Posted By Jason A. Wolf, PhD, CPXP,
Monday, April 13, 2020
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I have started almost every email, conversation, webinar or call in the last few weeks with a simple wish that you, your families and colleagues are safe and well. Each morning as I hear my two boys rustle themselves awake, I am reminded of how precious our lives are, how important the people around us remain and how every moment we have is one to appreciate for its essence and to contribute to making better with our every breath.
This is no different than in our shared efforts to address COVID-19 as a community, to stand with each other during this crisis and to sustain and ensure that a focus on human experience is not lost in these critical times. It was just 10 years ago to this day – April 14 – that I first stood in front of a room of people to publicly share what my dream for The Beryl Institute was. I believed the opportunity that we were called to address and the possibility I saw in our coming together was not to simply espouse certain ideas, but rather to foster connection, to ignite innovation, to catalyze connection and to elevate a conversation that has only grown at the heart of healthcare over the last decade.
My hope for our community then is being realized now, as I called on us at the time to establish a destination for shared information and research and an incubator of new ideas and practices that positively impact the patient experience. What we have become together is much more now, as we are truly a global community of practice committed to elevating the human experience in healthcare.
This journey led us to this moment where we reinforce that our efforts have never been about the Institute, but rather they have been about what the Institute represents in the voices of those who are served by healthcare and those who serve in healthcare every day. That is the power of community, for the voices right now spending tireless hours to care for those in the most dire of times are doing so moved by something bigger and knowing there are so many more standing behind them with hope, with commitment, with shared purpose and with a belief that together we can and will move through this crisis.
At a time when days feel like weeks where people are either charging in to care for others on the front lines, supporting it from afar, showing up to provide essential services in so many needed industries such as food stores and pharmacies or by doing their part by staying home to flatten the curve, teaching their children or providing care at home, this crisis has called on all to contribute, and it will take all of us to succeed. That premise of all of us together is fundamental to the essence of human experience that brings us all together in our growing community with the Institute. Just last week alone we saw over 1000 people engage across webinars, phone calls or virtually online to share and support one another. Those voices represented thousands more in their own organizations, each touching the lives of thousands more in the communities they serve. That is the powerful and positive ripple effect we are creating together! And why the human experience is not something to lose in this moment in our history.
As you follow the stories of challenge and success, of loss and hope, of overcoming odds and succumbing to this disease, in all of this what we have done and continue to do as a community is ensure the humanity at the heart of healthcare burns brighter than ever. I think at the start of this crisis there was concern that the dire needs and actions required would squelch out the embers of humanity at our core, but in all we have seen in acknowledgement and success, compassion and clinical excellence, sacrifice and unwavering commitment to fellow humans by so many, the idea I will forever reinforce – that in healthcare we are human beings caring for human beings – has only seemed to grow stronger.
At the same time, we are reminded of the vigilance this crisis will take. If we pull up on the reigns of our essential efforts too soon, we will find ourselves slowing before the finish. And I believe that as we look at this crisis, we will never truly get beyond it. This is not a pessimistic tone, but rather one grounded in optimism for all we will have and will continue to learn. I do not believe we will have a post-COVID era, or even a new “normal.” Nothing about this is, or will be, normal…but rather, we will have a NEW EXISTENCE where much of what we espoused and worked so hard to put in place before this crisis will remain essential. At the same time, cracks have been revealed and systemic weaknesses highlighted for healthcare globally, many which we subtly or in passing have acknowledged, some with more extensive efforts to address underway, but in the midst of this crisis have become ever more apparent.
In our latest episode of the To Care is Human Podcast released this week, I had the chance to speak with Dr. Shantanu Agrawal, President & CEO of the National Quality Forum. In our conversation, as in many I have had with leaders and community members in the last few weeks, we discussed the revelations of this crisis beyond the challenges of readiness or even the lack of “systemness” in our regional, national and global healthcare system, to that of the inequity that is revealed in healthcare itself. This crisis has revealed powerful things about us societally as well, not just about those we serve in healthcare but even the everyday heroes in our midst who don scrubs or coveralls, aprons or gowns to support the very foundation on which healthcare operates. We will be called as a result of this crisis to tackle those issues in ways we have yet had the muscle to do.
At the same time, healthcare’s self-perceptions on the dangers found in assessing risk versus acting with agility and speed has been challenged, as we have seen technology application rapidly deployed, protocols overturned or rewritten, inflexible structures cracked and quickly rebuilt and more. All of what we are learning in the face of the real suffering and sadness in this crisis is also what responsibilities we have to change and address our own opportunities as a healthcare system globally. These bigger issues will be part of the larger conversation on new existence, but we too cannot get too far ahead as we have people now living life’s final moments, while others are working feverishly to save those lives.
At the heart of the actions and efforts of so many lie what turns us back to the humanness of healthcare. Yes, the clinical excellence at healthcare’s roots will ensure we save lives, but the efforts we are seeing to elevate the human experience now will ensure we honor those lives through and beyond this crisis as well. While we struggle with the realities of bed space, access to personal protective equipment, ventilators, adequate testing or other needed technologies, we too have seen humanity elevated in ways we knew existed and will remain forever possible.
- Even in the face of limited visitation policies, organizations are finding technology and other means to connect people to one another, to enable those in isolation to feel less alone and provide a face and voice of comfort, even if not in person, at the end of life. We are working more to ensure we connect as people…that is the essence of human experience.
- We are seeing the human spirit personified in the efforts of so many on the front lines of care hidden behind masks and screens putting a picture of themselves with a smile and even a note or two about who they are as a person on the front of their gown. We are working to break down barriers and structures to the people we are…that is the essence of human experience.
- Caring for healthcare teams has been elevated to new heights from social-emotional needs of having support lines and respite rooms to ensuring basic needs are met in providing internally- developed markets to provide for food and sundry needs for those focused on healing others. The breadth of support for those who serve has never been so evident and tangible, even in the face of some of the challenges those providing care still face…this recognition and effort too is the essence of human experience.
- While most charging into the trenches of this crisis, from doctors and nurses to environmental service and food service workers and so many others, would not call themselves heroes, the recognition of their sacrifice in the face of potential danger is real. This is the same for all providing essential services in grocery stores or pharmacies, transporting goods or delivering food. These individuals are the synapses of a physically distanced society and the bond on which it will be connected once again. We too see an outpouring of appreciation and acknowledgement from the blaring sirens of fire and police departments, to the flashing car lights, street signs and chalk art appearing outside hospitals and care centers, simply to say thank you. These gestures remind us that what binds us is and must remain stronger than what divides us…that is the essence of human experience.
These are just some examples of what people have stepped up to do at this time, but we are reminded again and again in times of crisis that our most important resource and our greatest source of hope is one another. It is in our capacity to face what is in front of us, both for its ugly realities and its moving successes, that make humanity and, yes, the humanity in healthcare so powerful. This is not to downplay the seriousness of what we are fighting as human beings, but rather to recognize as human beings our motivation to fight comes from our ability to overcome challenge, to acknowledge and celebrate success, to see hope in darkness. That is where community comes in and why community is so important, and that is why we are and will always be stronger together!
For many, a tough stretch continues over the next few weeks and for some small cracks of relief may even be visible. With that all we have created together in our web of knowledge and support is powerful, broad and unbreakable. Know that no one stands alone, and this global community stands behind and with you in what lies ahead. I encourage you to review what the community has created together to support one another at this time in the Institute’s COVID-19 Resource Center. That is how and why I know our new existence will be a place that honors the tragedy, sacrifice and sorrow of this time, but has roots in our strength, in our collective innovation and in our shared passion and purpose.
The human experience we have all committed ourselves to has never been more real, more critical or more needed. And from all we have done and will do together in ensuring we overcome this crisis, I think we can all stand reassured that our commitment to the human experience will not be going anywhere any time soon. That is the essence of human experience.
Please stay healthy and well and thanks for all you do…it will truly take all of us…together.
Jason A. Wolf, PhD, CPXP
President & CEO
The Beryl Institute
personal protective equipment
Posted By Jason A. Wolf, PhD, CPXP,
Thursday, March 7, 2019
In 2011 when the Institute was still learning to crawl as a community committed to improving patient experience, I had the opportunity to meet Dr. David Feinberg. He attended our first Patient Experience Conference at the Institute with his team from UCLA, where he was CEO at the time, and offered a powerful keynote on the power of leadership, culture and presence. He told a powerful and compelling story grounded in the very humanity of our healthcare system, of the potential at its core and of the possibility ahead for our healthcare organizations to ensure we took the next steps in elevating the care in healthcare.
Our connection has been maintained through the intervening years via On the Road visits and roundtables, shared panels and Grand Rounds, all the while through our friendship we realized often implicitly we were working to do something bigger for healthcare. That story of connection, that idea of commitment to purpose, that alignment around possibility and the humanity of healthcare frames the core ideas that have been the foundation for the Institute on our journey. It is these connections, these opportunities for learning, these shared commitments that makes this community a unique, innovative and safe place.
It is what also led us to my latest opportunity to connect with Dr. Feinberg as we launch a new offering from the Institute, The Beryl Institute’s To Care is Human
podcast series. What was an opportunity to connect turned into a rich and robust conversation on the current state of affairs in healthcare and the opportunities we have ahead. While I won’t share everything we discussed (you can listen to the full podcast
and access the transcript
), I will offer a few reflections on what we discussed and how it frames the experience trajectory on which healthcare now finds itself.
Healthcare should be here to help
For the expertise on which healthcare is built, we cannot forget its purpose. It is not just about operational efficiencies, though we need them. It is not just about process improvements, though we aspire to realize them. It is not just about clinical excellence, though we must expect it. Rather it is around the needs of those that seek care to feel helped, cared for and understood. How do we ensure our systems can deliver on that human need? As Dr. Feinberg offered, “What we'd like the healthcare system to do is to say, we've been expecting you, we're ready to take you in, put our arms around you, and love you, and get you all the right stuff that you need to make the right decisions. That to me is the experience that we're trying to create every time for every patient.”
We must address the issues of healthcare systemically
So much of what we have done to improve healthcare has dispersed versus aligned our efforts. Games of improvement whack-a-mole, internal battles over constrained resources in protection of our operational silos have not done service to what healthcare can be. Rather than disparate, competing or even redundant efforts, we must strive to look at the needs of those healthcare serves and those who serve in healthcare as one opportunity for excellence. This applies to improving clinical quality and safety or overall experience, tackling burnout and fatigue and even financial challenges. And it stems from larger systemic and population health issues, not simply those confined to organizational boundaries.
Dr. Feinberg suggested, “I see burnout as something different. Burnout started (and continues today) because doctors couldn't get things they needed for their patients.” He noted that if the circumstances around us prohibit our ability to do the work of healthcare, that may be our biggest impediment. If we cannot take care of the broader circumstances that impact experience and outcomes, we will continuously be spinning our wheels. He added, “To me, burnout is (tackled by) actually addressing the social determinants of health for those we care for. [This] will decrease the burnout of our providers.” Yes, we still need to ensure effective and efficient systems to support care, but [let’s] ensure “patients come first. Let's take care of them, and let's give our caregivers all the tools they need to be able to deliver on that care.” If we get that right, we are laying the groundwork for the best in overall outcomes.
Healthcare is fundamentally relational
If healthcare is about helping and our ability to think systemically, it calls for us to change the way we think about how we operate. As a system built on task, checklists, and protocol, healthcare has become a primarily transactional system. This was done with purpose, but at what cost? As the largest people-facing industry in the world (for patient and consumers of care alike) the expectations as we have discussed are to support the relational nature of care. As a transactional healthcare system, we have attempted to bolster our transactions with relational practices to make it feel more personal, but rather our opportunity is in creating a relational system, and then working to find the best transactions to ensure that that relational system is effective. This idea summarizes much of how Dr. Feinberg has led in his two previous organizations. Dr. Feinberg added, “[Healthcare is] people caring for people, and if we give them the right tools, and get them the right caregivers, it's an incredibly rewarding occupation. I think you could put it up there as one of the most rewarding. If we can get that system to hum, I think bi-directionally, people will feel cared for. Those caregivers will feel also cared for because you just get to really enjoy very intimate parts of people's lives.”
Healthcare must ultimately be about keeping people healthy
If we are helping, with a systemic perspective and relational intent, then our ultimate calling is to keep people healthy. Keeping people healthy is about a focus on well-being, around changing the systems and structures of health and about access and affordability to care and services that can impact longer term care issues. If we separate out social determinants of health or population issues as something else we do outside of caring and the experience we provide we minimize voices, we shrink the possibilities of experience and we limit the ultimate capacity of care.
Dr. Feinberg supported this idea in sharing, “I'm a believer in customers. I just think it's really crucial to have that mindset to make things much better for those that we care for. I believe that when we talk about patients, it almost, by definition, means that our healthcare system only takes care of you when you're sick. So what do we call you when you're not sick? When we still could be taking care of you and preventing you from getting sick? Then are you a person, are you a customer? To me, those words are really important, [but] if we keep only focusing on "patients", we're only going to continue a sick care system. Instead of really talking about keeping people healthy.”
Healthcare experience remains at the “N of 1”
This idea that we have an opportunity to reimagine healthcare as a system that keeps people healthy as a means to ensure the best in human experience is significant in its simplicity. In many ways it feels the weight of the systems we have built in healthcare is the primary impediment to our capacity in healthcare to do what we know is needed and right. Yet if we can collectively recognize this challenge, we should be able to collectively address it. It feels as if much of the journey we have been on has been to elevate just that conversation. It is also the reality that for all the evidence we seek in the science of healthcare, the ultimate sample size we have is the “n of 1”. Human experience happens at the point of interaction of one person to another. This also means that anyone, in any place in our healthcare system globally can make a difference right now.
Dr. Feinberg reinforces this point in saying, “Often times I get asked the question, ‘You know, the CEO of my hospital doesn't think like you, [so what do we do?]" My answer is, wait a second, wait a second. There is a patient right in front of you. There's a clinic you're responsible for, there's a team you're working with. Everybody can fix this. You start with one patient. If you do it with one patient, it will have a ripple effect. Don't use excuses that your system doesn't think this way. You can think this way yourself. No one is going to stop you, and so you have this opportunity to do this stuff in your own little ecosystem. Even if those people up in the [c-suite] aren't talking the same language. Don't wait to take care of people.”
That may be the essence of human experience in itself. As Dr. Feinberg shared, “Don’t wait to take care of people.” And I would reinforce that this is not just those you care for, but those you work with and the communities you serve. Our capacity in this health system we have created is grounded on the possibilities we create between people. While the science may be miraculous, the humanity at the heart of healthcare is where the magic truly occurs. It is incumbent upon us to realize the opportunity we have as the dynamic evolution of healthcare will continue to gain speed. If healthcare is to realize its ultimate role as a place that exemplifies the pinnacle of human experience, and I dare say it should, these ideas will be central to our next steps. In an attention to helping and a systemic view, in a focus on the relational and a commitment to health, with a recognition that the person right in front of you is where you have the greatest opportunity right now to make the biggest difference, that is where the possibility of human experience is found. That is where the possibility of healthcare is rooted as well.
Dr. Feinberg’s generous spirit, vision and commitment to what is possible is inspiring, but as he has taught me, it is about what we all do with those seeds of inspiration that will have the greatest impact. I look forward to where it will lead us and am so grateful to Dr. Feinberg for our conversation and his commitment to this cause. Now is the time we all must sow the seeds of possibility.
> Listen to The Beryl Institute's To Care is Human Podcast Series
> Download the transcript
Jason A. Wolf, PhD, CPXP
The Beryl Institute