Wednesday, April 13, 2011

Have I gone over the the Dark Side? Cast your vote!

Can anyone lend me one of those donut-shaped pillows to sit on?

'Cause I just got spanked!

Check out Dale's comments about a recent post regarding CIHI's reporting on wait times.  As you see from my response, I stand by my opinion, but something else he said - "Swing back to the positives you used to write..." - got me thinking.

The content and tone of this blog has evolved over 4 years.  Longtime readers know that I started with straightforward reporting of our Advanced Access/Clinical Practice Redesign work.  It was pretty peppy stuff.  We were able to accomplish a lot and make some significant improvements in our urology practice.

Then, as we realized that factors outside our practice limited what we could change, I started to become interested in the broader healthcare system.  I remain committed to working for quality improvement and want to be a positive influence, but every day, I see many examples of how the system fails patients and wastes resources.

I write this blog for a few reasons.  First, writing helps me clarify my thoughts on a subject.  I may start with a vague notion in my mind, and the discipline of writing about it helps organize my thoughts.  Many a post has been started, then discarded when a seemingly blinding insight evaporated.

I also want to spark discussion.  It's really satisfying to me when someone tells me they read something here and talked with a friend or coworker about it.  A controversial topic is more likely to be discussed.

Finally, I want to challenge myself to be open with my thoughts and feelings.  While I am truly encouraged to see the efforts and successes of others working to improve healthcare quality, I wouldn't be honest to myself if I were just cheerleading in this blog.  There's so much to be done, and the pace of change is frustrating.

But, let's see what you think.  Maybe you feel I should go back to the good old days of rah-rah.  Or maybe you prefer my "Blue Period".  Take the poll at the top of the right-hand column.

Oh, about that pillow...


  1. I love being challenged too, so let’s see how much stirring of the pot we can do. History has shown us that leading in a negative fashion is so easy. Many wars have been started by this, people quickly jump on the complaining wagon and we love to laugh when someone slips on the banana peel. I can write about all the bad things that happen in healthcare that’s easy. The solutions and things that help us improve healthcare are much harder to promote. For every positive change I have witness I get ten “yeah buts”. So what is my point about you (Kishore) telling more positive stories? Glad you asked. When you tell me how you adjusted your schedule or reduced your backlog to get patients in to see you in a timelier manner that allows me to see what you have done and then apply it to my situation. Positive – win healthcare. The CIHI data could be a positive story – SCA had a 19% increase based on CIHI’s current way of measuring – that’s positive. Then teaching people about creating a baseline based on the voice of the customer (VOC) that’s a positive. You would help a lot of people improve the healthcare system and measure accurately. Stating that they got it wrong did nothing for me nor gave me direction. That’s the “perkier and cheerier Kishore we need. Volley ... balls in your court my friend.

    Dale Schattenkirk

  2. Well, to take you at your word Dale (about being challenged I mean), I really think you continue to miss Kishore's point.

    For me, he has remained optimistic and positive, while also having the courage to raise issues that might be easier to ignore, the courage to recognize the fact (see poem below). There is always a healthy dose of constructive in the criticism and I know that he has had, and continues to have, a hard look at his own practice.

    I offer for consideration this poem by William Stafford. Paul Batalden has used it in his work teaching about QI and I have found it very inspiring and a helpful reminder.

    A Ritual to Read to Each Other

    If you don’t know the kind of person I am
    and I don’t know the kind of person you are
    a pattern that others made may prevail in the world
    and following the wrong god home we may miss our star.

    For there is many a small betrayal in the mind,
    a shrug that lets the fragile sequence break
    sending with shouts the horrible errors of childhood
    storming out to play through the broken dyke.

    And as elephants parade holding each elephant’s tail,
    but if one wanders the circus won’t find the park,
    I call it cruel and maybe the root of all cruelty
    to know what occurs but not recognize the fact.

    And so I appeal to a voice, to something shadowy,
    a remote important region in all who talk:
    though we could fool each other, we should consider---
    lest the parade of our mutual life get lost in the dark.

    For it is important that awake people be awake,
    or a breaking line may discourage them back to sleep;
    the signals we give---yes or no, or maybe---
    should be clear: the darkness around us is deep."

    — William Edgar Stafford

  3. Thanks, Kath. I think it's going to take many readings of this poem before I plumb its depth.

  4. Ooh Dale - you never want to stir the pot with Kath Stevenson - she lives for debates!

    And it's an interesting debate for sure. I am the biggest advocate of Releasing Time to Care in the province. I love the program and I love how front line staff, managers, and leaders have embraced it and have worked SO hard to make improvements in their wards and facilities. They too work their butts off on a daily basis. I am their biggest cheerleader and champion for the work they do to improve care to their patients/clients/residents.

    However, last year my grandma fell and broke her hip on an RTC ward and it has been a horrible year for her and my family recovering from that injury.

    So, I think the balance is important. Yes, be a champion and a cheerleader and tell the positive stories but don't let that overshadow the impact our system has on individuals and families when we fail them. My family cringes when an article about the success of RTC is written in the newspaper. For them, it is difficult to celebrate the "success" of RTC because in their eyes, all they see is failure.

    It's not about negative stories versus positive stories it's about taking those negative stories and TURNING them positive stories from the perspective of patient and their families. We'll know we're doing better as a system when patients and families say we are not when WE say we are or a random measure says we are.

    If we can do that, when we'll know we're on the right track.