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	James L. Holly, M.D.

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Your Life Your Health - Pursuing Excellence in Healthcare Delivery:Personal Mastery and Electronic Medical Records as Tools of Excellence

James L. Holly,M.D.

January 08, 2009

Your Life Your Health - The Examiner

January 5th is the latest day in the New Year calendar upon which you will begin writing the events, which as your future becomes your past; your history will be read. If New Year's Day had fallen on a Monday, Tuesday or Wednesday, we would have been back at work on the 2nd or 3rd. If it fell on a Friday, we would be back at work on the 3rd. Four days have already pasted in the New Year and today we begin writing our 2009 story. How well our story reads will be determined by the decisions we make today.

SETMA's "target" for 2009 is EXCELLENCE. The problem with this goal is that it requires persistency which will look like relentlessness. It will require, in Churchill's words, that we, "never ever surrender." We will be tempted to "surrender" to fatigue, or to convenience, or to expediency, but when surrender is rejected, excellence can be the result.

And, why would we choose excellence? We choose it because anything less is compromise and is unworthy of the "calling" which we all have as participants in the delivery of healthcare to our friends, families and patients. Lest the choosing of the goal of excellence be considered arrogant, after all, how can you judge excellence, in the words of Dr. Mark Wilson it must be stated, "Excellence is not a stop sign which you pull up to having â€˜arrived.' Excellence is a direction in which you are going." Essentially, excellence is the determination to be better than you were before, with the constant goal of continuing to improve. Excellence does not happen by accident. It is intentional and its achievement requires the establishment of goals, objects, measures, reviews and critiques.

However, excellence will never be achieved by design or by resolution; it will only be achieved by character. It is only as excellence is compelled from our heart and soul that we will have the resolve and the strength to daily and hourly pursue excellence. The drive to excellence which comes from within us has many faces. Some of those are found in a competitive spirit, but the good news about excellence is that I is not a zero-sum game, i.e., if you are excellent, it does not prevent others from being excellent as well.

Excellence is objective but it is not comparative. It is not like an examination in school where a bell-shaped curve determined who could receive an "A" for "excellence" and who would receive a "C" for "mediocrity." In fact, in life and particularly in the delivery of healthcare, in the short run those who are excellence may not have the best results because they accept the challenge of meeting the healthy care needs of the neediest.

Today, I invite you to join the journey which will not end at a destination, but a journey which is defined by our commitment to a standard which is excellence. Only you can sustain that standard. Only you can relentlessly pursue that goal every day, every way, every time. No amount of scrutiny or auditing can achieve excellence which is not driven by your heart and soul.

Excellence as the standard for your 2009 story will be the inevitable result of caring for every person you see, every day this year. Caring is first the result of you seeing everyone as someone of import. For Christmas, I gave my wife a porcelain box which has the following hand-painted message on its top: "To the world you are one person, but to one person you are the world." So it is with each person we see each day, they must for the moment we "see" them become, "our world," receiving from us our full attention and caring.

But excellence will also be seen as we apply the highest standards to that caring; standards which are defined by "best practices" and "national standards." Whether it is the care of a patient with diabetes, hypertension, heart disease, depression, anxiety, uncontrolled pain, etc., excellence requires the application of the best knowledge in existence and our best effort - every time.

This may be the greatest promise of electronic patient records (EMR). Designed and executed best, the EMR is a tool for excellence. The EMR provides a benchmark of excellence against which you can measure your performance every day with every patient. The EMR provides an objective standard for determining that you have applied "best practices" and "national standards" to every patient. And, when coupled with genuine caring for others; when coupled with that person being the world to you receiving your full attention as if they are the most important person to you, the EMR will fulfill its greatest potential.

The commitment to excellence is an individual passion but it becomes a collective, organizational passion as two, then three, then ALL embrace from their heart and soul the same standard. Sustaining excellence is much easier when it is the product of a group's effort. Like the "three-fold cord which is not soon broken," the group sustains the one's commitment to excellence at times of fatigue and discouragement. The physics of the three-fold cord is that at the point of one cord's weakness another is strong and the reciprocal is also true. A cord which can only support 200 pounds, when intertwined with two equally strong cords, the three can sustain 2,000 pounds. So it is with our effort and commitment of excellence. What we cannot do alone, we can do together.

MIT's Dr. Peter Senge, wrote the following which describes a "learning organization:

"Most of us at one time or another have been part of a great â€˜team,' a group of people who functioned together in an extraordinary way - who trusted one another, who complemented each other others' strengths and compensated for each others' limitations, who had common goals that were larger than individual goals, and who produced extraordinary results. I have met many people who have experienced this sort of profound teamwork - in sports, or in the performing arts or in business. Many say that they have spent much of their life looking for that experience again. What they experienced was a learning organization. The team that became great didn't start off great - it learned how to produce extraordinary results."

Excellence and greatness are within the grasp of any organization which is made up of individuals who have a shared vision and purpose which creates and sustains the energy and drive toward excellence of the group. Those who most contribute to that sustained effort are those who have achieved "personal mastery," i.e., they drive events rather than being driven by them; they define their future rather than being surprised and disappointed by it; they are agents of change where the change makes a difference.

In his work, The Fifth Discipline, Senge identifies the characteristics of a person who has achieved personal mastery:

They have a special sense of purpose that lies behind their vision and goals. For such a person, a vision is a calling rather than simply a good idea.
They see current reality as an ally, not an enemy. They have learned how to perceive and work with forces of change rather than resist those forces.
They are deeply inquisitive, committed to continually seeing reality more and more accurately.
They feel connected to others and to life itself.
Yet, they sacrifice none of their uniqueness.
They feel as if they are part of a larger creative process, which they can influence but cannot unilaterally control.
They live in a continual learning mode.
They never ARRIVE!
(They) are acutely aware of their ignorance, their incompetence, and their growth areas.
And they are deeply self-confident!

The last two seem contradictory, don't they? Yet, it is true that those who have achieved a degree of personal mastery are self-confident while being aware of "their ignorance" - what they don't know - "their incompetence" - what they are not good at doing - "their growth areas" - where they have room for improvement and where they need to improve.

Today is New Year's Day for SETMA. In this year we will begin our 15th year in existence. We will be joined by new colleagues and we will be judged by others as to how effectively we pursue our goal of excellence. Today, we begin writing our history; as we anticipate reading that history in 2010, let us work so that we can be pleased with our report card.

Let us be our harshest critic. Perhaps we could all adopt Churchill's habit. In 1939, he told his private secretary, Sutton Coldfield, "Every day I try myself by court-martial to see if I have done anything effective that day, not just pawing the ground but something really effective."

A year of excellence will be achieved one day at a time. If every day, we set our minds and hearts to do something really effective and we do that for 365 days in a row, our history will be a credit to ourselves and to our colleagues. Today is the beginning; we shall see how we fare.

Happy New Year! For SETMA, as for everyone in Southeast Texas, the New Year starts today.

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