Best organizational health – recovery

 

Individual best health depends on organizational best health. I spent a valuable portion of my professional career working in behavioral health. Organizations and individuals all suffer tragedies from time to time.  Many similarities exist between organizational improvement and personal recovery. For example, an addicted person follows a longstanding behavior without question. The behavior affects the addict negatively, even tragically, but definitely results in poor performance.  Resistance to change is fierce. The addict will not be forced to change. When the addict perceives the hopeless of the addiction, usually in a heightened state of collapse and despair, he or she becomes open to exploring new behavior patterns and significant belief systems become rearranged, thus creating positive change and subsequent improvement. Paradoxically, hope evolves from despair or surrender. Healing occurs first in the spirit, then in the mind and last in the body.

When an organization suffers a tragedy, it also recovers first in spirit, then in the mind and finally in the body. An organization recovers by rebuilding its spirit (mission) by embracing and focusing on its mission in all areas of operation. Next it strengthens the mind (leadership) by rebuilding coalitions, aligning collaborations, and rounding to maximize employee and patient experience.  Finally, it heals the body (staff, processes and systems) by mindfully involving all stakeholders.
Have you experienced organizational recovery? How has it recovered?

Magic lever – resilience

Tragedy is the common unifying force of life and organizations. The more seasoned you are, the more likely you are to have experienced personal and organizational tragedy – a death, diagnosis of serious illness, job loss, legal difficulties, downsizing, loss of a contract, loss of key staff, loss, loss, loss.


My daughter-in-law texted me, May the force be with you, as I was in the midst of a personal tragedy.  What is this force, this superpower? How does a person or an organization survive a loss, a tragedy and regain best health? Resiliency. According to SAMHSA resilience is the ability to:
  • Bounce back
  • Take on difficult challenges and still find meaning in life
  • Respond positively to difficult situations
  • Rise above adversity
  • Cope when things look bleak
  • Tap into hope
  • Transform unfavorable situations into wisdom, insight, and compassion
  • Endure
The American Psychological Association reports the following attributes about resilience:
  • The capacity to make and carry out realistic plans
  • Communication and problem-solving skills
  • A positive or optimistic view of life
  • Confidence in personal strengths and abilities
  • The capacity to manage strong feelings, emotions, and impulses
Can resilience be learned? How can we increase the resilience capacity for ourselves, our families, our organizations, and our communities? What tools can help increase our resilience capacity?

Magic lever – Setting a goal for best health

A best health goal is a milestone in a health journey. These goals can be set individually or collaboratively with a health team. Goals can run the continuum from lose 10 pounds in the next 3 months to make an appointment with a dermatologist to stay alive until my grandson’s wedding. The goal can be one of several, such as walk 50 feet with assistance, manage pain without IV’s or injections, and have meals brought to my home so I can be discharged. Goals need to be specific, measurable, possible, and explicitly stated. One of the characteristics of valued members of my health team is that they help me set goals and attain goals. If they can’t do this, they aren’t part of my team. The goals that I have set with my team this past year include lose 35 pounds in 9 months, walk at last 5 miles per week, do eye exercises 10 minutes every day until the double vision decreases, and stretch my quads twice a day. I have been able to meet all but the last one. Factors for success for me have been that the goals were stated and written; I kept a log of my activity and progress; and these goals were discussed at every opportunity when I met with members of my team, including my wife and my family. As a nurse it’s inexplicable to me how disconnected goal setting can be from the patient. While every profession has a treatment, care, discharge plan, often the patient and family don’t explicitly collaborate in setting the goals and mapping progress happens in the patient record or between professionals and not consistently with the patient and family. How can we get better at setting explicit measurable goals with our health team?

Magic lever – changing habits

One of the magic levers impacting best health is automatically using widely accepted, well tested practices (evidence-based practice). For example hand washing. Seems like a no brainer – washing hands between patients for professionals, before caring for your loved one, after going to the bathroom for everyone. Another is limiting antibiotic use to treat viruses. Also preventing or reversing obesity. I’m fascinated how hard it is for professionals to change practice informed by widely accepted research or even common sense. Is it similar to maintaining good life habits? I suspect that inertia plays a major role. It’s hard to change gears in a busy productive life. Heck, its hard to change gears in an unproductive life. How do we get the stars in alignment to do the right thing when we definitely know what the right thing is? How do you effect change in your professional and personal life? What are key factors that others can replicate? We spend so much money and human capital on trying to change behavior – consultants, training, how-to-manuals. What works? Being able to change habits is a superpower.

Me? or Populations?

One of the challenges for the health care team – patient, caregivers, and professionals – is arriving at the patient’s personal goal of the moment and collaborating toward reaching that goal. I have found myself struggling to differentiate the likelihood of treatment success for a population versus the likely effect for me, my patient, or family member.  As my neurologist says to me, you are not the population. What works or happens for populations doesn’t necessarily happen or work for you. As a multiple sclerosis patient effects of treatment choices on populations is only one consideration got me. For example, I know that I will take no medication that makes me depressed or even less optimistic, no matter its proven clinical effects. My health team knows this.
Have you confronted such dilemmas in seeking best health?

Releasing the Inner Improviser

Best health includes improvisation in the relationship between health professionals and those in their care. One picture of improvisation is discretion to customize response and interaction and go off script and track with each individual’s or families journey. Yet the capacity of health professionals to remain up-to-date in their knowledge, compliant with practice and regulation, and productive while still able to be kind and improvise approaches possessing a superpower. As Kate commented yesterday, other knowledge workers – teachers – have the same challenges.

What conditions release the inner improviser?  Let’s consider a few: clarity of purpose; trust and team dynamics; predictability and responsiveness of  systems; and ability to learn from the improv: fix what seems broken.

Clarity of purpose can be mission, focus on the task at hand, or even clear boundaries. Every organization I’ve worked for had a mission statement. St. Peter’s Health Care Services (SPHCS) in Albany, NY, was committed to being a transforming healing presence in the communities we serve. Like the golden rule, easy to say, tough to do. Difficult decisions at SPHCS often included explicit consideration of the mission.  Focusing on the task at hand is mindfulness. As in right now the task at hand is pain relief, teaching, mobility, whatever. Not my co-worker, not the next person who needs me, not Dancing with the Stars. Concentration. Zen. Finally, improvisation occurs within boundaries – knowing the tune. For health workers the tune is policies and procedures, regulations, standards of practice.

Trust and team dynamics. Sustaining kindness and improvisation without feeling trust in yourself and your team truly IS superpower. Good team dynamics are healthy relationships – role clarity, communication that greases the constant shifting and movement of the day’s flow, re-prioritization, and mutual helpfulness.

Predictability and responsiveness of  systems used by your team –  workflow, supply chain, information systems. Knowledge workers create work arounds when systems don’t work quite right. They ingeniously seek a state where they can accomplish their daily tasks productively. Disruption of these systems draws valuable energy away from kindness and improvisation.

If all the stars are in alignment and staff feels able and empowered to improvise, we are idiots if we don’t learn and fix. Some proportion of improv is kindness and some is in response to something that is broken. Often both. Lord, I feel another post coming on.

I contend that the most important job of leaders – the people who supervise those who touch the public – is to nurture the environment of kindness and improvisation. Nurture the environment and model the behavior.

Improv and Health Leadership

Why improv and health leadership? Health experience is unique, of the moment, a journey. A different possible riff every moment.

The patient, client, consumer (let me use the term consumer for now) expects safe, quality, kind, empathetic care and service from professionals and their organizations-it’s a given. Even when safe, quality, and kind are present the health journey can be a very rough road. The challenge for the professional and support staff is to maximize the ability to know and relate to consumers as individuals and respond to the roadblocks, detours, potholes of that journey. 

The compliments my peers hear about health care are not usually about saving a life, successful surgery, hand washing. Rather it’s about the housekeeper who brought coloring books to the child; it’s about the nurse who knew the child’s passion for Ninja Turtles and brought a Ninja Turtle balloon to the bedside or exam room; it’s about the doctor who called the family on her day off; it’s about the registrar who found a private space for a mother to breast feed a non-patient child. These leverage the whole experience positively.

The relationship between professional caregivers and consumers includes constant improv-discretion to customize response and interaction and go off script. Yet the capacity of caregivers to stay up-to-date in their knowledge, compliant with practice and regulation, and productive while still able to improvise approaches superpower.

How can professionals and support staff tap their inner superpower without the intentional complicity of their leaders? Health leaders model and create the conditions that cultivate and learn from this improv. More about those conditions in the next blog.

Improv and Best Health

Why improv and health? Health is unique, of the moment, a journey. A different possible riff every moment. Successful maneuvering the roller coaster of dis-ease depends on religious taking care of what is well with your instrument; on you and your team dynamics; on the predictability and responsiveness of the tune: systems and infrastructure through which you journey; listening for the germ of truth in yourself, your caregivers, and professionals. Best health seeks simplicity: values, mission, common sense and of course chutzpah when you can afford it. The rest is commentary.

How is your health improv?

Improvisation

As an amateur jazz musician I spend 3-6 hours per week working on improvisation.  In NY I studied with Al Golladoro, a virtuoso extraordinaire. Now in MA I learn from Jeff Harrington, a saxophone professor from Berklee College of Music, and for the past year I’ve played weekly in a student combo practicing improv under the direction of Dan Fox.  I’m blessed with the chutzpah to venture outside my comfort zone. I’ve landed on several fundamental principles while studying improv:

  1. Listen first, play next
  2. Know the underlying tune
  3. Keep my place
  4. If nothing else, feel the rhythm
  5. Less is more
  6. A good sound beats dexterity
  7. Forget it all and have fun
The lessons of improv serve me well as patient, caregiver, nurse, and leader. Subsequent blogs will dive into improv and the other hats, but I can distill it down as follows:
  1. Listen first, act next 
  2. Excel as a team member on a good team
  3. Know the goal and the related systems
  4. Keep it simple
  5. Enjoy life

Superpowers

What are my superpowers? What are your superpowers? Love having this conversation with my grandson. Today, he has atomic breath like Godzilla (especially in the morning). I first had this conversation with my son when we first knew he was dying of cancer. His superpower was poetry.

i am not things.
i am sums of things,
guessing that i’m part of God,
wondering if there is some place
where my soul will go
from where i might look down
with advantages my eyes did not have
and see the tops of trees
which i used to walk beneath for
shelter from rain and sun,
and see the way things go together
like continental tracts of land
punctuated by water and lights
and roads and other concrete artifices

Preface to “the way I become about dying” by Michael P Funk, 2002

When diagnosed with MS, my superpower became the ability to accept what is. Superpowers are a magic lever for best health.

What are your superpowers?