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!

Highlighting Quality Improvement in Toronto

By Craig Olmstead, Medical Student, University of Toronto

It was a long, but satisfying day.

From the early-morning set up to the take down in the evening, the 2^nd annual Quality Improvement & Patient Safety (QuIPS) Conference, presented by the Institute for Healthcare Improvement’s University of Toronto Chapter, provided ample opportunity to discover the breadth of health care system innovations occurring in Toronto and beyond.

Held May 5 at the University of Toronto, the conference drew about 140 delegates from across universities in the greater Toronto area. Presentations from professionals and students alike highlighted the many initiatives being undertaken to improve health care delivery throughout Ontario, from developments in e-Health, to mobile phone applications for children with diabetes, to improvements in hand washing compliance.

Most gratifying, however, was seeing the projects done by the many students present, displayed for the whole conference to see. I was incredibly proud that the work my team had done was one of these projects. Over the better part of the last academic year, five students from various health care-related backgrounds, including myself, have been engaged in a quality improvement project at one of the major hospitals in downtown Toronto. We had the chance to work on a program to improve physician adherence to well-established guidelines on the prevention of serious blood clot formation in the legs of non-mobile patients. We had an opportunity to see how frequently physicians were considering this risk, and to initiate interventions in one department aimed at improving the rates of risk assessment. While results are still preliminary, it does appear as though there was an improvement after these interventions.

After months of dedication demonstrated by my teammates and our in-hospital support, it was very rewarding to not only have our poster be viewed by so many influential individuals. (Having our efforts recognized by being voted 2^nd in the conference poster competition was simply icing on the cake.) It was a fitting culmination to over half a year of hard work overcoming challenges to make improvements to the health care system in our community.

The QuIPS conference was an excellent venue to share our story and learn from others, and I can express nothing but appreciation for being given the chance to do so.

QI Field Trip: The UNH IHI Open School Chapter Comes to Cambridge

By Jessica Hatch, Nursing Student, IHI Open School Chapter Leader, University of New Hampshire

Is your chapter in the Boston area? Have you considered taking advantage of touring the IHI offices and meeting the Open School staff?

If you haven’t, then you should! If you did not know about the opportunity, then start inquiring! And if you are thoroughly disappointed that you are geographically unable to visit, I honestly cannot blame you.

What I can do is offer you an inside scoop on the environment of IHI: engrained in the values of quality improvement and innovation, the offices are the epitome of an unforgettably original and exciting organizational culture.

The IHI offices are housed in the high rises of the Charles Hotel in the heart of Cambridge, overlooking the locally beloved Charles River. Immediately upon exiting the elevators, guests and employees alike are greeted with a motivating segment of the IHI’s mission statement displayed in large font above the reception area. The open floor plan invites group collaboration with only the slightest segmentation of task forces, by either low dividers or glass frames. Each task force is encouraged to gather centrally at their shared tables throughout the day, again showing how highly teamwork is valued in the organization.

Interesting and colorful progress boards are found throughout the hallways, offering information on upcoming goals, previous achievements, and often a comical comment for a good laugh or two. One wall is strictly dedicated to displaying the history behind IHI, like a timeline, reminding all whom explore the building of the hard work and underlying values that have allowed this organization to continually improve and flourish. 

Have I mentioned the numerous quotes strategically strewn throughout the office space? Not only were they visually pleasing, but they were thought provoking and encouraging. As students, we all looked around and could envision ourselves working in such an amazing space. Or perhaps it was the idea that one’s organizational culture could be genuinely represented in the design of their workplace. If we are to proclaim the ideas of interdisciplinary collaboration, transfer of knowledge, empowerment of staff, and evidence-based best practice, what better place to start than to immerse yourself daily in a floor plan that is supportive of just that?

Without going on and on much more about how the beliefs, values, and aspirations of IHI were evident in each staff member as well, I will share the takeaways that a number of fellow peers shared after our tour:

“Inspiring to see quality improvement in action at such a large scale…great opportunity and encouraged us to use IHI resources now and in the future”

            -Katie

“I found all of the quotes on the walls inspiring as well as the enthusiasm of our tour guide and the people with whom we stopped and spoke with along the way. It showed that they are not just people sitting behind desks pushing out tutorials for the front lines. They are passionate about their work, live their mission and vision, and truly care about making hospitals and ambulatory care settings a safer, better environment.”

            -Dawn

“At first I was confused as to why we were taking a tour through an office building — aren't they all the same? But I soon learned that there is value in seeing and understanding how IHI employees work.  The atmosphere within the office seems to mirror the philosophies of the organization. Meeting with the IHI Open School team was also a very useful conversation. I didn't realize how new the concept is and how much it is still evolving. I felt that the meeting was beneficial on both sides (I hope it was!) since the Open School course work focuses on quality improvement just as the CNL does.”

            -Beth

“They were extremely kind and do amazing work. I thoroughly enjoyed it.”

            -Jackie

“The tour encouraged future use of IHI resources when no longer a student — IHI is a life-long valuable resource.”

            -Stephanie

“Their enthusiasm for their work was infectious. Our cohort got so much out of this visit and we are excited about bringing IHI resources into our future practice.”

            -Kristin

“IHI is a community of innovative, forward thinkers and it was exciting to see and have hope for the future of health care!”

            -Rachel

“I appreciated the folks at their desk that took a minute to tell us what their job entailed. The personalization brought it to life … I’m interested in staying connected and motivated to complete the QI process through IHI.”

            -Sarah

“I loved that their work environment matches their philosophy. The workplace truly would inspire collaborative teamwork, creative thinking, and inspired innovations. Everyone was incredibly friendly, open, and approachable. We felt so welcome; it was great to have the open discussion at the end too to learn more about IHI, and it was awesome to see the IHI team genuinely interested in our feedback”

            -Justin

“I greatly appreciated the open management structure. It was nice to see a more horizontal leadership approach outside of the textbook. From my view, openness facilitates the creative process.”

            -Anthony

Bring in the Patients

- Ginny Combs,  RNC-MN, BSN, IBCLC  Graduate Nursing Student at Worcester State University, Maternal Newborn Nurse at UMass Memorial Hospital

Confessions: Even though I have been a maternal-newborn nurse for more than 20 years, I have little knowledge about the process of improvement and creating change. I have the passion, but not the know-how. The word “improvement” was never uttered when I went to school. Every day, I see how evidence-based practice does not reach our patients. Every conference continues to highlight the evidence, but the conversation ends there. It seems as if the research sits in books and journals waiting for us to unwrap it and “birth” it with the patients.

Notice I wrote “with.” My first instinct was to write “for the patients,” but after my IHI time, my lens has changed. Soon, I think you’ll understand why.

In my search for answers and knowledge about process improvement, my Worcester State University nursing department director introduced me to the IHI Open School and I felt as though I’d landed on a new and fabulous planet. And last week, I was fortunate to attend a deeply inspirational and transforming event as an IHI Open School student in New Orleans..

The IHI Perinatal Improvement Collaborative all-team meeting gathered for three days of powerful discussions regarding improvement in perinatal systems and how to actually work on creating change!  My mind was pleasantly overwhelmed and racing with ideas. I felt like I was on fire with a “new way” that truly changed how I see health care.

Witnessing this team of committed change agents work with perinatal groups from around the United States was one of the most empowering experiences I’ve had as a nurse and student. The IHI team, led by the inspiring Sue Gullo, walks the talk. The conference included a patient panel of mothers sharing heartfelt stories about their births and birth losses. In that large room of more than 100 people, I could feel a tilt happen. In our own ways, we all committed to putting the patient at the table with us — and always at the center of what we do.

The mothers spoke through tears as they described what mattered to them while in the hospital. One mother shared how “it’s not what you do or say, but it is how you make us feel that matters.” Another mother bravely discussed the loss of her infant and how important the staff was to her healing. “Patience is so important, don’t rush; some things can’t ever be pushed” as she told of her need to have just one more ultrasound to know she had lost her baby girl. This mother wanted to “pay it forward” and now works with other mothers on this hospital unit who are experiencing a loss.

The audience was tearing up and we embraced this sacred chance to learn from — and really tune into — the experience of patients and how our own actions can support or deter healing. Many in the audience nodded their heads and spoke of how those in health care can get desensitized and how vital it is to our work to bring the patient into the health care discussions. We all have either been a patient or will be one!  How different would our health care would be if patients contributed at all levels, offering wisdom through their own experience?

As we move from students to clinical work, I’ll pass on the challenge the IHI Perinatal Team put forward at the conference: Bring in the patients. Not just as a side note, but as a real contributor for change. It got me thinking of how we can include patients in our own IHI Open School Chapter meetings. How can patients inform students regarding innovative health care ideas and healing? How might hearing the story of a mother needing just one more discussion, more time, and more compassion color our thoughts when we  often move too quickly through our tasks as health care workers? We can “birth” new health care WITH patients, not for them. Take the challenge, bring in the patients, and be ready for the change!

Words, Words, Words

- Alex Anderson, Executive Assistant at IHI

Recently, I joined my family in remembering Harriet Berman. At Harriet’s funeral, her children celebrated her life in many ways. Among the many stories and reflections, one message stood out to me: Harriet deeply disliked the language used to describe the experience of being a cancer patient—being a victim of cancer. Fighting a Battle with cancer. Living as a Survivor of cancer.

Harriet did not like the implications of the language. Battling something implies there is a winner and a loser. It implies that if you’re fighting, and losing, then you are not fighting hard enough. If you could fight just a little harder, with stronger or better tools, you might survive a little longer.  

This immediately made sense to me. I never thought to question the ubiquity of the cancer-patient language. After thinking about the language, I was surprised that a conversation around it has not sprung up at IHI. I would like to start that conversation.

I do not know what the right language should be. I am sure there are many cancer patients who find the current language comforting, and I do not want to discredit any of the comfort they find in the language. However, I think we can do a better job understanding that different people may respond in different ways to the language we accept as normal.

How can we shift this conversation? What are the words and phrases that will enable us to provide support and encouragement to people facing difficult situations? I do not think that one wordsmith can find the right answer, but if we discuss this together, we may find a more inclusive way to support each other.

Focusing on Patient Safety in South Carolina

Susie Robinson & Amanda Hobbs, President and Vice President, Clemson University IHI Open School Chapter

The 5^th annual SC Patient Safety Symposium, held April 25 in Columbia, SC, proved to be a valuable experience for both of us! We learned a lot about patient safety and had the opportunity to her many leading experts in the field.

(We would first like to thank the South Carolina Hospital Association (SCHA) for sponsoring our attendance and for its constant support of the IHI Open School Chapters in the state of South Carolina.)

Here’s a rundown of our experience:

-          We kicked things off by meeting with leaders within the IHI Open School community, including the members of University of South Carolina’s IHI Open School Chapter and our two Southeast Regional Coordinators. 

-          As the Symposium began, we took front row seats and listened to Maureen Bisognano, CEO of the Institute of Healthcare Improvement.  She first recognized our state for the strides South Carolina has made in decreasing health disparities between populations, especially in Columbia.  Bisognano spoke briefly about the Triple Aim and recognized areas for health care improvement.  Bisognano then introduced Regina Holliday, a painter and patient advocate who painted representations of both the provider and patient perspective throughout the conference.

-          Next, Dr. Atul Gawande spoke about the future of Safe Surgery 2015, and the progress of South Carolina as a pilot state. 

-          After a short break, Dr. Eric Coleman from the University of Colorado spoke about the Care Transitions Program.

-          At lunch, the few students in attendance were recognized and the Lewis Blackman Patient Safety Awards were presented to honor deserving individuals from around the state. (The lunch, accompanied by the South  Carolina Philharmonic Orchestra, was delicious.)

-          As our day wrapped up, we were fortunate to spend some time talking with Maureen, Dr. Rick Foster, SCHA Vice President of Quality and Patient Safety, our IHI Open School Regional Coordinators, and patient advocate Helen Haskell (Lewis Blackman’s mother). 

We are grateful we had this opportunity through our involvement with IHI Open School!

IHI CEO Maureen Bisognano poses with faculty and students
at the 5^th Annual SC Patient Safety Symposium in Columbia, SC.

Introducing The Conversation Project

What if every citizen’s end-of-live wishes could be expressed and respected in a way that was simple and transformative? Would you have the conversation about your views on a “good death” if you knew it would bring peace, security, and calm to your loved ones?

We are all mortal, yet as a society we have been painfully slow in recognizing and acknowledging how many of the people we love are not dying in a manner of their choosing: in comfort, among people who care about them, and engaged in what matters most for as long as possible.

Many Americans assume these conversations should and will take place between doctors and patients, but doctors are often uncomfortable and untrained in initiating these end-of-life discussions, so wishes are never expressed and words are never spoken. The Conversation Project fills a void by bringing these important conversations from the hospital bedside to the kitchen table, so patients’ choices drive the decisions rather than medical finances.

Our mission is to provide individuals, communities and society at large with the knowledge, wisdom and grace needed to have what can be a painful conversation. The Conversation Project is your forum for sharing stories, a coordinated messaging and communications effort, a social marketing campaign, and a web home base for conversation starters. It’s where you will find guides to help you ensure your end-of-life wishes are respected. 

We are not interested in a temporary change, but rather a full cultural shift that will enable us to remove the stigma and uncomfortable nature of the topic, enabling us to have the conversation within our own families but also, collectively, across cultures, workplace communities and neighborhoods.

Our goal is to help people of all ages engage loved ones, care providers, clergy, and others. Rather than promote a ‘desired’ action, the Conversation Project plays the role of catalyst and advocate for families and circles having these conversations. Those who have had The Conversation report the benefits far exceed any preconceived expectations. We know this is hard, but we also know the number of people who want to have these discussions will continue to grow.

We ask you to join us by having The Conversation with your loved ones. We promise never to steer your decisions, only to support and encourage your discussions.

To learn more, follow @convoproject on Twitter. The Conversation Project website will launch in June.