Let the Record Reflect I No Longer Practice
Posted: June 19, 2013 Filed under: Education Technology, Just Culture, Leadership, Medical Education, Patient Centered Care | Tags: Medical-Legal Liability, Nursing, Sarah Easterling, Telluride Patient Safety Educational Roundtable 1 Comment »By Guest Author, Sarah Easterling, Telluride Patient Safety Roundtable Health Science Attendee, 2013
-Previously posted on Transparent Health
As it was, I didn’t feel great about my time as a defense attorney. I enjoyed being a lawyer in the most utopian sense of the word: I enjoyed being an advocate and an adviser to healthcare professionals. I didn’t enjoy hanging a plaintiff’s dirty laundry out to dry. I didn’t enjoy burying someone in motions to buy time or meet my billables. I didn’t enjoy working at a law firm.
I got out of litigating because my work didn’t mean anything. By the time I was involved, something had already gone grievously wrong, and someone was angry (and injured) enough to bring suit. I worked the case to a resolution, but that didn’t mean anything either. I billed the bejesus out of it, distributed the insurance money accordingly, and went about my day. I always wanted to go back to the hospital or the provider and say, “Let’s make sure this never happens again!” But, it wasn’t my place. Three years ago, I was fortunate to be in touch with Dr. McDonald who advised that if I wanted to make a difference in a risk management/patient safety capacity, I should go to nursing school.
And now, here I am. One week away from my NCLEX, and two weeks from working in the risk management department I’ve admired for years. After my first day, I was excited to be here, despite feeling winded after three flights of stairs. After yesterday, I couldn’t be more ready to start working next month. I still maintain that at some level, I helped healthcare providers at a time of personal crisis. But now I also see what I might have unintentionally done to families, and I wholeheartedly apologize for that.
The Telluride Patient Safety Educational Roundtable (#TPSER9) is giving me a new perspective. Patients and physicians are no longer plaintiffs and defendants. I work as an advocate and adviser to both: By working directly within healthcare (and not as outside counsel), I will educate providers on why transparency is crucial, support providers when they are hesitant about disclosing, and maintain open lines of communication with patients.
Ia Ora Te Natura E Mea Arofa Teie Ao Nei
Posted: June 16, 2013 Filed under: Healthcare Innovation, Just Culture, Leadership, Medical Education | Tags: Jimmy Buffet, Medical Education, Telluride Resident Summer Camp 1 Comment »
“And there’s that one particular harbor
Sheltered from the wind
Where the children play on the shore each day
And all are safe within.
I know I don’t get there often enough
But God knows I surely try
It’s a magic kind of medicine
That no doctor could prescribe”
For those who have followed our Educate the Young blog through the past year, you know I am a big Parrot Head…yes, a long-time Jimmy Buffett fan. Fellow Parrot Heads will quickly recognize that the title of this post and the lyrics above are from the Buffett song titled “One Particular Harbor”.
The song always comes to mind when I arrive in Telluride each year for our annual Patient Safety Roundtable and Summer Camps. Telluride is my personal “One Particular Harbor”…”I don’t get here often enough but it is a magic kind of medicine that no doctor could prescribe.” All who join us each summer leave inspired and invigorated – they discover this “magic kind of medicine”.
The one hundred resident physicians and health science students who won scholarships to attend one of our Patient Safety Summer Camps this summer are the children. They bring a passion and energy that is contagious to others. The residents and students come to learn, to test, to validate, to network, and to play. They work side-by-side with patient advocates, those who have lost loved ones due to medical error but have passionately dedicated their lives to making care safer for others. Like the lyrics of the song, the residents and students discover they “all are safe within”…sharing their own personal stories in a safe haven – a haven that is not always safe back at their home institutions. If you have been reading their reflections this past week posted on this blog, it is easy to recognize that they discover they are not alone and quickly connect with others who have similar passions – safe, high quality patient care. You can feel their passion and commitment to things like outcomes, best practice, standard work, open and honest communication, and most importantly patient-partnership. They are asking important safety and quality questions…questions many from my generation including myself never asked.
Be it the great quality and safety educational work being led by the AAMC, the ACGME and many other academic organizations and institutions across the country, change is happening. It is happening with our new caregivers. Many resident physicians across the country (including numerous past Telluride Scholar alums) are now leading safety and quality projects at their hospitals. Each year, the residents that come to Telluride seem to start the week where last year’s group left off. You can feel the change…it is palpable and it must continue. Kim Oates, an international leader in patient safety education from New South Wales, travels from Australia each summer to join us to Telluride. He flies over 8200 miles in the hope he can make a difference in a young caregiver’s career. Kim is one of a handful of physicians who can say Don Berwick was his resident when both were at Boston Children’s many years ago. Despite significant jet lag that stayed with him for most of the week, he shared that if the residents and students who attend Telluride each year are a true reflection of the next generation of healthcare leaders, we are in good shape (See TH post-I have looked into the future and it looks good). I fully agree – while we are not at the tipping point quite yet, the future is bright. We can’t lose sight of “Educating the Young”.
Amazing first week of work in this “One Particular Harbor” called Telluride.
*By the way, Ia Ora Te Natura E Mea Arofa Teie Ao Nei means: Nature lives, Have pity for the Earth, (Love the Earth).
Resident Reflections from Telluride 2013 #TPSER9
Posted: June 14, 2013 Filed under: Healthcare Innovation, Just Culture, Leadership, Medical Education, Patient Centered Care, Patient Safety | Tags: Resident Physicians, Resident reflections, Shared Decision-Making Leave a comment »
Having just returned from Telluride, I can share that the future of medicine looks extremely bright. Twenty-eight residents, all extremely passionate about patient safety, patient-centered care, shared decision-making and righting the wrongs they see in healthcare, have all promised to tell 10 colleagues about the empowering cultural messages shared in Telluride. They will then ask those 10 colleagues to share the lessons learned with 10 more, and so on…
As Telluride organizers Dave Mayer and Tim McDonald say, they will pay it forward.
Following are just a few of those messages in excerpts from resident reflections on the Transparent Health blog. All post can be found here.
From Dr. Kerrie Bossard — The opportunity that I see after completing this exercise is that although we can all make small incremental changes in our respective practices, how can we reshape the practice of medicine to make our small individual changes part of a bigger and more permanent cultural change? If all 28 of the scholars would communicate with 10 colleagues about the importance of shared decision-making and informed consent we could make a small change. But if we made our goals for next week bigger and decided to change the entire process for all residents for generations to come, we may succeed in making lasting change and forever changing the practice of medicine related to these issues…(continued here)
From Dr. Shabnam Hafiz — What an incredible week! I have been so fortunate to be surrounded by such a brilliant group of people leading change all over the country. You have all inspired me and energized me to go back and promote the mission that we have all set out for ourselves- create a system that is patient first… (continued here)
From Dr. Michelle Espinoza – …today’s experience was life changing…To be here in Telluride is truly a blessing, and to be surrounded by such knowledge, talent, wisdom and passion is AMAZING…Today I learned that I am not alone in thinking our hospitals are one of the most dangerous places for patients. That my internal conflict regarding my concerns for residency training is not isolated to my hospital, and that there are people who not only believe this is wrong, but have dedicated their lives to making a change…(continued here)
From Dr. Lauren Sontag — Shabs recent post, How Can We Teach, regarding her QI project standardizing an appropriate informed consent discussion. She says several times that we need to put “patients first.” It warms me from within to hear this; I was already going to put up a little post about that very idea. I had the great fortune to go to medical school at the Mayo Clinic in Minnesota, and the most important thing I learned there was this philosophy: the needs of the patient come first. When we believe this and act upon it, we have the courage to address problem behaviors among our peers (and even our attendings and consultants!). We find the moment to sit down instead of hovering near the exam room door and we don’t accept the status quo. Consider it as a mantra for yourself and something you teach others!
From Dr. Stephanie Wappel – …It is so easy to become jaded in medicine, especially as a resident, and this is exactly what I needed at this point in my life to reinforce why I went into medicine in the first place: for the patient. I’m making a personal commitment to myself and to everyone here at TSRC that I am taking this home and will implement more patient safety measures and quality improvement at my home program…I am going to start with resident education because I feel like this is the greatest need at present. We can each make a difference as long as we keep our eye on the common goal which is the health and safety of the patient…(continued here)
Changing Behavior Through Patient Stories in Telluride
Posted: June 12, 2013 Filed under: Healthcare Innovation, Just Culture, Medical Education, Patient Advocacy, Patient Centered Care, Storytelling | Tags: Helen Haskell, Patty Skolnik, Storytelling, Telluride Resident Summer Camp, The Lewis Blackman Story, The Michael Skolnik Story 1 Comment »
Each new session in Telluride, Dave Mayer and Tim McDonald share the Tears to Transparency educational documentary films — stories of harm that befell Michael Skolnik and Lewis Blackman–both promising young men–and the impact that harm had on their two families. As a result, Patty Skolnik and Helen Haskell (Lewis’ Mom) have dedicated their lives to changing healthcare for the better, and have become nationally recognized patient advocates. Through their new careers, both Moms have recognized the need to both “educate (and empower) the young”. Medical students and residents who attend Telluride often have the opportunity to talk with both parents after each film in an open Q & A. Many students express this being a first exposure to the dysfunctional side of medicine. On the flip side, many also express having witnessed similar poor behavior by those in a leadership position.
Through the generosity of both Michael and Lewis’ families, and the sharing of their stories, Telluride attendees are able to practice the difficult discussions focused on in the films in a place where open and honest communication is not only encouraged, but modeled and set as the baseline. This also re-emphasizes the power of story to change behavior, and as a result, culture. Hopefully this sets a “new normal” for all Telluride alumni — one that they can take back to workplaces and educational systems where bullying or a lack of respect prevails and infuse new ideas. Or to carry home these stories, and the power of the resulting discussions, to further embolden environments where a just culture is the norm.
A trailer to the film, The Story of Michael Skolnik, played yesterday morning for our resident scholars is included above. The value of the conversations that follow these films each year are unmatched. The resident reflections on the Transparent Health blog today (found here) share some of the takeaways both The Lewis Blackman Story and Michael’s story have inspired this year. The theme from Michael’s story is “Can a conversation change an outcome? Can a conversation save a life?” Based on what is going on in Telluride this week, I am happy to report back that the answers to both questions is a resounding YES! Authentically sharing your stories and experiences allows others to do the same thing. I’ve watched this yet again take hold in Telluride. Let’s take this idea viral along with the courage to do the right thing for patients, no matter how difficult, every time.
Follow Telluride 2013 Resident Summer Camp Reflections at Transparent Health Blog
Posted: June 11, 2013 Filed under: Healthcare Innovation, Leadership, Medical Education, Patient Advocacy, Patient Safety, Storytelling | Tags: Communication, Not Running A Hospital, Patient Centered Care, Paul Levy, Resident reflections, Shared decision-ma, Telluride Patient Safety Educational Roundtable, Transparent Health 2 Comments »
Please join us in Telluride this week!
We are well into day two with our resident scholars in Telluride, where the topic for 2013 is Change Agents: Teaching Caregivers Effective Communication Skills to Overcome Patient Safety Barriers in Healthcare.
This amazing group is engaging in some truly moving conversations around patient centered care, shared decision-making, personal experiences with near misses and the dangers that exist within medical education. Their bravery, knowledge and commitment to their patient is so very evident — it is inspiring, and gives hope of a very bright future for healthcare.
We will be posting summaries of the days events for the next two weeks here on ETY, but please also join us this week at our Transparent Health blog, (found here). Today’s post on the TH blog shares a number of resident reflections and can be linked to here.
Paul Levy, Not Running A Hospital, has joined us in Telluride to teach negotiation skills to our resident physicians and is also blogging about the experience. You can find his reflections here.
What Doctors Feel
Posted: June 10, 2013 Filed under: Healthcare Innovation, Just Culture, Leadership, Medical Education, Storytelling | Tags: Bullying, Culture of Respect, Danielle Ofri, David Mayer, Just culture, Lucian Leape, Telluride Patient Safety Educational Roundtable Leave a comment »
I came across a post last week on Slate, The Darkest Year of Medical School, revisiting the idea that medical students lose not only empathy during their medical education, but according to author and NYU physician, Danielle Ofri, “altruism…generosity of spirit, love of learning, high ethical standards—are eroded by the end of medical training.” On June 4th, Ofri also published What Doctors Feel: How Emotions Affect the Practice of Medicine, having performed numerous interviews to draw her conclusions. I read some of the comments on her blog post above–many sharing “medical school was great”. Yet research–past and present– shows many students are not having that experience.
Ofri’s post and newest publication caught my eye as we embark upon the 9th year of the Telluride Patient Safety Educational Roundtable and Resident/Student Summer Camps. This will be my third year in Telluride. The first year I attended, I had the privilege to share a breakout discussion with Lucian Leape and a group of students in the shadows of the San Juan mountains. Throughout that week, Lucian emphasized the need to get a handle on the bullying that occurs in medicine, and instead, instill a greater respect for all in the medical workplace. He shared that unless we are able to do this — treat one another with respect — patients would pay the price, as well as healthcare providers and students.
Having not yet read Ofri’s book, I wonder if medical students who report enjoying medical school overall, were safely ensconced within a workplace with the culture of respect that Dr. Leape refers to as being so very important to patient well-being. It is safe to assume just how empowering a culture of respect would be for students, making them feel competent, part of a team and confident in their newly acquired skills. It’s also safe to assume how students who were bullied might feel (see Bullying in Medicine: Just Say No).
For more information on a culture of respect, and how to create one, see Lucian’s papers:
Telluride Alumnus Shares QI Project Inspired by Conversations at Resident Summer Camp 2012
Posted: June 6, 2013 Filed under: Healthcare Innovation, Leadership, Medical Education | Tags: CIR, David Mayer MD, Nate DeFelice, University of New Mexico Hospital Leave a comment »On the closely approaching eve of the 2013 Telluride Patient Safety Educational Roundtable & Student/Resident Summer Camps (#TPSER9), Nate DeFelice MD, a 2012 alumnus, sent us the following report of a project that was inspired by his time at the Resident Summer Camp last year. Stay tuned for more great stories and learning from this year’s Summer Camps kicking off Sunday night, June 9th.
By Nate DeFelice, MD, Department of Internal Medicine, University of New Mexico Hospital
At the University of New Mexico Hospital, a group of residents across departments created and published a journal featuring resident-led QI projects called, University of New Mexico Journal of Quality Improvement in Healthcare (check it out!). As far as we know, it is the first of its kind in the country, and the 2nd edition was released at the beginning of the month with great excitement.
The journal includes resident-initiated projects, both completed and in-progress, covering a range of topics from readmissions to handovers to medication safety. It is an impressive showcase of the many ways residents have used their energy and time to make the UNMH healthcare system more patient-centered, efficient and safe. This journal has not only increased the level of excitement around QI projects for residents, but we are hopeful that the sharing of ideas will springboard even more innovative work in our departments. The support and commitment to this journal has been inspiring to watch — it’s hard to believe this is only its second year.
On a personal note, this editions includes a project by myself and another internal medicine colleague, first conceived during my time at the Telluride Patient Safety conference last year. During this conference, several residents from other programs across the country, along with director David Mayer MD, discussed the great work they were doing on increasing resident reporting of adverse events and near misses. We decided to give it a try at UNMH, and began an internal medicine resident near miss/adverse event reporting system. The data is still rolling in, but we are hopeful that reporting of near misses has increased, and our patients are safer as a result of our efforts.
The journal was made possible because of a strong collaboration between our resident union, CIR; GME; and UNM Health Sciences Center. Funding for the journal was made possible through funds we negotiated in our last contract that are set aside to assist residents in carrying out QI projects. We imagine after such a strong showing of support it will continue to grow stronger, and the journal will continue to improve while at the same time, making our hospital safer.
For more information on the Telluride Patient Safety Educational Roundtable and Student/Resident Summer Camps, see the following video!
