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Got Atherosclerosis in Your Place? (Leadership Notes from the Cardiac Ward)
By Bill Catlette
We do about half our work in the health care field, and accordingly, we value any opportunity to do field research. Just this week, Richard spent two days touring nursing homes in two states, to prepare for an upcoming speech.
Recently, I had the occasion to spend time in what is unquestionably one of the finest heart hospitals in the southwestern United States, a shiny, new, facility with state of the art everything. It wasn’t a scheduled visit like Richard’s. Instead, I arrived horizontally in the middle of the night, accompanied by two crews of EMTs…and Richard, my steadfast but sleepy, and slightly shaken business partner.
As us 50 year olds are wont to do on occasion, I had awakened around midnight with an urge to visit the restroom. I never got there. After hopping out of bed, things went fine until somewhere between the 3rd and 4th steps, when the lights suddenly went out – the ones in my head, not the already darkened hotel room. My next recollection was feeling the back of my head bounce on the floor of room 125 of the Holiday Inn Express Hotel, exactly 1037 miles from my home. (They should really use a better grade of carpet in those places.) Although staying at this particular Holiday Inn Express hadn’t turned me into a brain surgeon (as the chain’s commercials suggest), feeling the deep gash that spanned the width of 4 fingers in the back of my head told me that treatment was going to be a little more involved than a self-administered band-aid. Thankfully, I had the presence of mind to apply pressure to the wound, unlock the door, and summon help before plopping onto the sofa in the room. (If you’re going to bleed all over something you may as well pick the most expensive thing around, right?)
The paramedics arrived in short order, examined the head wound, and were busy asking all the usual questions until one of them discovered a rapid and irregular heartbeat. Though I didn’t find that particularly remarkable after what had just happened, things got noticeably more intense as they struggled to get an accurate pulse reading.
Moments later I was whisked out the door aboard a stretcher. Having spent so many nights in hotels with other folks awakening me in the middle of the night, a little sadistic pleasure arose from returning the favor as we wheeled noisily down the hall and into one of the waiting ambulances. On the trip to the hospital, an EMT administered 2 intravenous doses of Adenosine in an effort to slow the heart rate. It succeeded only in scaring the hell out of me, as it felt as though I was being suffocated. I gave both EMTs a 2nd glance to be sure Dr. Kevorkian hadn’t climbed aboard.
While Richard dealt with the first round of paperwork, I was wheeled into room #4 and descended upon by an RN, Nurse Technician, and soon, the on duty ER physician. Each was polite, professional, and focused on doing their job. After the administration of IV fluids and an assortment of drugs, my heart decided to convert to normal sinus rhythm on its own. (Hospital billing department PLEASE TAKE NOTE OF THIS.) The ER physician then proceeded to suture and staple the scalp wound. Perhaps in confirmation of some prior accusations of hard headedness, I distinctly recall him complaining about Bakersfield suture kits not containing a ‘needle driver’.
Over the next 36 hours I had a whole bunch of tests run to see what kind of damage can be done by the combination of atrial fibrillation and using one’s head as a pile driver, AND to observe the internal workings of a hospital – something I hadn’t done since my college days when I worked as an orderly. I recall Richard muttering something to the effect that some people will stop at nothing to do field research.
Some Observations:
1. Numerous medical professionals have suggested that when it comes to health care, there are four (4) key components: Patients, caregivers, science/technology, and money. I would propose a 5th variable – Information, specifically its capture, use, and dissemination. Sadly, in my recent experience, the information handling (or lack thereof) within the hospital essentially mitigated any advantages gained from having a wonderful facility and a trained, motivated staff. Other experiences suggest this is no aberration. For that matter, it’s probably true of ALL our businesses, not just healthcare.
There is simply no reason in the 21st century for professional staff (or any staff for that matter) to have to ask patients 3 or more times to supply their address, phone number, insurance ID, next of kin, family physician’s name, social security #, and record it on yet one more stinking form. Maybe we should just take a lesson from the folks whose web sites seem perfectly capable of irrevocably capturing all this and more from a single page view.
Lest we forget, this type of waste doesn’t just interfere with patient care; it saps the morale of people who are smart enough to know that what they are doing at that moment is redundant and completely useless. As one RN pointed out to me, “I attended nursing school to put my hands on patients, not paper, and yet I now spend 27 minutes of every hour feeding an overweight bureaucracy.” And we wonder why so many nursing professionals proclaim that, while they love their work, they hate their jobs.
Of greater concern is the fact that information flow within much of the health care organization is entirely one-way (all intake). The fact that I was never officially appraised of any test results during 27 hours of nonstop testing and observation was (and is) more than a little bothersome. Sporting a portable heart monitor, I spent a morning on a lovely outdoor patio just outside my room retrieving Email, from wherever Email comes from, via a Palm Pilot, while considerably more important stuff, namely the results of an Echocardiogram, CT scan, VQ scan, X-Rays and assorted blood tests were seemingly lost within that very building!
Were it not for the kindness of technicians who could generally be coaxed to provide an unofficial ‘nod or wink’ in response to questions about the results, I would have known nothing about my condition during this period. If you want to watch someone’s heart rate and BP go up needlessly, just keep them in the dark about their condition. In fact, when I finally did see somebody with an MD after their name, I suggested that this treatment might prove an effective, not to mention cheaper alternative to the cardiac stress test.
I’d like to throw down the gauntlet for the medical community on this one. If FedEx can come to your door in the evening, pick up a package and deliver it in a time and destination-certain manner half way around the world the very next morning for 1/4th the cost of a chest X-ray, is there really any valid reason why something at least approaching that standard of performance can’t be achieved when it comes to acquainting anxious patients (and caregivers) with their test results? Come on, folks!
2. As one who spends and depends heavily on technology to do his work, I’m about the last person to resist the sensible deployment of chips and software in the medical arena. Yet, there must be limits. When an MD responsible for ordering tests and meds for a patient relies exclusively on remote digital data without the benefit of having seen, met, talked with or examined that patient, it would seem that we have crossed into the danger zone. To be sure, there are cases when such methods are necessary, especially those involving the emergency rescue and transport of patients, but as a wise ER doc explained to me recently, the digitization of medicine is not entirely a good thing.
A minor case in point… In addition to anti-coagulants and anti-hypertensive medication, one evening my nurse mentioned that I was being given a stool softener, all presumably on the order of an MD I had not yet laid eyes on. When queried about the latter medication, she replied that it was often needed to counteract the effects of the narcotics that had been administered, and the result of spending a lot of time in bed. When told that I had spent a considerable amount of time that day not in bed, but in the bathroom dealing with some guy named Montezuma, she mercifully countermanded the orders.
The situation could easily have been worse. While in the ER, I was connected to an automatic blood pressure cuff that was programmed to record my BP every hour. Initially, this seemed to be a really neat labor saving device. At exactly 14 minutes before each hour, this puppy would inflate, do its thing, and send the data off somewhere. That’s all well and good except for the fact that, on two such occasions, the cuff over-inflated and squeezed my left arm to the point that I frantically began looking for a way to dismantle the sucker. The second incident was alarming enough that my heart rate and rhythm, recorded on an overhead monitor, were visibly affected. I’m thankful that no one decided to administer more Adenosine on the say so of a BP cuff that had apparently OD’d on Viagra.
So what’s the point here? Every day, in EVERY organization, talented and otherwise motivated staff find it difficult if not impossible to do their jobs to the best of their abilities. Their efforts are frustrated by a host of systemic obstacles, some large but mostly small – everything ranging from policies and procedures that don’t make sense, to errant work direction, antiquated systems, or the lack of needed tools and supplies.
I watched in amazement as two highly trained, well paid nuclear medical technicians in a room chock full of Siemens’ best diagnostic gear, spent five minutes (I’m not kidding) searching for an ink pen with which to sign a form. A second but slightly different reminder of this occurred at exactly 4:17AM the next morning when a Nurse Technician ventured into my room to take vital signs. (They didn’t have the automatic BP pythons on the patient floors.) So far, so good. But then, she mentioned that it would be necessary to turn on the light and weigh me, something that had occurred less than 12 hours before.
Awakening from my first good sleep in 2 days, I asked if this was really necessary in view of the fact that my bodily intake and output had each been carefully measured, I wasn’t perspiring profusely, and hadn’t left any presents under the covers. After all, it seemed a rather simple mathematical problem, right? Wrong, doctor’s orders. And no, it couldn’t wait until a more reasonable hour, either. I thought for a moment about insisting that she phone the mysterious physician right away to tell him of what she had uncovered on the scale, but thought better of it and went back to bed.
I will submit that, if those in leadership positions within the health care arena redoubled their efforts to reduce or eliminate outright some of the systemic blockages to staff productivity (and attendant patient care/satisfaction levels), our staffing shortages might not seem so acute. Moreover, patient recovery/throughput and facility utilization rates will improve measurably. Following are a couple thought starters for treating our own little organizational form of atherosclerosis. Just think of them as a little dose of Lipitor.
- After a good going over by an audiologist, we could all stand to do a better job of listening – really listening… not just to data from a heart monitor, blood test or Email, but the real pulsating human being who sent that message. We should be listening intently to what the individual is saying, what they are trying to say, and what they are not saying.
Folks, if we do that to our young children and our elderly parents, and we do, we sure as hell do it to our employees, patients/customers, and colleagues. I’ve been assured that each of us was issued two ears and only one mouth for a reason. Maybe we should rediscover that reason.
Promise me (no, promise yourself) that you will vacate your office for a half hour this week, no matter what the patient or paper load is, and go ask your people what kinds of things keep them from doing their very best work. Ask them for a solution, hear them out, and give them an up or down decision on the spot – no waffling! Regardless of that decision, unless there is one hell of a good reason not to, grant them the authority right then and there to fix the matter. My bet is you’ll be so pleasantly surprised by the results, you will soon look forward to doing this every week.
- Good leaders find ways for their crews to enjoy regular moments of levity or celebration even as things are going to hell around them. It worked for Sir Ernest Shackleton, the Antarctic explorer we featured a few weeks ago in this newsletter, and it worked at the hospital that night.
Yet another lesson from Shackleton’s adventure involves the propensity of great leaders for saying thank you – a lot. In this particular case, there is one important individual whom I have thus far failed to thank appropriately. So, pardon my use of public bandwidth and your time for doing so, but thank you Richard for being there when I really needed you.
Please print the following attribution for this article: Bill Catlette and Richard Hadden, co-authors of Contented Cows Give Better Milk, help clients clobber the competition by having a focused, fired up, and capably led workforce. They deliver powerful conference keynotes and leadership training. They can be reached at 800-940-7006 (+1-904-720-0870 from outside North America) or www.ContentedCows.com.