— George Bernard Shaw
Well, in our particular case, I’m not so sure we have achieved even the illusion of adequate communication. Does anybody really think that the ideas and concerns of our Medical Staff members are adequately communicated — and acted on — through the administrative structure of the hospital?
Everybody agrees on the importance of good communication in any large organization. And a lot of attention recently has been given to improving the ability to communicate concerns of Hospital and School of Medicine leadership — particularly with regard to quality issues — to the medical staff, nurses, and other hospital staff. Quite rightly so.
But good communication is a two-way street, and what’s missing, in my opinion, is a commensurate emphasis on how rank and file clinicians can transmit their concerns and ideas — which of course are also mainly about quality issues — to hospital leadership. Who, after all, knows better than these clinicians (both physicians and nurses) what works and doesn’t work in this hospital, and what changes are needed to improve the quality and efficiency of our clinical care? Our bedside clinicians represent a potential gold mine of excellent ideas for improving our clinical processes, and they are also the best possible early warning system for potential patient safety threats in the hospital.
Too often, though, physicians don’t know where to go with their ideas and concerns. Or, even when we do pass them along — perhaps to mid-level nurse managers — we are met with denial, defensiveness, or a stifling institutional inertia whereby good ideas are left to wither on the vine due to lack of administrative follow-through. Is there any one among us who has not been frustrated at times by a “can’t-do” mentality in our particular clinical arena?
It may not be immediately obvious, but I believe that a major reason for this situation is the fact that, for the past 10 years and more, we have lacked adequate means to effectively express the voice of the bedside clinician at both the individual and leadership level. The resulting vacuum has of necessity been filled by hospital and nursing administration. We live every day with the consequences of this deficit of physician involvement, which is optimal neither for the quality of patient care nor the clinical quality of life of the Medical Staff.
This is why I have focused so intently, along with some of our other colleagues, on reforming our Medical Staff organization, so that we will (very soon) have a legitimately elected chief of staff, with a mandate to speak for the rank and file medical staff and to ensure that our voices are heard and our concerns are properly addressed. I hope that whoever becomes our first elected COS will recognize the crucial importance of this role.
Of course, it’s hard to implement medical staff suggestions if they aren’t communicated in the first place. This is why we need dramatic improvement in our communications processes and technology. How many of us know whom to call or where to go when we have a process improvement idea or a patient safety concern? How many of us are familiar with, let alone using, the Patient Safety Net (PSN)?
The PSN is a software program, found on all of our hospital computers, which takes you through a seemingly endless series of confusing and time-consuming steps in order to report a patient safety issue. (It doesn’t really even pretend to function as a means of suggesting process improvements). If you do successfully complete the process, there is no feedback as to who will receive your report, or whether your issue was ever addressed. Not surprisingly, this modality is rarely used by physicians.
Unfortunately, the PSN is a required feature for hospitals that are members, as we are, of the University Health Consortium (UHC) — and for a lot of good reasons we’re not about to drop out of UHC. We can certainly lobby for improvements, but meanwhile we must work on alternatives. For example, I am currently working with Kevin Tabb, our chief quality and medical information officer, to devise a “hot line” and/or a “suggestion box” mechanism specifically for medical staff members. The key will be to have adequate feedback — nobody will continue to provide input if it is unacknowledged. This doesn’t mean that all suggestions will be followed, of course, but at least we should know who is addressing our issues, what the outcome is, and why.
Medical staff lounge drop-in sessions, where the president of the Medical Staff and chief quality and medical information officer make themselves available for informal questions and discussion for a couple hours every month, is another means of enabling the Medical Staff’s voice. I hope we will have had the first session before you read this, but if not, watch for e-mails and posters announcing the times (we’ll vary these so everyone has a chance to drop by).
And of course you can always contact me directly at bbohman@stanfordmed.org or through my office: (650) 323-0617. I’d be particularly interested in any other ideas you might have for improving our communications processes.
With your help, and the continued efforts of your Medical Staff representatives, we can rise above the illusion of communication and achieve the reality of it, much to the benefit of our patients and ourselves.
PS: E-Mail Addresses Needed!
The chief of staff election is coming soon. We will be voting via e-mail, so please make sure we have your e-mail address. If you’re not certain that we do (and if you haven’t been seeing a lot of EPIC-related e-mails over the past few months, we don’t), please send an e-mail from your preferred address to medstaff@stanfordmed.org with the subject heading “email address”, or call the medical staff office at (650) 725-6021.
