Out of Africa

ABUJA, NIGERIA -- ACPE faculty member Eric Berkowitz and I have just finished a two-day course for physician leaders in collaboration with the Guild of Medical Directors (GMD) at the Protea Oakwood Park Hotel in Lagos. Tomorrow we do it here in the capital city of Abuja.

Charles Cudjoe, a member of the College for several years, is the force behind this first-ever OnSite on the African continent. In addition to being a surgeon and ordained Episcopal priest who preached at Trinity Church in Boston, Charles owns a hospital, and is the president of the Guild of Medical Directors.

Charles has identified a need for physician management and leadership education here as the economy grows. The last few days with Charles have been unforgettable. I’ve appreciated his business acumen, devotion to his patients, and the number of people who are his friends. His enthusiasm and optimism are irrepressible. When Charles sent personal messengers to knock on the doors of physicians in rural clinics to inform them of our planned session, we knew we were all committed to making this happen.

Physicians here are working for bank-owned HMOs, private and public hospitals, and private medical groups. The response has been exciting! In the audience were Nigeria’s only physician-health economist, a crown prince, and the medical director of the government’s central bank. We see that the country’s reputation and passion for education are real and palpable. Colin Powell was here last week. Michael Porter, who developed the Five Forces model of strategy while at Harvard Business School, is scheduled to be here July 23 to speak with business leaders.

I’m hoping that many of our members in the US and elsewhere will be willing to help some of our new members in Nigeria think about how to address the problems and frustrations of an emerging managed care model. The next post you read will be from Charles Cudjoe.

What I Believe

A personal mission statement. It’s not easy, but the end result has been very powerful for me. In the process, I was able to define what’s important to me – and what isn’t. It applies to my family, friends, professional colleagues, and the counter help at Dairy Queen. Without it, it’s too easy to wander down the wrong career path or spend time on unproductive leisure activities. It takes courage to share this on the Internet, but I made a promise a couple of blogs ago:

I’m an artist, architect, and healer.
As an artist, my medium is people and relationships, showing reverence toward the unique skills and spirituality of every person in my life.
As an architect, I use discipline and love to the guide the creative process that builds rock solid change from the status quo.
As a healer, it is my sacred duty to find the calm, peaceful center of conflict, and help others find connection and common ground.
The quality of my work is measured by the achievements and attitudes of the people I serve.

I worked with an executive coach with very special expertise in language and expression. It took a couple of days to develop this, picking out relevant words from an exhaustive list. It was interesting what types of words had meaning for me, and which didn’t. Every person is different. Now I know that if I ever meet Warren Buffett at Dairy Queen, and he asks me what matters in my life – I’ve got an answer.

Drawing Inspiration from Hospitalists

The Society of Hospital Medicine concluded a very exciting, high energy meeting last weekend in Chicago. A major focus was improving quality, safety, and reliability on a system level through the key roles that hospitalists play at the center of hospital care. The passion that these young physicians have for making a difference in their own hospitals, and sharing those improvements far and wide with their colleagues across the country, is remarkable!

No one told these physicians that they must do this, and no one is paying them to do it. They’re engaged in these activities because of the best motive of all: an internal desire to be involved with innovation, improvement, and learning from clinical colleagues.

Heading to the National Patient Safety Foundation’s Annual Congress this week. I'm also in conversations with leaders of The Joint Commission last week in Chicago on the topic of how to engage medical staffs at academic centers, community hospitals, and group practices in quality and safety improvement is a common thread. No one has found the answer yet.

Will the emerging work on the impact of diagnostic error, coupled with the engineering science of high reliability, create curiosity and a desire to learn more about becoming a better physician? Are we aware that how we communicate and lead our clinical teams has an impact on patient safety? How can we spread the hospitalists’ enthusiasm and action to improve health care?

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.

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.