Wednesday, April 25, 2012

Seeing quality clearly in Denver



I am spending a couple of days in Denver as the guest of the PSE Partnership.  This is a small non-profit that has received a grant from The Colorado Health Foundation to provide patient safety curriculum for medical students and residents in three 3 metropolitan area hospitals that are part of the HCA/HealthOne network.  In this picture, you see Shelly Dierking, who runs PSE Partnership, with Brian Dwinnell, director of graduate medical education at Presbyterian/St. Luke's Medical Center.

The day started when I joined a small group to watch teaching rounds on a medical unit at P/SL.  Dr. Erin Marcum, an internal medicine attending, was in charge, and her brood included Sara Grace, a transitional year intern, and Obiora Chidi, a third-year medical student on his first rotation in the hospital.

Obi, Erin, and Sara consider a patient's needs
There is something remarkably old-fashioned about teaching rounds.  You really get the feeling that you are watching the apprentice system of old-time craftspeople at work.  And, in fact, that is a large element of what goes on.  The residents and students are given the responsibility of analyzing and summarizing each patient's condition and recommending a treatment plan.  While there is an order and protocol to their rounding -- subjective assessment, objective assessment, and treatment plan -- each presentation is a stand-alone report, incorporating the experience, skills, judgment, and intuition of the trainee.

This is a necessary part of medical education, for sure, but as I have noted elsewhere, rounding does not generally teach residents and medical students about process improvement in hospitals.  So, the work done by Shelly and her colleagues is an important supplement.

Today, though, I had a chance to see an excellent teacher in action.  Obiora was responsible for reporting on two patients, based on what he had learned earlier from the nurses, test results, and chart reviews.  This being his first day, he was understandably nervous:  You could literally see his mind churning as Erin would ask questions.  But, she in turn, was an excellent practitioner of the Socratic method, gently applying and relieving pressure, allowing him to learn adaptively.  As Ronald Heifetz would have admired in his book Leadership Without Easy Answers, Erin was displaying a strong aspect of leadership, "a special sort of educating in which the teacher raises problems, questions, options, interpretations, and perspectives, often without answers, gauging all the while when to push through and when to hold steady."

Later, I was invited to address many of the residents in Shelly's program, focusing on issue of quality and safety improvement, transparency, and front-line process improvement.  Following that talk, it was off to the University of Colorado Anschutz Medical Campus, for another presentation in front of the local chapter of the IHI Open School.  My hosts (seen here) were Wendy Madigosky, the faculty lead and the director of the Foundations of Doctoring Curriculum, and Daniel Stoll, a first year medical student and president of the local chapter.  Again, the topics of the day were quality and safety improvement, transparency, and front-line process improvement, but also with a strong emphasis on engaging patients and families in hospital decision-making.

All in all, it was a very full day and rewarding for me and, I hope, the students and faculty with whom I met.  I was left, though, with one unanswered question:  What on earth is this sculpture on the Anschutz Campus supposed to symbolize, if anything?


3 comments:

Anonymous said...

The sphere of life. :)
You raise an interesting point - the mode of medical education on the wards has not changed in decades, despite major advances in technology. (Your story was enough to raise a frisson of familiar terror in me) And the word 'craft' is telling - we are still teaching in the old way as the rest of the world has moved on.

nonlocal MD

Dan said...

Paul- thanks for a great visit here in Denver. I very much enjoyed meeting you and learning from you- and hope to continue learning with you. Although most of us had no idea what that spehere sculpture is.. Doug Jones has enlightened us. From his response:
"The sculpture is by a sculptor from North Carolina whose name I forget. It is the first part of an installation that goes across the breadth of )the old army hospital), "Building 500" – each of the boxes – and ends with the metal sphere near the research buildings. It is supposed to represent knowledge in an unformed state – the earth toned, rough sphere – going through successive stages of development – each of the box installations along the way – ending up as complex, elegantly structured knowledge at the end. If you look west through the boxes everything lines up – except the metal sphere. That is out of line because the axis created by RC1 did not line up with the east-west axis in front of 500. That drives the people responsible for public art in the state nuts because it wrecks the symmetry and symbolism of the installation. Rumor is that the artist is indifferent. By itself, I could not agree more that the east-end ball is unattractive. It makes absolutely no sense on its own. I expect some would say it makes no sense regardless!"
probably more than you wanted to know, but hey, you asked!- dan

Melissa said...

Ever since that ball was installed I've had the theory that the "real" art is inside the ball, and that rain and weather will slowly wash away the dirt on the outside until something beautiful, surprising is revealed. Every time I walk by, I look for any signs that something underneath is peeking out. My classmates think I'm ridiculous, but to me it's the most plausible theory for why we would have such a crazy-looking piece of art!