More Thanksgiving thoughts

This post is prompted by the following note from one of our chiefs to his staff:

You can't fail to hear from most everyone that Thanksgiving is "my favorite holiday." No exceptions here. Among other things it is a stimulus for me to reach out, express awe and appreciation for the exemplary jobs you do in fulfilling our collective mission. This is not easy work, but the rewards are beyond measure. Thanks to you on behalf of our patients and this medical center.

I have the good fortune to work in a marvelous place like BIDMC, surrounded by well-meaning people who spend their time helping others deal with illness and disease and the real dramas faced by families as they go through difficult times. There are happy times here, too, when people are cured of their illnesses, and the happiest of all, when babies are born and new life arrives -- literally in rooms just a few floors above my office.

While there are daily challenges in the hospital environment, it is the underlying good will of people in these places that is the dominant characteristic. As teenagers in the 1960's, my classmates and I were inspired by John and Robert Kennedy and Martin Luther King, Jr., to enter careers of public service. In our self-centered way, we used to think of our generation as special in that way. But in this place, I see people in their 20's through their 90's who are devoting their lives to alleviating human suffering caused by disease. It is a marvelous commonality of purpose that binds us -- people of all ages, nationalities, religions, and races.

Before I worked here, I wondered (along with many of my friends) if people who worked in hospitals cared anymore. Much of what you hear about hospitals from the outside is related to complaints about insurance rules, difficult working conditions, burnt-out doctors, harried nurses, and rude front-desk staff. I have learned and want to assure my readers that the folks in hospitals do care and care deeply, but the health care environment is often not well suited to bring out the best in people. (By the way, I have learned through my travels that this is not just a US problem.)

Beth Israel Deaconess is characterized by a kind of warmth, compassion, and respect that is legendary, but even it can be a tough and tiring place to work. I view my job as CEO as trying to create a workplace that reflects the deep underlying values of our staff, working to minimize those aspects that inhibit or impair their ability to carry out their heartfelt mission. In this, I am warmly and strongly supported by our lay leaders, members of the community who volunteer to serve on our boards and have the ultimate governance and fiduciary responsibility for this institution. Not many of us are given the privilege of heading up an organization like BIDMC, so I am trying to use my tenure here to make a positive difference for the people who work here.

Last week, I sent the following email to our staff along these lines. Like other things I have shared with you about BIDMC, I am sharing this one. Those of you who are new to this blog might find it surprising that I do so. Regular readers will not be surprised. A hallmark of this administration is transparency -- even when such openness is awkward or embarrassing -- because holding ourselves publicly accountable is the best way for us to improve.

I will also keep you informed of our progress as we move through implementing the program outlined in email. I do so because I think we will learn a lot about ourselves and about the path towards process improvement. I am very confident we will flub up aspects of this as we move along. There may well be those out there who will be quick to judge when we do. But as an academic medical center, one of our jobs is to share what we learn so that it might be helpful to others here in Boston and throughout the world.

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Dear BIDMC,

What's the most important activity at our hospital? Providing patient-centered care?

Right!

But what do we spend most of our time doing? Patient care??

Wrong. It is fetching. As in spending time trying to find a piece of equipment, a certain paper form, or some other supply. Or it’s re-doing work. As in writing the same piece of information in 3 different places.

Admit it. If you are a nurse on the floor or the OR or the PACU, a respiratory therapist in the ICU, a person cleaning surgical instruments in CPD, or a practice assistant in a clinic, think of how much time you spend fetching instead of actually taking care of a patient or doing the job you’ve been hired to do to support patient care – whether that’s running lab tests, preparing food in our kitchen, or repairing a broken piece of equipment. How much of your day is spent in these ways versus face-to-face time with patients or in doing something tied directly to patient care and the support of that care? If you are a typical person here, it is way over 50% and more like 80%.

But I don't have to tell you that, do I?

We might have the latest in cutting edge technology to take care of our patients and the finest doctors, but in a big institution like BIDMC -- like in most hospitals -- the organization of our work is based on patterns and systems that might as well be 100 years old.

The practice of medicine in academic medical centers like ours is a cottage industry. While other fields and industries have progressed in terms of process improvement, ours remains woefully behind.

Every day, thousands of you undertake "work-arounds" to solve the problems you face in delivering care. And you do solve those problems -- by dint of personal commitment, hard work, and good will. As a result, our patients get extraordinary care.

But, because we all invent work-arounds, we often don’t solve the underlying work process problems that pervade every aspect of what we do. And you go home feeling really tired and wondering how you really spent your day.

Over the next several months, we are going to start a program to work on these problems. Our goal is simple. We want to improve the quality of the time you spend here at BIDMC so you can focus on the things that matter instead of working around problems you encounter.

While the goal is simple, the solution is not. We want a solution that will identify and start to solve problems on the floors as they occur. We want a solution that will uncover and fix underlying problems, not result in yet another set of work-arounds.

We have been studying other efforts around the country and have come up with an approach that we think makes sense for BIDMC.

Recently, we had a chance to spend some time with people from a group called Value Capture. They relayed the content of speech by former Secretary of the Treasury Paul O'Neill at the Harvard Business School. He outlined the three questions every employee should be able to answer with a resounding "Yes!" every day in order for an organization to have the potential for greatness:

Am I treated with dignity and respect by everyone I encounter, regardless of role or rank in the organization?

Am I given the knowledge, tools and support that I need in order to make a contribution to my organization and that adds meaning to my life?

Did somebody notice I did it, i.e., am I recognized for my contribution?

Does that sound right to you? It feels right to me. The Value Capture folks, who have done this in some other places, are going to help us design the program for BIDMC.

Let’s be honest. We can’t all answer "Yes!" to these questions today, and, in fact, in many instances we don’t even come close. But our goal is to get there. If this works, we will set a new standard for staff satisfaction and participation in the operation of an academic medical center.

The program will involve some training and new approaches to our work. Most of all, it will involve you. Don't worry. It will not be painful. It may actually -- dare I say this? -- be fun! And in the long run, we won’t see this as a "program", but rather just as the way we constantly improve work and care at BIDMC.

Have I got you curious? I hope so. Stay tuned for more details this winter.

In the meantime, though, I need help. Every program has to have a name. What should we call this one? I am hoping for something decidedly unbureaucratic -- and maybe even with a sense of humor. Please write back with your ideas.

Best wishes to you and your family for a lovely holiday!

Paul