The most common question I get--worldwide--after I give a talk or seminar on creating a learning organization to improve clinical processes in hospitals is: "I really like what you are saying, but what can I do if those above me in the organization have not adopted the philosophy you espouse." I respond by saying, "Start small, and just try to get something fixed in your area, working with other like-minded people. Maybe the ideas will spread organically. Maybe they won't, but at least you will have made things better for some."
Well, May Wong from Sydney didn't need my advice. My buddy Sarah Dalton at the New South Wales Clinical Excellence Commission told me the story:
Several years ago in her intern year, the thing that most frightened May was having to participate in a resuscitation. To alleviate part of her anxiety, she checked the resuscitation trolley ("code cart" in our region) in her ward to be intimately familiar with the location of every device or supply she might need if an emergency arose.
A few weeks later she was working in another ward, and a code was called, and she found to her dismay that the trolley on that ward was organized differently, and she had difficulty finding the airway equipment.
She said to herself, "This is ridiculous. Shouldn't every cart be organized the same way?" And she decided to get the problem fixed.
She started knocking on doors. Her registrar (senior resident) said, "That's the way things are." Her consultant (attending physician) said, "That's not my problem." The nurse manager said, "It's not a problem. All of our nurses know how to find what they need."
Eventually, someone suggested that she should talk to the Director of Clinical Governance. She searched around to find out who the DCG was and where to find him, and he said, "Oh, is that a problem? I didn't know." He said, assemble a team, collect data, construct a statement of aim, come back to me, and suggest the change concepts you want to implement.
So she did. She brought the issue to the Resuscitation Committee, gathered other junior medical offices, invited the nurses from several wards, and even engaged the medical head of the ICUs. And she got it done. By the end of her intern year, all of the resuscitation trolleys in the hospital were organized in the same way.
But things didn't stop there. May went on to work with other house staff to create a regular forum in which they could compare their quality and safety improvement ideas and progress and help one another with suggestions. It is now a regular part of the hospital's culture.
What can you do? May has provided you with the path to your answer with her thoughtful actions.