Building Mutual Respect in a Culture of Safety
Michael Brodman, MD, professor and chair emeritus in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, discusses how mutual respect is a prerequisite for any institution developing a culture of safety. Healthcare has an unfortunate tradition of being hierarchical, and this kind of culture is made worse by significant differences in background and training amongst healthcare professionals. The increasing complexity of medical care in nearly every aspect of care delivery, makes optimal teamwork and communication essential. And this is only possible if every member of the team feels respected and is free to speak up when they think something is wrong.
Featuring:
Dr. Brodman has served as Chairman for the Department of OBGYN for 19 years.
Over the years, Dr. Brodman has been involved in many roles within the department
and health system. He served as President of the Medical Board and Faculty Practice for Mount Sinai Hospital. He has won numerous awards both nationally and locally for his roles as an educator and clinician. As a nationally renowned pelvic surgeon he has been a pioneer and founding member in the newly created sub specialty of Female Pelvic Medicine and Reproductive Surgery. He has created a Global Health program at Mount Sinai and personally travels abroad to perform needed pelvic surgeries. Dr. Brodman is also nationally recognized for his work in quality and safety in obstetrics and gynecology, a role that has expanded to include the health system.
Michael Brodman, MD
Michael Brodman, MD, is Professor and Chairman Emeritus of the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai. He also serves as a Senior Vice President for Safety for the Mount Sinai Health System. He graduated from the Mount Sinai School of Medicine in 1982 and continued on as a resident in obstetrics and gynecology and then as a fellow in pelvic surgery, finishing his training in 1987. He also holds an undergraduate degree in bio-electrical engineering from the Rutgers College of Engineering and a Master’s degree in Biomedical Engineering from the University of South Carolina.Dr. Brodman has served as Chairman for the Department of OBGYN for 19 years.
Over the years, Dr. Brodman has been involved in many roles within the department
and health system. He served as President of the Medical Board and Faculty Practice for Mount Sinai Hospital. He has won numerous awards both nationally and locally for his roles as an educator and clinician. As a nationally renowned pelvic surgeon he has been a pioneer and founding member in the newly created sub specialty of Female Pelvic Medicine and Reproductive Surgery. He has created a Global Health program at Mount Sinai and personally travels abroad to perform needed pelvic surgeries. Dr. Brodman is also nationally recognized for his work in quality and safety in obstetrics and gynecology, a role that has expanded to include the health system.
Transcription:
Dr David Feldman (Host): Patient safety and high reliability continue to be elusive goals in healthcare. Creating a culture of safety that will allow us to achieve these goals requires a number of important elements. In this series, we'll address what we believe are the essential ingredients in developing such a culture: mutual respect, teamwork and collaboration, human factors engineering and just culture.
I'm David Feldman, MD, Chief Medical Officer for The Doctors Company and Healthcare Risk Advisors, part of TDC Group. On today's episode, we're delighted to welcome Michael Brodman, Professor and Chair Emeritus in the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai. He also serves as a Senior Vice President for Safety for the Mount Sinai Health System.
Today, Mike will discuss how mutual respect is a prerequisite for any institution developing a culture of safety. The increasing complexity of medical care in nearly every aspect of care delivery makes optimal teamwork and communication essential. And this is only possible if every member of the team feels respected and is free to speak up when they think something is wrong.
David Feldman MD, MBA, FACS (Host): This is the Leading Voices in Healthcare podcast.
Dr David Feldman (Host): So let's begin. good Mike, what got you interested in the issue of respect in healthcare?
Dr Michael Brodman: Well, many years ago when I was a junior attending, there was an incident on the labor flow where one of the nurses gave a narcotic and it was kind of confusing as to whether the doctor ordered it or not. And the long story short is she was suspended and he was told not to do it again. And it really struck me then as being really unfair and horrible. And then fast forward, when I became the chair back in 2003, I believe, Mark Chassin who's now the President of the Joint Commission was actually the Chair of Health Policy at Mount Sinai. And we did a survey on the labor floor. And this was shocking 75% of the nurses said that if they saw a doctor doing something wrong, they wouldn't say something if they knew they were doing something wrong. I mean, that was shocking. And, you know, the take home message there is they were afraid that somebody would yell at them or they'd get fired, so they kept their mouth shut and did their jobs.
Dr David Feldman (Host): Unbelievable. That's inspiring to hear that. It, I guess, really got you going on this whole topic, huh?
Dr Michael Brodman: Well, yeah. And then, once you hear that, then you realize where a lot of the root cause of adverse outcomes come from, just lack of communication and teamwork. And again, back to the topic at hand, it's respecting everybody on the team.
Dr David Feldman (Host): Mike, why do you think respect is so important in the goal of developing a culture of safety? Why is this such a critical ingredient that you really have to start with? Why do you think?
Dr Michael Brodman: I actually think it's pretty simple. I mean, to have a high reliability organization or team, you need teamwork. Everybody has to be able to communicate openly. We see that in the military, we see that on the aircraft carriers. I mean, when I was a little kid and I was playing sports, I realized the teams that got along and everybody felt like they had the same mission and they were on the team together did better than the teams where everybody was a solo player. Same thing in healthcare. If you don't communicate well, part of that is if you don't respect the nurse that's working with you, you're not going to tell her what you're thinking and you're not going to care what she's thinking either. So I think respect is key.
Dr David Feldman (Host): Powerful message. I had my own experience in a hospital I used to work at where there was an anesthesiologist. He was a great anesthesiologist, but he just didn't get along with people, was not respectful. And nurses used to tell me they were afraid to talk to him. They just were afraid to talk to him. And so if we think about no human physician or nurse or other provider can ever get to hundred percent, to get to that 10, if you will, in getting everything right. So if you get it right, seven or eight out of 10, but you have a team behind you, that's willing to tell you, "Hey, This is how you can modify this," you can get from your seven or eight to 10. You start with somebody who's a nine that's really good, but nobody wants to talk to them, they're stuck at a nine. They're never going to get to that 10. So having that team behind you that's willing to say something so they really work together and get the benefits of that teamwork is just so know
Dr Michael Brodman: Agreed.
Dr David Feldman (Host): So Mike, tell me a little bit about, how have healthcare institutions and their providers dealt with this problem? Can you give us an example of something you've done to try and get to this? We've got a problem here? How do you fix it? What have you done to improve this, to get this thing going?
Dr Michael Brodman: So I mean, th goal of a healthcare system is to have good outcomes, good quality, have a safe environment, and also have a place where the employees enjoy coming to work. And I realized very early on and, I didn't do the work, I read about it, that if you have poor communication and, again, respect is part of that, then you're going to have more adverse outcomes.
And so when I became chair, I decided that we had to fix the safety question at Sinai. And the foundation of all this was getting everybody on the labor floor to work together, to enjoy working together, and have the same mission and goal of having great outcomes. So getting everybody to respect each other and work together and appreciate what each person does for the team was the basic step. And I think healthcare organizations now are realizing that safety and quality go hand in hand with communication and mutual respect and you can't get one without the other.
Dr David Feldman (Host): And did you develop a program as the chair in your department to try and help address this?
Dr Michael Brodman: Yeah. So in 2003 or 2004, I created what we call The Code of Professionalism. And basically, what it was is an anonymous or not reporting system where anybody on the labor floor could report somebody else for bad behavior. And we formed a committee. I was on it. The chief nursing officer for OB-GYN was on it. At that time., we had the Director of the NICU on it and we had a safety nurse. And the four of us would review these reports and decide how to take action. Sometimes it was a doctor would meet with me and I'd say, "Bob, that was very unprofessional," and we'd have a little conversation and sometimes we'd escalate. And certain physicians were having issues in their lives and I sent them on to receive professional help. But then we started that in 2003 or 2004, I believe. And again, the uniqueness is anybody could report anybody. So a doctor could report a transporter, a transporter could report a doctor. And whatever the incident was, we investigated and made sure that whoever was acting inappropriately, we got them help.
Dr David Feldman (Host): So this has been in place for-- I mean, it's still in place now. assuming, yes?
Dr Michael Brodman: Yeah.
Dr David Feldman (Host): Fifteen years, right?
Dr Michael Brodman: Yeah. More.
Dr David Feldman (Host): More or less. So have you gotten feedback from your staff, from people about did it change the culture? Did it give people the opportunity to do all the things we've talked about? What do you think? What kind of feedback have you gotten about it?
Dr Michael Brodman: So yes, we did repeat some of the surveys. And that survey that I spoke of earlier, where 75% of the nurses said they wouldn't say something, went down to about 10% or 15% about five or six years later.
And basically, the point was the nurses felt comfortable working on the floor. They knew that I had their backs, that it was not a two-tiered culture where the doctors can do what they want and the nurses can. I created a just level playing field, and morale went up and, not surprisingly, adverse outcomes went down. We instituted a few other things, but the basis of this was just getting everybody to work together on the team.
Dr David Feldman (Host): So, Mike, what do you think is a best practice? You know, people like to use that term as sort of the gold standard in healthcare. What's the best practice in healthcare for doing this thing, for establishing a culture of mutual respect?
Dr Michael Brodman: So it's a great question. And I think it really starts at the C-suite, the leadership of the hospital. The hospital leadership has to be committed to creating a just culture. And that means nobody gets a pass. That means the physician who makes the most money for the hospital or a dean or a department chair does not get a pass. And if they're a part of the problem, they have to be helped. The process should be helping people, it should not be punitive.
And if you see somebody, and I'll give you an example, it's kind of a crazy example, but it makes the point. So if I'm in the parking garage in the morning and I can't find my car and I start yelling at the parking attendant. And then at lunch, I'm in the cafeteria and I'm on the cash-only line and I don't have any cash and I yell at the cashier. And somebody recognizes that behavior, I don't think you have to have a stretch of the imagination to realize that very soon or already I will make a medical error. There's clearly something going on in my life that's distracting me from my work. And I couldn't find my car and I got on the wrong line and then I got testy about it. So, you have to find those people at that stage and help them, because who knows what was going on in my life that distracted me. And so you have to do three things. You have to identify the people, you have to help them, and then back to the beginning of this, which was what I started with, if somebody just really a bad player, just a cancerous individual in your organization and you can't help them and they refuse to be helped and they just are toxic, then again the C-suite has to be able, no matter who that person is, to say, "This person is hurting our organization. We have to let them go.
Dr David Feldman (Host): so we talked about, you know, best practices, what are you doing now you're working in your system role in safety as Vice President for Safety at Sinai? What are you doing now to get your institution to this practice? Tell me a little bit about what's going on.
Dr Michael Brodman: Sure. So as part of the work we were doing to try to reduce malpractice, we came across this program at Vanderbilt that they had published some papers saying that they put this program in place and it lowered adverse outcomes and malpractice. And we went to Nashville and we visited their site. And interestingly, the program was not put in place to lower malpractice. It was put in place, I don't know how long ago, 25, 30 years ago, to improve their culture. And as a result of this program, they not only improve their culture, but a very nice byproduct was the improved outcomes.
And we've adopted that program into our system and it's basically similar to the program I've put in place on the labor floor at Sinai. It's a reporting system. Theirs is much more sophisticated. And basically, the program is such that you can report unprofessional behavior. And, if you get reported, we hear about it and we assign a messenger and we have trained messengers who have what we call a cup of coffee and they sit down and they say, "Listen, you were reported for bad behavior. We don't know whether it happened or not we don't investigate. But be mindful of how you interact with everybody." And in the institutions where this program is already running and there's a lot of data, they have very good data to support the fact that this very simple program works.
Self-awareness for physicians is a very powerful tool. People say, "Oh, I guess I've been acting like a jerk. I better watch my behavior." So that's what we're doing now in our system. We started it at about almost a year ago.
Dr David Feldman (Host): That's great. Just great. And I understand they have millions and millions of reports like this. So because you always hear physicians who say, Well", you know, I'm a urologist. It doesn't really apply in my specialty," and actually it does. I think you and I have both seen this data. It really goes across all specialties. These kinds of patterns of doctors behaving badly, if you will, is not unique to one specialty. Although people often think it's just the surgeons that are nasty, and we may be. We have a higher level of this than others, but it does go across specialties. And, in the malpractice world, we know that this group show, as you said, 20 years ago, that there's a direct correlation between the number of these reported events that individual doctor has and their malpractice profile. So it's great to know that along the way it's improving the culture, even more important improving outcomes and then ultimately reducing malpractice. Excellent. Excellent. So, Mike, tell me, what suggestions would you have for our listeners, for those who are just trying to get started on this culture of safety journey? Obviously, not so easy. Any suggestions you have for our listeners on this?
Dr Michael Brodman: A couple of things. The first and foremost, leadership of the hospital has to be 100% behind this, because there are so many obstacles and roadblocks and bad cultures that, unless senior leadership is behind you, you're going to fail. Once they agree that we have to fix this, there are different ways to do this and we chose this one path. it was just at a conference where they were discussing what's called peer review. So the other way to do this is to just put a very elaborate system in place where you can track physicians, and then be able to collect the data and then act on the data. If I do 10 operations and I don't dictate my operative reports, that's indicative of something. And somebody has to see that and say, you know, "Why haven't you dictated your reports?" Let's talk about it. And again, it shouldn't be punitive. We all went into medicine to do good and help people. So when we don't do that, it's not because we're bad people, it's probably something going on in our lives. And so, step number one is get leadership involved and supportive. Step number two is to put some program in place where you can track behavior. And then, the third piece is you have to really get everybody to respect everybody else on the team, have a shared vision, a shared mission and work together. The other way we did this is we instituted SBAR, a way of communicating with each other and a few other things, but you have to put programs in place like simulation, where people work together in simulated settings. Again, it builds teamwork and comradery. You have to have a good communication systems. We use SBAR, but there are other ones. You have to have a way of tracking all of this, and then you have to have corrective action, the ability to do corrective action in a positive way, not a punitive way.
Dr David Feldman (Host): Right.
Dr Michael Brodman: And those are the steps.
Dr David Feldman (Host): It's interesting because, and our listeners may have said, "Well, why are you so focused on physicians?" And the answer is because, to be honest,, at least in a hospital setting, right, most of these other folks, nurses and allied health professionals, therapists, and so forth, they're employees and they already have this. It's part of their corrective action plan, right? But doctors, even employed doctors, for some reason, they just fall out of that system. So it's just the holding doctors accountable in the same way we hold everybody else accountable for their behavior and, frankly, everything else. It's leveling the playing field, so that we're all on the same mission,
Well, thank you so much, Mike, for joining us today. I really appreciate your comments and your thoughts, and I'm really anxious to see how your journey continues.
Host: thank you so much for joining us today and thank you all for listening to our leading voices in healthcare podcast, visit our website@thetdcgroup.com to learn more about the services we provide to healthcare professionals.
Dr David Feldman (Host): Patient safety and high reliability continue to be elusive goals in healthcare. Creating a culture of safety that will allow us to achieve these goals requires a number of important elements. In this series, we'll address what we believe are the essential ingredients in developing such a culture: mutual respect, teamwork and collaboration, human factors engineering and just culture.
I'm David Feldman, MD, Chief Medical Officer for The Doctors Company and Healthcare Risk Advisors, part of TDC Group. On today's episode, we're delighted to welcome Michael Brodman, Professor and Chair Emeritus in the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai. He also serves as a Senior Vice President for Safety for the Mount Sinai Health System.
Today, Mike will discuss how mutual respect is a prerequisite for any institution developing a culture of safety. The increasing complexity of medical care in nearly every aspect of care delivery makes optimal teamwork and communication essential. And this is only possible if every member of the team feels respected and is free to speak up when they think something is wrong.
David Feldman MD, MBA, FACS (Host): This is the Leading Voices in Healthcare podcast.
Dr David Feldman (Host): So let's begin. good Mike, what got you interested in the issue of respect in healthcare?
Dr Michael Brodman: Well, many years ago when I was a junior attending, there was an incident on the labor flow where one of the nurses gave a narcotic and it was kind of confusing as to whether the doctor ordered it or not. And the long story short is she was suspended and he was told not to do it again. And it really struck me then as being really unfair and horrible. And then fast forward, when I became the chair back in 2003, I believe, Mark Chassin who's now the President of the Joint Commission was actually the Chair of Health Policy at Mount Sinai. And we did a survey on the labor floor. And this was shocking 75% of the nurses said that if they saw a doctor doing something wrong, they wouldn't say something if they knew they were doing something wrong. I mean, that was shocking. And, you know, the take home message there is they were afraid that somebody would yell at them or they'd get fired, so they kept their mouth shut and did their jobs.
Dr David Feldman (Host): Unbelievable. That's inspiring to hear that. It, I guess, really got you going on this whole topic, huh?
Dr Michael Brodman: Well, yeah. And then, once you hear that, then you realize where a lot of the root cause of adverse outcomes come from, just lack of communication and teamwork. And again, back to the topic at hand, it's respecting everybody on the team.
Dr David Feldman (Host): Mike, why do you think respect is so important in the goal of developing a culture of safety? Why is this such a critical ingredient that you really have to start with? Why do you think?
Dr Michael Brodman: I actually think it's pretty simple. I mean, to have a high reliability organization or team, you need teamwork. Everybody has to be able to communicate openly. We see that in the military, we see that on the aircraft carriers. I mean, when I was a little kid and I was playing sports, I realized the teams that got along and everybody felt like they had the same mission and they were on the team together did better than the teams where everybody was a solo player. Same thing in healthcare. If you don't communicate well, part of that is if you don't respect the nurse that's working with you, you're not going to tell her what you're thinking and you're not going to care what she's thinking either. So I think respect is key.
Dr David Feldman (Host): Powerful message. I had my own experience in a hospital I used to work at where there was an anesthesiologist. He was a great anesthesiologist, but he just didn't get along with people, was not respectful. And nurses used to tell me they were afraid to talk to him. They just were afraid to talk to him. And so if we think about no human physician or nurse or other provider can ever get to hundred percent, to get to that 10, if you will, in getting everything right. So if you get it right, seven or eight out of 10, but you have a team behind you, that's willing to tell you, "Hey, This is how you can modify this," you can get from your seven or eight to 10. You start with somebody who's a nine that's really good, but nobody wants to talk to them, they're stuck at a nine. They're never going to get to that 10. So having that team behind you that's willing to say something so they really work together and get the benefits of that teamwork is just so know
Dr Michael Brodman: Agreed.
Dr David Feldman (Host): So Mike, tell me a little bit about, how have healthcare institutions and their providers dealt with this problem? Can you give us an example of something you've done to try and get to this? We've got a problem here? How do you fix it? What have you done to improve this, to get this thing going?
Dr Michael Brodman: So I mean, th goal of a healthcare system is to have good outcomes, good quality, have a safe environment, and also have a place where the employees enjoy coming to work. And I realized very early on and, I didn't do the work, I read about it, that if you have poor communication and, again, respect is part of that, then you're going to have more adverse outcomes.
And so when I became chair, I decided that we had to fix the safety question at Sinai. And the foundation of all this was getting everybody on the labor floor to work together, to enjoy working together, and have the same mission and goal of having great outcomes. So getting everybody to respect each other and work together and appreciate what each person does for the team was the basic step. And I think healthcare organizations now are realizing that safety and quality go hand in hand with communication and mutual respect and you can't get one without the other.
Dr David Feldman (Host): And did you develop a program as the chair in your department to try and help address this?
Dr Michael Brodman: Yeah. So in 2003 or 2004, I created what we call The Code of Professionalism. And basically, what it was is an anonymous or not reporting system where anybody on the labor floor could report somebody else for bad behavior. And we formed a committee. I was on it. The chief nursing officer for OB-GYN was on it. At that time., we had the Director of the NICU on it and we had a safety nurse. And the four of us would review these reports and decide how to take action. Sometimes it was a doctor would meet with me and I'd say, "Bob, that was very unprofessional," and we'd have a little conversation and sometimes we'd escalate. And certain physicians were having issues in their lives and I sent them on to receive professional help. But then we started that in 2003 or 2004, I believe. And again, the uniqueness is anybody could report anybody. So a doctor could report a transporter, a transporter could report a doctor. And whatever the incident was, we investigated and made sure that whoever was acting inappropriately, we got them help.
Dr David Feldman (Host): So this has been in place for-- I mean, it's still in place now. assuming, yes?
Dr Michael Brodman: Yeah.
Dr David Feldman (Host): Fifteen years, right?
Dr Michael Brodman: Yeah. More.
Dr David Feldman (Host): More or less. So have you gotten feedback from your staff, from people about did it change the culture? Did it give people the opportunity to do all the things we've talked about? What do you think? What kind of feedback have you gotten about it?
Dr Michael Brodman: So yes, we did repeat some of the surveys. And that survey that I spoke of earlier, where 75% of the nurses said they wouldn't say something, went down to about 10% or 15% about five or six years later.
And basically, the point was the nurses felt comfortable working on the floor. They knew that I had their backs, that it was not a two-tiered culture where the doctors can do what they want and the nurses can. I created a just level playing field, and morale went up and, not surprisingly, adverse outcomes went down. We instituted a few other things, but the basis of this was just getting everybody to work together on the team.
Dr David Feldman (Host): So, Mike, what do you think is a best practice? You know, people like to use that term as sort of the gold standard in healthcare. What's the best practice in healthcare for doing this thing, for establishing a culture of mutual respect?
Dr Michael Brodman: So it's a great question. And I think it really starts at the C-suite, the leadership of the hospital. The hospital leadership has to be committed to creating a just culture. And that means nobody gets a pass. That means the physician who makes the most money for the hospital or a dean or a department chair does not get a pass. And if they're a part of the problem, they have to be helped. The process should be helping people, it should not be punitive.
And if you see somebody, and I'll give you an example, it's kind of a crazy example, but it makes the point. So if I'm in the parking garage in the morning and I can't find my car and I start yelling at the parking attendant. And then at lunch, I'm in the cafeteria and I'm on the cash-only line and I don't have any cash and I yell at the cashier. And somebody recognizes that behavior, I don't think you have to have a stretch of the imagination to realize that very soon or already I will make a medical error. There's clearly something going on in my life that's distracting me from my work. And I couldn't find my car and I got on the wrong line and then I got testy about it. So, you have to find those people at that stage and help them, because who knows what was going on in my life that distracted me. And so you have to do three things. You have to identify the people, you have to help them, and then back to the beginning of this, which was what I started with, if somebody just really a bad player, just a cancerous individual in your organization and you can't help them and they refuse to be helped and they just are toxic, then again the C-suite has to be able, no matter who that person is, to say, "This person is hurting our organization. We have to let them go.
Dr David Feldman (Host): so we talked about, you know, best practices, what are you doing now you're working in your system role in safety as Vice President for Safety at Sinai? What are you doing now to get your institution to this practice? Tell me a little bit about what's going on.
Dr Michael Brodman: Sure. So as part of the work we were doing to try to reduce malpractice, we came across this program at Vanderbilt that they had published some papers saying that they put this program in place and it lowered adverse outcomes and malpractice. And we went to Nashville and we visited their site. And interestingly, the program was not put in place to lower malpractice. It was put in place, I don't know how long ago, 25, 30 years ago, to improve their culture. And as a result of this program, they not only improve their culture, but a very nice byproduct was the improved outcomes.
And we've adopted that program into our system and it's basically similar to the program I've put in place on the labor floor at Sinai. It's a reporting system. Theirs is much more sophisticated. And basically, the program is such that you can report unprofessional behavior. And, if you get reported, we hear about it and we assign a messenger and we have trained messengers who have what we call a cup of coffee and they sit down and they say, "Listen, you were reported for bad behavior. We don't know whether it happened or not we don't investigate. But be mindful of how you interact with everybody." And in the institutions where this program is already running and there's a lot of data, they have very good data to support the fact that this very simple program works.
Self-awareness for physicians is a very powerful tool. People say, "Oh, I guess I've been acting like a jerk. I better watch my behavior." So that's what we're doing now in our system. We started it at about almost a year ago.
Dr David Feldman (Host): That's great. Just great. And I understand they have millions and millions of reports like this. So because you always hear physicians who say, Well", you know, I'm a urologist. It doesn't really apply in my specialty," and actually it does. I think you and I have both seen this data. It really goes across all specialties. These kinds of patterns of doctors behaving badly, if you will, is not unique to one specialty. Although people often think it's just the surgeons that are nasty, and we may be. We have a higher level of this than others, but it does go across specialties. And, in the malpractice world, we know that this group show, as you said, 20 years ago, that there's a direct correlation between the number of these reported events that individual doctor has and their malpractice profile. So it's great to know that along the way it's improving the culture, even more important improving outcomes and then ultimately reducing malpractice. Excellent. Excellent. So, Mike, tell me, what suggestions would you have for our listeners, for those who are just trying to get started on this culture of safety journey? Obviously, not so easy. Any suggestions you have for our listeners on this?
Dr Michael Brodman: A couple of things. The first and foremost, leadership of the hospital has to be 100% behind this, because there are so many obstacles and roadblocks and bad cultures that, unless senior leadership is behind you, you're going to fail. Once they agree that we have to fix this, there are different ways to do this and we chose this one path. it was just at a conference where they were discussing what's called peer review. So the other way to do this is to just put a very elaborate system in place where you can track physicians, and then be able to collect the data and then act on the data. If I do 10 operations and I don't dictate my operative reports, that's indicative of something. And somebody has to see that and say, you know, "Why haven't you dictated your reports?" Let's talk about it. And again, it shouldn't be punitive. We all went into medicine to do good and help people. So when we don't do that, it's not because we're bad people, it's probably something going on in our lives. And so, step number one is get leadership involved and supportive. Step number two is to put some program in place where you can track behavior. And then, the third piece is you have to really get everybody to respect everybody else on the team, have a shared vision, a shared mission and work together. The other way we did this is we instituted SBAR, a way of communicating with each other and a few other things, but you have to put programs in place like simulation, where people work together in simulated settings. Again, it builds teamwork and comradery. You have to have a good communication systems. We use SBAR, but there are other ones. You have to have a way of tracking all of this, and then you have to have corrective action, the ability to do corrective action in a positive way, not a punitive way.
Dr David Feldman (Host): Right.
Dr Michael Brodman: And those are the steps.
Dr David Feldman (Host): It's interesting because, and our listeners may have said, "Well, why are you so focused on physicians?" And the answer is because, to be honest,, at least in a hospital setting, right, most of these other folks, nurses and allied health professionals, therapists, and so forth, they're employees and they already have this. It's part of their corrective action plan, right? But doctors, even employed doctors, for some reason, they just fall out of that system. So it's just the holding doctors accountable in the same way we hold everybody else accountable for their behavior and, frankly, everything else. It's leveling the playing field, so that we're all on the same mission,
Well, thank you so much, Mike, for joining us today. I really appreciate your comments and your thoughts, and I'm really anxious to see how your journey continues.
Host: thank you so much for joining us today and thank you all for listening to our leading voices in healthcare podcast, visit our website@thetdcgroup.com to learn more about the services we provide to healthcare professionals.