Planning a “Good” Death

Dr. Ken Murray, a retired clinical assistant professor of family medicine at the University of California, wrote a thought-provoking article earlier this year in the Wall Street Journal entitled, “Why Doctors Die Differently.”

The essential point of the paper was captured in the sub-headline, noting that doctors’ experiences throughout their careers teach the limits of treatment and reinforces the importance of the need to plan for the end.

In essence, physicians – and I would add other clinical care providers to that list – know all-too-well that medicine cannot fix all, especially at the end of life.

Murray quotes nursing professor Karen Kehl, who in the article called “Moving Toward Peace:  An Analysis of the Concept of a Good Death,” noted features of a graceful death, such as:

  • Being comfortable
  • Being in control
  • Having a sense of closure
  • Making the most of relationships, and
  • Having family involved in their care.

Unfortunately, in today’s world, many patients experience a death without these attributes. Physicians have seen this so frequently that it influences how they think about the end if their lives too.

Why the disconnect? 

To avoid what may be considered undo influence, physicians try not to impose their own views on the situation.

Providing hard clinical data to enable a patient to make a decision is generally believed to be the extent of the information a physician or care provider should offer.

When asked directly what they would do for themselves, physicians often deflect the question to ensure patients are not overly influenced by their answer:

“It is what you would want to do, not what I would do.” 

This is adherence to the medical ethical principle of autonomy, making sure that patients or their decision-makers make decisions for themselves and without coercion.

But perhaps we have lost something by the answer we provide.  Continue reading

Share Doc in the D:

Doc in the DC

 

Congratulations to the employees of Henry Ford. This award was won by each and every one of you…

Nancy Schlichting and Bob Riney receive the Malcolm Baldrige National Quality Award in Washington, DC.

Share Doc in the D:

The Stanley Cup of Patient Care

I spend a fair amount of time going “South of the Border,” talking to hospital and academic leaders, physicians and others about Henry Ford Hospital – the great doctors, nurses and programs of the Flagship.  

We are very respectful of the Canadian health care system and the great care it provides. When alternatives cannot be provided from Canadian resources, Henry Ford Hospital is there to provide the best of care to the sickest of patients.

As such, we provide clinical support for this extraordinary patient care, at the request of the doctors and providers in Windsor and Essex County, whenever it is needed. 

Most notable of this clinical support is the work that we have done in cardiovascular disease, especially in acute myocardial infarction.

No amount of my discussions of the value of our partnerships compares to this story, especially the video of a true “Miracle on the Boulevard.”

To our cardiovascular surgical team, the surgeons, the anethesiologists, the nurses, and the technicians: This story is better than winning the Stanley Cup.  Continue reading

Share Doc in the D:

Drinking from the Fire Hose

I am not sure exactly what is going on in the world to have caused the major increase in emergency visits and hospitalizations at Henry Ford Hospital over the last several days (or weeks or months). 

Maybe it’s solar winds, sun spots, loss of insurance, inadequate access to primary care, excessive co-pays or the leap year effect? It’s probably a combination of all of the above.

Maintaining high volumes of admissions by and large is good for the hospital. Better than the opposite. 

It’s a bit like: drinking water is good, while drinking water through a fire hose has its problems.

I do know that the teams of nurses, doctor, and all other employees at Henry Ford Hospital have been working at levels that have not been present for almost a decade. 

In the last few months, we’ve had the highest admissions of any January in 11 years, the greatest number of admissions (over 180) and the greatest number of discharges in our recorded history. 

It doesn’t matter if you are working on the front, middle or back end of hospitalization; you are experiencing high work loads, significant stress and strained processes.

Thank you for being here.

I was walking in the emergency department with Ronnie Hall, our COO, who I have worked with for over 25 years. Patients in CAT 1 were very sick, and triage patients, to our surprise, looked even sicker.  

Patients and their families were patient, but weary. Being sick and feeling poorly, waiting in a wheelchair or stretcher to be seen, is no way to spend a beautiful March afternoon.

In the midst of a sea of patients in triage, one of the patients wanted to leave before service could be provided. She was tired and just wanted to go home. Continue reading

Share Doc in the D:

It’s the Little Things (and the Routine Things) That Count

Every day I hear a patient care story at Henry Ford Hospital that absolutely inspires me and fills me with pride. 

Henry Ford Hospital teams work to bring water into the hospital during the August 2003 power outage.

These are often heroic efforts of clinical expertise and team work, with many of our people working against all odds to perform care that saves a patient from what appears to be an impossible situation. These “miracles on the Boulevard” seem almost routine.

Times of crisis also seem to bring out the best in Henry Ford. 

I noticed this years ago when we lost electricity on Campus on two occasions. 

You could not have had a group of people working together more incredibly to overcome not only the obstacles of minimum electrical power, but the even greater challenges of inadequate water so needed for thirst and cleanliness.

I sit back in awe of our people at these times.

Where do we falter?

What is remarkable is that when we fail, it is in the little things or the routine things that we need to perform on a daily basis. The concentrated efforts and energy during a crisis do not always translate as well to our daily tasks.

Not that it is easy to have these bursts of focus at all times. 

As a physician once told me, you can sprint for periods, but you can’t run a marathon by sprinting. It takes a different approach and mindset.

Much of health care is a marathon. Repetitive, frequent, routine, if you will. 

No fan fare in our employee newsletter and no flurry of congratulatory emails on a remarkable effort.

Our true business challenge is to relentlessly focus on day-to-day patient care and to do it as well as it can be done.  It is the most important element to ensure our success as a hospital.

Yet these daily acts – the ones that we must do – count just as much as all of our photo-op moments.  Continue reading

Share Doc in the D:

The Happiness Advantage

Jack Butler, Surgical Imagineer in the Department of Surgery at Henry Ford Hospital, emailed me after hearing me talk about the importance of patient centeredness.

Jack wrote: “I am lucky often to be allowed to slip in and listen to the adults talking. Your insight that the various interviewees never brought up the patients – the center of our world – made me think about how do we get off track and, how do we get back on. I chose to be a happy person. It made me smarter. Enjoy this and always start with a chart.”

In Jack’s email was a link to the above video. The TEDx talk in the video is by Shawn Achor, CEO of Good Think, Inc., where he researches and teaches about positive psychology.

What an entertaining and enlightening talk. I would like to share with you some of the points made.

Our positivity or negativity is the lens that our brain uses to view the world and shapes our reality. Often times we assume that the external world or successes determine our positivity or happiness.

Studies have demonstrated that if one knows everything about an individual’s external world, you can only predict the individual’s level of happiness by 10%. The vast majority of the time, the way your brain processes the world determines our level of happiness.

Studies have also shown a strong correlation of positivity leading to success.

Some of these studies suggest that whereas 25% of success is associated with intelligence or talent level, 75% is determine by positivity (Horn and Arbuckle, 1988) or happiness, optimal levels of social support, and ability to see stress as a challenge not a threat (Estrada, Isen, and Young, 1997).

Many of us, me included, have all been taught that if we work harder, we will be more successful, and, if we are more successful, we will be happier. This is likely incorrect. Continue reading

Share Doc in the D:

One Week Proves Why We’re So Much More Than Just a Hospital

It only took one week to prove a point that I regularly tell people: Henry Ford Hospital is so more than just a hospital, a place to care for patients.

We’re a destination in Detroit for education, culture and some truly unbelievable events for our employees, patients and the community. (And it all happens while our health care teams do what they do best: provide the absolute best care and service to each and every one of our patients – each time, every time, every encounter.)

Many of my regular blog readers have already gotten a glimpse at some of the amazing things that have happened recently at Henry Ford Hospital.

It all started with a community event to celebrate Dr. Martin Luther King, Jr. Day, which showcased some of the amazing choral talent in our city (and in our hospital), as well as a keynote address by Bankole Thompson, the senior editor of the Michigan Chronicle.

God's Hands of Praise performs at Henry Ford Hospital

If you have not heard Mr. Thompson speak, you have missed the brilliance of passionate commitment and challenge. Sam Logan, rest in peace; your charge will continue.

And the choirs from the Mosaic Singers, Detroit Rescue Mission, God’s Hands of Praise, and our own Martina Gifford and the Henry Ford Health System Choir stirred the blood as much as the soul.

Each year, this event is better than the last, and serves as an important reminder of how Dr. King’s visions and principles continue to drive and inspire us in the work we do every day. 

Only a few days later, our employees welcomed the Detroit Tigers 2012 Winter Caravan to our hospital. With Miguel Cabrara, Brennen Boesche and several other Tigers stars in attendance, we were reminded why baseball is such an important part of the growing excitement surrounding our city.

Ramon Santiago with Marla Hull, Inpatient Case Management.

Baseball is one of the constancies in American life (all respect to James Earl Jones and Field of Dreams).

Those of us around in 1968 know the way baseball and the Detroit Tigers calmed and soothed a battered city. 

Dr. King’s vision was seen in the stands of every home game, and showed us that how even in the most polarizing situation most of us are alike with common goals, aspirations, and dreams.

Countdown to Opening Day at Comerica Park: 11 weeks. Continue reading

Share Doc in the D:

On the Journey from Good to Great: The Baldrige Award

I cannot tell you how proud I am of everyone at Henry Ford Health System for winning the 2011 Malcolm Baldrige National Quality Award.

Let me make that clear:  YOU WON THE BALDRIGE AWARD.

Nancy set the goal, Bob and the Executive Team set the framework, Bill Conway drove the quality agenda, and Sue Hawkins, Edie Eisenmann and their teams created the work plans and applications.

But they could not win the Baldrige Award even with all of their aspirations and actions. Only you could.

Nancy and I spoke about this after the site visit. I cannot tell you how we were in awe of the way in which every employee surveyed, individually or in groups, expressed our mission and vision, as well as identified how their work fit into the greater whole of what we do each and every day in restoring patients and communities to health and wellness.

You know that something different is happening when medical and nursing students, who are not yet Henry Ford employees, can express what we do, how we do it, and what it means in their evolution as the next generation health workers.

After winning, my deep reaction to the award is we must get better, as an organization and as individuals making up that organization.

Justin Verlander knew he won the MVP. He already is thinking about how he can be better. We should too.

Continue reading

Share Doc in the D:

A Thanksgiving Rx: It’s Good for Your Health to Give Thanks

Last November, I wrote a Thanksgiving-themed post about the positive impact a grateful and positive attitude can have on one’s emotional and physical health.

So in the spirit of good health, I want to try something a bit different this year on Doc in the D. I would like my 2011 Thanksgiving blog post to be about you, the team of health care workers who give of themselves daily to care for others.

If giving thanks truly is good for your health, it’s something that every CEO should prescribe (especially if he or she is a doctor).

Here’s my Thanksgiving prescription to you:
In the comments section on this page, tell me what you’re thankful for in your life, your career, your families, your friends, or the simple comforts in life.

Think of it as a virtual Thanksgiving table, where we all have a turn to share and give thanks for what makes us happy in life.

During the week of Thanksgiving, I’ll randomly select some of your responses to feature on Doc in the D and the Henry Ford Hospital Facebook page!

Share Doc in the D:

Care Rounds

As you may have read this week in a Detroit News article, my leadership team and I have recently incorporated care rounding with patients at Henry Ford Hospital into our weekly activities.

You might ask, “What’s new about a physician and an administrative team rounding on patients in a hospital?”

My response? “Quite a bit.”

At Henry Ford Hospital, care rounds concentrate specifically on the general care and services a patient receives.

Although not fully divorced from clinical issues, these rounds bring out issues related to environment, food, communication, ease of use, and general comfort. Quite simply, it is the service aspect of our profession and business.

At the hospital, all of us go about our activities with a specific purpose. As a physician caring for patients, my concentration and intention is primarily on the diagnosis and treatment of the patient. Patients’ needs are generally first viewed from the perspective of their clinical care.

Much is discovered when the lens is focused intently.

I was struck by the application of purposeful activities when studying LEAN-inspired management methods, where so called “waste rounds” had managers stepping out of their usual role (which includes waste reduction in processes) to concentrate fully on eliminating unnecessary steps or use of supplies.

On care rounds, after asking if I can come into the room and talk, I introduce myself and acknowledge the patient formally before asking one simple question: “How has your care been at the hospital?”

Continue reading

Share Doc in the D: