Question hour

I can remember a couple of occassions when i along with a sick relative step out of the doctor's room and then think of a hundred questions i should have asked while in there. This is a real problem and doctors dont make it any easier. The Agency of healthcare research and quality in the USA has built a question list to make it easy for the patient. And i think those working in healthcare should have a glance through it and use it while communicating with their patients.

'Marriot moments' in the hospital

For years, I would get into stimulating conversations with other members of the teams about clinical outcomes and its importance to the growth of patient numbers. Slowly I realised that we were not focusing on patient outcomes in the right way. This is not to say that clinical outcomes are not important. But that above and beyond the percentage of clinical successes there is the perspective from the patient that we never thought about. What does he or she or their loved ones want from the whole experience with our service? The patient experience is something we never talked about. Then I realised that despite having the same technologies and similar expertise, patients did actually like some places better than others. They kept coming back to some of my client organizations more than others. The technology backbone was similar and was provided by the same expert - myself. So what can we do to improvise the experience? We need to do more on that front and it is good that I am finding more of our colleagues interested.
In fact the world of design itself is re-orienting towards design experiences more than anything else because as Tim brown explains in his book " change by design", a good technical idea is no longer enough. The new economy has consumers who are looking for a good experience more than the technological features of the product or service. He gives the interesting example of Marriot contracting designers who find out that the most important moment for the customer who checks-in and where his or her experience can be focused on to elevate his satisfaction is the 'exhale moment' when they reach the room, throw the jacket and shoes to stretch out on the comforting bed. In healthcare those who work closely with the patients will easily be able identify numerous points in the patients' journey where this 'exhale moment' occurs. But what are we doing about it? And do the healthcare planners and managers who have never worked with patients be able to understand the significance of these moments?

Who will slap the surgeon?

If you have worked in the theatre as a lowly intern then you couldnt have not experienced this moment where you want to do this. Its also not an unusual situation when working as a nurse or other member of healthcare team. So how do you deal with someone like this?

Does your boss bring you the coffee?

I have worked as consultant in several clinical units and even simultaneously in multiple units. Sometimes a full timer too. What this mixed job history has done for me is an ability to have an insider perspective from the outside. Let me explain. It means that while I was not a full timer nor dependent on any of these units for all the work, I did spend significant amounts of time with the teams that some of the employees would consider me a part of their trusted circle. I got to see more than all the smiles and good behaviour that a visitor often gets to see. And that has changed my perception of how good a workplace can be?
I now believe that there is no such thing as a perfect work place in healthcare at least. There is always something or the other that just isn't right. While we all like to believe that one day we will end up in a place where the boss takes care of your coffee, you adjust your salary according to how much you worked, your colleagues love to do some of your work and where all clients/patients smile even when you are at your worst..it is unlikely you will find such a place. And so what do we do about it? The first step is to lower your expectation on all the superficials..the coffee included. But what you should not do is lower what you believe is the standard of service a patient or customer should experience. And if you think your own growth is taking a hit, you should make sure that this need be only a tactical retreat from what you want and never give up on your personal and career goals for the longer term. Do you think you can do that?

OK you are a doctor or nurse, but what do you play at work?

So if healthcare teams were to play a sport which game would fit in with their team dynamics? If you think it would fit into any team sport, think again. Bolman and Deal present an insightful way of looking at team structure and dynamics in my old favorite book ' Reframing organizations'.They talk about 3 different team structures represented by 3 different games -football, baseball and basketball. Football involves various platoons executing sequential patterns of action - defence, midfield that sets up an attack and the daring attackers. The defence rarely takes an attacking role and vice versa. Basketball on the other hand involves multiple roles for all members with rapid switching of roles and well coordinated actions. Baseball is a game of lone players doing individually what they have to do with little dependance on the others. This is not to say they don't have team goals and objectives but they are relatively independent. So what kind of team play are you involved in? Its not a case of which one is better as long as it fits in what your team is trying to do. R and D teams probably work well in baseball format and it would probably be an ineffective R and D team if it does its research works in basketball format. An IVF care team could be fine in a football approach.
However the key point is to fit team structure to purpose and even for a team purpose can change.

Tale of two hospitals

One needs to look with an 'organizational culture' frame when trying to understand why 2 services having the same technology and equally qualified people can provide different quality of patient experiences. Here is what I found when looking at 2 IVF clinics and their unequal performance over the same 5 year period despite being similar technically.




Its no wonder that clinic A had excellent results and better growth in patient numbers while clinic B was stagnant in patient numbers and results lower but not bad enough to put off patients.

Clinical microsystems and the lone champion

5 months of hardwork had paid off. Work in the laboratory medicine facility had become more streamlined, workflows better defined, the manager had better control and patients happy that they don't need to wait. All this with one less staff member. Patting myself on the back, I disappeared from the scene as there was not much for me to do.
A year later I walked into the same department and met with a sorry scene. The earlier chaos, long queues and dissatisfied technicians. The very things we got rid off. So what happened? The problem was in my approach. Assuming that complaining patients and problems with employees would be serious enough issue for upper management to keep the issue as priority, I did what was needed on the operational front. Optimize the systems and reach the objectives of the project which is make patients and employees happy and bring costs down. But I did not realise that as soon as the project went off the radar, the top people in higher management would forget about the circumstances and problems which led to the sorry state in the first place. And gradually the attitudes, the lack of understanding of the ground reality and the disconnect with the frontline came creeping back. No one noticed until the finely tuned system broke down again and business was back to normal. The middle managers who had changed in the meantime went back to doing what they knew to do in such situations I.e ask the employees to work harder and faster. The department head who supported my earlier effort was more a technical person than managerial. She really never understood how with her support we managed to turnaround the situation so she did not know how to deal with the 'recurrence'. Herein was the problem, there was no local change champion who would hold fort despite the external or internal pressures. These pressures can be strong and flow against the balance that is required to keep the system running smoothly.