Holiday enlightenment

Christmas holidays enlightened me about a couple of things.


My usual practice while on holiday is to spend some time every day answering work-related emails, reading professional papers, or just contemplating clinical or improvement work.  I decided to try something different last week.  Over the Christmas break, our family spent 4 days at Elkridge Resort, near Prince Albert National Park, and I deliberately disconnected from work.  I left my laptop at home. There was no Wi-Fi in our cabin.  My cellular network doesn't reliably cover that part of the province, so I couldn't sneak email peeks on my phone.

When we first arrived, my kids rapidly assessed the telecommunication situation.  No Wi-Fi for 4 days! Barbaric.

"Looks like you'll have to walk up to the main hotel lobby to check your emails," my wife told me.  I guess my holiday routine was predictable.

It was surprisingly difficult to give myself permission to slack off.  It wasn't a problem while we were outside tobogganing, skiing or hiking.  But inside the cabin, I had a nagging feeling that I should be doing something... productive.   If I would have had my laptop or other work paraphernalia with me, I'm sure I would have succumbed to the temptation!  Instead, I played board games, watched TV and read a book.

Lesson learned: I have to work at relaxing.



During the school year, our home life is very busy (our own doing!).  Much of our time in evenings and weekends is spent rushing to children's activities, then back home to get ready for the next day.  This can lead to some stressful family interaction (Hurry up! We're going to be late!).

Even on holiday, old habits die hard, and we over-schedule our vacation activities. (Get your boots on - we're going tobogganing at 2:45.)  I surprised myself a couple of times when the kids weren't ready to head outside, by flopping back down on the sofa rather than cracking the whip.  We got to the sledding hill eventually, and everyone was in a better mood when we got there.

I also enjoyed a switch in some traditional family roles.  We decided to try cross-country skiing - which I hadn't done for over 20 years.  After we rented the skis, one of my sons announced that he had been skiing at school recently and showed me how to clip my boots into the bindings.  It was a very satisfying change in our usual parent-child / mentor-student relationship.

Lesson learned: There are other ways of being that are hidden by the self-imposed flurry of daily life.


Back to work tomorrow - I hope these lessons stick with me.

Improving healthcare by learning about hotel management - IHI Forum Excursion

Who would have thought that you could improve healthcare by learning about hotel operations?

The organizers of IHI’s 24^th annual National Forum, that’s who.

The Forum Excursions are a very popular item on the menu in Orlando this week.  I had the chance to visit behind-the-scenes at the Marriott World Centre, with the intent of linking best practices in other service industries to healthcare.  (Yes, we are a service industry!)

A few lessons learned:

Visual management –  hotel staff used visual management extensively to relay information such as daily guest volume, special events and that day’s guest service focus (that day, it was “anticipating guests’ needs).  There were no fancy computer displays, just white boards, markers, colored paper and tape. 

Eliminate variation – at a buffet service, every item – right down to bread and salad – is placed at the same location, every time.  This makes it easier to tell at a glance when items need to be replenished and makes it less likely that a certain dish will be overlooked.  Staff can work together more efficiently as each person knows ahead of time where their partner will be placing the dish that they are carrying.  Less confusion and rework.

Relations with staff – Marriott staff are called “associates”.  Managers all said the same thing: Take care of your associates and they will take care of the guests.  I asked if the hotel was unionized.  It isn’t.  One manager commented “If we look after our associates, there’s no need for 3^rd parties to be involved.”

Standard work – A great quote from the executive chef: Open the kitchen with a list; Close the kitchen with a list.  He told us that staff were required to use a series of lists for every aspect of running the kitchen.  Even if a cook had worked in the same area for 20 years, they would still use a checklist to start the day, and be accountable for each task by initialling it. 

The most surprising insights about hearing the customer’s voice came from an unlikely area – Lost and Found.  These associates gather, store and (hopefully) return items found on hotel property.  The manager told us that they keep every (legal) item no matter how worn out it looks.  She gave the example of a scrap of worn and stained blanket that had been left in a room.  Frantic parents called the hotel looking for their young daughter’s special “blankie” and were thrilled to hear that Lost and Found had it.  The manager told us that only the customer could decide the whether an item was valuable or not. 

We asked whether the hotel staff telephone guests to let them know that an item was found in their room.  We were surprised to hear that they don’t do this.  The manager explained that, if they were to call a guest’s home and say “This is the Marriott in Orlando.  We found your cellphone in your room,” the spouse answering the call might be surprised to find out that their partner had been in a hotel room – without them.  Calling the guest’s home seemed like it would be an innocent and helpful thing to do, but hotel staff realized that it was a potential violation of privacy.

Forum Excursions – highly recommended!

Show me that you care. With sticky notes!

I knew I was in good hands when I saw this on the table:

"Yay! Sticky notes! Today is going to be a good day."

I was only half-joking to my table mates as I sat down to start a day-long meeting.  In the centre of the table was a plastic bin full of coloured sticky notes and marking pens.  And the sight really did give me a warm feeling.

Sticky notes and marking pens mean that audience participation is planned. Usually, participants are invited to write comments and contributions on the notes, then post them on a flipchart where they form the basis of, well, just about any kind of planning work. They also usually indicate that there will be discussion and debate.  That's fun.  (Also, occasionally, productive.)

But most importantly, their presence means that someone prepared for this meeting.  Somebody thought about what needed to be accomplished and how the attendees could be active participants.  Somebody wanted to hear our opinions.

Somebody cared about the day's outcome.

That's the real reason I was excited; the sticky notes were just an indicator.  An epiphenomenon.


The meeting's closing speaker related a story that linked my sticky note experience to my daily clinical work.  She told us about a man who had gone through 2 joint replacement surgeries.  At the first surgery, he remembered that the OR staff had been laughing and joking when he entered the room and he felt that they weren't paying attention to him.

Several years later, at the time of his second operation,  the surgical safety checklist had been used.  Staff all stopped what they were doing and focussed on hearing the plan for his surgery.  The man related that he felt everyone really cared about what happened to him that day.

Completion of the surgical safety checklist didn't guarantee a better outcome for him.  But he (rightly) interpreted its use as an indicator that someone had put effort into planning for his safe care.


What other indicators - positive or negative - are patients reading as they traverse the healthcare system?

Making it easier to do the right thing - Is there an app for that?

I was out running this morning and came across this:

A beer can on the road.

I'll pick up the occasional piece of garbage while I'm out and about, but I don't want to lug it all the way home with me.  I definitely didn't want to run very far carrying a beer can because, you know, people would talk.

I happened to be on a familiar path and knew that there was a garbage can right around the next corner, so:

That made me think that there must be plenty of like-minded people walking around Saskatoon, that is, people who will pick up a piece of garbage, but only if they know a garbage can is handy.  They may be motivated to do the right thing (clean up their neighbourhood) but need a little help to follow through.

Here's a suggestion for some entrepreneurial programmer:

Smartphone app that people activate when they are in an outdoor public space.  The GPS-enabled phone signals when a garbage can is within X metres (X varies according to individual preference).  Maybe there would be a recorded voice encouraging the user to "Pick it up" or "Let's clean up".

Each city would need to enter the locations of garbage cans.  This could be done by municipal employees who geo-locate garbage cans, once again with GPS-enabled phones.  Or, public users could contribute the locations.  This might be a revenue source for the app developer, as each city would need a unique database of garbage cans, licensed on the developer's server.

Individual users could record their contribution by logging the number of pieces of garbage they pick up.  Nothing like a little competition to encourage participation!  Users could submit pictures of the trash they pick up, with prizes for the most unusual object.

I'm not sure if there are researchers studying trash, but if there are, they could ask users to log the type of litter they find (e.g. fast food packaging including the restaurant name) to better understand the source of the garbage, and lobby the responsible businesses to reduce packaging.

Anyone up for this?