Why Hospitals Should Fly...

Isn't it appropriate that after 7hrs of flying and a 1.5hr windy car ride I find myself in Telluride, CO at an elevation of over 10,000ft to spend a week participating in the 8th Annual Telluride Interdisciplinary Patient Safety Roundtable?

My third year of medical school has been nothing short of transformative. While my classmates and I have grown tremendously in translating our theoretical knowledge into clinical skills, what has also grown is an increasing awareness of the plight of our patients. Many of our patients are already in a vulnerable position given their medical conditions. What does the health care system do to help them regain their health? We force them to navigate the rough seas of a fragmented health care system.

Out of frustration for one of my patient's experiences while on my Family Medicine clerkship, I wrote this welcome message that satirizes the typical patient experience in our current system:

Welcome aboard the US Health Care Cruise Line! Please take your time to explore all of the great features we have to offer on our entertainment Decks to take care of all of your medical needs, whether you need them or not! Here, our motto is “more is better,” so take this opportunity now to indulge away!

First, a brief message to our VIP guests: As the group of people with multiple health and social needs that are the true drivers of high health care costs, welcome! As you navigate this beautiful vessel outfitted with the latest most expensive technology and drugs, please keep the following in mind:

Primary care services are conveniently located on Decks 1 and 5. Deck 1 is only accessible via our exclusive Jet Ski coverage program. If you are not a Jet Ski member, we recommend you seek services at Deck 5. Deck 5 is only open three days a week in the afternoons. Both Decks have the friendliest of staff, but are only trained to address clinical questions.

Housing, childcare, utilities, legal, financial assistance and food services are available. With constantly evolving entertaining activities being offered through these agencies, we unfortunately do not have updated directions to reach them. But, if you wander around the ship long enough, you will surely find your way! These are some of our busiest services with the greatest demand, so please don’t be discouraged if we cannot address your needs. None of our passengers have suffered too greatly due to inaccessibility to these agencies.

24 Hr Care is available on Deck 9. You can access Deck 9 by any means. But, in exchange for this convenience, you will likely need to wait several hours before being seen. A 24 Hr All-You-Can-Eat Pizza Bar is also located on the same Deck to make waiting more tolerable.

Getting around the ship is most efficiently completed on foot as there are long staircases that connect most Decks. However, if this is difficult for you, please call the main office to arrange for transportation. We have a limited number of staff who can carry you to your desired destination. But, your height and weight may prevent you from taking advantage of this great service.

Specialty care services for diabetes, cancer, asthma, mental health, and hypertension are located in a gilded section of the ship. We are practicing cutting edge techniques that are so advanced that there is little literature available about them! Please don’t hesitate to let us know if you are having difficulties finding our specialty services. We would be happy to escort you there. Just be sure to bring your boarding passes, credit card statement that documents the purchase of this cruise, and any records of all of the experiences you have had here onboard. We do not have an electronic system connecting all of our services.

Lastly, drug and nutritional supplements must be purchased off of the ship, so you are encouraged to step off and explore our various stops. These islands are not very well-equipped, so please be flexible with the inconsistencies of what they have to offer.

Only the Captain is completely familiar with the ship and its services, but given how busy he is, he is unlikely to be able to help you navigate your stay. We are confident that you all are capable of coordinating your own cruise activities!

With these simple rules, I can guarantee that you will feel so overwhelmed by our top notch services that you will be wondering, “was it all really worth it?” Again, welcome aboard and enjoy your stay!

Despite sporadic episodes of safe, effective, patient-centered, efficient, timely, and equal care throughout my third year, our inconsistent ability to deliver high quality care has left me almost hopeless for the future of health care. But, what has reenergized my spirits was reading the book Why Hospitals Should Fly written by John Nance, a professional pilot and lawyer with a distinguished career in leading the patient safety movement. The book is a fictional narrative that follows a former CEO of a hospital, Dr. Will Jenkins, as he travels to a suburb of Denver, CO to visit the fictional St. Michael's Memorial Hospital. St. Michael's is THE ideal hospital that exudes quality not only in its basic processes and operations, but also in its culture. As Dr. Jenkins visits various departments in the hospital, the reader not only learns about the effectiveness of specific interventions to improve safety (i.e. multidisciplinary rounds, team huddles, checklists, etc.), but also indirectly gains insight to the process of implementation (probably the most difficult part of patient safety work).

When I finished reading the book, I felt like my head had been lifted up from the chaos of our current broken system. My head is now 10,000ft above sea level, the same elevation where aircraft passengers can safely use their electronic devices. While I'm forced to drink liters of water a day to ward off acute mountain sickness, perhaps it is necessary for me to be at the level where airplanes fly in order to better understand how to redesign our health care system to achieve high quality care. That is probably the reason why we are all here at Telluride, CO.

Stay tuned throughout this week as we dissect some of our health care system's greatest challenges. You can follow our thoughts here and on Twitter (#TPSER8). You can also take a look at Paul Levy's experience here at Telluride on his blog. Here's to a strong take-off tomorrow!