DOP Update: Refining Things That Matter Most

Teammates,

Today brings another edition of DOP Updates, an email sent to members of our Department of Pathology team and interested stakeholders intended to share information of common interest.  As per usual today’s edition is also [linked] in PDF form to preserve formatting across your mobile platforms.  Send me a note if you have comments, concerns or stories to share with me or in the next edition of Updates.

Life at NCRC . . . and at UH, CVC, Mott, East Ann Arbor, West Ann Arbor, Brighton, MidMichgian, MetroHealth and Beyond!

In the last August 2018 edition of Updates, I talked about NCRC, what was working, what improvement opportunities remained, and some specific strategies to bridge the gaps that separated us from where we wanted to be.  Today, with the support of our department and the institution we have made substantial progress while recognizing that much work remains to be done.

Those doing the work are the frontline of our quality program, a program in which we do the work in a standard way that we created, remain alert to things going wrong, fix it when it does, and find and fix the root cause(s) so that it is less likely to happen again.  In our case staff, trainees and faculty have been at the frontlines, helping us recover and stabilize from a move that included well-designed solutions working exactly as intended and other well-intended plans that served only to show us what we could not have otherwise known.  Focusing on our problems as learning opportunities we are responding with collaborative countermeasures that, in the spirit of Plan-Do-Check-Adjust (PDCA), will serve as the next round of experiments from which we will learn more about our work in a new place with a new set of realities, opportunities, and challenges.

While those at the front lines are making adjustments in collaboration with managers and laboratory directors to improve the quality of our work, we have launched a large cross-functional project team working on the value stream from arrival at N-LNC to archiving or return of materials with the goal of more efficient, timely and safe receipt, transportation, delivery and archiving of patient assets relevant to the daily care of those who look to us for answers, care and compassion.  At the moment we have become the rate limiting step to care in several of our practices which is a place in which we have never been before, and we are passionately committed to close the gap between where we stand today and where we need to be to remain the place that others imagine when it comes to excellence in delivery of laboratory services.

NCRC Huddle and a Question About Burnout

In other areas, there are experiments underway to understand the link between our new and soon-to-be remodeled spaces and our capacity for collaboration and creativity.  One experiment includes a daily huddle held every Thursday morning at 8:30 AM in “central park” in building 36 at NCRC focusing on learning from one another and being more intentional about using the space as a tool to make us better than what we could have otherwise been.  Last week we touched on gratitude and the things that matter most as a conversation in response to concerns expressed about the risk of burnout for our staff, our trainees and our faculty.  While we tend to focus on workload (“overburden”) when we speak of burnout there are multiple important drivers that include,

• loss of autonomy or control,
• lack of community and a sense of social support,
• lack of organizational justice or fairness,
• lack of transparency, and
• lack of aligned values and the incentives that make them tangible.

Feeling and expressing gratitude with one another as a daily practice while focusing on the things that matter most may address, at least in part, some of our needs when it comes to community, social support, and an understanding of values that are either aligned or for which there are gaps that might benefit from our attention.  In our conversation about the things that matter most to those who were gathered in that space we heard about always putting patients and families first which may sometimes mean going above and beyond (“going the extra mile”) our usual expectations.  We talked about the importance of being recognized for one’s work and doing what needs doing because it matters.  That was linked to the importance of feeling valued and supported, having opportunities to grow both personally and professionally, having opportunities to meaningfully participate in cutting-edge health care, transparency in all things including the decision making processes that affect our daily work lives and being resourced appropriately to position all of us for success.  We concluded by talking about the relationships between our values, feeling supported, and resources.  And while it may be easy to point fingers in any conversation about resources in a resource-constrained environment, we recognized that all involved are moving forward with the best of intentions but too often without successfully stepping into the shoes of one another to better understand the resource allocation paradigm.  And we began to wonder what experiments we might run to close the communication gap in the spirit of improved relationships, understanding and transparency with the goal of being more effective partners with those in leadership roles whose decisions we may not always understand.  Stay tuned as we continue the work of closing some of the gaps that may contribute to the sense of burnout percolating through our department.

Values ↔ Support ↔ Resources

In the meantime, I have [linked] a recent publication that focuses primarily on physicians when it comes to the national phenomenon of burnout in our provider community.  The principles apply more broadly to all of us.  Please send me a note if you have your own thoughts about experiments we might run in order to better understand the problem and in better understanding the problem create solutions that might pave the way to a healthier future.

Gratitude

Last Thursday night I received a text from my brother who lives – or lived – in Paradise, California, a town largely destroyed by the Camp Fire still burning in northern California.  He sent it so that his family would know that he and his wife had safely evacuated their home.  He smelled smoke and heard about the evacuation order while driving to his place of business in Chico.  He turned around to rescue his wife.  By the time he arrived, it was clear that they were in trouble – the picture to the left was taken from his backyard.  They ran to their car and escaped down a road threatened by fire on both sides.   They would learn later that all 4 of the earliest reports of people who perished in their cars were discovered the road on which they live(d).  It was close.

In response to the protestations of concern and grief from others, he responded with gratitude.  Happy to be alive, happy that his wife was safe, grateful that the only things they lost – including not only their home but also her Paradise store – could be rebuilt and replaced, and grateful for the friends that offered them shelter.

For years he labored on creating the perfect man cave in a caboose carefully positioned on a segment of track constructed on a roadbed that he himself built.  When he sent the picture of what remained of his caboose and the melted lamps adorning the yard around them I responded by saying, “A memorial to the place!”  He replied, “Actually a project still in place.”

Last night he texted another picture with the caption, “It’s good to be homeless.”  In the phone call that followed he reiterated the same, saying that compared to the suffering of others this was but a minor inconvenience that reminded him of the things that matter most.

This morning as I was writing this story, I received an email from a grateful patient dying of his widely disseminated cancer.  He wanted to share with me the importance of the comfort he can offer to others in the midst of their grief, and he wanted to tell me about acceptance as a strategy for navigating this latest and perhaps last chapter in his life journey.

Never once have I walked out gratitude in a way that comes anywhere close to the courage and gratitude modeled with sincerity and grace by my brother and a patient who has taught me far more about life than I was able to teach him about his cancer.  Daily I complain and worry about minor problems that pale in comparison and have little connection to the things that matter most.  It is a reminder to me and perhaps to you the importance of gratitude, grace, kindness, and courage in the face of adversity, and that what matters most is not so much what happens to us but how we respond.  Arianna Huffington said it this way:

“We have little power to choose what happens, but we have complete power over how we respond.”

That’s the news to the moment from my desktop at NCRC.  Please send me a note if you have something that you would like to share with your teammates.  Until the next time, let’s be careful out there . . .

—Jeff