Campaigning for quality and safety in your hospital

   Why has health care quality failed to improve? One of the major reasons is the old fashioned and maladaptive culture that exists in nearly all of our medical centers, particularly our academic medical centers (AMCs). Each department is a silo with a hierarchical structure, and as one physician told me "I feel like a grain of sand." Other than managing their individual patients physicians rarely have any say in what goes on. Nurses in most AMCs are all but ignored by physicians. The other day I saw a physician turn his back when a nurse asked him a question. "Nurses annoy me all the time by paging me", he stated. How can there be improvements on the front lines with this culture and these attitudes?
  I have begun a new initiative to organize our caregivers around a simple goal: How do I as a caregiver improve the experience of my patients?  Because I view a health care leader as anyone who influences others to improve the health of our patients, I believe everyone can be a leader, and we will need a distributive leadership model in order to improve quality and safety. But how can I and others encourage leadership?
   By using the techniques first employed by the American founding father, Samuel Adams I believe we can transform the cultures of our AMCs. Through one-on-one meetings, creation of leadership teams, large gatherings, and newspaper editorials he built a powerful community of like minded colonists to transform the 13 colonies from complacent subjects of the British Empire to independent citizens who demanded a true democracy. Using one-on-one meetings I have been able to build a campaign leadership team. We have set as our goal to recruit 200 caregivers to our campaign by February of 2011. We had our kickoff, A Forum on Doctor-Patient Communication, last Thursday. Approximately 75 people came and participated, including surgeons, internists, obstetricians, pediatricians, anesthesiologists, patients, nurses, social workers, and a chaplain. Two patients spoke about what they expected from their caregivers. Following their very personal and meaningful presentations, the entire audience began contributing their views. As the conversations continued the spirit in the room lifted. A sense of community and of shared goals became ever more apparent. We are off and running. Our next Forum will be on Doctor-Nurse communication, followed by Doctor-Doctor communication. I will keep you posted.