Shari Hughes, Associate Registrar—Practice, College of Physiotherapists of Ontario

Guest Blogger: Shari Hughes, PT

I just read something inspiring—so inspiring in fact, that I want to share it with my fellow PTs. Here it is:

“Our quest [as health care providers] is clear…It’s a search for meaning in the value of the person who has come to honour us with his or her quest for some help. And we think to ourselves, is this a [prime minister]? Is this a hero? Is this a mother? Is this a father? An artist? A craftsman? An honest labourer? A climber of hills? A singer of songs? Who is this person who honours me with their presence, and what can I do to help them?”

I read this paragraph in an article describing the closing keynote speech delivered by Don Berwick at the Institute for Healthcare Improvement (IHI) 27th Annual National Forum on Quality Improvement in Health Care.

I read the article because it was about Don Berwick—a powerful thought leader and an engaging speaker committed to sparking bold, inventive ways to improve the health and health care.

This is not the first time Berwick and the IHI group have inspired me.

The first time was in 2005 with the 100,000 lives campaign. I’ve also turned to IHI to learn about rapid response teams and care bundles and PDSA improvement cycles and the Triple Aim initiative—I could go on and on but you should check them out for yourself at www.ihi.org.

Maybe it’s because I’ve heard and have been impacted by Don Berwick before. Maybe it’s because it’s a new year filled with new possibilities. Or maybe it’s because I can so easily apply his words to the profession I love so much.

In this latest speech he also talks about a new era in health care and nine steps to take going forward.

1. Stop excessive measurement: I don’t mean that we should stop measuring. Indeed, I celebrate transparency in every form. How else can you learn? But we need to tame measurement. It has gone crazy. Far from showing us our way, these searchlights training on us, they blind us. We can’t find Sean in that glare. I vote for a 50 percent reduction in all metrics currently being used.
2. Abandon complex incentives: We need a moratorium, I think, on complex incentive programs for individual health care workers, especially for doctors, nurses and therapists. If a program is too complicated to understand, too complicated to act upon by getting better, then it isn’t an incentive program. It’s a confusion program. It’s a full-employment program for consultants.
3. Decrease focus on finance: This could be impossible. I feel naïve, almost, suggesting it, but for just a while, wouldn’t it be great if we could step off the treadmill of revenue maximizing? …If leaders really did care about profit, they would concentrate unremittingly on meeting the needs of people who came to them for help, but they aren’t. We aren’t.
4. Avoid professional prerogative at the expense of the whole: From Era 1, we clinicians, doctors, nurses, we inherited the privilege. It’s still there. We can still use it. It’s the trump card of prerogative over needs, over the interests of others. ‘It’s my operating room time.’ ‘I give the orders.’ ‘Only a doctor can.’ ‘Only a nurse can.’ These are habits and beliefs that die very hard, but they’re not needed. They’re in our way.
5. Recommit to improvement science: For improvement methods to work, you have to use them, and most of us are not. I’m trying to be polite, but I am stunned by the number of organizations I visit today in which no one has studied [W. Edwards] Deming’s work, no one recognizes a process control chart, no one has mastered the power of testing PDSA (plan-do-study-act), Nathaniel’s Method or the route to the top. You can see the proof of concept. This is beyond theory now.
6. Embrace transparency: The right rule is really clear to me. Anything we know about our work, anything, anything we know about our work, the people and communities we serve can know too, without delay, without cost or smoke screens. What we know, they know, period.
7. Protect civility: With the self-satisfaction courted by Era 1, with the accusatory posture that’s at the heart of Era 2, civility and, therefore, possibility have been in much too short of supply. I don’t lack a sense of humor, although I may sound like it right now, but in my opinion, jokes about herding cats or green eyeshades or soulless bureaucrats or the surgical personality, or the demanding patient—these are not funny.
8. Listen. Really listen: These terms—coproduction, patient-centered care, what matters to you — they’re encoding a new balance of power: the authentic transfer of control over people’s lives to the people themselves. That includes, and I have to say this, above all, it has to include the voices of the poor, the disadvantaged, the excluded. They need our mission most.
9. Reject greed: For whatever reason, we have slipped into a tolerance of greed in our own backyard and it has got to stop … We cannot ask for trust if we tolerate greed. The public is too smart.

As insightful and thought-provoking as the nine steps are, what resonates so much for me is the powerful reminder of my role as a physiotherapist in the simple question: “Who is this person who honors me with their presence, and what can I do to help them?”

History is full of little sayings that inspire big outcomes.

I’d love to hear more about what inspires you—what makes you get up every day and love doing what you do. Tell us, please!