I submit that all hospitals must address their broken processes in some manner. We at LPCH chose lean – there are other types of performance improvement techniques to embrace. However, without embracing and enhancing performance improvement, we will forever be a steeped in the principles of service recovery.
It must be noted that lean or any other performance improvement method is a long term play—it takes years to create a culture capable of undoing the complicated and inefficient healthcare systems we’ve created. While this is in flight, there must be attention to creating an environment where high service standards are the norm–where the patient is the customer. Patients are sick, in pain, scared, feeling mortal, and are looking to the healthcare system for help. At LPCH, we have reinvigorated our service standards; we call it PCARES. The principle tenets are that patients are the customers; we are in servitude to them—from phone etiquette, to how they are greeted, to how we listen to their issues, to helping them way-find in the labyrinths we call hospitals, to how we treat each other.
We aim to have this become the norm, not the exception whereby we invoke these principles only when we have wronged a patient. We have many partners on our journey. Dr. Bridget Duffy and her team at ExperiaHealth have created solutions that map to this concept by deploying process and technology changes that improve communication and relationships, thus humanizing healthcare.
In parallel, we must support our staff. It is not acceptable for them to agonize alone after a bad event. We should diminish preventable bad events. Again, we are using our lean system to help with that. However, when harm does occur, we need to reach out to them, support them, just the way we support our patients. How can we ignore the reams of organizational psychology data that demonstrate that engaged, happy, supported staff will result in an environment that is best suited to create a healing environment for its patients?
Our first step in this journey is to borrow from Dr. Duffy the concept of Code Lavender. We have started applying this staff-centric emotional support when we embark on staff interviews after an adverse event, prior to a root cause analysis meeting. Recreating the event with the staff 24 or 48 hours after the fact can be demoralizing. We now start the interview by asking about and offering, by a variety of means, emotional support.
Ultimately, what does every patient want from their hospital experience? I’ve asked that question of many patients and their families. They all say the same thing: Make me feel like the only patient in the hospital, find my problem, fix my problem (and fix it right the first time), alleviate my suffering to the best of your ability, listen to my concerns, and please do it at a cost that doesn’t prohibit me or my insurer from accessing your services. Not one of my interviews included requests for more coffee cards, discounted bills, free parking, or special amenities. My goal is to make their wishes a reality.
About Craig Albanese, MD, MBA
Craig T. Albanese, MD, MBA, is Vice President of Quality and Performance Improvement at Lucile Packard Children’s Hospital at Stanford University Medical Center. In this role, he is responsible for overseeing the children hospital’s Lean transformation. Under his leadership, Craig is approaching Lean transformation by developing a rigorous daily management system to support ongoing improvement efforts and the hospital’s core goals. In addition, he has recently overseen the implementation of a production control management system in the perioperative services department and is expanding this work to the rest of the hospital. Craig is also a pediatric general surgeon, Professor of surgery, and holds the John A. and Cynthia Fry Gunn Directorship of Surgical Services at Lucile Packard Children’s Hospital.
Craig obtained his BS in Natural Sciences and Mathematics from Washington and Lee University. He earned his MD at Downstate Medical Center, subsequently completing his general surgery training at The Mount Sinai Hospital in New York and his pediatric surgery fellowship at the Children’s Hospital of Pittsburgh. He was on the faculty at the University of Pittsburgh followed by the University of California, San Francisco before joining the faculty at Stanford in 2002. In 2008 he earned an MBA from Santa Clara University’s Leavey School of Business. Craig still practices pediatric general surgery. His 26 years as a surgeon in a broken healthcare system has shaped his passion for increasing value for our patients.