Kumbaya Consult

Our nursing leaders have finally recognized that there are problems within the department. Morale is low, units are either understaffed or forced to float; the Emergency Department stacks patients up in the halls; the NICU is chronically operating at more than 100% capacity. Managers are unresponsive to the needs of their staff or provide punitive measures to those who complain.

In order to solve our problems, they have sought the counsel of a spiritual guru named David Dibble who runs a California consulting company called New Agreements in Healthcare. (www.TheNewAgreements.com) David is a former CEO (although he does not specify what company he ran), spiritual teacher, systems thinker, consultant, trainer and keynote speaker. For eight years, he studied with the Toltec master, don Miguel Ruiz (www.miguelruiz.com) who gave him insights into the Toltec wisdom that has influenced his personal and professional philosophy.

Prior to working with BWH nursing, New Agreements in Health worked with Gila Regional Medical Center in New Mexico and Gerber Memorial Health Services in Michigan. Both of these institutions have fewer than 100 beds and serve very rural areas. Gerber Hospital even has 50 physicians.

However, it would be insincere to discredit the work that was done at these institutions. From the New Agreements website David lists some of the problems they tackled and successfully solved:

Problem: Patients can’t always wash their hands when they feel a need to do so.
Action: The team specified and procured a personal hospitality package for each patient that includes towelettes, personal grooming, hygiene and other items to make the patient’s stay at the hospital more comfortable.

Problem: The Tub Room was being used as a makeshift storage room.
Action: The team partnered with maintenance to remodel the room and prepare it to be used again as a Tub Room, a significant benefit for some patients.

Problem: Some things were not being completed in the discharge process.
Action: A discharge checklist was created and implemented in the dischargeprocess.

Problem: The refrigerator in the ER was on the floor and it was difficult (hardon the back) for caregivers to locate meds while bending or squatting.
Action: The ER team partnered with maintenance to raise the refrigerator to amore optimal level.

Problem: Patients had no place to put trash.
Action: A small disposable trash bag was attached to every bed in a place thatis convenient for the patient.

Problem: Charts in Chemotherapy were taking up significant space to thepoint where people had difficulty moving around in the department. .
Action: The team moved charts to Medical Records (into a special sectiondesignated for Chemo).

Problem: In MedSurg, caregivers tend to make their first rounds together.This means that it can be as long as one hour that a patient is in a room beforeseeing a nurse.
Action: Now nurses make rounds separately so that they get to all the patientsin a timely manner.

We are sure that we can all relate to some of these problems and would want to find similar solutions. Given the aging of the US nursing workforce, it would be a relief if all of the small refrigerators were raised up off the floor. However, we don’t believe that would solve the real problems in the nursing department at the Brigham.

According to David Dibble’s website, some of the problems at our institution have already been solved. The Operating Room area has been a problem for a long time. The MNA Committee has repeatedly raised serious issues during our meetings with nursing administration. We thought our complaints were falling on deaf ears. However, according to an Assistant Nurse Manager in the OR, with the help of David Dibble, the problems have already been solved!

"New Agreements Healthcare principles and systems tools are simple, straightforward, and address problems that have been plaguing us in the OR for years. It’s made a huge difference for frontline staff and me in caring for patients and each other. New Agreements Healthcare is a bold new approach whose time has come. With compassion and good systems we are delivered to a place of genuine care. We are the ones we have been waiting for."
—Barbara DiTullio, MA, BSN, Assistant Nurse Manager, Brigham & Women’s Hospital, Operating Room

Wow! Just what is it that David Dibble does that makes people think that their problems have just disappeared? Perhaps it has something to do with his study of the Toltec philosophy:

"The Toltec believe that this life is a dream, and that the dream we are having, which we consider reality, is created out of our beliefs and thoughts. Therefore it is malleable. We can change it by changing our beliefs and thoughts. Deconstructing our current view of reality and understanding how that view forms our experience of reality is the primary work involved in the Toltec path." (www.dailyom.com/articles/2005/448.html)

Many of you have received an invitation to join committees to work for change at the Brigham. We believe that change is necessary and that nurses should certainly be involved in identifying the problems and determining the solutions that will work best.

We do not discourage involvement in any committee where staff level nurses are given the power to influence the direction and outcome of the committee work. However, if any of you choose to participate in the David Dibble project, we offer a bit of advice: DON’T DRINK THE KOOL AID!