All posts by Thomas Dahlborg

Thomas H. Dahlborg Bio Tom is an Industry Voice for Relationship Centered and Compassionate Care AND Servant and Relationship Centered Leadership. An author, consultant and advisor, he is also a nationally recognized speaker, partner and collaborator. He is passionate about changing the healthcare system to a healthCARING system. Tom has more than 28 years of extensive leadership experience building relationship centered, patient-and-family focused, empathetic, compassionate care models; analyzing and meeting patient and family expectations; optimizing strategic partnerships, ventures and teams; innovating leadership, and bending the cost curve. Prior to leading the Dahlborg Healthcare Leadership Group (DHLG) Tom was the Chief Financial Officer (CFO) and Vice President of Strategy for NICHQ (the National Institute for Children’s Health Quality) where he not only led the financial turnaround of the organization he also ensured 100% of NICHQ projects included a key focus on parent partnerships and engagement. Before joining NICHQ, Tom was the executive director of the Hygeia Foundation, a nonprofit research institute focused on innovating patient centered care and leadership models; and prior to that the Chief Business Strategy Officer for Network Health Corporation (a Medicaid Managed Care Organization of service to a local Safety Net Hospital); and the Chief Operating Officer (COO) for the Health Plan Division at Martin’s Point Health Care. Through the Dahlborg Healthcare Leadership Group, Tom is currently addressing health disparities and improving health equity by collaborating with the Daniel Hanley Center for Health Leadership to ensure the voice of patients and families are successfully incorporated into these improvement efforts. Also in collaboration with the Daniel Hanley Center for Health Leadership, Tom, as the patient and family engagement expert, is leading efforts to improve end of life care. Tom recently delivered opening remarks and facilitated the Patient and Family Advisor Panel at the Patient and Family Centered Care (PFCC) Conference, and chaired the World Congress Patient Engagement Summit. He is an advisor to the Patient Voice Institute (PVI), an Advisory Board member for the Center for Health Engagement, a PIPSQC Ambassador, an Arnold P Gold Foundation, Hope Tang, MD Humanism in Medicine Essay Contest Reviewer, a Patient Voice Impact Judge, and recently a member of the National Quality Forum (NQF) Patient and Family Engagement Action Team, and also recently a Social Media Super Leader for the Robert Wood Johnson Foundation. Tom writes extensively on relationship centered and compassionate care, patient engagement, patient safety, healthcare innovation, collaborative care models, health systems improvement, servant and relationship centered leadership, and is an industry voice for Hospital Impact and FierceHealthcare. He is also a guest blogger for the Paediatric International Patient Safety and Quality Community (PIPSQC), ISOQOL, the Arnold P. Gold Foundation, and many others. Tom is also currently writing the health care novel, From Heart to Head and Back Again … a journey through the healthcare system. He also shares stories of love, parenting, coaching and family through the Big Kid and Basketball series. Tom received his master’s degree in Health Services Management from Lesley University and his bachelor’s degree in Healthcare Administration from Stonehill College.

10 Steps for Benching Bullying

Tom Dahlborg
Tom Dahlborg

In the January 2013 NICHQ Leadership message Beyond Bullying, I shared that 42 percent of children in a Yale Rudd Center study reported being bullied by physical education teachers and sports coaches. Yes, 42 percent! Quite frankly I was shocked at this statistic.

That said, another study found that 45 percent of children “said their coaches called them names, insulted them or verbally abused them” and another study, this one from the United Kingdom, found that 25 percent of 6,000 young adults reported that they suffered emotional harm at the hands of their coaches.

Just think about that for a moment. Depending on the study, between 25 to 45 percent of our children who play sports are falling victim to a coach who is habitually cruel and abusing them. Let that really sink in. Up to almost half our children who play sports are being abused by coaches.

As Nancy Swigonski, MD, MPH, associate professor at Indiana University’s School of Medicine, has noted in her piece in the journal of Pediatrics, the damage these coaches are doing to our children is devastating and can be everlasting. “It can impair social and emotional development and cause substantial harm to mental health.”

As noted in Charlie Homer’s recent blog about NICHQ’s name change, there are many broader influences that affect children’s health outside of the clinical setting. This certainly includes the bullying that happens on our ball fields that can lead to physical injury, social problems, emotional problems, mental health problems (e.g., depression, anxiety), and even death. Not to mention bullying can turn children off from physical activities and this can potentially lead to obesity. As an organization that aims for all children to achieve their optimal health, there is much work to be done…together.

So what can parents do?

  1. Interview the coach and his/her staff. Ask about philosophy, priorities, playing time, values and also ask how he/she measures the outcomes of each.
  2. If your child is already on the team and you have concerns, ask your child about his/her experiences, the messages that are being sent, and follow each path your child raises a concern about.
  3. Inquire of other parents who currently or perhaps who previously had children on the team.
  4. Look for red flags: According to Kody Moffatt, MD, a pediatrician in Omaha and executive committee member of the Council on Sports Medicine and Fitness for the American Academy of Pediatrics, the number one red flag is a coach who wants “closed practices” where parents and other adults are barred from the practice. “That may be innocent, but as a pediatrician, a parent and a coach, I don’t think any coach should tell an adolescent not to tell another adult something.”
  5. Be sure to attend (or perhaps rotate with other trusted adults) your child’s practices.
  6. If you notice bullying behavior, document it and include specifics.
  7. Identify and map behaviors to team, school and/or league codes of conduct. Use this as a tool to share very specific examples of your concerns.
  8. Address your concerns directly with the coach. Focus on the impact on the children and be specific.
  9. If discussion with the coach is unsuccessful, reach out to the athletic director, school officials (if school based program), and/or league officials, and share your findings. NOTE: It is absolutely crucial to make note of how the coach is treating your child AND it is also critical to keep an eye out for how the other children are being treated as well. These are our communities and regardless of whom the child is these behaviors are unacceptable and it is incumbent upon us all to speak up for those who cannot do so for themselves and make a difference.
  10. Ensure that you also focus on developing warm family relationships and positive home environments so that if your child is bullied the negative outcomes from the bullying will be minimized. According to the study “Families promote emotional and behavioural resilience to bullying: evidence of an environmental effort” published in the Journal of Child Psychology and Psychiatry, “Warm family relationships and positive home environments help to buffer children from the negative outcomes associated with bullying victimization.”

Bullying is harmful and can lead to tragic ends. Together with these 10 steps we can identify it, stop it, mitigate its impacts, and help our children achieve their optimal health—mental and physical.

Systems Level Healthcare Improvement Starts with Individual Relationships

Tom Dahlborg
Tom Dahlborg

Recently, I was invited to a meeting of experts to discuss how best to improve patient and family engagement in healthcare at a system level.

As I walked in to the meeting room, I was pleased to see I was slated to sit next to the meeting co-chair, who I had met previously and wanted to get to know even better. As I walked out to stow my luggage, one of the meeting coordinators approached me and let me know that they were moving me because another individual required access to a plug (which happened to be right behind the seat I was initially assigned to).  Oh well I thought … I will simply connect with the co-chair later in the day.

Interesting how fate works.

Shortly thereafter I realized I would be sitting next to a brilliant patient advocate, who also happens to have a chronic degenerative neurological disease. (I will refer to him as Neal.) And throughout the day, Neal showed all of the following symptoms of the disease:

  • Tremors
  • Bradykinesia
  • Rigid muscles
  • Impaired posture and balance
  • Loss of automatic movements
  • Speech challenges

As the meeting began, I became aware of Neal’s breakfast. How he appeared to struggle with his fruit. How the juice cup in his hand flailed precariously close to being dumped on him, on me, and/or on the table. And I realized I had no idea how to help. I had no idea whether Neal wanted help. Would I offend him by offering help? What was Neal’s preference?

As the day went on, Neal confided in me that he was getting tired and I noted his symptoms worsening. He stood up abruptly and his chair, which was on wheels, flew backward so I grabbed it and held it for him. I saw him stumble and thought he would fall so I reached out and held his arm.  Neal brought out a pill container and I thought he was having some difficulty extracting his pills, but decided to hold off at first on offering assistance. Again, I wasn’t sure what he would want and whether he was finding my persistent questioning, e.g., “Can I help you?” “How can I assist?” “Can I get that for you?” bothersome. He retrieved his pills on his own. He then began to lean toward me and I asked again “can I help you,” but received no answer.

A bit later Neal handed me a can of soda and asked me to open it for him, which I was happy to do. And yet as I did so I noticed he also had a cup of ice and based on what I was witnessing I was thinking there was no way he would be able to pour the drink into his cup without spilling. And as I was about to ask him if he wanted me to do it (feeling more comfortable after a number of hours together), Neal leaned over to me and asked me to do so for him.

It’s interesting what thoughts go through your mind during these times.

Feeling that at any moment I could be wearing Neal’s drink, I made a pact with myself that if it does happen I will not show any manifestation of being startled, I will not immediately get up and go clean my suit, but rather I will take it in stride and ensure that I do not cause any sort of scene which would adversely impact Neal. Or, in other words, I will do my best to treat Neal how I would want to be treated in lieu of not truly knowing Neal and his preferences.

At the end of a long day I noticed Neal circling me. He came near and then circled away. He came near and then stumbled (and I supported him) and then circled away again. He then stopped nearby and we made eye contact and he simply said, “Tom, I want to shake your hand,” which we did and I responded, “Neal, it was so great to meet you.”

During a long commute home I continued to process these events.

I was blessed to be sitting with my new colleague. I was fortunate to be further reminded throughout the day of how important it is to develop relationships, to develop trust, to share openly and honestly, and to understand one another’s whole story, preferences, goals, desires, and so much more … and especially so in healthcare. I learned that the more I got to know Neal and understand his preferences the better I felt and the better I was able to respond accordingly and meet his needs more effectively.

Want to improve the healthcare system from a systems perspective?

Develop systems which allow for time, continuity, relationship, trust, authentic sharing, the telling and hearing of the patient’s whole story at each healthcare encounter. Create system change which positions clinicians to use tools such as emotional intelligence and motivational interviewing to ensure optimal sharing and comprehension. And not only collect data from these encounters, but rather turn the data into information and the information into wisdom by co-creating with the patient and family care pathways that are 100 percent aligned with the now understood preferences of the patient. Lastly, develop systems which track progress toward achievement of the co-created care plan (measure the impact).

If we are going to truly

  • engage patients and families,
  • improve patient satisfaction, engagement, activation,
  • improve clinician satisfaction and retention,
  • ensure resources are not wasted (save healthcare dollars), and
  • profoundly change and improve the healthcare system,

then we must.

Yes, Neal, it was so great to meet you. Thank you for allowing me the opportunity to learn from you.