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Authority Or Responsibility?

authority-or-respect_

A few weeks ago during a question and answer session of a speaking engagement I was asked the following question: “What happens if I do not have the authority to make those decisions?”

I love this question, so I figured I would share my take on it with the broader audience.

People are often waiting to be given the “authority” or the power to make decisions. This is often used as an excuse, or a way of letting ourselves off the hook for not making a decision, making a change, or performing a task.

I do not have the authority, so I do not have to do anything about it.

Authority in many organizations resides at the top and cascades down. This structure allows for decisions to be made and for workers/people to be compliant to follow those decisions.

As long as we follow the decisions and directions, we keep our jobs.

Few of us will ever have the “authority” or be close enough to the top to make decisions in which people must comply with in order to be paid.

Forget about authority. Seek responsibility.

Responsibility is abundant. There is more than enough laying around for any of us to pick up and take.

Each of us has an opportunity on a daily basis to do something that requires us to be accountable, answerable, and responsible for doing something. It can be writing a letter, it can be guiding a patient to a waiting room, it can be answering a phone, it can be changing a workflow, it can be staying late to help transition care between shifts.

No one is asking us to do it. No one told us we must do it. It may not be written down in a job description, or a process improvement, or in a manual. It may not have been done before. It may not be something that we are paid to do. It may be risky. It may be weird. It may be odd.

It may also be the one thing that changes the perception for a patient. A family member. A physician.

Each of us has the ability to take responsibility. To do something.

If it succeeds, spread that acknowledgement around. Share it with others on your team. Commend others for the success. If it fails, stand up and take accountability for your decisions to act. Claim ownership for trying something different.

The more times we take responsibility the more people will realize that we are here to lead.

Leadership is not about a title , or the top of the organizational chart, or having authority.

Leadership is about taking responsibility.

I take responsibility at the N of 1.

As always you can feel free to email me at cancergeek@gmail.com or follow me on Twitter @cancergeek

~Cancergeek

#JACR Chat 6/26: Patient Perspective on Lung Cancer Screening (#LCSM cohosts)

This is a guest blog post in support of patient experience, JACR, and LCSM.

On Thursday June 26, at 12 noon Eastern Time, the Journal of the American College of Radiology (#JACR) tweetchat will discuss the patientís perspective of lung cancer screening. It will be hosted jointly by #JACR and #LCSM, using the hashtag #JACR, and will be moderated by Dr. Ruth Carlos (@ruthcarlosmd) of #JACR with guest moderators Ella Kazerooni, MD, and Janet Freeman-Daily (@JFreemanDaily) of #LCSM. #JACR posted about the chat and provided the following information:

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“Ruthie, your dad fell down and now he has cancer.”

My dad had tripped down a short flight of steps to the basement. In Urgent Care, he received a chest X-ray for shoulder pain, inadvertently detecting his lung cancer. I was grateful that he accidentally fell, grateful that he received a chest X-ray rather than shoulder X-rays, grateful that I still have my dad, a 70 year old man who smoked two packs a day since he was 18.

The survival rate for early stage lung cancer is nearly 50%. The survival rate for late stage disease is less than 5%. The U.S. Preventive Services Taskforce (USPSTF) recommends a more systematic way to screen individuals like my dad: use low dose computed tomography, also known as low dose CT or LDCT, to find early stage lung cancer. The National Lung Screening Trial enrolled more than 53,000 participants in a study. It showed lung cancer screening with LDCT resulted in 20% fewer deaths from lung cancer compared to screening by chest x-ray. On the strength of these findings, the USPSTF showed strong support and issued a “Grade B recommendation” for lung cancer screening with LDCT, requiring private insurance plans to completely cover this service. Medicare administrators now are weighing the decision to cover lung cancer screening, balancing the benefits with the unintended harms.

Some of the harms associated with lung cancer screening include “false-positives” —detected nodules or tumors that are actually not cancer. Low dose CT can also detect abnormalities outside the lungs, such as thyroid nodules or heart problems. These are called ìincidental findingsî or “incidentalomas,” most of which are benign. However, because a small percent of incidentalomas turn out to be potentially harmful, additional diagnostic testing may be required. These additional procedures can lead to increased cost to the patient, even if the screening test is free. Both false positives and incidentalomas can potentially increase patient anxiety, test-associated radiation, and out-of-pocket costs.

Understanding patient concerns about lung cancer screening is essential to fully implementing this life-saving medical service of LDCT. Patient-Centered Outcomes Research, or PCOR, focuses on addressing patient questions such as “What can I do to improve the outcomes that are important to me?” and “How can clinicians and the care delivery systems they work in help me make the best decisions about my health?” Per a USPSTF recommendation, the ECOG-ACRIN cancer research group proposes to develop a registry of participants who receive lung cancer screening in order to understand the full patient experience, including what outcomes, benefits and harms are most meaningful to patients, how to consistently communicate these benefits and harms, and how to support patient choice regarding screening. ECOG-ACRIN is one of the National Cancer Trials Network groups launched this year by the National Cancer Institutes. It is implementing PCOR principles in the development phase of the registry to incorporate patient voices and perspectives.

Here are the four questions that will be discussed during the Tweet Chat:

T1: What clinical, psychological and cost outcomes are most important to patients who receive lung cancer screening? #JACR

T2: Some lung nodules detected by lung cancer screening are ìfalse positivesî (not cancer). What effect would this have on you? #JACR

T3: Lung screening might detect other conditions (e.g., thyroid and heart) needing more tests. What concerns you about this? #JACR

T4: What aspects of lung screening benefits and harms are difficult to understand? How might understanding be improved? #JACR

If you would like to be considered for a patient advisory panel about lung cancer screening or want to tell us about your experience, email us at lungscreeningregistry@gmail.com.

Moderators for This Chat

@ruthcarlosmd (Ruth Carlos, MD), Deputy Editor for JACR and Co -Chair of the ECOG-ACRIN Patient Centered Outcomes and Survivorship Committee.

@JFreemanDaily (Janet Freeman-Daily) , cofounder and comoderator for Lung Cancer Social Media #LCSM Chat on Twitter.

Special guest: Ella Kazerooni, MD, Cardiothoracic Division Director and Professor of Radiology at the University of Michigan, is the Vice Chair of the National Comprehensive Cancer Network (NCCN) lung-cancer screening panel. She recently testified before the Medicare Evidence Development & Coverage Advisory Committee on the value of lung cancer screening and the need for Medicare coverage of LDCT.

As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek

~CancerGeek

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