A few weeks ago, I had the privilege of delivering the opening address at the Cerner CommunityWorks annual client summit. Before the event, I wrote a piece that captured the essence of my speech, and I'd like to share it with this community as well. If you do me the honor, you can read it here:
https://www.cerner.com/blog/achieving-operational-excellence-in-community-hospitals.After 30 years of working in health care, the past 20 in the rural space, I say with high confidence that communication always has -- and will always be, the key to excellent quality, care, and service. Too often, communication is an afterthought. For example, leaders make decisions behind closed doors and emerge to share the news that is most comfortable/permissible with the organization. As you'll read, operational excellence becomes far more attainable (certainly more fulfilling and less painful) when communication is integrated fully and deliberately into an organization's strategic plan and mission. If I had a penny for every time, a hospital employee pulled me aside and declared, "they don't tell us anything," I'd be golfing on the private course I purchased somewhere in the tropics. If added the pennies from the number of times hospital leaders told me they are accessible and feel they overshare, you'd be right there with me on the first tee.
Excellence in health care is, of course, a shared goal for this community and yet, I wonder how many member organizations are making investments in developing the communication skills in their teams, from senior leaders to department managers, staff in supporting roles and those working to meet patients on the front lines. By 'developing' skills, I want to be clear that I am not referring to "training," and here's why.
Every time I deliver the same address as I did at the Cerner conference, or speak to groups about the topic of high-reliability or stakeholder engagement, I ask participants to raise their hands if they've had training in TeamSTEPPS ® and if they routinely use the tools provided in their practice and processes. The responses are mixed, with some nodding yes, others no, still others looking around to see what the person next to them has to say about it. I especially love it when an audience member reveals she has a stack of the little booklets in her office buried in a pile someplace.
Don't misunderstand. I believe TeamSTEPPS is an excellent program -- when used correctly of course, but there are some instances when the tool becomes a check-box, a communication crutch, such as what I experienced in March of this year. It was the morning of my first colonoscopy. I had significant concerns about the procedure, some of them my fears from previous experiences as a patient, others derived from what I've observed in my work with hospitals to help them understand the root of their communication challenges that either triggered or contributed to an adverse event. Like any other morning, the day surgery team showed up ready to go with a full schedule of people like me awaiting "routine" procedures. On this morning, however, the surgeon was running an hour late, I was the first case of the day, and that could only mean nurses, techs, anesthesiologists, members of the environmental services team, everyone in that unit would also be running behind the remainder of the day. As we know, it's not like air travel; there's no picking up speed with the help of a strong tailwind to get you to your destination faster.
The hospital where I chose to have my colonoscopy identifies themselves as a "High-Reliability Organization," known as HRO. Indeed they do use the communication tools provided in the TeamSTEPPS training, in fact, I was a bit relieved to hear, just before being sedated, a nurse or tech (I can't be sure of what her role was) call the ever-important "TIME OUT." She did so to check the team to make sure that me, the patient, was identified correctly. At that moment, the silence was deafening. The caregiver, whose voice was heard to protect me, read the wrong name and not a single person charged with my care in that suite caught it. Nobody checked my band to verify, they were about to continue and yet the patient whose name she uttered shared my first name, and that's the only thing she had correct. Neither the last name or the age was accurate. At that moment, I called my own time out. It was me, the patient situated uncomfortably lying on her side waiting over an hour after my scheduled procedure time, cold, hungry, nervous and frustrated, who looked every person in that room in the eye and said, "That is not me!"
I'll share the rest of the story if you want to know. In the end, my message here is that communication, where patient care and safety is concerned, is, (not can or might be) is impacted by several human factors, including and in my view, most predominately, emotionally intelligent communication. This team and the many professionals I work with have plenty of tools to advance and improve communication. I'm also confident every person in the room, on the unit, working and volunteering that day in that hospital, had good intentions where I was concerned. At the same time, I believe that what I experienced, was not an isolated event; instead, an indicator that their work to achieve organizational excellence must continue. Think about this. They were in attendance; however, not present.
Fortunately for me, I was alert enough, had the experience as a professional in this industry to know how to respond, and the confidence to speak up. Others are not so lucky, and we can all agree, luck isn't a strategy.