Faculty

Brian D. Wong, MD, MPH — CEO

You’re one of the most sought after speakers in the healthcare industry. What is it about your message that is so relevant for everyone in healthcare, from physician to nurse to board member?

We all know that the current state of healthcare is unsustainable. Our workforces are an overwhelmed collection of tribes and sub-tribes in an initiative-overloaded system that has deteriorated into an every-man-for-himself environment. This leads to dissatisfaction, disengagement, not to mention quality and safety issues...and the thousand other things we know aren’t working. We’ve learned a vital, simple and universal truth along the way: in order to reform the system, we must also reform ourselves and our interactions with each other.

Where the Bedside Trust has focused—and what I’ve spent most of the last decade on—is discovering a way to teach every person in healthcare this universal truth and to build a foundation on it, a relational foundation that can then drive operational results. We teach key business essentials that guide the process, including learning how to diagnose a problem, any problem, at its root cause. With that skill in place, we teach our clients to utilize a specific problem-solving method that results in community intelligence to produce the best possible solutions.

It’s really quite simple, not that it’s always easy.

What are the three or four top takeaways you offer your clients and audiences?

That’s a really important question and it’s crucial that people understand that this isn’t some soapbox lecture. Our audiences leave with new skills—real, usable skills—that will allow them to begin the process of creating change. We don’t set people on a two-year journey that might eventually lead somewhere. We hand out tools the first hour...and every hour afterwards, so they can start now.

The top takeaways, to name a few are:

• Tools to create a foundation—what we call a cultural operating system—that intentionally links relational capabilities with operational capabilities.
• How to embed key drivers and a powerful problem-solving tool to produce an organization that is both powered by community intelligence and is self-organizing.
• The way to eliminate unnecessary PI initiatives and maximize the organization’s limited resources
• That these lessons are simple, easy to learn, timeless and universal in applicability and that they can be used by anyone, anywhere to solve any problem

We know your work has had a dramatic effect on the medical communities and hospitals you’ve worked with. Can you give us an example of the impact this has on physicians who are often viewed as the most difficult group to engage?

Being a physician myself, I’m aware of our collective reputation. We’re known as driven, high performing, over-achieving, rugged individuals who are accustomed to being the smartest ones (the “Top Dog”) in class. Taken to extreme however, these same characteristics can also lead us become impatient, judgmental, demanding, unforgiving, egotistical, prima donnas, all of which are not helpful in a team setting.

Recently, I met a physician at a client organization who had a reputation for being an excellent clinician but also a very disruptive physician known for whining, blaming, complaining and retaliation. He sat on the medical executive committee and was seen by administration as a very difficult person to deal with.

Following a keynote address in January, he came up to me to thank me for giving him what he considered to be life-changing insight. Almost immediately, administration and nursing began to see a change in him. By April, he was participating and fully engaged to improve physician-staff relationships in a rapid cycle process improvement project. By July, he had become a champion of the process, actively recruiting other physicians and assisting in rolling out the successful “test of change” to other units at his hospital. In August, he was unanimously selected winner of the hospital’s quarterly service excellence award.

Those kinds of stories are great to hear. Amazingly, they are not that unusual either.

You’ve been quoted as saying “we must change the way we get things done.” Can you help us understand what you mean by that?

The way we currently get things done in healthcare is simply unsustainable. As an industry, we’re overwhelmed, inefficient and fragmented. And the solution isn’t a matter of what to do. We have enough to do. We’re at capacity. We know what to do, but our methods of getting things done are too complex and ineffective. In order to achieve the performance measures we’re striving for, there are two things we have to achieve in every healthcare organization. First, the organization has to learn to solve problems at the root cause and solve them collectively, as a team. Second, we must acquire the community intelligence that the organization needs to innovate and produce the best possible solutions to our problems. These two principles are at the core of our Cultural Operating System.

But we know how to solve problems, right? Yes. We've each been trained as expert problem-solvers. The problem is that we are taught this skill solely as individuals. We've never been taught how to solve problems together, or even why this is so important. As things become more and more complex, it is imperative that we master this skill.

I once saw a T-shirt that read: Teamwork - when a lot of people do what I tell them. This seems the perfect fit for us in healthcare. In my work with organizations, I often hear, "Be reasonable, do it MY way." When you have a room full of smart people with very strong opinions (and large egos), each trained to solve problems on his or her own, it’s a recipe for disaster.

At the very least, it becomes a recipe for impasse, for lack of consensus and for organizational paralysis. Typically, this is overcome through the sheer exercise of power: the loudest, the smartest, or the highest ranking exert control and make the tough decisions on behalf of everyone else. This is “command and control” at its worst and it’s indicative of much of our industry.

Those on the frontline who must carry out these decisions rightly feel disempowered, so the result is more "upward delegation" until only those people at the very top of the organization possess the power to solve problems. This, in turn, leaves those at the top feeling overwhelmed and dissatisfied and those at the frontline feeling disrespected, disengaged and downright unhappy.

What's needed is a completely new philosophy, a new mindset, a new approach. This is what is at the essence of the statement “changing the way we get things done” and it's the key to our collective effectiveness, efficiency, productivity, profitability and fulfillment. It’s what our Cultural Operating System is predicated on: teaching organizations to solve problems collaboratively, to create a self-organizing system, to develop community intelligence so that we find the very best way and provide the very best care, every time.

Larry McEvoy, MD, FACEP — Client Advisor

You are an ER physician, a physician-executive and now the CEO of Memorial Health system in CO, as well as being one of the founders of the Bedside Trust; what can you tell us a little bit about your vision for healthcare?

Anyone who has ever been sick or had a family member who’s been sick realizes how important it is to have very skilled and very committed people taking care of you. From my standpoint, healthcare has always been and still is blessed with an abundance of very committed, very skilled people.

If you look to the future of the industry, the complexity of the tasks now requires us to do things better; and better in a way that is just as personal but even more reliable. That, to me, means I can no longer simply be a good doctor or a good nurse. Now I have to be part of a team of very skilled, committed people giving very good care.

To do that, each of us has to make a profound transition from being skilled and committed individuals to becoming teams of skilled and committed people who can constantly innovate and improve the care we provide. The skill of successful teamwork leads naturally to a self-organizing workforce and collaborative problem-solving, which are the two fundamentals that every organization must master. Only by solving problems as teams do we create solutions that best benefit the quality of care we offer, the people who work for us and the communities we reside in.

As co-creator of the Cultural Operating System and a CEO who has implemented a COS in his own system, what are the most significant benefits to the patient, to the medical community, and to the organization?

The COS was designed to help organizations guide their relational and operational parts and to integrate them in order to drive the best possible results. It’s a lot like a computer; your computer has an operating system that enables it to run whatever programs you want--Microsoft Word or Photoshop or a game. Like computers, healthcare organizations need an operating system. In our industry, that system (what we call a COS) is composed of two-parts: an essential set of relational guidelines and a specific problem-solving model that utilizes these.

With a COS embedded, an organization can run any program or initiative successfully. Problems that were once unsolvable can now be addressed with an approach that works. The COS shows us what to do and how to do it and it enables us to be self-organizing systems, which allows us to be dependable, to renew what we’re doing and to constantly innovate.

As someone who has embedded a COS in my organization, I’m amazed with the momentum that’s been created. People are becoming master problem-solvers and they now have the tools to work together to create community intelligence. At the organizational level, we now have a common set of rules we utilize to govern individual behaviors and these enable us to work together to solve problems collectively.

The results I’ve seen in my own organization and in the others I’ve seen are astonishing; there’s a decrease in unnecessary PI spending, a maximization of resources, and a reduction in time wasted on escalating problems rather than solving them. What’s perhaps more remarkable is that community is driving the changes. Work is getting done more easily and people are seeing what things they’d like to get accomplished and they’re initiating change themselves.

One of your primary focal points is on the importance of self-organizing teams. This has had a major impact on a number of Bedside Trust client hospitals. What about this concept is so crucial to the success of any organization?

Creating a self-organizing system is a key principle of our Cultural Operating System. Currently, our industry is trying to work by the “command and control” method and we’re failing. Our people are at capacity and they aren’t engaged; problems are constantly escalated, and assets and resources are squandered on trying to push the organization in the desired direction.

To evolve, our organizations must be self-organizing. Our work in healthcare is so complex, so ever-changing and it can be so chaotic that you literally can’t improve quality with a command and control approach.

To get the innovation we need, we have to create a culture that supports that kind of activity. That means a culture that can both meet that inherent complexity and also be ever-changing, ever innovating and yet stable. In development of our Cultural Operating System, we explored the conditions that drive self-organization and the skills that allow it to flourish. What resulted were The Trust Cycle and the Stem Cell Solution.

One part of the COS that you often highlight for others is the Trust Cycle. It seems to be something that’s gone viral in your organization. What about it is so vital to your organization’s success and how is it fundamental to the industry’s culture in general?

The first reason for the Trust Cycle’s success is that it isn’t something someone else invented. It comes natively out of clinical endeavor. In the ED, for instance, my colleagues and I always looked for someone with certain attributes. Over the years, we knew the kind of people we wanted to work with. It’s true of all of us. If you’re in the middle of a procedure and in trouble, you know exactly the kind of person you want to help. The attributes that rose from that are what make up the Trusted Colleague, which is the first step in the Trust Cycle. These attributes are guidelines that set the tone of the organization; they drive the culture. They can’t be overemphasized. In my opinion, they’re more important than mission/vision/value because they’re the things that drive M/V/V.

We’re experiencing success with the Trust Cycle in spades in our organization. We began by using the Trust Cycle with our executive team and now, I have doctors coming to me for it. They see it working in the executive team and they want to take it to their teams. Those team members then cross over to other departments and take it with them, and in this way, it propagates itself through the organization. It isn’t some declaration from the executive suite that says, “Everyone has to do it this way.” The desire to utilize the new tool comes from those who’ve seen it work. And so they drive it themselves.

The first question we ask when we start the Trust Cycle is ‘Are you willing to be one’? You can’t put it in reverse. You can’t ask other people to go first. It requires personal commitment and that is a huge factor to itself impact and its success.

Your audiences often hear you talking about the importance of designing an organization that integrates culture with operations. Your Stem Cell solution is a model that ensures this incorporation takes place. What are the benefits of cultural and operational integration for physicians? What about for healthcare executives?

We always talk about how bad processes and relationships blow up good people, and in turn how bad relationships and bad behavior blow up good process. If you’re clear on what you want to do, that’s an essential starting point, but you have to be clear on how to go about doing it. You have to answer the how piece from the standpoint of method, process, approach and what kind of relationships, behaviors, culture will enhance those.

In med school, we weren’t taught how to collectively solve problems. We might be good at it individually but through this Stem Cell Solution process, we’re learning for the first time how to problem solve collectively. This is critical. Currently, the industry is reductive because our methods are deductive. If the industry is going to be generative and innovate better solutions and practices, then our methods must be generative; conversations have to be generative, methods have to be generative. We don’t want reductive simple answers to complex problems. We have to access lots of different perspectives, insights, and ways of looking at things in order to acquire the community intelligence which allows us to find not just a solution but the best solution.

It’s also important to recognize that the Stem Cell Solution doesn’t work without the Trust Cycle. The solution can’t just be operational without that core relational piece. This is why the COS incorporates both: the relational Trust Cycle with the operational Stem Cell Solution.

When you provide both the essential skill sets—the Trust Cycle—and set the conditions for the problem-solving—the Stem Cell Solution—then you get that happening. It creates generative results—self-organization and acquired community intelligence. That’s what we’re building for the future of healthcare.

Debra Parsons, MD, FACP — Lead Faculty

You’ve served as medical staff president of Exempla Saint Joseph Hospital in Colorado. How does that experience feed into your work with your Bedside Trust clients?

What my experience really drives home is the undeniable truth behind everything the Bedside Trust does: an organization’s culture and its people is both what drives and what impairs its success. I can’t emphasize that enough.

If we have barriers, overcoming them has to stem from forming strong relationships . If we have successes, we can thank a successful culture. Getting medical staff to partner with administration in order to improve delivery, safety, and quality...it’s all about culture.

The industry’s new buzzword is leadership and people love to fall back on that. “The problem is the leadership....where’s the leadership?” But the truth is that the leaders can’t effect change without the right culture in place. That’s what our work at the Bedside Trust is all about. And my experience as medical staff president speaks to just how effective the Bedside Trust’s method (what we call the Cultural Operating System) is.

You joined the Bedside Trust faculty after the company was created. How did you become acquainted with their methodology and what about it drew you to join them?

Brian came to Exempla Saint Joseph Hospital before I was medical staff president. He presented a keynote and did some facilitation and at the time, I remember being impressed. His message made sense and he had a real impact, but it wasn’t until I took over as medical staff president that I realized that Brian’s system was exactly what we needed to engage our teams.

So we brought him back. The result was two of the most successful collaboratives in the history of our organization. That’s 140 years! We derived success because we identified what contributes to success and these were based on the primary tenets of the Bedside Trust.

We discovered that if we began by understanding what our teams wanted to do and then gave them control over where to invest in improvement projects, let them organize into teams, the result was that we saw real change. They self-organized, they sustained their energy and we got more growth, better capacity, safer, smarter processes. It’s phenomenal.

My mission now is to help every organization reach the kind of epiphany we experienced by helping them learn the specific things they can do to change the course of their organizations. Hand in hand with that is my goal to help our industry develop leaders in ways that enable these epiphanies by using the Bedside Trust philosophy and tools, by having world cafes to discuss problems, and by using the Bedside Trust approach to solving them

Why is utilizing the Cultural Operating System helping organizations solve so many of the issues we’re experiencing in healthcare? How does this have a sustainable impact on the overall industry?

It’s sustainable because the practices are second-nature and it works because it’s simple. The first part of the Cultural Operating System sets up guidelines about how to show up at table and the second offers a proven methodology to solve problems once we’re there. The first piece makes the second possible. That is, the first part creates an environment where it’s possible to understand problem first. And because it sets up the way in which we treat each other in that process, people are willing to speak honestly and to invest themselves.

With the foundation of the first, the second problem-solving methodology works. And it works with every problem, no matter how big or small; it also works for physicians, for nurses, for any group or cross-section as long as we follow the behavior guidelines of the first part.

In this way, people can work independently; they become self-organized. Then, what we see is a feedback loop. These incremental, vital changes enable the organization to achieve real success, which then breeds more change and furthers the organization’s successes.

As individuals, we want to focus on things that are clinically relevant for us, so we drive those projects and in the end, the administration derives the benefits of better quality and lower costs.

Talk to us about some of the breakthroughs you’ve seen clients experienced by using the BT’s problem-solving method. Can you describe the value of the problem-solving process and why it’s so crucial to the industry?

Part of the breakthrough of this method is that it allows people to have an understanding of the root cause of problems, something we don’t normally get. Going to the root cause, we see all the layers and we learn about things most of us have never considered. The process of drilling down creates all sorts of epiphanies for people, new ways of knowing, seeing, and understanding.

Discovering the root cause also serves to bring people together and make them recognize that success means working as a team, utilizing community intelligence, in order to get the best choice for the group. With that, they can discover a good solution. It’s no longer black and white, which has historically led to the every-man-for-himself mentality.

With this system in place, organizations now leverage their collective community intelligence to the best end result.

In your career as an internist, you’ve also been chief of staff and a clinical professor for twenty years. With all this experience, you have a well-rounded view of what the industry is suffering from and how to treat it. How would you describe the diagnosis and the best treatment?

Brian describes it better than I ever could: overwhelmed, fragmented, and inefficient. I whole-heartedly agree with what he calls the distrust cycle and I also agree that no one wants it to be this way.

Doctors may show up angry and disrespectful, but they began with an altruistic core. We all did. We’re largely deflated because of being overwhelmed and the resulting waste is phenomenal, unbelievable. When you see it, it’s depressing. Most people don’t know how to proceed, which leads to this survivalist mechanism of every-man-for-himself. We surround ourselves with people who think the same way because we need someone to validate our points of view. We all know it can’t continue to run the way it is.

The best treatment is to begin with the relationships, the conversations. Show up every time as T.R.U.S.T.E.D Colleagues and understand the problems before we try to solve them. That way, we can change how the industry is working. That’s the magic in this. It’s embedding simple, straightforward building blocks that we either lost or never learned...and then using this fundamental intelligence to ask the right questions, find the right answers, one at a time.