February 2009

Jared N. Schwartz, MD, PhD

Better to show than to tell

When I opened the New York Times and saw a story headlined “The Urgency of a Defensive Back,” I knew that Harvard professor John Kotter, whose latest book is titled A Sense of Urgency, had again captured a trend. When a term like “urgency” shows up on page one of the sports section, it’s safe to assume we have turned a cultural corner. Urgency is in.

In the New York Times story, sports­writer Karen Crouse describes 22-year-old football prodigy Dominique Rodgers-Cromartie, a “6-foot-2 beanpole with a beaming smile and blazing speed” who has only one kidney. He is focused, intense, and confident, she says, perhaps because his medical history and personal story have taught him to live in the moment, “getting the most out of today because tomorrow is not promised.”

Kotter talks about urgency as a quality of leaders whose line of vision is steadily trained on the big picture. He describes an intentional, informed perspective that drives purposeful action. A sense of urgency, he says, translates to behavior that is neither frenetic nor anxious. His role models are comfortable with change, clear-headed, and results driven. They listen to their employees, their competitors, and their peers. They understand it is most often the heart, not the mind, that motivates, and that actions speak louder than words.

Kotter underscores the opportunity cost of failing to recognize that the greater environment is in flux and to act accordingly. He acknowledges that we are inclined to assume that if our own house appears to be in order, we must be safe, especially if we work in a traditionally sound and well-managed system. So he advocates for strategies to “bring the outside in.”

Kotter describes what he calls “burning platforms”—once–solid foundations that catch fire as the environment heats up. There are always opportunities in the embers; those who are alert will choose change to survive. The leaders in our specialty are well ahead of the curve on this one; people are doing the right things right in laboratories all over the country to transform the role of pathology within the health care system.

“Show us, don’t tell us” is especially useful when a lot is going on and people are distracted. For example, new Medicare rules cap compensation for care of inpatients who have suffered designated “never events,” which include certain hospital-acquired infections. This, in turn, has drawn attention to controllable behaviors, including insufficient attention to hand-washing protocols.

At John H. Stroger Jr. Hospital in Chicago, Kathleen G. Beavis, MD, who chairs the medical divisions of microbiology and virology, has created a novel campaign to promote hand washing. Her staff will circulate to other hospital groups, set up a table with blood agar plates, and invite everyone to leave fingerprints on a plate. Microbiology will incubate the plates and participants will stop in the next day to see the results, which will be confidential and anonymized upon request. Dr. Beavis is confident the hospital staff will respond to the colonies on those plates come morning in much the same way her daughter’s young schoolmates did: with a dramatic improvement in hand-washing frequency. Like most great ideas, “show us, don’t tell us” hand-washing education is deceptively simple. It is also an idea that can change behavior, improve patient safety, and demonstrate her department’s commitment to peers on the hospital staff and the patients they serve.

While the hand-washing demonstration is about reaching out, Dr. Beavis also routinely “brings the outside in,” as Kotter would say. Her staff keeps a log of telephone calls to identify typical questions and complaints. Her department hosts laboratory rounds for infectious disease physicians, during which laboratory staff talk about current patients, introduce new instruments or tests of interest to their guests, and try to address a few of the FAQs on that telephone log. A technologist might demonstrate why separate patient samples for HIV and hepatitis testing will accelerate processing, or why a stat test turnaround can take 48 hours. Bringing outside physicians into the laboratory helps her staff members connect with the physicians and patients who rely on them and raises the profile of the laboratory in patient-centered care.

A similar goal has prompted a new awareness campaign, “Every number is a life,” launched by the College to highlight that laboratory professionals are engaged in direct patient care and to underscore that every specimen and requisition represents someone’s mother, father, sister, brother, son, or daughter. Wristbands imprinted with bar codes drive home the tie between each bar code in the laboratory and a patient in the hospital. Posters that carry this message have been sent to about 17,000 CAP laboratories. Three of these posters will be featured on the final episodes of the popular television program “ER” beginning this month, and there is a chance some actors on the show will choose to wear the wristbands. “Every number is a life” should help raise awareness of our role on the patient-care team. Please see that the posters go up and encourage your staff to join you in wearing the wristbands and checking out the show.

This is an exciting time for health care, but the system as a whole is in flux and external change demands internal change. When I chose to open with a Super Bowl story, I knew football would be history by the time you read this. That was part of the message. Today it’s basketball, tomorrow baseball. Seasons pass in a blink; they always do, and opportunities we fail to seize today will be in play next season. If we don’t keep our eyes on the ball, another team could take the field. We can stay on top of the game by ensuring that we bring a certain urgency to our work and help our colleagues do the same.