Culture

I am reminded of the old joke about the holiday ham:

A young bride is preparing her first holiday ham as her adoring husband watches. She slices off one end of the ham and sets it aside and puts the remainder in her roasting pan. “Darling,” her husband asks, “why did you lop off the end of the ham?”

“Why—I don’t know. My mother always did,” she replies. Curious, they call her mother, but her answer echoes her daughter’s: “My mother always did.”  When grandma is called, she has the same answer.

Happily, great-grandma is still on the scene. Her answer to the question is quick: “Why,” great-grandma says, “so it will fit in the pan!”

The obvious point being that sometimes we need to question whether old routines still serve us well. A more subtle point for anyone involved in improving performance is to recognize a workaround for what it is. The more than 3,500 unit-based teams at Kaiser Permanente have daily opportunities to question “the way we’ve always done it.” And as team members become skilled at problem solving and create a culture where asking questions is encouraged, they can create systemic solutions to recurring problems.

In these and other ways, they will create more efficient, cost-effective and safer ways to deliver quality health care. It is essential work, as the cover story of this issue, “Affordable Health Care for All,” makes clear. And the work already is well under way: Every story in the Winter 2013 issue if Hank highlights a different way that teams are improving quality while working to keep Kaiser Permanente affordable.

Kaiser Permanente is the model for the future of health care. Check out this issue's stories and be inspired.

It’s not hard to figure out why people are hesitant to speak up at work. Offering a suggestion for improvement or pointing out when you think something isn’t right exposes a person to any number of possible responses—many of them unpleasant.

There’s the sarcastic retort. There’s the deafening silence. There’s the reply, pointing out exactly why you’re wrong, delivered in the nicest of tones but carrying an unmistakable edge of one-upsmanship. Who needs it? Who wants to create waves and risk a good job?

But when we don’t speak up, we put health and happiness at risk. As Doug Bonacum, Kaiser Permanente’s vice president of quality, safety and resource management, says in this issue’s cover story, speaking up “is mission critical for worker and patient safety.”

In addition to the moral imperative of protecting people from injury, there’s a strong economic incentive for speaking up. Improvement doesn’t typically come from a single person’s great idea—it comes from people sharing ideas. And we at KP have to keep improving, finding ways to deliver care as good as or better than we deliver now with fewer dollars per member. Our future depends on it.  

Since we get good at what we practice, we each have to practice speaking up. Practice means starting with lots of baby steps—don’t tackle the high-stakes stuff first! And let’s practice being good listeners, too, providing the space that lets others speak up safely.

The Labor Management Partnership and unit-based teams provide the framework for transforming what Bonacum calls a “culture of fear” around speaking up. But with that framework in place, it’s still up to each and every one of us to find the courage to address the immediate, particular obstacles that keep us silent.

Take, if you will, the humble cell phone.

Oh wait. The cell phone may be ubiquitous, but it’s far from humble. Today’s smarty-pants phones have more power than the computers on the Voyager 1, which was launched in 1977 and 36 years later departed our solar system. Its three computers can process about 8,000 instructions per second. A smartphone swallows more than 14 billion.

The articles in this issue of Hank—articles about how technology is transforming care delivery and about how individuals and Kaiser Permanente are meeting the challenges that presents—would have overwhelmed the Voyager computers’ memory.

For communicating across distances, the string with two tin cans is humble. Even the rotary phone, patented in 1892, seems modest in comparison with today’s devices, which are used more for all manner of modern information sharing than for something as quaint as talking to another human being.

A rapid tech-based transformation, akin to the makeover of the old-fashioned phone, is already sweeping through care delivery. It’s hard to fathom the many ways technology will allow us to decentralize the delivery of health care while improving our connection with our patients and members. The changes will require new skills.

And starting today, the mindset we bring to the workplace is just as important as our skills. Without a willingness to explore new ways of doing our work, we are (to mix a metaphor) like an ostrich dialing the operator for help on a rotary phone, patiently waiting the long seconds for the 0 to return to its starting place while the future creeps up from behind. We’ll never know what got us.

Be bold. Be willing to go where no one has gone before.