Ten years ago, I became a Zen Buddhist after reading The Heart of the Buddha’s Teaching: Transforming Suffering into Peace, Joy, and Liberation by Thich Nhat Hanh. In the book, Thich tells the story of a man traveling on a horse. When asked where he is going, he responds, I don’t know; the horse is taking me! The moral of the story is that most of us live lives like the man on the horse, being manipulated by external factors and lacking consciousness of where we are going.
But what is consciousness and how does it apply to healthcare? According to Merriam-Webster, it is the quality or state of being aware especially of something within oneself. But surely consciousness must exist in a healthcare setting. After all, the consequences would be tragic. Unfortunately, they are, and the evidence suggests that healthcare workers are not as aware as they should be. According to Dr. David Bates of Brigham and Women’s Hospital, 15-25% of all patients are harmed in a healthcare setting and hospital harm is now the 3rd leading cause of death after cardiac and cancer. Furthermore, anecdotal evidence taken by the Kōhei Group showed that frontline staff members could not articulate why they did work in a certain way, most commonly stating, That’s just the way I do it. I can’t tell you why. Others similarly could not state the why and responded that’s just the way I was taught.
The harm lack of consciousness could have is clear. However, what are the benefits of a conscious workforce in a healthcare setting?
The Benefits of a Consciousness
The benefits of consciousness in a healthcare setting are powerful. When an employee can state why they do the work in a certain way then, most likely:
1) The work they are doing is value add
2) They have retained the knowledge of how to do the work
3) They can embark this knowledge with patients
Let’s use a practical example to demonstrate using patient mobility.
Patient immobility has been linked to a number of serious and costly hospital complications, including pressure injuries, pneumonia, falls, DVT/PE, and muscle deconditioning. Each year, billions of unreimbursed healthcare dollars are spent treating complications related to patient immobility. Although this knowledge is widely available, why do these sorts of injuries persist? In my interactions with frontline staff, the root-causes are threefold:
1) The Standard of Care is not made clear to frontline staff
2) The Why is not emphasized or even taught at all when frontline staff are trained
3) Patient satisfaction is used as a scapegoat
In other words, frontline staff are not given a clear direction on mobility targets for patients, are not taught the why regarding mobility, and/or are allowed to ignore mobility requirements due to the potential dissatisfaction it can cause a patient.
However, there is another scenario that leads to better health, better care, lower cost, and workplace joy.
Imagine in this second scenario frontline staff are given targets for mobility which included initial movement in bed, then progressively sitting, standing, and walking. In addition, frontline staff are taught how to meet the Standard of Care, including the why. For example, the Standard of Care mentioned in this scenario has shown to have a major impact on recovery for patients who had experienced strokes, brain tumors, and other neurologic conditions. As such, the frontline staff would be empowered to share this why with patients who would now be more likely to want to follow the Standard of Care. In fact, according to the Kōhei Group, the performance to 15 of 22 HCAHPS questions (removing 5 of the demographic questions) or 68% could be substantially improved with such an approach, i.e. During this hospital stay, how often did nurses explain things in a way you could understand?
The direction to take is obvious, but not easy. Consciousness doesn’t just happen. It requires design. For a step-by-step guide on how to do so, including free tools, click here to read our other blog post, The high-impact, low-cost way to close the healthcare training gap.
 Klein K, Bena JF, Albert NM: Impact Of Early Mobilization On Mechanical Ventilation And Cost In Neurological ICU. American Thoracic Society International Conference Abstracts. http://www.atsjournals.org/doi/abs/10.1164/ajrccmconference.2015.191.1_MeetingAbstracts.A2293