Barbara Balik
Executive Vice President for Safety and Quality Systems
Allina Hospitals and Clinics
"The community in Minnesota is very collaborative." (1:15)
My name is Barbara Balik. I am Executive Vice President for Safety and Quality Systems at Allina Hospitals and Clinics in Minneapolis/St. Paul, a big system in the greater Minnesota area. Came together, as many systems did, from a variety of mergers of both hospitals and clinics. So, it is a very interesting gathering of lots of people providing care. It is the largest health care provider in Minnesota. I partner with the Chief Medical Officer and we view it as doing two things: working on the quality of our product as an organization, which is health care services, and secondly, how do we look at the quality of our systems and of our people and particularly our people systems to deliver on that promise we have in our mission?
The real benefit of being from a large organization is that we can point to almost always somebody who has figured this out in our system and, if not, in our community. The community in Minnesota is very collaborative and it’s got a weird, collaborative, competitive mix, so you can always point to somebody in that community, or again through the IHI community, who has done it and so you can easily say, “Okay, we are not satisfied with our results and we know someone who has done it.” As one of my colleagues, Cheryl Hermann, says, “Don’t we owe it to our patients? Isn’t it a moral imperative?”
"If you have an employee injury and you have a patient injury, it really boils down to some of the same skill sets you need to address both." (1:30)
The whole work in patient safety and employee safety and the integration of those two, it is a common culture, so how do we do that? Most often they are seen as two different sets of activities and there are two bodies of expertise, but when you start peeling it back, if you are a first-line manager or a manager of a clinical department for instance, and if you have an employee injury and you have a patient injury, it really boils down to some of the same skill sets you need to address both. And that is from my own personal learning. When I was a hospital president, I was really advancing the patient safety agenda and finally a couple of really clear-sighted managers said, “Barbara,” or kind of earth-to-Barbara message of, “You can’t be really championing patient safety, when you are not doing the same for employee safety.” The message was just too dissonant. It lacked integrity and that was a great, hard-learned lesson and, as soon as we started focusing very aggressively on employee safety, we got great traction with patient safety. Again, it was the same sort of mind-set that took you there.
Often when patients fall, staff are injured. They either attempt to prevent the fall or they attempt to get the patient back up from a fall or they are in the room trying to juggle around multiple things. So, when you look at them as an integrated whole and say, “Well, why do patients fall, what can we do to prevent that,” then you don’t put staff in harm’s way. So, it is as basic as that.
"Be willing to stand in that humble place of a learner, to say, 'I don’t have a clue, and this is really hard work, and I wonder who knows it better than I do?'” (1:26)
We tend to use old styles of leadership and, if those worked, we wouldn’t have the problems in health care that we do today. But something about us as leaders is reluctant to let go of the models we have had. So as we have a collection of learners, that begins to give an absolute rock-solid statement about “this is another way to lead health care.” And where we lag is as leaders adopting that as fast as we could, having our schools teach the tools and techniques as fast as we can, and not to have the tools and techniques of quality and quality improvement that apply to everything, not only clinical care but everything we do, not seen as a sideline but as core. The faster we move on that, the faster we are really going to transform health care.
The second thing that I think that anyone can do, it is within our realm, is to be willing to stand in that humble place of a learner, to be wide open, to say, “I don’t have a clue how to make this better, and this is really hard work, and I wonder who knows it better than I do?” And being willing to ask really dumb questions. I often say that people are rarely reluctant to talk you out of saying you are dumb. If you say, “I am dumb, I really don’t know how to do this,” they rarely say, “Oh, no, no, no, Barbara, you are brilliant!” They are usually willing to help share their wisdom and, as long as you are open to that, some of it works, some of it may not.
"A social movement is a very good metaphor for what is going on. That is the way that you really transform really highly bureaucratic organizations that aren’t going to change easily from the inside." (1:07)
I think a social movement is a very good metaphor for what is going on, and maybe it is just my age and having been through some social movements before, it has that feel and I think we should not underestimate the continued need and emphasis for us to view it as a “grass roots, let’s keep going with this work” because I do think that is the way that you really transform really highly bureaucratic organizations that aren’t going to change easily from the inside.
The second is skills. You develop the skills. So, just as you think of the Highland School where Rosa Parks learned some of her skills of peaceful resistance, there are some skill sets that we can apply to the work and then success stories, things that sustain you past your own work. So, I think there are a lot of things to it and not waiting for anyone’s permission to do it. Health care organizations are highly bureaucratic, steeped in both military and the religious structures of the past, and so sometimes it just seems too hard to make those changes. So, again, that is ripe for kind of a social movement kind of activity.
"We need all sorts of voices to make a movement work." (1:01)
I started my career as a Labor and Delivery nurse in a large university setting in the Midwest, and within two years it went from dads couldn’t be in the delivery room because they would contaminate the sterile field — I tell that as a joke and people laugh today and I say, “Believe me, people thought that was dead serious then.” Two years later this place had wallpaper and dads could go anyplace they wanted and I said that didn’t happen because a lot of nurses and physicians wanted it. A few. But primarily it was because consumers demanded it and women demanded it. That is how we have breast centers today; women demanded it.
And sometimes people like me who advance the ideas that I am talking about are a little bit on the “there she goes again,” a Looney Tunes; I call them wing-nut end of the spectrum. And so, a lot of this is about translation. I am a big fan of the concept of translation. Sometimes you have to translate from one paradigm to another, from one world view to another, because we need all sorts of voices to make a movement work.
06/12/2006
