As we start the New Year here are the top 5 concepts that I think are going to be critical to meeting the enormous challenges for healthcare systems, organizations and leaders.
Holland Bloorview’s vice-president of programs and services Diane Savage shared the American Board of Internal Medicine Foundation (ABIM) “Trust Challenge” with me toward the end of 2018. The premise of the challenge is that in order to provide great health care teams must have a “stable foundation of trusting relationships.” If this rings true (and it does to me), then how can we as leaders in health care help to nurture and grow trust, in hospital leadership, in each other as members of teams, in the institutions that support us?
Edelman publishes an annual “Trust Barometer” which has demonstrated an erosion of trust in government, media, business and non-governmental organizations (NGOs). Most surprising is the rapid erosion in trust in NGOs with only half of the general population reporting that they trust NGOs according to the latest Canadian data. What to do? Be clear about the change we are trying to make as healthcare institutions; share credible information grounded in evidence; and mobilize health professionals, researchers and healthcare leaders in public discourse.
We in health care have an advantage because healthcare professionals are trusted. Jane Sarasohn-Kahn (@healthythinker) shared a recent Gallup poll on Twitter looking at the most trusted professions in the US. Four of the top five are health professions with nurses at the top of the list.
But the medical profession has also been at greater scrutiny than ever for the way that relationships (and financial ties) can impact objectivity. One of the New York Times top health stories of 2018 was on conflicts of interest in medical research. How we manage the relationships for the credibility of our hospitals has been a key focus of efforts for the Toronto Academic Health Science Network over the past two years and Holland Bloorview will be advancing our efforts in disclosure and management of relationships this year.
We have observed the increasing complexity of the clients we are seeing at Holland Bloorview over the past number of years. This is demonstrated by data we have on the proportion of our clients with multiple diagnoses, the increased medical acuity of many of our inpatients, and the proportion of our client families that are experiencing economic precariousness and other social determinants of health.
What we are seeing is consistent with what we know are the pressures on hospitals across the city and the province and has motivated initiatives such as Complex Care Kids Ontario (sponsored by the Provincial Council on Maternal and Child Health ) and Connected Care (created by SickKids and funded by the Toronto Central Local Health Integration Network), as well as the Kids Health Alliance , of which Holland Bloorview is a founding member.
A recent synopsis of two studies caught my eye with their special relevance to what we are requiring of our nursing professionals and the health human resource challenges of this increased patient complexity. As we know, complex children are being cared for not only in specialty hospitals but also in the community (home, school, other residential settings) where kids should be spending their lives. But we don’t yet have a truly coordinated high quality system of child and family centered care for this small but growing population.
Managing this level of complexity requires work at all levels of our hospital. Much of what we at Holland Bloorview think is required is contained in our No Boundaries strategy that asks us to personalize pathways for our clients, to use our research and academic mandate for rapid impact – to discover for action, and to connect the system in order that care can be more integrated. But I hear all the time from clinicians in particular that we aren’t as clear as we ought to be about how to make the No Boundaries strategy live in their work, and to support them with the quantity and complexity of their work.
Marilyn Monk, Executive Vice President at SickKids recently tweeted a Harvard Business Review article that makes the case that for organizational change to be successful it has to be grounded in empathy. In other words, understanding the team’s perspective is critical to change that is sustainable and lasting. You can’t get insight without asking (and that means everyone) and creating transparency.
There are some great thinkers who have made empathy a focus in 2018. For example, on my reading list are Brian Goldman’s The Power of Kindness and Brené Brown’s Dare to Lead. In the waning days of 2018, I discovered Nathalie Martinek on Twitter (@NatsforDocs) who is writing about and working on “burnout culture and disconnected medicine.” I’ve also noticed that the concept of “moral distress” (the conflict between the “right” thing to do and scarce resources) which has been in the nursing literature for more than three decades is starting to be used in the context of medicine and I’m hearing a similar tone in conversations I’m having with professionals in the health disciplines I talk to at Holland Bloorview.
We are proud to have been the first hospital in Canada to implement the Schwartz Center Rounds® to enhance compassionate care, improve teamwork and reduce caregiver stress. There are also plans to increase access to the quality of engagement provided by Schwartz Center Rounds® with a “pop up” version for individual clinical teams.
How will we advance empathy while faced with system constraints?
4) Equity, Diversity and Inclusion
We are investing in equity, diversity and inclusion this year at Holland Bloorview. We know that part of the complexity in our clients’ lives is impacted by social determinants of health. We also wonder if there are clients that we are not serving as effectively as we could, or ways our programs could take equity, diversity and inclusion into consideration in design and delivery.
Research funders are requiring a greater degree of attention to equity, diversity and inclusion. We are rising to this challenge in our research institute.
We also are paying attention to equity, diversity and inclusion in the Holland Bloorview team. Do we at Holland Bloorview represent the diversity that we see in Toronto? We are in good company with the University of Toronto Faculty of Medicine, also deeply invested in this issue and finding ways to widen the pathways into medicine and other healthcare professions.
We want everyone who works at Holland Bloorview to feel comfortable bringing his or her whole selves to work – a critical part of the authentic culture of compassion that we know is also critical to providing child and family centred care.
We are grateful that we will have leadership in all elements of this important work at Holland Bloorview with our new Executive Lead of Equity Diversity and Inclusion, Meenu Sikand.
All of these roads lead to the wellness of our team. I know from talking to colleagues across health care that burnout among healthcare professionals is one of our most pressing concerns. The Institute for Healthcare Improvement (IHI) describes the challenge this way:
With increasing demands on time, resources, and energy, in addition to poorly designed systems of daily work, it’s not surprising health care professionals are experiencing burnout at increasingly higher rates, with staff turnover rates also on the rise.
Burnout leads to lower levels of staff engagement, patient experience, and productivity, and an increased risk of workplace accidents. Lower levels of staff engagement are linked with lower-quality patient care, including safety, and burnout limits providers’ empathy — a crucial component of effective and person-centered care.
The IHI has developed a framework for improving joy in work emphasizing that systems change is what is needed not only to reduce burnout but to actually ensure high quality care.
Team wellness is a top priority for me and I’m excited that work has begun on our new No Boundaries people and culture plan – a plan that will be about “doing” rather than more “talking” (stay tuned on how members of the Holland Bloorview team will be engaged in this important work).
Whether it is a healthcare system or the team in any individual organization, hospital or community-based, wellness is mission critical. Let’s make 2019 the year we take our system and our organizational wellness to the next level.
Want to provide feedback on how we can take it to the next level? Email me at firstname.lastname@example.org or tweet at me @hanigsberg. (For members of the Holland Bloorview team, come to my next CEO Coffee Chat. See HBConnect or stay tuned to your email inbox for HBConnect Weekly for timing and location details.)