True north

It has been a wonderfully busy first day here at the eleventh annual gathering of the Academy for Emerging Leaders in Patient Safety: The Telluride Experience. As I sit down to review my notes and reflect on the discussions from the day, my mind wanders from the exhilarating views from the Telluride gondola to the emotional stories shared with and among the group. Where does one begin amidst all of the challenges, opportunities, and excitement in patient safety and quality improvement? Actually, the answer is easy: the truth north of why I came to Telluride in the first place.

Through the years, we have accomplished more when we have stayed focused on what matters most: providing medicines and vaccines that save and improve people’s lives.

Almost six years ago, I scribbled down this quote on the first day of orientation. But it wasn’t orientation for medical school or for any clinical rotation; rather, it was for my job as an engineer for Merck Vaccines. My work there was my introduction to safety and quality concepts and tools including Lean thinking, six sigma, human error, and root cause analysis to ensure the quality and safety of vaccines. We often started meetings with a safety moment at Merck, and the fact that we started the conference this morning with a safety moment and will start it with a safety moment every morning warmed my heart.

As a freshly minted physician, I understand the routine of patient care. I have seen rushed explanations of informed consent and abbreviated histories and physicals; I even admit to doing it myself in the name of efficiency. But I want to grow, I am willing to listen, and I am ready to be inspired. As I prepare for my internship and residency in anesthesiology, I realize that the status quo of the current medical culture is inadequate, and that my exposure to formal and informal learnings and discussions on patient safety and quality has been limited. I am hopeful that this roundtable will help me become a more compassionate anesthesiologist, a more skilled instructor, and a more thoughtful team member.

In thinking what I will be taking forward with me from today’s experience, the lessons fall roughly into two related levels: the individual, and the system-wide. The challenges and opportunities for improvement in healthcare can be overwhelming, but I can see two levels on which I could make an impact in the future.

On the individual level, I am reminded of the fundamental importance of treating others with respect, and of practicing mindfulness in my communications and actions. I am more convinced than ever that it is possible to do immense good through role modeling such behaviors that promote patient safety with direct benefit to patients and my colleagues in health care.

On a broader system-wide level, there are structural changes that can facilitate a culture of respect that is too often lacking. One idea that especially resonated is the use of universally accepted and understood “critical language” to escalate patient safety issues, including words like, “I need clarity” or “My concern is…”. I have seen this used effectively at the Children’s Hospital of Philadelphia, where I did several rotations in pediatrics. Another key take home point for me was the efficacy of using multiple approaches to persuade and inspire others to join your cause, including data, structure, and stories. Without a doubt, the most memorable are the stories, and I know I won’t soon forget the legacy of Lewis Blackman.

Similar to that first day of orientation at Merck, I know that “we accomplish more when we have stayed focused on what matters most”, and I want to renew that focus.

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