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

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

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

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

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

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

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

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

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

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

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

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

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

Defining Moments

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

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

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

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

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

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

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

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

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

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

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

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

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

positive attitude

Create a culture in which excellence can flourish.

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

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

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

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

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

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

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

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

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

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

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

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

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