Last week was the first of three annual Patient Safety Summer Camps for graduate resident physicians in 2017. Each year, I learn from the resident scholars who attend about the current safety challenges and barriers they face on a daily basis as they try to both deliver safe care to patients, and learn to become good physicians. Over the last few years, however, I have noticed a growing concern among our Telluride Scholars, a theme that centers on the overall well being of resident physicians in the healthcare workplace.
Discussions around resident well being reached an all-time turning point this past week during an interactive presentation on Care for the Caregiver programs led by Crystal Morales from MedStar Health. During the presentation, Crystal asked the residents to think back and remember the first patient death they experienced—not from a medical error, necessarily, but just the first patient they cared for who died. She asked them to focus on how they felt versus the details of the case, and then inquired if anyone was willing to share their story with the group.
A first brave resident raised her hand. Before she could finish her story, she broke down in tears yet she continued to talk about how that patient’s death affected her still to that day. A second hand was raised and then a third…it was like someone opened an emotional faucet. Each story shared seemed to be both validation and acknowledgment that the pain in serving witness to such loss deserved, and needed, to be honored. The sharing of these stories seemed cathartic; helping ease the pain this group collectively had been holding on to for far too long. Many in the room described Telluride as a “safe place” where they felt comfortable sharing these feelings, and their stories. Portions of their reflective posts on our Telluride Summer Camp blog are shared below. I encourage all of you to visit the Telluride blog and read their stories in their entirety.
- “The afternoon of day 3 left many of us in tears as we went through our stories of first deaths and tragic patient outcomes. It was clear, as these stories came out that many of us were still hanging on to these painful memories and will probably do so for the remainder of our careers. Another common thread in these stories was the lack of support after these unforgettable events happened. In healthcare, we are expected to take a deep breath and move on with our days as if nothing ever happened. Take another history, make another diagnosis, and speak to another family, all while making sure we check our emotions at the door”.
- “Yesterday during one of our group discussions, people went around the room discussing the first time they were involved in the death of a patient. The different stories told were poignant and extremely emotional. Some of these stories were quite recent while others happened years ago. The unifying trait in all of the stories was the raw emotion and pain in the voices of the speaker. Every story told ended the same way… “and then I just went back to work.” Years later it is entirely evident that these wonderful caring people are still hurting. As a profession we are failing. We are eating our young with the perverse attitude that it will build a thick skin and make you a better doctor. We are not robots.”
- “Why is this happening? We, the physicians, need to speak up. We need to consider how talking about our own reactions to and reflections of patient care events is indeed a critical piece of patient-centric care. Today, we finally had a chance to let it out, to vent our frustrations, to discuss our feelings of self-blame and near self-collapse. These stories are so important because we have to let each other know, YOU ARE NOT ALONE.”
- “If we are unable to care for ourselves, we won’t be able to provide the best care to our patients and their families. The tremendous support ‘care for the caregiver’ provides is amazing and has inspired me to investigate the options my institution can provide.”
- We discussed how good it felt today to open up about the loss of our patients and the support (or lack of) we get in these moments. So many times we just need to talk it out, feel heard, and feel validated. These conversations are cleansing and necessary.”
- “Today, we talked about care for the caregiver. After all, there is no other workplace like the hospital in terms of sacrifice, acuity, and risk of burnout. With such high stakes, healthcare providers are subject to exorbitant levels of stress that perhaps defy human physical, mental, and emotional capacity.”
In its 1999 report, To Err is Human: Building a Safer Health System, the Institute of Medicine (IOM) concluded that medical errors, particularly hospital-acquired conditions, may be responsible for as many as 98,000 deaths annually, at costs of up to $29 billion. Suddenly, quality healthcare and patient safety became central, public concerns in the United States. According to the Institute of Medicine (IOM; 2000), medical errors accounted for between 48,000 and 98,000 deaths annually in the U.S. At that time, medical errors were considered the eighth leading cause of death in the U.S.; more prevalent than deaths from breast cancer, AIDS, or motor vehicle accidents.
I started my practice in medical education in 2000 at Southern Illinois University College of Medicine. At that time we were creating a new and robust, medical curriculum. Similarly to other medical schools, however, we had just a few lectures in this content area. By 2003, quality and safety had become central concerns in the U.S. Communication failures were identified as the root cause of the majority of both malpractice claims and major patient safety violations, including errors resulting in patient death. The Joint Commission found that communication breakdowns were the root cause of 60% of medical errors, 75% of which resulted in death. 2,034 errors, which means 915 people died as a result of a communication error in 2003. Clearly it was time to get serious.
It was 2005 when I joined the University of Illinois Chicago College of Medicine faculty in the medical education department. I had the opportunity to engage with faculty members seriously interested in training learners in patient safety. For two years, I worked with this team to create and deliver lectures and simulations, co-lead a patient safety elective, and was invited to attend the Telluride Experience.
In early 2007, we were in the middle of creating a patient safety institute to deliver a formal curriculum on the subject. One of my goals was to create an online, degree-granting patient safety leadership program. 6 months later, the Master of Science in Patient Safety Leadership (PSL) proposal was created. Once it had been approved by the various required entities, the curriculum was created by our team of patient safety experts. In fall 2008, the first cohort of learners began; however, this was only the beginning. The PSL program was very successful and applications were rolling in. The learners couldn’t get enough learning and we were getting rave reviews. Despite the program’s success, however, I found a letter from the Senior Dean for Medical Education that said they no longer needed my services.
So the journey continued… Thankfully, I had received opportunities from other medical schools. As the Associate Dean for Medical Education at the University of Cincinnati College of Medicine (UC), I had the opportunity to work with an amazing faculty and a very talented Senior Dean for Medical Education, Andrew Filak. Within 20 months, we created a new, contemporary, four-year medical school curriculum, which was awarded full accreditation from the Liaison Committee on Medical Education. . During these very busy years, we created an Institute for Healthcare Improvement (IHI) Open school and embedded safety, quality, and leadership into the curriculum. With other deans from nursing and pharmacy we implemented interprofessional sessions for medicine, nursing, and pharmacy learners. Each year, I also attended the Telluride Experience as a faculty member and continued to bring learners from UC to the events. One day, I picked up the phone and everything changed again.
It’s 2013 and the original PSL team is back together again; this time in Baltimore, MD and the District of Columbia. Despite 14 years of experience in medical education, I was amazed by how little quality and safety training was provided in medical and nursing schools nationwide. Basic training is required by accreditation bodies, but it does not adequately prepare the physicians and nurses for the complexity of medicine in today’s world. While some positive changes have occurred, we are still battling the same issues.
A little over a decade later, medical errors are now the third leading cause of death and account for more than 400,000 deaths per year. Recent studies have reported that as many as one-third of hospitalized patients may experience harm or an adverse event, often from preventable errors. Unfortunately, competencies for optimal patient care outcomes in the clinical environment include knowledge, skills, and attitudes in critical disciplines not traditionally trained in medical or other health science programs. Frankly, it’s hard to imagine that one can provide ‘care of the entire person’ if attention to quality care and patient safety is missing.
The absence of such training leads to medical errors – a serious problem that affects not just patients but also the health care workers involved. Many good physicians, nurses, pharmacists and other health care professionals have left the field due to depression and lack of support from their colleagues. Even more unfortunate, a growing number of health care professionals take their own lives each year when involved in a preventable medical error.
It’s 2017 and we have created a solution to this pervasive crisis. I worked with Georgetown University and MedStar Health to create a new Executive Master’s Degree in Clinical Quality, Safety and Leadership (CQSL).
CQSL unleashes a systematic, evidence-based education that will achieve striking results in safety, quality, reliability, and healthcare value. With a learner-focused environment the CQSL program will equip learners to become leaders in the advancement of safety science and quality healthcare. The curriculum includes online asynchronous coursework, simulation, team training, and one onsite residency. The inaugural class begins in fall 2017.
Health-care practitioners and leaders need new skills and attitudes to meet the changing needs of patients in a medical environment that has complex multilayered systems, informatics, assessment, outcomes, and quality indicators. Secondary to these changes, health care has become a high-risk industry. As Yukl (2002) noted, “A vision is seldom created in a single moment of revelation, but instead it takes shape during a lengthy process of exploration, discussion, and refinement of ideas”.
And so the Journey continues…
As many of us begin our regular summer pilgrimage to Telluride, Colorado, it is hard to believe that thirteen years have passed since a small group of passionate healthcare leaders came together in Telluride to design a comprehensive patient safety curriculum for future healthcare leaders. As a result of that work, many wonderful and highly committed patient advocates and safety leaders will once again convene in Telluride the next two weeks to continue our mission of Educating the Young. For those not from Colorado, summertime in Telluride may be one of the best kept secrets in the United States. Be it the old west feel of the town, or the hypoxic “magic” that happens at an elevation of 9,500 feet, Telluride has always been an educational mecca for everyone that joins us during these memorable weeks of high altitude learning led by the MedStar Institute for Quality and Safety and the Academy for Emerging Leaders in Patient Safety (AELPS).
Over the past thirteen years, about 1,000 students and resident physicians from across the world have attended one of our AELPS Telluride Experience workshops. Many of our past alumni have gone on to lead work that has inspired real change at their home institutions–change that is helping make care safer and more transparent. We look forward to meeting yet another class of emerging patient safety leaders these two weeks who will also stand up for patients, transparency and a true culture of safety during their careers.
Through the generous support of The Doctors Company Foundation (TDCF), Committee of Interns and Residents (CIR), COPIC and MedStar Health, about 180 health science students and resident physician leaders will be attending one of four, week-long Patient Safety Summer Camps being held in the United States this summer. The US camps are held each year in Telluride CO, Baltimore MD, and Napa CA. In addition, another 100 future healthcare leaders will be attending one of our AELPS International Patient Safety Summer Camps this year in Sydney, Australia and Doha, Qatar.
A new generation of caregivers – young physicians, nurses, pharmacists and other allied health professionals – are stepping up and starting to make a difference in healthcare. Many of them understand and appreciate they will soon be the gatekeepers for safe, high quality, high value patient care. They are taking this responsibility seriously – more seriously than I and my colleagues did when we were their age. These young leaders are the future of healthcare…and the future is bright.
We hope you will follow our activities and learnings through our student, resident and faculty blogs, found here on ETY or The Telluride Blog, found here. Please comment and join our conversation on the blogs or on Twitter (@TPSSC and #AELPS13).