Telluride “East” Kicks Off at Georgetown University in Washington DC

This week we transport the Telluride Patient Safety Educational Roundtable and Resident/Student Summer Camps to the heart of the nation’s capitol — Washington DC. Dave Mayer MD and Tim McDonald MD/JD along with faculty Paul Levy, Rosemary Gibson, Helen Haskell, Cliff Hughes, Kathy Pischke-Winn, Joe Halbach, Gwen Sherwood and more will educate the young of healthcare, sharing communication skills, patient stories and negotiation training in the spirit of keeping patients safe. The Telluride alumni numbers continue to grow, building that critical mass of voices who can share the wisdom of open, honest communication and transparency throughout medicine.

Student reflections on this year’s camps, as well as last year, are found throughout the Transparent Health blog, on Educate the Young and on faculty member Paul Levy’s blog, Not Running A Hospital. Look for additional reflections from this week’s class soon to come, and follow us on Twitter via #TPSER9. The goals of this week’s program follow.

TRANSFORMING MINDSETS III

“The Power of Change Agents: Teaching Caregivers Effective Communication Skills to Overcome the Multiple Barriers to Patient Safety and Transparency”

Patient Safety Student and Resident Summer Camp learning objectives:

By the end of the Patient Safety Summer Camp, students will be able to:

1.)   Describe in-depth at least three reasons why open, honest and effective communication between caregivers and patients is critical to the patient safety movement and reducing risk in healthcare.

2.)   Recognize and apply basic communication skills to improve effective communication among members of the healthcare team.

3.)   Utilize effective tools and strategies to lead change specific to reducing patient harm.

4.)   Implement, lead and successfully complete a Safety/QI project at their institution over the next twelve months.

#TPSER9 – Telluride Student Summer Camp Reflections on USA Today Article and more

By Aaron Cantor, BS, ENS, MC, USNR, MSII Pennsylvania State College of Medicine

On my way back home from Telluride, I happened to pick up a copy of USA Today from 20 June.  I was pleasantly surprised to see that the front page featured a special report, “When Health Care Makes You Sick: Under the knife for nothing.”

Although the article highlights medical errors, interviews Lucian Leape and Rosemary Gibson, and even mentions the story of Michael Skolnik, its tone perpetuates acceptance of medical errors and withholding of valuable information:  there is a way to know the total number of cases in which people got surgery that wasn’t needed if honest disclosure is practiced; hospitals are required to report infection and surgical errors to a governing body, but reporting to the patient and family (those who are most affected) may not be required.  The article goes on to describe several other instances in which reports of complications are too difficult to obtain, doctors are pressured into performing more surgeries to generate more revenue in a fee-for-service model, or people are rushed into procedures without being recommended to obtain a second opinion.  The article also places most of the burden of preventing unnecessary surgeries on the patient, promotes a doctor-patient antagonism, and erodes trust in the healthcare system.  Stories and methods of overcoming these barriers to safe and effective healthcare are not described, which maintains a negative attitude against healthcare and sensationalizes only poor outcomes.

Fortunately, an important comment from Gibson is included in the article but it is not further explained.  She states that “the system, in my opinion, doesn’t want to know about the problem [of unnecessary surgeries].”  As we discussed during our meetings, most of the healthcare system is perfectly designed to the results it gets…so let’s focus on how the system promotes, say, unnecessary surgeries and work towards changing that system.  The past few days in Telluride with our awesome group allowed me to meet agents of this change and learn about techniques for both enacting system changes and promoting awareness of system faults.  For instance, Tim explained the new Clinical Learning Environment Review (CLER) Program, which assesses the graduate medical education learning environment and focuses on patient safety and quality improvement among six focus areas.  This is great ammo with which to convince administrators to more carefully consider the culture and systems in place at your institution and support a project you are planning that aims to reduce errors.

But as Garrett and Suresh describe in their most recent posts on 21 and 23 June, respectively, these types of changes and patient safety training often receive too little emphasis from top administrators all the way down to residents and senior medical students.  I think at least two activities can help encourage students to support system changes towards greater transparency.  One method is experiential learning; if students personally experience outcomes of a common procedure or medication, then they are more likely to understand the patient experience and be better equipped to describe, say, what to expect during an MRI or nasogastric tube insertion and maintenance.  Understanding the patient experience translates to greater honesty and a higher degree of care and mutual trust.  Reminding students to pause and think about the patient as if that person were a family member may also influence students to act more cautiously and disclose all relevant information.

Another activity is following consenting patients with chronic conditions during their normal activities of daily living.  This affords students the opportunity to experience how illness affects people and their families outside of the medical environment and further enhances empathy, all of which encourage greater transparency in healthcare.  An example of this activity is below.

A description of The Patient Project can be found here. Videos can be found here.

The caliber of all Telluriders was phenomenal as well as inspirational, since each of us will have to overcome an ingrained healthcare culture at some point in our careers if not done so already.  I look forward to learning about the results from ongoing and developing projects as well as the sharing of ideas that emerge from our meeting.

Reflections from Telluride, Week 2

By Jan Boller, Western University of Health Sciences

Yesterday was my first day at the inter-professional Patient Safety Summer School for medical, nursing, and pharmacy students. I echo the conclusion (by Kim Oates) that the future is brighter. As I listened to the students reflect on what they were learning, it was inspirational. They will reshape healthcare to be safer, more effective, and more affordable. I felt a renewed sense of urgency to spread and sustain this exemplary model for preparing future health professionals. Thank you to David, Tim, Kathy, Gwen and the entire faculty team for creating this exemplary program, and to The Doctors Company Foundation for providing the student scholarships. Brilliant idea!

The best advocate

By John Joseph, MS2 Wayne State School of Medicine

We completed the first day of the Telluride Patient Safety Summer Camp and I can say already that I am so glad I took the time to make the trip out. Telluride is a beautiful place and the enthusiasm and passion of the participants and leaders has reignited my interest. The lesson that stood out the most to me today was the video put together by Drs. Mayer and McDonald on the heartbreaking case of Lewis Blackman. His mother, Helen Haskell, fought tremendously for Lewis while he was in the hospital (and she continues to fight the system that killed him to this day) after a routine surgery. She trusted her instincts that something was wrong and repeatedly pushed for more senior physicians to examine Lewis, over and over and over. I was shocked that despite her insistence, that her requests were not honored. I was also horrified to think that if this type of cascade of errors can persist when the patient has a vocal advocate like Helen, what must happen to patients that are alone or do not have advocates that feel comfortable or able to question at all? How many children and adults have died because they did not have someone on their side? This hammered home the need for patient advocates and I look forward to learning more about their roles and implementation later in the week.

Telluride — “Old West” Town Embraces Patient Safety

Screen Shot 2013-06-02 at 10.45.44 PMFirst posted on Educate the Young, June 3rd, 2013

June has always been a very exciting month for me. For the last eight years, Tim McDonald and I have journeyed west to Telluride, CO, a beautiful mountain town known by many for its skiing than summer activities. For those outside CO, Telluride may be one of the best kept secrets around. We often choose to take the scenic six hour journey from the Denver airport to Telluride each June, making our way up the mountain to run our annual Telluride Patient Safety Roundtable and Summer Camps, and to be reminded of the power of the peaceful surroundings we will be teaching in for the next 2-3 weeks. Over the years, people have asked me “Why Telluride?” My response has always been the same – “Why not?”  Be it the “old west feel” of the town, or the magic that happens at an elevation of 9,600 feet, Telluride has always been a learning mecca for us.

Nana Naisbitt, Executive Director of Telluride Scientific Research Center (TSRC) and her son Rory, have been wonderful to work with through the years. TSRC hosts about 24 scientific programs each summer. The smaller, roundtable format we use is designed to foster creative thought and consensus building through lively conversation in a relaxed and informal setting. This format attracts patient safety leaders from around the world to Telluride each summer to “break bread” and share ideas on current issues and challenges. Because of this unique venue, a lot of discovery and sharing of ideas happen on the walking paths, hiking on the mountain trails, in a coffee shop, or over a glass of wine.

Screen Shot 2013-06-02 at 10.46.03 PMThrough the generous support of The Doctors Company Foundation (TDCF), COPIC, Committee of Interns and Residents (CIR), Mag Mutual and MedStar Health, over 100 health science students and resident physician leaders will be attending one of three, week-long Telluride Patient Safety Summer Camps this summer. The first two weeks will be in Telluride and a third week in Washington DC later this summer. Numerous health science students and resident physician leaders from across the country applied for one of the summer camp opportunities.

Our objectives for the Patient Safety Summer Camps are the same each year:

  1. To identify and help develop future healthcare leaders and champions in patient safety, transparency and open, honest and professional communication between patients, families and caregivers.
  2. To develop a growing number of Patient Safety Summer Camp alumni that serve as role models and mentors to (a) health science students and resident physicians at their respective medical centers and health systems, and (b) health science students and resident physicians enrolled in future Patient Safety Summer Camps.
  3. To create a social networking community where Patient Safety Summer Camp health science students, resident physicians and past alumni can interact with international leaders in patient safety, education and patient advocacy on issues pertaining to patient safety, transparency and open, honest and professional communication between patients, families and caregivers.
  4. To help create risk reduction and quality improvement collaborative projects between Patient Safety Summer Camp alumni, faculty and patient advocates that are implemented within the Patient Safety Summer Camp alum’s institution and beyond.

Screen Shot 2013-06-02 at 10.46.14 PMNext Monday, many wonderful and highly committed patient safety advocates and leaders will once again convene in Telluride to continue our mission of “Educating the Young”. The first week, we will have twenty-nine resident physicians, future physician leaders from across the country, immersed in learning about transparency, patient safety, and patient partnership. It truly is an amazing experience that always leaves me energized for months to follow.

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