Take a Break from Hooking that Ugly Rug

My daughter hears with a cochlear implant. My 17 year old son, born with a digestive system problem that would have been lethal 50 years before his birth, now referees his dad's hockey games. Thanks to a heart-lung transplant, my first cousin lived to see her son grow from age 2 to age 12. Aggressive medical and surgical management of heart disease has enabled my dad to live beyond, by many years, the age when heart disease claimed the lives of his father and older brothers.

I think my family is probably a lot like yours. We're full of people who are the beneficiaries of medically-mediated miracles. When I visualize what modern medicine is capable of, the image is profound, mature, purposeful. It pulls from the best of what humans--energies harnessed and God-given talents extended on behalf of others--can do. Maybe it looks like this:

In the day to day business of healthcare, though, the challenge of engineering a system where safe, effective, and accessible care is realized can flummox mere mortals.

Don Berwick talked about the imperative of seeing the big picture earlier this week at IHI's National Forum. (I didn't attend this year, but benefitted from the summary Paul Levy shared on his blog.) If you didn't hear Berwick's words, Levy's post is worth a read.

The processes we use to make things come alive may work best when we break them into little bitty steps. But it's worth thinking about what it is you're trying to create and how you paint that picture for those whose efforts are integral to the success of the improvement efforts undertaken. Most professionals I know won't line up to see--let alone help craft--something that's supposed to come out like this:

When engineering quality measures, invest in front line clinicians. Engage them. Celebrate what they already do well. They're not all Michangelos. But few will be inspired to contribute by what's found in the craft aisle at Walmart.

It's also worth remembering that what's produced is going to be displayed in forums more like juried art shows than grandma's frig. So go on, take a break from hooking that ugly rug.

Appreciative Inquiry: Grand Rounds

I've been thinking about writing a post about Appreciative Inquiry (AI), an analytic strategy that relies on seeing complex systems as "glasses half-full." This topic hasn't risen to the top of my queue yet, although one of my dearest nursing colleagues, Anne Challis, recently published a piece about the value of AI in RN retention in Nursing Management. (Anne's piece is worth tracking down, if only to see what a doggedly determined optimist can do with an employee's observation that "This job is a joy-sucking horror.")

I think "patient safety" might benefit from some AI treatment (or at least better PR). How, I've been wondering, will healthcare organizations more fully engage the citizens they serve with: "We kill fewer patients by mistake than our competitors"? And exactly who do we think wants to roll out of bed to work in that place?

So I was happy to see that Mark, of Medic999, chose "The time when it all fell into place," celebrating great catches, communication, and coordination of care for this week's Grand Rounds theme.

Today's Grand Rounds is worth visiting for another reason: You'll learn more about what care looks like from the perspective of first reponders and medics. This is valuable information for people interested in patient safety because fewer professional silos, less rigid hierarchies, and more effective communication across the continuum of care are things that improve outcomes. And that's good news for patients.

Enjoy Grand Rounds. And have a nice day.