Shane Elmore, RN

Alexander Pope once said “To err is human.” If we are honest with ourselves, we know this is true. I’ve made my share of mistakes and I know that I have hundreds more left in me. However, it seems that our culture - both at work and at home - have so heavily stigmatized being wrong or failing or making a mistake, that people are now either too afraid to take risks or are afraid to admit when that have made a mistake. 

What does this look like in your house with your significant other and/or children? What about at work? Is it okay to make a mistake? I think we’ve all worked for that boss or supervisor who found their pleasure from making an example of anyone who made a mistake. I remember this most in baseball when I was in high school. It was as if the coach was waiting for us to swing at a bad pitch or boot a ground ball. He had a couple of funny yet humiliating sayings. When it was a bad throw, it was “million dollar play and a dime throw.” When it was a particularly bad mistake, he would tell us to "join the circus.” 

You’ve probably heard it said before that failure is inevitable, and of course that is true. No one of us is immune to failure. But, as much as failure is a normal part of everyday life, it’s important to know that you don’t have to stay there. Failure is normal, but being stuck in failure shouldn’t be. The following are culprits I’ve found to be shared among people or institutions who feel stuck in a pattern of failure.

We live in a world of constant stimulation, of more is more, and, as a result, of multitasking. Most of us think we’re pretty good at multitasking, and greatly overestimate our proficiency at doing two or more tasks at once. I think I’m better at multitasking than most, but I guarantee that if my wife reads this she will bust a gut laughing … I can’t even listen to her with the TV on. I’m not alone here, am I?

Which is more important?

What you do.

How you do it.

OR ...

Why you do it?

In medicine, what we do makes a difference. The world of evidence-based medicine dictates our practice. When we have certain outcomes we’re not happy with, those outcomes prompt changes in protocol. Those protocol changes are implemented, and we then measure the difference.

Somewhere, sometime, a consultant met with your hospital leadership team and began the process of strategic planning. From there, you developed a vision, mission, purpose, core values and all that jazz. Unfortunately, for most hospitals, this is just rhetoric and jargon. I’m sure that at some level the leaders within the hospital make decisions based off of these “values,” but it seldom permeates in a meaningful way to the people who are providing care for patients.

For some people and organizations, the process of making a decision can be a very challenging thing. If your facility is like the hospital I used to work in as a STEMI coordinator, you talk about the decision at hand in your committees, you have meetings before the “big” meeting, and then you have still more meetings after.

tPA for stroke patients? No way. I’m not killing them.

Have you heard that before? It’s a common mantra in the emergency setting - and with good reason. However, the stroke world is rapidly changing and we all adopt the new science. Unfortunately, many organizations and practitioners are not aggressive with stroke treatment.

While comprehensive stroke centers are well-positioned to treat a lot of patients for Acute Ischemic Stroke, it is a regional system partnership. New trials released last year at the International Stroke Conference have concluded that endovascular treatment of stroke is the real deal.

Fewer things are more frustrating for a medic than calling in a STEMI. First they have to send the ECG in for the physician to see before they arrive at the hospital, and then they are asked to stop at the door to get another one using the hospital’s ECG machine. When they could be out saving more lives, duplicating their efforts is the last thing they want to be doing.

There used to be a time when prehospital ECGs were lacking in quality compared to those obtained using hospital machinery. Field ECGs simply weren't of diagnostic quality - but today's field monitors have come a long way and are now of comparable quality to hospital machinery. As
 such, it no longer makes sense to require medics to repeat their ECG upon hospital arrival.

In my role at Pulsara, I travel the country meeting with coordinators and administrators of EMS agencies and hospitals. In my travels, I've noticed that the majority of organizations can be grouped into one of two distinct categories based on their overarching attitudes and self-perceptions.

On the surface, both attitudes look the same, and both tell themselves and others “We are the best.” The distinction, though, lies in a fundamental difference in belief. The organizations in the first category believe they are “the best” as a result of pride, whereas the second camp holds this belief with humility. Allow me to elaborate:

Think back: can you remember the first time you were introduced to an executive in a company that you’ve worked for? I remember this experience at one of the hospitals where I worked and the prep for the meeting ended up being more awkward than the meeting itself. My boss gave me an impossibly long list of pointers and tips about what to say and not say …  it was exhausting!

It was very obvious that this executive had been placed on a pedestal, and as a result, I couldn't help but see him as separate and distant from the rest of the team. It turns out I wasn’t the only one.

For many of us, this is the image we’ve grown accustomed to when we think of leadership. We spend a great portion of our lives trying to get up on that pedestal ourselves, not so that we can make a genuine difference, but rather just so that we can say “Look at me! Yo Tucker, I did it!”

It was my first day in my new role as the STEMI/Chest Pain Coordinator. Because this position had been vacant for a year, the To Do list was daunting to say the least. As I attended my first meeting, I noticed that the EMS personnel in attendance was completely disengaged. I’m sure if I called him out on it he would have claimed that he was taking notes. In reality, he was probably playing Angry Birds or Words With Friends. I didn’t blame him. We weren’t a cohesive team and it showed.

The meeting was uneventful. Afterwards, my new boss said something to the effect that EMS is always disengaged and “Good luck with that!” I needed the EMS team to be on my side in order to build a successful program.

Fast forward 30 days.

“I want it so bad that it hurts.”

You’ve been there. It’s that one thing that you wish upon ceaselessly. That one thing that begins to dominate your every thought and steers your actions. We have all experienced how effortlessly human nature can take thereins and drive us to extreme measures in such situations.

CASE IN POINT

Recently, my eight-year-old daughter REALLY wanted a pet hedgehog (yes, it’s a common request down here in Texas). For weeks, she carefully plotted. The first tactic included warming Daddy up to the idea. Then she moved on to bartering and a smattering of clever negotiation tactics.

"Try and fail, but do not fail to try" - Stephen Kaggwa.

Have you ever felt like you made a mistake or failed as a leader? Of course you have because all leaders have failed. What separates the best leaders from the rest of the pack is how they view their failures. For them, failure is a gift rather than a curse. They view failure as a way to assess a better way forward, an opportunity to learn, or an experience that will shape their next decision.

It’s lonely at the top.

Yes, it was a long way from the top of the corporate ladder, but there are two things I know for sure: 1) I was in a leadership position and 2) I was VERY lonely.

But here’s a secret:

If you are in a leadership position and are alone, you’re doing it wrong.

Yup, I said it. If you are in a leadership position and are lonely, you’re missing the point.

The good news is that you’re not the only one. In fact, throughout my travels with Pulsara, I connect daily with fellow coordinators – from large and small health systems – that feel the exact same way. I get it. It’s a tough position. In fact, as a coordinator, the very essence of your job is influencing people in areas where you have no authority.

“The only people who like change are wet babies.”

-- Mark Twain

How true is that statement? If you’re looking for an enemy, just go and change something. I wish it were different, but it’s one of life’s inevitable truths. Many of us live under the false pretense that one day all things will stay the same and we’ll find ourselves sipping umbrella drinks on the beach. This is true; one day you’ll find that change is not longer relevant, but it requires that you die first.