There's a good deal of angst about reform legislation among health care professionals. Much of the commentary has been critical of the law and the difficulties it seems to create for hospitals and health professionals in providing care. It has been suggested that hospitals risk financial collapse and that patient care will suffer unless the law is modified substantially.
This negative attitude on the part of some of our nation's health care leaders is troubling and sends the wrong message to hospital employees, physicians and, most importantly, patients. We need to recognize that how we conduct business and the way we are organized are all invented; there is no reason why, with creativity and innovation, we cannot come up with a new model for delivering care.
Last February, five weeks after a devastating earthquake, my wife Donna and I were privileged to be part of a 17-person medical team that went to Haiti to assist the relief effort. Team members came from three different countries and, with few exceptions, had never worked together.
One group from Canada and another from the United States met in Philadelphia for our flight to Haiti. We met our team leader there and were surprised to learn that she was only 24 years old and that this was her first time organizing and leading a relief effort. But based on her thorough preparation during the preceding weeks, we all had confidence she could do the job. Our faith in her was justified as she negotiated our way through customs and regional air carriers, and resolved issues involving the large amount of medical supplies we were transporting.
We staffed a small clinic in an area northeast of Port-au-Prince. It had no running water and limited electricity provided by an aging generator. All parts of the clinic had to be organized: the triage function, the exam rooms, and the set-up of the pharmacy. We coalesced into small work teams based on individual skills and expertise and by noon of the first day, the clinic was ready to receive patients. We cared for more than 100 patients until closing time.
That night and every evening thereafter, we had a team debriefing. We used this time to celebrate our accomplishments and to suggest improvements to our processes. It also allowed team members to express their feelings about what they had seen and how this experience was affecting them.
In addition to the clinic, our team provided medical care to the internally displaced persons camps that had sprung up all around Port-au-Prince and consisted of makeshift shelters of sticks, scrap lumber, sheets and tarpaulins. These camps had no running water nor sanitary facilities, and the residents had not received any medical care since the earthquake.
We drove an old school bus to the camps and set up a small tent next to the bus. We saw women and children on the bus and men on folding chairs outside in the 100-degree heat. Many children suffered from infectious diarrhea and the resultant severe dehydration that necessitated emergency treatment with intravenous fluids. IVs were started and administered in the bus. We saw as many as 350 people a day.
Our team leader visited us every day whether we were at the clinic or in the field. Even though she did not have a clinical background, she was interested in the problems we were seeing in the patients and did her best to ensure that we had all the supplies and resources we needed. She was also attentive to our well-being and encouraged us to drink plenty of water, take breaks and eat enough to maintain our energy.
Every day we learned something new, and each night we made adjustments to our processes and passed the information to other team members who alternated days between the clinic and the IDP camps. Our team spanned the Facebook and Western Union generations and comprised physicians, nurses, paramedics, nursing students, crisis counselors and lab techs. There was no hierarchy. Instead, we came together as a team united by a common mission.
Even though the work was difficult and the circumstances tragic, we tried to deliver the care in an effective and sensitive manner and, as the days went on, we were largely successful. By the end of our 10-day stay we had cared for more than 2,000 patients, saved some lives and improved others.
We lacked the marvelous technology we had come to take for granted in our own communities and hospitals, the ability to search the Web for medical information, and the ease of reaching an expert colleague by phone. We relearned how to rely on our instincts and our experience. More importantly, we relied on one another. We became better listeners and focused on good ideas and suggestions, not who made them. We comforted one another when the going got rough or when an infant arrived too late to be resuscitated.
We became a team that cared not only for the Haitian people but for one another. For each of us, the time in Haiti changed us in fundamental ways, and many of us were hopeful that we could join another relief effort there in the future.
Since my return, I have tried to mine my Haiti experience to help me as a board member address the challenges that confront every health care organization. I learned several lessons that may prove useful to others.
Leadership can arise from any quarter and does not depend on age or experience. In a time of crisis, a hierarchical management style may be ineffective. Leaders must be encouraged and embraced from all levels of an organization.
Creating and articulating a values-driven mission is an essential element in generating pride and joy in the work at hand. When the heart, will and mind are fully engaged, action feels effortless. Unfortunately, today's focus on financial metrics doesn't engage health care professionals whovalue improving a patient's outcome and experience.
The myriad problems confronting health care organizations must be prioritized, and plans must be compatible with the time, talent and resources available. Well-defined action plans must have clear goals, objectives and accountabilities. A reactive approach to every untoward event or abnormal parameter can undermine ongoing plans and projects.
The higher a person ascends on the leadership ladder, the less he or she can know about day-to-day operations. Decision-making contained within the board room or executive suite likely will be less effective than encouraging collaborative problem solving at the front lines. Self-organizing work teams can be particularly effective at addressing chronic problems and generating viable solutions.
The goal of continuous improvement is met best in an environment in which experimentation and multiple pilot projects are encouraged. Such projects stimulate creativity and innovation, encourage broad participation, and likely will generate change that is both widely accepted and durable.
Hospitals' focus on physician alignment should not be at the expense of greater interdisciplinary collaboration. For nonhospital-based physicians, interaction with the hospital environment amounts to only a fraction of a day. The nursing staff and nursing leadership do much to shape the physicians' impression of an organization and can contribute greatly to the quality and safety of care and patient satisfaction. Leaders should devote more time to nursing alignment and creating an environment that encourages nurse-physician collaboration. Ensuring that the nursing perspective is represented in the board room would be an excellent first step.
The challenges facing health care leaders today are unrelenting, and the accompanying stress can be enervating. Trustees should develop a greater sensitivity to and connection with their organization's workforce. They should make an effort to spend time with physicians and nurses to understand the challenges these clinicians face on a daily basis. With senior management, board members can make rounds to the emergency department, operating rooms and other areas. Finally, trustees can ensure that the organization recognizes the individuals and teams responsible for its success.
There is no question that hospitals and health systems face substantial challenges in the years ahead. My experience in Haiti suggests that even in the face of severe hardships and constrained resources, much can be accomplished. These times call for leaders who are sensitive, optimistic and creative and who remind us that it is possible to overcome great difficulty and generate pride and joy in the process.
Matthew J. Lambert III, M.D., M.B.A., FACHE (firstname.lastname@example.org), is vice chairman of the board of directors of Sisters of Charity of Leavenworth Health System, Lenexa, Kan.