Wednesday, April 16, 2008

Straight talk about SPIRIT

After each full-day training session for managers and others about BIDMC SPIRIT (almost 600 people now), there is a debriefing session. The comments that emerge are helpful to us in refining both the training program and our plans for calling out and solving problems throughout the hospital. To give you a sense of the issues raised, I am posting the comments from the last session. Remember, this is early in the process, not like at Toyota and other places where similar approaches have existed for decades. So, we are still feeling our way. I love that people are so open and clear about what they find reassuring and what they find troubling. That, in itself, is an important aspect of what we are trying to accomplish.

BIDMC Spirit Orientation
Participant Concluding Reflections
April 15, 2008
These reflections were invited by Ken Sands, our SVP for Health Care Quality. He started by saying, "We heard earlier today from a colleague about how logging of items about their unit had been used as a metric that wasn’t positive." Responses follow:

That was me. I did get a call from someone above me who said in effect, "There are a lot of call-outs in your area there must be some real problems there; what’s going on?" when it’s 4 out of 450 and I know we are trying to encourage call outs. I wanted to say that I’m a big supporter of this process, but it has been confusing regarding are we supposed to deal with things as they are called out and up "the help chain" or by getting calls from people above us or reacting to an e-mail from the log monitor? Are we supposed to scan it everyday? It’s not clear and it’s hard to know how to prioritize. We talked about it earlier today, and we discussed how we are all learning together including the leaders, but it’s important to be aware of this dynamic because it creates pressure and anxiety.

Thanks for saying that. The other day we had an issue and I ended up talking about it with the other manager by saying, "Maybe we can do a problem solving without logging it." And we actually had a phenomenal response; fastest ever. But there’s something about the log, it’s very visible, monitored, punitive potentially. It just feels like a difficult environment for me to call out in, at least at this stage.

The last five years have seen a great focus on greater accountability. We just don’t want to slip into blame.

I wanted to say that SPIRIT does empower us to deal in areas where we’ve struggled … it makes it much easier to engage on issues we’ve struggled with. I do have a suggestion about the training; make it easier to make a personal connection in the set-up, with phone numbers etc. Finding time was hard for me, so you send an email and you hope for a response but it’s not to anyone in particular.

I’ve been to a lot of trainings like this. The bigger challenge than training is how to keep it going. How does the organization reinforce this; how do we get reinforcement? Reflecting on today, I’m not sure I would have been as persistent and nice in working with the people involved. It’s a discipline. It needs to be reinforced/mentored. This is a cultural change!

My comment is about language. If we changed what we say from "problem" to "opportunity" it might help. Because that’s what they are – opportunities – and even the word problem seems to connote something negative.

It was inspiring to see people on the front line involved in solutions and being asked for their opinion, not just told. Being asked, "What do you think about this?" and "How would this idea come across to your peers if we rolled it out?" That was totally inspiring.


Anonymous said...

Very interesting indeed. I assume this debriefing is verbal and public; therefore the commenters have to have the courage to speak up - not a small thing here. There are no doubt many others who would like to comment but are scared; I assume there is a way for them to be heard?

I find the appearance of the word 'punitive' in the comments to be not quite ominous, but an early warning sign. Any perception that this project is going to be used in a punitive manner will kill it faster than you can snap your fingers. I recommend forcefully and VERY publicly nipping that perception in the bud!

And thanks for tolerating my constant unsolicited advice; it's just that I've been there, done that, in similar projects that failed. I want to see you succeed!

nonlocal MD

Anonymous said...

Love your comments! Thanks.

You are right on target. Any hint about blame or punitive reactions is a killer. We are always very, very sensitive to that.