Sorrel King is on call

Did you catch today's On Call teleconference with patient advocate Sorrel King? If you had a question or comment that you didn't get to share, here's your chance to weigh in. Sorrel will check this blog frequently and respond to your questions for the next few weeks.

Just click on the "Comments" link at the bottom of this post and leave your question or comment.

If you didn't catch the call, check out the recording and transcript. You can also watch a video of Sorrel telling the story of her daughter Josie, who died in 2001 as a result of medical errors.

Channeling Grief into Action: Creating a Culture of Safety...On Call with Sorrel King

On February 22, 2001, Sorrel King’s 18-month old daughter, Josie, died from medical errors incurred at Johns Hopkins Hospital. Channeling her grief and anger into determination, Sorrel created the Josie King Foundation, which is dedicated to making health care safer by creating an environment where providers, patients, and families can work together.

Sorrel believes that it is up to students to create this new culture in health care – a culture of safety.

Hear her moving story and learn:
• How to listen to patients more effectively
• How to speak up on behalf of patients even when you're at the bottom of your organization's hierarchy
• How to make patients and families an effective part of the care team

Join this free call! Advance registration is required. Click here to register!

Tuesday, February 24, 2009
5:00 - 6:00 PM Eastern Time
4:00 - 5:00 PM Central Time
3:00 - 4:00 PM Mountain Time
2:00 - 3:00 PM Pacific Time

Watch a video of Sorrel telling Josie's story.

This free call is part of a monthly audio conference series that brings experts in health care improvement together with students from medicine, nursing, dentistry, pharmacy, health care management, public health, and other allied health professions. Each hour-long call is moderated by a student, ends with a question-and-answer period, and focuses on an issue that affects you. Visit our website to download audio files or written transcripts of past On Call audio conferences.

Hope to see you all on the call!

How Would You Advise President Obama?

The American Recovery and Reinvestment Act of 2009 was signed by President Obama yesterday. The $787 billion economic stimulus package's health care provisions have demonstrated that health care reform is still on the table. The package includes funding for comparative effectiveness research, health insurance coverage for unemployed workers, health information technology, Medicare, Medicaid, and the NIH. The many concerns that have been expressed in the past few years in regards to health care have not fallen on deaf ears. Now that you have President Obama's attention, what would you advise him to do?

KaiserEDU.org is now accepting entries for its Annual Essay Contest, giving undergraduate and graduate students a chance to win a prize of $1,000 by writing an essay addressing the elements of health reform that President Obama's team should focus on in 2009.

Essay Topic: President Obama has stated that reforming the health care system is one of his top priorities, and there is broad interest from policymakers and the public in making a change. During the campaign, he outlined a framework for reforming health care. The essay should cover: what elements of his plan should be prioritized given the current economic crisis, what elements are most likely to garner support and which ones will be most challenging and why?

Click here to find out more information about the contest!

Check out an article titled, "The Lessons of Success--Revisiting the Medicare Story," by David Blumenthal, M.D., M.P.P., and James Morone, Ph.D. in The New England Journal of Medicine to start thinking about Presidents and health care reform.

Don't feel like writing an essay? Post a comment and share your thoughts!

How Many Ways Are There to Bake Bread?

If there was a contest out there that measured the degree to which an individual enjoyed food, my family would take the cake! My relatives in China are notoriously known as the overweight ones. My great uncle in Taiwan insists on trying a little bit of everything and can never eat the same cuisine two days in a row. It's really no surprise that a good percentage of my family decided to live in Houston, one of America's fattest cities. To make matters worse, my family's love for food extends beyond our consumption behaviors. I come from a long line of great cooks! Unfortunately, this has created a very serious problem.

I have been spoiled AND I don't really know how to cook. Living on my own this year and having to prepare every meal by myself has been tough. Someone who doesn't love food so much would be okay with eating ramen everyday. Someone with an unlimited amount of money would be okay with going out to eat everyday. Someone who has never tasted my mom's Russian influenced tomato beef stew would be okay with eating it only once or twice a year. I am not that person. So, in order to satisfy my love for food, I must cook.

Thankfully, I don't have to start from scratch. My parents, Epicurious.com, and the millions of cookbooks out there are my resources for best cooking practices. Years of cooking have taught my mom how to dice and slice meats and vegetables to extract the best flavors and cook without making a huge mess. She's done the experimenting for me. My dad is our in-house bread baking expert. If I wanted to bake a loaf of extra fluffy bread, he'd know exactly how to do it.

While I was home for the holidays, my parents asked me to cook dinner to test my few months of cooking experience. I decided to make a sausage broccoli pasta that was very well received at a pot luck. After about an hour of cooking, my mom walked into the kitchen with a crinkled nose of disgust. My sister didn't even want to touch the food and decided that leftovers would taste better. My dad ate less than usual and had an encouraging smile plastered on his face. Only my dog, May, seemed to enjoy dinner. I'll admit it tasted... different. How did this happen?

Mistake 1: I left my recipe in Boston
Mistake 2: I was too lazy to buy all of the correct ingredients so I improvised

This goes without saying, but I essentially made something entirely different. It was untested and it tasted bad. As I poured the pasta into Tupperware reserved for food that only May would eat, my dad asked me a very enlightening question: "Why didn't you use a recipe?"

Why didn't I use a recipe? I didn't have a good answer. My dad told me that even after many years of making bread, he still uses a recipe. He told me that you can make a few adjustments here and there. Add some raisins and cinnamon for raisin bread. Add an egg to make it more moist and rich. Substitute milk for water. But, there really is just one way to make bread. You will always need the basic ingredients and add them in in the same way. Each loaf will be different, but if you are making bread, your end product should look and taste like bread.

Here in the office today, we are celebrating the provisions in the stimulus bill to compare the effectiveness of different treatments for the same illness. Yet, many others see this as a recipe for health care disaster: cook book medicine is what they are calling it. Every patient is different they say. Doctors aren't robots. And what about the value of a doctor's intuition? Isn't that what makes great providers?

But, what would you say to this statistic: Clinical studies conducted by California’s RAND Corporation and other research centers consistently show that, for many medical conditions with well-defined criteria for the best treatment, only about 50 percent of the recommended care is ever delivered (1). That would be the same track record I have with my sausage broccoli pasta and that's clearly unsatisfactory. Thankfully, my pasta was not deadly. But lives are at stake in health care!

Medicine will always have a margin of variability since every patient is different and doctors are human too. But, if it is known that a patient has X disease, as a future doctor, I'd want to give that patient the most effective treatment known to treat that disease. And as a patient, I'd want to know that I'm receiving the most effective treatment available. Standardization is a scary word in the health care debate, but if you have a recipe for success, shouldn't that be shared and used widely?

I think my cooking is getting better. I will admit that I do call my parents to run through all of the necessary ingredients and any sophisticated cooking techniques at least once a week. I have also created a binder for standard dishes (so my parents don't get annoyed by my calls). Each dish has a list of ingredients, possible substitutes, important steps to remember, and plenty of room for edits. It's my binder of best practices and guidelines to ensure a happy stomach.

Comparative effectiveness research in health care can create that binder for medicine and help us prevent things from going wrong. Can you really think of a good answer to the question, "why didn't you use the best practice?"

I can't.

The New York Times on Comparative Effectiveness Research

Health Education Reform Ideas? $10,000 for your thoughts!

The stimulus bill has been all over the news. While I can't speak for the merits of the bill and its ability to rescue our ailing economy, I can report that health care has not been forgotten in the bill. The $790 billion economic stimulus package includes provisions for expanded health care coverage and allowances for health care IT. According to The Associated Press reports, the compromised stimulus bill includes "$21 billion to provide a 60% subsidy of healthcare insurance premiums for the unemployed under the COBRA program; $87 billion to help states with Medicaid, $19 billion to modernize health information technology systems; $10 billion for health research and construction of National Institutes of Health facilities." What does this mean for the Obama administration's efforts for health care reform?

Of course the health care provisions in the stimulus bill are not comprehensive. Greater access to health care and construction of health IT infrastructure are just part of the answer to better health care. For example, not mentioned in the stimulus bill are efforts to reform health education. As the next generation of health professionals, perhaps the greatest amount of change we can enact is right here on our home turf. Well, here's your chance to share your plan! The Mayo Clinic Health Policy Center and the MD Connector have partnered up to sponsor a health education reform essay contest that is open to all health professions students in the US and Canada. Over $10,000 in cash and prizes are being awarded in addition to the chance to present your plan at the 2009 Health Care Education Symposium in Rochester, MN. The submission deadline is March 16, 2009. Click here to find out more information about the competition.

To get those brain juices flowing, read this article by Parker Palmer called "A New Professional: The Aims of Education Revisited".

Practicing Like A Rock Star: The Need for a Culture Change in Medicine

Consider this definition:

prima donna: (noun) 1. a first or principal female singer of an opera company. 2. a temperamental person; a person who takes adulation and privileged treatment as a right and reacts with petulance to criticism or inconvenience.

www.dictionary.com

We've all interacted with these types of people before. They hog the basketball on the courts and refuse to pass the ball. They must be placed front and center in every dance formation if not given a solo. They are the rock stars that never show up for rehearsals, claim all of the glory, and blame others when their voice is shot from partying all night long. In several industries such as sports, dance, opera, aviation, and medicine these rock stars usually have amazing talent and have worked hard to reach their top position. But, what they fail to recognize is that their trade goes beyond their individual bubble--it's a team effort.

Dance and performance have been very important parts of my life from as early as I can remember. How many hours have I spent in rehearsal? How many people have I performed before? Those questions are just impossible to answer. Throughout college, I was involved with a dance troupe called the Asian American Dance Troupe. Every spring we would host a dance show on campus highlighting a wide range of Asian dance styles. The show, Eastbound, was always a huge, almost all-consuming, undertaking not only because of the 40 plus dancers in the troupe, but also because of the tremendous amount of coordination that was required to deliver a successful show.

Just to give you a flavor of what goes through the minds of the troupe's captains and board:

• Show shouldn't be more than 1.5 hours long. Absolute max 2 hours. Don't want people to be bored
  
• 14-16 pieces
  
• Need entertaining MCs
  
• Adequate spacing between pieces to allow for quick changes. Enough spacing for pieces with very complicated costumes
  
• Coordinate and space dancers in multiple pieces. Avoid back-to-back pieces and if unavoidable, veterans can better cope than newbies. Make sure we have enough guest groups to fill in between pieces
  
• Need stage managers and runners who are authoritative, are familiar with pieces, and know almost everyone's names
  
• Each dance needs costumes with strong stage presence. Coordinate costumes with choreographers and okay with costume manager
  
• All dances must be ready! Ask choreographers to be responsible for own dancers
  
• Block off lots of studio hours for last minute rehearsals
  
• Each dance needs proper lighting cues that match costumes and mood of pieces well. Coordinate with lighting director
  
• Lighting director and sound manager need to attend formal training sessions with performance space manager
  
• Ask sound manager to compile all music for show together on one CD, including guest group music
  
• Water and snacks in dressing rooms to keep dancers hydrated and happy
  
• Separate rooms for boys and girls, make sure not too many dancers in one room
  
• Need at least three cameras for filming. Hopefully, they are of comparable quality. Volunteer camera crew?
  
• Coordinate selling of bubble tea refreshments during intermission
  
• Coordinate police detail
  
• Cash box! Tickets! Lowell Lecture Hall seats 300 people!
  
• Tape the performance space. Mark center center, center front, center back
  
• All costumes need to be ironed

And that's just a subset of what feels like a million processes that must be executed for a successful show. How many people did I mention? 40+ dancers, a costume manager, a lighting director, a sound manager, performance hall manager, choreographers, guest groups, stage manager, film crew, audience members, and the list continues. A successful Eastbound requires full participation from all of these individuals--the performance team, and interactive communication among all. When something goes wrong, in the spirit of "the show must go on", the performance team steps up and takes care of the situation quickly and appropriately. As the audience claps at the end of the show, we all take the stage as a team and celebrate. WE did it!

I've performed with several different groups and must confess that a culture of teamwork is often the exception and not the norm. If we all don't pitch in to iron all of the costumes or go over the last eight counts of the first piece to make sure the circle formation does look like a circle, the audience's experience is diminished and our reputation is damaged. Everyone is a star dancer, but to truly make an memorable impression we need to be a stellar troupe.

Similarly, in health care, a patient's care does not lie heavily on the shoulders of one individual. A performance team of physicians, nurses, pharmacists, technicians, surgeons, administrators, receptionists, and many others all are part of the patient's experience. If Team Member A forgets to sterilize an instrument, Team Member B should speak up, and Team Member C can help find one that has been sterilized. Everyone on the performance team is a hero to the patient because they are providing them with much needed help--the performance team can save lives!

On January 15th, Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston, wrote in his blog, "Running a Hospital" about the resounding evidence of the use of a checklist to prevent surgical complications and what it takes to implement change in the health care system. Immediately following his provocative post is an even more thought-provoking dialogue bringing together patients, practicing physicians, nurses, and other care givers with some of the greatest leaders in the field studying the implementation and spread of best practices.

Are physicians prima donnas? Perhaps they are. But are they really to blame? Perhaps they are just a product of the current medical culture. A culture as Dr. Berwick shares in a comment that trains physicians to believe "a self-image of heroism, autonomy, and artistry...that the patient's fate is in their hands - that they personally and individually are responsible for excellence...They are not being dumb. They are pursuing the form of excellence and responsibility that they have been told to pursue."

In the dance world we excuse a prima donna attitude because of his/her talent. But, to achieve a fantastic show we need to stop making excuses. When we know that patient care could be better we need to stop allowing care givers to operate as lone individuals. The depth and breadth of skill necessary now to provide the best care to patients is too deep, too complex, and too wide to be a lone hero. As Gary Kaplan, CEO of Virginia Mason Medical Center said, "Our training to only trust ourselves to ensure our patient's well being is deeply rooted but ultimately maladaptive for today's complexities in diagnosis and treatment."

So what can we do to promote team work? As health professions students, I think we could start with better understanding of our patients and teammates. Spend a day with a patient and see how he/she sees the system. Spend a day with a nurse, spend a day with a physician, spend a day in the lab, spend a day with an administrator...and most importantly discuss your experiences with others. Any other ideas of how we can usher in a new culture of teamwork into health care?

I'll admit that I used to think that the tech crew helping with our shows were insensitive and incompetent. Didn't they know that red lighting flooded and overpowered pink costumes? Couldn't they hear the music and energy shift? That was until I went up to the tech pod and saw the large and complex switchboard that controlled all stage lights. Creating purple light didn't just require one button, but a pull here and a flick of this and a push on that. It was my impatience and lack of understanding that led to my frustrations with the tech crew. They were doing their best. After explaining what we wanted in advance and respecting their own artistic touches and expertise, I've never had difficulties with lighting. Since then, I've come to appreciate how lighting helps to set the tone of a piece and enhances our ability to express ourselves.

So, I guess the key to practicing like a rock star is to simply not practice like a rock star. Embrace the team and you'll see that practicing within a rock band is even cooler. If anything, you will always have your band mates with you to get through the bad and celebrate the good.

Click here to read an article in The New York Times titled "Arrogant, Abusive and Disruptive--and a Doctor" to see how teamwork breaks down.

Want to get into a great residency program?

If you're reading this, you probably think improving the quality of health care is pretty important. Here's someone who agrees with you:

Joel Katz is Assistant Professor of Medicine at Harvard Medical School and director of the Medicine Residency at Brigham & Women's Hospital -- one of the finest hospitals in the U.S.

When he's selecting residents, Dr. Katz looks for students who are interested in improving the quality of health care. In his own words:

The principal mission of the residency is to train great doctors -- "great" meaning doctors who can recognize who is and is not sick, act decisively in the absence of a complete data set, think critically about the 'big picture' of health and disease, and know their limits and feel comfortable seeking the advice and wisdom of their peers.

At the Brigham, Dr. Katz has recently launched a residency track in management leadership skills, including those directly relevant to patient safety and quality improvement.

Dr. Katz will be checking this blog between now and February 24. Leave a comment or a question for him here, and he'll see it. Ask anything you want. Curious about why most professional training programs don't emphasize the improvement of care? Want to know how you can make patients safer? Hoping for some tips on how to stand out in your field?

To ask a question, click the "Comments" link at the bottom of this post.