After a very successful Academy for Emerging Leaders in Patient Safety: The Doha Experience (#AELPS16) workshop in Qatar last month, our faculty will now head to Sydney, Australia mid-April to continue sharing our Telluride Patient Safety Summer Camp curriculum with future healthcare leaders from around the world. Through the years, many Australian patient safety leaders, such as Cliff Hughes, Peter Kennedy and Kim Oates, have been regular attendees and teachers at our patient safety workshops in Telluride CO, Washington DC and Napa CA. The Clinical Excellence Commission (CEC) in New South Wales has also supported a number of young Australian physicians to attend our US patient safety immersive workshops. These young physicians have then gone on to assume quality and safety leadership roles at their institutions upon returning home.
Kim Oates, emeritus professor and Director, Undergraduate Quality and Safety Education at the University of Sydney and Carrie Marr, Chief Executive, at the CEC are the visionary leaders bringing the Academy for Emerging Leaders in Patient Safety: The Sydney Experience program to Australia. The Sydney Experience team includes fellow CEC and Australian healthcare leaders such as Telluride Alum Sarah Dalton MD, and first time attendees, May Wong and Teresa Mastroserio. Thanks to the generous support of the Avant Mutual Group, the major medical defense group in Australia, the Division of Midwifery and Nursing, New South Wales Health, and the CEC, over thirty young medical and nursing leaders will be able to attend #AELPS16: The Sydney Experience, an immersive, four-day patient safety education program. The program has also received significant support from Minister Jillian Skinner, New South Wales Minister for Health, who will attend the last day of The Sydney Experience, and will address both learners and faculty.
We are both honored and energized by the opportunity to distribute our patient safety education curriculum to those at home and around the world who have similar passion of finding new and better ways to deliver the highest quality, safest care to patients. In just two months time, we will welcome Qatari and Australian healthcare professionals into our now global Telluride Experience Alumni network. In 2016 alone, over 700 future healthcare leaders will attend one of many Telluride Experience Patient Safety Summer Camps around the world and become part of this growing network of dedicated and caring patient safety leaders.
Whether or not Tiger Woods is deserving of being called a role model, the body of work he has accumulated is worthy of admiration, especially by younger players like Rory McIlroy. What caught my attention about yet another inspiring Nike commercial, wasn’t so much the role model himself, but the reminder that others are watching and learning from the actions of those put into a leadership position–regardless of how deserving.
In healthcare, as in sport, skills and technical acumen are only part of the equation, though often they can take many onto a stage and into the spotlight exposing behavior and character far less developed. Like McIlroy, those with talent coming up the ranks in sport can often drive their own destiny with dedication and committment. Athletes can stay a safer distance from those who have gone before them than young learners and junior healthcare professionals. But these young professionals too can drive their own destiny, and shape a new set of expectations for what success looks like in healthcare. Here’s a shout out to our Telluride Alum on this Friday!
*In the event the video is pulled, you can find it on YouTube — Nike Golf, Ripple
The deadline to apply for 2015 sessions of The Academy for Emerging Leaders in Patient Safety: The Telluride Experience has been extended to February 15th! Medical students, nursing students with less than 10 years experience, and resident physicians can apply online at The Telluride Experience website by clicking here. Dates and locations include:
- In Telluride, CO: For Health Science Students-June 7th-11th and for Resident Physicians-June 12th-16th.
- In Napa, CA: For Health Science Students-July 26th-30th.
- At Turf Valley Resort in Ellicott City, MD: A combined session for Resident Physicians and Health Science Students-July 8th-12th.
Students who are accepted receive a full scholarship covering room, board, transportation voucher & all educational costs. Resident physicians accepted to attend should be sponsored by their program. Expected faculty for 2015 include healthcare and patient advocate thought leaders:
- Founder–David Mayer, MD
- Curriculum Director–Anne Gunderson, PhD
- Aviation Consultant and Author–John Nance
- Leadership Coach and Author–Paul Levy
- Founder, Josie King Foundation–Sorrel King
- Director, Foundations of Doctoring Program at University of Colorado–Wendy Madigowsky, MD
- Healthcare Advocate and Author–Rosemary Gibson
- President, Mothers Against Medical Error–Helen Haskell
- Founder, Citizens for Patient Safety–Patty Skolnik
- Director of Undergraduate Education, Clinical Excellence Commission–Kim Oates, MD
- And more…
Join us in our 11th year and become part of a preeminent and growing alumni network while developing the skills and knowledge to be a patient safety leader of tomorrow!
We just concluded another great week of learning and inspiration at the Telluride East Patient Safety Summer Camp held at Turf Valley Resort in Ellicott City, MD. Educational discussions led by Anne Gunderson, Rosemary Gibson, Paul Levy, Wendy Madigosky, Patty and David Skolnik, Richard Corder, Rick Boothman, Tracy Granzyk, Kathy Pischke-Winn, Gwen Sherwood, Lisa Freeman – some of our wonderful faculty who gave their time to “Educate the Young” on the importance of Patient Safety, Transparency and Patient Partnership. There were so many great student and resident reflections during the week but one written by Mona Beier captured both the frustration – how the current educational system is “beating down” and desensitizing our next generation of caregivers – and a flicker of hope that they still may be able to salvage the caring spirit they entered their training with…that same caring spirit that will guide them to deliver safe, high quality, patient-centered care.
First of all, I have to say this will be my first ever blog about anything….so here goes nothing….I have to say these past few days have been eye opening, and dare I say, life changing. I went into the conference not knowing exactly what to expect, but at least thinking that I knew something about patient safety and quality improvement. What I have realized is that my idea of PSQI was so unbelievably superficial. Everyone at the conference has opened my eyes to see that through everything we do in PSQI, it is ultimately for the better of our patients. Maybe because we are all required to do PSQI projects at my institution, I feel that it was always presented to us as how to make YOUR life easier and less frustrating, instead of the patient. Maybe they felt we would only be motivated if we felt we were helping ourselves in some way. These talks, stories, reflections have all made me take a step back and realize what it is all about: our patients. It makes me really sad that in the very little time I have been in training that I have completely lost sight of that. There is really no excuse for that. I could blame exhaustion, long hours, too many patients in too little time….but at the end of the day, there is no excuse for not putting our patients as our number one priority.
I have had some really negative realizations of myself during these past few days. I hate to admit this, but during a lot of the talks and the videos, I saw things that I had done, and I have seen my colleagues do time and time again. It is almost a daily occurrence that I hear people labeling patients as “high maintenance” if they ask questions about their healthcare or if they “challenge” our decisions and our actions. Instead, we should be celebrating this and saying thank you to them for taking an interest in their own health care. I have replayed imagery in my mind about how many times I have rushed through explaining informed consents, or felt hurried to get histories and physicals because I have 48392 other things to do (seemingly). Or, how many times I have interrupted and not listened. Instead, I should be finding other ways to make my day more efficient so that I will have more time with my patients. Or, maybe I stay an extra 30 minutes a day so that I have that extra 5-10 minutes with patients. Sometimes, a few more minutes can make all the difference. I have thought about times when I have anchored, or had premature closure of patients I was taking care of—and it wasn’t until they were not getting better or something was going wrong that I ever stopped and thought that, hmm I could be wrong or that I was missing something. The talks at the conference have made me realize that I should be doing this every day–stopping, taking time to think–and say, is this what’s going on? what would be the worst thing that I could miss? should I go back and get more history? does this make sense? Moreover, I thought about times when something actually did go wrong–when patients on my team have gone to the ICU or have died. I tried to replay in my mind, and again, I saw myself saying “oh, they were very sick”–almost trying to justify it to make myself feel better. Being here these past few days is going to make me view this completely differently. I am going to take the time to think about what happened when things went wrong. Was it preventable? Was there something else we could have done? Why did this happen in the first place? What were the series of events that led up to this? Did I call the family? And more importantly, was my conversation meaningful with the family? Did I address their needs and reassure them? Was I there for them like I would want someone to be there for my family member?
Anyway, I could go on and on. There are a lot of other lessons I have learned. All I really know is that I am walking out of here a better person than when I came in. This conference has inspired me to take a deeper look into who I am—what kind of physician I want to be—and what kind of person and role model I want to be to my peers, my patients, and really everyone in my life. I am inspired to try and break the mold of the culture we have grown so accustomed to—the culture where everything seems to be about me–and remind both myself and others that is not why we are here.
Having just concluded another inspirational week of learning at our Telluride Patient Safety Roundtable and Resident Summer Camp, I couldn’t help reflect with our faculty on all the amazing and passionate young caregivers who were with us. Thirty resident physician leaders, each chosen by medical center leaders from across the country, actively engaged with international leaders in patient safety and patient advocacy, with the goal of making patient care safer. All of our faculty commented that the experience and passion of the residents grows each year, many citing the influence of past Telluride Resident Scholars who have led change and served as role models at their institutions.
However, what all of us also noticed is the growing frustration shared by many of these resident leaders. Their personal stories describe a health system that is totally broken – poor or little communication among care teams, disruptive and abusive caregivers, extreme work demands and pressures being put on them to get things done even when it means putting patients in harm’s way. Some shared that on call, they are being asked to care for as many as 50-60 patients while also having to admit new patients to their units with little or no support – a set-up they say all too often causes patient harm. Others shared their fear in calling for guidance from higher level care providers due to an underlying culture that says “you are weak and inadequate” if you call someone for help even though that call and assistance could save a life.
Many also shared their personal “silent hurt” after being involved in an incident that harmed a patient. Telluride provides a safe environment for attendees to share personal stories they cannot share at their own hospitals. While a number of institutions have started care-for-the-caregiver programs, this growing “second patient” concern among our resident physicians is not being addressed. I would like to share one of the many reflective posts authored by one of the residents this past week on the Telluride Summer Camp blog – this one by Nicholas Clark, a resident physician at Children’s Mercy Hospitals and Clinics of Kansas City. I had the opportunity to visit CMH last year – they are doing great work in safety and quality – their commitment to patient safety was again very evident in the five days I got to spend with Nicholas.
Where is our support… On Wednesday 6/11 we discussed the case of “Sally,” a 9-year-old girl who died because of medical errors. Regardless of how you look at it, this is a tragedy. In our discussion, the presenter described why this resident was “set up to fail.” The resident had undergone numerous emotional battles in the prior months on the wards and in the ICU, had struggles outside of the hospital, and ultimately quit the residency program as a result of Sally’s death, but there was not one discussion on Wednesday about how we should care for our residents.
Unfortunately, this resident’s story is all too common. Many of our Telluride attendees sympathized with the resident outlining how similar their experiences have been to Sally’s resident. I too can look back and see myself in that position. It is well documented in the literature that residents, regardless of profession, develop higher rates of depression and suicide than the general population as a result of our profession. Up to 20% of residents and medical students will face depression, and up to 74% of residents will face burnout. Those residents who battle with depression are six times more likely to cause medical errors than those residents who do not suffer with depression.
While it is easy to point the finger at the resident or the system for causing medical errors, and, at the same time, provide support for the family and the patient, there are few programs in place that support our residents and medical students. These are individuals who choose the medical field to cure pain and suffering, not cause them. When residents discover that, despite their best knowledge, skill, and intention, they harm someone, it is absolutely devastating! Do not get me wrong. I completely agree that we should first tend to the patient and family that have been affected.
However, we cannot forget about the second patient that was harmed – the resident. We need systems that automatically fire to debrief residents when harm occurs so they can learn from the event. We need systems that automatically fire to find systematic solutions to the problem so no other patient is harmed. We need systems that automatically fire to provide support for patients and families who suffer harm. However, we also need systems that automatically fire to provide emotional support for our residents when they are involved in a case of patient harm. Finding that you were part of the cause for patient harm can have a devastating and lasting effect on a resident. Residents are already a set up for depression which, as mentioned, is then a set up for further medical errors. These two perpetuate each other in a never-ending cycle. We need to break the cycle. We need support!
The stories shared by many of the residents reminded me of stories I have read about the psychological effects many wonderful and courageous military personnel suffer due to combat stress and personal events that have changed their lives. These are some of our top residents, chosen because they are Chief Residents or leaders among their peers. If they are struggling, how are others surviving? Our resident physicians are our future. They enter healthcare hoping to heal and do good things. Instead many finish their training traumatized and changed for the worse. They carry psychological scars that continue to haunt them for years…and they struggle with why they chose the field of medicine as a career. As Nicholas asks “Where is their support?” To be continued…
Telluride Patient Safety Summer Camps & The Doctors Company Foundation Add “Telluride West” for 2015Posted: May 23, 2014
David Kern, in his book entitled Curriculum Development for Medical Education: A Six-Step Approach, said, “The ultimate purpose of a curriculum in medical education is to address problems that affect the health of the public.” I think we can all agree patient safety is a public health problem, however, medical and nursing schools have been slow to change in the face of this crisis, and instead, remain mired in a very traditional 1980’s curricular model. I can’t help but think of Einstein’s mantra…“insanity is doing the same thing over and over, yet expecting a different result”.
Fortunately, others are trying to help…
The Doctors Company Foundation (TDCF), created in 2008 by The Doctors Company–the nation’s largest insurer of medical professional liability for physicians, surgeons, and other health professionals–is one group at the forefront of medical education change, supporting many medical education programs and projects. From their website:
The purpose of the Foundation is to support patient safety education for health care professionals in training and in practice, patient safety research with clinically useful applications, and medical professional liability research.
TDCF has also been a long-time supporter of the Telluride Patient Safety Summer Camps for health science students. Over the last four years, through their generous support, close to 200 health science students will have attended one of our week-long patient safety summer camps. Student summer camp reflections and experiences have been shared on the ETY blog through the years, as well as the Telluride Sumer Camp blog.
Because of our past success, and the willingness of The Doctors Company and its Foundation’s mission to make care safer for our patients, we are excited to announce that the Telluride Patient Safety Summer Camp will now offer three one-week student summer camps in 2015–with our newest patient safety camp being held in California (“Telluride West”). Ninety health science students from across the country will now be able to attend one of the three, one-week patent safety summer camps being held in Colorado, Washington DC and California. Leaders and visionaries from The Doctors Company and its Foundation, such as Richard Anderson, David Troxel, Leona Siadek-Rice and TDCF board members, believe in the Educate the Young premise, and back it up through their generous and continued support of our Telluride Patient Safety Summer Camp mission.
Combined with the two weeks of Patient Safety Summer Camps for Resident Physicians supported by COPIC, CIR and MedStar Health, there will now be five weeks of patient safety summer camps offered each year. That makes over 150 of our future health care leaders immersed in patient safety and transparency education led by international leaders in patient safety. I think even Einstein would be happy….
This coming Saturday, April 26th, the Committee of Interns and Residents (CIR) will be hosting its next QIIQ Conference titled, “How to be a Lead Agent of Change: From Bedside to Transformative Care“, in NYC. Rosemary Gibson, Carole Hemmelgarn, Shelly Dierking and I have the honor of joining leaders from CIR to help facilitate the all-day interactive session. While many faculty will be attending, the major focus of this educational meeting will be on the residents, both from CIR Hospitals as well as other GME programs, and aligns with the “Educating the Young” mission.
Residents can be change agents for safer, higher quality care. There are now numerous examples across the country of this fact–residents leading important quality and safety initiatives that have reduced risk and raised the quality of care provided–and they have done this work despite internal challenges and long work weeks. Those that have followed our ETY blog for the past two years will remember my post on the work of David Leach, the former CEO for the ACGME (see The Canary in the Coal Mine…). In one of his publications, Dr. Leach shared the most important role of graduate resident physicians was to act as the “moral agent” for their patients. Residents must be the gatekeepers for safe, high quality care–a sentinel on watch for the many unsafe conditions they might encounter while trying to provide optimal patient care, prepared to alert faculty and leadership to these unsafe conditions, and then work with their institutions to find solutions to remove risk from the patient experience. The analogy Dr. Leach used was the canary in the coal mine, taking on the role of guardian and protecting others from harm before it was too late. I loved this “moral agent” concept. It is so simple, yet so important in the quest for safer, higher quality, patient care. In academic medical centers, resident physicians spend more time in the hospital, have more direct contact with patients, and see many more unsafe conditions during days, evenings and weekends than most other caregivers, except possibly nurses. And they do it many times with little, if any, direct supervision. Resident physicians can be those sentinels and serve as excellent change agents for safer care.
We need more conferences like CIR’s QIIQ focused on our next generation of caregivers. Please help spread the word about the conference. Below is some additional background information with the links to register. The third link is the conference brochure which has additional details. We appreciate the support and as always, thank you!!
The one-day conference on How to be a Lead Agent of Change will be held Saturday, April 26th in New York City. Given the importance of the patient experience and the desire for more patient-centered care, the Committee of Interns and Residents conference is meant to empower medical residents to develop and execute high-value care projects in their hospitals and health systems, and better equip them with the competencies they need to work in a rapidly changing delivery system.
To register for this conference, please click here. There will also be a webcast, and people can sign up for that here. The agenda and conference brochure can be found here (this includes logistics on location and timing, as well as goals for the day and additional contact information). Please feel free to share this information, as well as the links to register, with your organization and networks.
*CIR has also been tweeting about the conference with the #QIIQ hashtag. Here is a sample tweet you are more than welcome to share with your followers: What’s your #QIIQ? Join @cirseiu & @EinsteinMed in NYC on 4/26 for the next #QIIQ conference. Register now! bit.ly/qiiq426
Kim Oates MD has been a regular faculty member at the Telluride Patient Safety Educational Roundtable and Summer Camps, which is no easy accomplishment given he travels to this remote Rocky Mountain town all the way from Australia. Kim, who is a pediatrician by training, is a medical educator to the core, and is now Emeritus Professor, Director Undergraduate Quality & Safety Education, Clinical Excellence Commission in New South Wales. The following is an excerpt from a piece he wrote on kindness in healthcare for the Royal Australasian College of Physicians, recently reprinted in the Medical Journal of Australia. Please feel free to share with colleagues. The entire abridged piece in MJA can found by clicking here.
Way back in my intern days, it was unusual for consultants to talk with their “public” patients…The hard stuff was often left to us — the interns, young people with minimal life experience, an overwhelming workload and no training in the gentle art of communication.
At my teaching hospital a time was set aside once each week when family members could come to the hospital foyer, page the intern and ask questions about their loved one’s condition. In my third month after graduation I assisted at a laparotomy on a fit, active 54-year-old man who presented with a hard lump at his umbilicus. The laparotomy showed widespread cancer with multiple metastases. The surgeon closed the wound. There was nothing to be done…It was my job to tell his unsuspecting wife when she came to the foyer to ask about her husband’s operation. I told her the truth as kindly as I could. Her eyes welled up with tears. So did mine.
Afterwards, I felt embarrassed about my show of emotion. Why couldn’t I be “more professional” like my consultants? I wondered if I was really suited to do medicine. Later, I realised that it may have helped her. She may have seen that even though the news was bad, I cared…In subsequent years, as a consultant, my eyes would sometimes moisten when I had to tell a parent that their child would not survive. And sometimes it happened when I had the pleasure of giving unexpected, but joyful news.
Was this behaviour “unprofessional”? Or is there is room for families, junior doctors and medical students to realise that we, the more senior doctors, do care? To realise that there is more to it than striding the narrow catwalk between aloofness and over-familiarity, that there is a place to show humanity and that it is not unprofessional to let people know we care…
…Of course, there are some professional boundaries which we must always respect…these well accepted boundaries are different from really caring about our patients and doing something about it…We don’t have to take off our compassion, or our ability to show it, when we drape a stethoscope around our neck. The need for doctors to be professional is not synonymous with being emotionless. There is more to this than just being nice to people. It is about being kind. It also has implications for the quality of patient care…
Powerful recommendations — listen to patients; model transparency; model trust; keep on learning.
One-Day Conference to Help Physicians Improve Patient Care and Publish the Results
Join a group of young healthcare innovators at the New York Academy of Medicine
November 23, 2013
CME Credit and Exposure to National Patient Safety Innovators
“QI: Plan. Execute. Publish” is the tagline for the November 23, 2013 conference, jointly sponsored by Albert Einstein College of Medicine (@EinsteinMed) and the CIR Policy and Education Initiative (@CIRSEIU), where resident and faculty physicians in New York-area hospitals will take a leap forward by meeting to empower physicians to conduct scholarly quality improvement (QI) projects. Many of the resident physicians and organizers are Telluride alumni, and we are always excited to watch them carry quality and safety initiatives to the next level.
Saturday’s meeting agenda includes the following faculty:
- Robert Sidlow, MD, MBA, Associate Professor of Clinical Medicine Albert Einstein College of Medicine Interim Chairman of Medicine Jacobi Medical Center and North Central Bronx Hospital, Bronx, NY
- Karyn Baum, MD, MSEd, Associate Chairman for Clinical Improvement
University of Minnesota Medical School Minneapolis, MN
- Gregory S. Ogrinc, MD, MS, Associate Professor of Medicine and Community and Family Medicine, Director, Office of Research and Innovation in Medical Education, Dartmouth Medical School Associate Fellowship Director, White River Junction Veterans Hospital, White River Junction, VT
- Amit S. Tibb, MD, FCCP, Assistant Professor, Department of Medicine, Albert Einstein College of Medicine Director, Medical Intensive Care Unit, Jacobi Medical Center
- Sepideh Sedgh, DO, Pulmonary Critical Care Fellow, Maimonides Medical Center, Brooklyn, NY
National President, Committee of Interns and Residents
- Farbod Raiszadeh, MD, PhD, Committee of Interns and Residents Policy and Education Initiative
- David Eshak, MD, Internal Medicine Resident Jacobi Medical Center, Bronx, NY
New York Regional Vice President, Committee of Interns and Residents
“It is tremendously gratifying to witness the cultural transformation which has taken place in the world of graduate medical education: it is now axiomatic that physicians must be given the skill set to “round on” and “cure” sick systems in addition to sick patients,” said Dr. Robert Sidlow, Associate Professor of Clinical Medicine at Albert Einstein College of Medicine and Interim Chairman of Medicine at Jacobi Medical Center. “Since frontline housestaff are now expected to learn and apply principles of Quality Improvement to their everyday work, it is only natural that we, as educators, teach trainees how to convert their efforts into generalizable, publishable scholarship and communal learning. This conference intends to accomplish just that.”
“As physicians on the frontline, we know our patients and we want the best for them. That’s why we’re leading quality improvement and patient safety endeavors in our hospitals,” said Dr. David Eshak, Telluride alum and an internal medicine resident at Jacobi Medical Center in the Bronx and a regional vice president of the Committee of Interns and Residents. “For us to be effective in QI, we need to work hand-in-hand with all stakeholders and we need to publish our work.”
The program features nationally recognized patient safety and quality improvement innovators Dr. Greg Ogrinc from Dartmouth Medical School and Dr. Karyn Baum from the University of Minnesota. Their hands-on, case-study approach focuses on closing the gap in training in evidence-based methods of process improvement and patient safety.
More information on the one-day program CLICK HERE