Comments on: It’s All about Always, part one

By: Bernie Henry

Bernie Henry — Fri, 01 Jun 2007 18:56:58 +0000

The key to healing is to realize that indeed time for emotional support and bonding lifts the human experience. The same is true in employee relations, The always manager makes sure that never, in the name of squeezing out variability to meet financial pressure, is the human presence and congeniality set aside. If emotional support and bonding is important to you it will always be on your calendar.

By: Jay Tatum

Jay Tatum — Wed, 16 May 2007 18:11:41 +0000

One of the challengs of the “always” methodology is allowing the disciplined practice to become a part of one’s being. I agree that the small adjustment in one area makes a huge difference. Yet the comment I hear most often from senior and mid-level managers is consistently the same – “That’s not who I am.”
I think when we seriously wrestle with our own personhood, defining our being from our doing, and writing and living that personal mission statement the “always” methodology always works. Whether one accesses, practices and participates in disciple-making determines what kinds of disciplines are important. The top performers always practice, practice, practice specific disciplines that produce results, always. Thanks for the upbeat vibe. Jay

By: Kitty Wrigley

Kitty Wrigley — Wed, 16 May 2007 14:26:41 +0000

One phrase in this article is “foundation of evidence-based leadership is to begin with aligned goals, which are created by effective leader evaluations and a leadership development process that links to desired organizational outcomes.” However, evidence-based practice (medicine or business) is founded on objective study, i.e., the literature. Here is a quote: Dr. David Sackett, the “father” of EBM wrote that it is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (BMJ 312:71-72, 1996) His concepts have influenced the business world, as seen in the publication of a book by two business professors at Stanford: Pfeffer, Jeffrey and Robert I. Sutton. Hard Facts, Dangerous Half-Truths & Total Nonsense:Profiting from Evidence-Based Management. The foundation of evidence-based anything is this: bigin with a search of the literature. This does not mean a Google search. Along the way, we develop goals and align them. Hopefully our goal development has included a thorough search of the literature. The practice of aligning goals is a good one, just not, in itself, evidence.

By: Frederick Navarro

Frederick Navarro — Tue, 15 May 2007 20:45:36 +0000

In your blog you stated, “When it comes to patients’ perception of care, it is all about always.” You later followed with, “The H-CAHPS instrument asks patients to describe their perception of the quality of their care by rating the frequency of events during their care.”

Frankly, I have never agreed with “frequency” definition of quality that has pervaded patient satisfaction research for years. Quality is not limited to a perception of frequency. The only reason that patient perception of care is always about “always,” is because frequency is the only dimension they’ve been allowed to rate on for years. This method of assessing patient care quality in fact minimizes the feedback of each individual patient. There is a big difference between asking patients to evaluate an event and asking them how often it happened.

But the biggest flaw implicit in the H-CAHPS approach is that each individual patient comes to a hospital as a blank slate with respect to expectations, prior-biases, or other issues that could infuence their perception of care. Is that really the truth? The H-CAHPS “world view” is that doctors, nurses and hospital staff are the only determiners of a patient’s perception of care. Each patient is a blank slate that the staff will mold like aluminum on a can-making assembly line. This allows them to excuse themselves from actually learning about individual patients’ needs, priorities, values, biases, or behavioral patterns, and working to shape the care experience accordingly. It excuses the institution from actually being “patient centered” because the only “patient” that matters is the abstraction defined by a collection of frequency ratings.