“I’m a prisoner here.”

I just heard one of our patients say that.  He had been sitting in a chair outside my office for about an hour.  Quietly fuming inside.

About an hour earlier, he had pushed the elevator button when a therapist intervened.  It went something like this …

Where are you going?

Outside.

No, you can’t do that.

Why not?

You have to stay on your floor.

Oh, and why’s that?

Well, because we have to know where you are.  We’re responsible for your safety.

Ok.  I’ll tell you where I’m going.  Outside by the entrance.  I want to go outside.

No, you can’t leave this floor.  If something happens to you, we’ll get in a lot of trouble.

An hour later, his nurse and CNA both tried to get him to go to the dining room.  This time he was resolute.  He wouldn’t budge.  He called himself a prisoner b/c the staff wouldn’t let him leave.  I would’ve been the same way.  After a few back-and-forths about whether he would or would not go to dinner or even ever leave that chair, I stepped out of my office and said,

You want to go outside?

They won’t let me.

Who won’t let you?

The people here.

There must be some misunderstanding.  They probably meant that you needed to go with someone.

No.  They said, “You can’t leave this floor.”

Well … let me see what I can do.  [I went to the gym and asked the therapists about him.  They were thrilled with the idea of me escorting him outside.  They just didn’t want him to go alone as he still has a ways to go to get his strength back and is at risk for falling.  I came back with the good news.  He couldn’t believe it.]

We went down together and I pulled the bench into the sun.  Gorgeous day.  We talked for about 45 minutes.  WWII veteran.  married to a ‘saint’ for 60+ years.  A few kids.  He’s the last surviving child of 8 kids in his family.  He told me about his ‘crooked’ father in law who died with $500,000 in the bank.  We laughed.  I teased him.  He teased me back.  We talked about religion and faith and cashing in his chips after 92 years on the earth.  After a while, he said, “Well, is it time for dinner?”

Yeah, are you ready to go back in?

You bet.

He literally had a large smile on his face when he sat down to eat dinner (after everyone else had already eaten by this time).  It struck me as I sat back down in my office how differently that could’ve gone (and sadly too often does) … the nursing/therapy staff get frustrated by the patient’s “behavior” and start to treat him as an object more than as a person.  He becomes a problem.  Stubborn.  “Non-compliant.”  A pharmaceutical intervention is ordered and the man, the WWII veteran, loses a little bit of his identity and dignity and control.

As a facility leader, it’s my role to establish a culture within the facility where that latter scenario is avoided — when it’s avoidable.  We have to create a mission, a purpose for our staff that is larger than a paycheck or a task to constantly motivate them to SEE their brother, sister, mother, or father in the eyes of the patient sitting in that chair.  I saw the difference tonight in being task-driven/objectifying and human-driven/personalizing.

Our great challenge is to systematically enable our great staff to personalize their residents’ and patients’ experience …

The EnsignPrize! home stretch

At Ensign’s 2011 annual meeting I spoke about some personal feelings re: hitting 10 years with the organization and in skilled nursing. It was a time of deep reflection. It was then that I developed some of the thoughts I’ve shared here about burn out, empathy, and a hunger to do more after surviving industry-common career crushing experiences. Some of those thoughts are found here.

As “luck” would have it, while I was in that very reflective mood, I was hit by some new, related ideas during a couple early morning rides. I love to listen to NPR podcasts during those runs/rides and back then I listened to a Freakonomics podcast that was like lighting a fuse in my mind. When I got to the office that morning, ideas started to crystalize, as seen on my whiteboard:

I don’t expect you can follow the train of thought there. But, with the help and input of my colleagues at Ensign, what started as some 10-year angst turned into the eprize! … our organization’s $150,000 competition to transform the industry by transforming the day-in-the-life of our residents. At that 2011 annual meeting, I shared with my friends and colleagues the story of how the idea of the eprize! was born and then challenged them to run with it. And … they did.

The executive directors and directors of nursing upped the ante to $150k and all agreed to put money into the ‘pot’ from their own facilities to fund the award. For more details about the competition and why we did it the way we did it, see this “halftime talk” I gave to the organization about it:

Well … the applications are finally in and uploaded onto the EnsignEprize.com website and the contestant facilities are lobbying their communities hard to have them ‘vote’ for their application. The eprize! award winner will be announced in early April. As I’ve read through and watch the videos of some of the applications I’ve gotten emotional to see the small and big improvements in the systems we use to care for our residents and patients with more dignity, humanity, and choice. I hope you take a minute to go to the website and see what we’ve been up to for the last year as a group. And, please, by all means … share this with your friends. Better yet, challenge your own organization to do something similar!