It Takes a Village – Part I: What I learned from my in-laws’ Thanksgiving dinner

By  |  July 16, 2014 | 

by Dr. Ryan Brown MD, FACP

It seems like it was just yesterday that I first walked into Thanksgiving dinner at my in-laws’ and remembered thinking to myself, “What did I get myself into?” Coming from a very small family, I had never been exposed to the chaos that comes from letting 70 people loose in an elementary school cafeteria for dinner. Overwhelming, yes! But amazingly, when the food was ready, the chaos subsided and by the end of the night everyone was fed, happy, and ready to do it again! Even more amazing was the look of satisfaction on the organizers’ faces as they saw the happiness they created.

Two decades later, I had that same feeling when I envisioned how 200 providers from 19 different facilities, separated by 400 miles and 2 different EMRs could all move in the same direction to achieve key quality initiatives. But then again, it is not many times that we get the opportunity to touch 400,000 patient lives a year with the projects that we undertake.

Today, our role as physicians has gradually expanded from providers of healthcare to change agents of community health. While a daunting challenge at first, the opportunity to impact population health substantially increases with every provider and every facility that aligns itself together. Physicians – hospitalists in particular – must learn to crack the code of broken processes in our healthcare system. And, even more importantly, we must learn how to spread that knowledge rapidly around our facility and to other facilities as well.

The successful spread of best practices between facilities is not without significant barriers and potential pitfalls. Through some trial and error, we have managed to fall upon a couple of key rules of engagement. Our experiences have shown that some of these rules are pretty universal while others are good suggestions. I’ve compiled a list of do’s and don’ts from our experience at Carolinas HealthCare System:

Definitely Do

Communicate! Start communicating early. Make your goals and reasoning for the QI initiative clear and concise.

Coordinate your band of bandits. A small group of enthusiastic colleagues at each site helps keep the fire burning. An engaged physician champion is worth their weight in gold.

Measure. People respond to data even if it is unfavorable. We all want to do a good job and convince ourselves that we are doing just that until we are presented with evidence to the contrary or modify what we’re doing. Keep in mind that the data will never be perfect but it should be directionally correct. Be transparent with the data.

Reward good behavior. Celebrate the wins- no matter how small. Many times, significant improvement is harder to attain than reaching a certain, smaller benchmark.

Probably Good to Do

Standardize. We all value individuality, but hard-wiring processes, when possible, provides the best chance of reproducing the essential components of a process among multiple providers.

Take time to catch up and compare. One of the biggest advantages that comes from being a part of a multi-facility group is the ability to share ideas. We have been most successful when we set up forums to share ideas between facility leaders. When a team solves a complex problem, spreading it to other teams in the group can help to accelerate the process of reaching your goal.

Competition breeds success. Healthy competition between providers and facilities are a good way to motivate teams and spur creative new ideas. Use it wisely.

Leverage the EMR. Whether or not you are fan of the electronic record, everyone recognizes the benefits of using the EMR to help capture and measure provider behavior. That feedback can be tailored to the individual provider and help drive personal improvement and group success.

Don’t Do

Don’t promote a project or program which solves a problem that the site does not have. Having a menu of items that all work towards the same goal can be just as effective as creating one standardized project.

Don’t get sidetracked by not being able to control the outcome. Most of the time we can achieve the end result by influencing others rather than controlling what they do. Every day we influence our patients but have little or no control over what they do outside of the hospital.

Don’t limit your allies. We have found that some of our most influential team members are our quality nurses and practice managers who help keep things moving when providers get really busy.

Like a family, we still have challenges- as do all large groups. What pearls of wisdom have you learned from your family (home or work) that have helped you implement something new at work to improve work flow and patient outcomes?

It most certainly does take a village!


Dr Ryan BrownDr. Ryan Brown MD, FACP has been a hospitalist since 2000 and is currently the Assistant Medical Director for Hospital Medicine at Carolinas HealthCare System in Charlotte, NC. He manages a group of 200 providers at 18 different facilities in his role with Carolinas Hospitalist Group. He also serves as Medical Director for the Acute Care Informatics for the organization and is responsible for the implementation, adoption and optimization of the EMR in all acute care hospitals at Carolinas. He started the Umbilical Cord Blood Program at Carolinas and presently serves as its Medical Director.

Prior to joining Carolinas HealthCare System, Dr. Brown served in the Navy at the National Naval Medical Center in Bethesda, MD and was an Assistant Professor at the Uniformed Services University of the Health Sciences. During his time in the Navy, he was stationed aboard the United States Naval Ship Comfort and received the Navy and Marine Corps Commendation Medal. He received his undergraduate degree from Duke University and his medical degree from the University of North Carolina at Chapel Hill.

Outside of his clinical duties, Dr. Brown has focused on health care informatics, health disparities, and medical mission trips in the Caribbean. In his free time, he likes to golf, grill and travel with his wife and 2 daughters.

One Comment

  1. John M. Scherr, M.D. July 18, 2014 at 5:12 pm - Reply

    Great blog Ryan! These are ideas that if more programs followed there would be fasterattainment of goals. It is nice to give the don’ts as well as the dos. I would add one don’t: Don’t spend a lot of time trying to fix a problem that others have identified as can’t be fixed. Try to work around it.

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