The art of ruckus making means doing generous work and serving others. Denise Wiseman explains the motivation behind her passion for improving the patient experience to Jim Cagliostro. 

 

Episode Introduction 

Denise explains the importance of a positive attitude in ruckus making, why healthcare needs a new paradigm of CARE, and the importance of setting rather than meeting expectations. She also highlights the need to make a ruckus about HCAHPS, the critical role of Patient Family Advisory Councils, and reminds us that all leaders are human – and everyone is a leader. 

 

Show Topics

 

• Making a ruckus is doing generous work 
• Calling for a new paradigm in healthcare
• Opening up conversations around the patient experience
• We need to make a ruckus about HCAHPS
• Expanding connections outside of healthcare
• Leaders are human too (and all of us are leaders)

 

07:32 Making a ruckus is doing generous work 

Denise explained how Seth Godin’s Akimbo program helped her to understand the definition of ‘’ruckus.’’ 

‘’So when I was given that opportunity to redefine my career, I took time to reflect and consider on what the right next step was for my career and also for my life. And so I took a few courses from Seth Godin and his Akimbo program and I don't know if you know much about Seth, but he ends his videos and his trainings with saying, "Go make a ruckus." And when he says that what he means, and this is a quote from him, "When we show up to make a ruckus, we're doing generous work. Work on behalf of those we seek to serve." And then he says, "We need to dig in and do something that might not work." And so when he is talking about making a ruckus, he's talking about thinking outside the box, embracing the unknown, being courageous and with a positive attitude and that's everything you'll see from Seth. It's with a positive attitude, stepping out, giving it your all, testing, trying and doing something differently. And Jim, that is exactly what we need in healthcare. And so being a Ruckus Maker, to me, is identifying those things that are problematic in healthcare. We're all aware of them. If you're on LinkedIn or in other forms, you're hearing people talk, complain about the problems of healthcare, right?  And I say, let's identify it, that's fine, but let's then understand enough that we understand the root of the problem, what's really going on to cause what we're seeing and then let's do something about it. And so that's making a ruckus, right? That's doing something about it. Let's stop blaming others, let's stop waiting for somebody else to solve it and let's take action.’’

 

09:39 Calling for a new paradigm in healthcare

Denise said a new paradigm of CARE would put the ability to take time to care back into the system. 

‘’So the second part of your question was my call for a new paradigm. And so you'll hear many people talk about the current situation in healthcare as broken and I'm one of those. And in many ways it is broken. Not everything. Not everything is broken, but we are a system in trouble. We have patients who are heavily burdened by many expectations of them, within healthcare. We have staff who are burdened by regulations, organizational policies and practices, by the current challenge of staffing, by the disconnect between those very highest in leadership and decision-making and what actually occurs in the moments of care delivery. Our current paradigm has healthcare that is not accessible to all. Our current paradigm refuses care or at least to pay for care for far too many or inadequately pays and leaves thousands financially devastated for seeking life-saving care. We have healthcare that being delivered on the backs of nurses and clinicians. They are beautifully heart-centered people for the most part and they're striving to do their very best. And when we talk about moral injury, it's true injury, they're suffering. So a new paradigm would be the definition of care and that's all CAPS, CARE. I'm talking about an experience of healthcare where there's trusted relationships between providers and patients, the patient is known by the provider, the gaps in care are eliminated, misdiagnoses and medical errors are greatly reduced if not eliminated. The new paradigm puts care, the ability to take time to care, back in healthcare. Or as my good friend Tom Dahlberg would say, "It includes love and the relationship of all connected with healthcare."

 

14:03 Opening up conversations around the patient experience   

Denise said the patient experience starts at the first moment of engagement. 

‘’….But here's the problem, there's a bigger issue with experience. Oh, so here we go. I should be able to schedule an appointment with my physician within days, maybe weeks of needing one. But in my most recent experience, I had to wait five months to schedule an appointment with a provider. Well, that's a bad experience from the moment I've engaged with your organization. And if I'm going to your ED and I have a two hour or more wait in the waiting room before any treatment has begun, that's experience of care. If I then have questions about whether or not I can trust the care that was given to me for whatever reason, perhaps a misdiagnosis, medical error or just a simple lack of or miscommunication, that's experience of care. And after all of that, I receive a bill for care that I can't pay for or will cause me extreme financial hardship, that is experience of care. And we are completely ignoring that with our conversations on our efforts for the improvement of patient experience.’’

 

18:21 We need to make a ruckus about HCAHPS

Denise said progress in the patient experience has been minimal. 

‘’We've not improved experience, not really. The nationally publicly reported data reflects that in those first few years, we did make improvements and that's because at that time there was concern about the money, the incentives that were attached to the results and there was some fuel behind that movement. And in part I think some of it, that improvement, is attributed to Studer Group. There was a lot of effort being done. But in the last decade, I pulled the numbers just recently and I put a thing out on LinkedIn about this. In the last decade, other than the most recent declines in HCAHPS because of COVID, our national data shows we're flat, we've made minimal, if any, like a one point shift improvement across the different components of the survey….And yet we spend hundreds of millions of dollars annually to the industry of patient experience and we've seen little value. In fact, I would actually argue that we're causing damage. So when we look at the survey, I don't have a huge problem with questions on the survey. So HCAHPS, we can look at, but there are actually over 20 CAHPS surveys and more are being developed and there are good reasons behind the questions they select. So communication with nurses and doctors is critical for our patient's safety. We have to be able to understand what we need to do to take care of ourselves. We also need to be able to express how the treatments are making us feel or any other communication.’’

 

25:47 Expanding connections outside of healthcare

Denise said band-aid solutions arise when we don’t listen to other perspectives. 

‘’… When we only ever hear from the same people, people with our same experiences, when we only experience the same experiences and when our knowledge is only deep, and deep is good, but it's not also wide, there's much that we do not know and our perception is narrow, it does not mean that our perception is wrong, but it's incomplete. And so when nurses only ever talk with other nurses, physicians with other physician, pharmacists with other pharmacists inside healthcare only willing to talk or listen to others from inside healthcare. And this one's really important in my opinion, when those who have positional titles or are considered thought leaders within their field are invited to the conversations or to make decisions, they're the only ones there. We're hearing only from the perspective of that group. We are then only working to solve our perspective of the problem. And this is what leads to band-aid solutions and gaps that we can't bridge. So I think it's absolutely critical for us to have a highly diverse, integrated and inclusive approach.’’

 

36:13 Leaders are human too (and all of us are leaders) 

Denise shared her leadership tips and emphasized the need for grace and understanding. 

‘’…in those positions, they're also under a lot of stress, they are triggered. And so I think the most important thing that I have learned working across our country and meeting with many different leaders is that leaders are humans. They are. I believe the majority of our leaders in healthcare, at whatever level they are, they truly come to work each day wanting to do the very best. Often they're not positioned to do their very best and they're struggling. And so when we talk about healthcare leaders, it's an area where we place a lot of blame. I see too much of that where we blame the leaders for the current situation in healthcare. And I think instead we need to seek to understand, we need to understand the very difficult positions they're in and why they are acting the way they are and making the decisions they are rather than just placing judgment on them. We need to be able to extend a hand to help and we need to be able to give some grace, if, when a leader makes a mistake because they will, we need to be able to give them grace and to let them correct. And then I think the other thing is each and every one of us, no matter what our position is, are leaders. And so how can we consider our own way of acting, mentoring, guidance, and leading in order to role model it to those around us, to those above us, et cetera. So instead of blaming and saying, well, they're acting that way, I don't have to be any better. I think each and every one of us owns our own actions and our own leadership in the space that we reside within.’’

 

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You’ll also hear: 

From dietician to Chief Ruckus Maker: Denise’s career history and lessons learned along the way. ’’What I've learned the hard way is that for-profit organizations are typically, for the most part, for profit before all else’’.

How an Achilles injury led to a life changing patient experience. 

The importance of setting patient expectations:  ‘’So that's a key word there that we're setting instead of meeting, and this is the psychology of experience. For example, a hospital is going to be noisier than your home ... .And so there's an element that talks about how do we set our patients up for that expectation, to ensure that they understand what we mean by the question on an HCAHPS survey about quiet at night. ‘’

Why HCAHPS surveys still have too many gaps: ‘’… huge demographic populations are underrepresented in the responses, but as I hinted at earlier, the surveys have many gaps. They're not capturing critical components of experience, they're not elevating systemic issues from our national healthcare system.’’

The critical role of PFACS (Patient Family Advisory Councils) ‘’…our PFACs are critically important, underutilized, under-supported. We ask people to volunteer their time when really they need to be a partner at the table with us and perhaps be paid in some method for their contribution.’’

 

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