Putting Organizational Culture on Trial

TV courtrooms like those in Law & Order, Suits, and Boston Legal are full of intrigue and excitement. Those fictitious legal settings were clearly the inspiration behind the recent CRICO Patient Safety Symposium held on June 5^th in Boston (#CRICO15).

Instead of the standard talking heads approach to a panel discussion, the organizers opted to put organizational culture on trial and examine its culpability in contributing to preventable adverse events, unsafe practices and increasing the risk of malpractice allegations. Richard Corder, MHA, FACHE, Assistant Vice President Business Development at CRICO served as the defense attorney while Dana Siegal, RN. CPHRM, Director of Patient Safety at CRICO acted as the prosecutor. An actual judge presided over the proceedings: Judge Hiller B. Zobel (ret) of the Superior Court of MA. Who was the jury you ask? The audience.

This theatrical format gave the event added drama and after an initial bit of awkwardness, the “expert witnesses” and audience really embraced the theme. By the end, every presenter was hamming it up and everyone had a lot of fun.

Siegal kicked things off with opening arguments. She presented facts and figures from recent CRICO studies that showed no significant improvement in safety. The data she presented, from claims distributions to issues in test ordering, supported her argument that we are not statistically any better off than we were 5 years ago.

Siegal’s most compelling statement came at the end of her presentation. She presented CRICO statistics on cases related to surgery that showed in 2014 “improper performance of surgery” and “improper management of surgical patient” are the two most significant contributors to surgical claims. Yet the best way to mitigate this surgical risk has been common knowledge for the past 5 years—checklists. Siegal pointed to this lack of improvement as proof that the true culprit is a cultural rather than a knowledge gap.

Gordon, Schiff MD of Brigham and Women’s Hospital followed Siegal with a well composed series of personal stories that demonstrated how powerful cultural norms are at determining individual behavior. Most stories were humorous, but all had the same warning undertone: We have a culture that expects MDs to do more and more yet we do not have many mechanisms to help those same MDs cope with the extra burden. The result is less time with patients and more stress on the system.

After Schiff, the jury heard two very powerful patient stories from Mary Salisbury RN, Founder and President of The Cedar Institute and Patricia Skolnik mother of Michael. Skolnik brought the audience (jury) to tears as she recounted the tragic story of her son Michael. Words cannot truly describe the impact her story had. You can see for yourself by watching this video: https://youtu.be/n83gd1piUu4

Skolnik was followed by:

• Laurie Drill-Mellum, MD, MPH – Chief Medical Officer at MMIC and UMIA
• Darrell Ranum, JD – Vice President of Patient Safety at The Doctors Company

Woven through both of their presentations was a theme of communication—specifically the lack of communication between various silos within healthcare. These silos in turn, were the cause of much of the stress and dysfunction within the system. All of them echoed Siegal’s opening statement that we KNOW where we are vulnerable and where we are at risk, yet the industry, for the most part, has not moved in a meaningful way to address them.

After lunch it was time for the defense to make its case. But Richard Corder, playing the part of defense attorney, surprised the jury. Instead of arguing that culture was not to blame, the defense pivoted and argued that culture was in fact the one thing we could change. Corder then brought up three “expert witnesses” to demonstrate that very fact.

David Whitley, manager of EMR Configuration and Support at Atrius Health, showed tremendous courage in getting the audience to join him in a round of James Bond Aerobics and then followed up with a fun exercise involving 5 volunteers self-arranging themselves based on character traits. Whitley’s central statement was that “fun” didn’t have to be the opposite of work—that with the right culture, fun + work could co-exist. His work and approach to Atrius’ EMR implementation was proof.

Adrienne Boissy, MD, MA, Chief Experience Officer at Cleveland Clinic, cited many examples of the triumph of how culture even at a leading organization could improve their internal culture. She cited many examples from her work with Delos Cosgrove MD, CEO of Cleveland Clinic and how he single-handedly challenged the organization to break free from its past cultural fence posts. From teaching empathy to building facilities that are functional works of art, Boissy hammered home a central theme of “All it takes is one person willing to make a change.”

The final “expert” was David Feldman, MD, MBA, CPE, FACS, Senior Vice President and Chief Medical Officer at Hospitals Insurance Company (HIC). Feldman made his case by challenging the audience to “think before judging someone”. His most powerful statement being: “Don’t assume people are doing what they are doing because they want to or enjoy doing it. They may be doing it just because that’s the way it’s always been done.”

In the end the audience/jury decided that culture is indeed a contributor to patient safety.

I learned a lot at #CRICO15 and I enjoyed the unique “trial” format. My one take away was that culture clearly has a bearing on patient safety and that work needs to be done to improve this aspect of the healthcare industry. The good news is that culture isn’t immutable—that we each have the power to change it as long as we have the courage, desire and will to do so.

“Now let’s go out and spread some empathy.” – Richard Corder

Photo courtesy of Colin Hung.

Guest blog post written by Colin Hung, co-founder and moderator of the Healthcare Leadership (#HCLDR) online community. Colin has extensive experience working with software and information technology and has spent the last 10 years working in the healthcare IT industry. He is currently leading the marketing efforts at @PatientPrompt, a Stericycle product. Colin blogs regularly on the #HCLDR blog. Join the #HCLDR Tweet chat on June 23^rd when Richard Corder will be a guest to continue the conversation started at the patient safety symposium: Is culture the guilty party in unsafe care?