Disney and Pixar Understand Patient-Centered Care

If there is any way to get John Lasseter and leadership from Disney or Pixar involved in developing healthcare of the future, I think we might want to consider recruiting their team. Big Hero 6 opened November 7th and led box office sales with $56M in tickets sold its first weekend, adding another $36M this past weekend. Urged on by a seven-year-old who is in the process of developing edible electricity to make dogs talk, my family purchased six of those tickets. Four adults and two kids spent Saturday evening just how Walt Disney intended us to:  at the movies!

Both Disney and Pixar have mastered the art of entertaining kids and adults with their stories, and lovable, life-like, animated characters. In Big Hero 6, it is the personal healthcare robot, Baymax, and fourteen-year-old orphan genius, Hiro, who steal the show. Baymax comes to life when he hears the word, “Ouch!” Breaking free of his 2′ x 2′ storage cube and inflating to StayPuff marshmallow form, he then waddles comically over to whoever he perceives may need his pre-programmed healthcare expertise.

“On a scale of one to ten, rate your pain,” says Baymax, as the visual pain scale lights up across his large, puffy chest also serving as a monitor for patients to view any medical findings. Baymax then scans his patient from head to toe, assessing location of injury or type of illness, and proceeds to prescribe proper treatment from a database full of disease information.

The kicker? To make Baymax deflate and return to recharge in his storage cube, his patient must first say, “I am satisfied with my care.” Wow! Go Pixar!

 

 


HPI Safety Summit: Communication Key Component of High Reliability Journey

The cab driver that took me to the Cincinnati airport as I left the HPI Safety Summit last week was from Ethiopia. He had made a point to say “east Africa” when I asked where he was from, as the Ebola virus had greater than average attention in the Queen City due to one of the two nurses who contracted the virus having recently passed through northern Ohio. Even though she never came any closer to Cincinnati than almost 250 miles away, almost every cab driver encountered during our stay mentioned Ebola. This gentleman, in broken but completely intelligible English, shared that he had been in Cincinnati for nine years, and was lamenting the fact that his accent remained far too apparent while his young children now spoke perfect English. Our conversation continued on the beauty of different cultures and their languages, and he told me 80 different languages are spoken in his small country of origin. A quick Google search confirmed this, as well as that anywhere from 1,500 to 3,000 different languages are spoken across the African continent. It dawned on me that the magnitude of such disparate means of communication might not only contribute to a lack of understanding, but with it, the slow-moving development experienced across Africa on the whole. He agreed, which led to an impassioned explanation on how the inability to communicate in a common language leads to a lack of trust among clans, violence and often the need to hire a translator just to travel from the north to the south of Ethiopia. I told him he had inspired an ETY post, as it is becoming increasingly clear that data and fact lose almost every time to fear, ignorance, poor communication and a good old-fashioned wives’ tale spun by a convincing storyteller.

Screen Shot 2014-11-11 at 6.21.23 AMCommunication was one of the overriding themes at the Safety Summit as well. HPI is endeavoring to make the language of patient safety universal across healthcare by providing consistent, process-driven training that gives healthcare professionals a vocabulary in high reliability, resilience and a systems approach to care. The number of partnerships HPI has formed with healthcare organizations across the US seeking to join the high reliability journey is growing, and with it, so follows the number of patient lives positively impacted by those employing their teachings at the frontlines of care. Their teaching excels in parallel with a clients’ ability to communicate the learning, and the session my colleague Erin Agelakopolous and I presented on the topic was standing room only. With newer clients in attendance at this year’s Safety Summit, there were many who wanted to understand how we were communicating the HPI learning across a health system of 30,000. We shared the tool kit designed by MedStar’s Communications team, our 60 Seconds for Safety videos, patient and provider stories, and a Good Catch program recognizing the excellent work at our frontlines while reinforcing the learning culture HROs need to thrive. And we shared that this has indeed been a journey—with our internal communications efforts growing in tandem with a collective comfort level in the new just culture tenets being increasingly embraced.

There were many excellent sessions at HPI’s Safety Summit. Of particular note was the keynote given by nationally recognized patient advocate, DePaul University Professor, Mom, MBA and former McKinsey consultant, Beth Daley Ullem. Beth emphasized the need for healthcare consumers to have access to data and information about the healthcare procedures they are purchasing. “We spend more time evaluating the purchase of mutual funds,” she said, “than heart surgeries.” Having lost a child to preventable medical harm directly related to the culture of medicine, Beth and her approach to this work, provided yet another inspirational reminder that we need a greater sense of urgency around the change we were all in Cincinnati to support.

The Children’s Hospital of Philadelphia shared their Good Catch program in a session. Cancer Treatment Center’s of America shared their HRO internal communication campaign and Safety Superheroes. Piedmont Healthcare shared how they are trying to communicate taking transparency to the next level. All expressed how important it is to find ways to communicate HPIs high reliability teachings and culture change across the health system. Being at the Summit was spending time with those already drinking the Kool-Aid of culture change. With all the social media and content development tools available to us, we now need to figure out how to take this excellent work along with the messages of just culture, transparency and open, honest communication in healthcare viral–

For more information on HPI and the Safety Summit, go to: www.hpiresults.com


Telluride Alumni and Faculty Continue to Leave Their Mark on Healthcare

As the Telluride Patient Safety Summer Camps prepare to expand in 2015, adding a third session for health science students to be held in Napa, CA (and fifth summer camp week overall when we include the two weeks for resident physicians) , our alumni continue to leave a lasting mark on healthcare. Most recently, Jennifer Loeb MD, former Telluride alum and now an internal medicine resident at the University of Illinois Hospital, published her thoughts in Hospital Impact, on how the need to provide patient-centric care drives her work at the bedside. She writes:

For me, safe patient care is more than adherence to checklists and standard operating protocols. It is a consequence of an approach to treating patients that’s characterized by applying medical evidence in a patient-centric way, by ensuring that compassion enters into care decisions and by listening with purpose to a patient’s articulated needs and, often helping them identify what those needs may be. I look forward to becoming a caregiver who can bring those attributes to my patient interactions…To say that I have evolved over many years to this point may be true, but it took a personal family challenge for me to truly appreciate all that it takes to achieve safe care. It’s not easy, it’s not one thing, it’s not just being careful or diligent — rather, it’s the way we deliver care, it’s how we see our role as part of a healing process, it’s how we put “care” into the word”caregiver.”…click here to read entire article

WineWisdom_Paul_Lauren_Shelly_Resident physicians from MedStar Health and medical students from Georgetown University SOM each held gatherings of their own local Quality and Patient Safety Councils inspired by leaders who spent time in Telluride as well. The MedStar Resident QIPS Council, co-founded by alumni Shabnam Hafiz, MD, and Stephanie Wappel, MD, has grown to over 40 members and is focused on inspiring the change needed to make care safer and of the highest quality. The QIPS Council sponsored its first educational event in September at The French Embassy in Washington DC, led by QIPS Council member (and also a Telluride alumni) Lauren Lobaugh, MD, QIPS Education Committee Chair. The event, entitled “Wine and Wisdom,” was standing room only, and the guest speaker was nationally recognized safety expert (and Telluride faculty–there’s a theme here…), Paul Levy, who spoke about “the art of persuasion”.  Guests from all over the region (Univ. of Maryland, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Johns Hopkins, INOVA, Walter Reed, and more) were invited to join the Council for a cocktail hour, lecture, and small group discussions about where we are today, and where we see our healthcare communities going in the future. The event also piqued the interest of local news outlets, and a story ran in the Washington Business Journal in September. Lobaugh was quoted in the article as below, and the rest of the story can be found here:

Making a mistake that harms a patient can be shattering for a doctor, said organizer Dr. Lauren Lobaugh, a fourth-year resident in MedStar Georgetown Hospital’s anesthesiology department. Over the summer, she headed to a patient safety boot camp held in Telluride, Colorado, and said she was impacted by the idea of “caring for the caregiver” instead of “shaming and blaming” them when an error is made.

And finally, Engagingpatients.org recently asked us to comment on their blog about how our patient advocates contribute to the Telluride Experience. Our patient advocates, and their stories, are such an integral piece of the Telluride Experience, it is hard to imagine the workshops without the depth of their contributions. From the post:

The Power of Storytelling
The power of stories is called upon regularly during the Telluride Experience.  Patient and healthcare advocates continue to return as Telluride faculty to share their stories—stories that leave a lasting imprint on the hearts and minds of the alumni and faculty audience…The films are a foundational piece of the TPSSC curriculum, and in each session, they stimulate emotional conversations around what was missed, how to avoid future similar harm, and the hidden curriculum of medicine…

The Human Side of Medicine
When Helen or the Skolniks lead the group conversation after the film, an additional element is added to the learning. Young medical students who have yet to even see this side of medicine are exposed in vivo to the impact their future decisions will have on the kind, loving people before them. The patient becomes more than a procedure, and the audience realizes first-hand just how human both patients and healthcare professionals are. Time and time again, we have seen how these stories change people in the moment…
For more, go to EngagingPatients.org

Applications for the 2015 Telluride Patient Safety Summer Camps will soon be announced open. Thanks once again to the generous and continued support of our sponsors–The Doctors Company Foundation, COPIC, and CIR–our patient safety army continues to gain reinforcements in hospitals and in medical/nursing schools across the country with now over 400 alumni scholars making patient safety contagious. For more information, go to www.telluridesummercamp.com.


Calling for Responsible Healthcare Journalism

IMG_20140729_162034As the Ebola virus lands closer to home, it has been disappointing to watch the hype, inaccuracies and blame circulating in various media on what continues as a yet-to-be controlled humanitarian and health crisis in West Africa. Those who have been aware of this evolving issue, such as many well-trained, conscientious infection prevention professionals around the country, know this disease has been threatening the West African countries of Liberia, Sierra Leone and Guinea with increasing magnitude since March of this year, taking the lives of far too many West Africans over the last 7+ months. As a result, Ebola abroad, and now for the first time in the US, is also a very dynamic situation, like much in healthcare. As such, responsible healthcare journalists, weekend warrior bloggers or persons with a Twitter account might want to take into account that as more is learned, protocols and best practices will, as expected, evolve.

An excellent Infectious Disease (ID) blog sharing good information about Ebola is Controversies in Hospital Infection Prevention, hosted by three ID physicians from the University of Iowa: Mike Edmond MD,  MPH, MPA, Chief Quality Officer, Eli Perencevich MD, and Dan Diekema MD, Director, Infectious Disease. In July, Edmond (@Mike_Edmond) posted, Ebola Hemorrhagic Fever: A Primer, which contains foundational information about the virus, much of which is based on CDC Ebola interim guidances, that are also evolving. And to put Ebola in a more realistic perspective and take away some of its horror film power, it is a very slow-moving infectious disease per Eli Perencevich MD (@eliowa), who writes in an October 9th post, Traveling with Ebola is not traveling with influenza:

The…most important difference between the current Ebola outbreak and the 2009 H1N1 pandemic is that Ebola is very slow-moving….the first case of Ebola is thought to have occurred 307 days ago on December 6th in a two-year old boy. Since that time there have been an estimated 8,032 cases …If you compare a similar 307-day period for 2009 H1N1, April 12, 2009 to February 12, 2010 CDC estimated between 42 million and 86 million cases occurred in the US with a mid-level estimate of 59 million people infected…7300 times more cases of H1N1 using the mid-level estimate

Fast Company staff writer, Rebecca Greenfield (@rzgreenfield), in Ebola Deeply is the Only Place You Should Be Getting Ebola News, directs those in search of Ebola related content without the hype, turn to the single source news website, Ebola Deeply, started by Lara Setrakian (@Lara) a former ABC News and Bloomberg reporter. After clicking onto the site, readers are immediately drawn to the NYTimes video story by video journalist, Ben C Solomon, also embedded below. The story shows what life is like on the streets of Monrovia for Gordon, a Liberian Ebola ambulance driver, separated from his family as a safety precaution for over five months. What he describes sounds like going to war against an invisible opponent, with limited armor and safe harbors. Certainly in a resource rich country like ours, we should be able to handle what courageous true front line Ebola warriors are fighting with much less.

While healthy critique of those charged to create solutions in the US provides a good check and balance, it’s disappointing to watch the finger pointing that rears up in such a well-resourced, educated country, especially as those in West Africa have far less time to discuss and instead are using that energy to improvise and stay alive while caring for their thousands of ill patients vs our limited number of cases to date. In fact, more people died in the last week due to all medical harm in the US than to an outlier of an infectious disease like Ebola. To add even greater perspective, a recent New York Times article by Elisabeth Rosenthal MD, For Ebola Health Workers Risks and Duty Collide, closes with the following:

…Meanwhile, Dr. Cooke said she has tremendous admiration for the doctors in West Africa: “It’s been inspiring to hear African health care workers saying ‘I’m a doctor, these are my people. There’s no choice.’ It’s a fundamental reminder of what it means to be an M.D.”

And with the arrival and death of an infected patient to a Dallas hospital, and the subsequent infection of two nurses who treated him, many of the existing cracks in our healthcare system are being exposed by the media on the larger stage that is now practicing medicine. In an interview on the Today Show last Thursday, a nurse working at the hospital spoke with Matt Lauer, sharing the need to come forward knowing full well she might lose her job. Not knowing the full story, the fact that this could happen comes as no surprise to those working in healthcare. However, it is important to note we still have one of, if not the, very best systems in the world–cracks and all. A safe healthcare system has a just culture, and when a nurse “voices concern” about his/her own safety, as well as that of patients and colleagues, he/she is heard, even thanked, by those who can fix and address those concerns. Many healthcare organizations across the US are creating environments that welcome this voice, yet others are still far from adopting this culture. While not at all familiar with the culture at this particular hospital, nor the institution’s side of the story, it appears from the Today Show interview this nurse voiced concerns that initially went unaddressed. To this end, we see how failure to embrace elements of a just culture could affect patient and provider safety in real-time. This could be an unfortunate example of a long existing need for greater urgency around culture change in healthcare.

And despite the “he said, she said” or “they should of…” thinking, there are many looking for solutions to stop the outbreak in Africa. In a recent @FastCoExist article, Can Better Design Stop Ebola? How Creative Minds Can Help, Jessica Leber writes:

…On just one day’s notice, almost 200 people crowded an auditorium at Columbia University’s engineering school on a Thursday evening in early October. Engineers, designers, and public health researchers were there to learn and brainstorm, and do so quickly…Columbia isn’t the only institution interested in applying design thinking to the health and humanitarian disaster. On October 9, USAID, partnered with the innovation platform OpenIDEO, the CDC, the Department of Defense and the White House, announced its sixth in a series of “grand challenges for development” focused on crowdsourcing ideas for better tools to fight the virus. Anyone can contribute to the brainstorm, and the government hopes to begin funding the strongest ideas in a more formal challenge competition “in a matter of weeks.”…

Getting to the other side of this real-time test of our infection prevention and containment abilities at home, the hope is that we will rise to the challenge and become that much stronger as a national healthcare system for having gone through the experience. As Edmond writes in a Controversies in Hospital Infection Prevention post on October 14th, Ebola: The Questions Keep Coming:

…the Ebola crisis is challenging us in many ways and will likely continue to do so for quite some time. But perhaps we’ll emerge from this with a more thoughtful approach to patient care that improves safety without sacrificing quality.


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. Daliha 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!


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