Wednesday, December 16, 2015

Weekly Tidbit #11 -- Letting go

by Paul Uhlig

In the evolution of collaborative care programs, a common question is often heard that arises from a sense of time scarcity and overwork. The question is, "Who needs collaborative care, and who doesn't?"

When this question is asked, it usually comes with a perception that collaborative care (the bedside rounds part of collaborative care), takes a long time, and that more familiar, "non-collaborative" care, is faster and easier.

If you find your team asking this question, you might want to reflect about what this question is telling you. At least operationally, this question is saying that your team is standing with its feet in two worlds. The problem with working partially in a collaborative way and partially in a traditional way, is that your team is therefore carrying and using patterns from both approaches, patterns which are quite different and often fundamentally conflicting. Keeping and using two entirely different sets of discordant patterns, cycling between them while maintaining both, is a fatiguing burden. Having and using two patterns is probably keeping your team from reaching a smooth new collaborative efficiency -- an efficiency that will become available only when your team is able to let the old patterns go.

The responsibility of caring for patients is one of the greatest and most sacred things that a person or team could ever do. Teams approach that responsibility calmly, in part, because of the comfort of familiar patterns they know and trust. It is terrifying to let go of the patterns that we were taught and that we rely on to do our best. "Believing" in collaborative care involves a leap of faith and a commitment to new patterns, trusting that they will help us meet our responsibilities in even better ways.

The next time your team asks, "Who needs collaborative care, and who doesn't?", try this answer: "Everyone needs collaborative care."
Ask yourselves, "What can we do differently? What patterns can we rearrange throughout our day so we can make this happen?" 

There is a saying worth remembering: "If you want to go fast, go alone. If you want to go far, go  together."

Wednesday, December 9, 2015

Weekly Tidbit #10 - Care that touches everyone

by Paul Uhlig
The topic of rounds today is gravy. 
Thanksgiving is only two days away. The exploratory procedure planned for a brief hospital stay had become a much longer recovery with no end in sight. The nurse practitioner is sitting near the end of the bed cradling her tablet computer with labs and vital signs, but her attention is devoted to a heartfelt story of gravy anxiety. The husband and others are listening and nodding. The patient's daughter has mastered the intricacies of raising three young children, but gravy making remains a mysterious, unsolved art. Grandma will not be home in time to provide the magic.
Fast forward three days. Rounds begins. "How was the gravy?" "It turned out great!" is the happy reply. And then another gravy story, this time from the doctor. His family's gravy exploded yesterday. The Pyrex dish wasn't Pyrex. Gravy and glass flew everywhere, over the turkey and the pies, flooding the stove and spilling over the floor. Thankfully, no one was hurt. Thirty minutes later the kitchen was spotless again, the food was carefully cleaned, and a wonderful dinner was enjoyed with much laughter and new memories. Connected by gravy.
Fast forward three more days. Rounds again, this time with an entire extended family present. Several little ones are moving from mother to grandmother to grandfather. Members of the care team are sitting in the morning sunshine by the window. Progress is reviewed. Plans are made. Laughter is shared.
A few minutes later, as people prepare to leave the room, the littlest one present, a three year old granddaughter, raises her head which had been nestled in her mother's shoulder. She looks around the room at each person, smiles, and says, "Thank you for helping to care for my grandma."