[quote style=”boxed”]I am always asking questions, including, “Why did this happen?” and “Why was the patient’s test delayed?” and “How can we improve each step of a patient’s care?” and “How can we improve how we communicate with one another and with patients?” When there is not an answer to a question, I analyze the situation and identify the drivers or underlying causes of the problem, and propose specific solutions. I then quickly swing into action. Sitting around thinking delays progress, and without action, anyone trying to improve a process quickly loses momentum.[/quote]
Dr. Fred Southwick is a professor of medicine at the University of Florida. He is an expert in applying manufacturing systems and athletic principles to improve healthcare delivery, and is a graduate of Yale University and Columbia University College of Physicians and Surgeons. In 2011, he completed the Advanced Leadership Fellowship at Harvard Business School, where he studied team dynamics, organizing people to bring about cultural change, leadership skills for transforming organizations, and methods to improve quality and safety in healthcare. In January of 2011, he was appointed Manager of New Projects in Quality and Safety for the UF & Shands Health System.
Dr. Fred is the author of “Critically Ill: A Five-Point Plan to Cure Healthcare Delivery,” a book that touches on the key processes that effective healthcare systems need to have in place to reduce errors and improve the quality of patient care.
What are you working on right now?
I am trying to enhance communication between doctors, nurses, administrators and patients to improve the coordination of care in our hospital system. We are hoping that, by creating true teamwork, we can reduce medical errors, improve the quality and efficiency of care, and make our health system a joyful environment in which to work.
Where did the idea for “Critically Ill” come from?
After studying our healthcare delivery systems for the past six years, I concluded that they were very dysfunctional, and despite more than a decade of public concern being raised at the highest levels, the number of preventable deaths has not budged. We continue to kill more than 100,000 people per year as a consequence of preventable errors. I realized our systems of delivery were critically ill. I wondered how I could make a difference. I then decided to write a book based on my own personal experiences with errors, and to summarize all that I had learned from my year spent studying at Harvard. I had learned that personal stories were powerful instruments for calling attention to a problem, as well as for creating a sense of urgency. In that vein, I decided to begin my book with the story of Mary, my ex-wife, and her critical illness precipitated by multiple oversights, misdiagnoses, and delays in decision-making. By dissecting Mary’s illness, I realized I could show how preventing her many complications could be extrapolated to cure our entire healthcare system.
What does your typical day look like?
My day often starts with a 7:00 a.m. meeting, because it’s about the only time of day when physicians are available to meet. Next, I complete patient rounds with the nursing leaders on our general medicine hospital unit. During rounds, we ask each patient about his or her care. We ask what was good about his or her nursing and physician care, and how could it be improved.
While on the wards, I also coach our physicians on how to improve their work rounds by creating more efficient verbal presentations and actively involving the bedside nurses, case managers and pharmacists in their decision-making. Next, I meet with members of my laboratory, where we are studying how bacteria cause disease by invading our body. My afternoons are devoted to designing experiments and new safety programs, reviewing and analyzing data, and writing papers. Before heading home, I end my day with a one-hour spinning class at our gym, or a six-mile row in the nearby lake.
How do you bring ideas to life?
I am always asking questions, including, “Why did this happen?” and “Why was the patient’s test delayed?” and “How can we improve each step of a patient’s care?” and “How can we improve how we communicate with one another and with patients?” When there is not an answer to a question, I analyze the situation and identify the drivers or underlying causes of the problem, and propose specific solutions. I then quickly swing into action. Sitting around thinking delays progress, and without action, anyone trying to improve a process quickly loses momentum.
I find people are too afraid of being wrong. As long as the solution does not endanger the patient or the caregivers, there is nothing wrong with giving a solution a try and seeing if it improves the situation. If an improvement fails to occur, go back to the drawing board; if an improvement successfully happens, you have made progress. People often fail to realize that progress is not linear, but rather has an irregular trajectory with small improvements followed by small backslides. The key to all improvement is optimistic persistence.
What’s one trend that really excites you?
The new payment rules for Medicare promise to encourage everyone to improve the quality of care. Soon, physicians and hospitals will not be paid when a patient has to be readmitted within 30 days for the same illness. Hospitals and physicians, for the first time, will have to provide a 30-day guarantee. This is just the beginning of a major shift in how our health delivery systems view their roles. These changes promise to create a new and long overdue focus on our patients, and on providing them with ever-higher quality care that is safer.
What was the worst job you ever had and what did you learn from it?
The worst job I ever had was in the summer of my senior year in high school. My father, an orthopedic surgeon, wanted to create models to demonstrate a new method for correcting a hip joint misalignment. He needed human femurs to create these models. I was assigned to surgically remove the femurs from all the medical student cadavers before their cremation. It was very creepy working alone with 50 cadavers. Several times, I ran out of the room because of uncontrollable fear, but each time I returned. I knew that by collecting these bones, I would allow my father to teach other orthopedists how to perform this special operation. By harvesting the bones of dead patients, I would be helping living patients walk without pain. I took away two lessons from this uncomfortable job: 1) Sometimes, we are required to overcome fear and superstition in order to benefit our fellow man, and 2) Those who donate their bodies to science can greatly benefit their fellow man. This experience encouraged me to become an organ donor.
If you were to start again, what would you do differently?
Nothing. I have been very pleased with my choice to become a physician and work in medical education and biomedical research. My job has been rewarding and creative, and I have had the pleasure of working with many caring and dedicated people, all of whom want to help others. Most importantly, I have been able to comfort those who are suffering throughout my career. Now, in my most recent role as manager for new programs to improve quality and safety, I hope to eliminate harmful mistakes that too often injure our patients.
As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?
At the end of each day, I review my upcoming plans for the next day. I ask myself, “How will each of these activities further my personal goals?” When there is an activity scheduled that doesn’t provide a good answer to this question, I often cross the activity off my calendar or make sure that I never let a similar one creep into my schedule again. There is only so much time in a day, and every hour is precious. I hate to waste time.
What is one business idea that you’re willing to give away to our readers?
I believe our athletic coaches could be used very effectively to improve many of the broken processes in healthcare. Coaches know that the team that makes the fewest mistakes wins. They understand human fallibility and accept errors as a normal part of human activity. Because so many of us benefited from athletic coaching, those in healthcare are likely to be far more receptive to suggestions made by experienced athletic coaches rather than administrative consultants. My dream is to create a consulting service that includes retired coaches.
Tell us a secret.
Sorry, I am not a secretive person, and I have always subscribed to personal–as well as institutional–transparency. What you see is what you get!
What are your three favorite online tools and what do you love about them?
Wikipedia: Although not totally accurate, I have found this tool provides me with an excellent overview of a field.
Google: I Google everything. I have found that this search engine identifies associations that the human mind would take months to derive. In the creative and diagnostic fields, I have found this search engine to be invaluable.
PubMed: This database searches peer-reviewed medical journals. This service allows me to drill down after a preliminary Google search and identify the most accurate and reliable information to help me in my decision-making and analysis.
What is the one book that you recommend our community should read and why?
I have found the book, “Thinking, Fast and Slow” by Daniel Kahneman to be very insightful. My takeaway is the importance of creating good mental habits. By making the right decisions over and over in the same situations, decisions become automatic and fade into the background. This allows the brain to focus its slow, deliberate, creative thinking on more sophisticated problems.
What’s on your playlist?
My favorite song is, “Turn the Car Around” by O.A.R. I also love Maroon 5, Rihanna, Green Day, Coldplay, B.O.B. (especially the song “Airplane”), Kelly Clarkson, Five for Fighting, The Fray, Roy Orbison, The Beach Boys, The Beatles, The Dave Clark Five, and The Byrds.
If you weren’t working on your book, what would you be doing?
I also love teaching medical students, caring for patients at the hospital, designing experiments and analyzing data.
What three people we should follow on Twitter and why?
I haven’t followed anyone on Twitter for very long. I just haven’t had time; it’s another future aspiration. I find the idea quite appealing. When I get home, I like to shut off the social networks and wind down. I find multitasking saps my creativity.
When was the last time you laughed out loud? What caused it?
I laugh at my brother’s stories. We are two years apart and love to kid each other. We are always making wisecracks about everything. When we get together, we constantly laugh.
Who is your hero?
Samuel Adams; he is the unsung founding father who quietly organized the colonists to rebel against Great Britain. His organizing skills transformed the Massachusetts Bay Colony from a collection of complacent British subjects to inspired freedom fighters who valued personal liberty, democracy and justice. It is my belief that without his heroic and persistent efforts (his campaign for independence took 15 years!), we would not be the United States of America.
Why are so many physicians resistant to change?
The students who earn admission to medical school are usually highly disciplined and focused. They have avoided the usual distractions of adolescence and devoted nearly every waking hour to studying and achieving high grades. Because many medical students have never stepped off the beaten track or taken risks, they fear change.
Why are you so passionate about improving our healthcare delivery systems?
Throughout my life, I have never hung out with the “in” crowd or accepted what others have said. My questioning has not always made me popular. However, when the choice has been between popularity and doing the right thing, I have always chosen to do the right thing. What’s right is right. Our patients are coming to our hospitals and clinics to be comforted and healed, but too often, because of our dysfunctional systems, they are being hurt. We cannot stand by and say, “Well, that’s the way it is” or “That’s the cost of medical progress.” To me, these excuses are unacceptable. I believe every caregiver should be working tirelessly to improve our systems, in addition to their own personal skills. That is the right thing to do!
Dr. Fred Southwick on LinkedIn:
Dr. Fred Southwick’s book: “Critically Ill: A Five-Point Plan to Cure Healthcare Delivery”
Mario Schulzke is the Founder of ideamensch, which he started a decade ago to learn from entrepreneurs and give them a platform for their ideas.