Friday, June 1, 2007

Preaching to the Choir

Sing. Sing a song. Sing out loud. Sing out strong. - The Muppets

This is a graph of reckless exhibitionism:

It is the weekly tally of hits this blog gets. It makes me break out in a cold sweat. People are finding out about this project. If we fail, we fail very publicly. "Specialists' waiting lists down to 2 weeks? Hah! I knew they couldn't do it..."

When we started, my first instinct was to keep things quiet. Let's be sure this is going to work before we spread the word. Then I mouthed off at a committee meeting. And got invited to present our project to another committee. And another. Then HQC asked me to write this blog. WWW = cat out of the bag.

Now that the word's out, I want to take advantage of it. I don't want to get carried away, but I have big expectations for this project. Way beyond improved access for the patients of one urology practice in one city. We're just the guinea pigs. If we can do it, why can't all specialists do it? And family physicians? All over the province! (Even WW! Read, wide world) Spread the word!

Who do we need to tell? Everyone reading this blog? Well, it's a start, but I suspect I'm preaching to the choir. (I wanted to say "QI-er" but a pun that bad is a sign of the Apocalypse.) Many people who follow this blog are already part of the Quality Improvement community. So, who else needs to know about this? How can we leverage publicity into action? Psst. Lean in close to the screen and I'll tell you: Grassroots. Forget top down. Let's go bottom up. Get the word out to the public, the people who are waiting for doctors’ appointments. Let everyone know that access can improve, and that it's already being done.

It's natural to resist change. Doctors are especially conservative. Remember when having your gall bladder out (cholecystectomy) meant a big abdominal incision? Then someone figured out how to do it using a few small cuts and some telescopes. For general surgeons, it meant learning a new way of doing things. Initially, many were skeptical. There was resistance. But soon, there was a critical mass of public demand (and professional acceptance). Now, virtually all cholecystectomies are done laparoscopically. (Q: What do you say to a general surgeon who doesn't learn to do laparoscopic cholecystectomies? A: Yes, I'll have fries with that. ) Once enough people demand (demand!) better access, we'll reach a tipping point after which resistance is futile.

Publicly-revealed plans are also a great personal motivator. It's easier to get the job done rather than have to make up excuses. Here's my little project this weekend: I'm going to make up a notice for our reception desk announcing our Access project to our patients. I'll provide some pamphlets with the blog address and encourage people to tell their friends. I'll have this up by Tuesday morning. Here's your project: Tell one person (email counts!) outside the QI community about Advanced Access. Give her this blog's address. Do it today.

Sometimes the choir needs the chance to get to know each other. Telling our stories helps build a community of change. Last week, I had the opportunity to attend the HQC Chronic Disease Management Collaborative (CDMC) conference. It was exciting to see 200 people - improvement teams from all over the province - sharing their work. Project story boards stretched down a hallway. Many were slickly-produced, full-color posters, but the one that caught my eye was decidedly low-tech. On one piece of poster board, the title hand-lettered with black felt pen, it told the story of a small medical office trying to log on to the CDMC tools. They spent the whole day trying to get the program running. And then admitted it publicly! Six months ago, I would have sniffed at that effort and moved on to look at multi-colored run charts. But now I understand the courage it took to display that homely little poster.

Sing your song.


  1. Originally posted by Anita 6/01/07 1:04 PM

    Kishore's writing style is very engaging, and the content so interesting, that I look forward to Friday to hear what's new with your project. You are quite correct - when enough people understand the concept of advanced access, they will demand it. Keep up the good work.

  2. Originally posted by Berwyn Larson 6/01/07 3:55 PM

    First off, I really enjoy how you write Kishore (very entertaining as well as informative). I must agree with the GP who said more specialists should do what your group has done, especially psychiatrists and cardiologists. It is kind of a running joke that any new psychiatrist in the district won't see any new patients after a month or two of "hanging out their shingle." I have no clue which psychiatrist to refer to most of the time! Cardiologists, instead of forwarding your referral letter to a more appropriate colleague in their department, send you a letter suggesting who should see this type of patient. What a waste of time! Just pick one for me please! I also hope specialist and specialist groups keep open a few appointment slots each week for emergencies (one or two day waits if not same day service) and urgent appointments (less than 2 week). Just a few of my thoughts. Keep up the good work.

  3. Originally posted by Lisa Alspach (Quality Initiatives Project Manager, Sunrise Health Region) 6/05/2007 9:08 PM

    Have been reading your blog with interest - I am giving a presentation this week and will be sharing your expectations vs. experience at the Foothills Medical Centre as an example of patient-centred care (hope this is ok with you). Hope all is well with your family. Keep up the great work.

  4. Originally posted by Lenore Howey (SPH Laboratory) 6/08/2007 11 AM

    I have just been tagged in the Singing of your blog song request, "To spread the word on your work with Improved Access to Primary Care." I am presently working on a Quality Initiative Project at St.Paul's Hospital Laboratory to implement Lean tools to reduce the "MUDA" in our laboratory operations, great new Japanese word to add to the list already learned through our project. Have you heard of "GEMBA"? Japanese for "go to the work". This is the grassroots you refer to. Go to the Gemba! Who knows the processes best? The front-line workers. They work the gemba every day. I will be singing the song of our project this upcoming week to make it official and out that we are committed to the quality initiative of reducing "MUDA" in our operations for our patients and staff. Your blog will be continued support for me as we move forward. Thanks for the great inspiration that change can happen if you feel it and fully involve those that work it. I have to go practice my vocals now.

  5. Originally posted by Mary Klaassen (Canadian Cancer Society) 8/3/2007 9:43 AM

    I am a registered nurse and the Patient Advocate for the Saskatchewan division of Canadian Cancer Society. While I was attempting to discuss wait times for prostate cancer patients in Regina with Saskatchewan Health I was referred to your blog. You cannot imagine how delighted I am to see not only that you have taken on the "adventure of improving access" but that you and your team is actually presenting the adventure in a public forum. I have spent most of this morning reading through your blog and I first have to say congratulations!

    I would estimate that 80% of my calls in the past few months are from men with prostate cancer and I have learned much but also have many questions as well. It is becoming apparent that health care delivery, like real estate, is becoming a matter of "location, location, location.” As I was reading you past postings, I noticed that sometimes your "good backlog" is due to other scheduling bad backlog. I was surprised to learn recently that, while Regina and Saskatoon have pretty long waits for CT scans – especially non-urgent – Moose Jaw and North Battleford can usually schedule within a week or two. Most of my patients are quite willing to make that drive in order to get on with the process. I also have several patients being considered for a current clinical trial of "Ablatherm" hifu in Toronto, and one who has recently undergone the procedure (at his own expense) with remarkable results (as far as can be determined right now, ablation of the prostate with full nerve sparing!)

    I have been reading about Dr. Brian Donnelly's Rapid Access Clinic in Calgary so I was very happy to see that you are seeing excellent results with your efforts in Saskatoon. I am also delighted to see that you have a patient advocate. I would certainly like to visit your clinic and meet Stephen and/or the rest of your choir. I love to sing!