Trust: The Most Essential Ingredient

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Always Trust your Instincts

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

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

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

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

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

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

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

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

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

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

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

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

Positive Moments, Healing Moments

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

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

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

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

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

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

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

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

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

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

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

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

 

Working Hard: Allow Your Purpose to Be Your Passion

Donna Sollenberger, EVP & CEO, UTMB Health SystemIn the past couple of years, I have started using social media, because I have found it to be a great way to keep in touch with family and friends, whether they are nearby or living across the country. Most often, my social media platform of choice is Facebook, because it is a terrific way to see pictures of my grandchildren each day and watch them grow.

I also enjoy seeing people’s posts of their favorite sayings. Even though the sayings do not always resonate with me on a personal level, from time to time, I come across a saying that really strikes me. This happened a few days ago when someone posted: “Working hard for something we don’t care about is called stress. Working hard for something we love is called passion.” How true!

Years ago, my daughter, Shannon, was in the final stretch of completing her MBA program, and she had started interviewing for jobs. She was considering offers at several big consulting firms, as well as a large energy provider. She called me one evening to talk about her dilemma. While the amount of money she could make if she chose to work at one of the consulting firms or the energy company was appealing, she kept thinking about an interview she’d had with United Way.

She told me that she really wanted to take the job offer with United Way, because she felt she would make a bigger impact in other people’s lives than she would at a consulting firm. Making an impact was really important to her. Yet, her friends kept telling her it would be a mistake to choose a non-profit organization, because she would never make the money there that she could earn in the private sector.

She and I talked about this for a while, and then I gave her my advice: We will all spend many hours at work, which will add up to a good part of our lives—we will often spend as much time with our work colleagues as we do with our own families, if not more. Thus, we should love what we do, so that when we get up each morning, we are energized at the possibilities that are before us at work.

My daughter eventually took the job with United Way and has not looked back. For Shannon, she put her business degrees to the best use by making the business case for individuals to give to those who are not as fortunate as many of us.

I’ve had the opportunity to work with many master’s prepared students over the years, and in the capacity as their preceptor, I have been able to provide career guidance. My message to them as they consider the various areas within health care they could work is to choose their passion. If you are passionate about your work, you will always love what you do.

I know that we face many changes and challenges as an organization, yet each day, I am excited to come to work. While I cannot provide direct patient care, in my work, I can influence decisions that will directly and positively impact our patients. I also have the opportunity to hear each day about the ways each of you positively impacts our patients and their families. That, in itself, is enough to keep me motivated and passionate about what I do.

I started a habit many years ago. Each day as I drive home, I try to reflect on the biggest impact I made that day. This practice has helped me to remain focused on the positive, rather than on the things that I found stressful or non-productive. I end the day with a smile on my face and feeling good about the work I have accomplished.

I hope that each one of you will focus on the positive contributions you make each day at UTMB. I know as I hear from your colleagues, your patients and their family members, you are each making positive contributions to the overall success of UTMB Health. Let’s make a habit of starting and ending each day thinking about the positive possibilities and the positive work that we impact. In doing so, we will remain passionate about our work and its impact on others.