Following the road less traveled to engage patients and families

I was recently gifted with the book “Touching the Top of the World” by and about Erik Weihenmayer. Erik was born with retinoscheses, a degenerative eye disorder, that left him blind by the age of thirteen.  His story highlights how he pushed past limits imposed by a seeing world to become an accomplished adventurer … reaching the summit of Mount Everest and the tallest peak on each continent.

Erik’s story touched me and inspired me to try my hand at indoor rock climbing as I consider other adventures such as ice climbing, rock climbing, and mountain climbing. And here is where the true lessons of Erik’s achievements took hold along with a relevance that I truly did not expect.

As I looked up at the 30 foot high 624 square foot climbing wall I was reminded of my tree climbing days back in elementary school. (My mother still talks of the time that she had to climb a tree while pregnant with my younger sister to rescue me from a failed attempt at reaching the top). Of course that was 35 plus years ago.

This wall essentially has 4 “pathways” to the top: an easy route which leads to a bell that the successful climber can ring, a medium route, and then a couple of more challenging routes.

As I scanned my options I made note of the long line for the easy route and the opportunity to ring the bell and be recognized by all within earshot for achieving the summit. I then made note of the slightly less long line for the medium route which provided a bit more challenge and yet the route was very similar to the easy one with only slightly greater risk of failure and still an opportunity to be recognized for success by all those within seeing distance. And lastly I noted the two most challenging routes … and as Robert Frost so eloquently put it “I took the one less traveled by”.

Now don’t get me wrong, there was plenty of input for me to take the road more traveled by and reach the summit, ring the bell, and be acknowledged by many for my success.  And yet that didn’t quite feel right.  In fact, it didn’t feel right at all.  It reminded me of the many healthcare organizations who talk of patient-centered care, of patient and family engagement, and yet they follow the easy path.  They invest in technology and they implement process measures associated with the Patient Centered Medical Home (PCMH) certification (“the road more traveled by”) and yet they very rarely truly engage the patient and family in the design of new systems nor do they take the time to see through the eyes of the patients and families with a full 360 degree perspective and use this wisdom to truly make a difference. No wonder the PCMH is not the panacea so many had expected, i.e., not achieving expected quality, utilization, or cost improvements.

Yes, they may achieve the summit of this more traveled road, i.e., ring the bell and be acknowledged for their “success” publicly but have they truly made a difference in the health and lives of the patients, families and communities they are blessed to serve? No.

So, as the pressure became greater for me to take the two more traveled roads I stood fast to my choice to take the road less traveled by.  I began my ascent alone as everyone flocked to the shiny bell option.  Alone and afraid I took my first few “steps” up the wall and I began to notice even more so how great a challenge this is.  I stopped and caught my breath and scanned the wall (an environmental assessment) and saw a couple of strong holds. I reached and secured my hands and feet and moved further up the wall.  As I climbed higher and higher and moved further and further away from the road more traveled by I felt more and more alone. I also noted the anchors I had found in the early part of the journey were fewer and fewer and those that were in my vision were no longer as secure and reliable.

And then it happened … I fell off the wall. I fell off the road less traveled by and I did so head first.  Funny how there were few people around to encourage my ascent up the wall and yet there were many to witness my fall … my failure.

And yet …

Was I discouraged? No. In fact as I was falling (which by the way felt like it was in slow motion) I recalled what a colleague of mine preaches daily … failure is not necessarily bad … it leads to success … it leads to positive movement … “we fail forward” to truly innovate.

So there it is … I failed.  And I did so publicly.  And yet …

As I approached the road less traveled by again I was now armed with new knowledge. Yes, I failed. Yes, I failed publicly.  And yes I learned. I now knew I would be travelling alone.  I knew that supports would be less and less as I followed this new path. I knew that I must be both mindful and bold.  And I knew doing so would lead me to summit and that the achievement of the summit was not about me but rather about those I am blessed to serve.  So I grew to respect the challenge even more and carefully I began my ascent again.  And interestingly as I climbed higher and higher I did find support.  Yes, less  supports, and yet the supports I did find higher up the wall were those that were steadfast and true. And they were also much more appreciated.

And with these fewer and yet stronger supports the summit was achieved.

I took the one less traveled by, and that has made all the difference.”

As healthcare leaders we all have choices. We can follow the road more traveled by and achieve “success” or we can follow the road less traveled by and make a difference.

I choose to follow the road less traveled by and will continue to work to develop systems which allow for time, continuity, relationship, trust, and authentic sharing, between patient, family and clinician. I will continue to create system change which positions clinicians to use innovative tools such as emotional intelligence and motivational interviewing to ensure optimal sharing and comprehension. And I will continue to work to not only collect data from healthcare encounters, but rather turn the data into information and the information into wisdom by creating systems which allow for the co-creation with the patient and family of care pathways that are 100 percent aligned with the now understood preferences of the patient. And lastly, I will continue to strive to develop systems which track progress toward achievement of the co-created care plan.

I will do so because I truly believe this is a road that will lead to the positive outcomes we owe to our patients, families and communities.

Will you join me on the road less traveled by?



  1. Thanks for this story of authentic innovation, Tom.

    One of the key lessons from outside of healthcare is to set up a rapid innovation loops as close to the front lines as possible. One mantra I have heard multiple times is, “fail often, fail fast, fail cheaply.” This understanding that future successes will be built on a foundation of multiple things we see as “failures” along the way, is and important attitude for healthcare to adopt IMHO.

    Hope you didn’t skin your knees up to bad 😉

    Dike Drummond MD

    • At NICHQ and with our through our Quality Improvement lens we have historically used the term “rapid cycle tests of change”.

      You are 100% correct, Dike. We are now bringing this to our innovation work and “failing forward as you say … often, fast, cheaply” as we innovate to improve the health of children.

      Thank you so very much for sharing.

      PS Knees were fine. Shoulder, back and wrist not so much. 😉

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