Residents as Sentinels and Change Agents for Safer Care

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!!

Background Info:
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!

“Educate the young, regulate the old”

“Educate the young, regulate the old”. That quote has literally followed me around the world. I can vividly remember when first making the statement. I was one of five “safety experts” on the closing panel at an international safety and quality meeting in Sydney, Australia a number of years ago. The thought was that the five of us would somehow be able to share “pearls” of wisdom regarding what was needed to create cultural change in healthcare from a safety standpoint – not an easy task to say the least and one for which I knew I had no silver bullets.

With my background and expertise in patient safety education, the microphone often ended up in my hands when related questions were raised which is exactly where it was when an audience member asked each of the panel members to summarize our thoughts in one simple, easy to understand sentence. Without hesitation, and I should also say without thinking, I quickly said “Educate the young, regulate the old”. My face froze, my hands squeezed the microphone. Oops…did I just say that? Can I do another “take” or delete that last comment? Too late. There was a mixture of laughter and hissing, clearly a sign I had hit a nerve. After a pause that seemed to last about an hour, I tried to explain what I meant.

Just before leaving the states for Sydney, at my previous position in Chicago our SCIP committee had reviewed our hospital data on compliance with the SCIP measures. It was a good meeting – data on the most recent quarter showed us to be 98% compliant. Committee members were happy and satisfied they were helping move the hospital in the right direction. We should have been happy…our previous quarterly data showed us consistently below 60% compliance. It begged the question “what had changed?”

For the previous two years, we had met regularly with the surgery specialties and anesthesia personnel to educate them on the SCIP measures and their importance in reducing infection and other perioperative risks. We had searched the literature for best-practice models we could implement within our environment. We put new process improvements in place to make antibiotic ordering and administration as simple as possible…yet we could not get our numbers above 60%. Now, all of a sudden in one three month period we were rapidly approaching 100% compliance? It took a few seconds of reflection to realize what had changed. CMS put new rules in place tying payment to compliance. Once it became a reimbursement issue, discussions in the operating room about antibiotic administration before the surgical incision now became routine. One new CMS regulation accomplished what two years of education, training, process changes and pleading had not.

I was devastated. Don’t get me wrong, I was delighted to see the positive results. But as someone who has spent a significant part of their career in health professions education, I was deflated. So still hurting from this harsh new view of the world attacking my educational psyche, when the question was asked, I responded without thinking and with emotion that had built up over a 20 hour plane ride and a couple days of jet-lagged sleep deprivation…“educate the young, regulate the old”.