Signs of Hope

I think this blogging is becoming a habit for me. Tell me to stop if you're not digging it! Actually, I'll probably run out of (interesting) things to say even before you make it to your keyboard.

Anyway, the more and more time I spend in the hospital, the more I see little things around that give me hope for the future of the quality and safety movement. It seems as though it's really winning hearts and minds. With luck, that also means that there is also greater willingness to include this kind of teaching in our education. I sure hope so. I think it's so important to the "complete" medical education.

In the meantime, I thought I'd share a couple things I've seen out and about in med school. Take a look at these pictures snapped on various recent rotations. The safety sign is from an underground passageway that lots of people take from the garage to the hospital in the morning. The CA-BSI (catheter-associated bloodstream infection) sign is in the PICU. Great stuff!

Have any of you seen anything similar? Write your story in the comments. Or, if you've got a picture, upload it imgur.com and leave a link in the comments.

Hope everyone is enjoying the weekend.

-- Alexi

Errors Take a Toll on Patients AND Providers

Hey everyone, me again. This blogging thing is addictive.

Another great article from Dr. Pauline Chen in the New York Times. It talks about the toll that errors take on physicians, specifically young physicians-in-training, but I suspect that the phenomenon applies to all health care providers in all fields.

The thrust of the article is that when a physician makes an error it can send him in a downward spiral of more errors, depression, and questioning of self-worth. If I might opine, I think it's the fear of making another mistake that drives this vicious cycle. As a fourth-year med student, I am so close to being thrown head-first into the scary world of residency. And let me tell you, despite a fantastic training in med school and even a good deal of confidence in what I know, I'm terrified that I might hurt one of my patients without the constant supervision I've had in med school. A single mistake threatens to prove my worst fears -- that I really don't know what I'm doing! Raise your hand if you feel the same way.

How can we fix this? Is it better training? Is it simulation? Is it a more welcoming environment? Dr. Chen gives the very vague suggestion that the system -- patients and our teachers -- need to re-calibrate their expectations. But what, really, does that mean? And will that alone work? Share your thoughts in the comments.

- Alexi

Setting Audacious Goals

Hello young improvers!

I'm a long time reader but first time poster to the blog. I came across a great article in this morning's New York Times Op-Ed section that I thought many of us would be interested in. It's a piece written by Paul O'Neill, the former Treasury Secretary turned health care improvement crusader.

In his piece today, O'Neill writes about how, thus far, the goals Washington has set for health care reform have not been "audacious" enough. He states that there is about $1 trillion of annual waste in the health care system and that's what we need to tackle, not the miniscule cost inflation reductions that Obama has wrangled out of the insurance companies. He offers that one great place to start is nosocomial infection reduction, and he points to some star health care improvement leaders -- Gary Kaplan, Brent James, Rick Shannon -- to give us shining examples of what's possible.

Best of all, O'Neill says that the system needs more improvement-minded leaders. That's us guys!

Hope you can check out the article. It's a good read.

- Alexi (Yale Med 2010)