Connecting in Telluride by Belle Brennan

Every medical student should read “Why Hospitals Should Fly”. More than once. The book not only provides practical solutions to the real problems we identify at the heart of Patient Safety, but also provides a constant reassurance and motivation of why we are making those changes. Today’s brainstorming session took us all by surprise. For the first time this week, we all connected on a completely different level; we were able to acknowledge the strengths of a particular project, but also raise the hurdles to implementation. In a few hours we had really transformed our minds to see that the changes we want to see in healthcare are possible.

The hike and dinner provided much more informal settings for us to discuss these issues. What I love about a group like this is that a conversation between one student and either Dave or Tim quickly becomes a small group all bouncing ideas of each other and making real critical analysis of situations.

I wish every medical student had the opportunity to absorb even just a little of the motivation and energy I’ve obtained from Telluride. But without a doubt, every medical school across the Country should have that fantastic book on its compulsory reading list.

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Day 3 Telluride Reflections–Denise Neal #TPSER8

The hike today was amazing.  We set our today at the bottom of the mountain with reservations of conquering the challenge ahead of us.  Some of us were unsure if we would make it to the top.  We already had moments of being short of breath just from the altitude.  The hike symbolized the challenges we will face as we move forward to implement change and increase patient safety.  At times we walked together; similar to when we are all in agreement with a change.  At times we also walked up hill alone, similar to when we do not have buy in for a change and we carry the burden to move it forward alone.  The journey seamed long at times and it was hard to know how far we had left to go, and felt unsure of how far we had come.  We took the climb one small step at a time and eventually we saw the end in sight.

We finished the day brainstorming ideas for change.  The group came up with many great ideas and solutions for change.  We discussed barriers that might get in the way and solutions to address these barriers.  We talked about identifying stakeholders in order to garner support for our patient safety solutions.  We also talked about measuring the outcome of the changes.  The group used creative ideas of how to share these solutions with other groups across the country.

Denise Neal

Stand Up–Stand Out! #TPSER8

Wednesdays, or the third day in Telluride, has become my favorite day of the weeks spent here at the Patient Safety Educational Roundtable and Student Summer Camps. It is because on Wednesday mornings, the group gathers unofficially at Baked In Telluride for coffee, a burrito or sweet treat before heading to the foot of Bear Creek Trail, our official meeting place, to start the annual (this year three-time) trek up to the waterfall. It has proven to be a great team-building experience over and over again–as we gasp through our excitement, sharing new ideas and unfailing awe of the mountains surrounding us.

What struck me in particular on yesterday’s hike, in addition to the inspiring conversation with my hiking partner Stephanie, was though I have been on this same trail three times in the last year, it is never the same. This year, the mountainside has been left dry and thirsty by a year of low snowpack, and even less spring rain. But despite the lack of water, jutting strong from the side of the waterfall was the beautiful, bright pink flower you see above in the photo captured by Tim McDonald at the pinnacle of our hike. To me, that flower stood for each one of the students here in Telluride, willing to do whatever it takes in order to stand up strong to protect their patients from harm.

It is clear you, and all your Telluride Alumni, are the future leaders of medicine. You have a solid network of support through your fellow classmates and the faculty who believe so strongly that the patient belongs at the center of every decision you will make as a caregiver. Remember this if you feel like you are standing alone, or standing out, when you return to your home institutions. You are all in very good company, even if that company is an email, or phone call away. Dr. Don Berwick wrote yet another heartwarming article, this one published in JAMA, To Isiah, and the following is an excerpt to carry with you as you return to those who have yet to learn what you have this week:

There is a way to get our bearings. When you’re in a fog, get a compass. I have one—and you do too. We got our compass the day we decided to be healers. Our compass is a question, and it will point us true north: How will it help the patient?

Delayed Gratification–#TPSER8

By Stephanie Christians

Having been a part of the group hike both years I’d been a participant at Telluride, I know how powerful this ritual can be.  Once again, I made room in my suitcase for a dusty pair of Garmin hiking boots, in preparation for the hike.  Earlier in the week, when people brought up the Wednesday morning agenda, I enthusiastically shared that I planned on going on the hike, even trying to convert those who had other plans.  So it seemed strange that this morning – a gorgeous morning for a hike – I found myself manufacturing excuses to bow out.

Thankfully, I’m becoming more skilled at parenting my inner four-year-old.  First, I began with gentle pleading: “All your friends will be there!  You don’t want to miss out on that, do you?!”  Next came bargaining, “If you climb with the group, you can get ice cream after dinner.”  After those attempts failed, my inner mom rolled up her sleeves and got a little salty: “Stop hitting snooze and get your @$# in the shower.  Now.”  The internal tug of war continued until I joined my peers just as they finished up breakfast.

Within a few minutes of joining the group, my internal whining subsided.  Thanks to the honesty of my fellow travelers, I knew I wasn’t the only one feeling less than enthusiastic about the work ahead.  Yet, in between shortened breaths, we all expressed our belief that in the end it would be worth it.  Before I went up the mountain today, I would have said this was the perfect metaphor for what it’s like to push for improvements in patient safety: Difficult work that’s worth it in the end.  For good measure, I would have included the observation that some days you just need to get out of bed, lace up your boots, and put one foot in front of the other until the rest of your body (or your colleagues) decide to follow suit.

Yet, today was different.  For the first time, the journey was just as rewarding as reaching our destination.  Tracy and I started out on the trail together, and in less than five minutes of sharing our current work projects, I got goose bumps – the same response that normally accompanies the sense of accomplishment and awe I feel once we reach the base of the waterfall.   Sharing honestly from our personal experiences not only made the time pass by more quickly, it helped us make creative connections that we may never have made on our own.

It’s tempting to withhold gratification for the end – once we reach the patient safety summit.  While creating a perfectly safe environment is a noble goal, postponing satisfaction until we reach our destination likely guarantees we never will.  All week we’ve discussed the myriad obstacles to creating and sustaining culture change.  If we can’t learn to find the value and joy in the journey, it’s doubtful we’ll be able to maintain the passion and enthusiasm necessary to accomplish our goal.

As we get ready to leave the patient safety incubator here in Telluride, I can’t help but think about the reality that’s about to come rolling back in on us: deadlines, obstacles, and pockets of toxic culture.  It’s normal to feel overwhelmed: We’d be naïve to think otherwise.  However, if we stay focused on taking small, steady steps and continue to reach out to our fellow change agents, we will not only achieve more than we could have on our own, but hopefully we’ll find that with each patient safety victory, the journey was just as important as the destination.

Telluride Roundtable: Week Three, Day One–Some Powerful Reflections

Introductions at Telluride Student Summer CampThe day began with introduction ice-breakers as student took turn introducing each other to the bigger group. From the introductions, it was clear that the Telluride Patient Safety Roundtable is hosting an extraordinary group of students this week – Medical Students, Pharmacy Students, and one student obtaining her Masters of Jurisprudence in Health Law. In addition, the Roundtable is blessed with faculty from Colorado, Illinois, Ohio, North Carolina, Maryland, Florida, and California.

Following introductions, the entire group attentively watched the film The Faces of Medical Error – From Tears to Transparency: The Story of Lewis Blackman. Unlike the two prior Roundtables this year, Helen Haskell, Lewis’ mom, was part of the faculty. She offered her own reflections on the events which occurred related to Lewis’ case, and answered questions from students and faculty. At one point Helen made the poignant observation that Lewis would have been the age of many of our students asking the questions. Had he lived, Lewis would have been 27 years old this year. He certainly was gifted enough to attend medical, nursing, or pharmacy school and could very well have attended such a Roundtable.  These observations were not lost on the students today.

In the afternoon, Deb Klamen from the Southern Illinois College of Medicine led the group in a discussion on leadership and the challenges students face in their day-to-day studies, and early clinical rotations. Small group discussions allowed the students to share their own leadership styles, as well as the leadership qualities of those they admire. Over and over a common, yet essential, leadership trait was described by students and faculty – COURAGE – the courage to confront those engaged in unprofessional and unsafe behaviors in a way that could avert future harm to others.

For the last exercise of the day, the students broke into two groups to engage in the now famous [infamous?] teeter-totter egg game. In an ironic twist the first group actually completed the task in the allotted time without breaking the egg while the second group suffered from a last-minute hesitation and injury to the eggs precariously placed below the ends of the teeter-totter. In almost all prior exercises, the first group most commonly fails while the second group learns from the debriefing and missteps of the prior group.

Most importantly, Dave Mayer led the two groups in reflections following the exercise and gave them an opportunity to understand the power of effective, clear, concise and goal-oriented communication tested through this “gaming” situations. The applicability to healthcare was clear to all.

Lasting Support and Friendship Found in Telluride #TPSER8

The past few days in Telluride have been nothing short of spectacular. Not only have I been exposed to important topics in patient safety through workshops and simulations, but I have also learned from the unique and interesting perspectives of my similarly-motivated peers and faculty. Dr. Mayer and others have spent a considerable amount of time organizing the thoughtful activities that we have experienced over the past few days, and I feel like they were very successful in generating important discussion. For instance, our discussion on the roles of nurses at different institution was eye-opening in the sense that many of my peer medical students had very little knowledge about other allied health professionals. I felt very fortunate that at my institution we have had several interdisciplinary sessions with nursing students before and after our clinical year exploring the power dynamics and abuse of power in the hospital. Our dean of student affairs has been a champion for this cause, and it would be great to see similar sorts of sessions spread to other institutions.

Additionally, I feel that the success of this camp is particularly evident in the spontaneous conversations about meaningful topics that occur outside these scheduled activities. This struck me last night around 1 am when, after a day involving hiking into the beautiful area surrounding Telluride, engaging in important patient safety discussion regarding communication, sprawling along a hillside listening to one of the nation’s largest bluegrass festivals, and spending a considerable amount of time in a hot tub with 15 other peers, I found myself in an intense debate about standardization of practices lasting late into the night. I am consistently blown away by the students that have assembled here, and I feel like I have developed relationships over the past four days that will surely last for many years to come. I was equally amazed by the faculty who have donated their time to speak with us here. In particular, some of my most thought-provoking and transformative conversations here have been with these leaders in patient safety during our breaks or leisure activities such as happy hours of barbecues. These experiences have taught me more about myself and have really driven me to think about how best to pursue a career in this important field. Throughout my time at Telluride, I have begun to recognize the patient safety successes and areas ready for improvement at my home institution. I hope to take my renewed enthusiasm for patient safety back to Yale and work to generate a similar level of awareness in my fellow classmates.

Student Reflections: Test for Change at #TPSER8

Elliott Schottland, Medical Student, says:

The discussion about nursing and doctoring reminded me of conversations I had with fellow classmates at school. We were studying for the NBME Behavioral Sciences exam and joking about the ethical  dilemma practice questions we were working on. A common theme that we noticed is that any answer involving soliciting a nurse for help or consulting with a nurse would invariably be wrong. We agreed that answers involving nurses can be crossed off and it would be nice to get one on the test because we could narrow down the answers easier. Almost like how there used to  rarely be positive depictions of minorities in the cinema, early medical education is nearly void of positive depictions of nurses. The best way to effect change in medical school is to test students on the material. This should be applied to learning about hospital hierarchy and inter professional awareness. If we can learn about the citric acid cycle it’s certainly fair game to test us on how well we can utilize the resources of the hospital and work on a team.

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