Here at the College of Nursing’s alumni day. Featured speaker of the day is Dr. Tim Porter-O’Grady. An engaging presenter, he keeps the attention of the audience through interesting stories, fascinating statistics, and engaging humor.
He compares the healthcare system of today to what we once had. The average length of stay of most patients is 4.5 hours. Nurses try to provide discharge planning just before patients go home, when patients can only retain 5% of what they hear. He referenced a hospital in Hackensack that has videotaped discharge instructions and posted them on their unit’s website so that patients and families can them once they return home.
Change isn’t a choice, he says. And, with a visual of a nice outhouse on the screen, the question is asked Do you really yearn for the good old days? Of course, some would say yes. Our educational systems are mostly grounded in the past. Two words matter, according to Stephen Hawking: Change is … we can do nothing about that.
It was interesting viewing O’Grady’s presentation. He evidenced many of the qualities that were described in a recent webinar I attended on How to Deliver Presentations like Steve Jobs. O’Grady didn’t have a slide for every point of his presentation. He often had a black, blank screen. When he had something on screen it was often an image and a few words. He spoke from memory – no notes, no bullet points on his slides to guide him. Yes, he is a skilled presenter and does numerous presentations … but his delivery of material (from early morning till mid-afternoon) was great. His energy level was high, his voice altered from high to low, he didn’t stand behind a podium but walked in the front of the room back and forward (in a not distracting way).
O’Grady engaged the audience all the way thru his presentation. He walked into the audience to speak to a table of faculty. He borrowed materials from audience members to illustrate points – such as how nurses take report at shift change.
How much am I doing? How much am I accomplishing? How much have I done? These are industrial age questions … they are not the questions of today. But, what are today’s questions? It’s not about what you do. “DO” is not a value.
Nurses are wedded to old ideas and old ways of doing things. We cling to paper and pen, which means that we cannot fully embrace the paperless and electronic world in which we live. We need to let go of some things in order to embrace new and current things.
He spoke of an information-driven mechanism for nursing education. Knowledge is not a capacity. We cannot know it all. Knowledge is now a utility. The issue is not do we have knowledge (you could only achieve 10% of what you need to know to be relevant and competent today). How do we make you access competent? Do I know how to access knowledge? Knowledge access is a skill, it takes discipline, it’s a learned skill. Access is only the first stage. We must take the knowledge we access and judge whether it can be applied and how we can use it. We must have translational skills and applicational skills. Third, we must learn how to let it go when it’s time. Most of what you got when you got it is irrelevant when you apply it.
Policies and procedures are a barrier to today’s healthcare system. You can’t do evidence-based healthcare in a non-electronic world. The applied framework often serves as a barrier to the application of evidence-based healthcare. BEHAVIOR is changed by what is directly available to us at the time.
We must start reading outside of our field. He referenced the following books (just a few of those on his shelf):
The “doing” of nursing is not the distinctive factor … it’s the “being” of nursing. His question: What do we be? We need to integrate to improve the patient’s journey. We must see our future differently from the path that got us here.
As nurses, we’ve got to be willing to explore places we’ve never been before. The journey is not without risk. Similarly, you can’t eliminate errors. You can manage error. You can learn from error. We have created risk-adverse people in our hospitals. As a leader, when you find an error you should call people together to celebrate it and learn from it.
He spoke about the DNP degree, saying that it was a timely degree, but that the healthcare system isn’t sure about what to do with DNP graduates.
Living in the digital world:
- information is greater than we are. Information is the vehicle we’re traveling on.
- Information is a utility, not a capacity
- Access is more important than having
- Knowledge is not permanently relevant
- Work never remains the same
- Effectiveness occurs at the intersections
- Look for the nodes and networks
He spoke about the sociocultural aspects of information technology. He noted that No discipline can ever again define for itself alone what it will be or do out of context of its relationship with those on whom it has an impact and those who impact it. What this means is that life goes on at the intersection of the information age – your sustainability is determined at the intersections.
Preservationist activities don’t work in transformational times. Disciplines that attempt to preserve their roles and their place in healthcare are not effective in transformational times. We must be flexible and create flexibility in the system. Change must occur when necessary … not in 6-9 months when the policy and procedure can change.
What I need to know is already out there. I just need to access it. We need to use PDAs. Portability, mobility and practice … simplify your practice and do your work versus servicing or working around the system. Need timeliness and access.
We each must be a catalyst for change.
Porter-O’Grady used the afternoon session to get people engaged with each other and the topic. His first question to the group that he asked each set of people to consider was “What is the one thing that you think you’ll hear when you return home after attending this session?” Some of the interesting responses from the group, and his response to them, included:
- Costs too much – how much does it cost to do what you’re doing now? What is the price we’re paying to keep doing what we’re doing now? The emotional price? The economic cost? We live in a value age. In the industrial age, we lived in a volume age – how much can you do. In the value age in which we currently live, we must demonstrate how we’re making a difference. What difference does what you do make? That’s the key question we’re being asked now. Nurses are good at telling people what they do … but the question of today is what difference does what you do make. Person, Profession, Patient – how have you made a difference in these three “Ps”? The diploma from your school isn’t an exit ticket, it’s an entry ticket. Now you begin to learn. Your educational preparation doesn’t tell you what you’ve accomplished … it tells you that you’re ready to accomplish. Demonstrate your value, competence. What impact did you have on your patient or population? Our work in nursing is to change something – it’s performance demonstration.
- How do we get the attention of a staff nurse who sees him/herself as a doer versus a leader/coordinator of change? Magnet and systems applications have demonstrated how we can do that. We cannot change behavior by just addressing behavior alone – we can’t just demand behavior change. You can’t change behavior if you don’t change the structure in which the behavior unfolds. You can only get the behavior that the structure permits. You will always get the behavior that the structure is set up to support. If you have a structure of hierarchy, you will only get dependence. Is the organization structured in a way that the expectations for behavior are clear? Accountability and consequences need to be there. In a system, if an option exists for a behavior, the option will be taken. We have more options than we have rules or behaviors. There aren’t any consequences for behavior. You must build an infrastructure that has accountability and with accountability you must have consequences. Need to make sure that participation is an expectation of the workplace.
- We tried it before and it didn’t work. This statement is code for “I am not going to be engaged.” You need to assign this person a role, that of watching out for how things are going and letting you know when things are coming close to looking like it did when things didn’t work.
- What’s in it for me? This is a legitimate question. It’s a primordial question and an appropriate one. We could ask this question more often. What do I get from what I’m doing … in terms of role, energy, commitment, contribution. In addition to asking that question, you must be willing to seek out the answer.
In today’s day and age, you can’t be a champion of nursing if you’re not a champion of technology.
Porter-O’Grady certainly delivered an interesting set of ideas that were fashioned around some of today’s literature and ideas. He’s well worth taking time to read and listen to.