Medical Student Speaks Up Under Influence of Telluride Mentors

Over the course of history, many young entrepreneurs have changed the world. Be it in the technology arena like Bill Gates, the social media world like Mark Zuckerberg or the newest Nobel Peace Prize co-winner, Malala Yousafzai–real change has been created by young leaders who envisioned a better way. These creative thinking young entrepreneurs are also leading change in healthcare. While their vision and action as patient safety advocates and role models may not send financial ripples across Wall Street, or redefine how we communicate with one another just yet, their efforts will save patient lives.

Over the last two years, ETY followers have read many stories about quality and safety projects being led by resident physician and health science student entrepreneurs, many Telluride Patient Safety Scholars and alumni. The attached video highlights another example of these young leaders in action, role-modeling the use of resilience tools that will make care safer for our patients. Dalina Aqbal, Telluride alumna and a medical student at the Georgetown School of Medicine, role models two resilience tools to over 300 faculty caregivers–the use of Safety Moments, and an example of “Stopping the Line” to validate and verify information when something doesn’t feel right. While many of these young leaders may not win a Nobel Peace Prize, they are truly helping change our safety culture as they lead by example.


A Safety Moment from Budweiser

No introduction necessary, though I did have to watch it twice to get the entire message because I was too taken in by the sad yellow lab.


A More Realistic Perspective on a Career in Medicine

Artesa_View_NapaDanielle Ofri, MD, physician, writer and editor, often turns her pen along with her focus to the emotional complexities that accompany a career in medicine. Her book, What Doctors Feel: How Emotions Affect the Practice of Medicine, is an honest sharing of what many healthcare professionals are often processing behind a mask of false bravado and confidence. The book, a must read for every medical education program in the country, can prepare and provide a realistic perspective of the road medical students can travel, to know they are not alone when doubt or disillusionment creeps in. It also can serve as an instruction manual of sorts for patients to better understand the person who provides the care. In just the Introduction, she writes:

There has been a steady stream of research into how doctors think…In…How Doctors Think, Jerome Groopman explored various styles and strategies that doctors use to guide diagnosis and treatment, pointing out the flaws and strengths along the way. He studied cognitive processes that doctors use and observed that emotions can strongly influence these thought patterns, sometimes in ways that gravely damage our patients. “Most [medical] errors are mistakes in thinking,” Groopman writes. “And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t even recognize…

…The emotional layers in medicine…are far more nuanced and pervasive than we may like to believe…they can often be the dominant players in medical decision-making, handily overshadowing evidenced-based medicine, clinical algorithms, quality-control measures, even medical experience. And this can occur without anyone’s conscious awareness…

…This book is intended to shed light on the vast emotional vocabulary of medicine…how it affects the practice of medicine at all levels.

It was the recent reporting of two young physicians taking their own lives at a time they should be celebrating academic and professional milestones that prompted this post. While we are not privy to what contributed to these terrible losses, the frequency with which similar lives are lost among the healthcare ranks speaks to what can often be a Grand Canyon-sized gap in the expectations and the reality of a career in medicine–as well as what is often left untreated or acknowledged within the profession: mental health and wellness of the healthcare professional. As Ofri writes in a recent article for Slate Magazine, The Tyranny of Perfection:

…it is clear that a career in medicine also brings on tidal waves of pain, confusion, stress, self-doubt, and fear. The eddies nip at our ankles from our first step into anatomy lab, gathering in force and ferocity over the years of training and practice. During medical school, at least half of students experience burnout, and some 10 percent contemplate suicide.

So much of medicine is a tyranny of perfection. Medical students are asked to absorb an immense body of knowledge…Yet, we act as though this perfection of knowledge is a realistic possibility.  No wonder nearly every student feels like an imposter during his or her training….We’ve been asked for a perfection that is unachievable, yet the system acts as though the expectation is eminently reasonable. It’s no surprise that disillusionment is a prominent feature in the medical landscape today. It’s also no surprise that such burnout is associated with unprofessional behavior and more frequent errors.

Each year (since 2010) we gather medical, nursing and health science students, and resident physicians together for the Telluride Patient Safety Summer Camps in Telluride, CO (now Napa, CA and the Washington DC area as well) for week-long educational sessions, discussing patient safety related topics such as the need for open, honest communication in medicine, the need to honor the patient’s voice, and in the past, the bullying that goes on in the healthcare culture. The hope is that we can empower young change agents that will put a more realistic, positive spin to a culture that seeks to heal versus harm one another, or patients, yet continues to fail on both accounts far too often. The students and residents that take time out of their ever-increasing busy schedules to spend a week of vacation focused on making care safer are some of the most interesting, well-intended and accomplished young people. They have big hearts and the energy to climb the healthcare administrative and cultural mountains required when choosing to open their eyes to the challenges that lie within the healthcare culture. What steps can be taken by those leading today, to clear a safer, more well-rounded path, for their training and well-being? The thought of any one of our Telluride alum experiencing what Ofri and others describe is untenable–as is the thought that there are people posing as healthcare leaders that would allow this to continue.

Today is the day to commit to do things differently. To act upon what your gut is telling you. Today is the day to protect those you lead as they learn!


“Don’t Breathe” from the 2014 Toronto Film Festival

Director Nino Kirtadze had no idea the patient education tool she created in the somewhat engineered documentary film, Don’t Breathe–a film intended as a study in the fragility of human nature. From my seat, however, the story she captured only further illuminates how in-the-dark many patients remain when it comes to their own health, and the care they receive. While the trailer alone tells the story many intimate to healthcare live each day, discussion after the film revealed the team had no intention of using it to educate patients–even as the gentle main character traveled from one doctor to another, enduring professional and unprofessional examinations, his diagnosis becoming more and more ridiculous, almost comical, and all too close to reality in many circles of care. Almost comical that is, if you ignore the fact this man was experiencing in “real life,” the fear which accompanies any suggestion by a healthcare professional that one might need surgery, have heart disease or worse.

How can this story, or even simply the film trailer, be used to educate patients on the need to speak up and ask questions about what their healthcare professional may or may not be telling them?

And as a related aside, I give the Toronto International Film Festival (TIFF), and Toronto, 5 glowing stars. The line-up of film premieres, number of A-List attendees, quality of venues and restaurants all within walking distance, and the ability to see the top films, were unmatched by past experiences at Sundance or the Chicago Film Festivals. Next year will be TIFF’s 50th Anniversary, and I look forward to returning. On the bucket list next, Cannes!


Paul O’Neill on Protecting Our Healthcare Workforce #NPSFLLI7

LLI Screen ShotBreakout sessions at last week’s Lucian Leape Forum included Dr. Lucian Leape himself, Paul O’Neill, Former Chairman and CEO, Alcoa, 72nd Secretary of the US Treasury and more. I had the long-awaited pleasure of hearing Paul O’Neill speak in person, during his breakout session entitled, Operationalizing, Disseminating and Implementing Joy & Meaning In Work and Workforce Safety, along with Julie Morath, RN, MS, President & CEO, Hospital Quality Institute of California. O’Neill’s unwavering standards and expectations in business, and for healthcare, have been an inspiration for many. Therefore, it came as no surprise that he seemed irritated with our progress to date, pulling no punches when asking the group how many of us in the room knew the real-time facts about injury to the people who do the work in our hospitals, and, did a system currently exist to provide that information with a 24-hour lapse? No one in the room raised a hand, and he shared that only 6/100 in a recent audience responded affirmatively to the same questions.

“We’re too far away from this type of excellence,” he said, following with a story that while at Alcoa, the company’s screen saver included real-time safety data. When a particularly concerning near miss appeared on his screen one day, O’Neill picked up the phone and called the team in Russia where it had occurred, asking for more information about what had happened. The personal attention to this near miss resonated throughout the organization, furthering the culture and behaviors that make organizations stronger. It’s this type of response and awareness to healthcare professional harm, as well as patient harm, that will move us to where we need to be.

“Why can’t we do this (in healthcare)?” was O’Neill’s resounding and animated challenge, many in the room knowing full well why we have not. Healthcare culture, leadership that says one thing but fails to support the necessary changes at pivotal moments, inertia–all of these however, are choices made by leadership. Either you’re in or you’re out.

Much of O’Neill’s breakout session was based on the LLI white paper, Through the Eyes of the Workforce, a must read for anyone serious about improving the quality and safety of care. Key takeaways from this breakout, as well as the summary session that followed, include:

  • It will be very challenging to protect patients if we first can’t protect our own.
  • The physical and psychological safety of our healthcare workforce is pivotal to ever improving the quality and safety of care.
  • Real leadership is enabling not controlling.
  • A leader’s first responsibility is to his/her people.
  • Safety is not negotiable – it’s not a trade-off. You figure out how to pay for it. A pre-condition is that people who work ‘here’ will not get hurt.
  • Habitually excellent organizations don’t “report” – they share information and act in a timely way when things go wrong.
  • The response is key when people do share information. You can shut down a reporting culture in a heartbeat if you criticize someone for what/how/where they shared information.
  • How would your healthcare workforce answer O’Neill’s 3 Questions: 1) Am I treated with dignity and respect by everyone each day? 2) Do I have what I need so I can make a contribution that gives meaning to my life? 3) Am I recognized and thanked for what I do?

We were reminded that it is hard to make a business case for healthcare professional safety, but data also shows that unhappy, un-empathetic, uninspired or unrecognized healthcare professionals directly impact the safety of patients, which directly impacts the “business case” in immeasurable ways. Too often, many in healthcare have observed our colleagues defend or excuse sub-optimal results, or continue to look the other way when observing behaviors that clearly are not in the best interest of colleagues or patients. O’Neill’s unwillingness to compromise standards or expectations is not only inspiring, those values created a company in Alcoa with a safety record that set the bar for his industry, as well as other high-risk industries. O’Neill left the group with many pearls, but following is one that particularly resonated along with advice from the world of storytelling:

“Organizations are either habitually excellent or they’re not – there’s no in between,” said O’Neill.

“Do or not do, there is no try,” fictional sage Yoda advises via the story world of Star Wars.

It is time for healthcare to do differently.

 


Informal Influence in Healthcare #NPSFLLI7

The 7th Annual National Patient Safety Foundation and Lucian Leape Institute Forum and Gala was held last week in Boston, gathering patient safety leaders together to share knowledge, recharge and re-energize their efforts in making care safer for healthcare professionals and patients. The opening keynote, Using Informal Influence to Drive Positive Change in Healthcare, was given by Andrew Knight, PhD. Assistant Professor, Organizational Behavior, Olin Business School, Washington University. Knight has studied innovation implementation, leadership and teams in high risk environments, such as the surgical suite, ICUs, Emergency Departments and the military.

Screen Shot 2014-09-21 at 8.51.32 AMKnight’s talk provided a number of take home tools for healthcare leaders to approach internal change with new power. He supplied a different lens through which to view company politics, one that allows for consideration of “the other” versus leaving a footprint on even your mother’s forehead to reach the top. He shared insight into the influence skills and the collaboration across teams necessary to move quality and safety initiatives forward. And, he stressed that data alone has not been the sole catalyst for the large-scale adoption of change needed to make the healthcare workplace as safe as we need it to be, using the tragic story of Ignac Semmelweis as evidence. Many are familiar with Semmelweis’ story–the doctor who discovered hand washing as a “cure” for the high number of deaths related to childbirth in Vienna clinics. His findings at the time went against the medical community’s thinking of the day, with physicians even taking offense at the request to wash their hands before caring for a patient. Unable to convince, or influence, others of his findings during his lifetime, Semmelweis was ultimately committed to a psychiatric hospital at the age of 47, and beaten by guards two weeks after his arrival. As the story goes, Semmelweis died shortly after from the same infection he was trying to protect patients from through hand washing. This simple, cost-effective step in the delivery of care at the desired 100% adoption rate still eludes health systems today.

Additional takeaways from Knight’s talk include the following. He is an excellent speaker and the topic couldn’t be more timely for healthcare.

  • When it comes to navigating the waters of company politics, do you consider yourself an innocent lamb, a straight shooter, a survivalist, company politician or Machiavellian? Knight asked the group to respond via a text message survey. Results showed a normal distribution, the majority claiming to be survivalists with one Machiavellian in the group, prompting Knight to tongue-in-cheek, warn all to watch their backs.
  • A more realistic view of company politics was offered, such as: Instead of considering what tactics might be used to influence someone, walk a mile in their shoes to understand exactly how what you offer might affect another. Or, instead of kissing up to those in power, feel free to compliment those you admire!
  • Driving positive change is hard work! A 2005 study showed more than 50% of attempts to implement innovations end in failure, and that over $500 Billion is wasted annually on new technology implementations, according to Morgan Stanley
  • To implement change, groups outside one’s direct circle of influence need to buy-in, collaborate, support, and supply resources to be successful. Influence skills can help gain the buy-in!
  • Informal influence at all levels of the organization is what makes for the successful adoption of new initiatives.
  • A numeric equation to map the political landscape related to change was provided, quantifying the amount of current support for any given project, by any given stakeholder, indicating likelihood of success.
  • “For most change initiatives we need commitment. Compliance is rarely enough.”

 


#Meded Fun on a Friday

These talented medical students may have a career in show business if the whole medicine thing doesn’t work out in the end. This group is from the David Geffen School of Medicine at UCLA, but search YouTube for “medical student parody” and you will find medical humor set to tunes from Frozen to “What Does the Fox Say?” to “Call Me Maybe” and this group’s choice, “Royals” by Lorde. Have a great weekend!


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