S H A R E is the Acronym for Culture change
Any organisation especially an old one has its ups and downs and that is true of century old institutions. The important factor of stability of leadership can create a glue or an intangible asset called culture. However, this is becoming increasingly difficult to define and implement and all discussions on the same end up in sporadic inspirational talks about the past without a clear direction and tangible action in the future.
We fall into a trap of gathering knowledge and thinking that ultimately we will implement the ideas which we learn. However, the game of daily fire fighting existence, survival and routine bogs one down and this crucial aspect of cultural transformation takes a back seat. As one embarks on this difficult task the pressure to show results again tend to put the driver of cultural change on the back foot as the organization which is struggling for survival has all its energy focused on the immediate task to get short term gain and advantage. The long term picture and the ability of the organization to have a vision is lost in this situation. Unless a cultural officer is given the respect and stature and freedom to function with a fair amount of autonomy, transformation is difficult to achieve. However, having said that the very process of adjusting to the role which is hitherto uncharted territory is part of the transformation of the organization. The most crucial cog in this as is said in NABH or any qualitative change is the Role of management, which has to invest time and energy in visualizing or defining culture specific behaviours. I am lucky that all this is available and falling in place and the mood for culture change is upbeat at Masina Hospital where I work today.
Coming to specifics in healthcare, I feel that we are in the industry of selling experiences and not commodities and clinical outcomes are delivered by the ability and skills of a doctor and the staff delivering the care. However, the one thing we can deliver without adding much cost is compassion a term which encompasses most of the common feedback responses from service users. A organization which is able to empathize and identify with the patients feelings is creating the experience which makes the service user a promoter rather than a passively satisfied customer or an active detractor.
Vision of the hospital I work in is very clear "COMPASSION EQUALS QUALITY HEALTHCARE"
I refer to Masina Hospital the oldest private healthcare institution of Mumbai.
This bold statement at once changes the game as I have not come across many hospitals who have made this their vision statement. Most hospitals in and around Mumbai and Masina Hospital have technology modern healthcare and quality as part of their vision or mission statements but when we say that there is no difference between compassion and quality health care we are not offering compassion along with quality care and outcomes but saying that one cannot be different from the other and and quality care without compassion is meaningless and merely compassion without quality care is meaningless.
So the ground rules laid down for this to happen stem from an acronym S H A R E
Sense the needs of your patients, caregivers (doctors, nurses, support staff) and colleagues and Co workers before they are expressed.
Help each other and work as a team, covering the back of each and every person in the hospital and present a unified face to all the persons coming in contact with you.
Acknowledge the feelings of every person using the services of the hospital. Also ensure that the same holds true for doctors and your co-workers.
Respect the dignity and privacy of all the persons using the hospital services. Courtesy and discrimination along with unqualified respect is the principle.
Explain in plane and simple words everything that is happening to every stakeholder and patient and keep everyone informed and aware of the things happening at all times.
Let us take each of these points and illustrate with Culture positive and negative actions to substantiate this point. While as an acronym the points seem exclusive and seperate, they seamlessly merge into one another especially when we think in each of our interactions how we can bring this acronym into play. The most important reason why a patient comes to the hospital is to make himself safe from a threat to his health which comes from a known or unknown cause. Despite, all preparations and use of the ubiquitous Google a person coming to seek services in the hospital has no idea of what to expect and therefore it is the duty of everyone to anticipate the patients needs before they are expressed. this maybe in the form of a wheel chair for a limping patient, giving directions to parking lots, departments looking for visual clues like limping gait, a sweating drained look, an expression of pain, confused or vulnerable person. Later things like plan of care discharge planning, billing, TPA approvals and even small things like the type of food preferences likes dislikes, need for walking aids, commodes, habits of patient, cultural nuances of which we are aware give all of us countless opportunities to sense patients needs before they are expressed. However, all kinds of staff will realise that they will not be in a position to resolve everything so it seamlessly leads to the next point of Helping each other.
Help each other is the teamwork atmosphere where there is very strong sense of focus on ones job with a keenness to sense the problems. If all employees use the three C's in using this acronym one can easily affect a massive culture change. Concentration on the task to be performed enables one to become better and better at sensing the needs of the patients and this leads to consistency in the same. Very soon this rubs onto others and we become co-operative. This atmosphere leads to employee empowerment and a sense of achievement. Many examples of the lack of teamwork abound in the hospital but once the culture positive behaviours are embraced the whole atmosphere of the organization changes.
Acknowledging feelings stems from empathy which is the one most important ingredient that comes out in all surveys in healthcare satisfaction data. The words and sentences which contain phrases like affinity for , compassion for, identification with, insight into, pity for, rapport with, understanding of, warmth in all convey that everyone in the hospital is acknowledging and listening patiently to the problems of the service user. This seamlessly leads to the next thing that matters which is mutual respect.
Respect needs to be earned and is always mutual. The present healthcare environment is one of doubts, distrust and hostility leading to anger, violence such that use of CCTV surveillance and security is now default setting. This problem is not easy to resolve but an ability to sense patients needs, anxiety with a strong ethic of teamwork especially where it involves visiting doctors who do not give complete clarity and information will help in preventing occasions of mutual disrespect flaring up into conflict.
The last of the acronym share is the one relating to explaining properly every single thing to the patient in detail in the language and words of familiarity cutting out the jargon. There was in the past an information asymmetry in the medical field such that the doctor could say anything and the patient would have a loss in understanding what was wrong or right. Many examples abound and we doctors and nurses along with the medical caregivers tend to exaggerate the diseases to either scare or keep the patient on the defensive. The patient caregiver who spends a few extra minutes explaining the problem and give enough knowledge in a slow and deliberate way, without information overload but with good amount of detail will help ease the problem of the patient in a far bigger way than otherwise. One of the most common problems in a hospital are delays on account of factors which are not entirely in our control. At such times keeping patient informed in a truthful manner and ensuring that the staff is available to keep informing the patient contributes in allaying the patients fears and anxiety.
Having set the framework and template of this cultural change the challenge is to launch it and create the change which is necessary without affecting focus on the sustainability and profitability of the hospital. I am keeping my fingers crossed but a positive change in culture and even sincere attempts to achieve this can result in increased revenue. Any company has many externalities which are seen but the underlying problems are unseen and this represents the image of an iceberg. It is important to get below the tip of the iceberg and uncover and align culture to higher values.
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Comments
.it is inborn .it is the reason we have become ddoctors.