← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Leading with heart: Building a culture of safety, trust, and transparency
00:20:59
Loading summary
Transcript32 lines
- [00:00]
A
Welcome, everyone, to a special edition of the Becker's Healthcare Podcast series. Today we will be diving into a conversation with Pat Ryan, CEO at press Ganey, and Dr. Kevin Churchwell, the CEO at Boston Children's Hospital, as featured on Press Ganey's PG Pulse podcast. We hope you enjoy this special episode.
- [00:20]
B
Welcome to PG Pulse, Press Ganey's podcast on all things healthcare, tech and human experience. In this podcast, we'll be joined by some of the best and brightest minds in the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
- [00:39]
C
Welcome. We're here at the PG Pulse. I have the privilege of being here with Dr. Kevin Churchwell from Boston Children's Hospital. Welcome, Kevin.
- [00:46]
D
Pleasure to be here. Thank you, Pam.
- [00:48]
C
Great to have you. We've known each other for a very long time. It goes back beyond when I led Press Canyon. I've always been a fan of Boston Children's and every once in a while a contributor. So it's great to have you here and you do amazing work.
- [01:04]
D
I appreciate that and thanks for the support. Always looking for that.
- [01:08]
C
Exactly. Well, my youngest son, who's 32, has had surgery there a long time ago, and you'll be glad. You know, it's all working out, so we're in good shape.
- [01:19]
D
I always like to check in.
- [01:21]
C
Exactly. Well, you know, this is a fairly dynamic time in the industry, but I like to start out with just a little bit of your background. And we were just talking that we both spent some time in Nashville. You more than me. Give us, give us the quick highlights. How did you end up in medicine? And you've. You've got an identical twin brother who, by the way, is. He's walked through meetings before. I. Kevin is so rude to me. He doesn't, he doesn't answer when I call out to him and recognize that I made a mistake. But give us just a quick background.
- [01:53]
D
Sure, sure. Actually grew up in Nashville, Nashville, Tennessee. And my family is five kids, three boys, four boys and a girl. And first time I really left Nashville was to go to college. I went to MIT and found out over a period of time that I wasn't really interested as much as I thought in the engineering aspect, as opposed to what interested me in terms of interaction with people, teaching, and also figuring out things. And so medicine became a logical idea for me to pursue. And so I decided to be a pediatrician and then made the decision to do my training in an environment where I would see everything twice. And there Weren't a lot of residency programs like that? There still aren't, but Boston Children's really fit that bill.
- [02:52]
C
Is there something, as you think about your recruiting, is there something about the mission of a children's hospital, that health systems in general should learn from the.
- [03:03]
D
Importance of kindness, importance of individuals that believe that that's important? I think that as you look into pediatric hospitals, children's hospitals, I'm not saying that adult hospitals aren't doing a great job. Everybody's working as hard as they can, right, to improve the staff experience, the patient experience. But we work with a really precious commodity, and those are our kids, and that's the future. And how we relate to them is extremely important. How we relate to the family, extremely important. So kindness is very important. I think you see that across the board when you interact at Boston Children, with my colleagues across the country, that we believe that that's incredibly important to relate to. Be kind, because kindness then denotes that we are thinking about them. Who are we here for? Am I here for myself, or am I here for the patient and the family? And so I think that helps them.
- [04:05]
C
That's fantastic. As you think about your going down that path, one of the things that you have pursued throughout your career is high reliability and safety. Yes, and we talk about it a lot. I. I recently had a safety event. My wife had appendicitis, and they ruptured. And there's a whole series of issues around it which I won't bore the listeners with, but I got an opportunity to sleep in a hospital for 10 days. And, you know, the obvious nature of this three system hospital, the day hospital, the night hospital, and the weekend hospital. And I called on our clients, I put out a note on it to consider looking at the huddles and the way that things occur on weekends. And I get a lot of tremendous responses from people. And it feels like the industry still has a big step forward with regard to safety. Lots of progress, but really looking at high reliability and safety, how do you feel about that and what drove your passion for it, and what's your advice to the industry?
- [05:19]
D
Well, part of the passion, of course, was the work that I did as a critical care physician, where you see the issues, you see the cracks in the wall, you see where things are dropped, and you can see where outcome could have changed if we communicated better, if we had better systems in place. At Boston Children's, we had worked very hard on safety, quality and safety, and it gotten it to a point where we were very proud of what we were doing. But it was very obvious that we had a lot of work to do. Power gradients, lack of communication, accepting an environment that we really shouldn't accept. We brought high reliability in for those reasons. I will tell you, it wasn't just duck soup just to get everybody on board. It was very clear that working with our staff physicians, the nurses got it very closely that they believed that we were doing as good as we possibly could. Why change? We were top notch. And what changed the conversation was one slide. We put together, one slide that showed how many kids we had harmed over a two year period. I'm not saying all the kids died from the heart, but there was harm to these children. And from the faculty standpoint, this slide probably had two or three patients in it. We failed the entire slide. And that was a wake up call. That was the wake up call. Oh, maybe we aren't as good as we think we are. Maybe we should cling on to this. And that then drove a different conversation. It drove a conversation with our faculty, with our nurses, with our teams around a board team approach, where the huddle became this organic entity that is now across the entire hospital, entire enterprise, where communication is not a bad word, but a word that is utilized all the time. You know what I love is the vocabulary of high reliability. I love it because I know that we've made progress when everyone's using it. So our physician in chief, who is the. Who at the time was our chair of pediatrics, got involved with it, wasn't really enthusiastic about it, but got really involved with it. But now we can be in any kind of meeting and he would say, kevin, can I ask a clarifying question? So I know that we've made progress. That was kind of using high reliability in some respects of vocabulary, a utilization of words to sort of really set the standard of how we communicate and what we communicate about. And in order to do that, you've got to get everybody to gleam onto that. And we've been able to do that.
- [08:31]
C
How do you do it? With the turnover in health Systems today averaging 20% for many people you think of every two years, you've got 40% of your workforce is new. Do you have the regular ongoing trading? Is it just embedded in your system? How do you make sure that the culture continues to focus on it so.
- [08:52]
D
Everyone who comes in and their orientation learns about it as part of it? There is refreshes that we have put in place. We're in a big refresh right now. We call it high reliability 2.0. It's what's happening now. And then it's right in front of everybody. Every morning I get the email how many days we've gone without a serious safety event. Everybody sees it. So you started with, we've gone two days, then it goes to five days, then it goes to 20 days. And then we celebrated when we got over 100 days without a serious safety event. And now we've had multiple times, but we've gone more than 100 days. It's 52 days as of today.
- [09:39]
C
I want to point that out to whoever's watching this. Your MIT work, your measurement matters.
- [09:47]
D
Measurement matters. So we put it out in front of everybody.
- [09:52]
C
That's an important point because I'm not sure all systems are that transparent with regard to it. And so how does transparency come to play? Is it that when people see it, no one wants to see a safety event and the transparency brings. Shines a brighter light on it?
- [10:08]
D
So transparency is very important from that standpoint. You have to get used to it. In the beginning, everyone said, why are you doing this? Should this be sort of hidden? And et cetera. But the more you do it, the more everyone realizes the importance of it and it creates a goal for everyone. How long can we go? What does that mean, to go that long? Well, it means we haven't harmed the child. That's fabulous work.
- [10:38]
C
How do you ensure your workforce has the resiliency to deal with the stress of the job? You talked about the event where you were working and you lost a child. I mean, that in itself is an incredible moment and experience emotionally. How do you ensure that your entire workforce and both the pandemic, obviously something we didn't expect, and now where I would say there's a high level of stress just in the overall environment, how do you ensure that you continue to work with them to build resiliency within the workforce?
- [11:20]
D
So that's one of our biggest challenges now. And that pre. Covid. Post Covid. The challenges our workforce, they've encountered, and this word resiliency has taken on multiple, multiple meanings, connotations. And the lack thereof has really brought. Has come to the forefront. And what have we put in place? Well, we've put in place both for our faculty and for our staff offices where they can come and get support when there are issues that really drive their lack of resiliency or increase the stress that they're under. We've put together different groups that meet on a regular basis, support groups. From that standpoint, we did something that I didn't think was going to work, but I think has worked beautifully is that we recruited an omnibus with her and she has been just fabulous to the point that now we have one and a half because of all the issues that they encounter. Our staff have a place to go to that is confidential. These individuals are just incredible in terms of their experience and how they interact with individuals and groups that are having these types of issues with resiliency. And there are other things that we've done, but it's still a challenge. It's not the way, I can't say this but I'll say it anyway. It's not the way I did it when I did it when I was taking care of patients. There's no more really, there's no more tough it out kind of stuff. Now certainly in that environment I had my own PTSD that shows up later on and not recognizing that at the time was just part of the. The way it was when it's not acceptable anymore.
- [13:33]
C
No, my, my children have informed me that the I walked uphill both ways through snow to school story is lost on them. It's an interesting story, but they only need to hear it once. And you know, we have a workforce that's my, my guess is your workforce is somewhere around 30, 40% millennials and Gen Zers.
- [13:55]
D
60%. Oh yeah, 60 years.
- [13:58]
C
Yours is higher than the, the average. And this is a group of people who are passionate about having impact sometimes wanting to know what their impact is every six months. But it's a, it's a different group to communicate with and I would argue probably better. I grew up in the same. Don't speak unless spoken to corporate environment and don't leave the office until your boss goes out the door and make sure he's got a good 10 minute head start right to, to the process. And you know, I'm now invited to go to lunchtime bar classes with my marketing department if I like. So it is a different workforce to manage. But I, I think they probably have the, the right idea with, with regard to it. So those programs are important experience in being an omnibusman.
- [14:50]
D
You can actually train for that and get certified in that regard. And actually she just came from the international conference. So it's a discipline that continues to evolve from that standpoint. But it's a combination of psychology, it's a combination of having legal expertise and so different individuals get into it based upon their profession. And the current person that we have is an individual who just. Can I talk about the listening aspect? And she has that listening gene, but she can translate it. To find the right conversation, the individual or the groups need to actually move forward, which I find incredible.
- [15:47]
C
That's fantastic. Tom Lee talks about social capital. I'm sure if you didn't get a signed book from them, you'll have one by the end of this meeting. But it's interesting, I wrote down the words that you've used with team, respect, kindness, communication. And what we've discovered with our data is that if you think about an organization, if you don't have safety, you don't have engagement of your workforce. And we see workforce is reporting that 60% of their nursing staff doesn't feel that they're completely safe at work, both physically and for their patients. And if you don't have safety, you don't have engagement. And if you don't have engagement, you don't have experience in the process. And this concept of building social capital with teams and bringing together with the kindness, the respect and the communication. Do you have a plan? Is it part of your strategy where you implement a plan to create that kind of social capital or call it what you'd like with regard to teams and building those separate teams.
- [16:58]
D
We put together our yearly safety plan, and don't put it on the shelf. Okay. That's an active, engaged entity or document that we sort of measure ourselves against throughout the year. And then we also present it to our subcommittee of the board that is engaged in patient safety so that there is a transparency and awareness at that level on the work that's happening. High reliability is a cornerstone for the work we do in that regard. Then safety for our staff, as you've described post Covid, the number of assaults, the number of just poor interactions between staff and staff, staff and families, staff and patients, patients and patients, it's just gone up dramatically. And how do we do a better job of providing that safety for our staff? Well, we do it by learning we started one way by, you know, sort of a Roman Legion approach, just put more people on it, more security and et cetera. And that worked to some degree, but it wasn't really getting to the issue. We certainly have changed the toll environment of how patients, families get to us. Not multiple ways to get into the hospital during two to three weeks. Right. No one can get to the floor without a badge. No one can get into the elevator and get to a floor without a badge. And that's really helped our staff feel safe from that standpoint. And then there is how do you interact with families who are frustrated, who have lost the ability to really interact in a way that you expect them to do. They reach out through their voice or physically. And how do you stop that? How do you really minimize that? We create a code of conduct that we sort of are spread out across the hospital. Signs saying this is what we expect of our families in care as a first start and give the staff the opportunity and the ability to talk to families to say, this is what we expect of you in the care of your child. The interactions between patients is also very difficult. And we're still working on that. I can tell you that how to do that well, what's the evolution of that is really the next frontier as we move forward.
- [19:51]
C
Thank you for that. And as we close out Kevin Churchwell, Service first listening, communication, respect, kindness. Those are the words I wrote down. He leads with that on his shirt sleeve. Thank you so much for everything you do. And I hope that our current administration will listen to your advice and put the kids first. So thank you very much.
- [20:17]
D
Thank you. Thank you, Pat. Pleasure.
- [20:19]
B
That's a wrap. Thank you for joining us today. And special thanks to our guests for sharing their time and insights. Stay tuned for our next episode, which will be released soon. In the meantime, visit our website where you'll find more information on the human experience and a lot more foreign.
- [20:45]
A
Thank you, Pat and Dr. Churchwell, for your time and insights today. We also want to thank our podcast sponsor, Press Gany. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.