Ia Ora Te Natura E Mea Arofa Teie Ao Nei

Latitudes_Harbor_St_Thomas“And there’s that one particular harbor
Sheltered from the wind
Where the children play on the shore each day
And all are safe within.

I know I don’t get there often enough
But God knows I surely try
It’s a magic kind of medicine
That no doctor could prescribe”

For those who have followed our Educate the Young blog through the past year, you know I am a big Parrot Head…yes, a long-time Jimmy Buffett fan. Fellow Parrot Heads will quickly recognize that the title of this post and the lyrics above are from the Buffett song titled “One Particular Harbor”.

The song always comes to mind when I arrive in Telluride each year for our annual Patient Safety Roundtable and Summer Camps. Telluride is my personal “One Particular Harbor”…”I don’t get here often enough but it is a magic kind of medicine that no doctor could prescribe.” All who join us each summer leave inspired and invigorated – they discover this “magic kind of medicine”.

The one hundred resident physicians and health science students who won scholarships to attend one of our Patient Safety Summer Camps this summer are the children. They bring a passion and energy that is contagious to others. The residents and students come to learn, to test, to validate, to network, and to play. They work side-by-side with patient advocates, those who have lost loved ones due to medical error but have passionately dedicated their lives to making care safer for others. Like the lyrics of the song, the residents and students discover they “all are safe within”…sharing their own personal stories in a safe haven – a haven that is not always safe back at their home institutions. If you have been reading their reflections this past week posted on this blog, it is easy to recognize that they discover they are not alone and quickly connect with others who have similar passions – safe, high quality patient care. You can feel their passion and commitment to things like outcomes, best practice, standard work, open and honest communication, and most importantly patient-partnership. They are asking important safety and quality questions…questions many from my generation including myself never asked.

Be it the great quality and safety educational work being led by the AAMC, the ACGME and many other academic organizations and institutions across the country, change is happening. It is happening with our new caregivers. Many resident physicians across the country (including numerous past Telluride Scholar alums) are now leading safety and quality projects at their hospitals. Each year, the residents that come to Telluride seem to start the week where last year’s group left off.  You can feel the change…it is palpable and it must continue. Kim Oates, an international leader in patient safety education from New South Wales, travels from Australia each summer to join us to Telluride. He flies over 8200 miles in the hope he can make a difference in a young caregiver’s career. Kim is one of a handful of physicians who can say Don Berwick was his resident when both were at Boston Children’s many years ago. Despite significant jet lag that stayed with him for most of the week, he shared that if the residents and students who attend Telluride each year are a true reflection of the next generation of healthcare leaders, we are in good shape (See TH post-I have looked into the future and it looks good). I fully agree – while we are not at the tipping point quite yet, the future is bright. We can’t lose sight of “Educating the Young”.

Amazing first week of work in this “One Particular Harbor” called Telluride.

*By the way, Ia Ora Te Natura E Mea Arofa Teie Ao Nei means: Nature lives, Have pity for the Earth, (Love the Earth).

Changing Behavior Through Patient Stories in Telluride

Each new session of the Telluride Patient Safety Summer Camps, Dave Mayer and Tim McDonald share the Tears to Transparency educational documentary films — stories of harm that befell Michael Skolnik and Lewis Blackman–both promising young men–and the impact that harm had on their two families.  As a result, Patty Skolnik and Helen Haskell (Lewis’ Mom) have dedicated their lives to changing healthcare for the better, and have become nationally recognized patient advocates. Through their new careers, both Moms have recognized the need to both “educate (and empower) the young”. The medical and nursing students and resident physicians who attend Telluride often have the opportunity to talk with both parents after each film in an open Q & A. Many students express this being a first exposure to the dysfunctional side of medicine. On the flip side, many also express having witnessed similar poor behavior by those entrusted with leadership positions in an academic medical environment.

Through the generosity of both Michael and Lewis’ families with the sharing of their stories, Telluride attendees are able to practice the difficult discussions focused on in the films in a place where open and honest communication is not only encouraged, but also modeled and set as the baseline. This also re-emphasizes the power of story to change behavior, and as a result, culture. Hopefully this sets a “new normal” for all Telluride alumni – a mindset they can take back to workplaces and educational systems where bullying or a lack of respect prevails and infuse new ideas. Or simply to carry these stories home in their heart, along with the power of the resulting discussions to further embolden environments where a just culture is the norm.

A trailer to the film, The Story of Michael Skolnik, played yesterday morning for our resident scholars is included above. We have been told more than once that the value of the conversations that follow these films each year are unmatched by anything yet to be experienced in the educational experience of health science students. The resident reflections on the Telluride blog today (found here) share some of the takeaways both The Lewis Blackman Story and Michael’s story have inspired this year. The theme from Michael’s story is “Can a conversation change an outcome? Can a conversation save a life?” Based on the enthusiasm for a new normal in Telluride this week, I am happy to report back that the answer to both questions is a resounding YES! When healthcare professionals and patients authentically share their stories and experiences it becomes contagious, inviting others to do the same. I’ve watched this yet again take hold in Telluride. Let’s take this idea viral along with the courage to do the right thing for patients, no matter how difficult, every time.

Upcoming Quality & Safety Educational Opportunities

Following are two exciting, upcoming educational opportunities focused on quality and safety that we would like to share with our ETY readers. Please feel free to share the information with colleagues!

This year, the Committee of Interns and Residents has partnered with the Healthcare Transformation Project of Cornell University to present a series of conferences in the New York metropolitan area providing education around physician leadership in quality improvement and patient safety. The first conference, entitled What is your QI IQ? Resident Physicians as Quality Improvement Leaders, will be held on April 13 in Manhattan. The one day leadership conference focused on residents and medical students has been organized and led by residents, including many from last year’s Telluride Patient Safety Summer Camp.

The conference will feature:

  • Interactive didactic sessions led by Dr. James Pelegano, Program Director for the Jefferson School’s Master’s Program for Healthcare Quality and Safety, and an innovator in the field of Patient Safety and Quality.
  • Small-group breakout sessions that will allow participants to practice and refine the methods they have learned.
  • A panel discussion with resident physicians who are currently leading QI projects in their hospitals.
  • A hands-on workshop on the formulation and writing of QI/Patient Safety project proposals.
  • Where: Executive Conference Centers 1601 Broadway, New York, NY
  • When: Saturday, April 13, 2013, 9:45 am – 4:00 pm (breakfast at 9AM, lunch provided)

The second exciting educational event coming up in June is the fifth annual AAMC Integrating Quality Meeting once again held in Chicago. This year’s meeting, Improving Value and Educating for Quality, is a highly interactive, interprofessional program that brings together healthcare leaders, faculty, educators, trainees and students from teaching hospitals, medical schools, health professions schools, and other healthcare organizations to share strategies for enhancing the culture of quality in clinical care and health professions education.

The program will feature:

  • A number of plenary sessions, interactive workshops, and posters on topics related to aligning organizational goals and strategies around quality and value
  • QI and patient safety education across the continuum
  • Team-based and interprofessional approaches to quality improvement
  • A plenary session by Peter Pronovost, M.D., Ph.D., FCCM, senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine
  • A plenary session by Gary Kaplan, MD, Chairman and CEO of the Virginia Mason Health System
  • Where: Intercontinental Chicago O’Hare Hotel Rosemont, IL
  • When: June 6-7, 2013

The Real Movie Stars of Patient Safety

By Michael Kantrowitz DO (Guest Author, and Chief Resident at Maimonides Medical Center)

It was exciting to be part of the filming of “Breaking the Wall of Silence” a few weeks ago as the filmmakers followed Dave Mayer up to New York where he met with leadership from the Committee of Interns and Residents (CIR).  The next day they came to Brooklyn and followed me around the hospital where I work, Maimonides Medical Center.  In a paradoxical way it was fun (albeit a little nerve-wracking) to be involved in the filming.  The documentary is casting light on some very serious issues regarding transparency and safety in healthcare and it was a privilege to be able to discuss some of the hurdles residents face in being part of the next generation of physicians who will need to address these issues.  There were a few residents who had “cameos” in the filming, who I also wanted to recognize: Drs. Steven Shamah, Nidhi Shah, and Prasun Shah.  They are three of the incredible residents I get to work with everyday, and are proof that there is a changing cultural tide in our cohort of physicians.  As we were filmed on rounds, we discussed safety issues such as the importance of accurate medication reconciliation and fall prevention.

After participating in the Telluride Patient Safety Roundtable last summer, I have tried to integrate what I learned into my role as chief resident.  As a result, I changed much of how I approach patient safety and care quality concerns involving residents from looking to find individual fault to identifying system failures.  That hasn’t happened overnight and I certainly have not perfected this approach, but not surprisingly I’ve found that it more effectively engages residents in the process, as opposed to putting them on the defensive.  In academic medical centers, residents are the front line physician staff.  They typically evaluate patients before the attending physician, and are often the first to respond to acute changes in a patient’s status.  I’ve always enjoyed the opportunity to beat the attending to the diagnosis or stabilize a patient before they arrive because I think it has led to my own growth and independence as a physician.  With such high stakes, however, it is really important to have a clinical environment in which to identify and learn from errors without fear of reprimand or ridicule.  I’ve been fortunate to train in such an environment alongside colleagues like Steven, Nidhi, and Prasun.

Telluride Patient Safety Roundtable 2012 – Resident Updates

By Michael Kantrowitz

Dr. Michael Kantrowitz is Chief Resident, Internal Medicine at Maimonides Medical Center, and member of the first class of Resident Scholars at the Telluride Patient Safety Educational Roundtable — Summer, 2012.

A few weeks ago, a small group of the New York contingent that attended the 2012 Telluride Patient Safety Roundtable met over Chinese food in Manhattan to update one another on our progress since June. Hilary Kunizaki and Justin Wood, who are roundtable alums, organized the meet up. They are staff members at the Committee of Interns and Residents dedicated to supporting resident’s work in patient safety and quality. It is clear that our week in Telluride transformed our thinking about quality patient safety.

  • Dr. Frances Briones, Chief Resident in Internal Medicine (2011-2012) and current Gastroenterology fellow at Harlem Hospital has been hard at work implementing a system for identifying medication ordering errors. In collaboration with the pharmacy department at Harlem Hospital, she was able to determine medication errors that were caused by house staff orders. Dr. Briones began offering monthly one-on-one feedback to residents in the Department of Medicine to educate them about causes of errors or apparent errors (such as delays in deliveries of non-formulary medications.) Since her educational intervention, monthly data has shown that the numbers of errors associated with house staff orders have been significantly reduced. Dr. Briones and CIR are planning to continue the work with the current leaders of the hospital’s house staff patient safety council.
  • Dr. Nate Margolis is a chief resident in radiology at NYU and Bellevue hospitals. He has been exploring the reasons why house staff report very few errors and “near miss” events in the NYU-Bellevue system. One of the major contributors to the problem is simply a lack of awareness of the hospital’s reporting system. Dr. Margolis set out to educate his colleagues about the reporting system. He is working with chief residents and members of the NYU and Bellevue house staff patient safety council to give presentations in each department. He plans to study the effectiveness of this educational intervention by measuring the number of house staff-reported events and near misses logged in the system.
  • My project has involved improving the quality of resident progress notes and development of care plans. As a chief resident in internal medicine at Maimonides Medical Center, I have been working with several faculty members in my program. We observed that patient progress notes written by residents using an electronic tool sometimes results in copying previous notes and failure to fully capture changes in patients’ condition or prognosis during a hospitalization. In the digital age, it is important that residents are trained in proper use of electronic resources. We will be using a 9-point evaluation tool developed at Columbia University Medical Center (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347480/). A team of faculty, chief residents, and peer residents will perform evaluation of notes. Improvement will be measured by scoring a random sample of notes on each monthly rotation through the hospital’s inpatient floors.

Unfortunately the busy lives of resident physicians made it hard for the all of the Telluride alums from New York to attend but we’ve been able to keep in touch and have heard about some of the exciting quality improvement project they have started in their hospitals. We plan to organize additional events that will continue to build on the work we started in Colorado. We hope to have some more updates soon!