Dr. Kaplan addresses GME patient safety retreat in New Mexico

I am in Albuquerque, New Mexico, for a series of events related to patient quality and safety and process improvement in hospitals.  We are starting this morning with a graduate medical education retreat  entitled "Residents and Patient Safety" being run by the University of New Mexico School of Medicine.

The keynote speaker is Dr. Jay Kaplan, who practices emergency medicine in northern California and also works with hospitals throughout the country on clinical improvement matters.  I'll try to summarize key points as he talks.  His theme is "Driving Hospital Quality."

In his introductory moments, Jay noted that a rule of his department is bedside change of shift report.  He presented a recent example from his own last shift of such a handoff to show that this protocol can help identify a patient's problems that would otherwise be missed.

His major point is that customer service and quality of care are intimately related.  Quality is often viewed as the "hard stuff," while service excellence is viewed as "fluff stuff."  This is not accurate and misses the degree to which the latter affects clinical outcomes.  Quality gets you in the game; service lets you win.

One obstacle is that doctors have not been trained to be team players.  They need to learn how to collaborate.  Trained as craftsman, likewise, they are often not conversant in process improvement.

We have to focus on both systems and people.  We need people to buy into well designed systems.  Likewise, though, systems have to be designed to support great people.

Efficient patient flow requires aligned behaviors and cooperation between emergency departments and inpatient floors.

He asks the residents to ask themselves, "What do you do every day to bring quality and patient safety to your patients?"  Integrate service provision into this question.

Think bakery.  What does a customer notice upon entering?  The smell.  Do bakers notice it?  No, because they are used to it.  The analogy is:  When people first walk into your practice, clinic, or hospital, what do they notice?  What patients see, feel, and hear is different from what you and I see see, feel, and hear.  We are used to the environment.  They are not.  View your workplace from the point of view of the patients.

Here are some ideas.  Take a fresh look:  Change the signs.  Sit down when talking with patients, so they don't think you are in a hurry.  People will not hear all of your words:  Use key words that will be remembered.  As you pause to wash your hands, mention that you are doing so for their safety.  At the end of the visit, ask "What questions do you have for me?" instead of "Do you have any questions for me?"  They will always say, "No," to the latter.

Here is another set of ideas, based on the acronym ICARE:  Introduce yourself and Inspire confidence in the patient; Connect with the patient and family; Acknowledge what the patient has said; Review the plan of care and how long the various stages will take; Educate about what to expect and Ensure their understanding.

Another key strategy is to have follow-up phone calls to check on adverse reactions from drugs, to check on patient understanding, the patient's condition, etc.  This will also increase customer satisfaction.  The average time it takes to do this is two minutes and will result in some of the most rewarding feedback you will get from patients.