Unmute the Muted

Recently, my hospital, the Cleveland Clinic required that all health care staff complete an on-line module on the topic of “Becoming a High Reliability Organization, (HRO). I moaned. Mentally, I said, “not another survey to complete by the end of the week, or else I would hear from my Chair.” Reluctantly, I embraced the module and surprisingly, learned much.

My interpretation and internalization of the module is likely different than what my institution expected. Becoming an HRO, would require that institutionally and personally, we must unmute the muted to achieve our goals.

Becoming a HRO requires culture change, process improvements, and changes in the human factors that affect health care. It requires that it becomes a part of all aspects of our culture. We must consider the human factors that cause us to make mistakes and work to prevent them. Most importantly, we must have highly reliable processes that are consistently followed.

While completing the module, I began to think not only about changes in our enterprise, but more importantly for changes in physician’s individual practices and how these concepts must be contextualized in our daily practice: hospital, clinic, private practice, and our hearts.

 These CORE behaviors include:

• Communicate Clearly
• Openly and Courageously Speak Up
• Retain a Questioning Attitude
• Embrace Accountability of Yourself and Others

Additionally, included in this module was the concept of incorporating LEAD behaviors for all our Leaders:

• Live Safety
• Engage Through Feedback and Team Huddles
• Account for Self and Team
• Demonstrate Alignment

Becoming a highly reliable organization is a lifelong journey for all health care workers. Changes do not happen overnight. Changes are not instantaneous. The changes that we strive for are mutable if not consistently practiced. We must seek to continuously make improvements every day. Learning that improvements come in all sizes and take place in every corner of a highly reliable organization, my immediate reflection and thought was—patient care.

How can we become an HRO without starting directly with the patient’s voice being present at the center of all we do? We must unmute the muted. See what they see. Do we really know what the patient experience is really like if we don’t ask direct questions. Do our “processes” really fit the patient’s needs? Or is it our needs? Becoming an integral part of the health journey of a family member has led to a 360-degree change—a major pivot in my view of medicine and how I do things within a HRO organization.

As we embrace a culture of improvement, ask yourself:

• What matters most?
• How are we doing today?
• What is getting in our way?
• Are we using the best-known way every time?

When we unmute the muted, we allow our patients to have voice and a place in healthcare discussions. Are we engaged and emotionally invested in our patient encounters? Or is it a chore? Informed and engaged patients have improved outcomes. During my career, I have found the following techniques have improved my “connectedness” with patients, improved my patient scores, improved outcomes, facilitated patient understanding of their illness, and encouraged questions. Most importantly, my patients say that they “felt heard.”

Certainly, I do not have all the answers, but these are a few of my own exceptionally reliable practices that I incorporate routinely:

• Knock before entering a room/space.
• Introduce myself and team members.
• Sit down when talking.
• Ask what prompted them to make the visit, the second opinion appointment—and then let them talk without interrupting. Too often we take the reins too early. Believe it or not, most doctors interrupt within 10 seconds of the patient narrative!
• Address pain or their comfort.
• Utilize patient diagrams.
• Encourage questions.
• Ask if their questions were answered and to summarize their understanding of the discussion.
• Hold their hand during induction of anesthesia.
• Present results of laboratory, surgical pathology, or imaging in pieces. Often referred to as “chunking and checking,” to make sure each part of the results is understood.
• Thank the patient for allowing us to be a part of their health care team, their visit, or being their surgeon.
• Say “I’m sorry,” when needed.

Unmuting the muted and the path of a highly reliable organization requires improving patient experiences and most importantly to display humanity to all patients. The journey of a thousand miles begins with the first step. Join me in making a meaningful impact and raising positive sentiment for the patients we serve.