Thomas Bottyan

Trickle down leadership

Trickle-down economics is a policy that gets a lot of heat from certain sides of the political aisle. But apparently trickle-down leadership is a must for healthcare.

One of our program leaders made a comment about how he would not work at a program where risk management answers to the team’s legal counsel. The implication of this, was that if risk management was not reporting to the CMO or CEO, the hospital had philosophy of safety that was an anathema to a culture of patient safety.

When asked what could be done if our institutions risk management reported to the wrong agency, the answer was succinct, “find work at a different hospital.” When asked what could be done if that wasn’t an option, the quote “culture kills the best strategies” came up again.

Without support from administration and leadership, changes are improbable at worst and ephemeral at best. Practitioners in… Continue reading

Culture kills the best strategies

In the line from the story of “Lewis Blackman,” one of the narrators mentions that there is a “perception” that it “is bad to call for help” in medical culture. There is no “perception.” It is a reality.

There are many expectations of providers that go without saying, to be upstanding professionals, compassionate, resistant to fatigue, empathetic, and un-jaded. These features, virtues essentially, are non-negotiable. They aren’t even talked about beyond medical school admissions, as residents we are simply expected to act this way at baseline. But there are two cardinal sins of residency, laziness and ignorance.

Often of the first things asked about a resident is are they “good:” a surrogate of the two measures, not lazy and not ignorant. A lazy resident is an involved problem, but an ignorant one causes a whole separate array of issues. They require additional oversite, their treatment decisions are in questions, and… Continue reading

Adverse Events

I chose to attend the Telluride Experience because intern year of my residency program, I was involved in a negative patient safety event. A patient being taken care of by my team was discharged from the hospital with the wrong type of antibiotic medication.
The patient had a community acquired pneumonia. He was responding to our initial antibiotic regimen and we were prepping for discharge. Though improving clinically, blood cultures came back positive. We waited for results and acted when we saw that the cultures speciated. We anticipated a quick discharge, but our patient kept barely failing discharge vitals parameters and we had to keep delaying sending him home. With pressure to keep our patient census low, the plan was to discharge him as soon as he meet safe discharge criteria.
We discharged him approximately a day later with medication for his specific infection. In our haste to discharge, we… Continue reading
Telluride Experience 2020 Dates

BRECKENRIDGE, CO:
Session One: Monday 6/8 – Thursday 6/11
Session Two: Monday 6/15 – Thursday 6/18
Session Three: Monday 6/22 – Thursday 6/25

WASHINGTON,DC/MD:
Wednesday 7/22 – Saturday 7/25

Possible 5th session, location TBD: Monday 7/13 – Thursday 7/16
 
Apply by January 15, 2020