A Key to Patient Safety — Don’t Just Listen, Solicit Input

New blog post in BMJ

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suzanne_gordonWant to be a better physician or nurse leader? Enhance patient safety? Effectively lead teams? One of the current consultant prescriptions is the recommendation that leaders spend more time listening than talking. Whether in the larger management literature or in the articles and books that specifically target healthcare, listening is portrayed as a key to leadership.

I am all for listening. Of course people have to listen to each other rather than silence, ignore, dismiss, or denigrate one another. When it comes to the implementation of genuine teamwork and patient safety within the hierarchical environment of health care, I don’t think listening is enough. As Amy Edmondson has written in her book Teaming, “Research shows that hierarchy, by its very nature, dramatically reduces speaking up by those lower in the pecking order. We are hard-wired, then socialized, to be acutely sensitive to power, and to work to avoid being seen as deficient in any way by those in power.”  READ MORE

Hey Manners Matter: Say Hello My Name Is Not Just to the Patient

Why Introductions Matter Is a New Post I did at the BMJ

suzanne_gordonThe other day, I was invited to give a seminar on interprofessional teamwork to a group of residents and attendees at a prestigious university medical center in Europe. The first thing people did when they trooped into the room was introduce themselves to me. Since there were about 25 people in the room, no one really expected me to remember their names. But each and every one of them went through the drill.

These introductions did more than convey instrumental information about who we all were and what roles we had. At the most fundamental level, what people are doing when they acknowledge a stranger walking down a street or shake the hand of a person whom they have just met is create a psychologically—not to mention physically—safe environment. Read More


Jeff Miller Doesn’t Believe Veterans Deserve the Healing Arts

Another blog post on how low people will stoop to deny veterans excellent care.

In Defense of Art in VA Hospitals

Conservatives are mad about spending government money on art, but it provides real medical benefits.

The Veterans Health Administration (VHA) has taken a lot of heat lately about using money to purchase art for its hospitals and other facilities. Last week, Gail Collins, in a column in the New York Times, joined in the pile-on. While Collins defended the VHA and opposed its privatization, writing that veterans “are satisfied” with its services and that “the care is in many cases excellent,” she couldn’t resist a jab at the VHA for spending $670,000 on two sculptures that were placed in a blind rehabilitation center. Her conclusion? “Veterans healthcare for everybody! But maybe with less art.”

The issue of spending on art first emerged last year when Congressman Jeff Miller (R. FLA) , Chairman of the House Veterans Affairs, a staunch advocate of VHA privatization, lambasted the VHA for spending $483,000 for a sculpture in a hospital courtyard. For Miller, whom Donald Trump has promised to appoint to the post of Secretary of Veterans Affairs should he be elected, the issue was not the quality of the art used at VHA facilities but the fact that the VHA was using taxpayer money to spend on art, period. Miller called such spending “wanton and abusive.” 

Read More


Bad News on Patient Safety from Ontario

Doris Grinspun head of the RNAO just sent me this article about the firing of a Chief Nurse who spoke out to protect patients.  Any Canadian nurse reading this should immediately join the protest.

The only good news here is that nurses are protesting this.

An Ontario nursing group contends Vanessa Burkoski was fired to silence her about changes affecting patient safety

By Jonathan Sher, The London Free Press

Vanessa Burkoski, past president of the RNAO (Postmedia Network)

Vanessa Burkoski, past president of the RNAO (Postmedia Network)

The boss of London’s largest hospital has sacked his chief nurse to stop her from speaking out against changes that put patients across Ontario in harm’s way, the head of a powerful nursing association claims.

Murray Glendining, chief executive of London Health Sciences Centre, tried to buy the silence of his chief nursing officer, Vanessa Burkoski, offering her cash if she would resign quietly, but she refused and was fired, Doris Grinspun, chief executive of the Registered Nurses Association of Ontario (RNAO), said Friday.

“It’s the most disgraceful thing I’ve seen in my 20 years at RNAO,” Grinspun told The Free Press.

Glendining fired Burkoski not for her work at the London hospital, where she received stellar reviews, served as a vice president and looked after safety and quality of care, but because she was serving as president of the RNAO when in May it produced a report that exposed how Ontario hospitals had harmed patients by replacing registered nurses with cheaper and less educated health care workers, Grinspun said.

Glendining isn’t the first Ontario hospital boss to try to muzzle hospitals’ top nurses, Grinspun said.

“Patients suffer the consequences because chief nurses are the safety valves,” she said. “We are outraged about this level of intimidation of nurses by CEOs who treat their hospitals like private organizations.”

But the London hospital boss went further by firing a nurse whose leadership in Ontario was almost unrivaled — before coming to London in 2011, Burkoski was the longest-serving provincial chief nursing officer, advising three Ontario health ministers.

“(Burkoski) is a person of stellar integrity, judgment and experience,” Grinspun said. “(Her firing) is just unconscionable.”

Asked by The Free Press about Grinspun’s concerns, Glendining sent a brief email: “We can confirm that Vanessa Burkoski is no longer an employee at London Health Sciences Centre. LHSC does not comment on any personnel matters.”

But Burkoski spoke to The Free Press about what she says happened — she says she was called into Glendining’s office June 8 to discuss the report produced by RNAO, called Mind the Safety Gap.

When she arrived, she said, she was met by Glendining and his vice-president for human resources, Stephen Coulahan and offered a cash settlement if she would resign.

When Burkoski refused, she said the two men asked her to reconsider, then meet with them again Monday.

Two more times, Burkoski said, she refused to resign with a cash settlement.

“After three requests for my gracious exit, they asked me if I understood what a termination meant in terms of (my) reputation,” she said.

Glendining fired her, and then on Tuesday, sent to senior hospital leaders a vague email to announce that Burkoski was gone.

“Vanessa Burkoski, Chief Nursing Executive, and Vice President, Professional Scholarly Practice is no longer with London Health Sciences Centre. We thank her for her contributions and wish her the best,” the hospital boss wrote in an email obtained by The Free Press.

The sudden departure and terse note left some wondering if Burkoski had done something untoward or even illegal, Grinspun said.

Under Grinspun’s leadership, the RNAO, which is not a union, has played a growing role — she led the successful push to get the province to scrap costly home care bureaucracies, called community care access centres.

The Free Press tried to reach Ontario Health Minister Eric Hoskins, but a spokesperson said he was unavailable Friday.



The Registered Nurses Association of Ontario says the chief executive of London’s largest hospital sacked its chief nurse because she was the public face of a report critical of hospitals. Here’s a summary of the report:

“In an effort to cut costs, health organizations across the province are replacing registered nurses with less qualified care providers . . . the RN share of the nursing work force has dropped significantly in recent years. This has left Ontario’s health system unprepared to meet rising levels of acuity in hospitals and in the community, and put the safety of Ontarians at risk.”

New Blog Post about VA at BMJ

This was just posted on the BMJ blog.  

Hope people will read and pass it on.

suzanne_gordonBy the end of this year, the US will have a new president as well some new members of Congress. The results of the 2016 election will not only effect the further implementation of the Affordable Care Act (Obamacare), but the future of the country’s largest healthcare system—the Veteran’s Health Administration. That’s because most of the Conservative Republicans running for President—as well as many of those running for or already serving in Congress—are not only determined to repeal Obamacare. They are also committed to dismantling the largest and only publicly funded, fully integrated healthcare system in the US—the Veterans Health Administration (VHA). Even many Democrats are not fully supportive of the VHA. While Hilary Clinton says she does not support privatization of the VHA, only Bernie Sanders (D. VT) has demonstrated a deep understanding of what the VHA does and how it actually works.

The Veterans Health Administration grew out of Abraham Lincoln’s Civil War pledge “To care for him who shall have borne the battle and for his widow, and his orphan.” Since World War Two, the VHA has become the largest and only fully integrated, publicly funded healthcare system in the United States. Its 1700 sites of care include more than 150 medical centers, 1000 community based outpatient clinics (CBOCs), and other mental health, nursing home facilities, and in and outpatient facilities.

The VHA has over 260,000 employees, over a third of whom are veterans. Its tripartite mission includes the delivery of clinical care, research, and teaching. Since 1946, the VHA has affiliated with major academic teaching hospitals and now trains over 70% of American physicians as well as students and trainees in 40 other healthcare professions. It’s vast research arm has produced innovations that have improved the health of veterans suffering from illnesses like Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), as well as spinal cord injury. VHA research has also produced innovations that help all patients. To name only a few, the VHA developed the first implantable cardiac pacemaker, performed the first successful liver transplant, helped to test the Shingles vaccine and develop the nicotine patch.

Republicans have consistently refused to adequately fund the VHA and have resisted expanding its services to all veterans. The VHA only serves veterans who have some form of honorable discharge and who have service related disabilities and/or low incomes. The result is that the system takes care of the oldest, sickest, and poorest veterans. The average VHA patient is 62 years old, has multiple physical co-morbidities and a higher percentage of mental health problems than the average patient in the private sector. In spite of this significant challenge, an Independent Assessment of the VHA’s record on care delivery, mandated by the 2014 Choice Act, documents that the VHA outperforms the private sector on many measures, is equivalent on some, and marginally worse on only a few. Despite variability in the VHA system, the Independent Assessment repeatedly reports that the private sector healthcare system provides care with even more variability than the VHA. The Association of VA Psychologist Leaders recently posted yet another review of the scientific studies on VHA care which document similar outcomes.

Ignoring the VHA’s record of care delivery, congressional conservatives are exploiting the wait time problems and delays uncovered in 2014 in Phoenix and some other VHA facilities to argue that the entire VHA system is broken and that the VHA should no longer pay for and provide healthcare services. They want to eliminate the VHA and transfer veterans to the private sector healthcare system, with the government serving as payer, rather than also the provider of care.

Needless to say, this would be a huge boon to private sector hospitals, which is why many support this plan. It is also favored by large pharmaceutical and medical equipment companies. Big Pharma has long chafed at the fact that the VHA—unlike say Medicare or other US health plans—negotiates lower pharmaceutical prices through its drug formularies. Since VHA physicians and other staff are on salary, they have little financial incentive to either over or undertreat their patients and thus use medical equipment and treatments much more judiciously than their counterparts in the private sector. They have also developed more integrated mental health, primary care, geriatric and palliative care services than other US health plans.

Finally, the VHA has long been anathema to conservatives. As Alicia Mundy has recently reported in an article in The Washington Monthly, the Koch brothers have funded a group called the Concerned Veterans of America—a veterans’ service organization that has no veteran members and provides no veteran services.

The CVA has been lobbying for partial and ultimately full privatization of the VHA. The mainstream media have been filled with stories about VHA dysfunction. Media outlets have promoted this narrative and ignored continuing evidence that the VHA—in spite of wait time delays and top heavy management—continues to deliver high quality care to veterans.

As a result Congress is now considering two bills that could pave the way for the privatization of the VHA. At the same time, a congressionally mandated Commission on Care tasked with strategizing about the future of the VHA, is also dominated by discussions of VHA privatization.

Seven of the commission’s members have written a proposal entitled “The Strawman Document” recommending the total elimination of the VHA. The Strawman document has produced an outcry from veterans’ service organizations (VSOs). Eight of the nation’s largest veterans services organizations—including the American Legion, Disabled American Veterans, and Paralyzed Veterans of America, have written a formal letter to the commission to express their concern about the report. These groups support proposals, like that put forth by VA Undersecretary of Health David Shulkin, that would strengthen the VHA, give veterans the choice to see outside providers if necessary, but maintain the VHA as provider and coordinator of healthcare services.

The fate of VHA will affect more than America’s 24 million veterans and their families. With its research, teaching, and innovative models of team-based integrated care, the VHA serves as a model for quality healthcare delivery that should be emulated rather than dismantled.

Suzanne Gordon is a healthcare journalist and co-editor of The Culture and Politics of Healthcare Work Series at Cornell University Press. Her latest book is Collaborative Caring: Stories and Reflections on Teamwork in Healthcare, which she co-edited and she is co-author of Beyond the Checklist: What Else Healthcare Can Learn from Aviation Teamwork and Safety. Most importantly she is a patient.

Competing interests: SG is currently writing a book about the VHA.