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Ray Jorgensen, Ph. D. "We are Part of the Problem and the Solution Simultaneously" 00:03:30 minutes |
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| Safety In Healthcare | ||
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| Written by Brian McElyea |
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Patient safety is an issue that touches each and every one of us. As a consumer, we obviously want to ensure a positive healthcare outcome each time we meet with our provider. As a healthcare system, we also want to make sure that every patient interaction is safe and effective. HealthGrades vice president of medical affairs proclaims that, “overall we see the number of patient safety incidents in American hospitals continuing to increase, at an enormous cost, and we still see a large gap between the incidence rates at the nation’s top?performing and worst?performing hospitals.” Further, the Institute of Medicine has assessed that as many as 98,000 patients die a year as a result of medical errors in hospitals and medical errors are the eighth leading cause of death for Americans. These are alarming facts but you might ask why such information is presented in a leadership newsletter and can Conversational Leadership play a role in reducing medical errors? The answer is yes and here is how! One of the central components of Conversational Leadership is effective conversation. Our consultants have learned to design conversations focused on influencing learning, the fundamental leadership requisite. As such, these conversations are called Learning Conversations with five interdependent guidelines. Listening for Understanding: When you listen for understanding you seek to understand an issue deeply and provide a safe space to extract what the person is feeling without judgment or blame and seek to live in the moment of the interaction from a place of learning, not knowing. In a study by the Institute of Medicine, “of 1,047 patients admitted to two intensive care units and one surgical unit at a large teaching hospital, 480 (45.8%) were identified as having an adverse event, where adverse event was defined as situations in which an appropriate decision was made when, at the time, an appropriate alternative could have been chosen.” Evidence exists that physicians are often rushed with competing elements for their time. If the clinical staff learned the Conversational Leadership strategies for listening for understanding, their limited time/interaction with the clinical staff and patient could be much more productive leading to a deeper understanding of the procedure to be performed and appropriate processes for the procedure, thereby eliminating/reducing medical errors in the process. Speaking from the Heart: When you speak from the heart you are candid and speak from your experience, for the moment. It is that genuineness that causes a deeper relationship to build during the interaction with the sole purpose of developing a common understanding and common purpose. From a book entitled, Crossing the Quality Chasm, two of the ten rules for redesigning the 21st Century Healthcare System to minimize errors are: (i) the patient is the source of control, and (ii) knowledge is shared while information flows freely. Studies show that when a patient is participating actively in the decisions about their own care they appear to have better outcomes, lower costs, and higher functional status than those who don’t participate. This means the relationship between the provider and patient has to be deeper to minimize medical errors and speaking from the heart can assist in achieving that objective. Holding Space for Difference: When we hold space for difference, we embrace differing views as an opportunity for learning. We actually acknowledge the usefulness of another point of view. As we examine errors in our hospitals for improvement in patient safety, every area must be explored. The diversity of thought concerning safety in various industries contains valuable insights; however, our own limiting views and mental models often preclude us from extracting those ideas and concepts. In a report to the President of the United States on medical errors in 2000 by a Quality Interagency Coordination Task Force, health care was declared as “a decade or more behind other high?risk industries in its attention to ensuring basic safety.” The recommendation was to look at how other external organizations (e.g., FAA, other nation’s healthcare practices, etc) address the issues of safety in a more effective manner. By understanding how to hold space for difference, the opportunities for exploring solutions significantly manifests itself. Suspend Certainty: As you suspend certainty you provide space for different opinions to enter the discussion. You hold a space for the need to be right or heard and especially hold your own opinion up for all to examine. A study from the Journal of American Medical Association stated that more than 10% of final?year residents feel unprepared to deal with certain types of care ?? including HIV/AIDS, substance abuse and geriatrics ?? this not a surprise to those who monitor skill levels of practicing physicians. Given this, it would appear that as residents gravitate through their programs; both facilitator and faculty need to be able to suspend certainty in their own limits of medical knowledge. Not doing so can lead to medical errors by residents proceeding with care due to fear of exposing their knowledge limitation—an issue many clinical professionals fear. Slowing down the Inquiry: As we allow time to digest the other person’s words and take time for the conversation to develop and expose, we deepen our common understanding of the issue we are analyzing. Consider that the average time a doctor spends with a patient is around 15 minutes to glean all medically important facts and 60% of all patients leave either forgetting to ask important questions to their provider or provide substantive information. Strategies to slow down the inquiry and provide opportunity for common understanding (two?way communication) is critical to reducing errors in medical practice and providing a deeper relationship. In a recent American Medical Group Association study, effective personal interaction with clinical leadership, coupled with leadership designing and communicating clear expectations, were amongst the major issues for physician retention during their first 90 days of work. By slowing down the inquiry, physician leaders can ensure a quality interaction and ensure safety expectations are understood (along with other expectations) thus leading to higher retention of a precious commodity—our newly enrolled physicians who understand medical errors in all contexts (business and clinical). Conversational Leadership has significantly more implications on patient safety then what has been presented in this paper. The purpose was to show brief and immediate benefits of how the conversation and strategies to ensure deeper understanding can improve patient safety. The examples were individual in nature and intended to illustrate a component and how it could impact patient safety directly. It must be stated that patient safety has many more components to assess, the least of which is the apparent imbalance between tort reform and patient safety policy. The Conversational Leadership practice of designing and using learning conversations is a system?based process that utilizes all five learning conversation guidelines interdependently and should be practiced in a way that utilizes all five components. Each component has strategies that can be engaged to maximize the effectiveness. To learn more about these strategies and how to apply and integrate them in your medical practice please feel free to contact Brian McElyea at Jorgensen Learning Center ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) or (904) 513-2259. |
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