Hero – a remarkably brave person; somebody who commits an act of remarkable bravery or who has shown an admirable quality such as great courage or strength of character especially under difficult circumstances; somebody admired.
Carole Hemmelgarn is a hero.
In the video that follows, Carole poignantly shares her daughter Alyssa’s story, and why their family’s loss has been the driving force behind the change Carole is fighting for – the delivery of safer care for all patients and families. Every person lost to preventable medical harm is a tremendous loss. Carole, and other courageous heroes like her, including Patty & David Skolnik, Helen Haskell, Victoria & Armando Nahum and Sorrel King give their time, their heart and their stories so we never forget these unfortunate events are not just statistics.
They are my heroes.
About once a week I receive an email from one of our Telluride Scholar Alums. These young care providers are eager to share new quality improvement projects or risk reduction programs they are leading, or provide an update on work started shortly after finishing their Patient Safety Summer Camp week with us. This week was no exception. Dora Zamora-Flores, MSN, RN, CPNP and Pediatric Nurse Practitioner, who attended Telluride East in Washington DC last summer, emailed to share how the knowledge gained at our Summer Camp is translating to real healthcare care change at the bedside of a small community hospital in South Texas.
Each year, thanks to the generous support of The Doctors Company Foundation, COPIC, CIR and MedStar Health, the number of applicants for a seat at one of four, week-long sessions continues to grow, as does the level of talent. We are always thrilled to see how these creative young healthcare providers take the learning from the heart of the Rocky Mountains (and now Washington DC) straight to the heart of patients. Here is Dora’s story…
I attended Telluride East this summer and want to give you an update on how I have used the knowledge gained. A small community hospital in deep South Texas is opening a brand new Women’s Services department next week. They currently do not deliver babies. I asked the CNO if she would allow me 1 hour to speak to all of the nurses- nursery, L&D and post-partum. I shared Diane Ford’s story, the NICU heparin incidents, findings from “To Err is Human”, a brief intro to Human Factor’s Engineering and the importance of teams, communication and reporting near misses. I ended with the Lewis Blackman video which you were kind enough to send me.
The response and the questions were tremendous. There were some tears in the room. It went much better than I expected. I encouraged them to take advantage of this unique opportunity to set the tone from day 1 of this unit for a culture of safety. A CRNA in the room, Tim Sparks was very interested in my experience in DC and he contributed to my presentation by sharing some of the mishaps he has witnessed during his years as a CRNA. I have given him your contact info. He oversees over 50 CRNAs and is interested in putting together a Safety Training for them. Thank you again for allowing me to be part of Telluride East. I continue to have many rewarding experiences due to the knowledge I gained there. -Dora
With the winter many of us have experienced this year, it is emails like Dora’s, along with the promise of June sunshine over the Sangre de Cristo mountain range in Telluride, that have me looking forward with great anticipation to meeting our 2014 Telluride Scholars when we gather this summer. For information on how to apply to attend one of the 2014 Telluride Patient Safety Summer Camps, you can go to our website at www.telluridesummercamp.com
Healthcare today is a wide open canvas, and technology continues to open doors for entrepreneurs, the tech-savvy young and old from any industry, and those whose immediate need for a solution is far greater than any competing agenda. Steve Gleason, ex-New Orleans Saints football player hit with the same life-altering illness named after the great Lou Gehrig (amyotrophic lateral sclerosis, or ALS), is getting on with the business of living thanks to a spirit that refuses to quit, a social support network without limits (they carried him to the top of Machu Picchu) and companies like Microsoft. A reminder that the sky really is the limit when the heart and mind remain open.
Following is a Guest Post by Telluride Scholar and Alumni, Matthew Starr, MSIII, Saint Louis University School of Medicine.
Better imaging starts with better decisions. The goal of the 100K Children campaign is 100,000 good decisions when imaging children by June 30, 2015–
The 100K Children Initiative began with a summit series convened by the American Board of Radiology Foundation. The goal of the meetings was to develop a national strategy for safe, appropriate and patient-centered imaging. The meetings brought together a broad group of stakeholders, including patient advocates, medical professionals, and oversight agencies. I had the opportunity to attend two of the three summit meetings. Out of these meetings came several goals and objectives for optimizing medical imaging, a few of which are being addressed by this campaign.
My role in this campaign began with developing a series of process maps for the summit series. The maps highlighted the many pathways patients could take through routine healthcare scenarios. It became quickly apparent that a patient might receive unnecessary imaging studies because of the variations along the process pathways. As the campaign progressed, my role became focused on promoting our program to medical students, building a grass-roots effort to expand the reach of the campaign.
One of the things I found very interesting during my time in Telluride, were the discussion around how the IHI used medical students to promote the surgical checklist. The movement spread nationally mainly using the work of medical students. Then as a group in Telluride, we were able to develop a project of our own that focused on improving hand-washing practices at our various home hospitals. I was able to use these discussions in Telluride as inspiration as I try to promote the optimization of medical imaging in children to healthcare workers across the country. My biggest message for students is that now is our time to take responsibility for the safety of patients. This movement is a way to get involved at your own hospital and community by informing both physicians and parents about the importance of appropriate medical imaging in children.
In summary, the 100K Children Initiative asks sites to report how often they make good imaging decisions for children. In essence, we are celebrating the small wins that frontline teams achieve every day. The structure comes from Chuck Denham/Steve Swensen’s 5 Rights of Imaging. Focus will be the front end (Right study, Right order, Right way).
|Measure||Primary Target||Secondary Targets||Simple Tally*|
|1. Right study:Observation instead of head CTs for children with minor head trauma||ER Physicians||Pediatricians, family practice physicians, and families||ER nurses provide a count of the number of patients who don’t get a head CT but rather are given instructions for signs to watch for after head trauma|
|2. Right order:Single phase CT studies (head and chest)||Radiologists||Referring physicians (ER, pediatricians, family practice) and families||Techs count number of single phase head and chest CT exams that they perform|
|3. Right way:How often was a child sized CT protocol used||Technologists||Radiologists, referring physicians, and families||Techs count number of times they use a pediatric protocol|
|*Simple tally offers quick data turnaround and is based on the honor system. Can use administrative data to verify each site’s progress with measures 1 and 2. Can use dose reports to monitor each site’s progress with measure #3.|
- An easy sell for the pediatric specialty centers since they are already following these recommendations. They will become the key nodes in the local networks that prompt community hospitals to follow suit. Children’s Hospital Association will likely be a key partner.
- Each site identifies staff in ER and radiology who will be responsible for collecting data on a weekly basis and submitting it. How they collect the data is up to them. We will learn as we go.
- Each week, sites submit their weekly count in each category. Data is due each week by Monday afternoon. Results are reviewed on a Tuesday morning conference call.
The success of our Telluride Roundtables and Summer Camps over the last ten years can be credited, in large part, to the generous time and participation of our faculty made up of patient safety leaders from around the world. The students and residents chosen to participate through the Telluride Scholars Program have been the beneficiaries of the knowledge and experience these great leaders and teachers all are so willing to share each year. Rosemary Gibson, Rick Boothman, Cliff Hughes, Kim Oates, Peter Angood, Kevin Weiss, Bob Galbraith, David Longnecker, Helen Haskell…the list goes on and on.
In the summer of 2011, students had the great fortune of working with Lucian Leape, who joined the faculty of our Telluride Patient Safety Summer Camp. It was an honor to have him with us, and something our alumni–young and old–will always remember. Lucian’s focus that week was managing disruptive behavior and returning joy and meaning to the healthcare profession. The photo included captures him in action doing what he does best–educating the young. As we begin a new calendar year still struggling with many of the issues Lucian called to light in his 1999 seminal work, I believe his teachings on Joy and Meaning in the workplace are more important today than ever before, and that those strategies will play an even greater role in preventing harm to our patients.
Caregivers at the frontlines consistently put considerable energy into achieving the highest quality, safest care possible for their patients in the face of considerable economic pressure and evolving healthcare models. We expect so much from our caregivers, and they far too often extend themselves beyond what is healthy–physically, emotionally and mentally–to meet the growing demands of the new healthcare. Lucian’s work on joy and meaning in the workplace is based on Alcoa leader Paul O’Neill’s premise that every employee should be:
As healthcare leaders, we need to clear a safe path for all frontline associates to be respected, supported and appreciated. At the same time, we also need to eliminate the disruptive behaviors that have plagued healthcare for far too long. This year, a driving focus should be on ensuring those well intended healthcare professional are elevated, their humanness not only accepted but also protected through just culture approaches and human factor partnerships that mitigate and finally eliminate the potential for patient and employee harm while embracing a workplace built upon the high reliability foundations of a true learning culture.
As Lucian continues to remind us, it is our dedicated caregivers working at the bedside that need to feel safe — to know that their effort is appreciated and celebrated, that they have our support, and are respected for the work they do.
Humanism in Medicine Essay Contest Winner David Duong On Fear, Trust & the Love That is Patient-Centered CarePosted: November 25, 2013
A recent post on the AAMC blog AM Rounds, 2013 Humanism in Medicine Essay Contest: Caregiving As Good Doctoring, shares a recorded version of David Duong’s essay of the same name. Duong, a third year student at Harvard Medical School, earned 2nd place in the Arnold P. Gold Foundation sponsored contest by responding to the call for essays reflecting on “…the barriers to humanism in medicine today…and…who the ‘good’ doctors are.”
In his essay, Caregiving as Good Doctoring, Duong describes the fortuitous experience of serving as translator by default being the only Vietnamese speaker available to a family in need of assistance at his training hospital. The patient, Mr. N, was flanked by eight family members all earnestly trying to understand options around end-of-life care for their father succumbing to Stage IV colorectal cancer. It was Duong’s job to gently translate details given by the attending physician, and as he describes, guide the family through this emotional time.
As Duong retells the story of his time with Mr. N’s family, it is apparent he has learned firsthand the personal and professional ‘benefits’ that result from more intimately participating in the healthcare journey of patients. Following are excerpts, but the full essay is one worth reading in its entirety, as well as shared with caregivers young and old throughout the health sciences. Research may exist that supports empathy to be lost by the third year of medical school, but Duong’s words that follow speak to an awareness and empathy of someone firmly grounded in what it means to “walk with you and yours through this (healthcare) journey”. Enjoy!
…In this intimate role as a caregiver, I am reminded of a phrase in Vietnamese that people offer each other at grave moments, when life seems beyond our control, when long-fought battles are lost, or when death takes its final grip: “chia buồn” or “share in the sorrow.” The phrase means that we share in the emotions, the experiences, the bullets that life fires at each of us. The phrase, gently intoned, is intended to ease the burden, to say, “I am here and will walk with you and yours through this journey”…
…What an honor, a privilege, and at times a burden, it is to undertake a profession that constantly invites us to engage and intersect with humanity at its most fragile moments. Therefore, it is our privilege and responsibility as good doctors and medical caregivers—along with our colleagues in social work, chaplaincy, and nursing, among many others—to strive to deliver the best care to our patients. In Dr. Francis Peabody’s statement to the 1925 graduating Harvard Medical School Class, he averred that “the secret of care for the patient is in caring for the patient,” which resonates with our 21st-century mainstream society rhetoric of the “patient-centered” approach. It is not surprising, then, that the highest ideals in medicine have remained constant…
..Throughout my third year of medical school, I have realized that there is no medicine to alleviate fear—the fear of illness, the fear of your body in someone else’s hands, or the fear of dying. But I have also learned that by caring for the patient, by placing the patient at the center of our medical practice, we can establish a trust relationship that just might lessen that fear. By doing so, we humanize our practice, share in the life of our patients and, in return, grow more deeply human…
Anna Quindlen is someone I have long admired. An aspiring journalism undergrad student, I read Living Out Loud almost twenty years ago, and was inspired by her need to share ‘the story’, as well as her ability to make a successful career out of doing so. Now, a well-known and respected Pulitzer Prize winning journalist and repeat best-selling author, Quindlen recently shared her wisdom and words with healthcare leaders–young and old–at the annual AAMC meeting in Philadelphia. It comes as no surprise that the accolades and tears shared in the Storify snapshot of tweets from her talk show organizers made an excellent choice by inviting her to speak. (Click image to go to Storify page if interested).
For those who missed her talk, Quindlen has given permission to the Arnold P. Gold Foundation to make the full text of her speech available until December 3rd, and it can be found here. Having read the transcript, I wanted to share some of the highlights in the event the tyranny of the daily takes priority and prevents the well-meaning click-through before 12/3.
Per her transcript, Quindlen shared the following:
- The story of a repeat surgery she recently underwent, along with the differences in the care she received from her anesthesiologists. Do you know who I am? is the takeaway for providers listening in, as the care team who understood her needs, values, preferences and goals knew who she was–someone who did not want a general anesthetic–and that made all the difference.
- The similarities between healthcare and journalism, and how in this day and age of technological advancement and depersonalization it is still the ability to hold the gaze of a fearful patient that makes the greatest impact.
- The story of the care her father, the patient, and she, the patient advocate, both received as they navigated and negotiated his stay on a burn unit. This story alone is worth the time for the click-through above, but in short, her father’s care team acknowledged and appreciated the knowledge she brought into the room, and as a result her father’s care plan was developed with the family’s needs, values, preferences and goals as the foundation. And while she says that the care he received was best-in-class, it was the social worker who stopped in to ask how they were doing, the nurse who played music for her father when she could not be present, the doctor who expressed three times his understanding of how hard it was to make the choice for palliative care, and the sympathy card she received from the staff, that stay with her now. But perhaps most important of all, she shares that her father’s care team:
…gave me a sense of power and control in a situation in which I was bound to feel powerless…they put a human face, a series of human faces, on my father’s care.
- And finally, she shared four “simple” takeaways for the audience: 1) Try to be present and in the moment 2) Acknowledge uncertainty 3) Practice empathy 4) Try to be kind
As news outlets continue to talk about patient harm, pushing for accountability and bantering about frequency, a more subtle form of harm occurs more frequently and is not meaningfully measured. That harm is steeped in the missed opportunity to know the patient. Providers fail patients on a human level because care providers are human, and humans caring for humans is far from a perfect science. Maybe it’s also about patients resetting expectations and not setting themselves up to be disappointed by, as Quindlen refers to, MDietys that are in fact just people like them. The four simple truths or takeaways she mentions are things all of us, patient–provider–caregiver–sister–son–father–boss–administrator, can ascribe to and make any encounter–healthcare or not–a better one.
Thank you, Anna Quindlen, for continuing to inspire others with your words!
So many of the healthcare stories shared in the mainstream are those that focus on patient harm, or egregious behavior by providers. It can make us forget that while these occurrences are still far too frequent, they are not the norm. For every patient harmed, there are roughly three success stories rarely shared. Stories of care teams, often operating in systems yet to be designed for optimal success, who manage to use the wonderful technology, knowledge and compassion at their disposal to send a patient home safely. While every patient story is of great value, so are the stories of those care providers whose voices are less frequently heard. When patients and providers work together throughout the course of a healthcare encounter real magic occurs. Human connection has power to heal, and will always complement any prescription or treatment. And it costs absolutely nothing…
Here is one of those success stories, recently shared by a colleague. Melissa, a patient in the Vidant Health system, was found to have an aortic dissection immediately after giving birth to her son. She takes viewers on her triumphant and tear-jerking healthcare journey, and shares what made her experience with Vidant so positive, and successful despite the odds. Following are a few of those highlights for those who don’t have time to view the entire video:
- Melissa felt she was listened to by the care team
- She needed someone to be human and care, and that is exactly what her healthcare team did
- Someone cared enough to push harder within the system when her survival depended on it
Here is Melissa’s story, in her own words. There is a wonderful tribute to the healthcare team that was part of her “family” during this challenging time in her life. If you have time, it’s a wonderful story to hear and to share.
Last week at the National Quality Colloquium, I had the opportunity to share research and ideas around the use of stories and storytelling to change behavior. The audience’s engagement and the lively discussion that followed gave evidence to the growing number of healthcare providers openly looking to embrace the power of stories in their daily work. As a result, many are looking to learn how to share stories in a meaningful way, so that their healthcare mission becomes contagious. One way to accomplish this is to borrow the secrets used by successful CEOs and filmmakers, and apply the intentional structure they use to weave what often feels like magic beneath their words. Peter Guber, film producer (Rain Man, The Color Purple) and author of Tell to Win, lays out a simple plan to craft stories that both move and captivate listeners in a Harvard Business Review article from 2007, “The Four Truths of the Storyteller“. Simply put, good storytelling requires:
- Staying true to the teller
- Staying true to the audience
- Staying true to the moment
- Staying true to the mission
Following is a video example of how TOMS CEO & Chief Shoe Giver, Blake Mycoskie, not only thanks his customers, but shares his mission in a way that captures the heart. For those who don’t know TOMS, it is a philanthropic-driven, hip shoe company that matches every pair of shoes purchased with a pair of new shoes given to a child in need. Storytelling is so important to TOMS mission that they have an entire section dedicated to their stories on their web page. Click here for more examples of stories that stay true to the TOMS mission.
Healthcare providers have been traditionally trained to distance themselves from the potential heartache of delving too deeply into each patient’s story, but that appears to be changing as medical humanities and narrative programs are growing across the country. As we search for ways to make the culture of medicine more inclusive, inviting patients to partner in their care includes a better understanding of their stories–who they are and what matters to them–as well as a willingness to step outside the comfort zone for some. Writers and filmmakers understand all too well where our comfort zones lie, and push us to those limits in ways that often leave us begging for more. Whether or not you saw the 1998 movie, Patch Adams starring Robin Williams, based on the experience of physician Hunter “Patch” Adams, MD the screenwriters deliver a fitting line of dialogue for this storyline:
You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.
Interesting to note that the real Patch Adams was seen as an outlier for staying true to his mission–patient-centered care–long before its time.
In a recent AM Rounds post, Not the Story: Medical Students’ Reflections on the Patient-Doctor Relationship, author/singer/medical student Jessica Bloom, shares a clip of an original song inspired by the patients and families visited during M1 and M2 years in the University of Michigan Family Centered Experience Program, run by Dr. Arno Kumagai. The trio of songwriters/performers/medical students, as well as their 1st & 2nd year medical school colleagues, came to better understand the needs and desires of patients and families dealing with chronic conditions by spending time in the homes of volunteer families, learning more about their patients as people in order to better understand what it is like to experience illness. At the end of their second year, the medical students are required to create an interpretive project of this experience, and many turn to the arts to not only express the voice of their patients, but also their new-found understanding of medicine from the patient’s point-of-view.
It’s worth a quick click to hear the clip — poetry unintended.
Stay tuned for more information to come on the growing number of medical humanities programs across the country…