20 Lessons Learned in Telluride by Heidi Charvet MD

I just returned from an amazing week in Telluride where I not only learned a lot but was also inspired and reinvigorated by the group of colleagues and faculty I met.  One of the most surprising things about the week was that despite our varied backgrounds and geography, we all came together with a common set of interests and experiences (sometimes bad ones) determined to make changes moving forward in our practice.  Thank you to everyone I met this week.

Here are the main lessons I learned during the week as well as some fantastic quotes from the group…

1.) Start every meeting with a story (it’s all about the patient!)

2.) The way we treat nurses when they bring a concern to us that ends up being wrong, is often more important than when they bring a concern that ends up being right (respect and appreciation are key or else you may not hear about the next concern that ends up harming a patient)

3.) The art of negotiation is about “letting them have your way.”

4.) Culture eats strategy for breakfast.

5.) Patients who end up in the “wrong ward” are often the most vulnerable.

6.) Your greatest enemy is complacency.

7.) Informed consent is a process, not an event.  An even better term for it is “shared-decision making”

8.) Doctor language can be disrespectful to patients (whoa!)

9.) Knowledge is power.  Your job is to transfer this power to the patient.

10.) Once you have made your point, shut up and listen.

11.) Seek first to understand and then be understood.

12.) Holding “patient safety event reviews” focused on resident education rather than RCAs, may be a better way to achieve buy-in.

13.) If you want to report something, but the other person involved is resisting, write it together so there will be no misunderstandings or division of blame.

14.) Reporting a patient safety concern is about the INCIDENT (and the harm or potential to harm) not the individuals involved.

15.) There is a role for situational leadership in healthcare.  You lead differently on a sinking ship vs. when making changes about parking at the hospital.

16.) Leaders do not make excuses, they build solutions.

17.) Some is not a number, soon is not a time.

18.) As physicians, sometimes we take steps to treat ourselves and not the patients.

19.) Build trust by saying what you are going to do, and then doing it.

20.) Problem-solving is one of the main barriers to listening among doctors.  We need to be cognizant of this when we find ourselves tuning out.

Day 2 – BHAG

Day Two At Telluride Patient Safety Summer Camp

Today’s final discussions revolved around what three tangible things we as residents can do when we return to our respective programs to improve shared decision-making and improve our ability to communicate in the case of patient harm. I was very encouraged that there was actually very little variation from each of the breakout small groups. We all seemed polarized to some very clearly defined, and what seemed like obvious, solutions to improved patient safety in our respective corners of the world.

The opportunity that I see after completing this exercise is that although we can all make small incremental changes in our respective practices, how can we reshape the practice of medicine to make our small individual changes part of a bigger and more permanent cultural change? If all 28 of the scholars would communicate with 10 colleagues about the importance of shared decision-making and informed consent we could make a small change. But if we made our goals for next week bigger and decided to change the entire process for all residents for generations to come, we may succeed in making lasting change and forever changing the practice of medicine related to these issues.

Considering the very talented group of resident scholars that we have, I believe that we could make broad sweeping changes to the practice of medicine. Although these changes would not be easy and would take time, diligence and perseverance, we really have nothing to lose. It would be incredible to leave a mark on the culture of medicine that would be lasting.

There is a concept of a massive, almost unachievable goal that is called the BHAG. For those who are not familiar with this, I would encourage you to learn about it. The acronym stands for Big Hairy Audacious Goal. Why not make goals as big as you could imagine. The worst that could happen is that you did not achieve the goal and would fall short, but this would be so much more monumental that making a manageable goal that would not likely expand your skills, knowledge or make a lasting change.

In the upcoming weeks and months, I challenge my fellow residents to think big. Think outside of the box. Imagine what would be your ideal for patient safety and work as a team to create initial steps toward these goals.

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

Day 1 by Nicole Hanrahan

I had an amazing first day in beautiful Telluride, CO! It was so great to get to meet my fellow MedStar residents and the host of other residents, physicians, and staff members. It is so rewarding that we are all here for a common cause and I feel grateful to be involved. I really enjoyed Paul Levy’s negotiations lectures. I realized that negotiating is something we do on a daily basis and may even be doing so without realizing that it is even a negotiation! It was helpful to step away from clinical scenarios and approach the topic from a different perspective. I can’t wait to take back what I’ve learned, and am excited for day 2!

By Kate Sullivan

In discussing the case of Lewis Blackman today, I could not help but think about the importance of good transfer of care. If the on-call weekend resident had a better understanding of Lewis’ immediate post-op progress (or lack of), the gradual change in his vital signs and exam may have sent up red flags sooner. It is easy to become overwhelmed with the number of unfamiliar patients one must cover as an on-call physician. One may not appreciate the subtle changes in a patient’s status when there is just a snap-shot view of the situation. We have all fallen victim to this, and the situation is worsened by sleep deprivation. I can recall a case when a patient had subtle labs changes over the course of her stay for preeclampsia. To the covering physician, these labs seemed relatively stable and the patient was sent home. She returned the next day actively seizing from eclampsia. Because of this, I am now in the habit of reviewing the record of all the patients I am covering before, or at the start, of my shift.  This is an additional layer of protection beyond our otherwise thorough patient hand-offs. It is important to appreciate the “big picture” in addition to the details.

By Molham Abdulsamad

I would like to start by saying thank you to everyone who made any single effort to make this amazing work about patient safety. I actually had a great experience this first session. I was really touched by Lewis Blackman’s story, as it made me look deeper into how easily a human life can be lost due to our mistakes. I think I learned a lot about how to be a better negotiator and I will absolutely use what I learned on a daily basis to get the best and safest care to my patients. Thank you again! I am so excited to get more out of this camp.

Resident Reflections: Day One at #TPSER9 2013

IMG_1635Following are reflections by resident scholars after a motivating and moving first day in Telluride, 2013! Thanks to all who have shared their thoughts so far. Keep the great ideas coming–

By Michelle Espinoza

Just finishing my first 24 hr call as “the” senior resident and Chief, I began my journey into Telluride completely exhausted.  I was fully aware of my limitations as a human being,  and my heart was still pounding thinking about the 18 patients whose lives had been entrusted to me overnight. However, I was joyful. I was not only going to a beautiful place that seemed to be the inspiration for all of  Bob Ross’s masterpiece paintings, but also a place where I had hoped to develop and mature as a doctor–“Doctor” as defined by its rudimentary latin origin, “to teach”.

However, today’s experience was life changing. Today it was reaffirmed to me why I had decided to make medicine my vocation. You see for me, Medicine is not just a career, it is a God anointed life calling. To be here in Telluride is truly a blessing, and to be surrounded by such knowledge, talent, wisdom and passion is AMAZING.

Today I learned that I am not alone in thinking our hospitals are one of the most dangerous places for patients. That my internal conflict regarding my concerns for residency training is not isolated to my hospital, and that there are people who not only believe this is wrong, but have dedicated their lives to making a change. It’s divinely inspiring and I can’t wait to see what the rest of the week brings.


By Heather Batchelor

After the first day at the Telluride Patient Safety Resident Summer Camp, the same word encompasses my awe as I was riding up the mountains to the gorgeous view that awaited us at Bear Creek Lodge yesterday: Wow.  Today was such an incredible experience of sharing and learning from other residents and leaders in quality and safety.  Already my expectations from this week have been surpassed.  Today’s most moving moment for me was watching the video of Lewis Blackman story.  The discussion that this emotional film triggered was truly remarkable and I appreciate my colleagues sharing their experiences without fear or hesitation.  The most striking thing I have found from discussions both inside and outside of the classroom, is that even though we are from all areas of the country with varying backgrounds, we all face very similar barriers when it comes to patient safety: hierarchical culture of medical training, honest communication, and implementing change.  Today set the tone for the rest of the week, and I am excited to learn from all of our differences and similarities in how we can all make positive changes for patients, families, and colleagues.

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