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what about employee-centered care?

Yesterday I was lucky enough to hear Chip Conley speak to an intimate group at Experia Health’s Patient Experience Round Table. Conley shared an anecdote about meeting the then CEO of Southwest Airlines. He was handing out peanuts during a flight. This was 2010, before Southwest began advertising their bags fly free campaign, although they were not charging at that time anyway. When Conley asked the executive why they didn’t charge his answer was an interesting one. “We don’t want to put that burden on our employees. First, it’s uncomfortable to collect the fee, people expect their bags to go with them as part of air travel. But what we really don’t want is to ask our staff to deal with having to check bags once the overhead bins are full. Have you seen the flight attendants on those other airlines, they are miserable now.”

(Well, he said something like that, I’m paraphrasing the paraphrase)

I’m concerned about how we work in healthcare. Despite the rewards caregivers get from taking care of patients, largely the work of healthcare has become a lot about things other than clinical work and caregiving. It’s meetings, hand-wringing, politics, wrought processes, data entry, reporting and analysis. Don’t get me wrong, some of those are worthwhile tasks —hey, it’s a large percentage of my job (hopefully not the hand-wringing part). But, there are two problems. First, we’ve built a lot of inefficient, difficult to execute processes under the banner of regulation, reporting needs, and analysis. Secondly, we’ve failed to adapt to modern work environment expectations.

The modern workplace has changed, and how we work has changed. Today, Millennials entering the workforce want to work in jobs which provide smart phones, offer flexible work hours and have cool cultures. Does that sound like many health systems?

Airlines, banks, mobile app developers —they all got hipped to the importance of realtime data years ago. Do you think it takes US Airways two weeks of abstracting and analysis to know the demographics of patients on any given flight? No way. And staff at telecom giant Vodafone don’t even have to be in the office to get data. Realtime dashboards are pushed straight to their phones and tablets via a platform called Roambi.

This may sound like a tech post. It is not. It’s a people post.

When we add layers of complexity on top of an antiquated work environment, well, this is what we get.


Here’s what we know, companies which are great places to work take better care of their customers. At Bon Secours, we measured employee engagemnt with Gallup’s Q12. the Q12 is a remarkably effective and simple way to understand how employees feel about their work. Gallup tells us an indicators of employee engagement include having the tools to do your job and working in a supportive environment. Until we wake up and realize we’ve made the process of working in healthcare less desirable than other industries, how will we ever tackle patient experience in a meaningful way?

I’m not suggesting the key is giving everyone an iPhone. I think we can start with some even easier steps:

1 Take Something Away - This is the first, crucial step to working smarter, not harder. Examine all the work our teams have to do, and take at least one thing away. Remember the lesson of Southwest and the baggage fees. Something which may look like attractive revenue on a spreadsheet can actually push staff past the breaking point. Which would you rather have? It can be the least important thing and you probably won’t have to look far to find it. Maybe it’s a superfluous field in a registration screen, maybe it’s a non-clinical tasks for a nurse. Whatever it is, ask yourselves do we really need this? If not, stop doing it.

2 Practice gratitude Chip Conley speaks about recognition in his TED talk. Taking the time to acknowledge each other is a surprisingly powerful emotional uplifter. Hey Joan, you worked later than expected last night to care for those patients… thank you for doing that! The trick is to make it a ritual. Start huddles or end meetings with moments of gratitude. It works.

3 Think about Employee-centered care too Patient-centered care is a result of engaged employees. Managers, try this: walk into somewhere you have employees and pretend it is your first day at work and you are hired to do their job. How’s the space? Is it clean, is it nice to work in? Do you have the tools do do your job? Do you clearly understand what your job is? Most importantly, ask yourself if this is the job you dreamed of walking into. Just because they didn’t give us dot-com style offices when we started in healthcare, doesn’t mean we can’t be the change we want to see.

Remember, every system is perfectly designed to achieve the result it achieves * . So, reverse engineer the system. If you sense, or worse can measure, staff dissatisfaction or burnout, consider the root cause. If you are focused on patient experience, observe the system in reverse order. What influenced those experiences? Likely it’s interactions with employees. Are those employees loving their job - are they called to it?

*Good luck attributing that often used quote. Most suggest Don Berwick first used it in 1996. Goolge returns several articles and transcripts of talks, each purporting to be the originator.

(Briefly) Winning the Olympics - pride and success from Phyllis Dawson

        Since we went early, when our marks were announced we had the best score so far, and for a brief time were in the lead.  My mother started telling everybody she saw, “My daughter is winning the Olympics!”  Embarrassed, I tried to shush her, pointing out that none of the really top horses and riders had gone yet.  “I know,” she answered, “that’s why I am saying it now, while I can!”

Phyllis Dawson on Albany in the 1998 Olympic Games

That’s my Grandma Grace’s rye style. Celebrate when you can, smile always and be quick with the joke. Only this time, it wasn’t a joke. Her daughter, my father’s sister, and my aunt was actually winning the Olympics. Phyllis was in a commanding lead over an unusually difficult olympic cross country course.

I remember being somethingorotherdoesntmatter years old - young enough to be silly and old enough to know watching your aunt on NBC riding in the 1988 Olympics was a big deal. I remember bragging. Man did I glow about that one. Did you see my aunt on TV last night? Friends started calling the house - remember when you had one phone downstairs and really long, twisted, medusa braid of a cord? No, then you are too young to read this blog. Get lost. The rest of you remember that? So here I am, on the downstairs phone, cord stretched around the door frame, down the hall and back into the TV room. Yeah, that’s my aunt Phyllis. Pretty cool huh? Ring, ring. Oh, you saw that? Yeah, I know her, she’s my aunt. Ring Ring. It’s for me? Hello, this is Nick, yes, yes my aunt was in the Olympics tonight.

If I could have pulled off a top hat, cane and, perhaps a chauffeured limo on the way to school the next day, I would have.

That’s how cool pride is. Pride is that feeling you get when you are associated with something awesome, and Phyllis is awesome.

Let’s recap:

  • Youngest of five
  • Owns and manages a substantial, working horse farm with over 50 horses
  • Evented at the world-class level
  • Olympian - 1988
  • Master equestrian teacher
  • Great photographer

But bullets alone do not tell the story. Phyllis’s story is about doing what you love, and loving what you do.

I know, cliche. Except when it isn’t.

My aunt Phyllis has made a life out of doing what she loves: riding horses. She is successful by many measures. There is something to be said about following your passions.

Last weekend, Susan and I had the opportunity to stop by for Windchase Farm’s 25 year anniversary. The day before, Phyllis wrote a compelling reflection on her experience in the 1988 olympics. If you want to know what success must surely feel like, read the rest on her site, Team Windchase.

Below is a snippet from her  detail on riding the cross country couse:

  Finally it was time for the Games to begin.  Eventing is always at the very beginning of the schedule, and we had our first veterinary inspection in the morning on September 17th, the day of the Opening Ceremonies.  It was a great relief to have the jog-up over with.  The team consisted of Bruce Davidson with Dr. Peaches, Karen Lende (O’Connor) and The Optimist, Ann Sutton (Taylor) with Tarzan, myself with Albany II, and Jane Sleeper as the alternate rider.

The Opening Ceremonies are always really interesting to watch on television, but it is very different from the athlete’s perspective.  We spent most of the ceremony lined up on the hot tarmac outside the stadium, waiting for our time to enter.  Toward the end of the ceremonies, each nation’s athletes would enter the stadium and walk around the track, in alphabetical order by country.  We were instructed to form rows for the procession around the track, but there were hundreds of athletes and coaches there from the United States, and unfortunately nobody to take charge and direct us.  So while most of the other countries’ athletes marched in orderly columns, the Americans ended up entering the stadium in a slightly disorganized group, looking around in awe and waving at the crowds, savoring the moment.  We were later criticized in the press as appearing disrespectful, but actually we just needed a drill sergeant.

But despite the glitches in our organization, there is no feeling in the world like walking into that Olympic Stadium in front of 100,000 people.  The Olympic torch was lit and the Olympic flag was raised.   It was an extraordinary experience, and an incredible sense of patriotism welled up inside us.

Finally the start of the competition came.  It had been decided that I would go first for our team, so I had an early ride time.  I worked Albany in the morning, and then returned to the stable for Jineen to braid him before the test.  When I got back to the stall slightly later than planned, Jineen told me that I would have to braid Albs myself, since I was the faster braider and I hadn’t left her enough time.  The other riders seemed surprised, but Jineen was my best friend as well as my groom, and it worked out well since it gave me something to focus on besides my nerves.

I was nervous of course, but I was also having the time of my life.  After all, this is what I had spent years working for, and now I was going to enjoy every last moment of it.  Albs was also enjoying himself; he had definitely picked up on the atmosphere - he liked crowds, and was enough of a showman that he was quite pleased that everyone was looking at him.

Albany warmed up well, but when we entered the final holding area before our test he got a bit tense, no doubt responding to my own tension.  There was a lot of atmosphere, with flowers and Olympic logos and the huge grandstands.  But as soon as we started trotting around the outside of the arena, he began to buckle down to business.

I will never forget the feeling of riding around the outside of the dressage arena just before beginning my test, and looking up at the big scoreboard and seeing my name in lights:  Phyllis Dawson, Albany II, USA.  As I turned up the center line, I was thinking, "Oh my God, this is it!  I am actually riding in the Olympics!"  It was the culmination of many dreams.  It was a pretty emotional moment, and it made me feel so proud to be there, riding in the Olympics, representing my country.  I rode into that arena feeling on top of the world, and Albany put in the best test of his career.  We finished the dressage phase in 10th place.

Phyllis Dawson and Albany II, USA.

via Windchase.

Elmo and the biofeedback loop of happiness

Elmo loves you, he just loves you, and everyone can understand that - Sesame Street Puppeteer Kevin Clash, has found the secret to the best biofeedback loop of them all. By making others happy for a living, he’s become one happy guy himself. Clash is the voice, wrist, and hand behind - or rather, inside - one of the most well known Muppets, Elmo.

I know what you are thinking. No, we haven’t spontaneously acquired toddlers. Clash is the subject of the newly released documentary, Being Elmo. Yes I watched it. Yes, I loved it. And, yes, you need to see it too!

Being Elmo chronicles how Clash’s childhood interest in making people smile through puppetry turned into a career of making people happy, which, in turn, makes him happy too. As a young, aspiring puppeteer, Clash honed his skills by preforming for sick children in hospitals. It wasn’t the captive audience which drew him to sick kids. As his parents narriate, it was all about making those kids smile. That’s exactly what Clash has spent the rest of his career working on.

Watching Clash, Elmo, Jim Henson, Kermit (both Love and The Frog), and Frank Oz light up as they bring smiles to others’ faces made me wonder: what are the keys to unlocking the happiness biofeedback loop and can we inspired more happines in the deliver of healthcare services?

Here is what I observed from Being Elmo:

  • Support - Clash’s parents encouraged him to pursue his dream, despite having restricted means. When Clash was a teen, his mom tracked down Jim Henson’s Muppet designer, Kermit Love, and asked him to mentor her son. Love agreed. One of Kevin’s Sesame Street colleagues reflects on the influence of his support system: Elmo is not Kevin, Elmo is Mr. and Mrs. Clash.
  • Focus - Kevin recognized his dream early. According to his brother: Clash stuck with his dream and stayed true to what he had in his heart.
  • Rapid iteration - When Clash made a new puppet, he sat in front of a mirror and tried hundreds of voices to find the one that fit. He glued himself to the TV and watched Henson’s Muppets and kept building new versions to try and figure out how they were built, to get it right. Once Clash took on Elmo, he tried different things with his hand to manipulate Elmo face, from that developed Elmo’s surprised, sad and confused expressions.
  • Be Inspired - Jim Henson, Frank Oz, the Muppet Show and Sesame street… hard to find better inspiration for happiness creators.
  • Have Mentors - Clash identified Kermit Love who coached him on making vowel sounds, puppet motion, manufacture, projection and character development.
  • Seize Opportunity - When Kevin’s senior class went to New York, he used the trip as way to afford to meet Kermit Love for the first time.
  • Go for broke - This seems to be a common theme among passionate, successful people; one which is hard for most of us because we’re tied to lifestyle, objects, locations, etc. For Clash when he was starting out, putting everything he had on the line, each time he auditioned or preformed meant taking risks - financial and personal. By taking those big risks, he also gained big rewards, scoring early roles on local Baltimore TV, with Captain Kangaroo and eventually the Muppets.
  • Curiosity - never stop learning. One of the first things Clash asked Kermit Love about was “the Jim Henson Stitch,” a sowing technique which resulted in a hidden seam between two pieces of material. Learning the stitch evolved Clash’s puppet making abilities.
  • Share your expertise - Clash traveled to France to teach the French cast about preforming Sesame Street. In one scene he shows how opening the puppet’s mouth, even a little bit, creates a subtle smile effect. When Clash does it for the first time, everyone’s face warms into a broad grin, subconsciously and automatically.
  • Stay Humble - When Kevin got his first chance to work directly with Frank Oz and Jim Henson, he was in awe, and so nervous he fumbled his lines. Clash, who had already had a lot of success at that time, says it reminded him to to stay humble.
  • Become Essential - Kevin became a key part of Sesame Street’s production, first as director, then executive producer; Part of sharing expertise
  • Be a mentor - When Elmo grows up, Elmo wants to be a teacher. When Elmo knows he helped somebody thats pretty important because it feels good. - Clash as Elmo to a live audience of Make-A-Wish children.

Towards the end of the documentary, Kevin Clash discusses how he approached creating Elmo’s personality: I knew that Elmo should represent love… And it worked. Almost instantly, after taking over Elmo, the majority of the time Sesame Street preforms for Make-A-Wish or sick kids, they ask for Elmo first.


I strongly believe healthcare, as a vocation, has a unique ability to foster the happiness biofeedback loop. Caring for others can, and should, make us feel good. I am excited to spend some time reflecting on the themes of Being Elmo and thinking about how they can be applied to enhancing the happiness we get out of working in healthcare. I’d also love to hear what thoughts and experiences you have to share.