So everyone remembers me talking about the hospitals huge initiative for safety from class a few weeks ago. How concept were being drilled into our head, concepts that directed us to pause and think before doing any procedure. Well….we have just had our first real failure of that system and it is kinda big. I am not going to go into details in a public forum like this, but this event that took place brought to mind this class. The powers that be are trying to change the mindset of its members and how we approach the very serious tasks that we do. I think the end goal of the program was hopefully to have no patient related errors in a year. I am wondering now will the organization look at this as a failure or a learning opportunity. Will they go back and review the event and figure out a way to learn from it. We talked about the 4th quadrant last week, ‘measure results to capture lessons learned’ I hope the organization treats this as a results and captures the lesson rather than see it as a failure and just say don’t let it happen again.
The second thing on my mind this week also deals with the hospital but in a different way. When we were talking last week in class about the 3rd quadrant and autonomy I was trying to apply this to my department and the hospital as a whole. I am curious to how Dixon or some of the entities like FutureSearch would implement this in a hospital setting. We talked about making decisions on the “line” and having the autonomy to do so. In my lab this is something we struggle with all the time. For example, there are procedures in our laboratory that are strict and for good reason, but as in everything emergent we have to make decisions sometimes in the heat of the moment that could save a patients life. It may be three in the morning and we don’t have time to wake residents and supervisors up to get permission to give certain products, you just have to make a decision. The problem with this is that if you are never allowed to participate in the decision making process in non-emergent times then how are you supposed to be able to make the best possible decision in a moment of crisis. How does one implement antonomy in a hospital? Nurses can’t make patient decisions but are there going to be times when tough choices are going to have to made? The answer is yes.
The last thing I wanted to touch on this week’s post is the concept map. For some reason I have been having a hard time wrapping my mind around the connectors and concept and I think I figured what was giving me the trouble. I think it is that the concept map question itself has a connector in it and it was throwing me off. I am going to go play with it and see if I can wrap my head around it a little more.
Torn is exactly what I feel a lot of the time here lately. I am torn about how much time I spend at work, school and on school work instead of with my daughter. I am torn about how much more work I seem to do at work than even those above me. And I am also torn about my feelings toward my organization in regards to organizational learning.
As I assume most people in the class are doing I am trying to compare what I am learning in this class to my own organization. Not just in VCUHS as a whole but mostly trying to apply what I am learning to what we do in the blood bank. There are some things I read and we talk about that I feel we are doing right, but there are others that we are not doing at all. For example, I think my manager has made pretty good strides at providing and promoting “hallways.” We have EPIC (Employee-Led performance improvement comittee) which any employee can meet and discuss things they would like to see done differently (no senior, supervisor, or manager can be a part of the meetings unless asked to). It has been stressed that these meetings are not just gripe sessions, but real problem solving sesssions. You can’t bring up a problem to management unless the group has come up with a solution for the problem. Another way my manger has created hallways is to move the staff meetings out of the lab and away form all the distractions. The problem that I have with these strategies is that neither one bring together EVERYONE. I see the idea of hallways as bringing all levels of the organization together to share ideas. Our committees still are separated from the different levels.
So I guess the biggest reason I am torn is that as I am reading I am thinking ahead to the culture assignment and trying to relate Dixon’s lessons to my organization. On one page I read and think we do a good job of that and then she may give an example or I think about how the WHO handled the same thing and I think we could do so much more and we could dowhat we do so much better. I know we all come in to a class with a set of experiences that shape what and how we learn the material and thus how we build our concept map. I feel that my concept map right now would look an incoherent mess!
When we were in class Tuesday night and Dr. Carter asked us to find a statement in the Preface that we really liked I had quite a few, but this quote from chapter one struck a chord with me…..”Learning is the process that underlies and gives birth to change. Change is the child of learning.” WOW! I read this and just sat and thought about it for a good five minutes. At first read this is just a statement about learning but upon further inspection I started applying it to my own experiences. One good example of this comes to mind at VCU Health System. The hospital has started a “Safety First, Everyday” initiative and all employees of the health system have to go to a 4 hour class that teaches different techniques to everyone like STAR (Stop Think Act Review). The classes also teach communication techniques, having a questioning attitude and accountability. They are really great classes. But that’s all they are is classes and if that is all the health system is doing to reinforce this idea then I don’t think the ideas would go farther than the classroom but there is more to the initiative than the classes. For example they started a safety star program to highlight individuals who went above and beyond the norm for safety. There are a lot of outside the classroom programs the hospital is doing to help the organization learn and those things are quite visible. I think it is invaluable for my learning process that I work for a company where I can apply what I have learned but also can see examples of what I am learning.
Something else I wanted to talk about from the reading was from chapter 1 where Dixon talks about how management has changed since the Knowledge Age began. I agree with her ideas that the roles of employees and managers have changed. But what really struck me about this section was her statement that “Learning creates equals, not subordinates, and thus work is increasingly conceived as a team effort.” I agree that learning is a team effort but I think a lot of the tension that surrounds organizations today stems from the learning creates equals assumptions. On the surface I agree with this notion, but think about it. If I work for “Bob” and Bob and I work as a team and learn and change the organization as a team and sometimes I even feel like I bring more to the table than Bob then why does Bob make twice what I make. I know there are varying situations and problems with this very basic example but I think it illustrates my point which it that in today’s organization where employees are required to not just follow a set of steps for 8 hours and go home, but are to problem solve and trouble shoot and analyze why is there still such a hierarchy in many organizations? I think this is cause for organizational tensions and I can definitely see examples of it in my own organization. We as blood bankers are required to make tough and quick decisions sometimes and then the very next day are made to feel as though we are just employees and are incapable of making those types of decisions. I have specific examples, but won’t get into here.
One last thing I wanted to reflect on come from class and the mind map discussion. The statement, all of our experiences, from birth influence our individual mind map. I loved thinking about that in class and wanted to share my thoughts here. My daughter is 15 months old now and she is walking and running and all that, but the most amazing thing she is now doing is trying to communicate verbally. I can see her trying to figure things out and essentially build her mind map. It is amazing. I know all of you parents out there are probably like “yeah yeah just wait til she won’t stop talking” but for me this is so cool. The example I was thinking about in class was one of Jolee’s new words which is hot. She used to want whatever I was drinking and I would give her some of my water but if I was drinking a cup of coffee in the morning I would tell her “no no it’s hot” and I would put her hand gently on the outside of the cup and show her what hot was. Well it took her a few days but she now knows what hot is and now everything is hot. She sees me blowing on the bits of food before I put them on her tray and dinner time and she picks them up and says “hot?” I put her in the car and if it hot in the car she says “hot?” And I hear her trying to use it more and more and discover how to use it. The best was when I was folding clothes from the dryer the other day and I had just stopped it. She came around the corner and put her hands in the dryer to help me pull the clothes out and said stopped, looked at me and said “HOT!” Way to build that mind map baby!
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