Following are leads from Resident Physician reflections after attending the first 2016 session of the Telluride Experience. Links are included back to the original posting on the Telluride Experience blog. Thanks to all who so courageously offered their stories from the front lines of care so that others can learn through them. It is by sharing our stories that we free another to tell theirs as well.
The Magic In Transparency
This phrase struck me as the perfect way to describe an experience I had my intern year. My first continuity ob patient had a fetal demise at 34 weeks. She was the first patient I had followed from the beginning of her pregnancy. I performed her dating ultrasound at 9 weeks. Unlike many of my patients, she and her husband faithfully came to every prenatal visit. She did not smoke, use drugs and followed the dietary guidelines. Her husband was the chatter one of the duo, while she would calmly take everything in at our visits. They both teared up when I told them they were having a girl at the 20 week ultrasound. They told me her name was Emma. More…
I was not going to share this but have been inspired by the courage of others around me. So thank you!
…In the first few days of Residency, we had a mandatory “Emotional Harm” meeting. I thought it was nice of them to do and always a good reminder. It focused on the empathy towards the patient and not losing our empathy when getting in the rhythm of dealing with similar situations and cases over and over again. I loved that they did this. This is something that is so important to remember and necessary to address.
Looking back however, I just wonder what about my emotional harm? Where are my resources? In this first 7 months of my residency experience two Senior Attendings committed suicide. I did not know the first, but I certainly knew the second. While there was heartfelt sadness and memorials to honor both, there was nothing else. No counseling offered to employees, no conversations, no checking in after some days, nothing at all. More…
Humility and Humanity
Humility and Humanity. This phrase stuck with me from Dan Ford’s talk. From medical school through residency it is drilled into us to be confident, un-phased, unemotional , these qualities are attributed to professionalism and success. Doctors are supposed to be infallible , so when we face an adverse outcome thats what we do instinctively. We become distant, listening to Helen, Sorrel and Dan thats the exact opposite of what patients need. Alienation only leads to prolongation of suffering for the patients family as well as the caregiver. Moving forward I hope to make these values a foundation of my practice.
Reading all the stories from my peers encouraged me to share as well, this was an amazing group of people and faculty. My first ICU night rotation as a PGY-2 I admitted a patient in DKA and septic shock. More…
The following is written by Guest Author and Patient Advocate, Carole Hemmelgarn
In the months of March and April I had the opportunity to take two amazing trips; one to Doha, Qatar and the other Sydney, Australia. Do I feel fortunate to have visited these incredible places? Absolutely! The irony is, however, I would not have been in either location if my daughter Alyssa’s life had followed its natural course.
I was invited to both places to be part of the faculty to teach patient safety and behavior change to the young emerging scholars in the fields of nursing, pharmacy, medicine and allied health. While these young individuals are regarded as our future patient safety leaders they represent something much more to me. They give me hope. Hope that we can start fixing a broken healthcare system by breaking down the hierarchy, improving processes and communication skills, creating resiliency, and learning to provide support and care to our very own healthcare providers. They are also the generation giving hope to patients and families; making sure we are at the center of care, and that our voices and stories are heard, listened to, and acted upon with dignity and respect.
Earlier this year I told my sister that 2016 was the ‘year of hope’ for me. People will tell me they want me to be happy, but I struggle to understand what happiness is or means. Hope, however, is something I can wrap my arms around. I can hope to see a beautiful sunrise while out running, to watch a smile spread across my son’s face, and to see a child exiting a hospital knowing they are leaving better than when they entered.
There is an incredible aftermath when you lose a child to medical errors. It is a topic rarely discussed and one no one can ever prepare you for. Grief is a journey; a journey without a beginning, middle or end. While those of us who have lost a loved one never want you to experience this overwhelming pain we would like you to understand why happiness may take time in returning, or hope may be the best we can ever do.
When I teach these young scholars, I share part of Alyssa’s story because it helps connect the head and heart, and we need to put this piece back into medicine and caring for patients. Every time I speak about Alyssa, I give a piece of myself and my hope is that you take this piece and use it to make change. The future of patient safety resides in hope because hope is not found looking down or back, it is only found looking up.
As in Doha, SolidLine Media was along to capture the stories being told at The Telluride Experience: Sydney! Thanks to Greg, Michael, John, Ali and team for pulling this short video together utilizing movie magic across the continents in time for the Minister of Health herself to view it live in Sydney, at the Clinical Excellence Commission’s reception for students and faculty before we returned home last week.
Truly a great team effort by all to bring the reflections and voices of change to life.
The Telluride Experience faculty has arrived at Q Station Sydney Harbour National Park, an idyllic Telluridesque location in Manly, Australia. The Telluride Experience: Sydney faculty and students will be tucked into this retreat location in Sydney’s National Park just across the water from the lights and cosmopolitan city of Sydney. Q Station and the National Park has a little bit of all Australian terrains, including Manly cove beachfront, bush land and the protection of a canopy of rainforest-like red gum trees.
These spectacular trees serve as home or rest to 150 different types of birds, and resemble our collective efforts at changing healthcare culture by also renewing themselves each year, as they shed their bark presenting a fresh, new salmon colored skin to the surrounding environment.
An old Quarantine Station protecting Australians from smallpox or other contagious disease potentially carried by those seeking to become citizens during the 1830s through 1984, this could not be a more fitting location to host what will be the epicenter of local of patient safety learning over the next four days. Last night, the group shared conversation, introductions and local food and wine to start the week, welcoming one another to yet another intimate and
International patient safety Telluride Experience. Join the conversation on social media, using #AELPS16.
Today’s post is by Guest Author, John Nance, Telluride Experience Faculty, Author and ABC Aviation Consultant
Having had the delightful experience of attending and working with all of the sessions of the Telluride Experience this summer, I’ve spent some time since returning from Napa thinking through the scope and the effectiveness of what we all came together to advance: The goal of never again losing a patient to a medical mistake or nosocomial infection.
It may well sound hackneyed, but in fact I think all of us as faculty mean it to the depth of our beings when we say that the medical students and residents and nurses – all of those who joined us – are truly the best hope of changing the course of a noble but tattered non-system that slaughters people at the rate of 50 per hour. That does not mean that existing healthcare professionals cannot or will not embrace the dramatic changes that are required to keep patients safe, because, indeed, thousands are passionately involved in just such efforts. It does mean, however that the opportunity for leadership from the newer members of this profession will be critical, from the small and subtle gestures, to the grand and sweeping reforms.
And the potential for meaningful leadership, of course, is why those who joined us were selected in the first place, and what we expect of them from here on: Courageous leadership steeled against the oppressive influence of the status quo.
Having participated in this battle for patient safety for nearly a quarter of a century, I can say with some degree of authority that no matter how many presentations, discussions, articles, consulting hours, or other efforts are thrown at the problem nationally, creating a major cultural change is perhaps an order of magnitude more difficult when you’re surrounded by the very environment you’re needing to alter. Coming together at a distance – especially in a resort atmosphere, or in the incredible beauty of Telluride itself – is an important element in achieving transference of ideas, concepts, goals, and determination as free of dogmatic and traditional thinking as possible. And, of course, catching people at the beginning of their careers before the insidious influence of cultural rigidity has been allowed to take root and oppose change, is an equally important key. I know of no better forum than this, and I’m truly honored to be a part of it.
And so we came together and told you horrifying stories that made us all cry, exposed young learners to the realities and predictability of professional human failure, and rubbed all our noses in the reality that a profession whose routine operations count as the third leading cause of death in America does not possess the ethical choice to resist meaningful change.
But at the end of the day – and our time together – it all comes down to taking those small sparks of understanding and recognition and fanning them into flames back home, never forgetting that every hospital room, scheduled surgery, ambulance arrival, admission, or diagnostic test involves a fellow human who is as entitled to the highest standard of care and caring as your own family.
From a very personal POV, I thoroughly enjoyed meeting each of our participants this season and pushing the quest forward, and I look forward not just to next year, but to hearing how the seeds we all helped sow will sprout and change the landscape of American healthcare.
As 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.
- 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…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.
The 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.
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.
Our 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.
This 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.
Once again, we gather in Telluride to talk, teach and learn about new ways to shape safety culture within medical and nursing learning environments by educating the young! The mission and hope of our Telluride Summer Camps (now part of the Academy for Emerging Leaders in Patient Safety) has always been to inspire the future leaders of healthcare to hit the ground running armed with an understanding of what it means to truly make patients part of every healthcare conversation, and to keep them safe in the process. Follow their reflections during the next ten days on the Telluride Blog.
2015 is well under way and our friends at the Josie King Foundation are determined to increase awareness and action around their mission of keeping patients, and providers, safe from medical harm. So determined, in fact, that Sorrel King is sacrificing her joints to run the Boston Marathon in April to raise awareness and funding for the cause. If you are going to be in the Boston area on Monday, April 20th — or running yourself — be sure to reach out and join the mission.
For more information or to make a donation, you can go directly to the Josie King Foundation website, or click below to read more!