Friday, May 3, 2013

Where Does Change Begin? Why we (you and I) must not settle.

It was only a few years ago that there were no red lines on the wall behind the beds in CCU –anyone providing patient care could only guess at what 30 degrees looked like. What was a Bundle? We couldn’t go for months without a Ventilator Associated Pneumonia (VAP). When I reflect on it now, it almost seems we planned care knowing that assisted breathing was inevitably, or at least understandably, going to be accompanied by pneumonia. It was hardly imaginable that we could go months without a VAP. Now VAPs and many other serious hospital-associated infections/complications are rare because of the innovative work of our staff. When I was initially trained as a nurse – not the formal school-based training but the ward/unit training which was something different altogether – I was taught that our 'rapid response,' commonly known as a Code Blue, was a team of highly skilled clinicians that rushed to a patient in need of respiratory or cardiac rescue/resuscitation. Today we have rapid response teams (Medical Emergency Teams, RRTs, etc.) that quickly bring additional needed assessment and care to patients when they first exhibit signs that may signal a dangerous decline in health – in most cases before a Code Blue.

Thankfully, things are changing here and everywhere. I find strength and inspiration in the stories from the bedside of those who are committed to improving health care. We are increasingly recognizing and embracing the fact that the use of improvement science does improve health and does so in dramatic and revolutionary ways. Our monthly Rapid Improvements Events are example of the ongoing improvement work in our delivery system.

As promised, here are the slides from last week’s Rapid Improvement Event (Kaizen) on the medication refill process. Many thanks to the staff from the front line and Patient and Family Partners who are working hard to improve our system for everyone. Your efforts are greatly appreciated. I also want to thank our team members who came out to support these teams. Improvement is hard work and your support is crucial.

Refusing to Settle

In spite of all the results seen here and around the world, why is it that improvement, led by front line staff, patients and family members continues to feel as though it is regarded as a "soft" or support activity? Improvement is about the work of saving lives.

We must be committed to driving defects and non-value-added activity out of what we do. I will stand with all of you, who are dedicated to serving our community and improving our system, to continue to focus on and pursue our mission.

George Halvorson in his book Health Care Will Not Reform Itself, states "the alternative to courage and focused action is a continuation and probably a worsening of the status quo." Many will agree that it takes acceptance, willingness, courage, caring and honest exchange to engage in a change effort. It also takes constancy of purpose and discipline.

There are many distractions along the path to an improved and sustainable system. The inertia of the status quo and pervasive nature of the health care industry's hierarchical culture can seem impossibly strong. Many have mastered the current state; their power, position and self-image may be derived from that mastery. Many believe that more of the same is good enough. I believe that to seek a new order, to resist the urge to 'settle,' to stand up and lead a transformation effort, is indeed the work of the courageous. It is our work. It is work we must do together. However, the first step is to change ourselves - which may be the most difficult step of all. Many will settle, taking refuge in the status quo. I will not.

What will you do?

More very soon,


  1. Thank you Anna for this reminder. With constancy of purpose and discipline I have seen change and improvement across our great public health system in Contra Costa. But I want to see more so I will not be distracted and I will not settle.

    My constancy of purpose is focused on the patients like my son who has been to the Psychiatric Emergency Services of Contra Costa Regional Medical Center 77 times in the past 10 years. That is not acceptable and I will not settle for him or anyone like him who is vulnerable and dependent on a system that is providing health and care to all.

    I had never heard of a bundle, VAP or RRTs before I attended my first Lean Improvement Event and asked staff to consider my family experience. I asked them to not think of my son as a recidivism statistic but as a young man who is loved by a mom, a dad, a sister, a large family and many friends. I asked them to welcome him back and not blame him or his family for his mental illness. I told them about his efforts to get well and stay well in our current system. I told them about how hard we tried to keep him from walking through their door. They told me how hard they worked to prevent harm and I went to the floors and watched how hard they worked. We taught and learned together about each others experience in the system. They heard me and I heard them and we went about the work of improving in partnership.

    I have been on the front line of change with all levels of staff, community members and patients and families. When I was “let in” back in 2009, the healthcare community of Contra Costa was asked to remember that it is the patient always that brings us to this work. It wasn’t that the staff didn’t already know this since it is the essence of what brings someone to this work. However, sometimes in the chaos of the system of care, policies and politics, the patient and family can get lost in the shuffle. The staff can get lost too. In full partnership with constancy of purpose and discipline we must not settle. We all deserve improvement.

    What I will do is to continue to tell my family story and teach about families like mine. I will continue to learn about the current state and I will ask questions respectfully about how to improve the current state for the patients, the families and the staff who serves them both. We are not critics because we ask questions or challenge the status quo. We are partners in care and community building who can see across the silos because we have been forced to navigate them to save our children’s lives.

    I am the proud mom of a son with schizophrenia who deserves a health system that will not shun him when he is sick. I refuse to let him be forgotten in any local, state or national forum where health policy is being considered. This work is anything but “soft.” It is hard and noble work and it is a privilege to be a partner of constancy of purpose, discipline and improvement. Thank you and your staff for welcoming me.

  2. Thank you for sharing this. It is a privilege to work with you and others in our community, Teresa. You are an inspiration. Happy Mother's Day!