Music to my ears

Originally posted 6-9-2010:
One of the main themes throughout the NPSF Conference was culture change.  Of all the aspects of healthcare, patient safety solutions involving culture change will take the most time and energy to achieve.  Many session topics at the conference focused on healthcare organization, teamwork, driving change, and training and education. The fun and refreshing way the conference opened really caught my attention.

The opening session was titled The Music Paradigm, with Conductor Roger Nierenberg.  Walking into the hall, I noticed the seats for the audience were scattered in between different sections of a full orchestra.  The room was full of different musicians of all varieties: brass, strings, percussion...even a harp.  My first thought as I sat down was what does music have to do with patient safety?

Conductor Nierenberg uses music and the dynamic nature of an orchestra to provide a metaphor for well run organizations.  The first five minutes was the orchestra playing absolutely beautiful music.  Then he starts to get the audience thinking about how an entire orchestra, with so many different people playing different instruments, can work together so well.  That is when it hits you, there is a comparison to how an orchestra runs with how a hospital is run. The conductor of the hospital could be the C-suite or the Chief of Medicine. The section leaders are like the managers of the different teams and specialties, perhaps a nurse manager or DOP.  Then the rest of the orchestra is the rest of the staff, both clinical and non-clinical.  Every musician with their instrument is essential to creating the music that will stop someone in their tracks to listen.  Just like everyone in the hospital is needed to provide the safe, high quality healthcare the patients expect.

The audience heard the result of an orchestra that was well conducted and worked together as a team. What would happen if different parts of the orchestra did not work together well?  He asked only the section leaders play, and the music still sounded good.  Then he told these select musicians to play the song with whatever style they felt like playing.  The music was off and flat.  He switched to asking only the strings to play, but he started waving his baton before they were ready.  The result was like hearing nails on a chalkboard.  In another example, Conductor Nierenberg was very casual in waving his baton and leading the orchestra.  You could see that he was not really listening to the orchestra and was in his own world on the stage. I'm pretty sure my old junior high orchestra sounded better as each section sounded as if it was on a different measure of the music.  Finally he asked the section leaders to play however they wanted, while the rest of the orchestra followed his lead.  The music actually sounded good, but no one would have guessed a few of the musicians were slacking off.  This was an interesting way of showing that even if everything sounds fine, there could still be issues lurking that need to be addressed.

I found this to be a fun way to discuss healthcare organization dynamics.  Getting that musical perfection was the result of everyone listening to each other carefully and working together as a well run team.  Each example resulting in poor quality music could be compared to a healthcare situation where the culture and teamwork broke down.  When a team is not functioning well it can lead to miscommunication, handoff errors, and frustrated staff - all of which can lead to a potentially unsafe culture for the patient.   Without a good conductor that promotes patient safety, the rest of the staff will be flat in achieving safety.  Every level and specialty has to work together smoothly to achieve the goal of safe patient care.  Healthcare organizations and teams should ask themselves, what is it going to take to make that music beautiful?