Telluride Experience: Sydney Alum Anna Elias Continues to Dream Big

HarborBrushEach of our Telluride Scholars adds their own voice and passion to the patient safety movement that continues to need attention. The following are most likely words of unintentional inspiration from Anna Elias who shows what one individual can accomplish when they care deeply about a cause, and dare to dream they can make a difference. Anna is absolutely right — Watch this space! — her space, because she is on her way to great things!

You can also link to the Telluride Blog where Anna originally posted this piece.

Watch This Space

I think big and dream bigger but have been told many times in my life to stop doing so. My grade 10 careers advisor told me to aim lower when I expressed an interest in studying medicine, a male physician once told me that training a woman was like training half a doctor and I’ve even had a family member tell me that women joining the workforce are responsible for the downfall of modern society. Despite this, I’m now in medical school and will one day soon achieve my dream of becoming a doctor.

Over the last few days I’ve been given the skills and knowledge to undertake projects that improve outcomes for all patients; I’ve been empowered to make a change. Unfortunately these things take time, you need to carefully plan, analyse, monitor and assess. You need a specific problem to tailor your specific, well researched solutions and I am sure in the months and years to come I will use the things I’ve learned and the frameworks provided to make change happen. However, at this point in time, my goal is big and broad, it’s in no way specific and while I’m prepared to to do my due diligence and execute some high quality, quality improvement projects once I find my focus, right now I just need to do something. Improvements to patient safety education shouldn’t have to wait for me to specifically define the problem in a measurable way or wait to get ethics approval. It can’t wait, not while I know there are things I can be doing that will have some impact right now.

Don’t get me wrong, I know we need to improve patient safety, safely by following the right processes and procedures but today I am going rouge, I am not going to wait. Like a hungry Roundtable delegate on the hunt for a burrito I am going to take action. Tonight I will email my contacts and state my case to ensure that patient safety is on the agenda of every student-run educational conference in my state this year. Additionally, I will push to have a safety moment at the beginning of each event my medical society hosts. Lastly, because I can’t be everywhere at once, I will make a time to train others in my medical society so they too can be safety coaches and start getting the word out about this important issue.

One day soon (when step 1 is behind me), I will start the research and do it the right way but I won’t sit ideally by in the mean time. Watch this space.


Voices from The Telluride Experience: Sydney

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.


Telluride Alum Works on Solutions to Overcome Social Determinants of Health

The following post is by Caitlin Farrell, M3, and Telluride ’14 Alum, and can also be found on her blog, Medical School Confessions. Caitlin, a true leader in patient safety, is currently following a passion in public health…

Bling bling

In medical school, no one teaches you how to set a ring tone on a cell phone. But that’s what I was doing, sitting in the basement of the homeless shelter where the local community health clinic was set up. My patient was a 70-year-old African-American lady, who looked to be about 90. She had, after months of working her way through the system, finally secured an independent apartment. After moving in, she spent weeks sleeping on the floor, because of course she did not own any furniture. She had made her way to the clinic today after taking two buses and walking several blocks.

As we pressed her about her medication, we asked her how the blister packs were working. Blister packs are packages created by the pharmacy which places all of a patient’s medication for a single day together in one nifty little package. That way, there is less chance that a patient will forget to take a certain medication. Our patient stared back at us blankly. What’s a blister pack? The little packages from the pharmacy, where they put the medication you are supposed to take that day in a pop-out package, we explained. Another blank stare. She said the pharmacy was giving her bottles, no packs. The doctor and I stared at each other. There was no way to know if our patient was taking her medication, or if she was taking it correctly. Based on her blood pressure as she was sitting in front of us, 150/89, there was clearly something happening with her hypertensive medication.

We had to brainstorm. We called the pharmacy, who assured us that they had been creating blister packs for our patient. These intricacies of medicine, the teasing of details from patients, calling pharmacies, understanding the determinants of health, are the topics that current medical education fails to address. In school, we are taught very clearly about the treatment of chronic diseases; what medications and lifestyle modifications should be recommended for hypertension, hypercholesterol, diabetes. We write on our prescription pads, then send the patients out the door. Clearly, this system isn’t working. As we see more and more uncontrolled chronic diseases, and label more and more patients as “noncompliant”, I believe that the medical profession needs to take a long hard look in the mirror and see if we are doing all that we can for our patients.

The doctor that I was working with that day had been serving this population for years. He spent his life working in community health clinics and substance treatment facilities, and often had unconventional methods. The only way to be sure that this patient was getting her medication and taking them correctly was a drug delivery service to her house. We asked her if she had a phone. Oh yes, she said. Well does it work, we asked. She assured us that it did. Unconvinced, we dialed her number from the office phone. It buzzed in her overstuffed pocketbook. Well, how will you know that it is ringing if it’s in your bag and you can’t hear it? You won’t be able to get your medications if the service comes to your door and calls you to answer. So the task was set to me, to set a loud ringtone so that our elderly patient would know that the phone was ringing. We then made her show us that she knew how to actually answer it. Once everyone was satisfied, she wrapped it in a piece of paper and folded it back into her bag.

A few days later, we had the patient return with all of her medications, just to be sure that she knew what to take and when to take it. She arrived with a bag full of bottles – the pharmacy hadn’t been putting her medications in blister packs after all. While this level of tedious care is not always possible with every single patient, the fact of the matter is, it should be. If all we are doing as providers is writing prescriptions and hoping that our patients can navigate the healthcare system alone, then we are failing our patients. So make sure you know how to set ringtones, friends. It might actually make the difference for a patient’s health.


John Nance Reflects on The Telluride Experience and Need for Patient Safety Immersive Learning

Today’s post is by Guest Author, John Nance, Telluride Experience Faculty, Author and ABC Aviation Consultant

JNance_Napa

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.

John Nance BooksAnd 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.


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.


The Content We Share: MedStar Health Inspiring Healthcare Scholars in Telluride

One of the conscious strategies behind the content created at MedStar Health is to inspire high reliability practice and patient centered care locally. Dave Mayer has always insisted we share as much of that content as possible with our colleagues across healthcare, as well as with young healthcare learners and resident physicians during the Telluride Experience. The piece referenced, Please See Me, was released in April of 2015, and was shared this week in Telluride. Following is a wonderful reflection from the Telluride Blog entitled, Forgetting Our Purpose, by one of our medical student scholars on the value she found in this piece. To see additional student reflections from the first session of the Telluride Experience for 2015, go to: www.telluridesummercamp.com/blog

Colleen Parrish is a Telluride Scholar, and rising M2 at the
University of Oklahoma

Throughout today’s sessions, one thing that really hit home for me as a student was the last video we watched created by the MedStar team. Within the video, it brought up a point that I think we as students tend to forget – especially those within the first 2 years of medical school or those within the most book heavy, patient free part of their healthcare curriculum. In the video, the doctor mentioned that she had memorized all the muscles and bones within the body, and gone to school for x number of years in order to take care of this particular patient; she had spent all this time and energy, sleepless nights, and damaged personal relationships in order to be a great caregiver for him.

This really resonated with me, especially with the recent completion of my first 2 years of schooling. I realized that within this period of books on books and lectures on lectures, we as students tend to forget our purpose – our “true north” if you will – of personally caring for and improving the overall well-being of our patients, our fellow humans. Without that constant reminder of why it is we are investing such time and energy into learning about bugs and drugs and such absurd sounding things as poop charts, we tend to veer from our true north into a path of “jadedness” and even resentment.  If we can take the time everyday to remind ourselves of why we are doing all this, perhaps by watching videos such as this one or “Empathy” from Cleveland Clinic or by simply writing ourselves a letter that we read in moments of stress and frustration as we watch our peers in other professions begin to have careers and families, if we can bring ourselves back to our purpose even within the classroom I believe we can all be not only more effective healthcare providers but happier ones.

I’m reminded of an article, [from The Atlantic, For the Young Doctor About to Burn Out] that I tend to turn to that helps remind me a lot of the deeper issues of the stress and burnout of physicians. It’s more of book review perhaps, but it really resonated with me as to a different perspective on how we can get distraught within our beloved training and professions.