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.