Day 2 was a roller coaster of emotions. We heard from our faculty who bravely shared with us their heartbreaking experiences. It was very difficult to hear, but incredibly moving knowing we as a healthcare system have to do better. We are not alone as we can work together towards a movement at each of our places of work/school. Seeing the flight map of all the estimated 93,000 commercial airlines painted the picture and brought home the fact that not even one of those flights on an average day will crash. There will be mistakes made or unanticipated events, but they are ready and will implement the needed actions, such as the Miracle on the Hudson, to get everyone safely back to the ground. I look forward to reading more about CANDOR and taking back many of the tools discussed including ARCC, Go Team, 16 second breaths, and 5-4-3-2-1. Also,… Continue reading
One of the big take aways from today was how important communication and listening are. As a healthcare provider, specifically a nurse, I thought we always did wonderful listening to our patients; after all, we are one of the top most trusted professionals. So when my organization sent an email to my unit saying that they wanted to work on communication with patients to increase our low scores, I was shocked. I was even more shocked when I heard the average time that patients and their families were first interrupted during a conversation. I need to take the tools I learned today and apply them to show patients that they matter and are the most important one in the healthcare dynamic.
Care for the caregiver was a really great reminder on how even resilient individuals need to take care of themselves and it’s ok to ask for help. Help is… Continue reading
After Day 1, I am feeling so grateful to be part of this group- to meet and make new friends with medical students, residents, nurses, and nursing students from all over the country with a common interest in patient safety. I am also grateful for our faculty, and for the patients we heard from on day 1. Watching the emotional video about the Lewis Blackman story, I was struck by how everyone clinical questions to ask and ideas about what went wrong, but people typically started with their emotions: “That was hard to watch”; “that was heartbreaking”; “I feel so badly for the Blackman family”. I think that was interesting because again it shows that our emotions were where we started and where we felt the same. Our ideas about how to fix the problem might be different- which part of the process/case to tackle- the resident who didn’t call… Continue reading
Today was an emotional day. We discussed many real cases of medical errors and got to personally meet several folks affected by such errors. I really enjoyed the panel aspect of the day because it afforded us gritty exposure to medical harms. Jack and Terry have shown enormous strength in what they’ve overcome. I’m excited but also apprehensive to learn about what happen to Steve’s mother and what we can learn from such mistakes. We played the puzzle game and our team won! We weren’t able to speak OR use the box. I certainly didn’t expect for our team to win, but I have to figure out what lessons to take from that…
I really enjoyed Dr. Tori’s lecture. As someone who’s used EAP services in my own hospital, I’m glad we have folks spreading how helpful it can be. Tomorrow, I’m looing forward to our breakout game and the… Continue reading
After day 2, I have done some more reflection and I have come to understand the importance it is to communicate effectively with the patients and their families. I have thought back to times I have communicated with families and patients and how those interactions went. I feel like I can definitely improve on my listening and body language.
I have learned from today, that those involved in hospital stays or requiring care, want honest, open communication. They want to know what is going on or what happened. The families do not want to be left in the dark. While I learned how important it is to communicate effectively, I also learned how important it is to communicate my needs as a caregiver.
I can not effectively communicate and care for patients if I am not well myself. I learned that there are a bunch of resources to… Continue reading
I’m writing this taking deep breaths (in 4, out 4, in 4, out 4) after what was an amazing, tiring, eye-opening second day. One of my main takeaways from today is that everyone is going through something- don’t discount that people are all fighting their own battles- patients, providers, colleagues, and we need to make sure that we still keep our number 1 priority, the patient’s safety, in mind. I was amazed learning more of our patient advocates and faculty’s stories. It made me heartbroken, but also really made me believe in the idea that I could change things by being open, honest, transparent about any mistakes that happen. I felt that the session on communication was immensely helpful in thinking about the best ways to speak with patients and how we might conceptualize a challenging conversation. Things i took away are: 1) body language matters. sit down with your… Continue reading
Communication is definitely a big key in patient safety. Communication can either ruin a patient and care provider relationship or it can progress to something great. Few things I have learned today is that communication holds the key to a caring process in healthcare. I have learned that taking a step back and just reflect makes a huge difference. Today, I have learned that I also need to focus on my coworkers and to make sure that I check up on them. I know that when a caregiver is in distress, patient safety can be at risk and also the care given cannot be a quality one. I have taken to account that I should emphasize and bring home a statement, “Patients are human beings and we have to stop putting tags on them and take time to listen to them and be silent for a few moments.”
This experience… Continue reading
I had a lot of learning yesterday from reflective practice to transparency. Watching Lewis Blackman story was difficult but made realize how system with multiple layers could fail and how many of these stories happen each year. It is great to connect with group of like-minded people and works together toward a common goal of improving patient safety.
Today was one of the most thought provoking days I’ve had all year. The entire day was filled with aha moments and I want to bottle it all up and bring it back to my institution. I was surprised to learn that self reflection is only helpful when followed by thoughtful action. Everything I learn here is only helpful if I can somehow institute change at my institution. And it’s hard to changes things , but I believe this summer camp really is providing all the tools to do so. The Lewis Blackman movie itself is so moving, and speaks volumes of the gaps in our system. No one person can be blamed for the disregard to the tachycardia and pain that surpassed 24 hours, and the repeated pleas from Helen that were ignored. 40-80K deaths per year are due to misdiagnosis. This is why anchoring and confirmation bias… Continue reading
Despite the Institute of Medicine’s (IOM) wake-up call in 1999, tens of thousands of patients still die unnecessarily, and a hundred of thousand are injured by medical mistakes.
Cultural change in the healthcare industry that mirrors the success seen in aviation is a practical way of making healthcare delivery safe.
The influence of FIRST follower is as important as that of a visionary and effective leader. The courage to be the first supporter of a change movement is the catalyst that perpetuates and drives change movement in the desired direction.
We do not learn from experience but from reflecting on our experiences. Reflective practice and mindful engagement lead to professional maturity.
A true narrative of a sentinel event resulting in the death of a 15-year-old was played. In this video, the 3 tiers of error-producing tendencies leading to the breakdown of patient safety wall were seen: PERCEPTION, ASSUMPTION, and COMMUNICATION.… Continue reading