A Tale of Two Gowns: The Patient Experience

Hospital_GownsI attended the Patient Experience, Empathy and Innovation Summit hosted by the Cleveland Clinic in May. Sessions covered a wide range of topics, including insight into how technology such as wearables, apps, and greater access to information about patients is influencing the delivery of care, and with it, the experience of care by patients. At the end of the day it was clear, engaging with patients honestly and with empathy, and inviting them to participate in the care they are to receive will never go out of style. It is encouraging to see the renewed focus and importance placed on the power of what have long been viewed as the “soft skills” of medicine. There are many of us, including an increasing body of research, who understand the healing properties of touch, a smile or a kind word to help reframe a healthcare encounter. What truly made the content shared in Cleveland come to life, however, was viewing it all through the lens of a conversation I had with a close friend who recently went through treatment for breast cancer.

I am most happy to report that my friend is now almost two years cancer free. With a family history that is all too weighted in favor of a recurrence, she is taking each day as a gift while at the same time remaining vigilant of every new ache or pain. When she was first “discharged” from treatment last year, she expressed dismay at how quickly and easily her “care team” said goodbye and good luck. With no more follow up visits to an oncologist or surgeon, and no more chemo or radiation appointments to attend, she also had no one regularly monitoring a disease that had taken the life of both her sister and mother. With no one holding some type of medical authority to give her a reassuring touch on the arm, or an all-clear from regular blood work, she has been left to wonder what the future holds alone. And I was left to wonder how post-cancer care can be so lacking in empathy for a patient, a person, who just experienced one of life’s most challenging events.

In the last six months, my friend moved from the often cold, unfriendly confines of the Chicago area for the warm, inviting sunshine she had left five years prior. When she arrived back in her adopted home town, she also needed a follow-up surgery as a result of infection from her implant resting on radiated breast tissue after the double mastectomy she had opted for in hopes of beating her odds of recurrence. This immediately put her in contact with a new breast cancer care team–one I can talk about without quotation marks because she is giving them high marks. She loves her new hospital, surgeon and everyone she has had to work with to get through this next health and life milestone. When I asked her why the care was so much better in her new environment, she shared the following:

They just seem to care so much more. It’s as simple as the gowns. Here the gowns are warm, soft and pink. When I would go to put a gown on at the old place, is was scratchy, cold and old, barely covered me and often tied in knots. I would sit there trying to untie knots in the gowns and get frustrated.

The image of my friend sitting alone, uncovered, frightened of what her future holds, and struggling to untie these knots brought tears to my eyes. Someone easily could have been mindful of making sure the gowns were easy to put on and take off; that they brought comfort instead of more anguish. Admittedly, it is a challenge to turn healthcare culture around on a dime, but can’t we at least hit the mark with the simple things? Couldn’t we try to make the entire experience of care feel like putting on a warm, soft, pink gown, even if we struggling to fix bigger system’s issues?

As her care continues at the new facility, she is also learning more about the way health systems work because people who work within this system are taking time to talk with her, explain things and put her mind at ease. She also feels more comfortable and welcome within in the new system, and is asking more questions. For example, she learned that her oncologist back home was not necessarily ignoring her by sending in a mid-level practitioner to talk with her. In fact, it was a signal that her recovery was going well because she did not need the oncologist’s time. Wouldn’t it have been nice to know this as a patient in their care, versus wondering about the quality of care being received as well as one’s prognosis?

At a recent surgical follow-up visit, my friend’s new surgeon took time to explain the procedure he had performed in detail, describing what he had done and how he thought she was healing. Not only did he take time to talk science, he asked her how she was feeling, and told her “it was his pleasure” to be of service to her. He used phrases that real customer service focused industries use, and my friend picked up on this because she works in the hospitality industry and notices things like this. And she notices when the simple niceties of customer service are lacking.

Do you know who your patients are? If you haven’t asked, it might be a good idea because they have skills and they are paying attention. Maybe just these few patient engagement/experience tips could be bullet-pointed and handed out at white coat ceremonies, or posted in hospital break rooms across the country. I’m hoping my friend will choose to become a patient advocate at her new location, as she has much to offer. Her first agenda item is to become well, and perhaps then she will share the wealth of knowledge she has acquired over the last two years about good and bad healthcare delivery. And while the new system is far better in her experience, she still has experienced bumps in the road. There is so much patients can teach us about what we do well, and where we need to improve, but they need to be invited into a conversation. Start today by asking a patient how he or she is feeling, if there is anything they need. or if you can be of greater service.


The 80-20 Rule and Disruptive Healthcare Professionals

80_20_Rule_ImageA colleague forwarded on a momentarily disheartening clip from the Washington Post last week. The article, entitled Anesthesiologist trashes sedated patient–and it ends up costing her, included an audio clip from the patient’s cell phone that he had inadvertently left running during a colonoscopy in which healthcare professionals charged to care for him instead chose to act like grade school bullies. The anesthesiologist, who was one of two physicians named in a lawsuit for medical malpractice and defamation, is clearly heard on the audio clip belittling and taunting the patient while sedated. Additional staff is heard laughing as the proceduralist and anesthesiologist continue their disturbing banter. No one in the room, or at least no one on the audio clip included in the Post article, told them to stop. I will bet, however, there was at least one person in the room who wanted to say something.

I say momentarily disheartening because as I sat listening and briefly wondering how any of the work we do educating the young–teaching them to stand up to bullies and disruptive healthcare “professionals” like this in the workplace–was going to overcome the still so well-ensconced medical culture, I quickly found solace in the fact that we like to elevate the train wrecks in all walks of life. And the Post was most definitely covering the story of a train wreck.

Knowing that our culture is comprised of the stories we share, I just as quickly recalled multiple stories of the great work being done in my small corner of healthcare alone. Take, for example, the weekly Good Catch stories shared throughout the MedStar Health system showing exactly how the 80-20 rule can be applied to the prevalence of healthcare bullies. I was comforted by the fact that for the 2 physicians mentioned in the Post story, I knew of at least 8 good people protecting patients in just one health system. Stories of visiting nurses who ensure the safety of those in the home, or of the local security guard who sits with a soon-to-be patient until help arrives. Stories of nurses who speak up when care does not seem to be going in the needed direction, and stories of physician leaders who actually lead, setting the stage for those often silenced to share their voice. Yes, the 80% is alive and well!

Those who aren’t convinced it is just good form or good karma to treat patients and/or colleagues with dignity and respect can turn to a growing body of formal research that contends bullying and incivility in the workplace has many costs, including patient safety and workforce overall well-being. An opinion piece in the New York Times on June 19th entitled, No Time to Be Nice At Work, by Christine Porath refers to a survey of more than 4,500 doctors, nurses and other hospital personnel of which “…71 percent tied disruptive behavior, such as abusive, condescending or insulting personal conduct, to medical errors, and 27 percent tied such behavior to patient deaths.”  Porath also references work recently published in the American Journal of Management, Does Rudeness Really Matter? The Effects of Rudeness on Task Performance and Helpfulnesswhich showed people working in an environment that lacked civility missed information directly in front of them and offered fewer creative solutions to tasks before them. The same was true if individuals simply witnessed an exchange of rudeness.

It matters not whether it ends up being the data or the stories that drives us to treat one another, especially patients, with dignity and respect in the healthcare environment. And maybe stories like the one in the Post last week are needed in some strange way, if only so that they might discourage the next bad actor who has failed to mature themselves from lashing out at the vulnerable. I do know, however, that we need to add at least five stories of the good work healthcare professionals are doing each day to counteract the negative force a story like this carries into the mainstream. In the meantime, we need to continue to empower those healthcare professionals who want to do better, especially young healthcare trainees. There are many within healthcare who look at the Post story and are embarrassed to be part of a profession that would allow this to continue but have yet to find their voice or platform. Here’s to the good guys and gals–the 80%–we know you’re out there. It is up to healthcare leaders to give them a pen…or a mic!


Reflections by A Young Physician Inspired by Telluride Experience

OVer_the_RockiesFor the last six years, health science students and resident physicians have inspired our Academy for Emerging Leaders in Patient Safety faculty as much as they report we have inspired them to become patient safety leaders within their medical centers. Each year, our faculty receive numerous emails sharing the safety projects they have been leading to make care safer for their patients. We hear about how the Telluride Experience has re-focused their purpose within medicine, sometimes even keeping them engaged at a pivotal point in their own careers when the burden of the current culture of medicine seems too much to bear. Bringing close to two hundred passionate and committed learners and future healthcare leaders to Colorado, Maryland and California each summer to work with our faculty from around the world is what keeps me excited and wanting to come back each year.

This post was inspired by the following reflection, Email I sent to my program leaders, posted on our Telluride Blog by Joy Solano, MD-PGY1. Thank you Joy! And thanks to all our Telluride Patient Safety Summer Camp Alumni (close to 500 strong now) for working to make healthcare safer for our patients, families and our caregivers.

Email I sent to my program leaders.  |

All,

I want to begin by saying THANK YOU for sending me to Telluride to learn from some of the nation’s pioneer leaders in patient safety and quality improvement. I have been so moved that I want this to be my “niche” in medicine as I continue on to become a pediatric hospitalist. I am hoping at some point to sit down with all of you to discuss the processes CMH has in place to reduce error and at the same time acknowledge human factors. I have not yet made it to error prevention training due to scheduling conflicts, but I am excited CMH is taking this step towards becoming a high reliability organization. Nick Clark (a previous Telluride Patient Safety Summer Camp alum) has done a great job of incorporating patient safety moments into many of the meetings he has led, and I hope to carry this forward in some way.

We watched a variety of videos and heard multiple stories of near-misses and unfortunately, preventable patient morbidity and death. Carol, one of the representatives from the patient perspective, shared the powerful story of the loss of her daughter who had been diagnosed with leukemia 9 days before she died from a hospital acquired (and too late recognized) C. diff. infection. A C. diff. infection! This year has been particularly hard for Carol and her family as her daughter would have gone to senior prom this previous April and then graduated from high school in May.

In order not to make this email too long, I want to just make 2 more points and then, hopefully, I can discuss my thoughts with all of you in John_Nance2person at some point.

1) John Nance, writer of “Why Hospitals Should Fly,” said during his talk: “You have been trained to be the center of your own universe.” I do feel as if I was trained in medical school to practice “independently.” On rounds as students and many times as residents, we are expected to diagnose a patient (even if we are completely wrong), come up with a firm plan…and then present it confidently. Our goal is for everyone around us to nod their heads in agreement with the plan we have made. We hope no additional input is needed. However, this erases the team-based approach to medicine we MUST have in place in order to create the most safe environment for our patients. Our plans may be acceptable plans, but others’ ideas should be elicited EVERY time and considered EVERY time, so that we can ensure we have considered all options.

2) I want to begin my own QI project, but I’ll need a mentor. I just don’t know yet what I want to focus on. Sometimes it’s better when I write or talk about my interests or concerns, and then a person outside of my head points out the obvious to me. I appreciate all thoughts any of you have to offer.

Thanks,

Joy Solano, MD PGY-1


Remembering Mr. Farrell and Other Fathers We Have Lost

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As we reflect on our continued commitment to eliminating preventable medical harm, it is important to never forget the lost loved ones that help keep us focused on our important mission. On this Father’s Day, as a proud parent and even prouder grandparent, I can’t help but reflect back this morning to last year’s Telluride Patient Safety Summer Camp and the personal story Caitlin Farrell shared with all of us on Father’s Day last year. Her story is also featured this weekend on http://runningahospital.blogspot.com/  It is one story I will never forget…

Fear, Forgiveness, and Father’s Day

Published June 16, 2014 | By CFarrell

Yesterday was Father’s Day, 2014. I woke up before everyone else in my room. Rolling out of bed, I padded down the stairs and brewed a cup of much-needed coffee. Pouring my face over the steaming cup, I looked out my window to the inspiring landscape of endless white-capped mountains. This year marks the ninth Father’s Day that I have spent without my dad, but the mountains and my purpose this week made me feel as though he were standing there with me, sharing our cup of morning coffee, just as we used to.

After taking the gondola ride into Telluride, the students and faculty plunged into our work of expanding our knowledge in the field of patient safety. We watched a documentary outlining the tragic case of Lewis Blackman, a 15-year-old boy who died due to medication error, miscommunication, and assumptions made by his medical team. The film explored the errors in Lewis’s care that have become far too common in our medical system: the lack of communication between providers and families, the establishment of “tribes” within medicine who do not collaborate or communicate with one another, the lack of mindfulness of the providers, and the culture in which all of these errors were permitted to happen.

But what resonated with me the most were the feelings described by Lewis’s mother. She defined her experience as one of isolation and desperation. “We were like an island”, she said. There was no one there to listen to her concerns. Ironically, Lewis died as a result of being in the hospital, the one place where he could not get the medical care that he so desperately needed.

A pain hit my stomach as she said these words. My family also shared the feelings of isolation, uncertainty, and loss throughout my father’s stay in the hospital. After Lewis’s death, his mother was not contacted. Instead, she was sent materials about grieving and loss in the mail. After an egregious error occurred during my father’s medical care, a physician did not give us an apology, but a white rose by a nurse.

An interesting discussion arose after the film. Our faculty emphasized the need for physicians to partner with the families of the patients. This will create not only a team during the course of treatment, but will cultivate compassion, empathy, and trust in the case of a terrible event. I know that despite the growing number of “apology laws” that protect, and even mandate, physicians to apologize to families after catastrophic events, few physicians actually do apologize. This results in families feeling like the events were there fault. I can say from experience that this is a burden that you can carry with you for years to come.

As I got back to my room and put down my books, this conversation mulled in my mind. The death of my father has given me the fuel to pursue medicine and patient safety as my career. It has instilled in me passion, energy, and determination. Yet the one thing that I have not found in the nine years since my father’s death is forgiveness. Although I do not hold any one doctor or nurse responsible for the detrimental outcome in my father’s care, I have not been able to forgive the team for what happened. I have not been able to go back to that hospital. And as I sat on my beautiful bed in the mountains, I realized that I also harbored another feeling: fear. Fear of becoming a physician who does not practice mindfulness, who does not partner with my patients, who does not apologize for my mistakes. I am afraid that despite my best intentions, I will only continue the vicious cycle. A fear that I will allow my patients to feel as though they are “on an island”.

I put away my computer and got into bed. Lying awake, I took in the gravity of the day. I am so grateful to be here at Telluride among students and faculty who share my passion in patient safety. I could not have imagined a more perfect way to spend Father’s Day.

 


The Content We Share: MedStar Health Inspiring Healthcare Scholars in Telluride

One of the conscious strategies behind the content created at MedStar Health is to inspire high reliability practice and patient centered care locally. Dave Mayer has always insisted we share as much of that content as possible with our colleagues across healthcare, as well as with young healthcare learners and resident physicians during the Telluride Experience. The piece referenced, Please See Me, was released in April of 2015, and was shared this week in Telluride. Following is a wonderful reflection from the Telluride Blog entitled, Forgetting Our Purpose, by one of our medical student scholars on the value she found in this piece. To see additional student reflections from the first session of the Telluride Experience for 2015, go to: www.telluridesummercamp.com/blog

Colleen Parrish is a Telluride Scholar, and rising M2 at the
University of Oklahoma

Throughout today’s sessions, one thing that really hit home for me as a student was the last video we watched created by the MedStar team. Within the video, it brought up a point that I think we as students tend to forget – especially those within the first 2 years of medical school or those within the most book heavy, patient free part of their healthcare curriculum. In the video, the doctor mentioned that she had memorized all the muscles and bones within the body, and gone to school for x number of years in order to take care of this particular patient; she had spent all this time and energy, sleepless nights, and damaged personal relationships in order to be a great caregiver for him.

This really resonated with me, especially with the recent completion of my first 2 years of schooling. I realized that within this period of books on books and lectures on lectures, we as students tend to forget our purpose – our “true north” if you will – of personally caring for and improving the overall well-being of our patients, our fellow humans. Without that constant reminder of why it is we are investing such time and energy into learning about bugs and drugs and such absurd sounding things as poop charts, we tend to veer from our true north into a path of “jadedness” and even resentment.  If we can take the time everyday to remind ourselves of why we are doing all this, perhaps by watching videos such as this one or “Empathy” from Cleveland Clinic or by simply writing ourselves a letter that we read in moments of stress and frustration as we watch our peers in other professions begin to have careers and families, if we can bring ourselves back to our purpose even within the classroom I believe we can all be not only more effective healthcare providers but happier ones.

I’m reminded of an article, [from The Atlantic, For the Young Doctor About to Burn Out] that I tend to turn to that helps remind me a lot of the deeper issues of the stress and burnout of physicians. It’s more of book review perhaps, but it really resonated with me as to a different perspective on how we can get distraught within our beloved training and professions.


Telluride 2015 Student Reception

Students_Reception_Mtn_BackgroundOnce again, we gather in Telluride to talk, teach and learn about new ways to shape safety culture within medical and nursing learning environments by educating the young! The mission and hope of our Telluride Summer Camps (now part of the Academy for Emerging Leaders in Patient Safety) has always been to inspire the future leaders of healthcare to hit the ground running armed with an understanding of what it means to truly make patients part of every healthcare conversation, and to keep them safe in the process. Follow their reflections during the next ten days on the Telluride Blog.

Dave_Student_Reception


A New Class of Patient Safety Leaders: Telluride Experience 2015 Kicks Off

IMG_0188This coming weekend, many wonderful and highly committed patient safety advocates and safety leaders will once again convene in Telluride, CO to continue our mission of Educating the Young. For those not from CO, summertime in Telluride may be one of the best kept secrets in the United States. Be it the old west feel of the town, or the hypoxic magic that happens at an elevation of 9,600 feet, Telluride has always been a learning mecca for everyone that joins us during these memorable weeks of high altitude education at the Academy for Emerging Leaders in Patient Safety: The Telluride Experience.

Over the course of eleven years, 450 students and resident physician scholars have attended one of our Telluride Experience Sessions, formerly known as the Telluride Patient Safety Summer Camps. Many of our alumni have gone on to lead work that has inspired real change at their home institutions–change that is helping make care safer and more transparent. We look forward to meeting yet another class of emerging patient safety leaders that will continue to stand up for patients and a culture of safety we all can feel safe working, or receiving care, within.

Through the generous support of The Doctors Company Foundation (TDCF), Committee of Interns and Residents (CIR), COPIC and MedStar Health, about 180 health science students and resident physician leaders will be attending one of five, week-long Patient Safety Summer Camps this summer. The first two patient summer camps will be starting next week in Telluride, two more patient safety summer camps will be held in the Washington DC/Baltimore, MD region (aka Telluride East) in July, and a final week will be held in Napa CA – our new home for Telluride West–thanks yet again to the continued support of The Doctors Company Foundation.

The smaller, roundtable format utilized at the Telluride Sessions, takes advantage of small group breakouts and learner-centered activities designed to foster creative thought and consensus building through lively conversations in a relaxed and informal setting. This non-traditional learning environment also attracts patient safety leaders from around the world to Telluride each summer, to break bread and share ideas on current issues and challenges while helping train the next generation of Patient Safety leaders. Because of this unique venue and format, much of our discovery and learning happens on the walking paths, hiking on the mountain trails, in a coffee shop, or over a glass of wine.

Next week, we kick off this year’s Patient Safety Summer Camps by welcoming 36 health science students and thirty resident physicians to Colorado. These young scholars and future healthcare leaders were selected from medical schools, nursing schools and residency programs from across the country, and will be immersed in learning about transparency, patient safety, and patient/caregiver partnership. It truly is an amazing experience that always leaves faculty energized for months to follow.

We hope you will follow our activities and learnings through our student, resident and faculty blogs, found here on ETY, at The Telluride Blog, found here or fellow faculty member, Paul Levy’s blog Not Running A Hospital. Please comment and join our conversation on the blogs or on Twitter (@TPSSC and #AELPS11).


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