Love as a Healthcare Strategy

EPISODE 19

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Over the past several months, we've seen a resurgence in the need for patient care and well-being with the COVID-19 pandemic sweeping the globe. Dr. Rod Brace, former hospital CEO and founding partner of Relia Healthcare Advisors, joins us to talk about what it takes to create a high-reliability culture. 

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Feel the love! We aren't experts - we're practitioners. With a passion that's a mix of equal parts strategy and love, we explore the human (and fun) side of work and business every week together.

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Frank Danna
Director

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Dr. Rod Brace

Dr. Rod Brace
Founding Partner, Relia Healthcare Advisors

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Mohammad Anwar
President

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Chris Pitre
Vice President

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Transcript

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Frank Danna
Hello, and welcome to love as a business strategy, a podcast that brings humanity to the workplace. We're here to talk about business, but we want to tackle topics that most business leaders shy away from. We believe that humanity and love should be at the center of every successful business. I'm your host, Jeff Ma. Okay, I'm just kidding. I'm Frank Danna. I'm a director at Softway, a company that helps businesses connect with their people to build resilience through culture-building products, leadership development, and technology. Each episode of love as a business strategy, we're diving into one element of business or strategy and testing our theory of love against it. Today, we're talking about love as a healthcare strategy. Over the past several months, we've seen a resurgence in the need for patient care and well being with this COVID-19 pandemic sweeping the globe. Does love have a place in this rapidly changing environment? Here to help us answer that question, is Dr. Rod Brace. Dr. Brace, can I call you Rod?

Dr. Rod Brace
Sure, absolutely.

Frank Danna
Okay, thank you, Dr. Brace. I'm sorry, it's gonna it's gonna take some time to get that right. But I do want to introduce you, Rod, because I think it's important that that folks know who you are and where you're coming from. So, Dr. Rod brace is a founding partner at Relia Advisors LLC here in Houston, which provides expertise and high reliability organizational models, organizational model and culture assessments and design, leadership development and governance board assessments and strategies including governance and management interventions. Dr. Brace most recently retired as regional president and chief learning officer for the Memorial Hermann health system in Houston. He served 30 years in operational positions including chief regional operations officer and hospital CEO and COO and nonprofit and investor owned health systems. Rod is an executive coach, national speaker, author and faculty member at both the University of Alabama at Birmingham and ACHE. He also holds an MBA and PhD in management with a research emphasis in employee engagement, organizational cultures and leadership. Rod, it's an honor to have you here.

Dr. Rod Brace
My pleasure. Glad to be here. Thanks, Frank.

Frank Danna
Also joining us some familiar faces and voices we have Mohammad Anwar, President and CEO of Softway.

Mohammad Anwar
Hi, Frank.

Frank Danna
And Chris Pitre, VP at Softway.

Dr. Rod Brace
Cheerio.

Frank Danna
Welcome, gentlemen. Okay, so, Rod, one of the things that we like to do at love as a business strategy is start off with some icebreakers. And I've just received the icebreakers from our executive producer, Maggie. So I'd like to start with Chris. Chris, would you rather mentally or physically never age?

Chris Pitre
Hmm.

Frank Danna
So the option is physically or mentally? Nevers a strong word?

Dr. Rod Brace
Yeah, that is such a hard one. Just like, I guess, physically age that way, you're alive longer, and you know, mentally aging. What does that mean? Really? Right. Like, you know, I feel like your brain is constantly hopefully developing and growing. So it's not aging if it's developing, right. So yeah, I would never I would never physically age so that my brain can continue to grow. And, you know, wisdom can be acquired.

Frank Danna
Man. That's good. I think you. You answered that question very well. Okay. Rod, I'll go to you. Would you rather have a rewind button or a pause button on your life?

Dr. Rod Brace
Huh, that's good. A rewind. I think I think pause would leave you second guessing all the time. And, you know, start and stop many times a day, but to rewind. Obviously, there's things that we say from time to time or moves and decisions that we make that we'd like to redo, so I'll go with the rewind.

Frank Danna
Okay, excellent. Mohammed.

Mohammad Anwar
Yes, sir.

Frank Danna
Would you rather, would you rather work more hours per day, but fewer days? Or work fewer hours per day and more days?

Mohammad Anwar
I'd work more hours and fewer days, so I have full days to myself. not do any work.

Frank Danna
I like that. I second that Chris thirds that

Chris Pitre
Friday's off right.

Frank Danna
So okay, thank you guys for starting us out and having conversation, it was all it was all themed around time. I like that. That's actually pretty an interesting thing. Thanks, Maggie for those. So I want to get us started, Rod, I want to start off with you and and really kick things into high gear here. I want to talk from your perspective. What are some of those unique challenges that you're seeing in healthcare right now?

Dr. Rod Brace
Yeah, so obviously the pandemic has caused healthcare organizations to rethink how they do things. As you can imagine, healthcare organizations are very dependent on protocols and policies and procedures. But then in the midst of that pandemic, a lot of those had to be thrown out. And obviously, need to for speed, the capacity, surge capacity and uncertainty when all this began of how the how the virus was communicate between people caused everybody to rethink. And one of the interesting things, at least on the teams that I've worked with, I work with some teams in New York City who got hit with with this the hardest was, one of the things that they had to do is sort of redefine their roles very quickly. And so the HR person was no longer just about HR, they had other things to do with setting up testing tents, and bringing in additional workers from all over the United States. And the CFO is not just about the finances, now they are in charge of working to provide medical staff. And so it caused sort of a reset or re-shifting of those roles and responsibilities of those organizations. And as you can imagine, when you're having to do that, and that's all this uncertainty, it really causes a lot of mental stress, a lot of mental pain, and many were dealing with issues at home, but they had to be at work. We, we saw nurses who just couldn't go back home, because they weren't sure at the time if they were taking the virus back to their family. So it was a lot of burnout and in areas that people were already sort of working up against the edge of human capacity. And then we saw some issues of the term which has been called by some a moral injury, whereby physicians, nurses and others were having to make decisions regarding who gets this care who gets this bed, or who goes in the emergency room. And so as you can imagine, those are very difficult decisions to make when it involves another human life. And so it creates this moral injury when you know, you should be doing something or you see something being done that, you know, should be done differently. But it just is not possible during all this. So it's very chaotic times.

Frank Danna
So I know that I know that one of the massive and important factors in healthcare is safety. And safety is a massive priority. But I'm interested to know because we've talked about psychological safety on this podcast before, in those moments when you're having to make choices that you've never had to make before. When doctors and nurses are essentially, in completely different capacities or roles. executives are in different capacities or roles. How have you seen psychological safety and the importance of psychological safety change or adjust as it relates to what's happening right now in the healthcare environment?

Dr. Rod Brace
Yeah, so if we back up, of course, psychological safety is just this essence, that you can be yourself that I can come to the workplace, I have people that I trust, I can say things, I can do things. And if if they're an error, then somebody will provide that information to me in a diplomatic and respectful way. And so in the, in the midst of a pandemic, when this uncertainty is in place, and just the speed of life of lots of patients showing up lots of people, not sure what they have, there were times and there are times where when we're in these new roles that you have to sort of rewire trust, that can I trust this person to do something that's not been done before? Can I trust this person to do something that's outside of their usual job, and we know that if someone is asked to do something that's beyond their competence level, then we know that that's, that can have a detrimental effect to psychological safety, because they're just unsure of themselves. And so the flip side of that, though, is, once you're in the midst of that battle, once you're in the midst of that firefight, trust builds very quickly, when when you have a team that comes together and they know the odds are against them, and they know that they have to depend upon each other and that trust can develop very swiftly and sort of that urgent and unforeseen atmosphere.

Mohammad Anwar
So I guess, Frank, that this relates to vulnerability-based trust in times of uncertainty, risk and emotional exposure.

Frank Danna
I would say yes, I think that that that that clearly articulates, you know, when you're in the midst of a crisis, you're you're able your capacity for forming bonds is increased. If you're open to building that trust. That's something that we talk about a lot here is the idea that trust is vulnerability-based trust is a collaboration of all three of those things. And it sounds like a lot of that has had to happen rapidly in the healthcare environment.

Dr. Rod Brace
Yeah, I mean, the old adage of never waste a crisis is always true, regardless of what industry you're in. And so this crisis has had good things come out of it. For one, they were sort of archaic organizational models in place that were able to be streamlined very quickly. And people saw that we didn't need all those levels of decision making it just give somebody the authority, and then let them go. And, and so even at the organization level, there's benefit, but also at the individual level, where I learned something about myself. And I learned that the extent of which I can operate under pressure is greater than perhaps what I thought it was, and or I more clearly see, from an empathetic point of view what somebody else is going through, and I can help them in that. And so a crisis is always a great incubator for some improvement. That, you know, obviously, the key is that you can implode there, there are many healthcare organizations who didn't do so well, through this. They, they tried to stay within traditional lines of thinking they tried to, perhaps ignore some things that they should have seen early on. I think, not just healthcare, but there are a lot of organizations who didn't really respond with a long term view of the pandemic, they thought, well, perhaps it'll be a month or two, and therefore, I'm going to put stopgap measures in place, but I'll go back to the way life was in two months, and you know, many months later, they've not been able to return to that. And now they're sort of behind on the curveball on getting their organization up to pandemic and post-pandemic speed.

Mohammad Anwar
I was gonna ask. So you just mentioned that there are some health systems that did well, compared to the others. Besides the long term view, or anticipation, what other factors do you think, lead, or have led these hospital systems to be more successful than others? What are the characteristics of some healthcare system versus the others that led them to be successful during this crisis?

Dr. Rod Brace
Yeah, so I think in any organization, but particularly in healthcare, it's going to come down to leadership and how leadership responds to that crisis. And so healthcare is no different than other organizations, if you have a leader at the head of the organization, that high on ego high on control command and control models, their bandwidth isn't big enough to really take on the change necessary in a crisis. And so the narrowing of decisions happen that we try to stay in a traditional mode, and it just can't respond. And so those systems that did very well had leaders at the top, that gave that power to others, that they empowered people to say, here's the end result, here's the, here's the outcome that we want, go do it, because frankly, each of us have so many things to do that we can't micromanage that situation. And my belief, micromanagement really comes from two things. One is you've either hired the wrong person, and so you have to, or you haven't trained them appropriately, you have to just really give them detailed step to detail step or the second thing and the one that applies to this situation is that your ego so big, that you won't let other people do the work. And so I think the health systems that sort of stalled throughout this had leadership in place that was not willing to give up the control, give the power to others, to innovate. And because it was uncharted territory, and I think one of the things that I see a lot in my coaching with my clients is that these leaders are held to higher levels of accountability. In other words, here's the annual plan, here's what we want to achieve, and here's all the things you've got to do. But they're not given the authority to do that. And so anytime there's a disconnect between accountability and authority, it's going to be a disaster. And so I think those health systems that didn't fare so well during the pandemic and some continued to this day, are those that have not been willing to push that authority down to the people that have that we're providing the assignment to the accountability team.

Chris Pitre
Interesting.

Mohammad Anwar
Awesome. Thank you.

Dr. Rod Brace
So we've been talking about the pandemic a lot. And to me, that's been, you know, a huge component in the current or the modern healthcare conversation. But prior to the pandemic, there was a term that was being circulated that I came across, which was high, high reliability. And, you know, I think that that's still relevant today, and even the pandemic plays into high reliability. But I would love to hear your sort of explanation of what that is, and and, you know, sort of describe, you know, what, what conditions or what's true of a high reliable culture, high reliability culture.

Dr. Rod Brace
Yeah, so high reliability, and that phraseology and approach really started many years ago with people that were responsible for nuclear reactors, or aircraft carriers and things that if there is something that goes wrong, it can be disastrous. So you could imagine any little thing that would go wrong in a nuclear reactor could have tremendous impact on that. And so it's been adopted in healthcare, or probably for the last 15 or 20 years. And it just means that it's an industry or an organization that has a very high risk of severe severe effects if errors occur. And so as you can imagine, in healthcare, those errors could be a medication error could cause a death, or misreading of an order that a physician gave to a nurse could cause the wrong treatment around injury. And so high reliability means that you just structure your organization with this sort of preoccupation with failure, that we know that all humans can fail. And therefore, we must do everything we can to create a situation where at least the processes and the procedures help prevent that failure. It's a reluctance to simplify. So for example, oftentimes, when something happens in our work, and somebody makes an error, we say, well, it's because they weren't paying attention. And so they made an error. Well, that's really not the root cause of that, though, you know, what, what caused them to not pay attention? What, what other distractions were out there, what resource didn't they have, they could protect their attention. And so it becomes this model of really an operating model that prevents error, at every possible place, and just studies the science of errors and, and really pushes that deference of expertise down in the organization. So that it's not the CEOs being asked how to fix this, because the people closest to the problem, fix it. Now, everyone, can, I think every organization can adopt principles of high reliability, it's just those that in essence, could cause a fatality, or sort of more apt to do it these days. And not all healthcare systems have adopted these. I mean, there, there's still hundreds of thousands of medical errors that happen every year in the United States. And so a lot of my work, a lot of work of my colleagues at Relia is really helping organizations understand those and then trying to create an organization, a culture, really, that is all about high reliability.

Dr. Rod Brace
That's great. Can you share just some of the principles that you think could be relevant to healthcare as well as non healthcare organizations out there?

Dr. Rod Brace
Yeah, sure. Well, just, for example, that principle of a preoccupation with failure, if you would look at an organization such as yours, what what are the mistakes that have happened in the past? Where are those errors, most costly? Why did they occur? And then taking an approach where you just continually ask why? And I'll delve into areas I know nothing about to try to give you an example in your world.

Dr. Rod Brace
An example would be, we haven't had Friday's off, right, we still haven't gotten that, you know, benefit from Mohammad yet. So I can imagine that creating, a lot of oversights, a lot of missteps, a lot of stress, you know, individuals creating work for clients and products that we're creating. And you know, you can start with that example. I'm just kidding.

Dr. Rod Brace
So I guess there was some meaningfulness behind Frank's question of Mohammad awhile ago.

Frank Danna
Maggie's trying to do Inception over here.

Mohammad Anwar
Just for clarity, they've been trying to get a four day workweek, instead of a five day workweek. And they want me to give Friday's off. So that's, that's the whole story, Dr. Brace.

Dr. Rod Brace
Let's solve that for them today

Frank Danna
Let's do it.

Dr. Rod Brace
The first, the first question is, why can't we get Friday's off? And the initial answer might be, well, we have too much work to do that we've got to extend it to five days. Well, the next question, then might be, is all the work that we have to do relevant? In other words, do we really need to do that work? Are there things that we're doing today that could be streamlined such that we don't need to do those and free up that capacity? And then if their answer to that is yes, then we would go to what is it about our normal day or normal five day work week, that could be eliminated, that could be streamlined that could be consolidated. And so it just becomes sort of this thread where you work backwards and backwards. And so the principle in high reliability is that you don't want to overly simplify. So we would overly simplify, but just saying, we have to work Fridays, because we got too much work. And most conversations would stop there. And so we always encourage people to ask why, why why, you know, five times you go through this, why? Well, why is it that we feel like we have too much work? Well, why? Well, because we've got a, you know, these clients are behind Well, why are that worked for that client behind? And so it's just why why why that would, that would be one. Another principle of high reliability is commitment to resiliency, that a lot of organizations lack resiliency, they give up, they get distracted, they sort of disengage from their work. And so as we teach people how to be resilient as we teach them how the organization is resilient, then that helps them become more focused in their work, become more engaged in their work, and you know, tell you in your organization, any organization, if everyone is fully engaged in their work, you're you're likely to increase your productivity by, you know, 40 to 70%, depending on the engagement level of your employees. I think another one, for another principle is this deference to expertise. Mohammad shouldn't be making all the decisions, I don't get the feeling that he does, I think he demonstrates sort of deference to expertise. But how can we do that more. And so in other words, you look through your organization, and you look for those disconnects between who am I holding accountable for what and have I really given them the authority to get that done? And that's really where expertise gets lessened in its capacity, because they don't have that ability to do that. Another principle is this idea of sensitivity to operations. And that just means that we don't work in silos. If something happens in this department, it's entered this interdependence, it will have some effect on other people. And so through trusting and honest and open communication, we have the ability to be very sensitive to any little flap of the butterfly wing, and Frank's department and how that might affect to Chris's department. And we have we have, because if you if Chris improves his outcomes, his safety, his quality in his area, but it's if the expense of Frank's area, then we've not really increased the overall level of quality and safety.

Mohammad Anwar
So I have a question regarding this high reliability systems. I know that you can Institute technology, process, and the people side the three components of building a full system. Where would you put the most weight on people, process, or technology in terms of building in a high reliability environment?

Dr. Rod Brace
Yeah, so a great question. But it's, it's sort of a trick question. I think the answer is you can't. And here's the reason. So one of the principles of high reliability is that zero harm is a core value of the organization. And so, zero harm would mean, zero harm to the patient, zero harm to the employee, zero harm to the community, zero harm to the leaders. And so if any of those three people process or technology is causing some harm, in other words, you say, I'm going to put more emphasis here at the detriment of the other two, then there is an element of harm there. Now, naturally, if you're in an organization where we've got sort of technology is going well, it's hardwired and policies and procedures are going well, and they're hardwired. And the only thing that's not up to its optimal level is employee engagement, then obviously, we'd put our attention there. And generally speaking, that that's how it works in most organizations, not just healthcare. It's the employee engagement, that is really sub optimized most of the time, and largely, it's because people don't necessarily understand, they they sort of understand what engagement is, I know it if I see it. But I don't understand what drives it. There are many years ago, there was an interesting, I think, McKinsey study that asked that very question. Do you know what, you know? Can you describe a highly engaged employee? And most were able to describe it. And then it asked, well, what are the causes of that engagement? And, and I think it was over 70% of the leaders, these are senior executives of the company, couldn't name the drivers of engagement, at least those drivers that have been found through science and research, it couldn't name them. They really thought it was things like, well, you got to give them stretch goals, and you got to show some tough love, and you got to throw a bunch of money at them. All of those actually, for somebody that's intrinsically motivated, are they disengage them from the work. And so I think we have this culture of leadership that just sort of steps aside and lets people be the way they are, they don't understand how to engage people. And so you know, the Gallup folks have done a survey for the last, I think, almost 15 years, every year to look internationally employee engagement, generally, about 70% of people across all organizations, all industries are not optimally engaged in their work. And so for in healthcare, at least the world I live in, that can be dangerous. If somebody's giving a dose of medicine, and they're not engaged in what they're doing. They're not sort of focusing on that, that can create serious harm to death. And so I think, to your question, Mohammad, and it's whatever needs the most attention, as long as by doing so we don't create a detrimental effect that causes harm in the other areas.

Mohammad Anwar
Got it. That makes sense. I do think though, that process and technology, you have a little bit more control, because you know, you can design technology to work a certain way. And you know, it's going to operate that way, 99.9% of the time. And, and, you know, processes can be defined the same way and have technology work around the process or work within the confines of it. But people on the other hand, it's the largest variation, like the variable, right, like, one day, the same person might be fully engaged the next day because of something that may have happened in their home or their personal life impacts their engagement level as at work as well. So yeah, I agree with you. I think you definitely don't want to harm any one of those. But the one that I think has the most chances of having fluctuations and, you know, the engagement level versus, you know, optimizing that part of the system. That's the hardest one. That's the trickiest one.

Dr. Rod Brace
Yeah, you're absolutely right. I mean, I think one of the mistakes that we make in terms of implementation of a strategy or project, whatever it might be, is that we assume that all implementers are the same, and operate at the same level every day. And and they don't they they obviously don't and, and so we have to at least create an environment in which they can flourish in that we were not able to make people be engaged, they have to choose to be engaged, but we can create a culture and environment in which it's easier to be engaged.

Mohammad Anwar
Sure.

Frank Danna
I actually wanted to ask a little bit about that the idea that, you know, a high reliability organization is operating. And we've talked about a lot of the principles that you mentioned. But I want to know a little bit more about like how that actually manifests in the doctors and the nurses in the patient care as a result of building these high reliability organizations. What have you seen in your experience when organizations and healthcare organizations are able to start implementing this type of approach? And how has that trickled down to the doctors, the nurses in the patients?

Dr. Rod Brace
Yeah, so it... the concept of philosophy can I guess you could say trickle down but the implementation of it has to really start from the nurses and physicians and people doing the work and i and i think the in the broadest concept is we know that healthcare is very complex and there are lots of moving parts to it. Therefore, we must assume that there are going to be failures. And we make that assumption and how do we put in place mechanisms for us to identify those, and then fix what the true source is that why, why, why, why. And the best way to do that is create a culture where people feel safe in bringing forward what we call near misses, I almost made a mistake or almost made an error, or safety issues. And they raised their hand and they say, this happened. Let's talk about how it happened and how we can prevent it. Now, easier said than done, because you have people who are fearful of being judged that I'm a bad nurse, I'm a bad physician, if I'm bringing up that I made a mistake, you have sort of the politics of relationships that well, you know, somebody, somebody else is going to get upset if I tell them their policy or procedure is not working. And so once all the human messiness gets in that, it tends to not happen, very busy, people don't necessarily want to take the timeout to sort of record what happened or almost happened. And so it's the job of a high reliability culture to make sure that you create an environment in which that happens as because the starting point, and it usually occurs in what in high reliability we call a just culture. and a just culture just means that there's trust, and honest communication such that people will bring those forward. And there's, there's not going to be a punitive reaction. When the nurse makes an error in in an injectable, there's not going to be a punitive reaction that says, well, you're a bad nurse, you're fired. And frankly, that happens a lot. For a lot of cultures, but the high reliability cultures would say, well, let's stop, let's talk about why that happened. While the nurse is distracted, or why they were distracted, well, they were short, a couple of nurses on the floor today. And so they were working short handed, or the the injectable for the drug that she was supposed or he was she or he was supposed to put inject into the patient looks very much like another drug that they actually chose by error. And so it's in the in the place that we store those drugs. And nowadays, we use technology so that they're sort of the barcodes where you barcode the patient and then barcode the medicine, it'll tell you if that but but still things happen. I had an instance where a pediatric nurse was giving a pretty routine injection to a newborn. And she happened to pick up the vial. And it just looked different to her. And even though as we went back, and we investigated it, what we found was it even though it had the right label on it, it was mislabeled at the manufacturer.

Mohammad Anwar
Oh, wow.

Dr. Rod Brace
It was actually something that would have been probably fatal to this child. But all the processes are in place, all the things are there. But it was that intuition. It was that high, highly engaged eye of that very seasoned nurse who said, yes, this doesn't look right. Let me let me just stop, just stop and try to figure out what's going on. And so the high reliability organizations are very good at creating those cultures, where every day we're solving new problems every day, we're finding ways that matter of safety could have could have been sub optimized. Every day they're trying to talk to the people at the bedside and say, well, what what created distractions for you today? What created barriers, what created a sense of urgency that was perhaps beyond your capacity, what areas of training do you need? Where are you not feeling competent in that? And so it's it's really more so of a culture, obviously, there are lots of ways that you can organize around committees to do the research and then in the investigation, training protocols, but it really comes down to having a just culture where there's nothing punitive about saying I made a mistake, unless that person willfully disregarded the rules, willfully went against the protocols that we have. And so a just culture is not necessarily a blameless culture. It just means that that somebody had to really break every rule to try to do it their own way, which caused harm to somebody.

Mohammad Anwar
So how do you how do you get people, and even in that scenario, I could see asking questions like, so why did this happen? And why do you think this could have been, you know, the reason and so forth? I'm just trying to empathize with maybe the nurses being asked those questions. Would that be intimidating and cause fear? Why would a nurse be open to responding to those questions with honesty? And like, what what have you experienced? And what what are some of the strategies or tactics that are used to still get to the bottom of those questions without causing fear?

Dr. Rod Brace
Yeah, that the, I think one of the biggest challenges for a healthcare organization that's moving from what we might call a fear based culture, a punitive culture, to a culture of just culture or high reliability culture is just that, where people have been taught that it's not okay to speak up and, as we all know, history is a great teacher. And so whatever happened to me, historically, I would expect going forward, until I build a trust that it's not going to happen anymore. And it's that bridge of trust, it's very hard to cross. And so in our experience, it basically, is, you just do it, you know, you you just find opportunities to demonstrate that we're not going to be punitive in our review these. And generally, what happens is, you'll have a group of employees who are perhaps a little more confident in their ability to kind of advocate for themselves or navigate these meetings, and we try not to make these meetings, you know, 10 people in a room firing questions at people, they're small, and they, they start with a handful of people that have an appreciation and empathy for it. And so you generally will have the people that will come forward and test the new the new structure. And once the other colleagues see that it went well for them, and they can encourage other people, then it's kind of snowballs. But it's, it's very hard, particularly when a mistake was made by a person. And particularly if it's a professional, such as a nurse or physician, that licenses are involved or staff privileges are involved, it's difficult for them to do that. And so once they do it, then we celebrate that. And so we've had instances where we'll, and many organizations to do this, you'll bring those employees to the board meeting, and let the board recognize them for their heroics of what they did coming forward. Thank them for making this information available to us. Thank them for having that commitment to zero harm, and in demonstrating, you know, through pictures in the newsletter of them, there or other ways people know that our our concern is for zero harm, and that that would include no harm to the employee, if punitive measures were not to be used.

Mohammad Anwar
Well, I definitely see that it's it does require quite a bit of courage and vulnerability from the employee standpoint, to be able to say, hey, you know, I made a mistake, or I was about to make a mistake that that definitely takes a lot of courage. How do you see the leadership playing a role in setting up this culture of just culture or high reliability environments?

Dr. Rod Brace
Yeah, so it's tough. It's tough. I mean, one of one of the things that we often experience is the CEO of the organization saw a presentation, saw one of our presentations, read some articles where, okay, now we want to be a highly, highly reliable organization. Let's show everybody a PowerPoint. I'll talk about how it's important. And then voila, we're there. And, and what has to happen is you really have to deconstruct how things have gotten accomplished in that organization for many years, because it's going to take the same path for this, quote, project and high reliability is not a project at all. It's a it's a philosophy, it's a, it's a way of being. And so what is oftentimes detrimental is sort of that second or third tier of leaders who said, okay, the boss said we got to be highly reliable, highly reliable now. Their employees know that they haven't bought into this non-punitive behavior, particularly when they still have a fear-based culture. And unfortunately, even through the pandemic, at least in my experience with my coaching clients and our the work that organizations that we work with, fear-based culture has sort of been increasing, not decreasing during the pandemic, because nurses were seeing colleagues being laid off, cutbacks, hospitals taking great financial burdens through this and, and so as you all know that the human mind is really constructed to try to make sense of everything. And so I can't make sense of why people are being fired. And I might be next. And obviously, if I make a mistake and admit to it during these trying times then I'm going to be gone, or the last time I admitted to my boss that I madea mistake here, she just went crazy on me, and you know, was very punitive. You just can't have that. And so a lot of our work is also assessing the leadership generally, when we go into organization we'll say, think about the top 20 leaders, either formal or informal, that it's going to require to move this forward, then we use some leadership assessment tools that do it's a 360, that not only looks at their self evaluation, but also the traditional stuff of peers and colleagues and so on. But it has a third piece to it, that's pretty unique in that it then ranks them on percentile against all other leaders are about over 100,000 leaders in this database that that we use. And so we're able to see through that, that this leader uses fear-based tactics with their direct report, or this leader and the opposite scale has a very high characteristic of care and connections or empathy or a selfless leader. And so it's those leaders that we know are going to have a better chance of really creating this just culture where, where they're not perfectionists where they don't have to be they're not, you know, overly disrespectful to people, they're, they're not accusatory, it's those type of leaders that are really going to have a tough time. All of a sudden, convincing people Oh, yep. slept on it last night. And today, I'm not gonna be punitive anymore.

Dr. Rod Brace
Yeah. You know, as I've been listening to you talk, it sounds like there's a, I guess, a high correlation between high reliability and inclusion, and the need for leaders to really think about how they make space for, you know, their direct reports, or folks that are maybe on different teams who might be closer to the, you know, frontlines and making sure that they have a voice, but not just a voice but a platform to speak from, or they don't have a voice it's given to them, or, you know, the leader sort of gives the microphone over and sort of steps back. But it sounds like there's that high correlation.

Dr. Rod Brace
Yeah. So even in the one most extreme, Chris, if we really have bought into the concept of zero harm, then anything that excluded people or was divisive in that would create harm, and therefore, you know, we should not be about that. But then on the other, the other more positive scale of that, I have a broad set of backgrounds and thoughts and abilities to manage innovation. Those are very beneficial to a culture of high reliability. Because every day in healthcare, there's some introduction of a new disease or a new technology or a new government policy. And so the more minds that we can bring around that, that have different perspectives to do that, the better, we're going to be prepared to crack the code on those complexities. And so absolutely, a just culture is built on justice. And justice really has to be equally applied.

Frank Danna
Wow.

Chris Pitre
That's awesome.

Frank Danna
I want to ask, this has been a phenomenal conversation, by the way. It has not felt like 44 minutes and 12 seconds, I promise.

Chris Pitre
I've been like taking notes if you can see me write that like writing, I've been taking notes as you've been talking.

Dr. Rod Brace
Thank you.

Frank Danna
And I wanted to I wanted to ask quickly before, before we let you go, I wanted to learn a little bit more about how you got started down this style of management and leadership. What inspired you to move in this direction and what continues to inspire you today to continue to move this forward for organizations interested in moving into high reliability?

Dr. Rod Brace
Yeah, so, um, you know, there, there have been a lot of things but probably the most impactful to me is when I was early on many years ago as a hospital CEO. First hospital I'd ever had, I'd been on the job a couple weeks. And one afternoon, our Chief Nurse Officer came to me and she said, Rod, I need to share with you that we've had a medical error. And a nurse gave the wrong medication. And unfortunately, it led to the death of this gentleman in his early 40s. And it's our practice here at the hospital, that we would meet with the family. That nurse that created the error is welcome to join us if she wants. It's not an obligation on her part. And so I've set that meeting up for this afternoon, and we're going to meet with this gentleman's wife. And I said, Oh, yeah, okay. I'll, you know, I'll be there. She said, I'll sort of lead the conversation. And so we get to that, in this obviously, this bereaved wife, she's a mother of two teenage twin girls. The nurse chose to come to the meeting. And she obviously was in tears and explained how she had been in a hurry. And she, this was before barcoding, and all that had picked up the wrong medication and gave it to this gentleman. And so we, the nurse apologized, we all apologized. The wife was very well composed, moreso than I would be. And so at the end of the meeting, I just said, Ma'am, we're so sorry. And if there's anything we can ever do, please, please let us know. And to her credit, she said, Rod, I appreciate that. I don't think there's anything you can do today. We just we just need to sort of come together as a family. But maybe in weeks to come if we could just talk about what happened, and maybe there's some things that we could do that I could give you some pointers on that this would prevent this for somebody else. I said, super absolutely. Frankly, I was ready for the meeting to be over. It was just one of the hardest meetings I've ever had, as a new CEO. Many weeks went by, and I frankly had forgotten about it. My Secretary came to my door one day, and she said, it's Mrs. So and so wanted to take you up on your offer to chat. And I did the name didn't quite click with me. And she said you recall, it's the the wife of the gentleman that passed from a medical error, mother of two twin teenage girls. Yes. Oh, yes, absolutely. Just, you know, ask her what time is best, have her come on by, I'll clear my schedule. And she's she said, well, I talked to her and she said, as you can imagine, she really didn't want to come back to the hospital, sort of bad memories there. And she asked would would you be willing to meet her for lunch? I said, absolutely. Forgot about it again. Two weeks later, I'm looking at my calendar that morning, see what I have. And I see I have lunch with this lady. And frankly, a little apprehension came into play that we're you know, we're going to be out at a restaurant and she's, you know, gonna lose it, is she gonna yell at me? You know, but I committed to doing and so I went. So I showed up to lunch and sit down at the table with her she was already there. And we exchanged some pleasantries. And, and she said, I really appreciate you meeting with me. I think there's some things that I saw during our stay that can help with, you know, reducing the load on the nurses of confusion. But before I do that, I just like to show you something. And so she reached down beside her at the table and a little tote bag. And she pulls out and sits on the table a photo album. And she starts to flip through those photos. So here's here's me and my husband as we met in college, and here's where we are at our wedding. Here's the birth of our twins. Here's them at their high school volleyball games, and she was flipping through this photo album. And after a few pages, the pages were blank. And she said, here's where I'd hoped to have pictures of my husband walking my daughters down the aisle and here's where I'd hoped to have family vacations and here's where I'd hoped to have pictures of him with our grandkids and she said, frankly, Rod, your hospital took that from me. And I'd used the phrase, you know my hospital, but I'd never heard it in that sense of your hospital, you Rod, your obligation to the patient. And so that was the one that sort of set for me sort of my obligation to my employees. And obviously the nurse that created this error wanted to quit, wanted to leave nursing, we talked her out of it, we made sure that we doubled down on nursing competence, strength training, we brought in a quality director. And so, that really personalized it for me. I think, over the years, I've worked with many professionals, my partner in Relia on Dr. Michael Shabbot, who you all know, Chuck Stokes, system CEO, nurse by background and have have really taught a lot to me about these principles we work together over over a decade. And so there's lots of other things. But I would say it goes back to that point in time where it was personal for me that I have to have a personal obligation to the people I serve, as well as the people that I lead. And so it's really a moral obligation for me.

Mohammad Anwar
Wow. Dr. Brace, that was a very, very touching story, but also very strong, you know, personal case for change that you shared with us that I think is gonna leave us thinking about this for a while. Really, really appreciate you sharing that. Thank you.

Dr. Rod Brace
Happy to be here, I appreciate the opportunity to chat with y'all.

Frank Danna
And and I wanted to say I think this is maybe a good place to close it. But I wanted to say thank you again, because your story is, is is extremely helpful on multiple fronts. Number one, I think there's plenty that any person in business can take away from the the approach that you're taking, and really the the passionate commitment you have to helping organizations change and become begin to thrive. Right? in this space where you have your you're moving from fear based to just. You're talking about care and connections and selflessness, people being non-accusatory, creating teams that are willing to share when they're making mistakes, you know, all of those elements, at Softway, we translate those to love. And, and I see I see such a deep rooted connection, in the way that you approach helping leaders recognize the opportunity and what it can mean for them helping, you know, nurses and and all these different individuals all across the spectrum, see how care for one another actually translates to better performance and more reliability. And I think there's plenty of lessons people can take from this conversation as to how they approach their own business.

Dr. Rod Brace
Yeah, totally agree that you use the term love, I use the term endearment. I think the goal of a leader is to have their employees endeared to their leadership, this deep affection. And I really summarize that, that all people want to be cared for, and they want to make a difference. And so it's up to that leader to really figure out how do you care for them? How do you make sure that they make a difference in life and when you do, people will be endeared to you and you'll naturally be endeared to them.

Frank Danna
That's amazing. Yeah. Awesome. I thank you again, so much for taking the time to speak with us, this has been a phenomenal conversation. And I just from everyone here, thank you for your time. I do want to talk about Love as a Business Strategy. We are posting new episodes every Tuesday. Is there a business topic that you would like us to cover, you the listener? Let us know. You can let us know by going to our website softway.com/LAABS. And if you like what you heard today, please, it does help to leave us a five star review. And subscribe on Apple, Spotify, Anchor, it would mean a lot to us. So again, Dr. Rod, thank you so much for the time. We really appreciate it. It was it was a wonderful conversation. And for our listeners. We'll see you next week.

Transcribed by https://otter.ai

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