Do one thing at a time, and do it well

“You can’t solve everything at once. You need to break down big problems into little problems and then solve them one at a time. Do one thing at a time and do it well.”

These were the final thoughts from the first day at the Telluride experience. Medical students, nurses, and residents from around the country had come to beautiful and sunny Napa California to learn about crafting a safer and more effective medical system.

Our first day was busy and full of learning. Through narrative, we connected with the deeply tragic and painful consequences of unsafe care. We reflected on the necessity of incorporating the observations and concerns of patients and caregivers when providing care. Additionally, we explored the deep-seated cultural differences that can serve as barriers to effective doctor-nurse communication and prevent providers from asking for the help they need.

One of the most inspiring moments on the day was hearing the residents speak about their work on QI projects that improved the safety and quality of care at their institutions. They had tackled varied projects including implementing an improved text paging system and reducing the amount of time to obtain a stat EKG. As clinicians, these residents had run into poorly designed elements of the healthcare system. Seeing a problem, they took the initiative to engage fellow residents, nurses, allied health professionals and hospital leadership to make concrete changes.

As a medical student, you can sometimes feel as though you lack the agency and clout to address the imperfections of healthcare delivery. There seem to be so many problems without clear or neat solutions, that the proposition of systemic improvement can feel daunting. It was nice to reminder that you do not need to fix the system all at once, and you don’t need to do it alone. It is important to doggedly and wholeheartedly pursue the systemic errors that you find most compelling, and partner with other doctors, nurses and administrators to address the problems. Through meaningful partnerships and unrelenting perseverance, change can be achieved that meaningfully improves safety and saves lives.

At the end to the day I was struck with two major take home points. The first – never be complacent with a system that does not provide the safest and most excellent care to all patients. Second, major systemic change is achieved via the cumulative action of interdisciplinary teams tirelessly striving for feasible and incremental change.

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