My Ankle is not Your Patient, Patient-centric Hospital Design, Burnout

The last two weeks have been quite demanding. After returning home from my UK trip, where everything that could possibly go wrong, did, my Swiss doctor took one look at my ankle and sent me for an MRI scan. Beyond the doors of my home, pharma is perpetually reorganising itself, the stock markets have taken a tumble, the news – and my emotions – follow the war in the Ukraine, talks on NATO, stagnation and inflation and the individuals I know, who are severely impacted by rising gas prices.

Resilience is important and easy to lose sight of when faced with the demands of the world. The topics I am covering today are influenced by: being a patient, finding direction in a challenging world, and a recent comment on a post about knowing when to change your job.

Today’s topics:

– Patient experience – or my ankle is not your patient
– Patient-centric hospital design. Where do I have to go? Follow the path!
– Is your disenchantment really a burnout?
– What chickens have taught me about global programme management

Patient Experience – Or my Ankle is not your Patient

On a recent trip to the UK, I twisted my ankle. The NHS did an X-ray. I was relieved that it was not broken.

Back home, my Swiss doctor sent me for an elective MRI saying, “It won’t change the clinical outcome but it would be good to know what shape your ankle is in.” Liking to know what to expect and not liking the thought of being inserted into a tiny space, I checked the MRI provider’s website for information. There was information on the team, on the sites, on the history of the company – everything a business would tell you about what they do. There was even a photo of an MRI machine. But no data on aperture sizes, scan duration, what to expect when you have a scan, things to consider, and what to do if you don’t like small spaces. There was no information on open/closed machines, magnetic fields or which machine can be used for which examination. As it was an elective procedure, I considered cancelling a number of times.

As I searched the internet, I noticed a stark contrast between Swiss MRI provider websites and US MRI provider websites. On the latter there was a lot of information for patients.

Finally, my key question: “If I am having a scan of my ankle, how far into the machine will I be inserted?” was answered by my calling two friends who had had knee scans, considering their height relative to mine, and then concluding with the help of a tape measure that I would be mostly outside the machine.

When I arrived at the site I was stressed and found it difficult to navigate the building; fortunately a friend was accompanying me and helped guide me to my provider. The technician was hurried. I asked him how often patients were nervous. He misunderstood my question and answered, “Oh, I have learned to not let it get to me at all.” As he put me into the machine, I felt like a product on a conveyer belt. When I asked him if I could talk to him during the scan, his answer was: “No, I will be working, so I won’t have time to talk.”

I got the scan results the next day and read them. They were not great. I was surprised by how impacted I was by reading them. When I saw my doctor, he said: “Oh, you shouldn’t have read your results, I would have broken the news to you gently”. It hadn’t crossed my mind to leave the breaking of the bad news to him. In retrospect it would have been a better idea.

It was, overall, an unpleasant experience from start to finish but it highlighted for me that what I need as a patient, is very different to what I need as a doctor; that when I am hurt and concerned, my worries are not technical in nature. It highlighted to me, the madness of developing anything for patients, that doesn’t involve the patient. A patient advocate once said to me, “When you design a car seat, you take the driver into account, so how can you design medicines and not take the patient into account?” You can read that interview here.

What a patient needs, what she desires to know, how she experiences a treatment, what she wants to know about the treatment schedule, timeframe, etc., nobody other than a patient can tell you that. Today it is a given that it is critical to involve patients in the development of any treatment, treatment process or information that is designed to help them make decisions on their healthcare. My experience highlights that not all cultures are equally attuned to this yet and that there is still work to do. This leaves me with two questions: Why is it taking so long to implement changes that are obviously needed and make sense? And why is it that every service provider asks me for feedback and enquires how they can improve their service, except the MRI healthcare service provider where my feedback might actually help improve other patients’ experience.

Patient-centric Hospital Design. Where do I Have to Go? Follow the Path!

Credit: Isabelle Widmer – San Raffaele Hospital Milan

The Italian healthcare system operates in an interesting way. While funding is regional, patients can choose to be treated in any hospital in the country that they like; the hospital then receives the funds from the region the patient is from.
Patients from all over Italy travel to leading research hospital San Raffaele in Milan to be diagnosed and treated. In 2016 I accompanied a friend there.

San Raffaele is a giant. The hospital provides 1.5 million outpatient services and 30,000 surgical interventions each year. I remember being overwhelmed by the size of the car park, comparable to large shopping mall car parks in the US. The size of the hospital was even more daunting; navigating the long hospital corridors was like trying to find your way around Heathrow Airport.

However I was impressed by the hospital’s navigation system. It was simple and effective, with a coloured line for each speciality. All patients have to do is follow that line, without thinking. I remember walking for ages, I remember linoleum floors in sunny yellow. I remember following the yellow line round corners, up and down stairwells and in and out of buildings. Other coloured lines ran alongside the yellow one, splitting off down different corridors, until just the yellow one was left. While in 2016 I admired the system, it took my experience of going for an MRI scan last week, to highlight just how important a simple navigation system is. When I went for my scan, my mind was on my scan and I found it a challenge on coming out of the car park to identify the correct building and floor for the MRI provider. I remember being embarrassed that I couldn’t do it and immensely grateful to my friend who kindly led the way.

Healthcare is not just about the right drug for the right patient at the right time. It is also about making things as accessible as possible for patients, whether in the real world, as in San Raffaele hospital, or on a website, using simple navigation menus and ensuring your medical scientific content is more accessible (more on how to do that here).

Is your Disenchantment really a Burnout?

In my last newsletter I wrote that when you no longer care about your job, it is time to change it. A fellow coach, MD and GM Michal Kazmierski commented on my post saying, “Isn’t it called “burnout”? If we don’t watch carefully, it will slowly and sneakily develop over time until we may find ourselves in a place where both our well-being and health are in danger…” He had me at sneakily.

Our current world is challenging. I meet many individuals who are in companies that are being reorganised. Some are hoping to receive a severance package. Some present their plans for next year to their teams and hear only laughter, after which they conclude that, perhaps in the future, they won’t have a job. Others report that the acronyms are changing, the organisational structure is changing, that budgets and headcount are reduced but that despite all the ongoing changes they are still trying to perform at their old levels.

Being disenchanted is perhaps natural, depending on the circumstances, however burning out is a real risk. One disenchanted individual I remember, did as little work as possible, he spent his days printing out job adverts on the office printer and applying for new positions. He was cheerful, fun to be around and just generally didn’t care about the position he was in any more. He left soon after and went on to have a stellar career elsewhere. Burnout is very different and as Michal writes, burnout happens slowly and sneakily. It is worth considering whether you are at risk of a burnout, whether that tiredness you cannot shake is a symptom of something more than just being chronically overworked.

Some things to consider: do you feel tired a lot of the time? Have issues sleeping because of work projects? Find it hard to achieve recovery after a weekend away from work or a holiday? Find it harder to prioritise your daily activities than perhaps in the past? Are you engaged in many projects with different leads? Do you struggle to say no to deadlines, even if they are unreasonable? Are you generally dedicated, loyal and have a perfectionistic nature? Do you worry about not disappointing anyone? When under work pressure do you reduce your leisure activities so you can focus more on work? Are you more emotional than usual, more easily triggered, more irritable? Do you find it hard to be joyful? Do you feel that a lot of your work life is out of your control, and you have little influence on your day-to-day workload and outcomes? Do you think of changing jobs, but you worry that you wouldn’t have the energy to go to interviews, or to even perform a job search?

Unfortunately, burnout creeps up on you, it’s hard to self-diagnose and so many soldier on. It helps to ask trusted friends for their thoughts if you suspect you might be at risk. It also helps to not look around your department and think, everyone else is struggling too, it’s normal. If you are managing a team, it’s important to keep this awareness in mind in these challenging times.

What Chickens have Taught me about Global Programme Management

If you have ever run a global project, you will have heard a variation of “This won’t work in my country”. Sometimes, you will be told: “It’s against the regulations”, sometimes: “No other company in my market does this”, sometimes: “It’s not a cultural fit with our customers”. If you are running a global project and you don’t hear any of the above from any country, what you will likely discover if you check how your project was implemented, is that something was done, but it wasn’t what you hoped for or expected. As a friend of mine said: “We get global recommendations all the time. We have given up saying, “This won’t work for us”, so what we do instead is say, “Yes”, then implement something else… nobody ever checks”.

Sometimes, global teams feel that the local teams are exaggerating. However, it helps to make sure you understand the objections. Cultures can be very different, and sometimes differences are in such basic areas, that you wouldn’t think to expect a difference.

To illustrate I am sharing my experience with chickens. Once in Russia in winter I went to a big market and bought a chicken. Telling me the price, the salesperson held the chicken carcass up to my face and spread the thighs at me, demonstrating that the internal cavity was empty. As this is how I buy my chickens in Switzerland, I was very confused. I kept nodding and saying, “Da”. Great conversations are not made when the speakers have less than five words in common. I later discovered that in Russia, at that time, chickens were sold intact and that I had bought a more expensive bird because someone else had already eviscerated it.

In another example, in an Ethiopian cookbook that was printed for the Ethiopian market, the instructions for preparing chicken are: kill your chicken, then submerge it in hot water and remove the feathers. Visiting my brother in Hong Kong, he told me his neighbours bought live chickens at the market and killed them in their flats. And an example from a Ukrainian friend, he once told me that during the time of communism he would go shopping and come home saying, “I found a goose” or, “I found a chicken”, because he could never predict ahead of time what the market would have in stock. Having grown up in the West this was unimaginable for me, although when he explained it made sense.

I share these examples to illustrate that differences in approach may not be obvious to you. You may not even think to ask. You may take a certain approach for granted, as I did with my chicken purchase in Moscow. This means you need to ask open questions and allow time for the responses. You need to be curious and open-minded. You need to avoid assumptions. If you don’t ask, you won’t know and if you don’t know you cannot accommodate for local variations, at which point your global project is potentially at risk of not being the full-scale success you’d like it to be.

I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.

Very best wishes

Isabelle C. Widmer