Healthcare Quality

The Power of Friendship

My grandmother, Ba, came to America when I was twelve years old. She had just recently lost the ability to move her legs from the waist down.  This quickly became a source of frustration for someone who had spent her entire life as a fiercely independent businesswoman.  Striving to provide her with the best care, my father called in a home health aid to help her with her daily routine. Because she only spoke Gujarati, an Indo-Aryan language native to Western India, it was nearly impossible for her to communicate her needs to her caretakers. Time and again, my father would receive a dreaded phone call at work: that Ba had fallen while bathing, or while transferring from her bed into her wheelchair.

My father then tried to find alternative help. He called in various trained clinicians, hoping for better care. However, the daily calls to his work… Continue reading

Reflections from Day One

Having only been at Telluride Experience: #AELPS11 for a day, I hadn’t imagined I would have learned so much. We covered a variety of topics with important patient safety learning points. I am so grateful for the opportunity to be here and share the experience with so many motivated individuals keen to be change agents.

I wanted to focus on one of the key moments for me: The Story of Lewis Blackman (http://qsen.org/faculty-resources/videos/the-lewis-blackman-story/). We were very lucky to have Helen Haskell (Lewis Blackman’s Mother) with us and I am so grateful to her for sharing her story. So many issues were raised during the video and I was able to draw many parallels to health care in the UK. For example, the issue of reduced staffing levels on the weekend (see link). The consequences of this can be severe as was found in a study published in… Continue reading

First day at Telluride Napa 2015

It’s hard to be more impressed after our first day at Telluride Napa 2015. The first set of sessions spanned the gamut from stirring personal patient stories, to workable and translatable sets of tools to take home to New York, to fantastic conversations with both faculty and medical student participants.

I have to say, my favorite (and most challenging) segment so far was the impromptu exchange between our lucky guest, the mother and inspirational patient advocate, and the CEO of The Doctors Company (a malpractice insurance provider). Their remarks touched on the candid, the taboo, and the important. The tension between “CYA medicine” or “defensive medicine” and doing absolutely right by the patient will be ever-present in our clinical practice (and that’s not to mention the central role of cost-effectiveness in the equation). So to see these boundaries being hashed out by two extremely invested experts was a privilege. I… Continue reading

Council of the Safety and Quality Jedi

Over a decade ago, our nation’s healthcare sector was in upheaval following the disclosure of the Institute of Medicines report on deaths due to medical errors (IOM, 2000).  In response, a Jedi warrior with a passion for patient safety education determined that someone needed to bring like-minded warriors together to discuss the plight of healthcare in America. Contemplating the vast need to join forces with other patient safety Jedi masters, the warrior identified and invited select masters to the table. In 2004, select Jedi made their way to a remote mountain in Telluride, Colorado. Over five long days and nights, each member of the Jedi council shared their knowledge and experience at the Telluride Roundtable. As the council members engaged in open conversation and consensus building, the initial plans for the rebellion against medical error became a reality.  As each member shook hands and agreed to meet again… Continue reading

Quality and Novel Delivery Models

We talked extensively about informed consent, and a key question was raised: “if true informed consent and shared-decision making occurs between providers and patients, will that reduce revenue?”

Although the question on this is a difficult one to answer, my thought is to say no. Along those same lines, Dave Mayer also commented that one group, particularly at MedStar Health, that has been on the forefront of improving processes has been Orthopedic Surgery. They have realized the paramount need to reduce variation in their practice patterns. As they say: No outcome, no income.

I wanted to comment particularly about a growing model of delivering care to patients, particularly with complex and semi-elective surgeries. This particular model is called Employers Centers of Excellence Network (ECEN). It basically is a form of value-based purchasing in which large companies such as Lowe’s, McKesson, Wal-Mart participate. If one of their employees needs a procedure… Continue reading

It’s Smarter to Travel in Groups

Today in Telluride we learned a lot about honest disclosure from Dr. David Mayer, negotiation from Paul Levy, and reliability/ safety culture from John Nance. At many times throughout the day I was wowed to be in the presence of individuals who I have looked up to and called upon during my study of the U.S. healthcare system.

However, most importantly today (as with many day #2’s in summer camp culture) was the day that our class of participants really began to gel as a group. Throughout the day, I engaged in meaningful, poignant conversations surrounding patient safety and our culture as a system with various classmates. This experience made me step back and reflect on how grateful I am to be surrounded by likeminded, passionate individuals that are as dedicated to patient safety as I am. Although I have many friends and colleagues in medical school that are supportive… Continue reading

We are clinicians, and we are human

To err is human, and to fail to recognize our humanity is disastrous. It think this recognition is at the core of what we’re talking about this week. One of the reasons that I’ve seen people being resistant to QI is because they are afraid that QI and patient safety interventions are making clinicians more “robotic” by introducing standardization and guidelines. Really though, I cannot think of a field that is trying harder than Patient Safety to get clinicians to recognize and accept themselves as human beings capable of error, empathy, creativity, mistakes, and brilliance.

We are all capable

Of humility. We began our second day in Telluride discussing disclosure of medical errors to patients and families. Recognizing our humanity in this situation is being able to admit failure, learn from it, and be humble enough to accept its consequences. That humility will allow us to tell patients and their… Continue reading

Wake your attending

We don’t always know enough to help a patient heal from a disease or illness. In medicine, we don’t always have all the answers.

But other times, we totally do. In fact, there is a group of people called attending physicians who are employed by hospitals to have lots of answers and to provide guidance in times of medical uncertainty.

Today, our conference room in Telluride housed some of the most accomplished nurses, medical students, and young doctors in American healthcare. Many individuals shared stories of hesitating to page on-call physician late at night. Providers and nurses hesitated to page because they did not want to be perceived as incompetent, or perhaps more upsettingly, they did not want to suffer any untoward consequences form waking or disturbing the on-call doc.

This mindset needs to end. Attending physicians and on-call doctors are paid by the hospital to provide guidance and oversee… Continue reading

Search and Rescue

Today was the first official day of 11th Telluride Patient Safety Camp and it far exceeded any expectations I might have had. From the moment I sat around the fire outside of our beautiful lodge nestled in the jaw dropping landscape that makes up Telluride, I was sold. The enthusiasm of everyone around me, the great conversations and the energy radiating off of this group of people all excited to be here learning from some of the best in patient safety as well as from each other tipped me off that this is going an unforgettable experience in my medical career.

After hopping on the gondola and experiencing one of the best morning commutes I could imagine, we settled in for a day filled with thoughtful discussion, heart wrenching stories and collaborative learning. Unlike many of my colleagues here, I have a very limited background in quality improvement and… Continue reading

What’s the Worst Thing It Could Be?

To kick off our Telluride experience, today we watched Helen Haskell recount the tragic story of her son’s death at the hands of the healthcare system in From Tears to Transparency: the Story of Lewis Blackman. While watching the film, Dr. Tim McDonald offered a great pearl of wisdom about arriving at a diagnosis. He said to always ask “what’s the worst thing it could be?” when piecing together a clinical puzzle in order to avoid premature closure and confirmation bias. As a rising second-year medical student, this advice resonates with me and I will carry this story and this advice with me as an example of how things can go awry when we lose sight of the importance of keeping an open mind and looking at all of the clinical clues.

I think Dr. McDonald’s advice rings just as true is in the realm of team… Continue reading

Telluride Experience 2021 Dates

BRECKENRIDGE, CO:
CMF Session 1*: 8/23 - 8/26
TDCF Scholars Session 2: 8/30 – 9/2

*Session exclusive to the COPIC Medical Foundation Residents.
 
ELLICOTT CITY, MD:
Bennathan Scholars Session 3: 9/9 - 9/12
 
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