A Note Aboute Music and Health Care

Recently, I have been able to speak with some experienced doctors about innovation in their workplace and what they see as critical to improving health care. Some of these doctor talks occurred during December and January, in busy hospitals, when my wife was in need of their skills and compassion.

The doctors seem to focus on breaking silos that inhibit communication. It's a cultural issue they say, that starts in medical school, while targeting specialization and hopefully, being recognized for expertise with documented work.

This "cultural issue" seems to permeate the way hospitals and other health care environments actually work. Teams of great expertise that cannot easily connect. And, it seems some are conditioned not to share information from early on in their careers. Don't get me wrong. I am on the side of these doctors. In our current system, I don't believe anyone enjoys the full benefits of their tremendous abilities. Including the doctors.

This perspective also joins the issues of technology. Lack of shared platforms and the somewhat partitioned software development that has inhibited talking across working boundaries.

More than one person referred to Michael Porter's book, Redefining Health Care: Creating Value-based Competition on Results.

When talking about innovation, several doctors suggested that medical staffs have a fundamental confrontation. "They must remember why they exist". And that's not easy in today's overworked and insurance directed workplace. Innovation is layered with payer requirements, certain incentives and the need to constantly deal with an overwhelming volume of information, work, and not enough people to help. Recognizing what's innovative is a risk.

However, innovation is critical to improvement, as this recent NY Sun interview points out.

"First of all, what we're doing is we're trying to maximize our innovative ability. We don't only give care, we try to develop better care tomorrow".

How Dr. Pardes Learned, the Hard Way, To Run a Hospital

Dr. Herbert Pardes now oversees a hospital system that includes 11,673 beds and employs about 82,000 doctors, nurses, and other employees.

By ELIZABETH SOLOMONT, April 20, 2007 http://www.nysun.com/article/52864?page_no=2

Like Dr. Pardes, the doctors I spoke with connected this need for a cultural change (which will take time),with overall performance improvement, and getting in better tune with the patient. They were talking about deep re-engineering on a social and bureaucratic level. And, the ability for people to share knowledge.

Today, medical staffs have to constantly meet new co-workers and achieve over and over again. They are not really conventional teams with time to hear theories about motivation and organization. They are more jazz than that. And I use the term with respect for the art form.

When thinking about how complicated it is for health care workers to participate as teams today, these conversations make me think about music.

Musicians have the abiltity to share experience and offer it to others spontaneously. Timing and discovery. Jazz, is an important collaboration of moments where preparation and instinct meet. Jazz musicians, like health care professionals, work very hard to reach a level of dexterity that allows them to listen and respond. They practice all the time.

Here's a thought.

When a classical orchestra begins their performance, the audience is first engaged in the tradition of witnessing the musicians “tuning up”. The oboist plays a concert A and each section of the orchestra sounds a note to join in sync and prepare to play. It is expected and necessary. It is a part of the preparation that the audience expects.

When a jazz “Big Band” begins a performance, the tuning ritual is quite different. The musicians actually tune with one another during the first song.

The tuning for a jazz band is the discovery of one another’s sound. This collaboration leads to continuous innovation that results in the virtuoso soloist moments, that are also discoveries. These moments are not random. Just the opposite. Journeymen musicians regularly collaborate with the staff players of renowned band leaders like Basie and Ellington. These musicians understand their responsibility to preserve the integrity of the leader’s vision (the compositions and arrangements).

The innovations during Big Band performances arise because the players have a fundamental understanding of why they exist and what their collaboration is to accomplish.

What’s underneath these conversations with doctors is interesting.

In the complicated set of relationships that hospitals have with doctors of different specialties and self interests (as well as payer demands), the medical staff does not have time for ritualistic “tuning”. Why they exist as a medical staff and how they might collaborate to produce continuous innovation may be lost, as the doctors suggest.

We can all influence this for the better.

Sal