web_vol47 4.pdf - International Hospital Federation

Opinion matters
What are you
prepared to see?
HUGH MACLEOD
CHIEF EXECUTIVE OFFICER, CANADIAN PATIENT SAFETY INSTITUTE
ABSTRACT: A hospital system is made up of interconnecting circles of complex activity; however, we are
conditioned to see and think in straight lines. What we see depends on what we are prepared to see.
This article asks the question: What do you see in terms of patient safety and quality of care?
Iposed myself a somewhat rhetorical question: in order to realize
safe care and quality improvement, what will be more difficult:
the challenge of scientific discovery or the challenge of changing
human behavior and mindsets? That may seem like an odd
question. Obviously, scientific progress is essential, but so is
change. I believe that we, as health professionals, health system
managers and administrators, need to take patient safety and
quality improvement change as seriously as we do scientific
discovery.
We need to “see quality as not just method, technique,
discipline or skill, but as a human and organizational
accomplishment, a social process” (Bate et al. 2008, p.13).
To achieve the promise of the future in the quality of health care,
change will be required at several levels; changes in our personal
behavior, changes in our hospital institutional cultures and
changes at the level of our health care system and leadership to
create the conditions for positive change.
At the personal level, I believe great leadership starts with deep
personal self-reflection. Moments of self-reflection restore
personal balance and make it possible for us to take the next risk.
We have to create the conditions for change in ourselves before
we can foster them to our colleagues. How we have evolved as
leaders is important to understand, given “what a person
becomes is influenced by the culture and milieu that person grew
up in” (Kofman and Senge 1995, p. 29). I have had my fair share
of teachable moments over the past 30 years of my health care
work life. If I had to pick one, it would be letting go and trusting
others to deliver. I, too, have experienced the political and
organizational “urgencies” of leadership and the conflict between
planning and the daily demands of the position. I, like many
executives, managers, professionals and front-line staff developed
careers in a silo-centered, bureaucratic model of health care
delivery, driven by the provider’s control of health services, not the
consumer’s perception of need. In command-control hierarchies’
behavior is honed to enable survival of the most political!
So, join me for a moment in a thought experiment. Imagine that
you could step out of your day-to-day hospital role for a moment.
Leave the lab, or the bed side, or the desk or the board table and
come with me up a steep flight of stairs. At the top of the stairs,
you will see that we have emerged onto a wide balcony. Below us
is spread the entire health care system. From here we can see all
its components. We can see the degree to which it is a system
and the degree to which it is not. We can see the strengths and
we can see the problems. We can see the interface with your
hospital. We can see the providers, working in their manifold tasks
and we can see the patients and their families. “System seeing
and thinking is the corner stone of how learning systems move
forward”. (Senge 1990, p.57)
On this balcony, we are joined by our muse, a challenging voice
who lives on the periphery of our consciousness and in the
comments of our colleagues. Sometime we cannot wait to hear
from our muse. Sometimes we try to ignore our muse. Generally,
to hear the muse, it is best to free ourselves of the day-to-day
pressures, if only for a moment. Every conversation with a muse is
different. Here is one sample:
Muse: You look terrible.
Self: Gee, thanks. I’m feeling overwhelmed and seem to be out of
ideas. I thought coming up here and looking things over would
help.
Muse: That’s good news. That you are out of ideas, I mean. That’s
good soil for a new vision to take root.
Self: What are you talking about? We already have a vision for our
hospital. We wrote it all down. I’ve got it here somewhere. Let me
read it to you.
Muse: Oh, please, not again! That thing sounds like a badly written
obituary, or so much of the same old, same old...it doesn’t capture
the essence of what drives you.
34 World Hospitals and Health Services Vol. 47 No. 4