Democratization 2.0

I heard a great talk last week by Andrew McAfee, a professor at Harvard Business School, about Web 2.0 and, as he terms it, Enterprise 2.0. This expanded into a discussion of the inherent democratization that occurs in the 2.0 environment, from which Andy rhetorically raised the question of how reliable and accurate this kind of approach is. Of course, my immediate response was, "Compared to what?" He then reminded us about the "contest" in 2005 that was held comparing Wikipedia to the Encyclopedia Britannica. The two sources were found to be equally accurate, until several hours later, when the mistakes on Wikipedia had been corrected!

This reminded me of a post I wrote several weeks ago about my hope to create the organizational equivalent of a wiki. And, of course, it relates to all the stuff I have been boring you with about BIDMC SPIRIT. The underlying premise is that a democratic approach to problem identification and problem solving is what makes it possible for a complex organization to discover ways to improve. As Steven Spear notes, the alternative method -- trying to design the perfect complex system in advance using the traditional business hierarchical approach -- is unlikely to produce a sustainable and efficacious solution, especially in an environment characterized by structural change.

Can health care institutions learn this approach to adaptation and improvement? The jury is still out.

Teaching from the test

Here is a recent entry from the SPIRIT call-out log, as an example of the types of things that are found and the process for fixing them. Sometimes existing sources of information are not effectively used because of a lack of knowledge or training about them. As always, the key here is not to blame anyone. It is to solve the problem called out and then to promulgate the solution throughout the organization.

PROBLEM: The lab test entered in the lab (Metanephrines) was different than the lab ordered on order requisition (Methemoglobin).

ROOT CAUSE: Why was Metanephrines entered into lab system instead of Methemoglobin? Metaneprines was selected from the list of 9 choices displayed in the blood lab information system when lab assistant typed in "MET". Assistant selected metanephrines (plasma) because asked a coworker what to select was told to pick this one because purple top vial is associated with plasma. Methemoglobin was not an option to select. Why was methemoglobin not an option to select? Assistant was working in blood lab information system. Methemoglobin is a blood gas test and is an option in that system only. Why was the assistant working within the blood lab information system? The requisition that the EP lab sent to the lab was a blood lab requisition not a blood gas requisition. Why did the EP lab send a blood lab requisition? The person requesting the lab test was unfamiliar with the test and did not have the information necessary regarding the type of tube and requisition to use. (Asked 4 people in cath department and lab and received inaccurate information and sent purple top and blood lab req. )

SOLUTION: Design a way for workers to have accurate information regarding which blood tube and requisition to use for each test. (Access to electronic URL that contains the lab resource manual on BIDMC website.)

ACTION: Wayne (Lab department manager) demonstrated the online lab reference to the nurses in the EP lab. Will continue to work with lab and nurses to work on a way for them to have the information that they need when requesting lab tests. Wayne will also work with his staff regarding a way to call out for help when the exact lab test requested is not an option to enter into the system.

Notes: The problem was found serendipitously when looking at a lab requisition for another issue (a half-printed patient plate). Wayne learned as much as he could from his staff then activated the help chain to request help in further investigation in the EP lab. Nurses in EP lab and in our small group were unaware of the online resource available to them and grateful to learn about it. This surprised Wayne. Question for consideration: Are the other nurses in the organization aware of this extremely useful tool and if not how can this be communicated to them?

The power of SPIRIT

From Jane to me (I have embedded the link to the SPIRIT post below):

Pat suggested I share the email below with you regarding my initial impressions of the Spirit program. As background, I was a longtime “old BI” nurse and left clinical practice back in the 1990s to do writing and other projects, which led to launching a consulting business a number of years later. However, after 11 years, I found I missed clinical practice, and I chose to return – albeit on a very limited basis (about 20 hours a month). This is becoming a lot of background - - but! - - folks in nursing were amazing in helping me get back on my feet, providing many hours of re-training and encouragement – just wanted to mention that also! I spend most of my time in the ED, and my email to Pat was following my shift last evening.

I think Spirit is fantastic; thanks for creating the environment where this is possible.

And her note to Pat, one of our SPIRIT organizer/trainers:

Just a quick note to say I think the SPIRIT website is fantastic. I used it last night to log my first “problem.” As you and I have discussed, as someone re-entering practice, and as someone who doesn’t work a whole lot of hours, I think I have a vantage point that is free of what you have called “tolerance of deviance” - - -I haven’t built up that tolerance, so some of these issues are just glaring me in the face. I am so pleased to have a way to share them.

That said, I’m a little worried about posting too many things!! Let’s discuss more when we talk next.

It is interesting to see the range of things posted. The few skeptics who are posting are disheartening, but I predict that attitude will die out quickly.

Here is a quick anecdote from my shift last night - - one that I think shows that just having this in place may help people become more aware of problems that they will then just solve on their own. Several people came through the ED looking for pillows. It is a chronic problem – lack of pillows. My tech had said to the pillow-searcher, “We don’t have any. We never have any.”

I was talking to my tech about this, and about how this could be logged into Spirit. (He was initially skeptical of the whole idea of SPIRIT but, I think, warmed to the idea!). Anyway, as I was showing him the program and encouraging him to log it in, he said, “Well, you know, we can call for pillows any time we want.” You could almost see a light bulb going off over his head - - saying, “Well then, why don’t we??”

I think the whole discussion of the idea of SPIRIT ratcheted things up for him to say, “Wait a second, I don’t have to live with no pillows, I can actually call for more and I think I will.”

Kind of a silly example, but I think the program will have this power.

That’s it, just sharing! I think it is very exciting.

Early SPIRIT success

Sometimes the little successes mean a lot. Here is a short story of a call-out and a solution during the first official day of BIDMC SPIRIT. This did not take a lot of work and really only involved a short investigation and the realization that a simple phone call could solve a problem. (Not all will be this easy.)

The story is told by Betsy, a manager in the Radiology Department, to the Techs and Associates in her department. The problem being called out was that Techs arriving to administer a portable chest image for patients on the cardiology floor would often find a patient missing. A wasted trip, and frustrating for these very busy people, who then also would wonder why the patient couldn't just have been sent to the Radiology floor to have the imaging done there.

Our first BIDMC Spirit call out was entered yesterday for portable chest ordered on Farr 6 when patients are off the unit. As many of you may have encountered arriving for a portable on Farr 6 - to find the patient is off the floor (usually in dialysis). So the SPIRIT was looking at why this was happening and what could be done. We learned a couple of things:
* This is a cardiology set-down unit.
* The person entering the order does not know the patient's schedule for the day.
* These patients have telemetry - so when they leave the unit they must be accompanied by a nurse. This takes a nurse off the unit, so they try to limit the time away - hence the portable order.

Solution - call the unit first to see if the patient will be there. The unit will be happy to help!

Thanks to everyone who was involved looking into this …see, there was a reason for the patient to be portable and a reasonable solution!

Betsy

The SPIRIT arises

(Email yesterday to the BIDMC Community, formally kicking off this adventure.)

Dear BIDMC,

Today we begin BIDMC SPIRIT across the medical center. Don’t expect flag-waving, speeches or any fanfare like that. This week is about first steps.

Why do we need to do this? Please read the following situations from some of our SPIRIT training sessions over the past few weeks:

The lights are too bright over my telemetry work station so it’s hard for me to read my screen, but if I turn off the switch it is too dark for the nurses at the rest of the nursing station.

When I mail a prescription to a patient and drop it in the BIDMC outgoing mail box it can take up to 10 days to get to the patient. We have resorted to buying our own stamps, hand-addressing the envelopes and dropping them in a US mailbox.

We are looking for a patient to bring down to angio. We have already searched in the day care unit and on the inpatient unit where we thought he was – but we found out that he went home yesterday!

I needed an IV pump in my recovery bay and I searched all over for one before I found out that we had none.

Think back to your first day of working here: Was it your goal to deal with situations like these? Probably not! But we all acknowledge that it happens every day. No matter where you work at BIDMC, you probably spend a chunk of your time hunting for things, tracking down something or someone you need, and fetching materials. You are well-intentioned, hard-working, creative and industrious. You have found ways to provide excellent patient care or support for patient care in spite of the challenges. Often you create “work-arounds” to simply get your work done. The problem with work-arounds, though, is that underlying systemic problems don’t get fixed. Now, with BIDMC SPIRIT, we aim to fix them.

My hope is to have us improve the quality of the time you spend here so you can focus on the things that matter instead of working around the problems you encounter. We know from other places that this can happen. They key is to empower every single person to call out problems, participate in solutions, and be appreciated for his or her contributions.

I will promise you one thing, though. During the first few weeks of SPIRIT, activities may feel clumsy – and perhaps chaotic. The number of problems called out will certainly exceed the number that can be worked on in real time. Not all of our managers have been formally trained, but we can’t wait for the timing to be perfect. We have to get started. So be please patient with each other – and especially me! -- as we get this going.

You probably have lots of questions. To learn more about how SPIRIT works, please read this Q and A (Note: This linked to the document below.). There are posters and flyers around in four languages so we can make sure that staff who don’t use computers or those for whom English is a second language are involved.

I also ask you to visit the general portal and click on the BIDMC SPIRIT logo some time this week. You’ll find a problem log up-and-running. Real-life, BIDMC problems and solutions from the first SPIRIT trainings are already there for everyone to see and learn from. It’s a great way to see what SPIRIT is.

You will be hearing much, much more about BIDMC SPIRIT in the coming weeks and months through e-mails, newsletters and the BIDMC SPIRIT site on the portal. Also, I will be documenting our progress for the world to see on my personal blog, www.runningahospital.blogspot.com.

Finally, many thanks to Andrew French, Research Administrator, who came up with our program’s name, BIDMC SPIRIT: Solutions Promoting Improvement, Respect, Integrity and Teamwork.

Sincerely,

Paul

----

And here is the Q&A that is referenced in the message above:

Frequently Asked Questions

The lights are too bright over my telemetry work station so it’s hard for me to read my screen, but if I turn off the switch it is too dark for the nurses at the rest of the nursing station. On…off…on… off. It doesn’t make sense. We need help!

When I mail a prescription to a patient and drop it in the BIDMC outgoing mail box it can take up to 10 days to get to the patient. We have resorted to buying our own stamps and dropping the envelopes in a US mailbox. Is this extra hassle really doing any good? We need help!

We are looking for a patient to bring down to angio. We have already searched in the day care unit and on the inpatient unit where we thought he was – but we found out that he went home yesterday! What a waste of time! We need help!

I needed an IV pump in my recovery bay and I searched all over for one before I found out that we had none! There has got to be a better way to do this! We need help!

What do these scenarios have in common?
They are all “call-outs” – BIDMC staff declaring that something is keeping them from doing their jobs in the best way possible. The call-outs above are real situations that came up in the first wave of manager training sessions for BIDMC SPIRIT.

What is SPIRIT?
SPIRIT stands for Solutions Promoting Improvement, Respect, Integrity &Teamwork.

You probably remember the e-mail from Paul Levy around Thanksgiving in which he challenged each member of the BIDMC community to be part of a new way to consistently identify barriers to care and implement system-wide solutions as close to real time as possible.

As Paul said in his message: While the goal is simple, the solution is not. We want a solution that will identify and start to solve problems on the floors as they occur. We want a solution that will uncover and fix underlying problems, not result in yet another set of work-arounds.

The goal of SPIRIT is to make the work lives of all of our staff easier and more gratifying. To begin, we must all see and think about what we do every day in a new light. Chances are we all have work-arounds that we do every day without thinking. Or we waste time fetching and hunting for materials or resources we need and we may not even notice.

Once you identify a problem, the basic steps are:
-- Call out a problem to your manager/shift leader.
-- Work together to identify the root cause of the problem and solve it as soon as possible – in real time.
-- Log it. (see below)
-- Use the Help Chain, if necessary. (see below)

Less time hunting and fetching can mean more time spent on patient care – which will have a major impact on our goals of higher patient satisfaction and improved safety.

When and how will we start?
We intend to launch the BIDMC SPIRIT program the first week of March.
We have been busy orienting supervisors, managers, directors and vice presidents to the basic concepts of real time problem solving. We are working with a group of consultants from a company called Value Capture. They have experience in leading system wide change at the international manufacturer Alcoa and leading similar change initiatives at several academic hospitals.

How will it work?
All employees will be asked to participate by “calling out” to their local manager/shift leader to report a problem related to hunting and fetching activities that are causing you to do work-arounds. Your manager/shift supervisor will help you to meet immediate patient needs as soon as possible. We call this “restoring the system.” Together, you will then log the problem into an electronic SPIRIT problem log (click on the SPIRIT logo on the general portal.) Your manager/shift leader will use real time problem solving strategies to facilitate a solution for the problem. Because you are the one who knows your work the best, you will be involved in the steps of finding a solution whenever possible. The goal for us is to have these call-outs addressed within 24 hours. The solutions will also be logged in the SPIRIT problem log.

I do most of my work in a patient care area, but I report to another department. To whom should I call out a problem?
You have two choices:
a) The unit’s nurse manager
b) Your departmental supervisor

When you call out a problem, ask yourself who makes the most sense to provide help. (You don’t need to spend too much time deciding this – there’s no ‘wrong’ answer.) Here is some guidance:

Is the problem related to patient care or work done on the unit? Call the unit’s nurse manager.
Example: While seeing a patient on Farr 7, a Case Manager finds that discharge paperwork isn’t ready at the right time. After solving the problem for the immediate patient, she calls out the problem to the Farr 7 nurse manager – because this problem involves the Farr 7 doctors, nurses and physical therapists and makes sense as part of the Farr 7 Unit Team.

Is the problem specific to your work, but not to the unit you’re working on? Call your usual supervisor.
Example: While seeing a patient on Farr 7, a Case Manager notices a serious bug in the case management software. It doesn’t make sense to call the Farr 7 nurse manager as part of the help chain for this problem, so she calls her supervisor in case management.

What is the SPIRIT problem log?
The SPIRIT problem log is a click away on the portal – just click on the SPIRIT logo on the top of the general portal. It provides a public space for you and your manager to log your “call-outs” and for us to track the various “call-outs” across the medical center. The SPIRIT log is not a notification system. Problems and work-arounds should be called out in person to your manager/shift supervisor whenever possible. At times when no one is available (night shift for example), go ahead and log it into the system anyway. Your manager will get back to you to involve you in problem solving if time allows. The SPIRIT log is visible from any public work station on the portal. The log will also track solutions. This will give us an opportunity to share the knowledge about fixes in one area that may be easily adapted for another area.

For patient safety reports or any report that requires the use of specific patient information, please continue to use the Patient Safety Reporting or Adverse Drug Alert or Adverse Event Management systems. The SPIRIT problem log does not provide the privacy protection needed when reporting patient related events.

What is the HELP CHAIN?
Every department is specifying the components of its HELP CHAIN. The chain flows from the local manager to the director to the VP to the President’s office and then to the Board of Directors of the medical center. We are creating a comprehensive list of departmental manager HELP CHAIN contacts so that your manager will know the name of a manager in another department who can be called when the problem “call-out” and subsequent root cause and solution involve more than your home department. We imagine that this is going to be the case for many of the “call-outs.”

How will I know how it’s going?
Information will be updated on the SPIRIT section of the portal. There will be weekly Friday e-mail updates about SPIRIT with a focus on stories about staff who are doing the work.

What about people who don’t use computers?
For staff who don’t use computers, the preferred way to call out problems is still to talk to their managers/shift leaders. If a manager isn’t available, there is a special SPIRIT phone number, (66)7-7474, for staff to call in a fetching or hunting problem. Information from the weekly Friday e-mails will be collected and put into to a print newsletter.

What about staff for whom English is a second language?
For staff whose primary language is not English, the preferred way to call out problems is still to talk to their managers/shift leaders. If a manager isn’t available, the special SPIRIT phone number, (66)7-7474, allows staff who speak Spanish, Portuguese or Haitian Creole to leave a detailed message in their first language. Staff from Interpreter Services will transcribe the messages and pass them on for the SPIRIT log. The print newsletter will also be translated into Spanish, Portuguese and French/Haitian Creole.

How can we possibly solve all of the problems called out?
We know that this is not going to be perfect on day one! We are all going to learn this together. There will probably be many more problems called out than can be solved in real time. Having said this, the important thing is that we begin by trying to solve some – everyday. This is the main priority for our work this year. Solving more problems in real time and involving those closest to the work will result in smarter solutions and less formal problem solving meetings over time. Remember, to reach our potential for greatness, every employee should be able to answer the following questions with a resounding “YES!”

Am I treated with dignity and respect by everyone I encounter, regardless of role or rank in the organization?

Am I given the knowledge, tools and support that I need in order to make a contribution to my organization and that adds meaning to my life?

Did somebody notice I did it, i.e., am I recognized for my contribution?

How things don't get fixed

So, as we start to implement BIDMC SPIRIT, here is a classic tale of a complaint and a solution that doesn't solve the root cause problem. Note that all people involved are very well intentioned, responsive, and caring of the patient , but how -- without a little prodding -- an underlying problem would have been left unsolved. By the end, we are headed in the right direction!

Note to me from a friend of a friend:

Amy S. suggested that I write to you about the difficulty that I have had registering on the BIDMC PatientSite. Quite simply, I tried to register as a patient and received a "Confirmation of Registration Request" by e-mail on February 11, 2008. I have still not received a username and temporary password. I currently correspond by e-mail with my primary care physician here in Worcester and find it quite helpful. The BIDMC patient site seemed to offer even more in terms of usefulness to a patient. It is frustrating and a little disquieting to discover that his piece of technology does not run as smoothly as I as a patient would hope the care at BIDMC runs.

My reply:

Hi. I am forwarding this to people here who can be helpful.

Reply to me from our CIO, with a copy to the right person in his place:

Happy to help. ABC, could you check on [this patient's] registration?

Note to the patient from ABC, with copy to me:

You are now registered for PatientSite. If you need further assistance, please do not hesitate to contact me.

Note to ABC from me:

Thanks. Now, I am curious as to why it didn't work for him. Can you explain? Is there anything we need to do to help others avoid this problem?

The IS person's reply to my query:

He sent two requests to register with Dr. X in the XYZ clinic. These requests typically go to office staff, and they did not respond to his requests.

My reply to administrative director in that clinic, with copies to others.

Well, let's pursue this and get to root cause and solve it, so it doesn't happen to future patients. (Pat and Jayne, also please note and offer BIDMC SPIRIT advice and assistance to [the AD] as needed.) Remember, no blame! Solve the problem.

Reply from AD, to me alone (!):

Thank you. Will follow-up with the admin staff.

Reply to the AD from me, again with copies to all others:

But, wait: There may be lessons for other clinics as well, so please do not do this in isolation. That is why I continue to copy others on this email thread....

Jayne, the VP who was copied, jumps in and says:

Dear All,

I will call a meeting to discuss the process for signing up for patient site. It would be good for everyone to understand the full process. Once we all know the full protocol and who is responsible for what portion of the process clearly without misunderstandings, then we can improve and re-document the process and roll this out to office assistants also as appropriate. Also, we need to ensure that the physicians also understand that they too need to approve their participation in patient site as I understand that has been a concern in the past.

ABC, can you bring a process flow of how IS and offices handle requests and timelines of the process for approval. Also, how is it fully communicated to the patient, etc. Then we can discuss other components that contribute to a less than optimal response to the patient and solve to root cause, then roll out to all, the improved system so that everyone understands their roles.

The SPIRIT lives on

Here are several more comments from people being trained as part of BIDMC SPIRIT, our program to enhance the workplace for our staff. I hope you all are not getting tired of this, but I think it is important to continue to share these observations -- both internally and with those of you in other hospitals -- to give a sense of how a program like this gets rolled out and what issues are brought to the fore.

I love the observations – wish they were longer because you can learn so much by watching other people’s work.

Think that seeing other areas of the hospital creates huge benefits in understanding how pieces fit together and how remarkable the people of the organization are.

I like the idea of having SWAT teams who can bring fresh eyes from across the organization to observe and help improve work in each area.

I’m worried about the documentation that may be caused by the Spirit program – we can’t let documentation overshadow problem solving.

There are still some important elements of the program that haven’t been clearly enough defined so I don’t know what to do tomorrow when I get back to work.

We need to get physicians and mangers from the “supplier” areas into the orientation soon so that everyone who is working on problems together is doing it using the same method and eyes and people don’t get stalled on all their early problem call-outs.

I did not expect to be able to see problems since I didn’t know the work well, but I was easily able to see many problems. At one point I saw seven problems in six minutes!

It would be useful to have scripts for starting the investigations that help us get started on the skills that the Value Capture staff demonstrated today.

This experience was so important for helping “throw out what you think you know” and create a whole new way of thinking.

We have to think carefully about what the staff will hear about what is expected of them and of their managers.

I learned the importance of staying on point to fix problems one-by-one so that we don’t try to solve multiple problems at the same time and fail at all of them.

I’d like to know how this process will effect human resource evaluations and whether we will be changing our forms and processes to align them with Spirit.

We have to be careful not to confuse Incident Reporting and Spirit, but also to potentially use both processes on the same problem sometimes to incorporate appropriate (non-patient/worker identified) transparent learning and real time problem solving for some of our dangerous events.

We have to address the off shift, weekend, and holiday help chain or we will make many of our employees very frustrated.

The Spirit program and this orientation create a common ground and a common language for problem solving that will be useful to change our culture.

I would have preferred that the packet that was handed out could have been sent sooner. It was not the same information that came over the e-mail. The positive was getting into the field and seeing all the situations staff are dealing with. Also seeing leaders with experience helping us. Having the direction of people who will be trainers was very helpful.

I agree. During the debrief after the problem solving, hearing from what the other groups worked on in the other departments – their experience, their action plans, that was was helpful to me.

Coming in I dreaded that this would go on for 8.5 hours but it by very fast and it was very informative. I can see it happening. I was involved in the envelope saga. It was amazing to follow it through and see all that can come from one little envelope.

This was a good tool to organize problem solving. It forces focus, etc. Organizationally, it can’t hurt. For me it will definitely help in organizing problem solving and solutions. On the side of needing improvement, sometimes it seemed we were looking for problems. It would have been nicer if there would have been more actual call outs from the staff while we were there. Maybe preplanning to be there at busier times … so we’re there when people are ‘freaking out.’ 

The case examples we did, the role plays, were very good to prepare us and get us ready for the floors. It gave us tools. On the negative, going during lunch time inhibited follow-up. Folks can stagger their breaks on the floor but it’s still a hard time.

This is my second time out. I am less in awe (which means confused). The process seems more “backed up,” clearer. The staff are very open. On the concern side, we are still in the learning phase, and we are supposed to be starting very soon. Some things are still fuzzy … that’s going to be very hard.

The process of building the scientific method in the morning was very helpful but out on the floor in the afternoon it sometimes felt like a solution in search of a problem (when you’re a hammer everything looks like a nail). The staff may be so used to workarounds it was hard for them to get into it. It was great getting into the field … the dialogue with the chief tech was just great.

This was my third time. Its amazing to see it come together. To go from this being very uncomfortable for me today, as co-facilitator, to see the program really shaping up. It won’t be perfect but we need to be ready to say – as I will say to my division – we need to be ok with a little clunkiness. Our biggest challenge and the key will be to really use this to empower the staff.

The roleplays were really helpful and really important to do. I still feel like we need more tools to use to actually solve problems. Not instead of the training we are doing but as a “plus.” There are 10 or 20 key ideas out there that we would really find helpful. A few sessions on those would help.

The positive was to be on the unit and see what staff are dealing with, to see the opportunity to help. Within just one hour to get to the root cause of a problem like that … was great. A concern is the time involved from the help chain people. I also worry how this process will fit with others [internal queuing of work orders], that it won’t be used to move other things to the top of that queue.

This was my second time. It was definitely much clearer and more solid. The training was well organized. I have concerns about people’s time. The little problem in the mail room – the implementation plan is not going to be so fast to come together. It is important to try in real time though. I see that.

The role plays were helpful. Learning about other areas, being non-clinical myself. The tools were a good basis but make them easy to access and painless to use … if not people won’t use them.

I enjoyed the whole day. It gave me a knowledge base of root cause problem solving that I didn’t have. It opened up possibilities for me in my thinking. I want more tools to help promote this in my departments and not have this be seen as burdensome.

As we get to action planning it will reveal tensions in the organization. That’s how we’ve done things in the past, and people dig in. For example, the envelope problem. Some may say don’t do x because we care about y. These things will reveal tensions; it’s how we resolve them that will be key. I also want us to consider the benefit of outside eyes today. When this starts, if it’s just me and my staff working on these things there’s less value in breaking silos and seeing things fresh. I’d like to build in those outside eyes.

The observation was wonderful and helpful. I would have like to review the material, observe in the AM, then come back to process, then go back to the floor to problem solve. It’s easier to start this where we know. I would have liked to have started in our own departments, on problems that stay there. Not jump into things in the middle that cross over into other departments. Could we start this this way? Staying away from the interdisciplinary problems?

I enjoyed going out. I’m new to the hospital (3 months). Hearing other managers with their perspectives. One point I’d make is that we need to teach how to respect each other. It can be the most important thing. I spend a fair amount of time looking at things between the OR and other areas. So many problems stem from communication; we need to teach how to have respectful conversations. Another suggestion: have aggressive 6 month feedback on how this is going and what we can learn.

I liked going and observing; I saw a lot of things in my own area’s registration-it was very eye opening.

I enjoyed working with people in other people in other areas, the group setting was nice, it was nice to see the people behind the emails.

This will change the dynamics of what people see as problems; this can break down barriers.

It should remind us all that immediate need for me might not be immediate an immediate need for someone else and we need to show respect for each other.

I like the practical aspect; it builds ownership within and among departments.

Observing the blood bank lead me to understand what our department can do better.

It was interesting to see that something as simple as how we put a label on impacts someone else’s work- we are probably making other departments take extra steps and we don’t even know about it.

Communication is so important; rather than just getting used to it (the problem).

There is a lot of work that will come out of this and some will be hit more than others.

The afternoon was really long.

It is awkward observing someone and I am sure they feel the same way.

How will people stay motivated when we are unable to solve everything, how will we feel about this workload, how can this become part of our intelligence versus hunting through a log.