Connection Critical to Healthcare

Lately I’ve been thinking a lot about healthcare organizations.  I recently spoke in New Haven to nearly 500 managers at Yale-New Haven Hospital and in Philadelphia to a group of CEOs that included several leaders from the Cancer Treatment Centers of America.  I’ve written from the patient’s perspective about my wife Katie’s battles with breast and advanced ovarian cancer and about Dr. Herb Pardes, head of New York-Presbyterian Health System, and how he is leading his organization to deliver patient-centered care. Recently, I interviewed Bill Shannon, Chief Wisdom Officer, at DaVita, Inc., the leading provider of kidney dialysis services and shortly I’ll be hosting a webcast with Pat Charmel, CEO of Griffin Hospital, a perennial member of Fortune’s best places to work list.

Two books I recently read reminded me again just how critical connection is to health care. In Aging Well, a book about Harvard’s Study of Adult Development led by George Valliant, M.D., the study cites adults increasing “social radius” as a key to thriving in life and in our elder years. Joshua Wolf Shenk wrote an outstanding article for The Atlantic about the study and about Dr. Valliant entitled “What Makes Us Happy?” I encourage you to check it out. 

In addition, I recently read Atul Gawande’s Better: A Surgeon’s Notes on Performance.  In this excellent book, Gawande touches on connection several times and throughtout you will find all the elements of Connection Culture including Vision (that makes people feel proud), Value (that makes people feel valued) and Voice (that makes people feel informed and that their ideas and opinions are seriously considered). 

Gawande tells one story of a two year long regional healthcare initiative in Pittsburgh that attempts to reduce infections when hospital employees fail to wash their hands before and after interactions with patients.  Nothing works.  The organizer, former Alcoa CEO Paul O’Neill, quits in frustration. One surgeon, however, has an idea.  He organizes small group meetings with health care workers and asks for their input.  Ideas come pouring out.  Most of the groups come up with the same ideas. Gwande then writes:

“The team made sure to publicize the ideas and the small victories on the hospital web site and in newsletters.  The team also carried out detailed surveillance-taking nasal cultures from every hospital patient upon admission and upon discharge.  They posted the monthly results unit by unit. One year into the experiment-and after years without widespread progress-the entire hospital saw its MSRA wound infection rates drop to zero.

The Robert Wood Johnson Foundation and the Jewish Healthcare Foundation recently launched a multimillion-dollar initiative to implement this approach in ten more hospitals across the country…It remains to me seen if the success can be duplicated nationally.  But nothing else has worked, and this is the most fascinating idea anyone has had to solve the problem in a century.”

Later in the book, Gwande marvels at the skills of surgeons he visits in Nanded (India) who work under difficult conditions and yet have achieved remarkable innovations and practices that make them among the most proficient surgeons in the world.  Gwande believes these surgeons show such energy and ingenuity because:

…They understood themselves to be a part of a larger world of medical knowledge and accomplishment.  Moreover, they believed they could measure up to it.  This was partly, I think, a function of the Nanded surgeons’ camaraderie as a group.  Each day I was there, the surgeons found time between cases to take a late-afternoon break at a café across from the hospital.  They swapped stories about their cases of the day-what they had done and how.  Just this interaction seemed to prod them to aim higher that merely getting through the day.  They came to feel they could do anything they set their minds to.  Indeed, they believed not only that they were part of a larger world but also that they could contribute to it.”

Once again, connection makes the difference.

Finally, at the end of the book, Gwande advises doctors in order to become better at what they do:

“make yourself ask an unscripted question: ‘where did you grow up?’  Or: ‘What made you move to Boston?’  Even: ‘Did you watch last night’s Red Sox game?’  You don’t even have to come up with a deep or important question, just one that allows you to make a human connection.  Some people won’t be interested in making that connection.  They’ll just want you to look at the lump.  That’s ok.  In that case, look at the lump.  Do your job.

You will find, however, that many respond–because they’re polite, or friendly, or perhaps in need of human contact.  When this happens, try seeing if you can keep the conversation going more than two sentences.  Listen.  Make note of what you learn.  …

If you ask a question, the machine begins to feel less like a machine.”

Again, connection.

To sum up, the evidence is beyond any reasonable doubt that connection and Connection Cultures affect medical outcomes.  In addition, connection affects healthcare workers’ level of employee engagement as well as the level of patient engagement. I hope in the coming months to speak at more healthcare organizations and make this case, to provide practical ways to increase connection in the delivery of healthcare and to inspire healthcare workers to have the courage to connect.

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