What Matters Most: A Conversation with Brian Wong, MD, MPH

In this article, Dr. Brian Wong describes a patient-accountable culture as built around the question, What matters most to patients? He asserts that it is up to each health care professional to take responsibility for his or her positive impact on the culture with every single interaction. Each interaction needs to support what matters most to patients and to the well-being of the team. As all health care professionals get better at showing up in a patient-accountable way, everything else gets better: patient safety, patient satisfaction, employee engagement, and even the bottom line. Not because of a series of initiatives but because we ask one question . . . "What matters most to you?"Keywords: coaching; health care team; patient-accountable culture; TRUSTEDMary Koloroutis: Brian, we appreciate your taking time to share your passion and your expertise with our readers.Brian Wong: I appreciate the opportunity to share.Koloroutis: In your book Heroes Need Not Apply, you describe how to create a patient-accountable culture. I loved reading what you wrote and that you linked accountability directly to the patient. How do you define a patient-accountable culture and how do you differentiate it from the broader concept of accountability within an organization?Wong: A patient-accountable culture is based on a pretty simple idea: what matters most to patients determines how we practice as leaders. Patient accountability is centered on the idea that we are here to provide what matters most to each and every patient and that if we appreciate that-if we buy that-then it's really important to know what it is that does matter most to patients.I contrast that with organizational accountability. What I observe in many organizations is that they are too busy with their tasks-doing things-to take the time to understand what matters most to patients.Koloroutis: Right now, there is a presumption that we already know what the patient wants and an expectation that patients conform to what is in store for them.Wong: Well put, Mary. Our actions say, "I already know what you want, and I am here to give it to you, so if you would just be quiet and let me do my job, then I can be accountable." Taken to an extreme, "You are accountable to me to let me do what I do."Koloroutis: That's where the concept of compliance comes in. "You are accountable to me-I know what is best for you."Wong: Going back to organizational accountability, part of the question that led me down this path is, to whom and for what, exactly, am I accountable? Who is the organization? Is it my boss? Is it the CEO? Is it the mission statement? Then, what is it they are asking me to do? If we exist to provide what matters, we need to know what that means and know what matters. Those answers are quite simple and straightforward if we give ourselves five minutes to figure them out.Koloroutis: When I became a licensed professional nurse, for me, the license meant that I am accountable to the people I serve: patients. Organizational cultures either supported that accountability or detracted from it. But my commitment through my licensure was not negotiable. I selected where I would work, based on whether I could serve what I committed to under my licensure. That gets diffused when people become employees; licensure becomes subsumed in employment. It should be compatible and coherent.Wong: There's a phrase that sums up that tension, that conflict: "No margin, no mission." As if margin is elevated to or even superior to the level of the mission. If I'm accountable to the organization, am I accountable to its margin and to protecting its assets, or to the mission? Many people in health care, not just physicians and nurses but the entire work force, are in personal turmoil over this. I have a personal mission: I went into health care to take care of people, and I want to uphold my oath-my license-and yet the organization expects me to place something else above that. …