Many have asked about the Telluride Patient Safety Educational Roundtable and Resident Physician/Health Science Student Summer Camps mentioned in previous posts. In short summary, interprofessional leaders in patient safety, patient advocacy, and health science education have come together in Telluride, CO for the last eight years to address educational challenges around patient safety. The original Telluride Vision–still true today–was to create an annual retreat where stakeholders in patient safety, patient advocacy and health science education can come together in a relaxed and informal setting to discuss, develop and refine curricula that support a culture of patient safety, transparency and optimal outcomes in health care.
The theme the last few years has focused on The Power of Change Agents: Teaching Caregivers Open, Honest and Professional Communication Skills to Overcome the Multiple Barriers to Patient Safety and Transparency. Through the generous support of AHRQ, COPIC, the Committee of Interns and Residents, and in particular The Doctors Company Foundation (TDCF) and MedStar Health, we have been able to add Patient Safety Summer Camps for health science students and resident physicians. This year, funding from these organizations is allowing us to sponsor 70 students and residents each to attend one of three week-long Summer Camps, where our focus truly is educating the young.
For more information on the recent Resident Patient Safety Summer Camp activities, I encourage you to visit Paul Levy’s blog Not Running A Hospital. Paul spent last week at our resident physician summer camp, and posted a number of stories about his experience with the residents while in Telluride.
Student and faculty daily reflections and comments can also be found on the Transparent Health blog.
Learning objectives for 2012 Summer Camps will enable the residents and students to:
1. Describe at least three reasons why open, honest and professional communication between caregivers, patients and family members is critical to patient safety, transparency and reducing harm in healthcare.
2. Utilize tools and strategies to lead change specific to improving communication and reducing patient harm.
3. Implement, lead and successfully complete a Safety/QI project at their institution over the next twelve months.
The passion and excitement exhibited by these young caregivers is contagious. Over the course of the week, they engage in both structured and informal discussions, addressing a wide range of issues related to transparency and patient safety. When the week is finished, they reflect and share their thoughts with all attendees.
Every one of the student reflections is powerful, providing insight into the front lines of medical education. I wanted to share one reflection from the residents’ week that captures the essence of the Telluride Summer Camps:
“If I had spent the last four days locked in a library researching the patient safety literature non-stop, I would not have walked away with as much knowledge, enthusiasm, and support as I acquired participating in the Transforming Mindsets: Patient Safety Summer School for Resident Physicians in Telluride, Colorado. The collective efforts, shared experience, and mutual support of everyone involved made for a special atmosphere (in the already special atmosphere of nine thousand feet) that allowed each of us to rise above our prior potentials. Within an hour of resuming clinical duties today, I was already championing our collective cause, walking a fourth year medical student through an incident report about a delayed dose of nevirapine in a newborn; her initial grimace at the optional “name of reporter” question eventually morphing into an enthusiastic smile as she entered her name following our discussion about the benefits of reporting and transparency. I couldn’t be more excited right now to motivate these types of small shifts towards a safety mindset while also pursuing large-scale systems shifts that ensure safety as well. Thank you to the faculty and especially to the other residents!”
For information on next year’s Telluride Patient Safety Roundtable and Summer Camps, email: david.b.mayer@MedStar.net and have a look at the following short film from last year’s summer camp which captures student and faculty comments about their experience.
Like well-written books, movies can have a similar, long-lasting educational impact on caregivers. Hollywood writers and film producers have known this fact for years. When done well, movies arouse strong emotions and feelings on important issues creating learning opportunities not achieved with traditional teaching methodologies. When these learning opportunities are reinforced with reflective group discussions, the knowledge gained imprints in ways a PowerPoint presentation cannot.
One such film that connects the heart with the head and uses emotion and feelings to educate is “The Faces of Medical Error from Tears to Transparency…The Story of Lewis Blackman”. This award-winning patient safety film is being used around the world as a teaching tool to generate discussions on patient-centered care and team-based risk reduction remedies. Attendees at the recent Eighth Annual Telluride Patient Safety Educational Roundtable and Resident Summer Camp used the film to kick off this year’s meeting. The Roundtable brings together international patient safety leaders, patient advocates, educators, resident physicians and medical students to engage in conversations related to open, honest and professional communication between caregivers and patients/families related to unanticipated patient care outcomes.
Twenty residents attending the Roundtable this year (through scholarship funding support from COPIC and the Committee of Interns and Residents) shared how their current environments were aware of the need for open and honest communication, yet failed to provide the support when an opportunity to have that conversation with a patient actually arose. Paul Levy posted the following resident comments on his blog Not Running a Hospital:
A deep and honest discussion ensued among the residents, reflecting on their current clinical experiences. Here are some of the comments:
“In my place, people are still not telling the truth to patients and families.”
“I am finishing my residency now. For a few patients, I know that I made the error. Not always did the attending physician want to debrief the case with me.”
“M&M’s in my hospital have gotten lame. I know of many cases that did not come up on the M&M docket.”
“Calling the attending is still viewed as a sign of weakness.” They will say, ‘You are not able to independently manage the patient effectively.'”
All in all, a powerful morning, setting the stage and providing motivation for positive change and for attentiveness to the following events in the summer camp.”
We will not achieve the success we are striving for in patient safety unless transparency and education targeting open and honest communication is fully embraced in healthcare. Those interested in learning more about the discussions generated by the film at the Roundtable, please see http://runningahospital.blogspot.com/2012/06/telluride-patient-safety-camp-day-1.html and http://transparenthealth.wordpress.com/
The educational value of narrative and reflective learning is well documented in the literature. These educational powers are especially true in healthcare when teaching health science students and resident physicians risk reduction strategies in the provision of safe, high quality patient care. Wall of Silence, written by Rosemary Gibson, demonstrates this educational power extremely well. The book shares numerous cases where medical error caused significant, many times fatal, patient harm. Unlike traditional medical case reviews discussed in M&M’s or written for journal publication, the book takes a different approach to these cases and shares through interviews what patients and family members expected from caregivers after good intentioned care caused harm. The take-away from these patient and family interviews highlight five areas of need:
1. The truth
3. An apology when appropriate
5. Commitment (and action) to change the system to protect others from similar harm.
Patients and family members are great teachers and educators. Lessons learned from these stories through the patient’s voice are powerful teaching tools that survive the educational decay commonly seen with traditional teaching methodologies. While these are all tragic stories, there is much to be learned when we as caregivers are willing to hear what our patients tell us and engage in truthful and transparent discussion. As Rosemary told me many years ago, the best teachers find ways to connect the brain to the heart and leave a lasting educational imprint on their students.
“Educate the young, regulate the old”. That quote has literally followed me around the world. I can vividly remember when first making the statement. I was one of five “safety experts” on the closing panel at an international safety and quality meeting in Sydney, Australia a number of years ago. The thought was that the five of us would somehow be able to share “pearls” of wisdom regarding what was needed to create cultural change in healthcare from a safety standpoint – not an easy task to say the least and one for which I knew I had no silver bullets.
With my background and expertise in patient safety education, the microphone often ended up in my hands when related questions were raised which is exactly where it was when an audience member asked each of the panel members to summarize our thoughts in one simple, easy to understand sentence. Without hesitation, and I should also say without thinking, I quickly said “Educate the young, regulate the old”. My face froze, my hands squeezed the microphone. Oops…did I just say that? Can I do another “take” or delete that last comment? Too late. There was a mixture of laughter and hissing, clearly a sign I had hit a nerve. After a pause that seemed to last about an hour, I tried to explain what I meant.
Just before leaving the states for Sydney, at my previous position in Chicago our SCIP committee had reviewed our hospital data on compliance with the SCIP measures. It was a good meeting – data on the most recent quarter showed us to be 98% compliant. Committee members were happy and satisfied they were helping move the hospital in the right direction. We should have been happy…our previous quarterly data showed us consistently below 60% compliance. It begged the question “what had changed?”
For the previous two years, we had met regularly with the surgery specialties and anesthesia personnel to educate them on the SCIP measures and their importance in reducing infection and other perioperative risks. We had searched the literature for best-practice models we could implement within our environment. We put new process improvements in place to make antibiotic ordering and administration as simple as possible…yet we could not get our numbers above 60%. Now, all of a sudden in one three month period we were rapidly approaching 100% compliance? It took a few seconds of reflection to realize what had changed. CMS put new rules in place tying payment to compliance. Once it became a reimbursement issue, discussions in the operating room about antibiotic administration before the surgical incision now became routine. One new CMS regulation accomplished what two years of education, training, process changes and pleading had not.
I was devastated. Don’t get me wrong, I was delighted to see the positive results. But as someone who has spent a significant part of their career in health professions education, I was deflated. So still hurting from this harsh new view of the world attacking my educational psyche, when the question was asked, I responded without thinking and with emotion that had built up over a 20 hour plane ride and a couple days of jet-lagged sleep deprivation…“educate the young, regulate the old”.