Contributed by Duncan Kennedy

Athletes develop muscle memory on the field, musicians rehearse seated as they would in the orchestra pit, and soldiers train in battlefield conditions. Is being a healthcare professional somehow different in needing the ability to meld ability with application and awareness?

For many healthcare professionals, though, learning new information, skills, and procedures often involves leaving the workplace environment in order to attend classes or access online instruction elsewhere onsite. While both facilitator-led instruction and online learning are proven and accepted forms of training (when designed and delivered properly), training away from the action of the clinical setting is usually at the expense of the learner’s enjoyment, their engagement in the instruction, and their ability to sustain the training and successfully apply it later.

How many of us have been in a learning lab in front of a computer mindlessly clicking through bullet-point text screens trying to reach the end of the course just to earn a mandated “completion” status for the latest organization-wide initiative? How many of us have been pulled away from daily responsibilities only to be placed inside an instructional artifice and forced to multi-task by absorbing the learning, sifting through its relevance, and then visualizing how to apply the parts that are actually applicable to workplace reality? Perhaps worst of all, once we return back to our work environment we find that being away for training often includes a pile of work to catch up on that accumulated while we were gone – effectively doubling the impact that training away from the work environment has on productivity. Plus, most of time you train solo without your leader and team members.

Instead of commoditizing the learning experience in order to maximize throughput or bluntly leverage resources, what if the focus was on customizing the instruction to best suit the learner to maximize impact, application, and sustainment? Using story to engage the human mind – the most powerful simulator ever created – is a proven and universal way to stimulate learner visualization of applying the training at the same time it is being comprehended. This “time compression” of learning and visualization is compounded when it occurs in the environment where it will be applied. Learners are fully engaged and most receptive to important information, new behaviors being demonstrated, and how to take action in a situation. Immersing themselves inside the story and viscerally experiencing it while at the workplace melds the unfamiliarity of the instruction with the daily reality of their work environment. What may not have been done before seems that much easier to accomplish when you’ve already imagined yourself doing it in the place where you work.

Combining the power of story, with the real world setting of the actual workplace, and the ability to visualize and embed new behaviors and practices without distraction or artifice shortens the distance between training, implementation, practice and sustainment.

Contributed by Richard Stone

Kevin Kelley describes in What Technology Wants how we possessed the same brain power that we have today at least 100,000 years ago, but it was not until 50,000 years ago that we went from being a primitive species using only rudimentary tools to true innovators. This explosion of innovation occurred almost overnight, concurrent with the arrival of language. Homo sapiens went from using sharp rocks at best, to the development of finely hewn knives, carved figurines, and hearths. Some might say that the use of tools led to the development of our language skills, but it’s more likely that the development of language – and more specifically, storytelling skills – was at the heart of the avalanche of inventions and discoveries that still continues 50,000 years later.

Why was storytelling so pivotal in assisting humans to consistently discover new solutions to life’s challenges? Kelly suggests that storytelling assisted our predecessors because it allowed tribesmen to convey to each other insights and inventions quickly, and to transfer knowledge easily. It proved to be the basis for most every innovation that followed—and each innovation became the foundation for new and more involved discoveries.

What is the significance of this phenomenon for healthcare organizations today? Hospitals that have a vehicle for their tribe (nurses, doctors, techs, pharmacists, etc.) to share what they have learned about creating a safer and more pleasant experience for patients will more likely succeed in the increasingly competitive environment that is certain to see winners and losers in the coming years. While we no longer can gather around the “central fire” in today’s modern work setting, it has become more imperative than ever to create for your team members moments to gather and tell their stories, to share insights as well as cautionary tales about near misses, and to collectively innovate on the job. Learning can no longer be relegated to a structured event a few times a year. It must be ongoing, all encompassing, and inviting. And the best way to do that is still the one that our ancestors first used some 50,000 years ago—storytelling.

Contributed by
Richard Stone

Continuing with my dad’s saga in the healthcare system…

After 9 days in the hospital precipitated by pain and discomfort extending from his chest to his abdomen (which led to a visit to the ED, hospitalization and a score of tests which all came up negative), they discovered during his stay that his atrial fib was not being properly regulated by the drug he was on. The pacemaker they installed just a few weeks previously was doing its job to keep his heart beat around 70, but he was getting abnormal spikes in rate sometimes up to 130 just walking down the hall. Increased dosages of the drug didn’t work, nor did increased frequency. So he sat and waited for the past few days for his clinicians to come up with a solution.

Even though he’s soon turning 97, his mind is still as sharp as a tack, as are his observational skills. Nothing escapes him, and the litany of mistakes and dis-satisfiers he noticed became a daily occurrence. The other night in my daily call to him he gave me his report. I believe they are instructive, but perhaps a bigger question is whether or not his observations and insights will ever make their way back to the hospital’s leadership, much less his care team so they can improve their performance.

Because of his age they are rightly concerned he might fall. He had firm instructions that he wasn’t to leave the bed without assistance, and they had him monitored to alert the staff if he attempted to make an escape from bed without them. Needing to use the bathroom, he called the desk. His tech answered. She said she had just two tasks and she’d be right there in five minutes. Forty five minutes later she still hadn’t shown so he got up and took himself to the bathroom. Apparently the alarm never went off because she showed up a few minutes later wanting to know if he was ready for the bathroom.

Another night, he asked for assistance to help him into the bathroom so he could brush his teeth and use three other tools the dentist recommended—a half hour ritual. So, his tech got him a seat so he didn’t have to stand. When he stood, his socks with the non-skid ridges stuck to the floor. My dad used to be in the janitorial business and he has watched as his room has been cleaned (and on some days not). They now use a device similar to the Swiffers that we can all buy in the grocery store. In the old days, his crews would have first cleaned the floor and then mopped with clean water to clean up the residue. Whatever the residue that is left on the floor by this new cleaning method may, for all I know, leave an antimicrobial barrier. But as far as he is concerned, since his socks were sticking to the floor … it wasn’t clean. This is a reminder that when it comes to patient satisfaction, perception equals reality.

Getting to his age, he’s got lots of meds in addition to those that are supposed to regulate his heart. Some need to be taken a half hour before eating, others an hour after breakfast. Consistently nurses or techs have either brought him all of the capsules at one time—usually the wrong time for many of the drugs. Or, as was the case yesterday, a nurse woke him at 5:30 AM for his drug that’s supposed to be taken a half-hour before breakfast. He asked her why she woke him up so early since breakfast had never arrived earlier than 8:30 during his many stays there. Why couldn’t she just come in at 7:30 and let him sleep? Her response: doctor’s orders. He was dubious. And now exhausted. The truth was more likely nurse’s convenience. He wondered why his care was so unpredictable from day to day?

I asked him if he had ever filled out a satisfaction survey after his many hospitalizations that began this past summer. Yes he had—sounded like it wasn’t HCAHPS given the length of the survey he described. Did he give the hospital poor marks? No, he wanted to be generous.

Then the other day someone from the hospital appeared at his bedside wanting to interview him about his experience there. All he could think is that if he told the truth, word would get back to his care team, and he wondered whether it would change their attitude toward him—for the worse. His response: everything’s been fine.

I went on hospitalcompare.gov to check out this facility’s HCAHPS scores. Consistently they scored below the Florida average, and well below the national average.

I wonder if anyone there is genuinely seeking the truth, and if they do find it, what are they doing to help their teams learn and improve?

Contributed by Richard Stone

Over the last few months, I have had the opportunity to see our healthcare system up close and personal as my dad, soon to be 97 years old, traversed through it with the first major health crises in his life. It started a couple years ago when he decided to rearrange the boxes in his condo’s storage bin. I came by one weekend and he wanted me to take some things, so I had to lift some extremely heavy boxes off a top shelf. When I inquired how they got up there he informed me he put them there. Interestingly, just a few weeks previously he had been complaining of abdominal pain and had been diagnosed with an inguinal hernia. When I asked at that time how in the world he had gotten a hernia he pleaded ignorance. But as I stood there in his storage area I put it all together and looked at him in disbelief. “I know how you got a hernia, you clod, you lifted these boxes all by yourself.” He was a bit sheepish when confronted with the fact that there are some things he simply shouldn’t be trying at his age.

Well, a few months ago he decided to get the hernia repaired. Something like this is now done in one day as an outpatient procedure, so I came over to support him and his wife. I kiddingly joked with his surgeon when he stopped by the pre-op area to check on him that my dad must be the oldest person he’s ever operated on for a hernia. I was wrong. He had done a repair on a woman who was 106!

Post surgery, I sat with my dad and his wife in a small curtained off area as the discharge nurse went over everything he needed to know to care for the surgical site. He had made it clear before the surgery that he often doesn’t do well with narcotic pain relievers, getting easily constipated, but who looks at charts these days? She gave him a Percocet and a prescription and sent us on our way, encouraging him to eat lots of prunes when he voiced his concern.

Sure enough, a couple days elapsed and he was severely constipated. A call to his surgeon resulted in some encouragement to eat more prunes. Another day or two passed and he was still constipated, and in a lot of discomfort, so now it was time for an emergency room visit. More admonishments to eat fruit, plus a script for a stool softener. Three days later he was back at another ER for a procedure to relieve him of bowel impaction.

I don’t know what the final tally was for all the medical bills for these aftercare visits that all could have easily been avoided—surely in the tens of thousands. All unnecessary. All preventable. But the charge nurse who originally administered the Percocet will never learn from this event. The first ER won’t either, just as the second ER won’t. They are all independent actors on a stage with sets separated by immensely high walls and lots of sound proofing.

Five weeks later my dad took a fall and broke 6 ribs. Even drove himself to the hospital. But that’s another aspect of the ongoing story of waste and mismanagement inherent in healthcare that I’ll share with you in an upcoming blog.