Hi-5 Communication Checklist

As a physician at Johns Hopkins, I try to improve my communication skills.

As a Healthcare Systems Leadership Fellow in the Armstrong Institute for Patient Safety and Quality, I worked with my mentor, Dr. Peter Pronovost, to develop a communication checklist.

Hi-5 Communication Checklist

About: This communication checklist was developed based on input from patients, their loved ones, and physicians who study and teach communication skills. This checklist is organized into five domains of behaviors. Within each domain, checklist behaviors, example tools/techniques, and explanations of why these approaches are valuable are listed. Some behaviors are not applicable for all types of encounters with a patient.

Domains	Suggested Behaviors	Tools & Techniques
1. Hi	þ Knock (announce) before entering
2. Familiarize	þ Introduce your first and last name; have team members introduce themselves and their roles þ Ask the patient how he/she would like to be addressed þ Have other people in the room identify themselves and how they are related to the patient; ask the patient if these people should stay in room	Use a Providers Pictures Sheet to identify team members and their roles (post it in the patient’s room for easy reference)
3. Interact	þ Sit down (be at patient’s eye-level) þ Ask open-ended questions þ Acknowledge and affirm patient’s efforts, experiences, and emotions	Ask about personal item in room, hobbies, or upcoming plans Use summary statements Allow for silence as appropriate
4. Voice	þ Set an agenda þ Engage the patient (and loved ones) to discuss the situation and plan	Use plain, simple language Write on white board to share information and explain concepts
5. Exit	þ Ask the patient (and loved ones) to summarize the plan þ Create a way for patient to record thoughts, questions, and concerns	Use Ask-Tell-Ask or Teach Back methods to assess understanding Ask “Anything else?” before leaving the room

The above version of the Hi-5 is the result of editing by leaders in a specific department to customize the checklist according to local needs, culture, and practice. Below is the original prototype of the Hi-5 that departments and clinical units adapt and take ownership of to customize the specific behaviors, tools/techniques, and why explanations to meet their unique needs, culture, and practice preferences.

Domains	Suggested Behaviors	Tools & Techniques
1. Hi (Entering)	þ Knock before entering þ Pause for three seconds before entering and take a deep breath	While pausing, say to self, “Just like me, this patient _______.” (e.g. “is scared” or “is a parent”)
2. Familiarize (Identifying)	þ Introduce yourself; have team members introduce themselves; and, share everyone’s roles þ Ask the patient how he/she would like to be addressed þ Have other people in the room identify themselves and how they are related to the patient	Use a Faces Sheet to help identify team members and their roles (and post it in the patient’s room for easy reference)
3. Interact (Connecting)	þ Connect with the patient as a person þ Invite the patient into the conversation by asking open-ended questions	Be at the patient’s eye-level, if possible Ask about a personal item in the room, such as a picture of a family member or of a pet Ask about upcoming plans for when the patient leaves hospital
4. Voice (Discussing)	þ Set an agenda with the patient þ Engage the patient (and loved ones) to discuss the situation and to determine the plan of care þ Acknowledge and affirm the patient’s efforts, experiences, suffering, and emotions	Use plain, simple language Ask, “What’s your understanding of your situation?” Write on white board to share information, explain medical concepts, and list plans / goals State, “You ask good questions.” State, “It sounds like you’ve been through a lot.”
5. Exit (Concluding)	þ Ask the patient (and loved ones) to summarize the plan þ Establish shared expectations for what will happen between now and the next encounter þ Establish a way for the patient to record thoughts and concerns to share at the next encounter	Use Ask-Tell-Ask or Teach Back methods to assess patient’s (and loved ones’) understanding Ask “Anything else?” before leaving the room Invite the patient to record (on white board / notebook / iPad) questions, thoughts, and concerns

Goal: The overall goal is to establish a consistent and shared mental model for all physicians in a department or an organization to use in care for patients. This checklist “domains of behavior” scaffolding also permits local ownership and customization to adapt to various clinical environments.

Cry Wolf or Wolf Cry: A Safety Culture Story

To cry wolf is to ask for help when it is not really needed. This rarely happens in medicine. Instead, perhaps far too often, the inverse is frequently true: we don’t ask for help when help is really needed.

This is the Wolf Cry Problem.

One night, I received a page while working a shift on night float, covering nearly forty adult medical patients in the hospital overnight. Beep after beep, the pagers (four of them) rattled around in my white coat pocket. Per habit, I found a phone and returned this page as fast as I could, unaware of what message I would receive on the other end of the phone call.

“Are you covering Mr. J in Room 4?” the nurse asked.

“Yes; I am,” I replied.

“He’s coughing up blood. Could you please come assess him?” stated the nurse, the sound of concern resonating in her voice.

“Yes; I’ll be right up,” I assured her.

She wasn’t crying wolf.

As I made my way to the patient’s room, I ran through potential scenarios in my head, considering the differential of consequence, preparing to think through rapidly what could be causing this bleeding.

And as I walked into the room, immediately, my first thoughts were clear: this patient is sick; this patient is bleeding actively; this patient needs a higher level of care. I called in my senior resident right away; that’s one of the first most important steps for me to take as an intern in residency training: communicate effectively with physicians higher in the hierarchy who are also responsible for caring for my patients.

My senior made his way to the room, joining me as we worked together to assess the patient and prepare for the possibilities (ordering fluids and blood for resuscitation, for example, to start).

But things evolved quickly.

At first, the patient was coughing up small amounts of bright red blood. The nurses suctioned it away. Within minutes, however, the rate of bleeding started to uptick. The senior resident recognized this shift and called the intensive care unit (ICU) attending physician, activating the highest level of care provided at the hospital.

And when the ICU physician arrived soon thereafter, the flood gates opened: the patient started hemorrhaging. The patient had esophageal varices that started bleeding. Esophageal varices are engorged veins around the esophagus; they are full of blood that backs up when blood flow through the liver slows down due to liver disease. This particular patient had a chronic hepatitis C infection in his liver; as a result, blood flowed poorly through his liver, making his liver like a leaky damn. Once esophageal varices “pop” and start bleeding actively, the horse is often already out of the barn: outcomes are poor because it is difficult to stop—to tamponade—the bleeding given the human anatomy at that location in the body.

That’s what happened in this case, unfortunately. What does this story illustrate about patient safety? A simple observation of safety culture.

During the moments between when the senior resident called the ICU attending and when the ICU attending arrived to the patient’s room, the nurses spoke amongst themselves briefly:

“What ICU attending is on tonight?” asked one nurse.

“I hope it’s not Dr. Y; he’s always such a jerk when we call,” another nurse stated.

“I think Dr. T is working tonight. He’s gruff and all, but at least he works with you and appreciates being called,” said the third nurse.

Stepping back, I reflected about this interaction. In the face of a patient bleeding out, we may cling to the ideal of aequanimitas, but that’s merely a façade: we are human beings after all. Patient safety culture is grounded in teamwork; and how we relate to and work with each other on teams influences how we care for our patients. It occurred to me that we, as healthcare providers, may hesitate at times to escalate a situation to a higher level of care appropriately because we worry about how we will be treated—or mistreated—by the healthcare providers higher in the hierarchy. When we ask for help and receive disrespectful or negative reactions from higher in the hierarchy—perhaps by dismissing or minimizing our concerns—we may be prone to not call for help in the future when the help is really needed. Herein the Wolf Cry Problem arises.

Supporting safety culture is not just about being “nice” to each other (though that is nice); it’s about really trying to work with each other—even when we are fatigued and tired—to help each other as teammates with a shared purpose. We understand (and expect) that people may not act as hospitality executives when immersed in a stressful patient care case, but what this story illustrates is that we may benefit from being mindful of how the totality of our interactions with our colleagues influences their future behaviors in serious patient care situations.

Honoring Dave Lull

After 25 years we're sad to see Dave leave but he's earned it! Happy retirement! pic.twitter.com/4IsQb2V9R4

— DuluthPublicLibrary (@duluthlib) July 24, 2015

Serendipity tends to strike unexpectedly.

Blessings sometimes emerge unpredictably.

In 2007, I started this simple blog with my first post:

http://epistemocrat.blogspot.com/2007/11/thinking-about-thinking-in-medicine.html

Soon thereafter, Dave Lull, a librarian and an information scientist, reached out to me and started sharing with me links to articles, interviews, books (and book reviews), and other fascinating leads for reading, learning, and reflecting. In turn, many of these leads led to writing as I integrated ideas through the process of composing blog posts as drafts in thinking, hashing it out, attempting to sort things out. I enrolled in Dave Lull University (DLU), with NNT's Black Swan serving as the mascot.

Over time, this process of attempting to connect-the-dots via writing led to new avenues of interest and inquiry, supporting me in a contemplative (Jesuit-spirited) journey. And it's this journey that I'm commemorating today:

Dave Lull retired (from one role). His unique legacy (which is still in the making) as an information scientist is one of friendly, thoughtful, humble, honest, and curious inquiry into the human condition. Numerous people have benefitted tremendously from his research and sharing as he has served communities both locally and globally, from his library to the blogosphere and beyond.

Dave is a thinkerer, thinking and tinkering with thoughts and perspectives, with the concrete and the abstract, with histories and with futures, and with the here and the now. As a deductivist, he has practiced epoche with epistemic humility, permitting a special type of empathy:

Openness to holding multiple hypotheses simultaneously.

And in holding these (even-seemingly-contradictory) hypotheses, there's space to admit that we all have faith in something; that taking opportunities to contemplate this faith intellectually, emotionally, and spiritually often provides room for personal growth opportunities amidst our individual journeys.

I'm thankful that blogging-serendipity connected me with Dave Lull; and, eight years later, as I think back on all the blessings that have emerged from my friendship with him, I am honored to have received the fruits of his information science expertise and hobbyist-volunteerism. From the blogosphere to the on-the-ground-sphere, the world is a better place because of Dave Lull's grace.

#Thx2DL

A Love Story: Longing for What Medicine Could Be

You have to stand for something; otherwise, you will fall for anything.

This mantra played over and over in my head as I reflected while reading Dr. Sandeep Jauhar's new, exceptionally well-written and wonderful book, Doctored: The Disillusionment of an American Physician.

Writing memoirs takes courage. This type of writing exposes you: by sharing yourself openly, you make yourself vulnerable. Being in love is, after all, all about vulnerability--a perpetual state of vulnerability, really--and Dr. Jauhar loves being a doctor.

The roller coaster love journey that he shares in Doctored reveals clearly that he is deeply passionate about medicine, but he has encountered frustrations, undoubtedly. Frustrations that make loving modern medicine quite challenging. Perhaps an impossibility. As a medical student who grew up in a family of healthcare professionals, I've caught glancing blows from these challenges throughout my life. These blows confront you; they test your ability to stand for something--to stand for your values while practicing the art and science of healing. Practicing medicine is an expression of values, ranging from morals about honesty in communications with patients to philosophies about human physiology to ethics about how to do business and make a living. In this memoir, Dr. Jauhar reveals how he has staggered but has not fallen; how he has made decisions that he regrets but has not given up. He still has hope. He has hope that medicine can be practiced differently by doctors (and their healthcare professional colleagues) in the future, in accordance with the values that called them to this profession in the first place. To this end, his book is an expression of what Langston Hughes once famously said, "Hold fast to dreams."

His book definitely helped me thinker further about my personal dreams.

By exposing the frustrations that he has faced in reaching his mid-career crisis as a physician, he speaks indirectly to medical students like me who are doing our best to hold fast to our dreams while growing increasingly saddened and disheartened by the reality that many doctors today are unable to practice medicine in ways that express their values and passions as they envisioned them when they entered this calling that is an honor, a responsibility, and an amazing blessing: when they committed themselves to a life of doctoring.

To be sure, many of the important points that Dr. Jauhar peppers in are old hat for those familiar with the history of the nation's health policy and administration discourse. If you removed the publication dates (and the names of key people and other give-away identifiers) from healthcare policy op-ed pieces in The New York Times and in The Wallstreet Journal and then showed them to me randomly, I would struggle to determine in which decade they were published: whether penned in the 1970s, 1980s, 1990s, or 2000s, it's essentially always the same lamenting, like Groundhog Day. But Dr. Jauhar strings these oft-cited points together thoughtfully, weaving them into his narrative naturally by using examples from his personal life that bring these issues to life in poignant, memorable ways. His book is highly instructive in this way. For instance, he illuminates the dark side of procedure- and test-based fee-for-service medicine that fueled the rise of the Golden Era of medicine while at the same time drove the demise of modern medicine. He accomplishes this feat by telling about his frustrating--and at times unethical--experiences as a moonlighting cardiologist trying to earn extra money just to pay his rent, educational debt, and other basic family living expenses. It's at these times that he catches glancing blows, staggers, and faces a critical series of questions:

What do I stand for as a doctor? I thought I stood for X, but in this healthcare business environment I find that I continue to compromise my values and behave in ways that indicate I stand for Y. I don't like Y. Why am I so perplexed and unable to stand for X?

It's a systems issue.

At Kaiser Permanente, founded by a fringe band of physicians out in the Mojave Desert in the 1930s, the question that undergirded this healthcare system's raison d'etre was simple: Can physicians manage the quality and costs of medicine? Dr. Jauhar thinks so; his emotionally-draining struggles with the business of medicine have convinced him that we need more doctors involved in shaping the quality and costs of medicine actively, rather than passively, because passive participation in the healthcare system leads to desperate attempts to game the system: to, at the margins, blatant fraud and abuse aided and abetted by convoluted rationalizing--by storytelling. And Dr. Jauhar confesses readily the stories that he told himself to rationalize (and attempt to justify) his participation in such unethical business practices, in the very practices that he knows underly many of the cost and fragmentation issues that we continue to face year after year in American medicine. It's this honesty that I respect and admire. He admits to what it's really like to be caught up in this game, playing it while it played him.

In the end, amidst escaping these schemes, Dr. Jauhar still longs, thankfully, for what medicine could be. To translate this yearning into reality, though, the reality is that we need institutions that provide the cultures and environments that support healthcare professionals in expressing their values as healers in ways that make their daily jobs fulfilling. This is not an impractical idealism; this is an absolute necessity if we hope to (1) restore sustainability, (2) revitalize human dignity, and (3) advance the safety and quality of medical care in our nation's healthcare systems.

It is to this end that I devote my medical career; to figuring out how to foster and support the evolution of new institutional solutions to our current healthcare system challenges.

That said, the Ancestral Health Symposium (AHS) is one such attempt; an attempt to foster and support a respectful, reflective (and fun!) forum where our understanding of what it means to be a human being evolves in valuable yet practical ways that help people enjoy healthy, fulfilling lives.

Ultimately, we all have to stand for something, or we will fall for anything. Together, healthcare professionals in partnership with their patients can stand up for what medicine could be:

A love story.

To good health,

Brent

From calluses to callousness: Interpersonal challenges in medicine

"Have thick skin," they often say.

At some point, though, thick skin wears thin. Or, perhaps even worse, thick skin grows too thick: it turns into calluses.

And with calluses comes callousness.

As we enter 2014, we face many well-recognized challenges and concerns in modern medicine: drug-resistance, surgical site infections, health insurance coverage, primary care physician shortages, etc. However, one challenge that we may have the most control over remedying is one that continues to plague hospitals and clinics daily: how we treat each other.

The Stanford Prison Experiment is alive and well in our healthcare systems, unfortunately. In 1971, twenty four male college students were randomly assigned roles of prisoners and guards and were asked to play out those roles in a mock prison. Within days, these college students were behaving in worrisome ways; in short, their role-playing became their reason for being. The experiment was stopped soon thereafter when one person finally spoke out about the abusive behavior that was occurring.

You be a nurse. You be a medical student. You be an attending. You be a nutritionist. You be a resident. You be an occupational or a physical therapist. You be a _______. We assign folks various niche roles in healthcare; providing medical care to patients is a team sport, whether we like it or not. No one profession--nor one individual--can carry out all the tasks and responsibilities needed to provide effective, efficient patient care. We need each other. We need interprofessional collaboration and cross-specialty communication. We depend on each other; and our patients depend on us: they depend on our teams to serve their health needs.

As a third year medical student, I often feel like a fly on the wall. In fact, frequently, I try to be a fly on the wall: "Speak only when spoken to," "Stay out of the way and make everyone's life easier," etc. are the mantras that (perhaps far-too-often) guide my day. In this peculiar role, I am able to serve as a quasi-objective third-party observer of the social dynamics that play out in various healthcare settings. I'm an outsider, after all; I'm merely passing through for a brief time: I spend two weeks on one medicine team, one week on an orthopaedic surgery service, etc. as I rotate through my clinical clerkships learning what each specialty of medicine does and, ultimately, what I want to do clinically with my career as a doctor. My clinical role tends to be ill-defined, and largely resident- and attending-dependent. Each day I wake up energized, grateful for the gift that I have been given, for the opportunity to play a (hopefully positive) role in healing people. I do my best to "be proactive" and try to "fit in" with the team that I am assigned to for that short stretch of training. I grew up playing sports, so I attempt to draw on my diverse experiences as a member of soccer, basketball, baseball, tennis, golf, and other athletics teams, many that performed at high levels. But what I find, over and over again, unfortunately, is that I feel like a witness to crimes against humanity, rather than like a member of a well-functioning, respectful team of healthcare professionals. Somehow, someway, the passion for healing is supplanted by complaints and by bullying: one profession complaining about another profession; one individual bullying another individual; and, the list goes on.

With lists of tasks to accomplish overwhelming healthcare providers--there are orders to write, drugs to administer, phone calls to make--and with healthcare providers operating mostly in silos--formal interprofessional collaboration is just starting to be built into our delivery systems--the statistical chances for miscommunication between and mistreatment of colleagues are high. The expectations of healthcare professionals are super-human. The environment for working is inhumane. And, the outcome is predictable: callousness. Personally, I sense myself turning callous when I starting blocking out things; I put "blinders" on--it's an adaptive response to a high stress, seemingly impossible situation. Without a doubt, hedging against this natural human tendency is challenging. But it's a challenge worth tackling.

We cannot reform our healthcare systems if we cannot first reform how we work, how we work with each other: how we treat each other. Misdiagnoses, unneeded tests, and other clinical errors result from poor teamwork, from healthcare professionals not working together in a professional, respectful manner.

At some point, it's not about having thick skin. It's about being honest with each other about the simple fact that we all are susceptible to feeling like our skin has worn thin. It's about recognizing that we are human beings; it's about appreciating our humanity--our reasons for being.

And we are all susceptible to the powers of role-playing. We have a forewarning: the Stanford Prison Experiment teaches us that our hospitals and clinics don't need to be prisons. Instead, they can be places that restore, places that heal, places that foster that passion that first motivated us to pursue the art and science of medicine.

As a hopeful medical student, that's my wish for 2014.

To good health,

Brent

Checklist Manifesto for Regulatory Issues: How to Manage Legal Complexity Effectively

HARVARD MEDICAL SCHOOL: HOME TO DR. ATUL GAWANDE, MD, MPH

Serendipity.

Is a mystery to me.

Is important to me.

Is plain fascinating.

The Internet has its pros and its cons; its positives and its negatives.

Personally, one of the greatest benefits of the Internet is exposure to the envelope of serendipity.

Recently, I connected with Adam Stoffa ...

Checklist Manifesto for Regulatory Issues: How to Manage Legal Complexity

Adam Stoffa, JD (@SEEAdamTrain and Stretch. Exercise. Eat)
Brent Pottenger, MHA (@epistemocrat and healthcare epistemocrat)

BRENT: Complexity gets complex quickly. In the face of such perplexity, human beings sense inherent uncertainty; they get uneasy. Attorneys, like physicians, must manage these feelings professionally; they must act responsibly. Despite the unpredictability associated with each specific client’s legal case, that does not justify practicing law willy-nilly. Instead, out of respect for human beings’ evolved emotional systems, we can introduce some strategic structure to the process to help avoid known missteps while simultaneously challenging ourselves to think about possible outcomes and difficulties. As Dr. Atul Gawande has shown in surgery, checklists provide practitioners with a simple modality that supports professionals as they push the humble limits of being human in various realms of performance. Like surgeons, lawyers could generate, test, and refine checklists to serve as minimalist frameworks for decision-making that prevent shortsighted mistakes while providing people with enough degrees-of-freedom to read and respond to local nuances and unforeseen details. Surgeons prepare for surgery in a team-oriented manner, checking and rechecking intake information about the patient, the procedure, and the instruments needed to act. Similarly, for a given “fact pattern”, lawyers must work as team members with clients, other regulators, third parties, etc., so engaging all these individuals in a check list process could help synchronize their efforts and ensure that everyone is on the same page, in synergy, from the start of the case.

*****

ADAM: Nothing tests the limits of our ability to perform like conflict, where hard-wired reactions manifest through emotions. Emotional reactions short circuit cognition; and, consequently, key steps are missed or skipped. Furthermore, by their very nature, reactions are not coordinated with others. In a complex situation, missing or skipping steps and failing to coordinate actions leads to unacceptable outcomes.

The analysis below focuses on responding to complaints alleging violations of the anti-discrimination statutes and regulations (EEO complaints). This particular type of regulatory compliance was chosen because Equal Employment Opportunity (EEO) complaints offer a particularly good example of a situation where failing to manage complexity impedes an organization's ability to achieve an acceptable outcome.

Emotions

EEO complaints happen. They are complex and controversial. When faced with such a complaint, organizations must work together, focus on accomplishing appropriate action steps, and find a way to achieve an acceptable outcome.

Unfortunately, pointing this out does very little to overcome the natural reactions of: (1) supervisors who see the complaint as a personal attack on their ability to manage; (2) the principals, those at the center of the conflict, who become defensive and/or combative as work-center awareness that a formal complaint has been lodged increases; and (3) third party witnesses, usually co-workers, who typically manifest a strong desire to avoid any involvement with the complaint. With this much emotional tension in play, it is no surprise that key action steps are missed and responses tend to be uncoordinated. High stress, missed steps, and disjointed responses lead to a status quo where it is acceptable to believe that the EEO system is broken and can not be fixed.

Strict Compliance

Beyond the emotional reactions of the key players, there is another aspect to EEO complaints that makes managing them a daunting task. The anti-discrimination statutes and the EEO regulations require absolute compliance. With strict compliance as the standard, supervisors become concerned that they will be unfairly criticized, as their decisions and decision making processes are scrutinized for discriminatory intent.

To a degree, this is a problem of context, as many of these same supervisors manage other circumstances that require strict compliance. For example, safety measures require strict compliance. Managers regularly meet safety standards and when they fall short, good managers do not give up in exasperation. Rather, safety standards are reviewed and adjusted. Thus, the problem is not that supervisors can not manage situations that require absolute compliance. Rather, they need to be aware that with EEO complaints they are facing a strict compliance standard. As with safety standards, they need a game plan for responding to potential violations.

The Two Types of Mistakes

Going a little deeper into our analysis, let's look at two types of mistakes that tend to decrease the probability of achieving an acceptable outcome. As Gawande explains in The Checklist Manifesto, Mistakes of Ignorance occur when the individuals involved do not know enough about the subject matter to properly respond to the situation. Because management has a duty to comply with the anti-discrimination statutes and the principles of Equal Employment Opportunity, mistakes of ignorance provide no legal defense to a complaint of discrimination.

A second type of mistake, Mistakes of Ineptitude, occur when key steps are skipped or responses are not coordinated with other members of the team. Whether negotiating a resolution or undertaking litigation, your organization’s response to the complaint is subject to interpretation. Consequently, mistakes of ineptitude may be misinterpreted as mistakes of ignorance; they may be construed as intentional acts designed to cover up misconduct; or they may be seen as indicative of a poor attitude, or a lack of dedication to the principles of Equal Employment Opportunity.

Setting an Agenda for Improvement

In setting an agenda for improvement, we must consider: (1) the need to break through initial emotional reactions, (2) the strict compliance standards for EEO, (3) the duty to eliminate mistakes of ignorance, and (4) limiting to the greatest extent possible mistakes of ineptitude. A fifth critical element, a team approach that facilitates communication between all players, must be in place.

Recently, I have been able to help organizations and their managers address these issues by introducing a matrix that provides an organizational approach to responding to reports of violations and a checklist specifically designed to aid the supervisor assigned responsibility for the work center where the complaint originated. Used in combination, by the organization and the individual supervisor, these tools provide a strategic overview and a tactical list of necessary action steps.

The Matrix

The matrix (above) is a reference document designed to give the team the 10,000 foot view. It introduces the team to the three phases of response (Immediate Actions, Follow-on Steps, Close-out) and four categories of action steps (Notify, Investigate, Correct Behavior, Remedy). During an actual complaint, the matrix can be a useful way for team members to orient themselves. However, this is only a general reference document. The matrix is not focused enough to be a checklist.

The Phase 1 Checklist

A properly formulated task-focused checklist reduces the likelihood that a key step will be overlooked, because it engages the thinking part of the brain. In the field, key steps are not so much consciously skipped, as much as they are missed due to environmental distractions. In the case of an EEO complaint, there can be many distractions, not the least of which is making sure that the affected work center continues to accomplish its work.

By creating an agreed upon checklist of action items, we decrease the risk that key steps are missed due to distractions. To this end, the Phase 1: Checklist for Supervisors serves as a cognitive safety net, making it easier for supervisors to engage the project at hand, responding to a report of unlawful discrimination. The Phase 1: Checklist for Supervisors follows the same design as the Matrix, but drills down to a new level of detail, providing action steps in each category for supervisors to follow.

The Toolkit

To go along with the checklist, there is a corresponding set of available tools for supervisors to use. For example, the Phase 1: Checklist has 3 steps dedicated to issuing a written notice to employees. Issuing written notice to the employees is a key step designed to reinforce management’s expectations for appropriate behavior at the work site and its dedication to assuring Equal Employment Opportunity. To facilitate carrying out the action steps associated with providing written notice, there is a corresponding tool, a sample memo that is available for supervisors to use.

Maintain Communication

Communication needs to start well before a report of a complaint is received, but it is critical that communication not drop during the process of responding to the complaint. The Matrix helps facilitate communication, as it describes the network of people involved, including an employee reporting a potential violation, other employees in the work center, the appropriate supervisor, higher level management officials, and appropriate advisory staff. To help ensure that basic communication is maintained, key communication steps have been built into the Checklist.

Can This Approach Work?

It is working. When I brief directors, maybe for the first time, they recognize that EEO complaints are not amorphous, personality-driven problems that they or their people cannot get their arms around. Rather, this approach allows for a structured response.

At the supervisor level, anxiety is reduced because the supervisors’ roles are defined, and they know they are part of a team. The Checklist engages a cognitive response and helps guide them through unfamiliar territory. Meanwhile, tools are prepositioned and ready for them to use along the way.

A coordinated response that pays attention to detail does more than guarantee regulatory compliance. It demonstrates to employees that management takes their complaints seriously and gives them due consideration. It lets supervisors know that there is an organizational standard to be maintained and if they do their part, they will not be unfairly criticized.

This approach is designed to maximize the probability of achieving acceptable outcomes without litigation. However, if litigation comes, the people within the organization can hold their heads high knowing that they did their best to work together and provide a focused response. When walking into a hearing, that is a huge advantage.

*****

BRENT: Medicine is a craft practiced amidst a regulatory landscape that requires special considerations given the fact that people's lives are on the line in unique ways. Experimenting with checklists provides one tangible way to help clinicians navigate this maze successfully.

*****

Here are some images from my journey ...

HARVARD DIVINITY SCHOOL

HARVARD HUMAN EVOLUTIONARY BIOLOGY: DAN LIEBERMAN'S LAB

Note that I switch from proper forefoot landing to heel-striking and then back to forefoot running in order to test the differences between these two styles of locomotion. The force plate readings from the treadmill captured this abrupt change beautifully: all of the sudden, instead of spreading force out over the natural roll of my forefoot, I struck the ground with my heel, creating an acute, sharp force on my body. Translation: recipe for injury. Takeaway: run naturally with forefoot landing. Parkour!

To good health,

Brent