My recent promotion to Director, Patients and Families First & Government Relations for the Saskatchewan Union of Nurses had exposed me to many discussions and presentations about the patient experience. But, in my urologist’s office on that day in August 2010, my prostate biopsy results propelled me into another new role–I had become a patient.

I admit my memory of the castration conversation may be faulty. Apparently, patients retain less than 50% of what they hear during appointments with their physician. I heard that my prostate cancer was very advanced, almost certainly metastasized. It was too late for surgery or radiation. Hormone therapy (chemical castration) was my only treatment option. My urologist was gentle and compassionate. But as my sweetheart and I left his office, I resolved to seek another opinion.

While waiting, I accessed reputable online patient resources, clinical guidelines and predictive algorithms based on my test results. These predicted a 50/50 chance of surviving 3-5 years, certain loss of sexual function, and eventual cancer progression to other organs and my skeleton.

After meeting each urologist, radiologist, and surgeon I was convinced (for at least 24 hours) that each was right, despite their conflicting recommendations. In my case, single brief appointments are a shaky forum for a fear-addled patient to make life-altering treatment decisions.

Finally, I was swayed by the argument that “this is an aggressive cancer, and requires aggressive treatment, or it will kill you.” A friend with the same prognosis is cancer-free a decade later. His experience with aggressive treatment offered me hope and my one shot at survival. Surgery, radiation, hormone therapy, and chemotherapy was to be my new future and patient experience.

Within days of my diagnosis, I realized I needed to ‘come out of the closet’ with colleagues and friends about my prostate cancer. Too many men over 50 fail to get annual PSA (Prostate-Specific Antigen) tests and then monitor any progression. I had an obligation to serve as the canary in the mine shaft.

I quickly learned that coming out of the closet about one’s major illness or life-threatening disease is a profound, life-changing first step for patients and their families. When I was healthy, I was blissfully unaware of the threat of death and disability that threatens many of us. Although my affliction was invisible, among healthy people, I felt like I was now a citizen of a very different country with sharply limited rights and freedoms.

Not a single day since has passed without achingly acute consciousness of my illness and looming expiry date. “Good morning, how are you?” triggers disturbing thoughts. The question, “Do you want to purchase the extended warranty on this mixer?” gives me pause.

I try to comfort my sweetheart and children with evidence that I am handling this frightening progression surprisingly well and ‘staying strong’. (This is interspersed with periodic episodes of sobbing and grief).

I have learned the difference between hope and realistic hope. False hope for a cure or long-term control is repeatedly shattered by more evidence that I am treading water. My care team is reluctant to provide me with an estimate of my remaining time. My treatment is described as palliative, not curative. I am learning that cancer progression, treatment options, and response to treatment are highly individual, frustratingly contrary, and unpredictable.

When I come out of the closet, I am offered countless anecdotes of surprising remissions or even cures. Compassionate and well-meaning people have offered me every prescription, from thinking positive, chelation, and meditation, to irrigation, heated blood transfusions, pomegranate juice, and dandelion root. Jesus, laughter therapy, asparagus and milk, or mushroom extract are offered with equal vigour, sincerity and claims of efficacy. It turns out most of us fall into the trap of being prescriptive.

I am even offered stories about other cancer patients who have died within days or weeks of diagnosis. After the third such story from an old friend in the Safeway store, I had to say, “please stop, these stories of death from cancer are not helpful.”

Yet, coming out has also made my bond with loved ones and friends much more powerful. This openness and vulnerability has also forged new and wonderful friendships from meetings with strangers who turn out to be empathetic, compassionate and responsive to genuine and continuing connections.

But, I really didn’t find peace until I had conversations with my sweetheart and children that went like this, “I have not lost hope, but I think we will all be better off if we accept the strong probability that I may only have a year or so of mobility followed by a year of disability and institutional care. Let’s agree to talk about our fears, our hopes, our grief–anything. Let’s talk about how can make the best of our precious remaining time together.”

I want to report more about what I’ve learned about this open dialogue about death and drinking deeply from the cup of life. Relationships, nature, food, music, art, conversations, reading, walking, writing, and simple human interactions bring intense pleasure. It’s true about every day being a gift. I will never be bored again.

I admit I have had a wonderful life, and still fortunate in so many ways. I see that there is more pleasure and joy in my future, not just pain and fear. My first urologist was right after all–I am a lucky man.

In his next post, Lawrence will share with us why he asked the Health Quality Council to share his stories through Qreview. Visit this blog again next week to find out how Lawrence’s personal experiences have led him back to work on health care quality improvement.

-Connection 2- Post 2.1: Out of the closet.-

Not surprisingly this RPIW was similar in many ways to other improvement events I have been involved in over the past 12 months . This recent visit to the gemba reminded me how fortunate we are to have such clever and capable health providers working in the ED.

I was still reflecting on this a few days later when I stumbled upon a fantastic commencement speech by Jeff Bezos, creator of Amazon. If you have 11 minutes and need an injection of inspiration, I highly recommend it.

His key message — cleverness is a gift, kindness is a choice — brought me back to one of my lasting impressions from those 5 days in Emergency as part of the RPIW.

I’ve seen and experienced many examples of kindness and compassion in the ED.  But I’ve also witnessed judgment crowd out that kindness, especially when “walk ins” show up in Emergency. During the RPIW, a health provider shared this powerful insight:  “It may be not be an emergency in our eyes but it is to the patient.  Ours is not to judge but to choose how we respond.”

As the caregiver of one of those “walk-ins” and participant on a team working to improve this experience for others, my hope is that our health providers always choose kindness.

What do you think? Why is it sometimes easier to be clever than kind?

I noticed that same spirit of ingenuity recently, when I participated in a Rapid Process Improvement Workshop aimed at reducing waits for low acuity patients presenting to the ED at Saskatoon’s Royal University Hospital. Once we had a picture of the current state — about 1 in 3 patients visiting the ED are low acuity, waits to see a physician averaging 2 hours, and about 8% leaving the ED without being seen — ideas for possible solutions began to fly.

Right away, someone observed, “this just shows how critical it is to set up a 24-hour urgent care clinic close to the ED” And I don’t think I’d be exaggerating if I said people were already imagining what that clinic would look like, bricks, mortar, and all.

Then reality hit. We had 3 days. No extra resources. Just a healthy dose of curiosity, imagination, and “just do it” attitude among the 8 of us on that RPIW team.

Well, we did “just do it.” In 3 days, we re-purposed 300 square feet of existing ED space into a minor acuity treatment area. Out went to 2 hospital beds and in came:

• a handful of comfortable chairs (after all, the folks coming to this area are walking in and able to sit);
• a curtained off examination table (not terribly different from a curtained off ED bed); and,
• access to an adjacent private room.

The RPIW team got input from four ED physicians, triage nurses, several other ED nurses and ED staff about what types of patients would be good candidates for this new treatment area. We talked about what standard work would look like, what we were trying, and why.

By the final day, we were seeing a 50% reduction in the wait time for low acuity patients (from the time they were triaged, to the time they were assessed by a physician), and even better, no patients left without being seen.

Is the new minor acuity treatment area perfect? Not at all. But, based on early data, it does appear to be an improvement over what was happening before the RPIW. Is there room for improvement, for working out the kinks? Yes, and this is tough  but “must do” follow-on work.

As with every RPIW, there will be a couple of audit metrics, to determine whether the improvements made during the week are sustained over the longer term. If they’re not, staff working in the area will need to determine what corrective actions to take to bring things back on track.

It’s still early days in this journey. Historically, we’ve thought of constraints as a barrier to innovation. However, my recent experience on this RPIW tells me we can tap into that same spirit of imagination and creativity that was so useful to us, and came so naturally, when we were children.

What do you think? Why do we have a tendency to think that innovation requires more resources, rather than seeing the need to improve without adding resources as an opportunity for innovative thinking?

video credit: Cleveland Clinic

I watched this video recently. I was moved by it, for several reasons.

It is a reality check to all of us when we enter a health care facility. You never know what that person in the coffee shop, or in line at Admitting, is facing.

It makes me realize how precious life is. You cannot take anything for granted. I never thought I would be sick and now doing what I am doing. I had dreams of being a nurse but life dealt me a different card. I know others are dealing with other things they never planned for but are making the best of it. You may be dealing with illnesses or even becoming a parent. All life is changing, but I feel it is how you deal with things that determines whether they are great or not. You have a choice.

I now make sure when I am walking through the hospital that I remember to smile. It may make that other person’s day just a bit brighter to see that someone actually takes the time to give that smile. It maybe the only smile they get that day.

It is also a reminder to those who work in health care, about how to view and treat patients and families. Many see me and may not know the things I have gone through, years in and out of the hospital, dealing with uncooperative staff and being talked down to. When I walk through those doors you have to remember not to assume. I am not saying everyone does that. I have had amazing service through the years. Unfortunately it is those negative experiences that resonate with me and also with many others. So instead of pre-judging and starting off on the wrong foot, start with a smile and remember this video.

I think this brilliant video should be shared with all staff in health care. It may change the way you look at your job.

Health care providers have amazing opportunities daily to help make the day of a patient, family member or even a fellow staff member.. Starting off with a smile is a great first step.

I challenge everyone who reads this to try just smiling and really acknowledging the next person you see in a hallway. You may just be making their day a little better.

As Saskatchewan works to make health care and care processes better every day, we have turned to the principles of the Toyota Production System (TPS) to implement a world class management system. A key element within a world class management system is the quarterly review.

The quarterly review is an intentional process that forces a system to ‘take pause’, every quarter. Quarterly reviews are closed sessions, involving the region or organization’s senior leadership team and CEO. Representatives from John Black and Associates (JBA), the lead consultants of the provincial Lean transformation efforts and the Provincial Kaizen Promotion Office, also attend to listen, learn, and challenge the group.

On May 3, 2013 Five Hills Health Region underwent its second quarterly review. Each quarterly review follows a standard agenda that serves to guide the reflective process. Each service line (including the Kaizen Promotion Office), shares their goals, progress and outcomes to date and then spends time discussing any barriers and lessons learned with the CEO and senior team. The afternoon is spent going to the gemba to tour each Service line area to see the work in action and speak to people who do the work on the frontline.

Five Hills currently has four service lines; acute and complex care, primary health care, mental health care, and surgical care. One highlight shared at the quarterly review was that the region has a 90% OR Utilization rate. While this is an excellent outcome achieved through focused improvement work, Five Hills is still not satisfied and is continuing work to achieve 100%. The region is also home to only the second Lean Leader in the province to be fully certified: Terry Hutchinson.

One of the big realizations that Five Hills had at this second quarterly review is that implementing Lean is more than implementing a set of tools, it is about changing mindsets — which is the work of leaders.

Following the review, Myles Cairns, the Director of Five Hills’s Kaizen Promotion Office shared some reflections on his region’s experience to date:

“I don’t think any of us truly understood just how hard or big the challenge was going to be a year ago, especially when you think about the additional stress and challenges of the work for the new hospital…the new hospital easily could be a full time job for most of the senior leadership team; however the FHHR team has accepted the challenge whole heartedly and I believe we are starting to see some rewards for the efforts. I know that there has been a lot of personal growth for everybody that was in the room because of the experiences over the last year.”

In this session, entitled 20/20, five different physicians were each allowed 20 slides, and 20 seconds per slide, to answer the questions:

• What is possible in health care?
• What tells you this is possible in Saskatchewan?

The last video in this series features Dr. Sean Groves, a physician from La Ronge, who is passionate about rural and remote health care, and shares his vision in this very engaging presentation: 

Watch the first video in this series with presenter Dr. Joy Dobson

Watch the second video with presenter Kelly Simo

Watch the third video by presenter Dr. Jason Hosain

Watch the fourth video with Dr. Kunal Jana

The Saskatchewan Health Care Quality Summit is an annual event that features inspirational presentations about quality improvement in health care. More information is available at www.qualitysummit.ca

Follow @QualitySummit on Twitter

What did you think of this post? Click below and let us know.

In this session, entitled 20/20, five different physicians were each allowed 20 slides, and 20 seconds per slide, to answer the questions:

• What is possible in health care?
• What tells you this is possible in Saskatchewan?

Urologist Dr. Kunal Jana shares what he believes is possible, and the idea of a “Nurse Navigator”, in this fourth installment of the 20/20 series:

Watch the first video in this series with presenter Dr. Joy Dobson

Watch the second video with presenter Kelly Simo

Watch the third video by presenter Dr. Jason Hosain

The Saskatchewan Health Care Quality Summit is an annual event that features inspirational presentations about quality improvement in health care. More information is available at www.qualitysummit.ca

Follow @QualitySummit on Twitter

What did you think of this post? Click below and let us know.