Tuesday, June 09, 2015

Faces of the Telluride experience

Here's a small compendium of some faces (students and faculty) from this week's Patient Safety Summer Camp in Telluride, Colorado.

As a freshly minted physician, I understand the routine of patient care. I have seen rushed explanations of informed consent and abbreviated histories and physicals; I even admit to doing it myself in the name of efficiency. But I want to grow, I am willing to listen, and I am ready to be inspired. As I prepare for my internship and residency in anesthesiology, I realize that the status quo of the current medical culture is inadequate, and that my exposure to formal and informal learnings and discussions on patient safety and quality has been limited. I am hopeful that this roundtable will help me become a more compassionate anesthesiologist, a more skilled instructor, and a more thoughtful team member.  A note from Dora.

All too often, patients are harmed in hospitals at the hands of well-intentioned providers. More often than not, when an event like this happens, a member of the care team had an inclination that something was wrong or unsettling but did not feel like they had the authority to speak up on the patient’s behalf. As a medical student, I have felt at times as though my job is to observe and absorb without offering input. The story of Lewis Blackman reminded me of how dangerous this attitude can be– silence and reticence to “bother” an authority figure ended up costing an innocent young man his life.

To keep things in perspective as I progress in my career, I’ll re-frame Dr. McDonald’s advice as it applies to team dynamics in the clinical setting: if I see something that concerns me, what’s the worst thing that could happen? If I raise the issue with a superior, could they find me incompetent or annoying? Maybe. If I don’t raise the issue, could another human being pay the ultimate price because I was more concerned with self-preservation than the safety of my patient? Maybe.

Through this lens, the choice is easy. No one ever died from looking stupid. A note from Elizabeth.

Each “tribe” has their own biases about the other “tribes” in the hospital including the patient and their family....

I am fortunate coming from Seattle and working at Virginia Mason to have been exposed to these ideas long ago, and they have driven me to where I am today. However in my current education, I am learning in a silo and have no clue what medical students, nursing students, pharmacy student and so on go through in their education and training. Being here today I had the realization that we must all work together as a team to accomplish an environment that supports patient safety. While each tribe has biases of the other, we must work together to break down barriers to better understand each other’s work. We have the luxury here at Telluride of already having a mutual purpose established. Going forward in my career, I understand the importance in establishing that mutual purpose with my stakeholders and engaging the staff. Sometime that means finding a champion to help get the message out. My role is going to be establishing that mutual purpose for all the tribes to create one unified tribe of healthcare workers that with speak up for patient safety. A note from Evan.

As healthcare providers, we need to remember that our goal is to provide our patient with the best care possible and do our best to ensure a positive outcome. While there are many tasks involved in this, we need to remember that our patients are more than just a diagnosis or a set of vitals. They are real people with real fears, concerns, and questions. Giving the best possible care means respecting the patient enough to take the time to address these issues with them and include them in their care. I feel that working together as a team in this way will help increase patient satisfaction and also improve patient outcomes. A note from Kathleen.

Before I started medical school, I spent a year working at a free clinic in Moab, UT. If you aren’t familiar, Moab is a small town of about 5,000 people sandwiched between Canyonlands and Arches National Parks–some of the most stunning landscape in the world. At the Clinic, we serve the many people who work to keep this popular tourist town (it has over 2 million visitors per year) running. As a first year medical student, I don’t have a ton of experience working on the hospital floors, but in Moab I worked as part of a two person staff where I coordinated our clinical volunteers and was the main point of contact for most of our patients’ follow-up care.

At the time, we were a clinic run entirely by non-medical personnel, so we rarely used the vocabulary of quality improvement and patient safety that I’ve since learned in medical school and in the first few sessions of the Telluride Summer Camp. However, I’ve come to realize that we prioritized patients’ needs, primarily through open communication between volunteer providers, clinic staff, and patients about the plan of care. We didn’t necessarily have protocols–we all sat as a team and discussed each case and each team members’ responsibilities. Much of this was done on the fly, but we seemed to have a pretty good system for making sure folks didn’t fall through the cracks. A note from Sean.

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