Paul Levy ex-CEO from Beth Israel/Deaconess, in one of his November blogs Running A Hospital, describes a friend’s complaint, in an infection control meeting, about how to improve the dismal hand washing compliance in his hospital. He simply thought that posting the offenders and their compliance rates would quickly solve the problem. Of course, this was met by a chorus of negatives and the meeting moved on.
In another instance, the chief nursing officer questioned the high central line infection rate. She was told by anyone who would listen that is was caused by everything from the type of line kits used to human resource issues. She was upset about not knowing what was going on but agreed nothing could be done about it.
Levy views a chasm between the hospital cultures of ‘can do’ and those of’ can’t do’. Yet, it certainly is not that simple. Even with a ‘can do’ culture, who and with what amount of buy in will these problems be addressed. It takes more than a desire to change. It really takes knowledge of how to institute change. This requires a certain level of business education among the changers. Any one person could initiate a change project on hand washing; create a team and move on to present some realistic solutions. It doesn’t take permission from the C-suite to propose a solution and realistic solutions to problems can rarely be ignored. The answers to health care improvement will come from the ground up. The business community has already discovered this and those who embrace it have already discovered success. The problems clinicians face today are for the most part not clinical but rather business process based. It takes leadership to institute solutions. Leadership is an activity, not a position. Moreover, leaders are not born; they are taught. They are taught the skills of instituting change, which requires buy-in from those who need to change. Today, physicians do not just need clinical skills and knowledge but also business skill and knowledge to participate in optimizing healthcare processes.