Mar 13, 2009

AMSA: One of Many "Powers"

Quality improvement of health care requires the help and participation of all of the players in the health care system: patients, nurses, physicians, administrators, insurers, government, employers, etc. This joint effort reminds me of the classic TV cartoon, Captain Planet. In order to save the environment, Wind, Water, Earth, Fire, and Heart needed to be combined in order for Captain Planet to appear and save the world! Similarly, to save the world from escalating health care costs and improve the health and wellness of all, we need to combine our powers and cooperate!

On Wednesday, Shannon and I had the wonderful opportunity to meet the future of one of these powers in the movement to improve health care at the 59th Annual American Medical Students Association (AMSA) Convention’s Preconvention Symposium on Patient Safety and Medical Quality. We were joined by about 40 other MD/DO students for an interactive day and complete immersion into patient safety and medical quality.

The day kicked off with a keynote presentation by former AMSA National President, Dr. Helen Burstin, now at the National Quality Forum. Dr. Burstin provided everyone with a high-level overview of what medical quality means, specifically focusing on the six aims outlined in the Institute of Medicine’s (IOM) charter document on quality, “Crossing the Quality Chasm.” These aims include: safety, timeliness, efficiency, patient-centeredness, effectiveness, and equity. Dr. Burstin also stressed the need for cooperation among all players of the system and introduced the National Priorities Partnership that brings together 28 of these players to the table to discuss and set goals for health reform. Click here to see a list of the diverse partners.

Dr. Don Berwick, then took the stage and gave a keynote presentation that delved deeper into what patient safety means and how students can act and make an impact on the field. Through descriptions of IHI’s 100,000 Lives Campaign and 5 Million Lives Campaign, Dr. Berwick illustrated various bundles to improve the safety and effectiveness of care, such as a bundle to prevent central line infections.

After the two keynotes, Pre-Convention leader, Wes Fischer, led the students in a emergency situation simulation. Students role played and learned firsthand the many nuances of effective teamwork and communication in a chaotic situation. Great job to all of the volunteers!

During lunch, Dr. Berwick led the students in the Red Bead Game demonstration. This teaching tool developed by W. Edwards Deming illustrates the methods of improvement. It sounds like a very dull demonstration, but I’ve watched the demonstration at least 5 times and still really enjoy it and learn something new from it every time! Click here to learn more about the game.

After lunch were three very interesting break-out workshops. In these workshops, we learned and practiced skills in effective communication between physicians and patients (SBIRT: Screening, Brief Intervention, and Referral to Treatment) and effective communication in teams (iSBAR: Introduction, Situation, Background, Assessment, and Recommendation). We also participated in a reflective session led by Dr. Paul Uhlig of the University of Kansas on why we were all interested in patient safety and quality improvement and learned of ways Dr. Uhlig had implemented interprofessional rounds and meetings to transform the culture of medicine in his health system.

Both Shannon and I learned so much and were extremely grateful to meet so many wonderful students. Hearing everyone’s enthusiasm and eagerness to learn more was very refreshing. Thank you to all of the students we had the fortune of meeting and all of the AMSA leaders for having us! I feel reenergized in my work and hope to have the opportunity to meet students representing the other “powers” soon. I sense that we will be able to soon unleash a “Captain Medical Quality” on the world! I can just hear it…. “By your powers combined, I am Captain Medical Quality!”

What can we learn from TV?

Last month, our poll asked you to pick the show you thought most accurately portrayed working in health care - E.R. won, followed by M.A.S.H. and Scrubs. House and Grey’s Anatomy get honorable mentions. I don’t usually watch much T.V., but when I do, Iend up watching one of the many shows related to health care. It gets worse – I find myself relating most of what I see to the work that we do. You can't help but notice the many examples of quality and patient safety issues that come up. Here are a few...

I couldn’t sleep the other night, stumbled into my living room during the wee hours, and flipped on the TV. I landed on TV Land and watched an episode of M.A.S.H. By the way, M.A.S.H. = Mobile Army Surgical Hospital.

Teamwork and communication. Alan Alda’s character (Hawkeye) works with a visiting surgeon. You know they’re off to a great start when the surgeon picks on the way Hawkeye washes his hands. They butt heads and can’t agree on what should be done to the patient. The medic assistant finally tells them to stop bickering and save the patient. Then, the camp is hit. Both surgeons fall; one breaks his right arm, the other his left wrist. Can you guess what happens next? They suture the patient together - one working with his left hand, the other with his right. In a very utopian fashion, they defer to one another regarding what’s best for the patient and agree on everything; smiles and all! Perhaps this it wasn't entirely realistic, but it reminds us how important teamwork and communication are, especially during stressful situations.

Surgical Safety. If you caught last night’s E.R. episode, the surgeon enters the O.R. in a rush, ready to jump in, but Eriq La Salle's character (Benton) stops the team from proceeding. They perform a time-out and use a surgical checklist. The surgeon again tries to hurry the team, but Benton tells everyone to "slow down, this will only take a minute." Aside from the checklist, you'll notice Benton also reminds the surgeon the use of antibiotics 6o minutes prior to incision cuts the risks of infection by half. I might have to start watching E.R... (Fran Griffin, thank you for sharing this clip today.)

Blame. I caught part of Grey's Anatomy last night. It looks as though Patrick Dempsey’s character (Derek aka McDreamy) is blamed for "messing up" a surgery on the last episode, resulting in the patient's death. The patient's husband sues McDreamy. After giving his deposition, we find Derek sitting in front of a stack of files. The files represent patients who died while under his care; he realizes he has lost more patients than he has saved. Derek goes into a deep depression and refuses to perform any surgeries, despite being one of few neurosurgeons in the hospital. Blame doesn't do anyone any good.

Hand Hygiene & Infection Control. There’s an old episode of Scrubs that shows the importance of hand hygiene and infection control. In the opening sequence, a bird flies around the waiting room. When asked why the bird hasn’t been removed, the janitor tells him the patients like it! Then, a bit of foreshadowing occurs. Dr. Kelso says,

“Do you know the number one cause of death in a hospital? Infection! And do you know how quickly infection can spread in a hospital...infection can start with a simple sneeze, and then a handshake, perhaps an accidental collision, and a simple touch on the shoulder...and just like that, you have a patient in trouble.”

Later, a character named Cabbage picks up a piece of trash before entering a patient’s room. When he touches the trash, his hands glow. Then, he shakes the patient’s hand, she turns green, (spoiler alert) and dies in the next episode due to an infection. The glow is a great visual of how quickly and easily infection can spread. [While I’m unable to pinpoint infections as the leading cause of death in U.S. hospitals, I can confirm hospital-acquired bloodstream infections are a leading cause of death in the U.S. and medical errors are the 8th leading cause of death in the U.S.] (Thank you, Dr. Rainu Kaushal, for sharing this with me last year.)

Where can I watch these episodes?
1. M.A.S.H.: “Lend a Hand
2. E.R.:

3. Grey's Anatomy: “I Will Follow You Into the Dark”

4. Scrubs: Intro: "My Cabbage

and End: "My Cabbage"

1. What examples of quality and safety have you seen when watching these types of TV shows?
2. What examples do students see in TV shows in other countries?
3. What do you think the effect these have on the audience when they see, for example, poor teamwork or errors?

Mar 10, 2009

News from the University of Michigan OS Chapter

The University of Michigan IHI Open School Chapter is really excited about our year so far. We began in the fall with a series of formative meetings in which we discussed the principles of IHI and quality-oriented, patient-centered care, and explored the challenges we face as future health professionals through case studies. Initially, our core group was comprised almost exclusively of Public Health graduate students in Health Management and Policy; when we reconvened after the holiday break, we all agreed that it was time to grow.

Growth for us means two things. First, part of our vision for IHI Open School here at UoM is creating an interdisciplinary coalition, and we are actively recruiting from all the health professional schools. At our last general meeting, we had representation from students in medicine, public health, business, and law, and we expect strong representation from nursing at our upcoming general meeting.

The second part of our vision for IHI Open School is creating a three dimensional learning experience, focused on:
1) increasing our knowledge around patient-centered care and quality improvement,
2) developing skills for promoting ideal care and overcoming existing barriers to its achievement
3) pursuing opportunities for hands-on, project-based experiences to deepen and solidify our knowledge and skills

As such, we are currently exploring several happenings here at UoM and looking for ways for IHI Open School members to both learn and contribute. As we remain in an information gathering phase, it is too early to say too much about where these will lead, but we are very hopeful of the possibilities they represent. Please check out our blog
to see descriptions of where we are focusing our efforts. Stay tuned!

-The University of Michigan IHI OS Team

Sprint Action Day! Today!

Today is the “Sprint Action Day” for the WHO Surgical Safety Checklist team. For those of you looking for a way to get involved or are looking for something to do with your Chapter, we created a Student Sprint Action Guide

Check it out! Your Chapter Challenge is to complete at least one of the tasks by April 1st, 2009!

Click here for more information about Sprint Action Day.

Mar 9, 2009

Leading from the Bottom Up: What did you think?

You probably have lots of ideas for improving health care. But as a student, you may feel a little unsure about how you're going to make them happen.

During today's On Call teleconference, Dr. Jim Reinertsen -- a senior fellow at IHI and former CEO of several health systems -- listed ways that students can lead improvement even when they lack formal power.

Jim's going to be checking this post for the next month and will jump into the conversation to answer questions. So tell us:

  • Have you ever taken a leadership stance in your organization? How did it go?

  • What do you think of the idea of "no complaints" as a central principle of leadership?

  • Do you think you have the power to change health care from the bottom up?

  • Do you agree that you don't need charisma or eloquence to be a good leader?

Any topic is fair game. You can comment by clicking on the "Comments" link at the bottom of this post.

If you didn't catch the call, listen to the recording or download the transcript.

We Need You! National Health Service Corps Scholarship

At the White House Health Summit last Thursday, when President Obama was asked about support for the development of nurses in his health reform efforts, President Obama replied saying, "This is a no brainer."

The Recovery Act has allotted $500 million to boost health care workers' training and employment with $300 million to double the number of beneficiaries in the National Health Service Corps (NHSC).

NHSC's mission is to unite communities in need with caring health professionals and to support communities' efforts to build better systems of care. The NHSC provides comprehensive team-based health care that bridges geographic, financial, cultural, and language barriers with a large emphasis on delivering quality health care to all. The NHSC specifically addresses populations and health issues that have the highest racial, ethnic, and socioeconomic disparities in treatment success. These include HIV/AIDS, mental health, dental care, cardiovascular disease, diabetes, etc.

Through strategies that include forming partnerships with communities, States, and educational institutions, the NHSC hopes to shape the way providers practice and work with the underserved. Of particular interest to health professions students are the opportunities that the NHSC provides to work with the underserved. These opportunities include:
    1) Scholarship and Loan Repayment Programs
    2) SEARCH (Student/Resident Experiences and Rotations in Community Health) Program

With the influx of money provided by the Recovery Act, about 80 new scholarships will be awarded this year. The NHSC is looking for students interested in careers as primary care physicians (MD or DO in family practice, internal medicine, pediatrics, obstetrics-gynecology, general psychiatry), primary care nurse practitioners, certified nurse-midwives, and general dentists or pediatric dentists. To find out more about the NHSC scholarship, click here.

Thanks Jay for sending out the information!