Saturday, February 23, 2008

The SPIRIT lives on

Here are several more comments from people being trained as part of BIDMC SPIRIT, our program to enhance the workplace for our staff. I hope you all are not getting tired of this, but I think it is important to continue to share these observations -- both internally and with those of you in other hospitals -- to give a sense of how a program like this gets rolled out and what issues are brought to the fore.

I love the observations – wish they were longer because you can learn so much by watching other people’s work.

Think that seeing other areas of the hospital creates huge benefits in understanding how pieces fit together and how remarkable the people of the organization are.

I like the idea of having SWAT teams who can bring fresh eyes from across the organization to observe and help improve work in each area.

I’m worried about the documentation that may be caused by the Spirit program – we can’t let documentation overshadow problem solving.

There are still some important elements of the program that haven’t been clearly enough defined so I don’t know what to do tomorrow when I get back to work.

We need to get physicians and mangers from the “supplier” areas into the orientation soon so that everyone who is working on problems together is doing it using the same method and eyes and people don’t get stalled on all their early problem call-outs.

I did not expect to be able to see problems since I didn’t know the work well, but I was easily able to see many problems. At one point I saw seven problems in six minutes!

It would be useful to have scripts for starting the investigations that help us get started on the skills that the Value Capture staff demonstrated today.

This experience was so important for helping “throw out what you think you know” and create a whole new way of thinking.

We have to think carefully about what the staff will hear about what is expected of them and of their managers.

I learned the importance of staying on point to fix problems one-by-one so that we don’t try to solve multiple problems at the same time and fail at all of them.

I’d like to know how this process will effect human resource evaluations and whether we will be changing our forms and processes to align them with Spirit.

We have to be careful not to confuse Incident Reporting and Spirit, but also to potentially use both processes on the same problem sometimes to incorporate appropriate (non-patient/worker identified) transparent learning and real time problem solving for some of our dangerous events.

We have to address the off shift, weekend, and holiday help chain or we will make many of our employees very frustrated.

The Spirit program and this orientation create a common ground and a common language for problem solving that will be useful to change our culture.

I would have preferred that the packet that was handed out could have been sent sooner. It was not the same information that came over the e-mail. The positive was getting into the field and seeing all the situations staff are dealing with. Also seeing leaders with experience helping us. Having the direction of people who will be trainers was very helpful.

I agree. During the debrief after the problem solving, hearing from what the other groups worked on in the other departments – their experience, their action plans, that was was helpful to me.

Coming in I dreaded that this would go on for 8.5 hours but it by very fast and it was very informative. I can see it happening. I was involved in the envelope saga. It was amazing to follow it through and see all that can come from one little envelope.

This was a good tool to organize problem solving. It forces focus, etc. Organizationally, it can’t hurt. For me it will definitely help in organizing problem solving and solutions. On the side of needing improvement, sometimes it seemed we were looking for problems. It would have been nicer if there would have been more actual call outs from the staff while we were there. Maybe preplanning to be there at busier times … so we’re there when people are ‘freaking out.’ 

The case examples we did, the role plays, were very good to prepare us and get us ready for the floors. It gave us tools. On the negative, going during lunch time inhibited follow-up. Folks can stagger their breaks on the floor but it’s still a hard time.

This is my second time out. I am less in awe (which means confused). The process seems more “backed up,” clearer. The staff are very open. On the concern side, we are still in the learning phase, and we are supposed to be starting very soon. Some things are still fuzzy … that’s going to be very hard.

The process of building the scientific method in the morning was very helpful but out on the floor in the afternoon it sometimes felt like a solution in search of a problem (when you’re a hammer everything looks like a nail). The staff may be so used to workarounds it was hard for them to get into it. It was great getting into the field … the dialogue with the chief tech was just great.

This was my third time. Its amazing to see it come together. To go from this being very uncomfortable for me today, as co-facilitator, to see the program really shaping up. It won’t be perfect but we need to be ready to say – as I will say to my division – we need to be ok with a little clunkiness. Our biggest challenge and the key will be to really use this to empower the staff.

The roleplays were really helpful and really important to do. I still feel like we need more tools to use to actually solve problems. Not instead of the training we are doing but as a “plus.” There are 10 or 20 key ideas out there that we would really find helpful. A few sessions on those would help.

The positive was to be on the unit and see what staff are dealing with, to see the opportunity to help. Within just one hour to get to the root cause of a problem like that … was great. A concern is the time involved from the help chain people. I also worry how this process will fit with others [internal queuing of work orders], that it won’t be used to move other things to the top of that queue.

This was my second time. It was definitely much clearer and more solid. The training was well organized. I have concerns about people’s time. The little problem in the mail room – the implementation plan is not going to be so fast to come together. It is important to try in real time though. I see that.

The role plays were helpful. Learning about other areas, being non-clinical myself. The tools were a good basis but make them easy to access and painless to use … if not people won’t use them.

I enjoyed the whole day. It gave me a knowledge base of root cause problem solving that I didn’t have. It opened up possibilities for me in my thinking. I want more tools to help promote this in my departments and not have this be seen as burdensome.

As we get to action planning it will reveal tensions in the organization. That’s how we’ve done things in the past, and people dig in. For example, the envelope problem. Some may say don’t do x because we care about y. These things will reveal tensions; it’s how we resolve them that will be key. I also want us to consider the benefit of outside eyes today. When this starts, if it’s just me and my staff working on these things there’s less value in breaking silos and seeing things fresh. I’d like to build in those outside eyes.

The observation was wonderful and helpful. I would have like to review the material, observe in the AM, then come back to process, then go back to the floor to problem solve. It’s easier to start this where we know. I would have liked to have started in our own departments, on problems that stay there. Not jump into things in the middle that cross over into other departments. Could we start this this way? Staying away from the interdisciplinary problems?

I enjoyed going out. I’m new to the hospital (3 months). Hearing other managers with their perspectives. One point I’d make is that we need to teach how to respect each other. It can be the most important thing. I spend a fair amount of time looking at things between the OR and other areas. So many problems stem from communication; we need to teach how to have respectful conversations. Another suggestion: have aggressive 6 month feedback on how this is going and what we can learn.

I liked going and observing; I saw a lot of things in my own area’s registration-it was very eye opening.

I enjoyed working with people in other people in other areas, the group setting was nice, it was nice to see the people behind the emails.

This will change the dynamics of what people see as problems; this can break down barriers.

It should remind us all that immediate need for me might not be immediate an immediate need for someone else and we need to show respect for each other.

I like the practical aspect; it builds ownership within and among departments.

Observing the blood bank lead me to understand what our department can do better.

It was interesting to see that something as simple as how we put a label on impacts someone else’s work- we are probably making other departments take extra steps and we don’t even know about it.

Communication is so important; rather than just getting used to it (the problem).

There is a lot of work that will come out of this and some will be hit more than others.

The afternoon was really long.

It is awkward observing someone and I am sure they feel the same way.

How will people stay motivated when we are unable to solve everything, how will we feel about this workload, how can this become part of our intelligence versus hunting through a log.


Anonymous said...

I don't know. . .I was not invited to participate on this "team" but I think it would be a good idea to incorporate every single person who works here to be part of the solution. The thought of a "trained team" going from department to department gleefully finding what everyone else is doing wrong and enthusiastically "solving" everyone's problems seems a bit high-handed. Empowering EVERYONE to create solutions is more in the "spirit." (Unless I'm completely missing the point of what this "training" is. . .)

Anonymous said...

You are totally right, and I am sorry if this gives the wrong impression. The idea is, indeed, to teach and empower everyone. These are just the intital folks being trained in how to train others to do that. They are NOT a separate group of people who will be a roving "solutions" team. There will be no such group.

So we are on exactly the same wavelength. Thanks for writing, so I could clear that up.

And, if you want to get involved early on, please contact Pat Folcarelli.

Anonymous said...

I think it would be important to have a person designated to capture or document the issues with this responsibility as a priority for that individual. Also, if a department has more than one shift as many do in the hospital, has there been any discussion about having someone on each shift with this responsibility? I think this may help capture more accurate information and does not over burden busy employees. Is there a format for complying issues?


Anonymous said...

Thanks for posting this info. I am eager to hear how this initiative progresses.

Anonymous said...


The idea is to have it working on all shifts. After all, lots of important stuff happens at night!

Anonymous said...

I am struck, as I have been with earlier posts, at how similar the issues aind experiences are at hospitals everywhere. I could practically have written some of the comments in these posts, without ever having set foot at BIDMC.
It makes me think we should be considering directing best practices efforts on a more national level, instead of each hospital having to reinvent the wheel. Although my old CEO said "all health care is local", I think that doesn't apply to quality efforts.....

nonlocal MD