Aug 6, 2012
Jul 8, 2012
Nostalgic for the hours I used to spend in college dining halls debriefing a long organic chemistry lab session, planning the next Chinese Students Association event or discussing the misuse of Murphy's Law when describing catastrophic global events, I take great comfort in studying in cafes or catching a casual drink at low-key bars. Food and drinks are within reach and conversations are aplenty. However, it seemed just too perfect that I would find myself at a Wolverine friendly bar and pizza joint called the Brown Dog in the middle of Telluride to catch Game 3 of the NBA finals with my new patient safety friends.
In between sips (true sips because alcohol and high altitude could turn into a physiologic disaster), we would seamlessly transition from discussing the patient harm that results from unstandardized hand-offs to watching the Miami Heat claw their way towards a lead in the series against the Thunder. The true cherry on top was the mouth-watering smells of Detroit deep dish pizza that surrounded us. Because the University of Michigan atmosphere mixed with good pizza and beer seemed to be a winning combination for stimulating patient safety conversations and Miami Heat success, we recreated the magic for the rest of Miami's journey to become the 2012 NBA Champions. As I wistfully look back on my week in Telluride, especially as I suffer in the inhumane heat wave that has metaphorically encircled Southeast Michigan in an inescapable head-lock, I can’t help but intertwine patient safety and health care quality improvement with basketball.
Since becoming a basketball fan when the Miami Heat won the NBA Championship in 2006, my home team has really tried my patience. Like any health care quality nerd, I began to see health care connections in sports. The Miami Heat represented all of the negative characteristics of a poor performing health care system, primarily an organization that had seemingly lost its way (click here to read more about the Miami Heat and its failures as an HRO).
2010 represented a turning point. In a politically unwise and arrogantly publicized event, LeBron James was recruited to join Dwyane Wade and play for the Miami Heat. Chris Bosh of the Toronto Raptors also decided to move to warmer climates. Before I knew it, amidst the global antagonism directed towards Miami, a new sense of purpose had been injected into my home team: The Big Three had promised to fill their fingers with championship rings. While the rest of the world derided the team for its bombastic promises, I bought into the dream. With three superstars on the same team, as the Boston Celtics had proven in 2007, how could the Miami Heat fail?
Did the Miami Heat succeed in the 2011 NBA Finals? No. The Big Three was simply that, three basketball superstars who all happened to play on the same team. An optimist would say that The Big Three’s first season together was a string of small experiments (PDSA cycles) on how LeBron James, Dwyane Wade, and Chris Bosh would share the court together. But, what this looked like on TV was confusion and a total lack of coordination. The Big Three had their moments when they would each individually live up to their All-Star reputations, but these occurred in unpredictable and unreliable spurts. The Miami Heat haphazardly played its way into the 2011 NBA Finals and an entire season’s worth of bewilderment became obvious to the world as it was blown out by the Dallas Mavericks. I distinctly remember watching the team disintegrate into a group of headless chickens that did not seem to know what to do even when it possessed the ball.
In retrospect, the 2010-2011 season should not have come as a surprise to me. In assembling The Big Three, the Miami Heat committed the same mistake that many health care organizations make: attempting to achieve greatness through cultivating great parts. In a thought experiment to build the world’s greatest car by assembling the world’s greatest car parts, Dr. Don Berwick, former CMS Administrator and CEO of IHI, describes:
- “Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence”… We’d connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo. “What we get, of course, is nothing close to a great car; we get a pile of very expensive junk.”
The basketball teams that want success to become an intrinsic characteristic of the team, invest and develop not just individual talent, but also create a reliable system of teamwork.
Examining the Miami Heat’s run for the 2012 NBA Championship, the Miami Heat has done just that: built on the talents of The Big Three and transformed into a high-functioning team. For those that continue to carry Miami Heat antagonism (I realize I am in the great minority being a Miami Heat fan), I’m not claiming perfection, but improvement. Although an abbreviated season, the Miami Heat discovered a rhythm of teamwork that allowed The Big Three to play together as a more unified front. The Miami Heat faced one of its first great tests in the second round of the playoffs against the Pacers. Chris Bosh was injured and out of the picture and the Miami Heat was shut out of Game 3, falling behind in the series 1-2. The Miami Heat of 2011 probably would have been knocked out of the NBA Finals running. But, the Miami Heat of 2012 readjusted and Udonis Haslem stepped up to the plate to fill in the gap that Chris Bosh left. The Miami Heat beat the Pacers 4-2.
Improved teamwork was even seen off of the court. In the wake of the Miami Heat taking the lead in Game 3 against the Thunder, the drama that erupted in the media was when Kevin Durant of the Thunder was caught telling Dwyane Wade, "You're too small." Although the statistics of the team do back-up Kevin Durant's statement, LeBron James' response that the actual size of the players doesn't matter as long as they're fundamentally sound and play with the effort that helps that makes up that difference, rang true of the 2012 Miami Heat teamwork mantra. Just looking at the media coverage of the Miami Heat's journey to the championships, the words "we" and "team" are being used more frequently and coverage of the last game sings the praises of not just the Big Three, but also Mike Miller, Shane Battier, and Mario Chalmers--critical teammates who all contributed to the win.
So, what does this all mean for health care? The theme of the week at the Telluride Roundtable was communication. While we spent the day discussing the importance of communication facilitating successful teamwork, what we had in front of us in our after hours was an example of the incredible transformation of a basketball team that truly took teamwork to heart. So, as many of us are getting ready to apply for residency and are looking for residency programs and institutions that value patient safety, don't fall into the trap of optimizing health care by just optimizing individual parts, also consider what programs and institutions do to facilitate excellent interdisciplinary teamwork.
While the IHI Open School facilitates interdisciplinary communication by bringing health professions students of all disciplines out of their isolated silos together to discuss quality improvement and patient safety, what else can be done to improve interdisciplinary communication and hence create a reliable system of teamwork? I'd love to hear what you are doing at your institutions, so comment below and share your successes and challenges--perhaps some drinks and pizza will spark some health care quality improvement magic.
Jun 27, 2012
Walking onto the oldest Jesuit and Catholic university campus in the United States — among the likes of Rhodes Scholars, heads of state, senators, and medical pioneers — can be a little intimidating, albeit exhilarating. Meandering through historic Healy Hall felt as though we had been transported back into time (or possibly to Hogwarts). Any daunting feeling we had, however, quickly subsided as we were warmly welcomed by volunteers from the IHI Open School Georgetown Chapter.
They had gathered for a two-hour training on how to staff and run an event, the IHI Blue Shirt way.
As a seasoned Event Manager from IHI (that’s me in the picture; I’m a little bigger in real life), I eagerly accepted the challenge to transfer all of my knowledge of planning large-scale events to the soon-to-be Blue Shirts, in a mere two hours. At IHI, we’re proud to know that the Blue Shirt title is coveted by many people from around the world who attend our National Forum or Office Practice Summit each year. Being a Blue Shirt is more than just directing with an open palm and helping people find the restrooms; it’s about embracing the values of IHI and transferring them to attendees, empowering them to take what they’ve learned and make changes in their own organizations. When attendees leave our programs thinking, “I could change the world” instead of, “I wish they had more sandwiches,” the Blue Shirts have done their jobs. So when Dan Alyeshmerni, Mark Fischer, and James Cervantes, Chapter Leaders of the IHI Open School Georgetown Chapter, told us they wanted their attendees to have a “Blue Shirt experience” for their lecture on June 5th, we knew exactly what they meant.
We knew that Dan, a repeat attendee of the IHI National Forum, had a deep appreciation for the IHI Blue Shirts. Surely, the volunteers from the Georgetown Chapter would be equally enamored? As it turned out, not many of the 15 volunteers had experienced a Blue Shirt event. If you, too, haven’t yet heard of a Blue Shirt, you may want to refer to this IHI Open School blog post.
After we showed the now famous Blue Shirt Video, we had them tapping to the beat of Jay-Z’s “Empire State of Mind,” but they didn’t quite grasp the Blue Shirt concept. It wasn’t until that Tuesday at 7 AM did the prospect of squeezing more than 400 attendees into the beautiful, yet compact, Gaston Hall, make them understand what being a Blue Shirt really meant.
Donning black pants and the notorious blue polo shirts (hence the affectionate term “Blue Shirt”), the student volunteers from various disciplines at Georgetown University arrived with excitement and anticipation. They were eager to attend the Inaugural Dr. Amitai Etzioni Lecture, “Putting the Patient First: Providing Health Care That is Patient Safe and Patient Centered.” At this inaugural event, Carolyn Clancy M.D., Director of the Agency for Healthcare Research and Quality, and Donald Berwick, M.D., M.P.P., FRCP, former Administrator of the Centers for Medicare and Medicaid Services (CMS) and former President and CEO of IHI, inspired us with their insight and expertise in quality improvement.
As the attendees began to arrive, the Blue Shirts (all wearing their best smile) manned their stations and began to greet, direct, usher, and herd until each of the seats in the auditorium was filled. They were not only polite and assertive; they went above and beyond, making sure each attendee was having a great experience. I even saw one Blue Shirt walk a lost attendee all the way from the parking garage, up the four flights of stairs to the hall, and into their seat in the auditorium. Now, that is what it means to be a Blue Shirt!
Stephen Evans, M.D., Vice President of Medical Affairs at MedStar Georgetown University Hospital, opened the lecture by offering sincere appreciation to the IHI Open School Georgetown Chapter for planning such a successful event. Dr. Evans labeled the Chapter accurately with his sentiment, “Thanks to the IHI Open School [Georgetown Chapter], who I describe as a hungry pack of wolves. You feed them meat and they go right after it.”
The IHI Open School was a reoccurring topic in both Dr. Clancy and Dr. Berwick’s keynote presentations. Dr. Clancy placed importance on the need for changing the culture of how medical professionals are educated. Dr. Berwick highlighted the IHI Open School’s wide range of online courses in the areas of quality improvement, patient safety, patient- and family-centered care, managing health care operations, and leadership. He reminded the audience that the way to put the patient first is by engaging and educating health care professionals around the world. With a membership of 93,895 students and residents, and 461 Chapters in 54 countries (and growing), the ability for the Open School to reach the masses of health care professionals is significant. Dr. Berwick also noted that “coverage is key to improvement, improvement is key to coverage.” Knowing the leverage that the IHI Open School has, Dr. Berwick challenged the School to enlist two million health care professionals by December 2014, stating that this is not only possible, but also necessary for the future of quality improvement.
After a standing ovation, the Hoya spirit shined as the tireless Blue Shirts resumed their positions, ushering and directing attendees toward the exits. As the buzzing crowd cleared the auditorium, it was obvious that the IHI Open School would be a few hundred people closer to the two million-person goal set by Dr. Berwick.
While the proud volunteers began excitedly debriefing the event (even hesitating to give back their blue polo shirts), we knew that these 15 people had not only understood the Blue Shirt concept; they had fully embraced it.
Jun 18, 2012
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:
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!
Jun 13, 2012
Jun 11, 2012