by Ted Eytan, on 23 Apr 2007 05:34 pm
The Journey
Shadowing the shadowers
I passed one of the managers of our clinical information system team this morning. She let me know that she was on her way to their weekly standup meeting. As part of our LEAN transformation, our information technologists have been shadowing physicians practicing their craft. Shadowing is a skill that involves being present for the purposes of observing, and nothing else. When I shadow a physician taking care of a patient (after consent is obtained), I work to minimize my presence, by keeping still and not responding to the interaction, even if asked a question or addressed by the patient. I will of course smile but will use body language that demonstrate that I am here to respect the patient-physician relationship. It was in this spirit that I shadowed our own team doing their work.
As much as we have been striving to see the impact of what our team does for our patients, it was great for me to see the impact of what our team does for our team. The standup occurred in front of the Cookie Jar, which has been pictured here previously. The manager went over each team’s work in sequence, and accepted suggestions for ways to have the work go faster. I learned about several items that were “must do’s” that got added in the last several days. The visibility of items like this was not high previously - they were just done without appreciation for the nature of the task. The manager gently introduced another LEAN tool as part of a conversation on cross training - the visual skills inventory.
The scene itself was impressive to me, embodying so many aspects of LEAN philosophy. The manager was standing in front of a white board that had a list of the team’s accomplishments from the last week on it. An e-mail was printed out containing a list of changes to our production system made in a short time with the words “WOW” written in a highlighter across it. The meeting took place in front of the visual system cataloguing the team’s work. There were so many cues beyond what was said that sent a clear message of “we respect your contribution.” None of this was planned to come together this way - the positioning, the visual messages, and the conversation - but it did in a great way.
Of course, I now want to bring a physician to shadow the shadowers with me…..the learning will be bidirectional always.
on 24 Apr 2007 at 1:15 pm 1.Sherry Reynolds said …
It is in the space between heartbeats that people really learn to live.
Quietly being present with Physicians as they care for their patients helps remind me that “care” as the Institute of Medicine defines it is fundamentally “the transfer of knowledge” and that requires Time. It also helps reframe the quality question from “How can we develop enough date to engage Physicians in Quality Initiatives” to “How can we engage in the Physician’s Quality Initiatives by transforming our exchange of knowledge.”
Presence also allows us to recognize the eco-system or community that surrounds not only the provision of health care but the importance of the receipt of it and the powerful role that consumers can play in designing new models of care. In addition to studying the latest LEAN process methods it is critical to listen to the patients voice and recognize that the real improvements in health care will require a new boundary of where health care is delivered when we realize that patient/consumers spend 99% of the time addressing their health care needs occurs outside of the office or hospital. Patients and Physicians need to be involved from the beginning as designers, motivators and in positions of Governance.
It is in this space, that cross boundaries, a community - where cultural and social factors play a major role and where the most dramatic solutions are possible. Recently in Whatcom County, WA there was a Robert Wood Johnson Pursing Perfection demonstration project for people with Chronic Conditions - in which the patients designed a shared care system to meet their needs. The outcomes were so dramatic (over $3,000 in cost savings per patient per year) and better outcomes (even though the project targeted those with multiple complex medical problems) that local specialists complained about the loss of income and the failure of the payment system to compensate providers who are able to keep their patients out of the hospital.
Now if we could all have someone as visionary and supportive as Ted in our organizations (hi Ted) there is no question that we would be able to provide high quality, patient centered health care to the entire community.