The Doctors Company Foundation Opens Applications for 2016 Young Physician Leader Essay Contest

Vinyard_With_ViewAs our final week of the 2015 Telluride Experience comes to a close, our Telluride blog has been nourished by a new year of talented healthcare trainee reflections. Many of these young physicians and physicians-in-training, along with their nursing colleagues, have submitted reflections that we will share more on moving forward, but they can be viewed here today.

Because our scholars and Alumni often return to the ETY blog as a reference tool, we wanted to share another opportunity for all to showcase their passion and commitment for keeping patients safe through writing. The Doctors Company Foundation, an organization that also sponsors a number of medical student attendees to participate in our Academy for Emerging Leaders in Patient Safety each year, is once again partnering with the Lucian Leape Institute at the National Patient Safety Foundation (NPSF) to offer The Doctors Company Foundation Young Physicians Patient Safety Award. The award will recognize young physicians for “their personal insight into the importance of applying the principles of patient safety to reduce the incidence of medical error.” Applicants are invited to submit essays of 500-1,000 words about a patient safety event they personally experienced during clinical rotations that resulted in a personal transformation.

More information can be found on The Doctors Company Foundation website. A short summary follows:

Applicants are invited to submit essays that will be judged by a panel identified by NPSF. Six winners of this prestigious award will be selected and receive a $5,000 award, which will be presented at the Association of American Medical College’s (AAMC) Integrating Quality meeting in Chicago, June 2016. Nominations must be submitted by 5:00pm ET, Monday Jan 25, 2016.

Eligibility:

  • As of July 1st, 2015, applicants must be either a 3rd or 4th year medical student at an American medical school
  • Award is for the best essay explaining your most instructional patient safety event experienced during a clinical rotation and that resulted in a personal transformation
  • Award will be presented by The Doctors Company Foundation at AAMC’s Annual Integrating Quality meeting in Chicago
  • Registration, hotel and travel will be covered to the AAMC meeting for Award recipients

Examples of winning essays from 2014 can be viewed via a past ETY posts (click here), and a review of the 2015 Essay Winners will soon follow. For additional questions, visit The Doctors Company Foundation website, here. We know there are many Telluride Alumni deserving of an award like this so please enter, and share the patient-centered care you are working so hard to make standard of care. Good luck!

 


It is happening…a New Generation of Healthcare Professionals

TE_Napa_GroupIt is happening…and it is growing. A newer generation of caregivers – young physicians, nurses, pharmacists and other allied health professionals – are stepping up and starting to make a difference. Many of them understand and appreciate they will soon be the gatekeepers for high quality, low risk, high value patient care. They seem to be taking this responsibility seriously – more seriously than I and my older generation colleagues did at their age. They stay connected reading new information shared through social media outlets. They are doing regular literature searches for new articles on quality, safety and value. They want to learn and understand.

TE_Napa_Reception3The reflective post shared below by Rajiv Sethi is just one of many similar posts that come from our Patient Safety Summer Camps. These young learners don’t just write reflections…they take their reflections and use them to research and learn best practices related to the topic in question. They want to learn, they yearn to learn.

There are days when many of us feel we are slogging uphill, going nowhere and will never live to see the changes so badly needed in healthcare. Working with these young caregivers revitalizes the faculty, just as much as the students are energized and educated around patient safety. Spending time to both educate and learn from the young is so important to the future of healthcare, but also our future and the future of every patients.

Reflections from Day One

Published July 28, 2015 | By Rajiv Sethi

Having only been at Telluride Experience: #AELPS11 for a day, I hadn’t imagined I would have learned so much. We covered a variety of topics with important patient safety learning points. I am so grateful for the opportunity to be here and share the experience with so many motivated individuals keen to be change agents.

I wanted to focus on one of the key moments for me: The Story of Lewis Blackman (http://qsen.org/faculty-resources/videos/the-lewis-blackman-story/). We were very lucky to have Helen Haskell (Lewis Blackman’s Mother) with us and I am so grateful to her for sharing her story. So many issues were raised during the video and I was able to draw many parallels to health care in the UK. For example, the issue of reduced staffing levels on the weekend (see link). The consequences of this can be severe as was found in a study published in the BMJ, Day of week procedure and 30 day mortality for elective surgery… where patients undergoing planned surgery were more likely to die if they have their operation at the end of the week. The new plans proposed by Jeremy Hunt (Health Secretary) to increase staffing provision at the weekend in the UK are causing much controversy, recently culminating in the hashtag #IminworkJeremy (staff posting pictures of themselves at work at the weekend).

Another issue I wanted to focus on may seem rather obvious, but as a student I believe is one of the easiest things to incorporate in daily practice; the importance of health care professionals and students introducing themselves fully to patients. In the story of Lewis Blackman, there was a lack of communication and identification of the team involved in the care of Lewis. As a result his family were unaware of who best to raise issues with.

There is so much to learn from this story but I want to end reflecting on Dr Kate Granger’s hashtag #HelloMyNameIs campaign. On her blog she describes herself as a doctor and terminally ill cancer patient musing about life and death (Click here for story). She has done remarkable work in encouraging health care staff to introduce themselves to patients, with support from over 400,000 staff in over 90 health organizations including many NHS trusts. Only recently did I see a lot of the standard hospital name badges at Guy’s and St. Thomas’ NHS Foundation Trust (where I train as a medical student at King’s College London) being replaced with bright and colorful #HelloMyNameIs name badges. Although it may sound simple, the impact on the patient experience is phenomenal.

 

 


Who is Healthcare Delivery Really About?

Helen_Discussion_072715_cropOur final session of the 2015 Telluride Experience kicks off in Napa, CA this week. Once again, the learning began by sharing the Lewis Blackman story, and we were fortunate to have Helen Haskell as part of the faculty to lead discussion after the film, along with Dave Mayer. Having been part of the team who created the film, and having viewed it more times than I can count, I am always in awe of the new ideas each viewing inspires. A large part of that inspiration arises from the conversations and stories that are shared by attendees after they hear the story.

Today, there were many excellent comments but it was something Natalie B, a nurse practitioner and educator, mentioned about the fear junior healthcare professionals hold of getting chewed out by healthcare leaders that often prevents them from speaking up when they are unsure. (See her post Transparency and Vulnerability=Scary! on the Telluride Blog). The second inspirational comment came from our newest faculty member, Kathleen Bartholomew, also a nurse, who pointed out the need for a greater sense of urgency around adopting a culture of safety above all else. She continued by pointing out that 900 similar case like Lewis’ occurred in the single day and a half since our group arrived at this meeting.

Dave_Lewis_StoryThis begs the question that, shouldn’t delivery of care always be about putting the patient first versus the care provider’s ego or fear of jeopardizing a career? This phenomenon is far from limited to trainees too, which is of even greater interest. Perhaps an interesting model to consider would be to have medical and nursing schools recruit, train and accept only the most courageous students versus those with the best MCATs or test scores. It would be nice to weed out those who would/could put their own professional well-being before that of their patient at any level.

The reminder of the need for a greater sense of urgency was both valuable and validating. There have been times when it has been hard to watch Lewis’ story yet again, knowing errors related to healthcare hierarchy and culture continue to occur again and again. Helen shared that on November 6th, it will be 15 years since Lewis died–was killed–if we’re being honest. She pointed out that all too soon he will have been gone from her life longer than he was alive. This is a hard fact for all of us to hold.

One of the greatest values to the Telluride Experience is infusion of the mindfulness and ire into the minds of young healthcare trainees that comes from hearing these stories. It is both that will be needed for real change. We need providers at all levels of training who are more afraid of harming a patient than of being chewed out by a dysfunctional healthcare mentor. I would challenge those going into healthcare, as well as those already in healthcare, to be prepared to put the patient first, always. Those who are unsure this is something they can do might want to consider a different career path.


A Tribute to our Unknown Soldiers

Group_Arlington_2015One of the highlights of our Telluride East Patient Safety Summer Camp each year is our trip to Arlington National Cemetery. The cemetery serves as a burial-place for “laying our Nation’s veterans and their family members to rest with dignity and honor.” Numerous daily honors remind visitors of the service, sacrifice and valor displayed by those in the military protecting our freedoms.

Again this year, our group hiked up the hill and to a spot just beneath Robert E. Lee’s House where Rosemary Gibson provided a touching “eulogy” on the history of the cemetery and lives lost due to preventable medical harm. She concluded by asking all of us to share the name of a patient or family member we knew who died from a medical error so we could all remember them…many names were shared and honored.

Arlington_Graves_GreenWhiteAs we stood on the  hill at the end of the ceremony reflecting on those lost to medical error along with those who gave their lives for our country, we looked out upon the white gravestones that could be seen in all directions. Gravestones that seemed to go on forever. The informational brochure says the cemetery is currently the final resting place for more than 400,000 people.

The irony of the 400,000 laid to rest in Arlington hits me each year, as this is the same number of patients who die every year due to preventable medical errors according to an article published in September 2013, A New Evidenced-based Estimate of Patient Harms Associated with Hospital Care in The Journal of Patient Safety. All the white tombstones that stretched to the end of the landscape and seemed to go on forever also represented the same number of patients who die each year from preventable medical harm. We fill an Arlington Cemetery every year.

Unknown_SoldierAfter our collective remembrance of those we knew who gave their lives to medical errors, I broke from our group and walked over to the Tomb of the Unknown Soldier. As I walked up to the white marble sarcophagus, it was easy to see the words inscribed on the back:

Here rests in honored glory an American soldier known but to God.

Wanting to know more, I began reading additional information I found at the Tomb…

On Memorial Day, 1921, four unknowns were exhumed from four World War I American cemeteries in France. U.S. Army Sgt. Edward F. Younger, who was wounded in combat, highly decorated for valor and received the Distinguished Service Medal in “The Great War, the war to end all wars,” selected the Unknown Soldier of World War I from four identical caskets at the city hall in Chalons-sur-Marne, France, Oct. 24, 1921. Sgt. Younger selected the unknown by placing a spray of white roses on one of the caskets. He chose the third casket from the left. The chosen unknown soldier was transported to the United States aboard the USS Olympia. Those remaining were interred in the Meuse Argonne Cemetery, France.

The Tomb sarcophagus was placed above the grave of the Unknown Soldier of World War I. West of the World War I Unknown are the crypts of unknowns from World War II, Korea and Vietnam. Those three graves are marked with white marble slabs flush with the plaza.

Maybe it was because I had just seen David Classen at our Telluride Patient Safety Summer Camp in Colorado, but at the exact moment I finished reading the pamphlet my mind flashed to his global trigger paper that concluded adverse events and deaths from medical errors may be ten times greater than what is reported. [See‘Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured Health Aff (Millwood). 2011 Apr;30(4):581-9. doi: 10.1377/hlthaff.2011.0190. Classen DC et al]

Standing in front of that Tomb, I couldn’t help but think that each of those unreported adverse events and medical error deaths that Classen and colleagues are referring to are the unknown soldiers of healthcare. In our own Telluride East ceremony at Arlington the last three years, we have paid tribute to those we knew had been lost to medical harm, but we failed to remember our own unknown soldiers. They say that what is seen cannot be unseen. What is felt or experienced first hand, or even vicariously through the experience of others, also leaves a lasting impact. Knowledge of the magnitude of our losses due to harm through study, along with the sharing of their stories firsthand through family members at Telluride ensures that next year, we will make sure to also remember the unknown soldiers of our own.


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 struggle 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!