As a longtime runner and marathoner, I often find myself using running analogies on this blog to share similarities between distance running and patient safety (see previous ETY post The Healthcare Safety and Quality Marathon). Training for a marathon takes hard work and sacrifice, as does changing a healthcare culture. Similar to running a marathon, there are times it feels like we hit the same “Wall” in healthcare that runners can hit at mile 18-20. It is only through perseverance and determination that we push pass that wall and achieve the goals set many months before.
The Boston Marathon is the ultimate marathon for runners. It is athleticism and celebration at its finest for those fortunate enough to quality. Being an average runner, I have always lacked the times required to qualify for Boston…. but like many, have always wondered what it would be like to be running the streets of Boston that Monday afternoon each April.
Last Monday, it felt to many of us that we as a country may have hit the “Wall”. But watching the light in our collective hearts overcome unimaginable darkness, we pushed through that wall in Boston and across the country–continuing to rise above yet another emotional challenge put before us as a nation. As a city united, Boston made us proud. Their EMT’s, police and firefighters responded with amazing courage, determination and expertise. So did their medical community. According to all accounts, they were amazing – many of whom were marathon runners themselves, and who immediately changed into scrubs and worked the next 48-60 hours helping those harmed by this senseless violence. Runners immediately went to hospitals after the race and donated blood.
Similar compassion and support is also occurring across our country…people are running to raise money to help those harmed in Boston. Having had family members waiting for me near many race finish lines, my thoughts this past week have been fixated on those family and friends less fortunate. They came in hopes of celebrating with their loved ones – now they need our support. The links below share ways that this support can be provided.
Donations have poured in for Boston Marathon bombing victims, with more than $2 million collected via online “crowdfunding.” Hundreds of thousands of dollars have been given for injured mother and daughter Celeste and Sydney Corcoran, Jeff Bauman (who first helped identify the bombers) and newlyweds Patrick and Jessica Downes, who each lost a leg, among others. This flood of generosity has raised concerns over fraud, since critics say the speed some crowdfunding sites allow for opening and collecting funds makes them vulnerable to abuse. But donors give anyway, and the biggest sites, such as Kickstarter, GoFundMe and GiveForward say their vetting and self-policing minimizes the risks. People wanting to contribute to a general Boston fund, as opposed to individuals, are encouraged to go through The One Fund Boston Inc. [www.nbcnews.com]
While I know I won’t be able to qualify, I do know where I will be next April 21st – in Boston on Exeter Street near the finish line.
By Michael Kantrowitz, DO (Guest Author and Chief Resident, Maimonides Medical Center)
It seems that there is a growing number of residents out there who are.
This past weekend, the Committee of Interns and Residents (CIR) hosted an event called “What’s Your QI IQ? Resident Physicians as Quality Improvement Leaders” in New York City. The program was developed as a partnership between the CIR Policy and Education Initiative and the Healthcare Transformation Project of Cornell University.
The day kicked off with introductions by Dr. Svjetlana Lozo, an ob/gyn resident from Maimonides Medical Center in Brooklyn and Dr. Rick Gustave, an emergency medicine resident at Lincoln Hospital in the Bronx. They described the push towards improved quality, safety, and transparency in medical practice and the central role that residents are beginning to play in leading that charge. Next up was Dr. James Pelegano who is an assistant professor and director of the master’s program in healthcare quality and safety at the Jefferson School of Population Health. Dr. Pelegano discussed his own experience in quality improvement in practice as a neonatologist. He then led us in a root cause analysis exercise using the recent death of Rory Staunton, a pediatric patient who succumbed to sepsis as case example.
Breaking into small groups, we were asked to take on various roles of the multidisciplinary team members who were involved to try to identify the contributing factors that led to the delayed recognition of Rory’s ultimately fatal illness. Many residents had never participated in a root cause analysis before, which sparked much discussion over the clinical and communication issues that could be improved. Dr. Pelegano challenged us to think like a hospital’s administration and find a process improvement that could be implemented within two days. He also discussed tools such as flow charts, Ishikawa diagrams, and PDSA cycles which we could add to our arsenal.
We then heard from three residents at CIR represented hospitals who discussed projects they have worked on at their institutions.
- Dr. Constance Liu, an ob/gyn resident at Boston Medical Center, discussed efforts to improve resident education and adverse event reporting. Residents at her hospital have received a grant for this work.
- Dr. Sepideh Sedgh, a pulmonary/critical care fellow, described the work that residents at Maimonides Medical Center have done as part of a joint quality partnership between CIR and the administration. Residents, including myself, took on the task of significantly improving the medication reconciliation process to make patient discharges safer
- Finally Dr. Say Salomon an internal medicine resident from Woodhull Medical Center explained how their House Staff Safety Council has been enhancing patient care. One project he talked about was a resident-led program to reduce heart failure readmissions through better patient education.
The day ended with an interactive discussion run by Jennifer Weiss, a public health consultant with SAE & Associates. She led a workshop on developing and writing quality improvement and patient safety grant proposals using our own ideas for projects. I plan on using these skills as I look to find funding for future projects of my own.
It’s safe to say that we all left with a boost to our QI IQ and I’m looking forward to more events like this, which will train and challenge our generation of physicians to improve quality and safety.
Terry Fairbanks MD, Director of the National Center for Human Factors in Healthcare and Neil Weissman MD, Director of the Health Research Institute, both at MedStar Health, are hosting a two-day, innovative and workshop-style conference to share knowledge, spark innovative ideas, and inspire new collaborations and partnerships to apply resilience engineering in healthcare.
The conference, entitled “Ideas to Innovation: Stimulating Collaborations in the Application of Resilience Engineering to Healthcare,” will be held on June 13-14, 2013 at the Keck Center of the National Academies in Washington, DC. Additional information and registration can be found at http://www.resilienceengineeringhealthcare.com.
What is Resilience Engineering and how is it used in Healthcare? Simply put, it is how individuals, teams and organizations monitor, adapt to, and act on failures in high-risk situations. In greater detail:
Resilience engineering is an emerging field of study that focuses on the fundamental systemic characteristics that enable safe and efficient performance in expected (and unexpected) conditions. It is a paradigm for safety in complex socio-technical systems, and its application to healthcare is very limited. During this two-day workshop, leading researchers and practitioners in resilience engineering and resilient health care will present a set of principles, practices and desired outcomes and products. After these presentations, attendees will be asked to initiate discussions that will lead to the development of an effective roadmap to catalyze the idea to innovation process – the ultimate goal is to help health care organizations and other interested parties improve quality and safety.
“Ideas to Innovation: Simulating Collaborations in the Application of Resilience Engineering to Healthcare” is hosted by the MedStar Health Research Institute and the University-Industry Demonstration Partnership (UIDP) as the first conference in UIDP’s Ideas to Innovation series.
Following are two exciting, upcoming educational opportunities focused on quality and safety that we would like to share with our ETY readers. Please feel free to share the information with colleagues!
This year, the Committee of Interns and Residents has partnered with the Healthcare Transformation Project of Cornell University to present a series of conferences in the New York metropolitan area providing education around physician leadership in quality improvement and patient safety. The first conference, entitled What is your QI IQ? Resident Physicians as Quality Improvement Leaders, will be held on April 13 in Manhattan. The one day leadership conference focused on residents and medical students has been organized and led by residents, including many from last year’s Telluride Patient Safety Summer Camp.
The conference will feature:
- Interactive didactic sessions led by Dr. James Pelegano, Program Director for the Jefferson School’s Master’s Program for Healthcare Quality and Safety, and an innovator in the field of Patient Safety and Quality.
- Small-group breakout sessions that will allow participants to practice and refine the methods they have learned.
- A panel discussion with resident physicians who are currently leading QI projects in their hospitals.
- A hands-on workshop on the formulation and writing of QI/Patient Safety project proposals.
- Where: Executive Conference Centers 1601 Broadway, New York, NY
- When: Saturday, April 13, 2013, 9:45 am – 4:00 pm (breakfast at 9AM, lunch provided)
The second exciting educational event coming up in June is the fifth annual AAMC Integrating Quality Meeting once again held in Chicago. This year’s meeting, Improving Value and Educating for Quality, is a highly interactive, interprofessional program that brings together healthcare leaders, faculty, educators, trainees and students from teaching hospitals, medical schools, health professions schools, and other healthcare organizations to share strategies for enhancing the culture of quality in clinical care and health professions education.
The program will feature:
- A number of plenary sessions, interactive workshops, and posters on topics related to aligning organizational goals and strategies around quality and value
- QI and patient safety education across the continuum
- Team-based and interprofessional approaches to quality improvement
- A plenary session by Peter Pronovost, M.D., Ph.D., FCCM, senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine
- A plenary session by Gary Kaplan, MD, Chairman and CEO of the Virginia Mason Health System
- Where: Intercontinental Chicago O’Hare Hotel Rosemont, IL
- When: June 6-7, 2013
By Michael Kantrowitz DO (Guest Author, and Chief Resident at Maimonides Medical Center)
It was exciting to be part of the filming of “Breaking the Wall of Silence” a few weeks ago as the filmmakers followed Dave Mayer up to New York where he met with leadership from the Committee of Interns and Residents (CIR). The next day they came to Brooklyn and followed me around the hospital where I work, Maimonides Medical Center. In a paradoxical way it was fun (albeit a little nerve-wracking) to be involved in the filming. The documentary is casting light on some very serious issues regarding transparency and safety in healthcare and it was a privilege to be able to discuss some of the hurdles residents face in being part of the next generation of physicians who will need to address these issues. There were a few residents who had “cameos” in the filming, who I also wanted to recognize: Drs. Steven Shamah, Nidhi Shah, and Prasun Shah. They are three of the incredible residents I get to work with everyday, and are proof that there is a changing cultural tide in our cohort of physicians. As we were filmed on rounds, we discussed safety issues such as the importance of accurate medication reconciliation and fall prevention.
After participating in the Telluride Patient Safety Roundtable last summer, I have tried to integrate what I learned into my role as chief resident. As a result, I changed much of how I approach patient safety and care quality concerns involving residents from looking to find individual fault to identifying system failures. That hasn’t happened overnight and I certainly have not perfected this approach, but not surprisingly I’ve found that it more effectively engages residents in the process, as opposed to putting them on the defensive. In academic medical centers, residents are the front line physician staff. They typically evaluate patients before the attending physician, and are often the first to respond to acute changes in a patient’s status. I’ve always enjoyed the opportunity to beat the attending to the diagnosis or stabilize a patient before they arrive because I think it has led to my own growth and independence as a physician. With such high stakes, however, it is really important to have a clinical environment in which to identify and learn from errors without fear of reprimand or ridicule. I’ve been fortunate to train in such an environment alongside colleagues like Steven, Nidhi, and Prasun.
Dave Mayer and Tim McDonald are two of the early adopters of the patient safety movement supported by luminaries and other early adopters like Lucian Leape, Don Berwick, Rick Boothman, and Cliff Hughes. Recently, I wrote on their acceptance of the American College of Medical Quality Founders Award, and promised to share some of the highlights of their collective body of work. Here are a few of those highlights:
- The creation of the University of Illinois at Chicago’s Institute for Patient Safety Excellence, one of the first of its kind in the US focused on the tripartite mission of clinical care, education and research. It is an interprofessional “confederacy” with membership from six health science colleges all working together with a medical center, leaving their personal agendas at the door, in efforts to make patient care safer and of higher quality. They recognized that the problem of patient safety and less than optimal quality is an interdisciplinary problem requiring an interdisciplinary solution. The Institute strives to discover and validate such solutions.
- The Telluride Patient Safety Roundtables and Summer Camps. The Telluride Roundtable is an annual retreat now going on nine years, where experts in safety, quality and health science education come together with patients, family members, residents and students to develop and refine health science education that supports a culture of quality, safety, and transparency in patient care. In 2013, over a span of three weeks, Dave and Tim will be bringing resident physicians leaders as well as medical, nursing, pharmacy and allied health student leaders – over 100 of them – to Colorado and Washington DC for educational immersion in quality, safety and the importance of open and honest communication in healthcare so they can go back to their schools and residency programs and “infect” others, sharing the importance of high quality, transparent patient care.
- UIC’s Masters in Patient Safety Leadership program – the first online, adult learning, interprofessional Master’s level degree program in the country where physicians, nurses, pharmacists, hospital administrators, lawyers and even patient advocates can come together and learn together. Dave shares that healthcare is a team sport today, and that all healthcare providers need to learn and practice together.
- A comprehensive response to patient harm that includes extreme honesty, full disclosure and early offer was created at Telluride in 2005 with input from Patients and Families. It has become known as The Seven Pillars Program and is the foundation of a multi-million dollar AHRQ grant that has allowed the pair to connect more than 1000 hospitals to these concepts. From a personal level, Tim shares that the program also includes their Best Practice – Physician Peer Support Program that is provided 24/7 for all physicians involved in emotionally challenging harm events.
- An award-winning educational film series entitled “The Faces of Medical Error…From Tears to Transparency”. The films are being used in medical schools, residency programs, hospital grand rounds and board rooms across the world to create conversations on how to make care safer and of higher quality. Many years ago Rosemary Gibson, a very wise woman, wonderful friend and mentor to both Tim and Dave, taught us the power of connecting the brain – the learning – with the heart – the emotion. Tim and Dave produced these movies with Rosemary’s words in mind and dedicated them to the families who have lost love ones due to unintentional harm. As Dave shares, they are the true heroes, the patent and family advocates who, despite their tremendous loss, give back every day in efforts to make care safer for others.
And what I’m personally thankful for is that they stuck with it — this is not a journey for weak of heart — and it’s not something for those driven by instant gratification. Changing an entire culture of an industry takes those like Dave and Tim, who can take their lumps along the way and keep moving forward because they care so deeply about the well-being of patients and the profession they have dedicated a lifetime to.