Transparency and Execution

LG

Loren Goodman

01/21/2014

When someone I care about is in the hospital, I want to be with them. Maybe I can help make them more comfortable, maybe watch over them while they sleep, maybe enjoy another middle-of-the-night, amazing, enlightening, meandering conversations you have when there’s nothing to do but talk, but, always, at the very least, be there for them.

And, unfortunately, on occasion being there for them has sometimes meant being the one who caught something slipping between the cracks before any harm was done. In almost every case, those mistakes could have been prevented with better communication between the patient and everyone who is taking care of them.

Nurses, techs, doctors – these people have tough jobs and put their hearts into them. In my world, I think it would be like doing hard core development on ten applications in parallel and having to switch from one to the next every ten minutes with having to cover the phones and a couple of toddler temper tantrums thrown in for fun. With all of that going on, they are helpful and cheerful and keep showing up the next day – even knowing that just one bad line of bad code could result in great harm or even death. They are amazing people who do amazing things routinely.

You probably already know that the nursing staff at a hospital usually works in 12 hour shifts. At shift change, the night nurse goes off and meets with the incoming day nurse to bring the new nurse up to speed on everything about the patient. They start off with the history of the patient, the prognosis, review test scores, talk about the prescribed treatment and so on, and most importantly, talk about the things that don’t really fit into the computer. Things like “Don’t put the head of the bed all the way down because he goes into a panic attack” or “the dosage for this medication is wrong in the computer and we are still waiting for the doctor to correct the change” or “make sure you ask if he has to go to the bathroom because he never told me and then tried to get out of bed to go with the IV still hooked up”

As you probably already suspected, I spent a fair number of nights in a hospital with someone close to me recently. And I noticed something that blew my mind. At this particular hospital, there was not a single minor mistake. The communication was beyond excellent. Every symptom the patient had was communicated to the doctor and everything else the nurses and techs did ran like clockwork. How can this be? Is my job security as an in room advocate in jeopardy?

I hope so. At this hospital, when the nurses change shifts, the nurse transition meeting is done in front of the patient and the family and participation is encouraged. This results in the nurses discussing every single aspect of the case with the patient twice a day. This transparency changes everything! Suddenly the patient feels like a participant as opposed to feeling like a subject. The roles of care giver and care receiver become blurred to the point that it feels like a single entity operating with a single goal – to heal. For this most recent stint, I witnessed countless bi-directional exchanges of information and feedback that simply would not have happened otherwise. With just one, simple, change, the quality of care was better than any I have ever seen.

Which brings me back around to the picture at the top of this article. That picture was taken in the nurse’s coffee station at the hospital I am referring to. A simple solution to knowing how old the coffee was without taking a slug of it first. No burnt tongues, insulted taste buds or dejected returns to the break room when they find out what is in their cup.

After talking to a couple of the nurses about it, they both said the same thing: the simple change of doing the handoff meeting with the patient also had an impact on everything else they do. The “coffee made at” is just one of a dozen examples I came across of incredibly clever solutions to communication problems. Free from having “top-down” solutions imposed on them because they are relied on as the experts in their field, they find easy and effective solutions. There were hand written signs all over the place for things as simple as “ice comes out fast” or “am going to café in 10, want anything?” In fact, when I asked a nurse if I could use the bathroom in the hospital room, she not only said yes, she made a sign and taped it to the bathroom door saying, “visitors welcome”!

All in all, the autonomy and transparency at this hospital really showed the power of bottom-up in comparison to top-down. They became a team with their patients, and their patients gave them tools to be better caregivers. They’ve become a team with management, and they gave management the tools to run a better hospital. Self-organized solutions abounded and the quality of care was off the charts because of it.

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