spinning atop their sticks. As some sticks began to slow down, it would cause the glass bowls to wobble uncontrollably—often getting a rise out of audiences thinking the bowl would soon smash to a million pieces. Just in the nick of time, Brenn would run in and save the day!

Erich Brenner spinning bowls and plates on the Ed Sullivan show. View the video below.

Erich Brenn spinning bowls and plates on the Ed Sullivan show. View the video below.

With so many initiatives underway as a result of a reforming health care environment and the progressive work taking place at UTMB, I often feel like we are spinning plates and bowls ourselves! Every day, our health care teams work hard to ensure our patients and families receive the highest quality care, and they are continually working to develop more efficient processes and new models of care. Meanwhile, many others are looking at ways we can improve access to our system and enhance communication with our patients and families—all multifaceted initiatives. Other projects include the improvement of documentation and reporting, so we can better understand how to improve care delivery and reduce readmissions. With the time we have left after all of this, we are garnering new accreditations, maintaining current accreditations and preparing for our upcoming Joint Commission reaccreditation survey—just to cite a few examples.

But wait, there’s more! (It’s time to add a little more suspense to our spinning act.) At UTMB, we are working hard to become the preferred health care provider in the region for our patients, partners and referring physicians. Our entire organization is buzzing with new construction and facility renovations. Meanwhile, we’ve been working around the clock to prepare for the launch of our new partnership with Angleton Danbury Medical Center, an exciting opportunity that will help us bring a number of important services to patients throughout our region. Our colleagues in Revenue Cycle Operations have collected over $10 million in additional cash beyond our targets this year. Many of you are involved in Medicaid 1115 Transformation Waiver program projects, and there are many end-of-year tasks to complete, like navigating our way through a new performance evaluation tool, completing annual compliance training and wrapping up the budget.

Just like Erich Brenn spinning plates and bowls on the Ed Sullivan Show, it can sometimes seem like a true marvel that we have accomplished so much at UTMB. Sometimes the plates spin a little faster, sometimes a little slower, but I can certainly say that, whatever challenges we accept, you all rise to the occasion, managing these tasks with grace under pressure and incredible skill. Just as importantly, you do it all through teamwork and realize that we are in this together for the ultimate benefits of our patients and families. Because we move forward with such momentum, I think sometimes it can be easy to forget to reflect on all that we have accomplished within the course of just one year—it is tremendous. With this in mind, I want to be sure you all know that UTMB’s executive leadership and I realize how hard you all work to help UTMB be successful. We thank you for everything you do!

Integrity: The Foundation for Building a Culture of Trust

Donna Sollenberger, EVP & CEO, UTMB Health SystemWarren Buffet, widely considered the most successful investor of the 20th century, is chairman, CEO and the largest shareholder of Berkshire Hathaway, a multinational conglomerate holding company. He once said, “I look for three things in hiring people. The first is personal integrity, the second is intelligence and the third is a high energy level. But if you don’t have the first, the other two will kill you.”

A person can have all of the capability to achieve greatness, and they may be successful in many of their endeavors, but if they are insincere—the opposite of someone with integrity—they are not very trustworthy! When a person’s trust level with others decreases, it diminishes their credibility and causes others to question their motives, agenda and behavior. This person will spend a lot of time and energy covering their tracks and carrying the load on their own.

There is a saying, “Character is who you are in the dark.” Integrity is a quality of character that can’t outwardly be seen by others; it’s how we would act if no one was looking. People with integrity do the right thing whether or not they will be recognized for it. They believe in what they do and why they do it. When a person acts with integrity, they stand firm in their values. That is why integrity is at the heart of building a Culture of Trust at UTMB and why it is one of our core values, guiding us down The Road Ahead.

Jim Collins wrote a book, Good to Great, based on a five-year research project that compared teams who made a leap to greatness with those that did not. He found that greatness is not primarily a function of circumstance, but largely a matter of conscious choice and discipline. He says that great leaders are “a paradoxical blend of humility and professional will”. These leaders are open to the ideas of others and acknowledge that no one can possibly know it all. Good leaders realize that it is better to act on the right ideas rather than to be the one with all the ideas—they are team players. They do what needs to be done because they know it is what should be done.

Having integrity requires courage—doing the right thing isn’t always easy or comfortable. Integrity is not only important when we are faced with something that hasn’t gone well or during times of confrontation. It shines through when our actions follow our words; there is no gap between our intent and our behavior. Demonstrating integrity, and therefore acting with sincerity and trustworthiness, inspires others to do the same. This is how, by holding the value of integrity in high esteem, we truly help build a Culture of Trust.

We all share in the responsibility of creating a safe and reliable care environment for our patients, their families, and our colleagues. We trust one another to do the right thing, and moreover, our patients and their families trust us do the right thing. But we cannot have a safe, reliable environment without integrity, nor can we ever achieve a Culture of Trust at UTMB.

So, how do we increase our integrity? There are a few simple questions we can ask ourselves each day:

  • Do I genuinely try to be honest in my interactions with others?
  • Do I “walk the talk”? Does the manner in which I speak to others reflect my respect for all those with whom I work? Do my actions?
  • Am I clear on my own values and do I feel comfortable standing up for them?
  • Am I open to the  possibility of seeing another side of a debate that may cause me to rethink the issues and my stance?
  • Do I consistently make and keep commitments, both to myself and to others?

Mahatma Ghandi once said, “To believe in something, and not to live it, is dishonest.” Compassion, integrity, respect, diversity and lifelong learning—our Culture of Trust depends on how well we demonstrate our core values each and every day.

Recognizing Team Accomplishments, Sharing a Vision

Donna Sollenberger, EVP & CEO, UTMB Health SystemThis week, I came across a posting of monthly clinic stats for the PCP Pediatrics Clinic developed by Practice Manager Ashley Dusek. The creative style she used to help inform her team of the most recent numbers for completed patient appointments really stood out to me. She did much more than simply reveal the data—she helped her team understand why the work they did during the month of February mattered to the 1,421 patients they served.

The post began, “Total Number of Completed Appointments 1,421. Why do I care you ask?” The communication continued:

“Because of you…1,421 patients were reassured their vitals were stable and that their lab work, which you drew, would be processed in a timely manner.

Because of you…1,421 patients were able to receive specialty care, immunizations, or just a simple reassurance by having their medical questions answered.

Because of you…1,421 patients were examined and given the right medications to make it all better!

Because of you…8,943 patient phone calls were answered. They were able to make appointments, ask questions, get test results, get prescription refills and know that we were there to answer and help with whatever they needed.

If you got to the end of this and you still believe you are too small to make a difference, Try sleeping with a mosquito!”

Ashley acknowledged the work her team had accomplished and also recognized that their efforts had positively impacted the patients’ experiences.

When I speak with individuals across the institution, whether their role is in direct patient care or they work behind the scenes, it is clear to me that as an organization, we believe we are ultimately here to serve our patients and their families. We find the greatest satisfaction in our roles when we know that we have provided good service to them and that we have truly made a difference.

Several months ago, when Sharon Johnson, a senior radiation therapist at UTMB, was asked how she felt she impacted the patient experience, her response wasn’t made in reference to the tasks she performs daily to deliver patient therapy alone. Instead, she answered, “I just try to be who they need me to be at that moment. Sometimes it’s a shoulder to cry on, sometimes they need a sister or a mother figure, sometimes it’s just a friend to hold their hand. I give a little piece of myself to the patients and I gain so much in return.”

While we all do what we do at UTMB because we receive the intrinsic reward of helping our patients and families, it also feels good to receive direct feedback that affirms we have made a difference. When our patients are satisfied, we feel satisfied with our performance. However, it can sometimes seem that we more frequently receive feedback about the areas in which we have yet to improve, and perhaps less frequently that our names are called out in a moving patient testimonial that so eloquently describes the true impact that we have made.

That is why, as team leaders, we must be supportive of the work our teams do. It is not always just about celebrating the major milestones; it is also about celebrating the small successes we have made along the way. When we feel good about what we do, we also develop a desire to continue that success—we have a sense of pride and ownership. Therefore, even when we do identify areas needing improvement, we must take care that we are constructive in our approach to both delivering and receiving the message. We want to emphasize fixing our processes, not assigning blame—that is a Culture of Trust.

Much of the work we do in health care today takes place under an umbrella of a changing health care environment. While this change is sometimes difficult, many of the best components of these changes are embedded in improving the quality and efficiency of care as well as the experience of the patient. It will take teamwork to be successful, and this means we are all involved, at all levels of the organization. This is a positive process! It’s important that we share information, celebrate accomplishments and provide timely, consistent and authentic feedback. Our focus of discussion is on how we can build on strengths and past positive experiences. We must do more than identify what is already working well; we need to identify what else can be done to enhance this work.

Tom Morris, author of If Aristotle Ran General Motors: The New Soul of Business, explains that while the pace of change may be at an all-time high, the challenge of change has always been with us. Change is the condition for positive, creative growth. At UTMB, we must stand firm in our values of compassion, integrity, respect, diversity and lifelong learning. We share in the vision of the road ahead, and we will work together to achieve it. We are here to work together to work wonders for our patients and their families!

If you would like to recognize an accomplishment or creative solution, please share with it us! Email us at health.system@utmb.edu