Unforgettable courage and commitment: Patient mapping leaves lasting impressions

Patient mapping 2012-12-07

I recently had an opportunity to participate in the Surgical Patient Experience Project, which is being coordinated by the Provincial Surgical Kaizen Operations Team (PSKOT). The project is designed to help health region providers and leaders better understand a patient’s surgical experience, by following a patient from admission through to discharge.

Before last week, I saw the Surgical Patient Experience Project as a technical opportunity for those who have been through Lean Leader Training, to practice using time observation, standard worksheet, and observation and defect tracking forms.  It would also be a place where regional leaders could build value streams maps and where we, collectively, could begin to analyze and study how to improve the care experience for our patients and families.

But last week showed me this project is so much more than simply a technical exercise…

Saskatoon Health Region, Keewatin Yatthé Health Region and PSKOT had arranged to map a pediatric patient from a remote northern community who would be traveling into Saskatoon for surgery. When one of the two regional staff who was to map this patient’s journey had a family crisis, I was invited to provide ”technical” support in the event that he was not able to participate.

As it turned out, this individual did end up carrying through. There are no words to describe the pure grit and level of commitment this leader demonstrated to this project – given the very devastating personal loss he had experienced only a week before.

By this time though, I felt such a commitment to the project that I didn’t want to step away. I asked how I might stay involved; we decided that I would join them at the place of surgery, as long as the patient and patient-guardian were comfortable with this, and I would prepare the ‘Daily Summary Report’ which is a requirement of being involved in the mapping project.

When I sat to write the report, after a full day of mapping, I began to really understand what this patient experience mapping project is all about and, in that moment, I felt incredibly humbled and grateful. The stuff that impacted me the most from this mapping assignment wasn’t even captured in that summary report.

I was moved by the dedication, passion and humanity demonstrated by the two regional mappers that I had the privilege of meeting on that day of surgery. The pair put in roughly 35 hours in just over 2 days. They traveled into the remote community and waited outside the home of the patient and patient-guardian, until they left for the 9-hour journey into the city. The following morning, they waited outside the hotel of the patient and patient-guardian, until they left for surgery.  And they followed the patient and patient-guardian all the way back to their home after the surgery, then turned around and drove back to their own homes. During all of this, they showed the utmost respect and concern for the patient and patient-guardian, and did so with smiles on their faces.

I was also struck by the courage, trust and vulnerability demonstratby the patient-guardian and patient, by agreeing to be involved in the mapping project.  Once the patient was taken into surgery, I offered to take the patient-guardian for something to eat, as he had not eaten since the previous day.  It was during this time, as we sat in a Tim Horton’s drinking our coffee and eating our sandwiches, that I learned that the three previous trips that brought this patient-guardian in from his northern community were for the loss of his wife, the loss of his aunt, and for his own recovery from a very serious and life threatening injury. For this man to consent to having three strangers literally follow him and his only child’s every step through a somewhat worrisome surgical experience, was utterly inspiring.

My final, and perhaps most profound, takehome:  I learned that there is no word for “hello” in the Dene language. Instead, this Northern people have a greeting that roughly translates to: “How are you? There is room for you here.”  The Dene also do not have a word for “good bye” as good bye means going away, and going away means to forget.

I will never forget the experience I had in meeting this father and son, and the two amazing regional leaders involved in this mapping experience.

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13 Responses to “Unforgettable courage and commitment: Patient mapping leaves lasting impressions”

  1. Donna Davis
    December 13, 2012 at 10:34 am #

    Thank you Debra, for sharing this most insightful account of the experience you shared with the patient and his family and with Dale and Carol. A picture speaks a thousand words as does walking a mile in anothers footsteps. I think what you have described here is a true testament that far beyond the statistics, policies, procedures and schedules is a vulnerable person and their family. I commend all who took the journey with this family and to all who have taken it into their heart and soul to learn from it.
    I plan to share this blog with my colleagues who will be part of a similar mapping process to inspire and perhaps share a little of what they might experience.

  2. Deborah Djan
    December 12, 2012 at 12:38 pm #

    Hi Debra
    That was pretty awesome to read. Amazing how the ‘simple’ act of walking in someone’s shoes can alter one’s perspectives. Inspiring stuff that.

    • Debra-Jane Wright
      Debra-Jane Wright
      December 12, 2012 at 1:08 pm #

      Deborah, Thanks for stopping in and sharing your thoughts. I am so glad you enjoyed the read. Who knew the power of quiet observation? It was an amazing, humbling and overwhelming experience!

  3. Margaret Kissick
    December 12, 2012 at 10:48 am #

    Hi Debra
    My heart is warmed that you got to spend time with two of our outstanding employees. Many of us try very hard to give every patient the best experience we can and sometimes this mapping is how we do it. We all feel the experience the the patient feels as we are the patients as well. It is first hand knowledge to all of that live and work for the region. I am so happy that you were able to feel our pain and help us countinue our journey to improve by recognizing us in this right up. Thumbs up to my co-workers for going the extra mile once again.
    Margaret Kissick

    • Debra-Jane Wright
      Debra-Jane Wright
      December 12, 2012 at 1:05 pm #

      Hi Margaret,
      Thank you for taking the time to share your comments. I agree that we, the entire health system, are working very hard to do the very best we can for our patients – I think we all, to some extent enter into health care, because we care – we are caring and giving people. However, as Dr. Don Berwick, the previous CEO of IHI says, ‘every system is designed perfectly to get the results that it gets‘, and our system is working exactly as it is meant to. We need experiences like this mapping project, to help us see our way out. In the day to day busyness of our work (where we are running as fast as we can to help and serve our patients), it is really hard to see how we could do things differently. I hope that this map and story, along with the 11 other maps and stories that this Provincial Mapping project will generate, will help us feel the pain and inspire us to rethink how we do things and help us challenge the status quo.

      and yes, your co-workers Dale and Carol rock!! 😉

  4. Tina Rasmussen
    December 12, 2012 at 10:00 am #

    Debra-Jane, thank you for bring this northern patients experience into another forum that is not looking just at the actual surgery stream. As the board sat and listen to the story presented by Carol and Dale, we were all deeply affected. Within the health system we focus a great deal of attention on the delivery of service in our hospitals and care centers. We often as service providers are unaware of the journey of the patient to get there and its impact on the experience of our portion of the service. We forget or are unaware of the other factors like language barrier’s, distance, medical taxi’s, hotels, food and transportation within cities that are also impacting the patients experience. For northern (and I expect rural) people who travel to large centers to get treatment these are all huge impacting factors.
    I want to credit the health system for having the courage to actually look at what impacts patient experience. This is the start of improvement. I also want to thank our staff, Carol and Dale for their role in telling this story and their commitment to making changes in our health system. Thank you to the father and son who allowed us a glimpse into their personal journey.
    Its a poignant story that reminds us that these are not numbers we are trying to achieve but human beings who deserve care and respect that we are trying to serve and without whom we would not exist.

    • Debra-Jane Wright
      Debra-Jane Wright
      December 12, 2012 at 12:52 pm #

      Tina,
      Thank you for sharing your thoughts and reflections on the blog and on the story that you had the opportunity to hear presented by Carol and Dale. I agree. This personally was an eye opening experience, not just for what we saw the patient and his father experience within the ‘four walls’ of the health care experience, but all of the other factors that reach far outside the health system, that impacted their overall experience – from start to end. This patient experience illustrates the opportunity that multi-sectoral collaboration can bring to our patients, and we owe it to them to think outside our ‘four walls’.

  5. Richard Petit
    December 11, 2012 at 10:55 pm #

    I too any honored to be able to listen to the patient story about his struggle to have his sone receive surgery in Saskatoon. This story has been presented to the board in a summarized version last Wednesday. A couple of our board members are actually drivers that take patients to their appointments. This type of journey is occuring almost weekly if not daily

    I am so happy to see the work that our region employees are doing because it takes an extra ordinary effect of compasionate caring people to do this work.

    I congratulate the Saskatoon Health Region and the Surgical Patient Experience Project with support of the Provincial Surgical Kaisan Ops team for the willingness to understand the patient journey.

    A special thank you to Dale West and Carol Gillis from KYRHA

    Richard Petit, CEO KYRHA

    • Debra-Jane Wright
      Debra-Jane Wright
      December 12, 2012 at 9:30 am #

      Hi Richard,
      Thank you for taking the time to read and comment on this blog. I am very happy to hear that the essence of this mapping experience has been shared with your Board last week. The more we share together in story, the more we will understand and appreciate the experiences that our current system is designed to create for our patients. Without this understanding, we cannot begin to think about how to change our system and without patient voices at the table, we are at an even greater disadvantage.

      I also agree – committing to this work takes an extraordinary and compassionate people and that you have in your two employees, Carol and Dale. It was an absolute pleasure and privilege to meet and work with them!
      Thank you

  6. Maura Davies
    December 7, 2012 at 6:57 pm #

    Debra-Jane, I really appreciated your view of this experience, especially since I have seen additional information about the guardian and patient’s experience, which reflected so many opportunities for improvement. To think that we put thousands of patients from the North through this every year inspires me to dramatically redesign this aspect of our care. There is a big difference between developing a theoretical value stream map on paper and actually following the patient’s journey. Even that does not capture the stress of experiencing care in a strange environment, in a strange language, without family supports. Thank you for helping us see and understand, and for recognizing the dedicated people who share your commitment to transform our system.

    • Debra-Jane Wright
      Debra-Jane Wright
      December 8, 2012 at 3:53 pm #

      Hi Maura
      Thanks for your reply. I was involved in such a very small piece of this mapping work (my hat goes off to the two regional mappers who were involved through thick and thin, from beginning to end) and yet, what I had the opportunity to observe and experience, offered me such richness in terms of challenging my own thinking about how we really interact and serve patients who need to travel far distances to access care. The experience that we mapped was very ‘uneventful’, nothing really abnormal occurred and because of that I feel it represents what many other rural or remote clients would likely experience and….being that it was uneventful, it begs us to think about doing things differently.

  7. Heather Thiessen
    December 7, 2012 at 10:31 am #

    Great job Debra. I really enjoyed your observations.

    • Debra-Jane Wright
      Debra-Jane Wright
      December 8, 2012 at 3:37 pm #

      Thanks Heather for your comment (and follow up email to me at work!). I agree it is easy for us city-dweller’s to forget about what experiencing the health care system must be like for those who need to travel first to access it.

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