“Some is not a number and soon is not a time”

By Fiona Campbell (Medical Student at the University of Calgary)

It was refreshing to hear all of the insightful closing comments from all of the Telluride East participants today, and exciting to hear what we all plan to work towards as we return to our schools. It’s easy to see why we would all come away with such momentum and inspiration. This week was full of eye-opening discussions and thought-provoking workshops. It’s easy to feel empowered by everyone with a shared passion, and to think that we really can make healthcare better around the world.

But it’s also easy to succumb to real life and let that momentum fizzle away. It’s easy to forget how important patient safety is when you’re once again surrounded by leaders who don’t value it. It’s easy to get caught up in all of the knowledge we are expected to learn at school and forget about pursuing initiatives that will improve the system.

I’m still in the newlywed zone and every day I am reminded of the vows that I spoke one short week ago. They weren’t ground breaking, but by speaking them out loud in front of so many loved ones, it helps me hold myself accountable to following them. Today, we all vowed to each other to take what we’ve learned here, bring it back to our institutions and create something from it. Let’s not let life get in the way of accomplishing what we promised to do, and let’s hold each other accountable for making change. But as Dr. Mayer pointed out, some is not a number and soon is not a time – we need to think in realistic milestones in order to hope to accomplish anything. So let’s create more specific goals for ourselves and share our successes and shortcomings along the way.

My first step will be to do a patient safety project with the Human Factors group at the University of Calgary. I will start by defining the scope of the project this month and come up with a manageable deliverable to be completed before I start Clerkship in March. I’ll come back to this blog at least twice along the way to share my progress and get inspiration. Thank you to all of the Telluride East participants and faculty for the knowledge, motivation, and support to work on making healthcare safer one project at a time.

Hope everyone has a safe drive home from the airport!

How can we teach?…

My Fellow Telluride Patient Safety Gurus,

What an incredible week! I have been so fortunate to be surrounded by such a brilliant group of people leading change all over the country. You have all inspired me and energized me to go back and promote the mission that we have all set out for ourselves- create a system that is patient first.

Inspired by Rick’s proverbs reminding us all that we are teachers and it is our responsibility to share the knowledge that we have gained to improve our systems, I’ve come up with an idea on how to approach teaching informed consent to our fellow residents.

But how do we teach?…How do we teach hundred of grown adults, physicians, those set in their ways with their own ideologies and beliefs that may or may not contradict yours. How do you teach change?…

Here’s my attempt:
Create an “Informed Consent Checklist.” What if we taught the complex art of informed consent as a systematic way of thinking how you approach the conversation, just like you would the steps of a central line. Gloria highlighted this point nicely- now she has a way to structure the conversation. It truly needs to be a step-wise approach that comes naturally and systematically after being taught the right way to do it.

The video gave a great structure on how to approach the conversation. We could use that as the learning tool to instill the importance and value of approaching the conversation in such a way. We can also add the structure of what needs to be covered- benefits, risk, alternatives, and doing nothing. This way it can be a comprehensive, step by step approach that is repeated time and time again until the “checklist” comes to mind unconsciously.

Let me know your thoughts, reservations, and tips for implementing. I think we can do this!

I want to thank you all again for an eye-opening experience that has re-energized me in the mission for disseminating patient safety efforts and changing our culture as we transform to a system that is truly “patient first.”

Shabs

Post Telluride Roundtable Reflections: Process Improvement-Real-Time Results by Julie Morrison #TPSER8

Upon returning to UT medical center from Telluride, I was filled with motivation and a new sense of purpose. Something had changed in me out there. I used to be more of a ‘thinker’ (forever told I would be good as an internist) and not so much of a “doer.” I struggled with this during my third year of medical school because I saw so many areas of improvement but often sat near the sidelines gathering information rather than jumping in and stimulating change. At Telluride I was so encouraged by the perspective of the senior faculty; the fact that they found similar aspects of the clinical world frustrating or inefficient and were looking for a collaborative team to face these challenges reinforced my perspective and encouraged me to take action. Telluride gave me a better vision of the organization and hierarchy of a hospital as well as the tools to accept such a call to action. I realize now that a vision cannot be translated into change without the support of various members of the care team and hospital administration. A good idea can fester forever within someone without ever seeing the light of day or be implemented without the correct support and flop because of a lack of motivation or proper support.

On the third day of the conference, we broke into small groups and discussed real life changes we would like to see in our hospitals. My team came up with a “bedside communication white board” that would list the care team (nurse, attending, residents, medical students, PT, OT, RT etc), their expected procedures and daily care plan. It would also serve as a place for the patient or their family to list questions and concerns. We envisioned that this tool would empower the patient to engage in their healthcare by making them informed participants and serve as a stop-gap from wrong procedures. When I returned to campus I was excited to stimulate change but tempered this excitement in order to stimulate the proper support for my ideas, as I didn’t want to be run over by resistance. I scheduled a meeting with the CMO of our hospital system and settled into my clinical rotation.

The first day I spied portrait covered papers in several patient rooms before a nurse manager came by and left a stack on the cart we were using for rounds. I immediately picked them up and found a paper form of our “bedside communication white board!” I almost couldn’t contain my excitement. I followed the nurse down the hall and asked her about this innocuous sheet she left. We engaged in a great conversation and she invited me to sit in on the quality improvement meetings that she attends. I took over the responsibility of filling out these sheets for each patient as we rounded for the rest of the week. I did so silently at first. And then I started getting questions from the other members of our team. In the past I would have been uncomfortable explaining my actions, I would have been concerned that it wasn’t a big enough idea, or that they would find it frivolous or frustrating. But not now; because of Telluride and the perspective of the senior faculty I spoke with confidence and clarity of vision. I knew that this tool would make a difference and I educated the other students, residents and even our attending so that they could see its value as well. By the end of the week I was receiving really good feedback from the patients having them say things like “oh I was waiting for this” or “this is so helpful, thank you” and even had the senior resident thank me for utilizing the sheets. I think it is going to stick, and I think we will have it implemented across the hospital by the winter!

Wonderful Start with New Friends

As we finish up the second day of the Telluride Patient Safety Roundtable here in beautiful western Colorado, I cannot help but think about what I have already taken away regarding patient safety and quality improvement from both the Roundtable itself and those who I am surrounded by.  For instance, I have been amazed with a number of interesting and innovative approaches to QI and patient safety at other medical schools around the country.  Certificate programs, interdisciplinary coursework, teamwork simulations, and clinical rotation QI projects are only a few of the great ideas that I have heard.  While I am immensely enjoying my time in Colorado, I can truly say that I am looking forward to getting the opportunity to return to my medical school to weave a number of these novel approaches into our curriculum.  With two more days left, I can only imagine what other great ideas I will be introduced to and look forward hearing more as the week progresses.

%d bloggers like this: