In his seminal book Sense Making in Organizations, Karl Weick tells a fascinating story about a lieutenant in World War I who sends out a patrol into the French Alps to scout out the positions of the German troops. The small patrol took no provisions, because this was intended to be just a short search and they planned on returning to camp by nightfall. But about two hours into their trek it began to snow—so hard that it was soon a white out and the soldiers could barely see their hands in front of their faces. They were in trouble. Their leader led them to a small overhang in the side of a mountain where they settled in, hoping that the snowfall would break by late afternoon. But it continued to snow through the day, into the night, and for the remainder of the next day. It was one of those blizzards [...]

Over the last few months, I have had the opportunity to see our healthcare system up close and personal as my dad, soon to be 97 years old, traversed through it with the first major health crises in his life. It started a couple years ago when he decided to rearrange the boxes in his condo’s storage bin. I came by one weekend and he wanted me to take some things, so I had to lift some extremely heavy boxes off a top shelf. When I inquired how they got up there he informed me he put them there. Interestingly, just a few weeks previously he had been complaining of abdominal pain and had been diagnosed with an inguinal hernia. When I asked at that time how in the world he had gotten a hernia he pleaded ignorance. But as I stood there in his storage area I put it all [...]

Continuing with my dad’s saga in the healthcare system… After 9 days in the hospital precipitated by pain and discomfort extending from his chest to his abdomen (which led to a visit to the ED, hospitalization and a score of tests which all came up negative), they discovered during his stay that his atrial fib was not being properly regulated by the drug he was on. The pacemaker they installed just a few weeks previously was doing its job to keep his heart beat around 70, but he was getting abnormal spikes in rate sometimes up to 130 just walking down the hall. Increased dosages of the drug didn’t work, nor did increased frequency. So he sat and waited for the past few days for his clinicians to come up with a solution. Even though he’s soon turning 97, his mind is still as sharp as a tack, as are his [...]

Athletes develop muscle memory on the field, musicians rehearse seated as they would in the orchestra pit, and soldiers train in battlefield conditions. Is being a healthcare professional somehow different in needing the ability to meld ability with application and awareness? For many healthcare professionals, though, learning new information, skills, and procedures often involves leaving the workplace environment in order to attend classes or access online instruction elsewhere onsite. While both facilitator-led instruction and online learning are proven and accepted forms of training (when designed and delivered properly), training away from the action of the clinical setting is usually at the expense of the learner’s enjoyment, their engagement in the instruction, and their ability to sustain the training and successfully apply it later. How many of us have been in a learning lab in front of a computer mindlessly clicking through bullet-point text screens trying to reach the end of the [...]

Kevin Kelley describes in What Technology Wants how we possessed the same brain power that we have today at least 100,000 years ago, but it was not until 50,000 years ago that we went from being a primitive species using only rudimentary tools to true innovators. This explosion of innovation occurred almost overnight, concurrent with the arrival of language. Homo sapiens went from using sharp rocks at best, to the development of finely hewn knives, carved figurines, and hearths. Some might say that the use of tools led to the development of our language skills, but it’s more likely that the development of language – and more specifically, storytelling skills – was at the heart of the avalanche of inventions and discoveries that still continues 50,000 years later. Why was storytelling so pivotal in assisting humans to consistently discover new solutions to life’s challenges? Kelly suggests that storytelling assisted our predecessors [...]

There’s a familiar saying that gets bantered about these days when things don’t change – Question: What’s the definition of insanity? Answer: Doing the same thing over and over again and expecting different results. Hospitals, like so many of us, suffer from this form of myopia. Little has changed in the past hundred years when it comes to role definitions. Managers continue to manage with other priorities being top of mind instead of how their actions contribute or detract from the safety and satisfaction of patients. It’s no wonder—there are so many things to keep track of. Staffing requirements, compliance with a whole host of ever changing regulations, pressures on nurses and other caregivers to handle the care of more and more patients, not to speak of the intermittent crises that emerge almost daily when the care continuum breaks down. In many healthcare facilities, the ship is sinking under the weight [...]

From one perspective, a hospital can be viewed as a beehive of intersecting and shared stories. First, a patient arrives at the front door with a history, both personal and health wise, and the trajectory of their personal narrative can be fundamentally altered by the outcome of what occurs during their health crisis. It can be just a blip on the calendar: an interesting tale to be told about getting stitches for a cut or a false alert about chest pains. And the individual picks up where they left off, now with an entertaining story to be told at a dinner party. Or, the health event can be so serious that it irrevocably alters the path of their lives. A good friend of mine who is a triathlete collapsed one evening two years ago with a hemorrhagic stroke. He barely survived and for the next two years took on his rehabilitation [...]

Each of us spends varying amounts of time in front of the mirror each day preparing, comparing, and analyzing our appearance related to a standard we have set for ourselves.  Seeing our reflection, we quickly receive feedback, make adjustments and perfect our look whether it is our hair, makeup or proper clothes. This daily ritual is a just that—a ritual or habit; repetitive and automatic.  We wouldn’t leave the house without our daily ‘reflection’.  What other reflective activities can be used to produce continuous improvement?  Effective, high performing teams use a very specific feedback event known as the ‘debrief’ to reflect past team performance and promote experiential learning.  Debriefs are short-lived instances where teams face the ‘mirror’ (each other) to reflect valuable insights, knowledge, and shared understandings designed to optimize performance. In a debrief team members get a chance to review decision-making, timing, efficiency, and effectiveness along with identifying opportunities for [...]

To some, the notion of using “story” or the act of “storytelling” as a tool for organizational change may seem new or even novel. But humankind has been using stories to communicate within and across organizations for thousands of years. In many ways, “story” is the original tool of transformation. Think back to the earliest form of organizational identity – the tribe. After departing Egypt, Moses delegated authority to the elders of the Israelites to listen to disputes, creating a hierarchy that ultimately reported back to him, creating what is probably the earliest known example of an organization. Looking closer to home, the native peoples who inhabited this continent prior to the arrival of Europeans had a rich tradition of using stories to impart knowledge across the generations for the ongoing benefit and sustainment of the group – where and at what time of year were the best hunting grounds, how [...]

At the recent Society of Simulation in Healthcare (SSH) annual meeting, over 4,000 healthcare professionals gathered to network, share and learn best practices related to the use of simulation.  The uses of simulation in healthcare include knowledge and skill building in professional education and performance improvement across the healthcare environment.  The ‘simulator’ has become the center of attention in the simulation industry with most of the research and development poured into creating a more high tech or realistic experience.  This level of realism is known in the simulation jargon as fidelity or the ‘suspension of disbelief’.  When you say the word ‘simulation’, most healthcare professionals immediate think of ‘talking’ mannequins that breathe, bleed, react and respond to clinical actions through a set of complex, computer programmed actions during a laboratory or classroom-based session.  The exhibitors at the conference are dominated by manufacturers that create these types of simulators and all the [...]