How do we take lessons learned and use them to create a stronger knowledge wheelhouse? A cloak of silence and shame is still attached to making a mistake. But only by wrenching back the curtain can administrators build the same kind of trust with the community and improve their own practice. Human Resources is probably the most complicated. The laws, in most places, raise liability concerns, so little is said and we asked for a resignation and in return we dangle a “carrot,” making it irresistible. An individual or organization steps away from the relationship and loses the benefit of learning. So without reflection and discussion, how do we learn to hire better, evaluate an opportunity, or define failed expectations in an unemotional manner. Employees or employers do not live up to “the pre-employment hype” for many reasons. How do we move interviewing from a sales pitch to a truth in labeling exercise? What can we learn from both what worked well and what did not work well?
Administrators need to speak to the community with the same frankness they urge clinicians to use with their patients. For example, I have argued that sending money back because of an over-billing would build trust with the community, give employees a behavior to model, and demonstrate transparency. The most senior leadership of a healthcare company was adamantly against it “because reimbursing the money would reinforce the community perception that the hospital company made a practice of over billing.” To this day I disagree with the decision taken and think the admission would have been a trust building gesture.
“Children learn what they live.” This age old adage describes leadership’s responsibility in an organization. Early in my career I served in a staff function and was a member of the leadership team in the United States. Our Hospital catered to very high profile clientele including a professional basketball team. Our patient’s livelihood depended on our ability to keep their information confidential. If news reporters or an agent learned of a frailty it had the potential to negate a player’s ability to negotiate current and/or future employment. In one such case during our weekly meeting the “senior team” was informed that one such patient would be in our hospital for surgery. We all agreed to that this was just another patient. Sadly, a member of the administrative team asked this Charlotte Hornet for a picture. We brought the subject back to that weekly meeting and focused on “where did the communication process fail?” Throughout my career, in almost every organization, I faced examples where do the right thing meant never turning a blind eye regardless of the size of the issue. Leadership must hold itself accountable and summon the rigor and courage from ourselves that we expect from clinicians. Admitting a error is a sign that we are human. No matter the culture, size, or mission being willing to self-correct is essential characteristic on the road to an organization being just.
The Chicago-based Joint Commission serves to guarantee a certain level of quality of hospitals. Its international branch has spread quickly in Asia—vertically—but has not truly taken root. What is the price of quality? We have heard the comparisons of cost of care in India versus the U.S. While the costs in the United States seem staggering by comparison, local regulations drive significant differences in cost. For example, U.S. regulations require single use of devices that can be sterilized and reused in other countries. More important still, the true value of accreditation is not the fee paid to the Joint Commission but in hard-wiring for future use those mundane practices that helped the organization attain the certification in the first place.
A learning organization must have an administrative process for self-examination and feedback in every department. The process must be dynamic and real time; It must flow up and down the chain of command and be non-punitive. Once this exists, honest communication with the public is possible. Hospitals that can achieve this level of transparency will thrive in a world where health care is a competitive.