Let me start by saying that over the years, I’ve participated in many conferences, retreats and uber spiritual events designed to inspire and spiritually reinvigorate participants. The good news/bad news stemming from these experiences is that I have developed a high “jaded” bar that an event must clear in order to really get my attention and touch me in a genuine, non-manipulative way. I’m a tough nut to crack. Understanding that back drop and filter, my response to Friday’s program was even more remarkable. Simply put, I was blown away by Friday morning’s team of presenters, first a pairing of Dr. Rachel Naomi Remen and Dr. Kristen Swanson, and then by Marcus Engel, a man who almost lost his life, went through years of hospitalizations and procedures and has come through it to be a voice of the patient for all of us.

Dr. Rachel Naomi Remen and Dr. Kristen Swanson: A Spiritual Dream Team

“What if I’m exactly what is needed at this time?” That was the central, transformative question posed by Dr. Remen, who suggested we ask that of ourselves as we enter a patient’s room, anticipate a difficult meeting, prepare for a procedure, or brace ourselves for a challenging situation. What would our attitude and approach be if we knew that we were exactly what was called for in that situation? Dr. Remen’s story of the new nurse standing in frozen terror in the corner of a patient’s room as his heart flat lined and doctors and nurses frantically worked to restart his heart; her feelings of failure and her subsequent return to the revived patient’s room the next day, her last visit before she was determined to quit nursing; their simple conversation in which he told her that through her raw, heart-felt caring, she “held” him in the room and tethered him to this life as he hovered above the scene. It simply set my heart on fire and still brings tears to my eyes in the retelling and remembering.

Dr. Remen’s stories and quotes were strung together like precious gems, each one with a brilliance, a unique sparkle that when looked at as a whole necklace was almost blinding in its beauty. Here are a few quotes that touched me…

“Reclaiming our relationship is central to our work. Healing is the recovery of the heart, soul, meaning and gratitude.”

“Our real power to make a change is in our own wholeness. We heal with our wholeness.”

“Being a human being is not being unprofessional. Our own wounds make us compassionate. Because we are all wounded, no wounded person should feel ashamed. “

“As a doctor, I was trained to see the world, the patient as broken. My job was to fix them. I’ve gone back to an older way of seeing the world and that has to do with relationship. ‘Tikkun Olam’ is a Jewish concept of healing the world. It states that all of us are healers, able to heal the world and be of service.”

“Simple gestures affect others profoundly.” (This was illustrated by Dr. Remen’s story of the physician who had treated her father and known him for many years. Upon her father’s passing away, this doctor had written a letter to her mother stating how much Dr. Remen’s father had loved his wife and daughter and what an exemplary physician he had been. Dr. Remen had found this lovingly tattered letter in her mother’s purse, which her mother had carried with her for eight years following her father’s death.)

“All life needs is for you to care for it day by day by day. The ways we do this is very old and hasn’t changed.”

“Our work is a work of service, a special kind of love.”

Dr. Kristin Swanson, RN, PhD, FAAN, an icon and leader in our field, followed with the perfect counterpoint to Dr. Remen’s talk with a discussion of “Human Health Ecology.” Her message of Organizational Mindfulness and Servant Leadership was reinforced by a story of nurses who went to Iraq thinking they were going to care for U.S. soldiers and ended up treating prisoners. “Their competence gave them a job; their compassion gave them a meaning.”

Dr. Swanson defined caring and healing as believing in another person and their capacity to come through a challenging experience. Following both presentations, Dr. Remen and Dr. Swanson fed back their impressions of one another’s talks; an innovative, “real time” way to generate discussion and develop thoughts following what is normally a one-sided delivery of information. This was followed by a long line of people from the audience wishing to share their reactions and stories. Some of the gems that came from this dialogue were:

“Bring your gifts to where they are used best.”

(Dr. Remen) “I took much criticism as a young doctor for not maintaining this distance, not having the detachment that I was told I needed to have clear vision and decision making. I found that it takes a tremendous amount of courage simply to love.”

“Of the 2,000 students who’ve taken our medical education program (run by Dr. Remen), the most important thing they learned was that they are enough.”

Marcus Engel: Transforming Tragedy into Meaning

Donna Wright prepares to introduce Marcus Engle and his dog Carson

Marcus Engel suffered a life-altering, almost life-ending tragedy when he was an unwitting passenger in a drunk driving auto accident. As a young man in his late teens, early 20s, Marcus had to learn how to live without the use of his sight, and with the many transfiguring surgeries required to rebuild his face where every bone had been broken or crushed. He was able to combine wit with tragedy and morph both into an amazingly powerful series of lessons relevant to all of us as health care providers and as human beings. Here are some quotes to give you a flavor for his talk:

“Sometimes your patients have no place to put their anger but on you.”

“Everybody has a backstory and deserves a little piece of grace.”

“Complimenting your coworkers (eg other nurses, health care providers) in front of patients has a huge impact on building a patient’s confidence in their caregivers.”

“I’m here are the two most comforting words a health care professional can say to a patient.”

Yes, Friday was the perfect soul-filling capstone of this 3-1/2 day symposium; balancing heart with learning, deepening insights from posters, new friends and familiar colleagues, and reinvigorating our commitment to practice relationship-based care. I don’t think I was the only one who left walking on air….

Terri Moss
Moss Communications

Co-author and Publisher,
Healing with Heart: Inspirations for Health Care Professionals

WINNER: American Journal of Nursing 2008 Book of the Year Award in the Leadership and Management category

www.mosscommunications.net

Mary Koloroutis, Vice President of Creative Health Care Management, introduces keynote speaker Stephen M.R. Covey

Moments of Magic and Measurement

Thursday’s Symposium was filled with presenters who stimulated, inspired and opened us up to ideas that struck a rare right/left brain balance by discussing both the magic and matrix of Relationship-Based Care.

I think it’s fair to say that the audience was blown away by Steven Covey and his topic, The Speed of Trust in which he courageously tackled the subject of quantifying a value we all implicitly know to be essential and the basis of effective communication, efficient teamwork and quality patient care. Covey reinforced that his message of trust is “completely aligned with the work of Relationship-Based Care” and that the impact and relevance of trust is there whether we see it or not. His fundamental message was conveyed in these three ideas:

1. Trust is both a social virtue and an economic driver that impacts the speed and cost of getting things done
2. Trust is the currency of Relationship-Based Care
3. Trust is a learnable skill that we can turn into an asset as we become good at it

The audience was asked to consider what it’s like to communicate and work with someone with whom you have high trust vs. someone you mistrust. Simply imagining both scenarios made the concept and impact of trust very real. In his summary, Covey noted that the concepts in I2E2 are woven into his 4 Cores of Credibility:
1. Integrity (honesty in doing the right thing)
2. Intent (motive of caring creates the most trust—that you seek and act in everyone’s best interest)
3. Capabilities (are you current and relevant?)
4. Results (“Evidence” in I2E2)

Steven Covey’s presentation was followed by a panel from Moses Cone Medical Center and McKee Medical Center who presented their best practices model of Relationship-Based Care. Moses Cone discussed how instituting RBC and Reignite the Spirit of Caring workshops increased employee engagement and patient satisfaction. They created a Reinventing the Spirit of Leadership program and have committed to all of these programs despite budgetary pressures, considering this to be an invaluable, long-term investment. Great stories emerged including the formation of The Bone Squad and their creative ways of making patients and families feel at home.

McKee Medical Center shared great stories and practical processes for instituting, reconstituting and sustaining RBC, including a lot of circle work, creating trusting relationships, a focus on creating a healing environment for patients, family and staff, the commitment from leadership and the need to involve everyone in their organization: those who deliver care at the bedside as well as those who support them. Both health care systems were inspiring and practical in the way they are committed to providing the best possible care while caring for staff.

Ann Rhoades finished off the day with a high energy presentation about people-centric cultures, using Jet Blue, Southwest and other organizations to illustrate her points. Some of her more memorable quotes were:

” Culture is a direct result of our behavior.”
“Our people must live the organization’s values. Values aren’t just letters on a wall. If caring is one of your values, show your employees that you care. You don’t need money to show you care.”
“You need to hire “A” players; you can’t afford to have “C” players in your organization. Most “C” players know they don’t fit. They want to self-eject and as a leader, it’s your responsibility to help them. “A” players mirror your values. Most people would rather work with fewer “A” players than a full staff of “C” players.”

Ann brought down the house with her final admonition: “When you think you’re hot….you’re not!” Humility and the importance of relaxing your self-imposed expectation to be perfect are critical to good leadership.

It was another amazing day punctuated by the inspirational singing of Barbara McAfee.

Terri Moss
Moss Communications

Co-author and Publisher,
Healing with Heart: Inspirations for Health Care Professionals

WINNER: American Journal of Nursing 2008 Book of the Year Award in the Leadership and Management category

Barbara McAfee deepens the meaning of keynote speeches with music

A Day of Inspiration, Stories and New Perspectives at today’s
Relationship-Based Care Symposium!

It was a day filled with new insights and shared stories that inspired
and renewed our commitment to our healing professions. Our morning
kicked off with Dr. Mae Jemison, M.D., a woman whose diversity of
talent and experience almost defies the imagination! How many doctor/
engineers/dancers do you know who have traveled to space, served the
poor in Cambodia, are the inventor and CEO of a high-tech medical
devices company and have a place in fifth grade science text books?
Here are just a few of the paradoxes and ideas that Dr. Jemison
challenged us to consider:

“The arts and science do not have to be mutually exclusive. They are
both rooted in creativity.”

“People invest in what they can measure. But just because you can or
cannot measure something doesn’t necessarily mean it’s worthwhile,
valuable, pertinent or important.”

On the subject of Health Care Reform:

“There’s a difference between access to health insurance and access to
health care. Health care is not part of an interchangeable business
model.”

On experience, she quoted Mark Twain:

“You learn something by carrying a cat by the tail that you cannot
learn any other way.”

On committees, she said:

“A committee is a cul de sac where good ideas are lured and then
quietly strangled.”

Finally, Dr. Jemison equated initiating ideas with holding a ball in
the air and the law of physics. The power of a ball is inert as long
as one is holding it up in the air. Its power is felt when one adds
motion. Similarly, ideas are nothing until someone takes the risk of
putting them into action.

All of us walked away moved and stimulated by Dr. Jemison’s unique,
challenging, and powerful perspectives.

NURSE-PHYSICIAN PARTNERSHIPS: Shared Commitment to Patient Care

What a captivating idea: let’s put a group of docs and a group of
nurses together and have them write for 10 minutes about a critical
incident, an unforgettable moment in their practice. Jack Truten, RN,
PhD and Lorraine Dickey, MD, MBA, FAAP shared their experiences of
running these groups in an effort to transform patient care, combat
compassion fatigue and rebuild teams. It works. Narrative
Professional Initiative Medicine has taken hold at Lehigh Valley
Health Network and amazing stories came out of this session. Some
universal issues that have emerged include:

• Nurses’ and doctors’ predisposition to beat themselves up when
something goes wrong: self blame and rumination on “How could I have
done that?” “Others are more professional than me” and similar
negative, unproductive self talk.

• Doctors and nurses asking themselves: “When is it my professional
obligation to speak up, especially when it’s on behalf of my patient?”

A program like this needs to be leadership-driven and grass roots
support. Tenacity and passion to stick it out are key.

Nurse-Physician Partnerships Intensive: Shared Commitment to Patient Care

POWER OF PRIMARY RELATIONSHIPS

Three health systems shared their experiences of implementing RBC. One
added dimension of the discussion was having presenters talk about how
phlebotomists and pharmacists are instituting RBC. Many inspiring
stories were told that reminded us of why we went into health care in
the first place. Patients remembering our names, forever being
touched by our patients, and our deep understanding that what we do is
truly sacred.

What the panalists left us with is simple and applies to anyone who is
being an agent of change:

1. Have fun
2. Keep an open mind
3. Don’t give up

There is power in sharing and it is truly inspiring when all of us
come together from across the country and in four countries to share
and realize all that we have in common. Another great day!

Terri Moss
Moss Communications
Co-author and Publisher,
Healing with Heart: Inspirations for Health Care Professionals

The Symposium began with a beautiful blessing from a member of the Oneida nation. Jayne Felgen, President of Creative Health Care Management then welcomed the attendees and introduced keynote speaker Peter Block.

Peter’s Address, “Community: The Structure of Belonging” was accompanied by songs and poetry performed by Barbara McAfee. Barbara brought further meaning to Peter’s key themes with her moving music.

Peter began his address by stating, “If you care about outcomes around health care, community or your family, it all rests on relationships. Relationship-Based Care is a revolutionary movement to integrate collaborative care in order to provide healing.”

Transformational change was a major theme of the address and Peter said, “All transformations are linguistic. A big issue for people is not making contact with others because I’m too busy doing things that don’t work! A key to overcoming this dilemma is collaborating in small groups. This is where transformation takes place. This is the space where everyone’s voice is heard.”

Peter’s insight, knowledge and humor was met with an engaged response from the audience and a standing ovation at the end of his address.

How are you building community in your organization to best serve patients and their families?

Dave Moe

Marketing Director, Creative Health Care Management

Jayne Felgen, President of Creative Health Care Management, welcomes attendees to the National Relationship-Based Care Symposium

In his book The SPEED of Trust: The One Thing that Changes Everything, Stephen M.R. Covey challenges the age-old assumption that trust is merely a soft social virtue, and instead demonstrates that trust is a hard-edged economic driver. Trust is a learnable and measurable skill that makes organizations more profitable, people more promotable, and relationships more energizing. Mr. Covey will be a keynote speaker at the National Relationship-Based Care Symposium to be held July 28-31, 2009 at the Turning Stone Resort in Verona, New York. He will provide health care leaders with insights that will help them support behavior change to inspire trust in the pivotal relationships of work and life.

The National Relationship-Based Care Symposium is being presented by Creative Health Care Management (CHCM), an international health care consultation, education and products company celebrating 30 years of transforming health care. CHCM created Relationship-Based Care as a model that places personal relationships between caregivers and patients and their families at the center of care delivery. This model provides tools for organizing care and effecting change as well as guidance in transforming the cultures of health care institutions from depersonalized, schedule-driven systems into person-centered sources of individualized care provided within a compassionate and healing environment.

At the symposium, a national community of courageous and passionate leaders who are committed to transforming health care through the power of Relationship-Based Care will gather to gain new knowledge, celebrate successes, and develop and renew collegial relationships. Exemplars from organizations across the country will share the lessons they learned in implementing and sustaining a Relationship-Based Care culture.

Additional keynote speakers include:

Peter Block: Author and consultant who focuses on empowerment, stewardship, chosen accountability, and the reconciliation of community.
Mae Jemison: Physician, founder of two technology companies, the first woman of color to go into space, and speaker on science literacy and technological and medical innovations.
Rachel Naomi Remen: Professor of Family and Community Medicine at UCSF, Director of the Institute for the Study of Health and Illness at Commonweal, and a pioneer in holistic and integrative medicine.
Ann Rhoades: Visionary human resources executive with more than 25 years experience in a variety of organizations including Southwest Airlines, Promus Hotel Corporation, and JetBlue Airways.
Kristen Swanson: Professor of Nursing Leadership and Chair of the Department of Family and Child Nursing at the University of Washington.

Other symposium events include concurrent sessions presented by content experts on a wide variety of relevant topics, panel presentations by exemplars, a poster extravaganza, and a world café.

In these challenging economic times, focusing on person-centered care and team relationships is more important than ever. At this first-of-its-kind symposium, leaders from acute care and long-term care facilities as well as academic settings can garner inspirational and practical ideas to help teams move to the next level, strengthen team relationships, and recognize and reward teams for the wonderful work they are doing. Symposium offerings are designed for multiple leadership audiences including:

Administration: CEOs, CNOs, COOs, CMOs, CFOs, HR leaders, and board members.
Results Councils and steering teams: Leaders representing communications, education, quality improvement, caring and healing, physician partnerships, and service support.
Department/unit managers and directors: Nurses, allied health professionals, service support leaders, physicians and pastoral care.
Staff: Unit/Department Practice Councils representing allied health professionals (RT, PT, OT, and pharmacy), service support (food service, housekeeping, transport, etc.), nurses, physicians and others engaged in RBC implementation.
Faculty and students: Nursing, medical, allied health professions, and health care administration.

For more information, a schedule of events, registration details and information about Turning Stone Resort, please visit www.chcm.com

 The National Relationship-Based Care Symposium will bring together hundreds of health care professionals from around the world to discuss patient centered care and how to make it happen. Featured speakers include Peter Block, Mae Jemison, Stephen M. R. Covey, Rachel Naomi Remen, Ann Rhoades, Kristen Swanson and Marcus Engle.

Over 100 poster presenters will be on hand to demonstrate how Relationship-Based Care was implemented in their unit or department. Posters are divided between the 5 elements of our transformational change model called I2E2 (Vision, Inspiration, Infrastructure, Education, Evidence). Using this approach participants will be able to effectively increase their capacity for sustaining momentum on their RBC journey.

Stay tuned to this blog as we will be posting each days happenings!