Right now, it feels likes healthcare is all about "meeting metrics". As someone on the front lines providing patient care, regardless of a person's ability to pay, it feels those metrics are ill-aligned with the realities of emergency medicine. It feels that the executives who are in charge of establishing the metrics and analyzing numbers and graphs have no concept of what really happens.
My job is to fix the broken and treat the sick. Yes, I can assess an ankle, order an xray, splint and give the person appropriate follow up in less than an hour. That's easy. However, sometimes my job is a lot more than things that can be quantified, assigned a number and plotted on a graph.
Sometimes my job is taking care of the family as much as I take care of the patient. Sometimes it is delivering life altering news, dealing with the heart broken, holding hands, drying tears. Sometimes it requires cultural sensitivity. Sometimes it entails enlisting an interpreter. Sometimes it involves finding a way to communicate with someone who is blind or deaf or both. Sometimes it is emotionally daunting being stoic during sexual assault cases and abuse cases. Sometimes the patient is violent and threatening or in police custody. Sometimes, a patient will die. All of these things happen sometimes, a lot of times. Something at least once a shift. All of these things create emotional trauma for the people taking care of them. All of these things cannot be quantified into a time or a check box.
My place of employment is currently hyper focused on times. How quickly the patient can be registered, can be moved to the assessment room, can be seen by a provider, can have a full exam/labs/imaging/treatment/diagnosis and how fast they can be discharged. In a factory producing widgets, this is easier... turn up the speed on the machine. In healthcare, we don't produce widgets or a product. We are people taking care of people. We deal with all aspects of human emotions.
Currently, I lead a team of fifteen Nurse Practitioners and Physician Assistants (collectively, Advanced Practice Providers or APPs) in two Emergency Departments. At a meeting it was highlighted that all of our APPs met the treat and release times for the last quarter of 2018. This is a big deal. A BIG f'in deal. I was asked how I did it.
First of all, it wasn't "me". I am just one person. I can tell you what I contributed to the effort.
There are different styles of leadership. Arguably, I exhibit different styles but I steer clear of being an authoritarian. I believe that educated professionals, particularly in healthcare, show up to work to do good and to help people. I believe that they truly try to do their best. I believe that when people are given the right resources, motivation and positive reinforcement, they will soar. I believe that when you're good to people, people will be good to you.
Everyone was made aware of the metrics, the goals the hospital wanted us to make. Everyone was given their personal numbers quarterly. That was the end of any strict focus on metrics. The rest was a focus on our people so that they could focus on doing their best at their job and focusing on their people... patients.
To best support our group, I make sure to know the people I work with, those whose life I directly impact as a lead. I know their strengths and weaknesses as providers. I know who prefers to work where and what shift. I know who likes the challenge of complicated patients and who prefers to work with easier fast track patients. We have a scheduler, but I still edit the schedule to make it work the best it can with talents and preferences.
I try to know about the real lives of the people I work with. I know who is married, who has kids, who likes whiskey, who doesn't drink, who bikes for fun, who loves dogs... We have developed a culture of supporting one another for unexpected life turns. Funerals, adoptions, sudden illness or injury in the family... we get those shifts covered for each other.
Our team is exceptional. Notice I did not say we're the fastest, the best, the smartest, the best at advanced procedures. Notice I didn't say we're all best friends and that we hang out all of the time. We have built this team together, harvested a culture that supports one another and strives to always learn. You don't have to be in a leadership position to grow this type of culture. Show your appreciation for the people who work along side of you. Particularly in the emergency world, no one else can really understand the toll this life takes on you better than your teammates.
The last shift I worked, I took over a patient for the person I was relieving. It sounded simple. Intermittent abdominal pain. Some difficulty moving bowels, but still having BMs. No nausea or vomiting. Didn't want anything for pain. I just had to wait for the labs and cat scan to get back.
I had to tell a man that I met an hour prior he had pancreatic cancer and that it had spread to other parts of his body. The only metrics that should be measured, in this case, are clinical judgment and compassion. Time should be irrelevant.
Whether we agree with them or not, there will always be some metric to meet. First do no harm. As long as our moral and ethical compass stays fixed on true North, it is not wrong to address the metrics sometimes. Some times will be met. Sometimes not. If you ever have the privilege of representing a team like I do and are forced with metrics... support your team in any way you know how. Support your team and watch them crush goals.
My job is to fix the broken and treat the sick. Yes, I can assess an ankle, order an xray, splint and give the person appropriate follow up in less than an hour. That's easy. However, sometimes my job is a lot more than things that can be quantified, assigned a number and plotted on a graph.
Sometimes my job is taking care of the family as much as I take care of the patient. Sometimes it is delivering life altering news, dealing with the heart broken, holding hands, drying tears. Sometimes it requires cultural sensitivity. Sometimes it entails enlisting an interpreter. Sometimes it involves finding a way to communicate with someone who is blind or deaf or both. Sometimes it is emotionally daunting being stoic during sexual assault cases and abuse cases. Sometimes the patient is violent and threatening or in police custody. Sometimes, a patient will die. All of these things happen sometimes, a lot of times. Something at least once a shift. All of these things create emotional trauma for the people taking care of them. All of these things cannot be quantified into a time or a check box.
My place of employment is currently hyper focused on times. How quickly the patient can be registered, can be moved to the assessment room, can be seen by a provider, can have a full exam/labs/imaging/treatment/diagnosis and how fast they can be discharged. In a factory producing widgets, this is easier... turn up the speed on the machine. In healthcare, we don't produce widgets or a product. We are people taking care of people. We deal with all aspects of human emotions.
Currently, I lead a team of fifteen Nurse Practitioners and Physician Assistants (collectively, Advanced Practice Providers or APPs) in two Emergency Departments. At a meeting it was highlighted that all of our APPs met the treat and release times for the last quarter of 2018. This is a big deal. A BIG f'in deal. I was asked how I did it.
First of all, it wasn't "me". I am just one person. I can tell you what I contributed to the effort.
There are different styles of leadership. Arguably, I exhibit different styles but I steer clear of being an authoritarian. I believe that educated professionals, particularly in healthcare, show up to work to do good and to help people. I believe that they truly try to do their best. I believe that when people are given the right resources, motivation and positive reinforcement, they will soar. I believe that when you're good to people, people will be good to you.
Everyone was made aware of the metrics, the goals the hospital wanted us to make. Everyone was given their personal numbers quarterly. That was the end of any strict focus on metrics. The rest was a focus on our people so that they could focus on doing their best at their job and focusing on their people... patients.
To best support our group, I make sure to know the people I work with, those whose life I directly impact as a lead. I know their strengths and weaknesses as providers. I know who prefers to work where and what shift. I know who likes the challenge of complicated patients and who prefers to work with easier fast track patients. We have a scheduler, but I still edit the schedule to make it work the best it can with talents and preferences.
I try to know about the real lives of the people I work with. I know who is married, who has kids, who likes whiskey, who doesn't drink, who bikes for fun, who loves dogs... We have developed a culture of supporting one another for unexpected life turns. Funerals, adoptions, sudden illness or injury in the family... we get those shifts covered for each other.
Our team is exceptional. Notice I did not say we're the fastest, the best, the smartest, the best at advanced procedures. Notice I didn't say we're all best friends and that we hang out all of the time. We have built this team together, harvested a culture that supports one another and strives to always learn. You don't have to be in a leadership position to grow this type of culture. Show your appreciation for the people who work along side of you. Particularly in the emergency world, no one else can really understand the toll this life takes on you better than your teammates.
The last shift I worked, I took over a patient for the person I was relieving. It sounded simple. Intermittent abdominal pain. Some difficulty moving bowels, but still having BMs. No nausea or vomiting. Didn't want anything for pain. I just had to wait for the labs and cat scan to get back.
I had to tell a man that I met an hour prior he had pancreatic cancer and that it had spread to other parts of his body. The only metrics that should be measured, in this case, are clinical judgment and compassion. Time should be irrelevant.
Whether we agree with them or not, there will always be some metric to meet. First do no harm. As long as our moral and ethical compass stays fixed on true North, it is not wrong to address the metrics sometimes. Some times will be met. Sometimes not. If you ever have the privilege of representing a team like I do and are forced with metrics... support your team in any way you know how. Support your team and watch them crush goals.
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