Mary Jane Kornacki, MS, interviews Kevin Rooney, MBChB, FRCA, FFICM, FRCP (Edin), Consultant in Intensive Care Medicine for Royal Alexandra Hospital, NHS Greater Glasgow & Clyde, Scotland, and Professor of Care Improvement at the University of the West of Scotland, during the 2017 IHI National Forum.
Mary Jane Kornacki: I’m at the IHI National Forum on Quality Improvement in Healthcare, and I’m sitting down with Kevin Rooney, an anesthesiologist [and] Professor of Care Improvement. His hospital in Scotland is the NHS Greater Glasgow and Clyde Trust. Kevin, you were telling me that you were very interested in exploring and enhancing joy at work and higher purpose for people you work with and people in the NHS. How did you come to the conclusion that was an important place to focus your energy? You are an anesthesiologist.
Kevin Rooney: Yeah.
Kornacki: This is something you do in addition.
Rooney: Yes. So, in February of this year, 2017, the Royal College of Anesthetists published a survey of over 2,000 trainee anesthesiologists in the United Kingdom, and they found out that over 80% of them felt at risk of burnout. And of these 80%, over 60% of them felt that they had been physically or mentally harmed as a result of this stress that they’re under. Bearing in mind these are trainee doctors in their 20s and 30s.
Over the course of the last 20 to 30 years, we’ve tried to make training better. We have, rather than 24-, 48-, or 72-hour shifts, we give them 12-hour shifts. We try to make the training more person centered. However, they still find our profession stressful, and as a result, they’re at increased chance of burnout and increased chance of moving from the profession. What I want to do is I want to bring back joy at work, because I know that a healthy and productive workforce results in better patient outcomes, less morbidity, less mortality, and shorter length of stay.
In Scotland, we love the sport soccer, or football as I call it, and one of the most successful Scottish football managers said that football is nothing without the fans, and I believe that health care and health care leadership is nothing without its staff. Our staff are our main priority. They, along with our patients, are the purpose of health care. If we make them happy at work, we will have better outcomes.
Kornacki: Do you think that a focus on patients first or patient-centered care over the last couple of years has perhaps shined a light brightly on patient care, but at the expense of caring for and nurturing staff and young doctors?
Rooney: I don’t think that’s what’s happened. What I think has happened is we have, as a profession, become more person centered, because we realize professionally the impact that has on our patients. We used to ask just what matters to the patient. We’re now figuring out we need to ask what matters to [staff]. The question I ask of our trainee doctors, and the question I ask when I visit hospitals is, “What keeps you up at night?” Because it’s leadership’s job to remove these barriers, or to make it easy to do the right thing and difficult to do the wrong thing.
Kornacki: When people share with you what’s on their mind or what troubles them — we might say here pebbles in the shoes, those sorts of issues — are you empowered to then help in those areas, or do you bring those issues to the attention of the people who need to get involved in them?
Rooney: There are two things you can do. You can encourage the person to sort out the problem themselves, because I may not work in their clinical area, and I don’t know the challenges. Normally, when you visit someplace, you find out the answer is in the room. So, if I said, “If I could empower you to fix it, what would you do?”
Kornacki: That’s the key question. If I could empower you to fix it, what would you do?
Rooney: That puts the onus back on them, to say, “Actually, I can make this better.” And [it] gives them greater self-esteem, makes them the master of their own destiny, and just has a positive effect.
Kornacki: How do you maintain your own sense of excitement and purpose and joy?
Rooney: I’m very fortunate. I’m a full-time clinician. I still do my practice of critical care and some anesthesiology. I have an academic role, where my interests are patient safety, joy at work, and improving outcomes from sepsis and patient deterioration. In addition to that, I get the opportunity to be faculty for IHI, where I get to travel. I get to meet interesting people. I teach, and I learn as I teach, and I see pockets of excellence throughout the globe. So it’s about keeping yourself fresh, and it’s about joy at work, and I think that variety is key.
Kornacki: Can you think of when you were with someone, and did have that kind of conversation, like someone saying, “Well, this is going badly,” or “I can’t do this anymore,” and you turned it back to them and asked them what could they do if they were empowered? Does anyone come to mind?
Rooney: I visited some people, and the answer was always, “We’re different.” If I visit HMC, visit Brazil, and they say, “Oh, we can’t do that. You’re Scottish, we’re different,” I say, “Think big, but start small, humor us. Let’s just try out one patient, one nurse, one shift.”
Kornacki: It sounds like you have a story to illustrate some of the points you just made.
Rooney: So, I said earlier, I’m fortunate enough to be IHI faculty, and about 3 or 4 years ago, we started an improvement program within the Middle East. When I arrived there, we were there to reduce complications from ventilators, we were there to reduce catheter-related bloodstream infections. But as I moved round the ICU, the first thing I noticed was that every patient was physically restrained. I wouldn’t be allowed to do that in the United Kingdom — that would end up with me going to prison. So, I asked, I said, “I’m curious as to why you need to do this.”
And they said, “We’re different over here. We have a large migrant population, people from all over the world, and they waken up sedated, and they’re agitated, so they’re at risk of harming themselves.” The restraint was in the person’s best interest, but I [asked], “Have you ever tried taking [the] restraint off?” They said, “Oh, no, no, we’re different, Kevin, you don’t understand.” And I said, “Humor me, okay? Let’s kind of think big, [how] we feel. I don’t want to be restrained, and restraint is generally a bad thing. How could we maybe move on from that?”
I said, “Why don’t we take one patient, one nurse in this afternoon. [The patient is] restrained with all four limbs, [but] let’s just take one arm, loosen up one arm?”
Kornacki: Start small.
Rooney: Start small, and what we saw was, the ceiling didn’t crash in. The patient didn’t extubate himself. The patient didn’t pull out the lines. What happened over the course of the next 6 months was we did this across every ICU, so much so [that] by the time we’d finished the program, that physical restraint had become a thing of the past. It had been consigned to the history books. It’s an achievement I feel that I have assisted teams deliver, that is person centered, and gave me joy at work.
Kornacki: That’s terrific. I can see where there’s a very gratifying 6 months, to make that kind of radical change. Thank you for sharing that.
Rooney: Thank you, Mary Jane.
This story was recorded at the Institute for Healthcare Improvement’s 29th Annual National Forum in Orlando, Florida, on December 10–13, 2017, by Mary Jane Kornacki on behalf of NEJM Catalyst. We wish to thank IHI for support of this project, especially Madge Kaplan for her technical advice and guidance. Click here for more Lessons in Leadership stories.