Day one of the third and final week at the Telluride Patient Safety Educational Roundtable and Student Summer Camp was not even officially underway when I had a conversation with Wendy Madigowsky MD, a medical educator and longstanding Roundtable faculty member from Denver, CO, about healthcare leaders having to first recognize the need for change in the way healthcare is delivered, in order to start implementing some of the ideas we are discussing here in the mountains. To that point, Dr. James Prochaska, who developed the Transtheoretical Model of Behavior Change and has authored over 300 papers on behavior change for health promotion and disease prevention, defined 5 stages of behavior change which include:
Those unaware of the need for change are considered Precontemplators in Prochaska’s model, and are defined as:
Participants at this stage do not intend to start the healthy behavior… Continue reading
I’d have to say that one my unexpectedly favorite parts of Telluride were the absolutely stunning flowers there–from window boxes to hanging baskets to the vibrant fuchsia peonies that currently grace the home screen of my iPhone, I certainly enjoyed them. My week in Telluride gave me ample opportunity to stop and smell the roses!
But this is a blog about patient safety and quality improvement, so how is that related to flowers?
On the last morning in Telluride, Carole asked the students this question: “You’ve walked up and down that flight of stairs many times since getting here. Can anyone tell me what’s sitting on the windowsill?” A planter of pink geraniums! I thought to myself. I notice them every morning! Someone quietly mumbled “Plants?” and I interjected with “Yeah, pink ones!” because I didn’t want to look too eager to share my knowledge of the pink geraniums gracing… Continue reading
In an unprecedented way the Telluride Roundtable enters its third straight week of engaging learners in the importance of open, honest, and effective communication in health care. With students and faculty gathered from all over the country, this week’s activities hope to build on the two previous, very successful weeks here in the San Juan Mountains! Under brilliant blue skies and with near perfect weather conditions, the conversations will center on ways these futures leaders in health care can champion change within their own hospitals and clinics and beyond.
Unique to this week’s attendee roster: Students of Pharmacy and Law will join the Medical Students in the learning process. From the Patient Advocacy perspective, Helen Haskell – founder of Mothers Against Medical Error – will share her perspectives on patient safety, patient and family-centered care, and the critical importance of honesty during the informed consent process, as well as when… Continue reading
Admittedly, I was not so good about posting to the blog during my week in Telluride. I did do quite a bit of tweeting, which I found to be a lot more fun than I expected. But I have spent a lot of time over the past week pondering much of what I learned. June has been a month of intense transition for me as I am completing my Internal Medicine training while beginning my Chief Residency. In my program, the new Chief Residents begin at the very end of May so that we can get our feed wet before the new interns start. I have said to many people, both in Telluride and now back at home, that after spending the past couple of months making schedules for next year and performing various other administrative tasks it was so refreshing to think about patients… Continue reading
As our discussions on Day 3 made very clear, health care professionals are not a united team. During a SBAR/I PASS the BATON communication exercise, it was blatantly obvious that by the end of our first year of medical school we have already been assimilated into our siloed profession–as medical students, we have absolutely no idea what nurses do or what their spheres of influence are in patient care.
As a fan of superhero movies, our deep confusion about how doctors and nurses work together to safely take care of patients reminded me of the movie, The Avengers. In the first half of the movie, a rag tag team of super heroes is brought together with the mission to save the world from alien domination. Each hero has his or her own superhuman talents (intelligence, strength, lightning generating hammer, etc.), not to mention movie franchise. However, the… Continue reading
Sitting in the airport after a successful week in Telluride, it is difficult not to reflect on where to go from here with regard to taking what we learned during the Roundtable and applying it to our home institutions. So many wonderful and innovative ideas for moving forward were shared on the last day, including ways to grow IHI chapters, methods of addressing patient safety and quality improvement with attending physicians, and developing student reporting tools, only to name a few. It was great to see so many students excited about returning home to spread the word and improve their systems, and I certainly share in that enthusiasm.
A few things that especially struck me most during the week were students’ lack of knowledge about the role of their nursing counterparts in the care of patients as well as the lack of “just” reporting tools for medical students… Continue reading
“If they haven’t learned it, you haven’t taught it.” This was a Woodenism oft quoted at the Resident Summer Camp in Telluride by special guest faculty, Paul Levy. Wooden and Levy are both coaches and teachers in their respective fields–one hospital administration and the other NCAA Men’s Basketball. With that statement, they both take responsibility to the fullest extent for successfully transferring knowledge to those they themselves are charged with educating. As I reflect on that week, this message rang especially true during the group’s conversation on informed consent and shared decision-making.
One of the residents had mentioned how surprised he was at an intelligent patient’s off-the-mark retelling of the information he had just conveyed. “It was like apples and orange,” he said, as John Wooden’s words rang loud and clear in my head. It was also becoming clear that as care providers, the role also encompasses educator… Continue reading
One technique that striked me as a great idea was the check-back method. This involves listening to another medical professional tell you about the patient, preferably in the SBAR format, you jot down the important notes, and then you read the notes back to the dictator.
Previously I had known about teach-back method which involves the patient repeating and paraphrasing the information that you given them. However, I never really thought about writing the information down. The written aspect is so powerful because it helps you to remember better, and it’s a form of traceable documentation.
One anecdote that I thought was very powerful was the one in which the doctor asks the patient, may I record this conversation? The patient agrees, thinking that the doctor wants to make a record to cover his tracks legally. At the end of the meeting however, the doctor takes out the tape from… Continue reading
Its been a incredible experience – whether it was bonding while taking our 3 mile hike or bonding during the picnic or in casual get togethers amongst friends at picnics and barbecues; we exchanged thoughts and imagined a system committed to bold, new ways of thinking of health care and the relationships between doctors and other care providers. Today we heard a touching story about a child that experienced an adverse outcome that highlighted the value of strong communication and truly understanding the environment/mood before making inappropriate diagnosis of patients especially kids who may try to naively consolidate multiple emotions and be more scared based on what they read/watched on TV. As I leave this round table – I think about what I can take back to my home institution and implement. Some of my thoughts include creating a difficult patient encounter in Clinical Skills where an individual has… Continue reading
Elliott Schottland, Medical Student, says:
The discussion about nursing and doctoring reminded me of conversations I had with fellow classmates at school. We were studying for the NBME Behavioral Sciences exam and joking about the ethical dilemma practice questions we were working on. A common theme that we noticed is that any answer involving soliciting a nurse for help or consulting with a nurse would invariably be wrong. We agreed that answers involving nurses can be crossed off and it would be nice to get one on the test because we could narrow down the answers easier. Almost like how there used to rarely be positive depictions of minorities in the cinema, early medical education is nearly void of positive depictions of nurses. The best way to effect change in medical school is to test students on the material. This should be applied to learning about hospital hierarchy… Continue reading