How It's Done - A Lesson From Mom

One of this year’s themes at the Health Quality Council Inspire Summit held in April was that of Putting Patients First, and the incredible ways Healthcare would be affected if it was to become a habit for those providing care and creating policy.  More than likely some of you have heard my thoughts on this subject before, but you’re going to hear them again – with a bit of a different spin this time.

Next Sunday is Mother’s Day.  And when I was thinking about what I should say to impress upon each of you the importance of putting the patient first, I was reminded of Moms, and the inherent ability most of them have to put their kids first.  I have no problem saying that has always been true of my Mom and maybe it is true for some of you as well.  I will always be thankful for, and amazed at, the incredible capacity she has to put her family and their needs before her own.  She’s the one person I know is always going to be there in my corner if I need her – she’s never let me down.  I’m watching now as she is dealing with the needs of the generation before her and am not surprised at the wisdom and compassion she is displaying as the issues come at her fast and furious.  My Mom is my hero and I can only aspire to being more like her as I journey through life.

In many ways, our patients and their families are in need of the compassion and wisdom that a Mom shows her family.  They need us in their corner – they are depending on us to advocate and lend them the knowledge we have of the healthcare system when they don’t know what to do next.  They need us to show them compassion – they are scared and sick and often alone and just need someone to treat them with dignity and gentleness when they are most vulnerable.  They need us to show composure when things are falling apart all around us – yes there are days when another issue is the last thing we have time to handle, but they want to deal with that issue even less than we do, and they are looking to us to have the experience and wisdom to give them guidance or to do so on their behalf.

Our patients are in desperate need of people to put them first.  And those people are you and me as healthcare workers.  I am in awe of the front line staff who strive to do this every day as they work in our Region’s facilities.  There is nothing easy about putting someone else before yourself, and I know that some days are harder than others. You are heroes for the people you care for every day and you touch their lives with every decision you make.  We are working hard to help you as you do that.  I want your input and ideas as to how we can continue to make it simpler for you to do your crucial work every day.  Our 100 Day Challenge we introduced at the Sun Country Quality Symposium is more than half over, and I am still hoping for your ideas for improving patient care and truly making sure their needs are being put first. 

I can’t begin to express my gratitude to my Mom for all the ways she has showed me how to be a caring parent and someone who can be selfless and compassionate.  It’s a gift that is given just because of who she is and it isn’t repayable.  To all of you who put the patient first every day, I say thank you for your compassion and willingness to do your job to the best of your ability.  It isn’t fully repayable either.  The wage you collect as an employee is compensation for the time and effort you give while at work.  But true payment comes with the knowledge that you have given a gift that everyone needs at some point.  So know that putting patients first is a huge gift to hundreds of people in our Region every day.  And you are appreciated!

Flight 201 Departing...Gate 1

If you could have a superpower what would it be?  The power to heal yourself or others?  Super human speed?  The ability to read minds?  Invisibility?  For me, it would be the ability to fly.  I would love to be able to take off and leave the constraints of land travel behind whenever and wherever I wanted.  The freedom and perspective that ability would provide is definitely something I would love to have. 

Unfortunately, none of us are likely to have a superpower wish fulfilled anytime soon.  I am, however, offering every one of you the chance to have freedom and perspective that you haven’t had before.  Flight 201 is a four day training opportunity for approximately 30 future LEAN Champions who are preferably front line staff with a passion for improvement and who are formal or informal leaders in their program/facility. 

When the training is complete, you will be able to assist your peers with LEAN projects on location and would be the “Go-To” person in the facility for LEAN questions.  And to support you in the work you will be facilitating in your workplace, we will have LEAN Champion forums to discuss your challenges and successes and put forward new ideas and opportunities.  My hope is that we will be able to plan these forums on a quarterly basis, but if time and activity levels allow we will do it more often!

Now, I have had some folks in the past balk at the term “champion”.  But when you consider that a champion really just means someone with repeated wins, it makes sense!  How exciting will it be for you to provide your co-workers with a win every time you facilitate a project or bring to fruition an idea they had for better patient care or access?  And I mean – really – who doesn’t like winning?

You may be wondering how you are supposed to have time for this with the demands of your everyday work.  Part of the sign-up process will include a contract for you and your supervisor to agree to that outlines some of the expectations – both of you and your supervisor if you are part of the training.

I know I feel empowered every time I encounter a challenge and am able to employ some of the LEAN knowledge I have to meet it head on.  I want everyone to feel like a superhero who can be free from the restriction of having to keep your feet on the everyday ground littered with bad processes and frustrating procedures.  If you are interested in initiating a string of wins in your facility as a champion, have your supervisor contact me before May 18 and we will talk about whether or not this training would be a fit for you!

Hoshin Kanri Rolling Along

Wondering where I have been?!?!  Well…

Over the past few months, team CQI has been crazily working on Hoshin Kanri (Strategy Deployment) - an initiative that started back in September of 2011, bringing together 16 CEO’s in Saskatchewan Healthcare.  This included representatives from all 13 Regions in the province as well as representation from SAHO, the Saskatchewan Cancer Agency, and Health Quality Council.  With this, we as a province started on a journey that in some articles I’ve read, is being called the 100 year game changer.  Now I’m not going to go into great detail or the nuts and bolts of Hoshin, but what I am going to do is give you an idea of what’s been going on, and what the objectives are.

This process has involvement from the CEO, Senior Leadership, and front line level.  Roll-out of the process to front line staff was just completed using engagement sessions for all staff at every facility.  A new strategy outlines the vision for improving access to a health system that provides Better Health, Better Care, and Better Value for everyone who accesses services here in Saskatchewan.  By building safer and more supportive work-places committed to patient and family-centered care, we will enable the development of Better Teams.

One of the Breakthrough initiatives that will contribute to the building of the “Betters” is the development of the Continuous Improvement System / LEAN.  These powerful tools enable us to make changes that result in improvement, as well as ensure that all of our efforts are sustained for years to come.  There are five major over-arching objectives to the plan that has been put in place: 1. Strengthening Primary Health Care, 2. Deploying a Continuous Improvement System (LEAN), 3. Improving Surgical Access and Transforming the Surgical Experience, 4. Enhancing the Safety Culture with a focus on Patient and Staff Safety, and 5. Implementing Shared Services. 

With all of the province working together to achieve these common goals, we are able to work on ensuring seamless care between regions and organizations.  As we all know, the ideal we should be working towards is healthcare in the province that has no walls or barriers.  To make sure that these objectives are met, we need to have support and engagement from everyone working in the system, as without this there is no way we can expect to accomplish the vision which has been laid before us of a transformed health system.  Healthcare has always been, or should have been, a team affair or failure is a sure outcome.  We need to work harder, now more then ever, to ensure that every employee working in the province clearly understands the impact they have and how their work supports this shared provincial vision.  Although not everyone may be able to identify their work in the five breakthrough initiatives, they will surely find a link in one of the 17 projects selected by SCHR that will move the breakthroughs (Hoshins) along.

This incredible transformation that is taking place everywhere, every day, in Saskatchewan healthcare is arguably the biggest healthcare transformation that will ever take place.  The sheer size and magnitude of a project that has so many organizations and staff working towards such an amazing, common goal like Better Health, Better Care, Better Value, and of course Better Teams is phenomenal and an experience I know I will never be exposed to again.  I am very excited to be a part of this, and I hope you will find the same excitement and join me on this journey of improvement and sustainability!!

100 Answers in 100 Days Challenge - Are You Up For It?

So today I sit thinking about multiple discussions that I have had during the past week of work.  There have been numerous conversations as to how we want 2012 to be the “Year of the Patient” and what that is going to look like.  Ultimately, we are here to provide timely, safe, respectful, high quality healthcare services to our customers and their families.  The questions start in my mind:  What needs to happen?  What needs to change?  What supports need to be put in place?  Who are the right people to lead this amazing charge?

In October of 2009, results were released from the Saskatchewan Patient First Review that was conducted by Tony Dagnone.  These results were presented to the Ministry of Health and called for changes as to how patients experience the health system, how health services are delivered, and how the system is managed.  Now this is all fine and good, but I don’t think this was something that anyone would dispute.  And the problem is, this really doesn’t give you a “paint by number” approach as to how it should happen.  So really, it is going to be up to us working in the system to make the Revolutionary Transformation.  And really…so it should be.

Earlier this month, I provided an update on what the SCHR CQI department has been up to over the last year.  There have been some pretty amazing results from the work that we were all a part of in 2011.  But this isn’t the time to “rest on our laurels” so to speak.  Now my problem is I missed signing up for Revolutionary Transformations 101.  My hope is, that all of you didn’t, because I am throwing down a challenge to every single employee of Sun Country Health Region.  I need all of you to give me the answers to the questions I put out at the top.  It’s up to all of you to help put Saskatchewan on the map for delivering the best healthcare found anywhere. 

My specific challenge is this – I want 100 answers in 100 days as to how we can make 2012 the Year of the Patient.  There will be lots of avenues for each of you to give me this feedback:

1)     There is a spot to post feedback on my blog – the link is at the bottom of my signature in all emails and is as follows:  http://www.walkthegemba.blogspot.com/

2)     Send your suggestions to lean@schr.sk.ca

3)     There will be a section on all bulletin boards for everyone to view this challenge; simply put them in an envelope and send them interoffice mail to me.  The boards will be checked frequently and every suggestion will be read.

I would really like to have the opportunity to follow up every suggestion with the individual or group, but I’m hoping the volume doesn’t allow for that!  And it is quite possible that you may not want anyone to know what your suggestion is.  Anonymous or not, please send them in and be sure they will all be considered. 

I have said time and time again that it makes no difference what service line you work in, or whether or not you even deal with patients or families face to face, we all have such an integral role in healthcare.  Without you doing the job that you do, and performing the amazing work that you do, this system will fail.  I often use the analogy of the wheel - if one of the spokes is weak or happens to fail, the entire wheel is compromised.  Similarly, if one of the spokes decides it’s going to try and take on the world alone, it’s going to over shoot the rim and what have you got? A flat tire and with a flat tire where do you find yourself? Pulled over to the side and the race is done.  So if we are to be successful in the race to the top of healthcare excellence, this needs to be a team affair.   

The only way to ensure that Revolutionary Transformation happens is to hear from the folks that really know best (all of you!) and put the Patient in the driver seat and let them hold the wheel as to the direction we are going to take.

In Your Words...

I have been inspired and encouraged over and over this past week.  What follows is just a sample of incredible insights and contributions from many of you.  A sincere thank you to those of you who have responded.  If you are one who did, encourage your co-workers to do the same.  If you haven’t responded yet and feel like you have nothing to add, trust me, we all have something to contribute and I need to hear your perspective.  Visit my blog at www.walkthegemba.blogspot.com for the questions and email your thoughts to me at lean@schr.sk.ca 

I have nothing else to say - the rest speaks for itself!  Enjoy…

…my favorite thing is to see young staff learning something and applying the learning.

…There is always something new to learn, a challenge to overcome and a great team to work with.

…I am in Healthcare to help make someone’s life better for them…to hold a dying client’s hand so they are not alone…to bring a smile to a client’s face by helping them.

…A woman I admire worked as a nurse until she was about 70 years old and had a quiet confidence, a gentle manner, and treated patients with respect and dignity no matter what else was going on.

…I take pride in doing a good job because then my work is always appreciated. If I can do my job and leave things better than I found them there is a trickle down effect which makes the work of others easier to perform.

…I admire my oldest brother – he is a professor/pediatrician/pharmacologist and researcher and he planned his lab space so the staff would have to walk by the waiting room of the pediatric oncology ward.   That way every morning the lab staff would see why they were coming to work – not for the rats they tested – but for the children in those waiting rooms hoping for a cure.  We have to put the patients in all the jobs in health care

…The best part of my job is meeting and assessing new clients for Home Care. The history that is passed on to you in each encounter is wonderful. The client enriches your life with their humour, determination and their personalities. It is always a challenge to prove services depending on their needs and schedules.

…Do something that you love and are very good at. Takes chances in trying new things, it makes you a better person.

…I emphasize the belief that if you find enjoyment in your work it really isn’t work. A persons career path should be chosen by the individual; not chosen for the individual

…I love working with people to make their lives better- whether that means healthier, improving quality of life, making a change to the environment. I feel such immense satisfaction from things like being able to control a palliative patient’s pain- it’s such a great feeling to know you’ve made a difference in someone’s life.

…A team approach will always be a better way to make a difference. We all bring in personal experiences and varied educational specialties.

…I admire my Father as he taught me to always embrace life’s challenges.

…Being a nurse allows me to care and nurture others through difficult periods of time in their lives.

…My career in Healthcare is quite transparent; like that of the stagehand in a theatre, nobody sees what is done but the work is necessary to the actor. My work is important; not front line patient care, but allows that to be performed by others.

…I feel if people aren’t compassionate, they should not work in a hospital.  Sound harsh? So is being looked after by someone who doesn’t want to be there.

…That the hardest experiences have taught me the most, and made me the person I am today- I don’t regret any of them and am thankful for the chance to learn, grow and become better from them.

…Follow your gut- intuition is not to be ignored. Learn how to be honest- even when you have to swallow your pride- ask for help when you need it- admit when you don’t understand something- if you believe something is worth fighting for then do it- regret is likely worse than any consequences you may encounter from speaking up.

…I tell my child to do what makes HIM truly happy and to challenge himself.  That’s what matters the most. Life is too short to be unhappy. And work is work, it shouldn’t define you. You should define what you do, not the other way around.

…Keep fighting the good fight - we can make a difference.

Look Out! Detour...

“Yes I make a difference every day - whether it is measured in a simple smile or being able to help diagnose a serious illness.  However that difference has to come from within - if you are not willing to put in the effort you will get nothing in return!!”

“Life is hard!!! Everyone has a story - it is whether you are willing to take the time to listen that matters.”

“Each change had its challenges but the rewards were huge. I learned so many things, which built on existing knowledge.”

These three quotes were taken out of two different responses that I just received in regards to my last article ~ Road Trip – Buckle Up.  There is absolutely no way that I ever could have said it any better myself. 

When putting together the last article, the only thought was how could I catch a glimpse of people’s raw emotion and really know how they feel so I could share it with all of you.  I’ve always thought that unless you are sitting across a table from someone, you won’t really know that a story has hit home without being able to see their reaction.  But as you can see from the quotes above, I was wrong, because in them lies that raw, often untapped emotion – and it is easy to see.  So I have to wonder why so many times we find ourselves searching for the answers that are right in front of our noses?  And why don’t we take the time to ask the people who undoubtedly want to share their passion and experiences with us?  And if this information is actually given to us what are we willing to do with it?

Let me tell you what I would like to do.  I am going to post some questions and I am looking for you, the experts, to answer them and tell me what you think and how you feel.  Everyone enters Healthcare for one reason or another right?!  I want to know what those reasons were and what keeps you here.  I am looking for you to open your heart and mind, share your insights and feelings with me, and we can forge an amazing path forward that will be something spectacular!

To be honest, this is not exactly the path that I had imagined for this process.  I had wanted to compile a set of articles that were to be the lead in for a big reveal at the Quality Symposium.  But after reading the feedback I shared above, I know there is no way that this can be a one man road trip (how fun would that be anyway).  And now I am so excited to be taking this great detour that will most definitely lead us to the same destination.  So my request of you is to have a part – let’s do this together.  I am willing to take the time to listen and am crazy excited to hear from all of you!

Now you may not all be the type of people who can just give your opinion without a starting point (and there are probably lots of people who love that about you!) so the questions that follow are your jumping off points.  Maybe you will send me an answer to two or three questions and think that’s all you’ve got, and the next day you will have an experience that is the perfect answer to another one of the questions that was asked.  Don’t hold out on me!  I can’t be there with all of you and this detour needs you!!

• Name
• Occupation
• How long have you been in Healthcare?
• Why did you choose the occupation that you have now?
• What would you say are the best things about your job?
• Why do you come to work everyday?
• What are your favorite things to do at work?
• What do you consider to be the most important part of your job?
• What part of your job makes you most proud?
• How do you contribute to making the patient experience better or what do you do to make a difference to others?
• Who is someone that you admire and why?
• If a child were to ask you what career to choose what would you suggest?
• If someone asked you why you were in Healthcare what would you tell them?
• Is there anything you would want to share about your experience in Healthcare?
• If you could say one thing to your fellow co-workers what would it be?

Whether you work in Sun Country Health Region or not, if you are or used to be a Healthcare provider I want to hear from you.  So please feel free to send your insights to lean@schr.sk.ca .

Buckle Up - Road Trip

Do you remember the last time you worked with a young person starting out in their career?  Do you remember their excitement for their profession and the idealism they had for the work they would be doing?  Do you remember their lofty goals and dreams for their career?  I don’t.  Not only do I not remember the last time I worked with an idealistic, naïve newbie, I don’t remember being that way myself.  And I’m not that old.  I think I might have read a novel recently that had that in the story line, but nothing in real life lately. 

Maybe I’m the only person that thinks some of that is missing in all of us.  And I’m sure there are those who never lose it.  But I know that there is definitely a diminished excitement in many of us who have been working for a while.  What is it that changes in us when we hit the ground running?  I don’t think it’s just healthcare that knocks it out of people; I think maybe it’s just how it goes.  I think part of it is just having to work with people.  People are hard.  We’re imperfect.  We’re high maintenance.  I also think part of it is what happens outside work.  Life is hard.  Life is imperfect.  And often life is high maintenance.  And I think the other part of it is we aren’t naïve anymore.  We see too much hard and too much imperfect and give up on trying to maintain anything that seems to be the opposite. 

But, I want to know what other people think.  So I’ve decided to ask.  In the next number of weeks I will be asking more than a few people some questions about why they do what they do.  Maybe I will come across people who still have that idealistic feeling about their job.  Maybe I’ll be able to see where it is that someone lost some of their idealism and why.  Or maybe I will just be getting to know some incredible colleagues in the healthcare field!  I think the answers will provide us with some insights and I can’t wait to share them with you.

There is a lot of criticism out there for healthcare these days, and it’s not just in Sun Country or Saskatchewan or Canada.  Healthcare is a topic that always seems to be a lightning rod for criticism.  I think part of the reason for that are the very ideals and dreams we have for the system.  And that’s all good – it just sets up some hard questions every now and again when we aren’t able to reach them.

The questions I will be asking aren’t hard and they aren’t really idealistic.  They are an honest attempt to understand why we do what we do every day.  I hope they will provide some answers to how we can better look after the people we daily encounter, as well as give us some ideas to improve the way we go about doing that.  I’m also hoping they will give us back a little bit of that idealism we all started out with a long time ago.  I’m thinking it could be a bit of a journey for all of us.  Want to come along?

Second Chances

Recent events have left me thinking about, and evaluating the work I do.  It’s the same for everyone – sometimes we pause and think about why we do things and what impact we are having.  And maybe, just maybe, the pause we all take on occasion is the only positive outcome to a given situation.

We have been talking about this being “The Year of the Patient” in SCHR.  Kind of sad really.  Every moment of every year, month or day should be patient focused and patient centered.  There is not a single HealthCare Employee who would have a job without the patient.  They are, in all reality, our employers.  What if we started treating them that way?   What if we afforded them the same respect we give our bosses, our supervisors?  What if their promptings were what directed our work?

Fortunately, or unfortunately, our jobs are often 100% directly focused on people.  And these people, in our cases, are among the most vulnerable in society as they have lost their health.  It is incredibly easy to look at the multitudes of people we may encounter in a day as just another “case” or “assignment” rather than people in need of our compassion and care. 

With all the people we come into contact with every day, it is, of course, impossible to have a perfect experience with every individual encountered.  Sometimes it may be through no fault of our own that there is a negative experience, and despite our best efforts, a good outcome is just not possible.  But there is always that second chance.  And amazingly, even if it was our bad day, or our mistake that created a less than positive experience for someone, most times people are wonderfully gracious in their ability to provide us with that second chance.  Yes, we are all human and we will all be less than perfect at times - no one will ever be surprised by that.  But what can surprise people, is the effort we make to get the second chance right. 

The word “second” in the phrase “second chance” brings something else to mind.  It only takes a second to make the second chance necessary.  Words that can never be taken back can be out of our mouths in one second.  One second without focus or attention and we can miss a critical piece of information being related by someone.  And one second is all it takes to change someone’s outcome from good to bad.  But isn’t it great that it can also only take one second to make our second chance successful?  Put a smile on your face when you approach someone’s beside, or say thank you for their time.  Such a small amount of time can have such a huge impact.

On behalf of the people we serve, who are the reason any of us have jobs, let’s pause and consider what it is we are doing every day.  Let’s consider how we are shaping futures, how we are impacting the generation coming after us, and how we are contributing to people’s most precious possession – their health.  Can we remember that they are depending on us to treat them like people, not time slots or extra work?  And above all, we need to be thankful for the opportunity and privilege we have every day to make a difference in someone else’s life. 

A “Year of the Patient” without the need for any second chances would be great, but maybe we would be missing out.  Maybe it will be how we use those second chances that makes this year really great.