VALUES BY DESIGN

Posted on in General

Healthcare workers are driven by values that they are largely unaware of. This came to the fore while reading the New York times today.

There was a brief article about Jacalyn E.S. Bennett and her company Bennett & Company which has been in business since 1984 making lingerie. The most striking part of the article was Ms Bennett’s description of her company’s values. She describes Bennett & Company as a “company with a conscience”.

The company’s business model is based on teachings of Gandhi and principles of the Buddha. That means her 1,800 employees working in China and Sri Lanka and her team of 35 at her headquarters in Newburyport, Mass., treat everyone with the highest respect. They donate to more than 30 nonprofits, from Sarvodaya Suwasetha in Sri Lanka to the Insight Meditation Center of Newburyport.

Eastern philosophy also informs why Ms Bennett chose to specialize in lingerie. Lingerie is literally closest to a woman’s heart. Though no one may see it, lingerie has a lingering influence on how we feel about ourselves during the day — which she hopes is special and cared for. When a woman is kind to herself from the inside, she projects that kindness out to others, which then is returned to her. This “circle of kindness” is at the core of the Buddha’s teachings.

This description created an immediate connection for me to her and her company. It was, in fact, riveting in its impact.

Why not make values explicit for doctors, nurses and patients. Let’s go beyond ethics and a rational understanding of what is ethically appropriate. Let us design, articulate and communicate these actionable values to our doctors, our patients and their families.

So I  started to look for values that have been communicated by our hospitals. And I found very little. They do, however, list the patient’s rights along with the hospital’s departments and the phone numbers.

So I am proposing that we design and articulate our actionable values to ensure that new doctors and nurses share them and patients understand them.  Or they don’t have to become doctors or nurses, they can become accountants, actuaries or economists.

Here’s a case study that might explain what I am talking about:

Charles was a 30  year old alcoholic who had been drinking 26 ounces of vodka per day for 2 years. He looked terrible: his eyes were yellow, his belly was very swollen, his legs were swollen, he was confused and he was shaking.  I sent him to the ER. The next thing that I heard was that he had been admitted and designated DNR which means ” Do Not Resuscitate”.

We were stunned by that decision. So we called the hospital ethicist and held an ethical review of that decision. It was inappropriate. The treating team agreed to start an IV.

Next, it was clear that Charles was dying because of his liver failure. So we asked if he could be put on the liver transplant list. The answer was a loud NO!  The policy is that any alcoholic who has been drinking within the last six months is not elligible for the transplant. So we decided to go to court with the transplant agency and hospital. We lost. The policy is hard and fast and global.

So we waited for Charles to pass. He received last rites on a Friday night. I called the nurses station on Saturday morning to find out what time he had passed. The nurse told me that he had “woken up”.  He proceeded to get better and was discharged to a rehab programme within 2 months.

The rehab programme that we selected was a one year programme. He needed time to heal. When he was there, he started to take courses at the local university and eventually decided to become a drug and alcohol rehab worker. That is what Charles is doing today.

So what values were working or not working in Charles’ case. The first consideration with values is that you have to hit the pause button to get into the values’ space. This is important. If the doctor or nurse is in their usual clinical haze, then values will be of no significance. See Daniel Golman on Ted talks on compassion.

We were respectful of Charles and did not condemn him because of his severe addiction to alcohol.

We showed persistence in seeking a solution. We did not give up.

We were curious about whether a transplant was an option. Liver transplant patients can live for 20 or more years with their transplant.

We were empathetic. We felt the pain that his family felt. He fought for him in the ethical and legal courts.

We were hopeful and not defeatist.

We were authentic. We want to help no matter what.

We were kind but not wimpy in the fight for Charles and his rights as a patient.

So, we find that perhaps that team that labelled Charles as a DNR case, were not aware of what values that they should have been following in caring for Charles. Maybe they were in a clinical haze and did not hit the pause button.

Go figure!