Thursday, April 30, 2009

The Journey Toward Self-Actualization

Our Annual Meeting in Chicago just ended. Amidst the leadership and business curriculum of the meeting, a key message that lingers is the importance of knowing who you are, and what matters to you.

Pete Athans, the soft-spoken, introspective Everest mountaineer, used the term “self actualization” to describe an important ingredient of rising to a challenge. Barbara Linney asked participants in her Base Camp to quietly write down the whos, whats, wheres, and whys that bring energy and positivity to our lives. Tom Royer, Christus Health's CEO, and Dick Clarke, Healthcare Financial Management Association's CEO, provided a powerful financial analysis of the wave of economic storms that are stalled over the health care industry. They emphasized the importance of a leader’s values, integrity and self-awareness during times of stress and challenge.

My many conversations with both first-time attendees and senior leaders had a similar focus. Each person was ready to move on from the status quo and saw something better ahead. Several said they were attending to acquire knowledge so they could have more professional options as the landscape of health care changes. Most see greater leadership and management roles for primary care physicians, as their numbers shrink and fail to keep up with growing demand. Entrepreneurs are looking at innovations that can “disrupt” the status quo and emerge from the recession as much-needed improvement for consumers and patients. Insurance and pharma physician leaders are deeply engaged in crafting new definitions of their industries.

So, is it more important who you are or what you accomplish? Can you accomplish what you want without defining who you are and what matters to you? Have you done your own personal analysis to understand your strengths, weaknesses, opportunities and threats? My bias is that the journey you undertake to define who you are is the springboard for what you will accomplish in both your professional and personal relationships.

Start crafting your personal mission statement. I’ll share mine with you in my next post, and the process I used to discover what matters to me.

Wednesday, April 8, 2009

What Dropping a Truck Bed Taught Me About Patient Safety

Four years ago an accident in my shop gave me a new perspective on errors and mistakes in health care. I have my son, a commercial pilot and A & P (airframe & power plant) certified mechanic, to thank for helping me find that different perspective, and making me curious about what we could learn from mechanics, pilots, and industrial safety engineers that could apply to health care. I’ve been learning ever since, and wishing I’d learned these concepts in medical school or residency!

The perfectly balanced steel truck bed crashed to the concrete floor because of my failure to follow our agreed upon plan that he outlined during the “time out” before undertaking the high risk maneuver. Then he said he wanted to take a picture of the mess to put on our website that chronicled the restoration process. Why? “To share our mistake, so that no one else tries the same thing, Dad. I guarantee you someone else will try the same thing. I don’t want them to get injured.”

Getting over my reluctance to share my mistake and the root causes of it with the world, I realized I should be less concerned about embarrassment, and more concerned about not wanting anyone else to be harmed. His training at Purdue taught him the key concepts of high reliability and safety. Karl Weick and Kathleen Sutcliffe’s excellent little book, Managing the Unexpected: Assuring High Performance in an Age of Complexity describes high reliability organizations as being “mindful” of how mistakes happen, and how to build in mechanisms to prevent catastrophes from happening. Another term they use is “preoccupation with failure” – understanding how small events or pieces of information often give us warning that a situation has the potential to deteriorate and cause great harm. Watching good pilots, mechanics, intensivists, hospitalists, surgeons, and other physicians in their daily work being preoccupied with failure is a positive attribute, if I’m a passenger or patient affected by their knowledge and decisions. It means that they know the signs of impending failure, and how to intervene to prevent it.

These concepts of high reliability, which come from engineering and cognitive psychology, may provide us a path to improving the reliability of health care. Health care organizations focused on primum non nocere (First Do No Harm) as their core business philosophy, and that have trained their staffs in the principles of high reliability, report better teamwork and operating results.

Sharing my shop mistake on the website was a great experience. I had no idea how many physicians, hospital executives, or their spouses were “gear heads” regularly checking on our progress with the old truck! The most common comment was, “I can’t believe you did that”, followed by, “I’d probably have done the same thing.” Then we laughed, learned, and moved on to another topic.