As I stood on the banks of the freezing cold San Miguel River listening to the leathered guide rattle off 73 different ways disaster could strike on our imminent rafting trip I thought, “WHAT in the WORLD have I gotten myself into? Intelligent people do not willingly throw themselves into an angry, foaming body of water with five strangers on a piece of plastic!” I was pacing, sweating, hyperventilating, silently imploding – when a colleague turned, looked me straight in the eyes and simply said, “Now imagine how our patients feel when we consent them for surgery.” I was blown away at the profundity of this comparison. Here I was about to embark on a journey considered to be relatively safe and yet all I could hear were the rare, but possible, adverse events. Everyone in my immediate vicinity, sensing my panic, whispered “they have to go over this stuff, it’s really safe” and, “if these things happened on a regular basis they wouldn’t be allowed to operate” etc., etc.
How many times are these exact words uttered minutes before a patient is about to enter the OR, stripped of their dignity in a thin drab hospital gown? The rafting guides had decades of experience between them, a good safety record and checked off all the required boxes on their list prior to launch. I should have been completely reassured that no bodily harm would come to me. But as I stood there in my ridiculous wetsuit, I just wasn’t. And I wonder how many of our patients feel the same way as their gurney wheels down the sterile hallways into the OR.
We had such fruitful discussions this week about our failures, successes, fears, barriers and future plans at our respective institutions. It was inspiring to hear not only aspirations but very practical concerns about sustaining momentum and affecting real change.
What I will take away from this truly productive conference, aside from an impulsive desire to quit medicine and take up oil painting in the mountains, is the notion that not all QI requires an IRB. Prior to this conference, I embarked on a project that will take up much of my third year and has the potential to improve efficiency and reduce costs. I have support from hospital administrators, my department chief, faculty, fellow residents and clinic staff. If we achieve success the project could become an integral part of our clinic…or it won’t. But it will not define my QI legacy.
Sustainability is challenging and relies on factors that are often out of our control, a phenomenon not unfamiliar in resident practice. What we do control is our approach to patient care and how we choose to practice each day. Improving the quality of care in our hospitals can happen simply by sharing your insights (as loudly and as often as possible) and encouraging colleagues to be mindful of our shared goal of patient safety.
Quality improvement is an ever evolving journey that can feel like navigating rough waters in a boat full of strangers. But if we’re prepared, know the risks, trust each other, work hard, remain vigilant and take the hits as they come, it can be one hell of an adventure.
Good luck to everyone! It’s on us now.