Notes from the Waiting Room

December 8, 2010

When Trees Walk

Filed under: Notes from the Waiting Room — bartwindrum @ 9:29 am

I’m attending my first IHI/Institute for Healthcare Improvement conference. Along with 49 other “patient activists” I’ve been invited to attend as a guest of IHI in its inaugural outreach to citizens who have felt compelled to act to help all of us overcome medical error, safety lapses, and provider-centered treatment (distinct from patient-centered care). In the run-up I learned that IHI is the heavyweight in the healthcare improvement arena, and the scale of this conference is immense. 5800 attendees (seats occupied, breakfasts and lunches served, bodies bussed hither and yon). Another 15,000 video linking for the keynotes.

In my own book and talks I say that “providers can’t see the forest because they themselves are trees.” Meaning, rooted; stuck in place. That it takes we citizens, who have traversed the medical forest and come out the other side, to map it for those whose turn is next.

What happens when the trees start walking?

The obvious answer is “some reconfiguration.”

This conference is filled with a provider mix of doctors, nurses, admins and others interested in and devoted to positive systemic change. One midwestern community hospital system built a new facility, after 3 years’ design time, that’s entirely patient-centric. They redesigned their concept and implementation of much of what transpires in a hospital with the express goal of making patient-family experiences there quick, easy, safe, and humane. The CEO and architects made the presentation.

I took part in an extended role-play exercise in which real doctors played the part of a doctor as they tried to learn how to initiate, sustain, and successfully complete The Talk (the conversation that ensues when a loved one is known to be dying). Never mind that I believe that docs are actually taking on more than their fair share in this pursuit; that it’s each of our responsibility to initiate The Talk, and years before our demise. Providers will do this because they must; it’s their daily environment. Even knowing how hard beginning The Talk is (I failed with my own father—and it was my failure, not his), watching long-time surgeons and ED docs struggle to get it right gave me new appreciation for how much cognitive, emotional, and language skill is required for a most sensitive series of moments.

Because even this provider population represents a fraction of providers, perhaps walking is not the term that best describes this activity on a system-wide scale at this time. Perhaps “writhing” is a better descriptor of the system as a whole. But there’s no doubt: a growing number of medical personnel are aware of, focusing on, and changing their behavior toward patient-family needs. The whole system won’t change anytime soon, and I remain prepared and ready to advocate for myself or my hospitalized loved one in any setting. A new aspect has arisen: now I must first assess to what degree providers I’m engaging are patient/safety centric. One might suggest that such centricity would evidence itself.

A real-time reconfiguring forest. Interesting place to walk.



  1. Interesting metaphor! Trees also bend with the wind, and perhaps the winds of change will make those difficult conversations between doctors and family members more fruitful.

    I also found the Forum, and your discussion with me at the Leadership Summit reception, highly stimulating. Thank you – great to meet you!

    Comment by Ken Farbstein — December 9, 2010 @ 8:37 am | Reply

  2. […] And so I kept at the repeat button, on the upmost upbeat, at full volume, for hours, and hundreds of miles. Anticipating the patient activist leadership summit at IHI. […]

    Pingback by Nanny Nay Nay « Notes from the Waiting Room — December 14, 2010 @ 11:42 am | Reply

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