Wednesday, March 20, 2013

Never-Always: Part 1

The month of March always features an emphasis on patient safety by the National Patient Safety Foundation and this year’s theme is National Patient Safety Awareness Week 2013:

7 Days of Recognition, 365 Days Committed to Safe Care. This annual lifting up of the ancient Primum non nocere concept (latin for “First do no harm”) reminds us of our fundamental obligation. Check it out on the link below.

Now you can actually translate and in fact summarize the profound implications of Primum non nocere with 2 words – “Never-Always”. Dr. Bruce Pitts, our Sanford Health Chief Medical Officer, has recently coined this weighty calling with a very simple but poignant definition of what our care should/could be, “Some things never happen and some things always happen”. You could say that safety is “Never” and quality is “Always” or reverse them, for they are imminently interchangeable. Never-Always simply works as a call to greatness in healthcare…like always wash your hands, always reconcile the medication list, always do a timeout, always get your influenza shot or never do not wash your hands, never do not reconcile the med list, never do not do a timeout and never do not get an influenza shot. Now add your own Never-Always ideas….the list is very long indeed.

As Dr. Pitts reminds us, “Articulating greatness in terms of ‘never’ and ‘always’ provides clarity and direction…By the standards of ‘never’ and ‘always,’ no health care institution in the nation or the world has yet achieved greatness. The new high ground is unoccupied.” Indeed this is a daunting challenge to our industry and represents a very steep slope up Mount Complexity. To accomplish this will require all of us climbing together, in order to ever hope of occupying this ground? This is why the IHI Open School matters!

So why does Never-Always so resonate and what is its connection to our South Dakota IHI Open School Chapter? The answer it seems may lie, not outside of us, such as a required course to pass or a mandatory benchmark to meet, but rather within us, as raised by Daniel Pink in his book Drive. Pink exposes the literature of intrinsic motivation and shows us that we humans are internally motivated by three major drivers - Purpose, Mastery, and Autonomy.

Check out Drive and strongly consider it as your next read. Here’s the link:

Intrinsic motivation is far more powerful than any extrinsic motivator, like a test or a benchmark.  Those individuals and organizations, per Pink, that tap into this rich bank of human capital can achieve extraordinary things. It’s really what pulled us all into medicine…not? So let’s apply Pink’s observations to Dr. Pitts’ notion of Never Always and then work it out as our chapter’s response to National Patient Safety Awareness Week, or maybe as our personal driver toward great contributions to medicine.

  • Never Always restores the patient to the reason for why we exist –  and that is true Purpose
  • Never-Always revolutionizes our work around the new science – or the science of the human caring for the human. In other words it challenges us to conquer ourselves and that is true Mastery
  • Never-Always engages the frontline imagination with joy and meaning – or in other words “I matter and  my work (and my learning) matters…I can make a difference” and that is true Autonomy

Try pondering  Never-Always as the motivator in your corner of the health care world and ask yourself a few questions. What things would you never want to happen or you would always want to happen in your setting? Better yet, ask yourself this, ”What would I want never to happen or always want to happen, to myself or the person most precious to me, if I/they were a patient?” Next, begin to connect the IHI Open School modules (achieved that Core Certificate yet?) and our chapter’s event opportunities, to this notion of Never-Always. This is a fantastic way to begin to master the new science of the human caring for the human and to reach for purpose and autonomy.
Every once in a while we run into words which capture the essence of things and upon which we can hang everything that matters. To that extent we owe a thank you to Dr. Pitts for articulating what greatness in healthcare can look like…Never-Always. I close with his challenge, “We…have concluded that we have no choice but to lead the industry’s march toward greatness.  We begin here by authoring it.” Could the South Dakota IHI Open School Chapter begin to lead the industry in interdisciplinary learning, and in some way help to author it? You bet we can, but it will require all of us to climb Mount Complexity…students, deans, faculty, frontline care givers, and healthcare systems. Our chapter is perfectly positioned, given the extraordinary accomplishments of just the past two years. We can achieve great things, because everyone of us just naturally brings the drive toward overarching Purpose, the drive to Master our discipline…and the drive toward Autonomy, or that I matter in the vast sea of American medicine…because I matter to the patient.

--Wendell Hoffman, MD, FACP is the Faculty Advisor for the SD IHI Open School Chapter, Patient Safety Officer for the Sanford Health Sioux Falls Region, a Clinical Professor of Medicine for the Sanford School of Medicine and a practicing Infectious Disease physician with Sanford Clinic.

If you would like to contact Dr. Hoffman with questions or comments, you can email him at