Dr. Rick van Pelt, left, Director of Global Programs

Looking at change with Dr. Rick van Pelt

Thursday, November 6, 2008

Dr. Frederick (Rick) van Pelt is a recent addition to the PHMI team. He brings to PHMI a rich background in the delivery of acute care, perioperative, and surgical and minimally invasive care services, as well as expertise in change management with an emphasis on systems-thinking and human dynamics. Prior to joining PHMI, Dr. van Pelt served in both clinical and administrative roles in the anesthesia department of the Brigham & Women’s Hospital. While at the Brigham he was active in helping to develop and improve the hospital’s anesthesia services, particularly in the areas of minimally invasive services and Out-of-OR anesthesia. Throughout his medical training and career, he has maintained an interest in improving patient care and service.
 

Q: At Brigham & Women’s Hospital you served in both clinical and administrative roles. Did these different roles offer different perspectives on how to develop and improve patient care services, and if so, how?

van Pelt: One of the great challenges in quality improvement has been to develop and implement changes that are sustained and that truly have significant impact at the frontline line of care. Frequently, health care organizations appeared to function with parallel leadership tracks and operational oversight, in which administration had responsibility for the facility and support services while care providers had responsibility for direct patient care. Of course this separation didn’t work very well because everything is connected, but what resulted was poor communication, working in silos, and the perception of misaligned objectives for patient care; where administration viewed quality improvement (QI) as a means to improve care and patient safety while potentially reducing cost, care providers often viewed QI as cost reduction at the expense of their clinical autonomy. My experience at BWH was that everyone cares deeply about and is committed to delivering the best patient care possible, and that the best way to achieve this is to work collaboratively.

The great opportunity that I had in “straddling the fence” was to be in leadership roles that integrated administrative focus with direct clinical experience for the development of care processes. I then got to be on the user-end of the changes, good and not so good, where we could make meaningful continued improvements. I’ve become keenly aware of the need to engage care providers in the continuous QI process. The people that use the processes know in great detail what needs improvement. With simple yet robust tools, some expert input, and strong hospital leadership support, frontline staff can identify and implement many of the corrective measures. This type of collaborative involvement creates credibility and ownership of the process throughout the organization and contributes greatly to achieving sustained results.

Q: How did your interest in health care quality and systems improvement develop? 

van Pelt: My interest in quality and systems improvement began when I was a resident in anesthesia. As I progressed through my training, I became frustrated by the sense of resignation and the lack of empowerment that many of my attendings expressed about their inability to engage in health care improvement. They frequently felt like they were on the receiving end of change, much of which they didn’t understand. I decided that if I was going to remain in health care, I was going to be proactive and develop the perspective and the skills beyond my clinical training. When I finished my residency and fellowship in anesthesia, I was accepted into Harvard Business School, and when I had completed the MBA program I came back to health care with a new insight into the quality challenges that health care faces.

Q: You’ve spoken and written about the need to create a supportive work environment for clinicians. What do you mean by that?

van Pelt: I was involved in an adverse event with a patient in which she almost lost her life due to an inadvertent intravascular injection of local anesthetic during a nerve block. The experience had a profound effect on me and made me realize that health care is not as compassionate to patients, families, and care providers as we would like to think, particularly when things go wrong. In spite of considerable barriers, the patient and I were able to come together in forgiveness and healing, from which developed a national movement within patient safety to address the need for emotional support following adverse medical events. What I began to recognize increasingly as we took this message into health care was that there is tremendous power when a supportive work environment is integrated into the quality improvement process.  Multidisciplinary teams that are connected by respect and compassion for each other are far more effective in creating innovative and sustained results. It is the difference between a team that fills the roles with individual talent and a team where the talent is synergized by that intangible esprit de coeur. Sustained change is a combination of systems-based thinking and a supportive work environment that fosters personal growth.

Q: PHMI has engaged in many projects that have the notion of change at their center. Often these projects, though rooted in specific processes and new ways of doing, are about significant cultural changes. When approaching such a project, what should those who are involved understand right up front about change?

van Pelt: I like to say that change is easy until you personally have to change your thinking and your behavior. Most of us are invested in minimal change at best and would much prefer to remain “comfortably uncomfortable” with what’s known rather than taking a chance of improvement in the unknown. Legacy systems abound in health care and it is a great challenge to introduce new processes into a culture that reveres autonomous care. Senior leadership defines culture and what is critical to achieving sustained improvement is to foster innovation in an environment that recognizes that the proposition for change requires personal understanding and support. In the setting of strong leadership, process improvement that is frontline-enabled with accessible systems tools and support is likely to produce a meaningful and sustained outcome. Lao Tzu once said, “When the best leader's work is done the people say, ’We did it ourselves!’" That’s the gold standard of culture change.

Q: What do look forward to doing or exploring at Partners Harvard Medical International?

van Pelt: PHMI offers a fantastic opportunity to take the best practices of quality improvement into the global arena. As health care recognizes that continuous process improvement (CPI) is the foundation for outstanding patient care, the demand is high for a robust, user-friendly CPI approach that extends beyond accreditation. I’m excited about taking our approach to global projects where leadership is interested and committed to pushing the CPI envelope. Part of teaching is the ongoing learning process and I look forward to incorporating new, data-driven ideas into the CPI approach that we take. It’s an upward spiral through and through.