Foreword

“RADCRAP with Faith.” That’s the mnemonic device we use to remember the sequence of the Self-Empowerment Pledge promises. Responsibility, Accountability, Determination, Contribution, Resilience, and Perspective. And Faith. When Joe Tye first gave us a set of his multicolored bracelets, one for each promise, we could immediately see the power behind this simple concept of reciting a promise each day that would impact the way we look at our lives and how we interact with others. Our favorite promise is Perspective, and not just because it is Saturday’s Promise. It reads: “Though I might not understand why adversity happens, by my conscious choice I will find strength, compassion and grace through my trials.” We wear a lavender Perspective bracelet every day. Why?

In late 1999, our son Patrick (Pat)—33 years old, a brand-new father to baby girl Riley and a most loving husband to his wife, Tena—died of complications of the autoimmune disease ITP. With Pat hospitalized for eight weeks, we were exposed for the first time to our healthcare system when it deals with the most critically ill people and their families. Without going into details of those worst weeks of our lives, suffice it to say that when Pat died, we as a family needed to find something to turn our attention to what was not life-threatening, gruesome, negative, painful. While we knew that nothing would help us make sense of Pat’s untimely death, we had to find something to fill the gaping hole in our hearts that losing him left. We had to find something positive. And we found it in our memories of the numerous nurses who cared for him during those eight weeks.

As a family, we expected that when your loved one is in a good hospital, the care will be competent. True to form, Pat’s nurses were clinically excellent. What we did not expect and what really got our attention was the compassion, kindness, and sensitivity his nurses showed to Pat, even when he was totally sedated, and that his nurses showed to us, even when we were a hovering family, asking the same questions again and again, fearing for the life of our Patrick, and surely not at our best. When Pat died, we were filled with gratitude to those nurses. We suspected that the nurses at Pat’s bedside were not unique. That nurses around the world demonstrate those same qualities every day in the huge life-saving things they do and in the little things they do that make a great difference in a patient and family’s experience.

We had to say “thank you” to nurses, so we created The DAISY Award for Extraordinary Nurses, with DAISY standing for Diseases Attacking the Immune System, since Pat had one. Our goal was to provide a means for patients, families, and colleagues to express their gratitude by sharing and celebrating in a meaningful way the stories of their extraordinary nurses. Little did we know when we started DAISY that there was no recognition program honoring what nurses became nurses to do—care for people. So the impact of The DAISY Award and the support by nurse leaders and organizations were tremendous. As of this writing, The DAISY Award is celebrating nurses in over 4,000 healthcare facilities and schools of nursing in all 50 United States and internationally. Over 1.5 million nominations have been written so far. Clearly, we are not the only people who want to say thank you to their nurses!

One of the hospitals that adopted our program was Midland Memorial Hospital in Texas. Bob Dent was the Chief Nursing Officer then, and he explained to us that The DAISY Award was a perfect fit for the positive environment he was building for patients and his workforce. We knew the stories DAISY solicits focus on all the “right” going on in healthcare. What we did not appreciate was the cultural impact this focus would have. Bob was among many prominent nurse executives who, in addition to research on meaningful recognition for which DAISY serves as proxy, helped us understand that while we were using the powerful expression of gratitude to cope with our grief, nurse leaders and organizations were using that gratitude to help create a positive work environment where the patient experience and employee engagement and satisfaction would benefit; nurses who are nominated for DAISY experience lower compassion fatigue/burnout and higher compassion satisfaction.

Bob insisted we get to know Joe Tye and learn about his construct for Invisible Architecture. Joe’s goals for the organizations he works with and DAISY’s are well aligned. His core values lead to a positive workplace attitude that is more efficient and effective for patient care. DAISY celebrates the actions that take place in that positive workplace with the knowledge that what is celebrated provides outstanding role models for all, taking an organization’s mission/vision/values statements off the hospital wall and bringing them to life in day-to-day care.

Joe describes how to create a culture in which employees not only take ownership for their work but also hold their patients and families to their hearts and do their very best for them because it’s the right thing to do. DAISY Award Honorees own their practice and their relationships with patients and families. They are proud of the work they do yet oh so humbled when it is recognized. “I didn’t do anything special. I was just doing my job” is the most frequent response by a nurse when it is announced that they are being honored. Taking ownership for their care is, to these “DAISY Nurses,” ordinary. But to those of us on the receiving end of that care, it is extraordinary, and we celebrate those special nurses who provide it. Invisible Architecture creates the space for this extraordinary care to live and breathe, impacting patient care quality and experience.

Understanding the principles of Invisible Architecture has helped us as co-CEOs and full-time volunteers of The DAISY Foundation to understand the culture our own organization has built. There are now 23 people working at DAISY. We work out of our homes in Annapolis, Atlanta, Detroit, Northern California, Oklahoma City, and Seattle. Only our Vice President for Nursing is a nurse, and the rest of us have experienced the impact nurses have on us as patients and families. We connect with each other thanks to an online database we share, an online meeting resource, online shared files, and telephones. Most importantly, we are connected by a commitment to our shared mission that we never lose sight of—our passion to say “thank you” to nurses for their extraordinary care and compassion.

Everyone on our staff owns her/his work. John, who ships out DAISY Award gifts, packs every box with loving care and answers every email from a hospital with an uplifting quote or a photo that makes the reader smile or laugh. Every Friday, Janet sends “good news” emails to ensure that we head into the weekend knowing the impact DAISY has made that week. Not only does Christina respond to organizations looking for information about DAISY and help current partners in her region with best practices, she makes all of us at DAISY better with her dedication to improving our use of technology. Peter and Jennifer tend to our finances with such attention to detail you would think it was their money, not DAISY’s. Cindy S. manages a significant load of abstract, article, and presentation writing, ensuring that DAISY has a presence and voice in the nursing profession in ways we cannot achieve without her expertise and insight as a nurse. Cindy L., our pro bono researcher, is relentless in researching the impact of our program, helping us understand how The DAISY Award is making a difference. Melissa and Tena, our beloved daughters-in-law, have both experienced firsthand the best of nursing. They, along with Alex, Chelsea, Dawn, Faith, Jaci, Julie, Kara, Kate, Lisa, and Meaghan, work tirelessly to ensure our gratitude is felt and that implementing The DAISY Award is a creative and rewarding process for the nurses who run it at their hospitals. Dana reads every DAISY Honoree story registered with us, creates a beautiful webpage for each recipient, and ensures we all keep boxes of Kleenex around by sending the most emotional stories to us to keep us focused on why we do what we do. And our assistant, Erin, keeps us on track, running our lives, our calendars, our nonstop travel arrangements, and our dogs.

All of them will tell you they have the “best jobs ever.” We think we have the “best staff ever” because we share the same values, we focus on the positive, our gratitude is received with gratitude back to us for all we do to celebrate nurses, and we know we are making a difference. Our team has each other’s backs, so when one is out, others pitch in. Without asking how they can help each other, they just help. We do our best to live RADCRAP with Faith, with a special effort on Saturday’s promise—to keep everything in Perspective. (And we are grateful to Joe for referring to Determination rather than Tenacity for Wednesday’s Promise.)

We believe in the Invisible Architecture you will now read about and in the tools Bob and Joe propose to create a positive, successful environment for your staff, your patients, and their families. We hope you will find this book an uplifting read and a very effective approach to improving the environment of care in your organization.

Importantly, to all of you who take care of patients or who care for the people who care for patients, we express our gratitude! The work you do is extraordinary. We certainly keep that in perspective every day, and we hope you do, too.