Educate the Young, Regulate the Old…the Whole Story

For those who have yet to hear the story of how this blog was born, here is Dave Mayer our host, who shares the origin of our title. The clip was put together by documentary filmmakers, Citygate Films. Citygate is at work on Breaking the Wall of Silence, a documentary film focused on the work healthcare leaders, like Dave, are doing to make open, honest communication and transparency the new normal in the delivery of care. They are shadowing Dave’s work at MedStar Health as he leads the 10-hospital health system on a journey toward high reliability, as well as others across the U.S. doing similar work to make this transformation a reality. The film trailer can be found at a previous ETY post: Breaking the Wall of Silence: A Documentary Film in the Making.

“Educate the Young, Regulate the Old” from Citygate Films on Vimeo.

Teamwork + #SXSW + #Minecraft + #Healthcare = Sum Greater Than Parts

There is a call in healthcare for all stakeholders to move toward a culture where team-based care is the norm. Where patients are welcomed into the care team as equal partners, moving away from the traditional, hierarchical approach. To make this shift, new skills will need to be embraced by those accustomed to old ways of delivering care. Many of the younger learners, in medicine and elsewhere, are great resources to turn to as role models for these team-based skills, as their play environments have proven to be wonderful training grounds for the same. For example, teamwork is thriving in video gaming environments — environments that may seem an unconventional place for medical training, but are proving to hold promise for more than just acquisition of surgical skills.

It was this knowledge I carried while attending SXSW in Austin, TX two weeks ago, during which I had the pleasure of sitting in on the Mindful Minecraft session in the Gaming and Interactive track. For those who aren’t familiar, the video game, Minecraft, has sold over 20 million copies across all gaming platforms (PC, Xbox, iOS, mobile), and is played by both kids and adults, alone or in a multiplayer environment. Servers across the country house multiplayer Minecraft sessions, where players work together to build worlds limited only by their imaginations. My own Minecraft knowledge is nascent, and I hope to convince my niece or nephew to slow down when they play and explain it further. Until then, I’m left to appreciate the artistry and the opportunity this gaming environment offers young and old. Following is a video shared by the #SXSW Mindful Minecraft presenter, Mike Langlois, a social worker who uses the video game as a tool to better understand his young patients, and redefine the way gaming addiction is perceived and approached.

Langlois also shared a number of interesting facts about both the single-player and multiplayer Minecraft environments that could be directly applicable to our healthcare learning environments. Mindfulness and teamwork were the two components of this game mentioned that really hit home for me. If you watched the video above, and understand just the basics about the game, the creation of such a work of art by a team of individuals located around the world is amazing in and of itself, and speaks to the coordination and teamwork developed in order to be successful. Langlois reported on additional findings from these gaming environments which could also show promise for learning emotional intelligence not taught through traditional healthcare curriculum, such as:

  1. Mindfulness — The game requires intentional, focused attention and keeps players in the moment. By taking a non-judgmental approach to the game, players learn to experience “what is”.
  2. Bullies in a the multiplayer gaming environments are soon marginalized. According to research on bullying, video game environments are ahead of schools in how bullies are managed.
  3. Kids eventually work out issues that arise on their own, before their Minecraft-playing parents have to intervene.
  4. Mode of play (i.e. single-player, multiplayer, creative, survival) changes the way players interact with, and within the game, allowing them to practice different social skills accordingly.
  5. Through different modes of play, autistic learners may be able to learn empathy.

Research has shown that surgeons who play video games were 27% faster at advanced surgical procedures and made 37% fewer errors than those who did not play video games. Additional studies have shown that scientific reasoning is improved through certain video game environments. Wouldn’t it be reasonable to think that care providers who practice mindfulness and team-based play in a video gaming environment might have better outcomes related to both? This is a study I would like to see funded!

Storytelling Tips From the Pros

As mentioned previously on ETY, stories are increasingly being used within medicine (and other industries), as a way to more deeply engage with patients and customers. A colleague, Ed Tori (@rookiedoc), passed on what seems to be a great resource for writers and storytellers, Aerogramme Writers Studio, and I wanted to pay it forward for those who might be interested. The blog shares writing tips from the likes of Pixar Story Artist, Emma Coats, Filmmaker/Writer/Director-with-a-cult-like-following-of-fans-and-cast-members, Joss Whedon, and more.

Following are a few of their tips for ETY storytellers-in-training, seasoned writers and those simply interested in the art of storytelling. Please share your thoughts on how they might help healthcare providers better understand and share in the life stories of their patients and families, or how they might help care providers make sense of their own experiences within healthcare.

From Joss Whedon’s Top 10 Writing Tips (click on his name to see the full post):

Everybody has a perspective. Everybody in your scene, including the thug flanking your bad guy, has a reason. They have their own voice, their own identity, their own history. If anyone speaks in such a way that they’re just setting up the next person’s lines, then you don’t get dialogue: you get soundbites. Not everybody has to be funny; not everybody has to be cute; not everybody has to be delightful, and not everybody has to speak, but if you don’t know who everybody is and why they’re there, why they’re feeling what they’re feeling and why they’re doing what they’re doing, then you’re in trouble.

You have one goal: to connect with your audience. Therefore, you must track what your audience is feeling at all times. One of the biggest problems I face when watching other people’s movies is I’ll say, ‘This part confuses me’, or whatever, and they’ll say, ‘What I’m intending to say is this’, and they’ll go on about their intentions. None of this has anything to do with my experience as an audience member. Think in terms of what audiences think…

From Pixar’s 22 Rules of Storytelling, which evolved from Emma Coats‘ Twitter feed (click on her name for the full post):

5. Simplify. Focus. Combine characters. Hop over detours. You’ll feel like you’re losing valuable stuff but it sets you free.
6. What is your character good at, comfortable with? Throw the polar opposite at them. Challenge them. How do they deal?
7. Come up with your ending before you figure out your middle. Seriously. Endings are hard, get yours working up front.
8. Finish your story, let go even if it’s not perfect. In an ideal world you have both, but move on. Do better next time.
9. When you’re stuck, make a list of what WOULDN’T happen next. Lots of times the material to get you unstuck will show up.
10. Pull apart the stories you like. What you like in them is a part of you; you’ve got to recognize it before you can use it.

And finally, a storytelling tip of my own:
Explore and dissect as many stories in all their glorious forms as possible (books, movies, short stories, flash fiction, documentaries, web series, etc.). Think about what you liked. What you didn’t like. Take notes and use those devices in your own stories. Here is a recent favorite from a story expedition I went on at #SXSW — a trailer from Joss Whedon’s latest, Much Ado About Nothingdue out June 7th. It is an incredible remake of Shakespeare’s timeless work, showing that good stories–stories that have at their core the emotions universal to all of us–never die, they just gain a larger audience.

Sitting Down with Patients

This past weekend, I had the wonderful opportunity to give the welcoming remarks at the Annual Recent Advances in Obstetrical Care conference in Baltimore, MD. Being an anesthesiologist, I have worked closely through the years with many obstetrical caregivers in the labor and delivery suite, and I am always honored when asked to share a few thoughts on healthcare today. A few attendees who knew of our blog asked if I would post my opening remarks on Educate the Young. Following is an excerpt sharing my comments on the increasing demands for transparency and the true value of patient partnerships:

What types of transparency are now being asked of us by our patients?

They want Transparency in outcomes. I have heard Peter Pronovost say, “consumers can get more information about the toothpaste they buy than about the care they will receive”. Patients want information on healthcare similar to the information they can obtain and review before buying a new car, choosing a hotel for a vacation, or selecting a restaurant for dinner. They want to be able to make more educated choices about their care options.

They want Transparency in shared decision-making. Informed consent doesn’t cut it anymore. More and more patients want their caregivers to fully understand their values, preferences, needs and goals before any discussions on care options, risks, benefits and alternatives begin. They want information on the hospital and their physician’s experience related to the procedure they will undergo–more succinctly–how many similar procedures have we performed, and how well have we done? They want to know our infection and complication rates. And more and more patients also want to understand the costs related to different treatment options.

And they want Transparency related to medical errors when that error has led to personal harm or loss. They are understandably frustrated and angry when traditional “deny and defend” approaches to unintentional patient harm are used because of medical malpractice fears, or when they are “passed off” to administrators and lawyers when trying to get basic questions answered about their care and possible follow-up treatment needs.

It is my opinion these new patient demands for transparency have been long overdue, are badly needed, and will help move us to a more cost-effective, higher quality, lower risk patient care model. It will be a new and better healthcare system, but history has taught us change will not come easily or quickly.

As you begin your educational meeting today, I want to leave you with one “take-home” suggestion – truly engage and partner with your patients. Many of us who work in quality and safety have learned so much from our patients and family members through the years. For me, one example of this valuable partnership is what I have learned through Carole Hemmelgarn, an amazing woman and patient advocate who taught me the following important communication skill.

When you enter a patient’s room, instead of standing at the foot or side of the bed (as I had done for so many years) pull up a chair, sit down and have a true conversation with them. Research has shown that patients perceive caregivers who did this to have spent twice as much time in the room with them, versus a comparison group of physicians, who actually spent the same amount of time with the patient, but stood at the foot of the bed while talking to them.

Through Another’s Eyes

Courtesy of our friend, Paul Levy at Not Running A Hospital, who shared a post from ePatient Dave’s healthcare blog, made by Cleveland Clinic and inspired by the words of Henry David Thoreau. What would healthcare, and the world, be like if everyone remembered to see through someone else’s eyes?

Please share!

#SXSW Interactive Top 10 Takeaways for Healthcare in 2013


There were far too many terrific takeaways over the four days I spent at the SXSW Interactive Conference in Austin, TX this past weekend, many of which I promise to elaborate on in the coming weeks. For now–here are my Top 10–really in no particular order, as all will be coming your way in due time. I cannot say enough good things about the SXSW experience — please comment and share your own takeaways if you also attended!

  1. Mobile and Responsive design: For anyone creating content of any kind–this is the bus to be on, and it’s well on its way down the road. As a medical device or a content viewer, for healthcare diagnostics or your favorite magazine–almost any tool or content being developed today needs to have a mobile version ready to go. Responsive design adapts web content to the device it is being viewed upon, and ideally should be a consideration when any content is developed.
  2. Visual presence: Will be key to sharing/driving/conveying ideas. Designers themselves were highly visible speakers, and emphasis was put on good design being the mechanism that will not only introduce the feel, the heart and the soul of your brand or organization, but also break through the sea of content being developed. See Huffington Post and BuzzFeed, two leaders in the news “blogosphere”, for examples.


    MakerBot 3D Printer & Freshly Printed Products

  3. Subtraction: With the exponentially increasing amount of information, data and content coming at us, learning how to remove the unnecessary will be the way to achieve your goal. Knowing when to stay open to the “noise”, and when to tune out, will take discipline for those seeing unlimited opportunity in everything now available to us with the swipe of finger or click of a mouse.
  4. Collaborate: Open source everything! How will medicine respond to this call?
  5. Sensors for health: The body will become the data source of the future. Talk about transparency–Ouch! BodyMedia was one health tech company present sharing their technology for tracking exercise, sleep and calories in a meaningful way.
  6. Change is the new “black”: It’s here, it’s in and begs to be embraced by every generation. There will be much of it heading our way, and it will require all of us to change our behaviors as a result at some point. How will healthcare leaders not only embrace change, but lead change?
  7. Print has a shelf life: While this may not be a news flash to many, it was confirmed by leaders in media and publishing ahead of the game. Not sure when the switch will turn off, but have your digital, interactive content ready to go in responsive design mode.
  8. A good idea is only half the equation: The other half is knowing how you will spread your message. Social and mobile have converged, and will be the main avenues through which all things spread.
  9. Google and android platform: For a dedicated Mac user, this is a conclusion I can no longer ignore. Not sure where this is all heading, but I know I need to understand it better. The openness of the platform alone is worth a deeper understanding. Guy Kawasaki, of Rich Dad, Poor Dad fame, puts his manuscripts out on Google docs for his readers to edit. Google Glass appears to be here to stay, and I recently heard David Letterman do a Top 10 on Google Talking Shoes…
  10. “Maker Movement” is here: What tangible content, assets or services are you adding to good of the world? These folks had a strong presence at SXSW, and it’s not just the 3D Printer folks, who admitted we are a ways off from printing spleens any time soon.

The Healthcare Quality and Safety Marathon

As someone who has run a number of marathons in my life, I have come to appreciate the term hitting the wall. No matter how well a runner trains, or how good we feel during the run, “the wall” can still stop us in our tracks around the 18-20 mile marker. Speaking from experience, when a marathoner hits the wall there is a choice to be made. There is an overpowering urge to walk off the course and go home–it is a miserable feeling. But we continue, walking at times if we need to because we are so close to the finish line and reaching the personal goal we set.

Many of us who spend our time in quality and safety can also hit a similar wall at times – I know I do. There are times when it seems like we take one step forward and two steps back. We get frustrated when change comes slowly, or certain physicians push back, wanting to keep the status quo even when the evidence shows they need to change the way they do things because it is harming patients. People tell us changing culture takes time and we need to be patient, but it is not always easy to accept–especially when we watch patient harm continue.

When I hit that quality and safety wall, I turn to our next generation of caregivers – residents and students. They are my 5 hour energy drink, my Red Bull, my Jolt Cola. This happened to me recently…but two next generation, resident-driven quality and safety successes pulled me out of my “we will never change healthcare” funk, and re-energized me as it always does:

  1. via Joint Commission

    via Joint Commission

    First, seeing that the John Eisenberg Patient Safety and Quality Awards recognized the great work being done by a group of residents at the New York-Presbyterian Hospital/Weill Cornell Medical Center for their implementation of a Housestaff Quality Council (HQC). I first heard about this wonderful program when it was presented at an AAMC Integrating Quality meeting in Chicago a few years ago. Driven by a small group of committed residents who wanted to improve the quality of care being provided for their patients, they didn’t sit back waiting for their faculty to lead – they stepped up and led the work themselves. Because of their determined efforts even in the face of long duty hours, the HQC contributed to a number of hospital-wide sustainable care improvements for their patients. More information can be found in this Jt Comm J Qual Patient Saf article.

  2. Second, I was able to spend time with a number of friends from the Committee of Interns and Residents (CIR) a week ago in New York. Similar to the work being done by the HQC at New York Presbyterian Hospital, quality and safety leaders Hilary Corrigan, Justin Wood, Sandy Shea and Michael Kantrowitz shared some of the great quality and safety work CIR residents are doing across their system. CIR made a major commitment to resident quality and safety education a few years ago. Part of that commitment is the funding of ten resident leaders each year to attend the Telluride Patient Safety Resident Summer Camp. Many of you have read their reflections on the Telluride experience and about the work they are doing at their hospitals in this blog as well as Paul Levy’s blog–work that originated in Telluride. It is all resident driven work that is helping improve the quality of care being provided to their patients while saving lives.

Sometimes you don’t really need to “Educate the Young” – we just need to mentor them a little, provide support when they ask for it and then get out of their way. If the academic medical center culture is supportive (and not toxic), resident physicians can help us make significant improvements to patient care. They do this work because they know it is important and much needed. Without 20-30 years of growing accustomed to a certain way of doing things, and the lifestyle that comes with it, they don’t question what needs to change. They just roll up their sleeves and change it.

#SXSW, #HIMSS13 and Healthcare Innovation

This has been, and still is, an exciting week for those focused on healthcare innovation as it relates to the evolving landscape of health information technology (#HIT), mobile health (#mhealth), content delivery/design and interactive media.

by Eric Topol MD

by Eric Topol MD

First up? The Healthcare Information Management Systems Society (HIMSS), just closed their annual conference, HIMSS13, which included high-profile keynote speakers such as former President Bill Clinton and Dr. Eric Topol. Clinton, who has spent $3B on human genome research according to HIMSS moderator Dr. Todd Husty, is now working in similar circles as long-time personalized and mobile health proponent, and Creative Destruction of Medicine author, Eric Topol.

Mobile technology also took center stage, as sales of mobile devices are now outpacing that of desk and laptop computers. The increasing capabilities of mobile devices to help patients self-monitor their health miles from a doctor’s office further empowers patients with ownership of their own data. Both tablets and cell phones continue to play a larger role in all areas of healthcare–from monitoring to diagnosing on through care delivery. Here is an update from the HIMSS13 conference center floor in New Orleans:

And SXSW kicks off this week! From its humble beginnings as a music festival in Austin, TX with 700 attendees in 1994, SXSW has now grown to almost 32,000 international attendees, and includes film and interactive media contingents as well. The conference with a festival atmosphere starts today.

This year, an ever-increasing presence of companies and individuals involved in health tech start-ups and serious games for health will share time and space with top venture capitalists along with healthcare and tech stakeholders. Rock Health, a start-up incubator for health tech companies lists their top 6 SXSW health related sessions to include:

I am so very fortunate to be covering SXSW this year. The only challenge will be getting to all the great sessions, as meetings this rich truly make one wish for time travel to be a reality. Tops on my list for the next few days include:

I promise to Tweet and share as many highlights as possible with ETY readers. If you are here at SXSW, please reach out to me @tgranz on Twitter!

Lucian Leape Institute Report on Joy and Meaning at Work Creating Safer Health Care

With so much coming out this week related to patient safety, I wanted to be sure to share a link to the Lucian Leape Institute report released on Monday, March 4th entitled, Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. The report was a result of roundtable discussions with invited experts such as: Rick Boothman, a leader in disclosure and transparency; Kathleen Sutcliffe, high reliability expert; Sandy Shea, policy director at SEIU Healthcare; and led by Paul O’Neill and Julianne Morath from Vanderbilt.

From the Executive Summary, 7 recommendations are made for creating an environment of safe care, driven by employees who feel valued and part of the solution for healthcare change. Here are those recommendations:

Strategy 1: Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.

Strategy 2: Adopt the explicit aim to eliminate harm to the workforce and to patients.

Strategy 3: Commit to creating a high-reliability organization (HRO) and demonstrate the discipline to achieve highly reliable performance. This will require creating a learning and improvement system and adopting evidence-based management skills for reliability.

Strategy 4: Create a learning and improvement system.

Strategy 5: Establish data capture, database, and performance metrics for accountability and improvement.

Strategy 6: Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.

Strategy 7: Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients.

Please forward to anyone you think may appreciate–Happy Patient Safety Awareness Week!

Breaking the Wall of Silence: A Documentary Film In the Making

The following documentary film trailer for the work in progress entitled, Breaking the Wall of Silence, further reinforces and outlines the need for healthcare consumers to have better access to transparent information as it relates to every aspect of the care being purchased. From access to medical records, to the track record of the physicians performing procedures, to open, honest communication when things don’t go as planned — healthcare thought leaders share their experiences in a system that has taken on a life force of its own, at times at the expense of patients and families. Filmmakers, Carolyn McCulley and Brad Allgood from Citygate Films, also follow Dave Mayer MD, as he leads the Quality & Safety journey at the MedStar Health system in Washington DC/Maryland to create a care environment that embraces the new and evolving demands of healthcare.

Click here to support the film via the Kickstarter Campaign for Breaking the Wall of Silence.