IHI Open School

IHI Open School Blog Has Moved

noreply@blogger.com (IHI Open School) — Mon, 06 Aug 2012 18:37:00 +0000

The IHI Open School is happy to announce that our blog has moved to the IHI website. You can find the blog here.

Why the move? It allows the blog to be better integrated into our workflow and more connected to the content we produce. For example, searches on IHI.org will now include our blog posts.

Looking for an old post? Don’t worry. We’ve migrated many of our most popular posts from this Blogger site to the new blog, allowing you to search back through old content.

While you’re checking out our new home, be sure to look out for several other blogs IHI is launching in 2012!

Drinks, Pizza, and a Little Basketball

noreply@blogger.com (Eva Luo) — Mon, 09 Jul 2012 01:51:00 +0000

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.

Helpful Hoyas: Training IHI Blue Shirts at Georgetown

noreply@blogger.com (IHI Open School) — Wed, 27 Jun 2012 19:58:00 +0000

By Lindsay DeGennaro, IHI Event Manager

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.

Why Hospitals Should Fly...

noreply@blogger.com (Eva Luo) — Mon, 18 Jun 2012 06:44:00 +0000

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

noreply@blogger.com (IHI Open School) — Wed, 13 Jun 2012 15:08:00 +0000

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

noreply@blogger.com (IHI Open School) — Mon, 11 Jun 2012 13:23:00 +0000

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

noreply@blogger.com (IHI Open School) — Wed, 30 May 2012 13:28:00 +0000

- 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

noreply@blogger.com (IHI Open School) — Fri, 25 May 2012 15:24:00 +0000

- 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

noreply@blogger.com (IHI Open School) — Tue, 22 May 2012 19:55:00 +0000

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

noreply@blogger.com (IHI Open School) — Wed, 09 May 2012 15:19:00 +0000

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.

Former Hospital CEO Visits Chapter at University of Colorado

noreply@blogger.com (IHI Open School) — Tue, 01 May 2012 13:52:00 +0000

The University of Colorado IHI Open School Chapter, in collaboration with the Patient Safety Education Partnership, was proud last week to host Paul F. Levy, author and former CEO of Beth Israel Deaconess Medical Center.

Levy related stories about reducing patient harm, transparency of clinical outcomes, and leadership in medicine. The 80 attendees included students and faculty from the schools of Medicine, Nursing, Pharmacy, Dental Medicine, and Public Health, as well as residents and staff from several area hospitals.

All attendees received a copy of Levy’s new book “Goal Play,” provided by the Patient Safety Education Partnership, which you can learn more about at http://www.psepartnership.org/. The Chapter continued the discussion this week through a deliberative dialogue that explored the potential benefits and drawbacks of several strategies for the improvement of patient safety.

Pictured: University of Colorado IHI Open School
Chapter Steering Committee members Racheal Gilmer,
Josi Schwan,Betty Geer, Eric Wannamaker, and Dan Stoll;
Paul Levy; Chapter Faculty Advisor Wendy Madigosky

Listening to Paul Batalden

noreply@blogger.com (IHI Open School) — Thu, 19 Apr 2012 14:03:00 +0000

Attendees enjoyed many treats at the 2012 International Forum on Quality Improvement and Safety in Paris. Inspiring keynote speeches. Impressive poster presentations as far as the eye could see. Croissants and macaroons around every corner.

Few treats, though, compared to sitting and listening to Dartmouth professor--and improvement legend--Paul Batalden share his lessons and wisdom at a student lunch session on Thursday. He offered up Improving Health Care: A One-page Book, a book he developed "to open the topic [of health care improvement], not close it." Students, professors, and other improvement gurus (such as Don Berwick) followed along with interest.

"We get so many signals every day about the broken health care system," Batalden said. "The habit we've developed is to ignore them. We have to change that. We've got to figure out a way to make improving a simpler proposition. We have to move from where we are to where we need to be."

As a writer in the room, it was hard not to just write down every word out of Paul's mouth and hit "Submit" on this blog post. It would have been much easier and much better. For example:

"My sense is that the only thing powerful enough to overcome a habit, the only way to overpower that is with community and hospitality," he said. "And that's not tea and crumpits. Find some way to create a local group with curiosity. We didn't set out to create the IHI. We started with a group of people we knew and trusted, and became a community of curiousity."

Anyone who has met Paul has something positive to say about the interaction. He's warm, generous, brilliant, and anxious to share what he knows, which is an awful lot. But it's not how much he knows; it's how he shares it. He tells stories that engage every set of eyes in the room.

"I remember this visit to one of the parts suppliers at Toyota. They were talking about the employee suggestion system ..." he started at one point on Thursday.

Then another:

"I remember one time taking care of an 11-year-old boy who developed pancreatitis ..."

The richness and the lessons of each story stick with you long after he moves on to the next one. And when you think about them later in the day, they mean even more.

The teaching--and the conversation--lasted only 45 minutes, but it's hard to imagine a better way to spend three-quarters of an hour. It was a treat that will last much, much longer.

- Mike Briddon, Managing Editor, IHI Open School

Follow @IHIOpenSchool on Twitter for news and updates from Paris!

Bringing Learning Home from D.C.

noreply@blogger.com (IHI Open School) — Tue, 10 Apr 2012 16:13:00 +0000

Four students—one from Bellin College in Green Bay, WI, and three from Eastern Virginia Medical School (EVMS) in Norfolk—went to the 13^th Annual International Summit on Improving Patient Care in the Office Practice and the Community in Washington, D.C., with hopes of bringing home valuable lessons to their respective communities. The Bellin student was seeking inspiration and some new ideas for her Chapter. The EVMS students were seeking information for Health Outreach Partnership for EVMS Students (HOPES), their student-led free clinic. Here are their experiences:

Kimberly Herman, 4^th year nursing student, Bellin College

I decided to attend the conference with the hope that I could bring back useful information and proven techniques to assist with the quality improvement initiatives that our Bellin College Open School Chapter has undertaken at area hospitals in Green Bay. Having attended the IHI National Forum in Orlando this past December, I was interested in seeing how quality improvement and patient centered care could translate to office and community settings.

I was not disappointed.

It was inspirational to see all of the people in health care that are devoted and actively working to improve the quality, safety, and experience of patients. (I think that too often health care is seen by the public as a business with its focus on making money instead of caring for people, families, and communities.) I attended sessions on interprofessional communication, individualized care, and the use of e-visits and social media as a way to reach out to patients in different ways. This sort of interaction looked into correcting misinformation, informing patients, providing more individualized information, and offering support for a patient during the course of treatment.

From these sessions, I left with realistic and useful ways of helping to provide safe, appropriate, high-quality care in future day-to-day interactions with patients—and several valuable lessons for my Chapter!

ChengXi Wang, medical student, Eastern Virginia Medical School

My primary goal in attending this conference was to gain insight into models of primary care, which I would then share with the EVMS community. Specifically, I wanted to see successful examples of how care can be coordinated across the various health professions and in community-based settings.

I found everything I was looking for—and more.

I learned about the tiers of influence in health care and realized that health education in the doctor’s office just isn’t going to suffice. I saw examples of what worked, including Communities That Care and NUKA (a model of care from the Southcentral Foundation of Alaska), which will serve as frameworks for how I can do the same, albeit on a smaller scale. I learned about Kano and Lean Principles as applied to health care, and cross-training and its importance to team building. Before the last day of the conference was over, I had already sent out correspondences to members of the EVMS community as to what I learned and what we can apply. I even sent correspondences to former coworkers in the Baltimore City Public School System about several hugely applicable principles! (I taught for 5 years prior to attending medical school.)

To HOPES, I’ve proposed that we revamp the current continuity system so that care coordinators are cross-trained and that at each visit, patients are asked: “What matters to you?” We’ll truly adopt patients as partners in their health care by having a conversation at each visit about contexts and priorities. Utilizing community resources, we’ll help patients with their own goal setting and self-management, celebrate their progress, overcome setbacks, troubleshoot obstacles, and continually re-evaluate their goals and priorities. I hope that this proposal makes its way through the PDSA cycle with results we can then share.

Krishna Aluri and Clay Nelson, medical students, Eastern Virginia Medical School

We went to the conference looking for general ideas and specific strategies for improving the quality and continuity of care in our student-run free clinic that runs on almost no budget and is administered entirely by volunteers. We found applicable and inspiring ideas in talks held by the keynote speakers, in various workshops, and in many other sessions.

Being involved in a clinic that cares for uninsured and underserved patients, we were especially interested in improving continuity of care and ideas for helping patients overcome some of the barriers that they face in receiving and making use of health care. We were inspired by Maureen Bisognano’s discussion of Health Leads and social advocacy (one of our goals and necessities for helping patients), as well as by Dr. Donald Berwick’s explanation of the Health Impact Pyramid— something that we learned to address in the care of patients before I had ever heard of the pyramid itself. In these talks, we learned the importance of assessing each patient’s understanding of their illness and their barriers to care as well as using patient-specific goals, and models for continuity of care to bypass the barriers and get better health care outcomes.

From the learning labs, we took away ideas and goals that included greater automation in our upcoming use of an EMR (such as triggers for e.g. diabetic patients—described by one participant as an IT reminder system for patient care) and the standardization of care using an EMR to achieve specific goals (important for us since the HOPES clinic has continuously changing clinical teams of volunteer students and attendings). Related to social advocacy and continuity of care, we were glad to hear how other clinics and teams improve care coordination by having specific tasks for pre-visit, visit, and follow-up patient encounters that are carried out by a diverse and integrated clinical team (the follow-up, we learned, may have the most significant impact on compliance with treatment plans). Using examples from clinics in underserved areas of the US and abroad, another session showed us how to improve our continuity of care using only limited resources.

In other sessions, we heard about the importance of matching patient materials and education efforts to their health literacy level (which the HOPES clinic and other EVMS programs already strive to do), as well as how to go about assessing barriers and challenges that are keeping patients from reaching their own goals and the goals that their care teams have for them. Along with this, we learned how to study and improve our operations at the clinic by using PDSA cycles to study our efficiency.

We also gained insight into the health care system as it applies to us as a students and future physicians. We were intrigued by comments on sustainable health care and on eliminating the waste in US health care—two major ideas that will affect us as physicians. (Victor Montori’s discussion of patient-centered care was one of our favorite talks.)

Overall, the conference gave us insight into the future of health care implementation that is better designed to meet the needs of the patient population. As a result, we believe we will be able to deliver better patient-centered care and are better equipped to face future health care challenges.

Duke Students Share Three Lessons from the 13th Annual International Summit

noreply@blogger.com (IHI Open School) — Wed, 04 Apr 2012 14:13:00 +0000

As first-year medical students, we spend almost all our time reviewing material related to human health, disease, and the management of illness. This foundation is necessary for practicing medicine.

But we want go above and beyond “necessary and sufficient.” We want to work together with our patients, colleagues, and communities to provide the highest quality, safest, and most effective care—every single time. The skills needed to achieve this goal are lacking in the traditional medical school curriculum.

This is where IHI and IHI Open School come in.

From March 18-20, we attended IHI’s 13^th Annual International Summit on Improving Patient Care in the Office Practice and the Community in Washington, D.C., and were blown away by the advances being made in building systems where each person has the health care that best fits her/him. We walked away with three major themes:

1. For care to be optimal for each unique person, health care must operate in a people-centered fashion. That means considering an individual’s economic and psychosocial circumstances. We learned, for instance, about different case management models that take these factors into account and in which health professionals work with a panel of patients to help them manage chronic illnesses. Work from other countries (Canada, England, Scotland) was particularly revealing in illustrating how different cultures approach these problems, and how, often times, we in the US can be narrow-minded in our thinking of how health care functions and the interactions it can have with other community institutions. On the other end of the spectrum, from large government driven programs, we heard practical advice from leading US solo/small practice physicians in how they achieve high quality care in their relatively resource-limited settings. Seeing how their passion for quality was intertwined with relationships they had formed with their patients over decades was extremely inspiring.

2. We learned that the pace of research on how to improve care is increasing. We live in an era of active research and increasing knowledge on best practices for improvement gaps, such as chronic disease management and avoidable hospital readmissions. As future health care professionals, we need to remain aware of these advances (they may be just as important to our future practice as a drug discovery) and possibly consider becoming involved in health services research ourselves. The panels on the Triple Aim and PDSA were particularly good at illustrating how quality improvement work occurs.

3. Technology provides the backbone to improvement. The process of incorporating technology is cumbersome—both in terms of time and resources. We heard from hospital systems that are using Meaningful Use regulations as a jumping board to achieve higher quality of care. We also learned about the use of mobile apps for individuals to better manage illness. Electronic health records, databases, patient portals, and other technology advances, when used meaningfully, allow health providers and patients to achieve better results. Examples of health data in action from overseas (England, Scotland) offer exciting ideas for how we can also meaningfully use similar data here.

In all, IHI’s 13^th Annual International Summit reminded us once again of the tremendous challenges, but more importantly, exciting opportunities we—as only beginners in our medical journey—will face as we enter the health care field. It is an exciting time. We look forward to staying informed and continuing to work with IHI to build on the great improvement work already being done.

Parastou Fatemi, Medical Student, Duke University School of Medicine and President, Duke IHI Open School Chapter

Marisa Dowling, Medical Student, Duke University School of Medicine and Vice President, Duke IHI Open School Chapter

Welcome New IHI Open School Regional Leaders!

noreply@blogger.com (IHI Open School) — Wed, 28 Mar 2012 14:25:00 +0000

Regional Chapter Leaders, which are selected after a region comprises at least 25 Chapters, serve as intermediaries between the IHI Open School team and local IHI Open School Chapters. They form the backbone of the Chapter network and help foster the growth of the IHI Open School community. We are thrilled to have them join our team and are immensely grateful for their contributions! Feel free to drop them a line and say hello. They’d love to hear from you!

United Kingdom IHI Open School Regional Leader

Hi, my name is Andy Carson-Stevens. I’m thrilled to be the new Regional Leader in the United Kingdom. The IHI Open School has played a huge part in my professional life. As a medical student in 2008, I convened the Wales Chapter as a student program allied to the 1000 Lives Campaign in Wales. During an internship at IHI in 2009, I realized the power of the IHI Open School network, and co-founded the first student-led global patient safety campaign to encourage the spread and implementation of the WHO

Surgical Safety Checklist. To our surprise, thousands of students got involved in the “Check a Box. Save a Life.” Campaign! Through academic scholarships awarded by the IHI Open School, I’ve been fortunate to attend IHI learning events such as the National and International Forum, and in 2010, I attended the Student Quality Leadership Academy. I’m now honored to be the lead author on a new course for the growing IHI Open School catalog. The IHI Open School has given me a family of friends to share and learn with from across the world - I look forward to learning with you!

Starting this August, I will be a primary care physician trainee and a Lecturer at the Institute of Primary Care and Public Health, Cardiff University. You can reach me at andypcs@gmail.com.

United States Midwest IHI Open School Regional Leader

My name is Lakshman Swamy, and I am an MD/MBA student in my final year at Wright State University in Dayton, OH. I'm excited to serve as the Midwest Regional Leader this year! My goal is to create a stronger network between our Chapters—new and established—and to promote more interdisciplinary communication as well.

I'm also looking forward to spending the next few months at the Center for Clinical Excellence at Brigham and Women's Hospital in Boston. I'll be getting started on regional events by working closely with the IHI Open School staff while I'm there, as well. Feel free to drop me a line anytime to share your ideas or talk about Chapter programming. You can reach me at lswamy@gmail.com. Looking forward to a great year!

United States West Coast IHI Open School Regional Leader

I’m Jessica Schwartz, and I just moved to Denver a few months ago from San Antonio, Texas, where I attended Trinity University’s Masters in Healthcare Administration program and led San Antonio’s IHI Open School Chapter. I am completing my Administrative Fellowship at Children’s Hospital Colorado from January to December 2012, and I’m really excited to continue my involvement in IHI!

As the Regional Leader of the West Coast, I hope to shine a light on the great work these local Chapters are doing, foster collaboration in and between Chapters, and organize at least one regional event. Please contact me with any ideas, suggestions, or comments. I look forward to working with the Chapters in my region, other Regional Leaders, and the IHI Open School staff to really make some positive change. You can reach me at Jessica.Schwartz@childrenscolorado.org.

End of Life Care: Does it ever get easier?

noreply@blogger.com (Eva Luo) — Wed, 21 Mar 2012 13:00:00 +0000

May 9, 2011 was the first day of my third year of medical school, first day on the cardiology inpatient service, and the first day I met Ms. W, my first patient. Ms. W was a 77 year old woman with COPD, right-sided heart failure, pulmonary hypertension, and was in the ICU for ARDS due to spontaneous hemorrhage of unknown etiology. Because taking care of Ms. W would be challenging and overwhelming, my senior resident and I walked into Ms. W’s room together for introductions.

I naively expected to see a charming elderly lady who was just a little short of breath. However, one could argue that formal introductions were not needed because Ms. W likely never even knew we had walked into her room—she was on a ventilator and thus was heavily sedated. Nevertheless, Ms. W was very much present. Her gray hair was pulled back in a high loose ponytail, her hands were warm and her head bobbed up and down with each breath. She would inconsistently raise her eyebrows at the sound of her name and her tongue would slide towards whichever side her body was turned on. Despite the lack of any form of acknowledgment at our first meeting, Ms. W made a significant impression on me because just fifteen years earlier, my grandmother, who was 77 years old, was also in the ICU heavily sedated and dependent on a ventilator.

I worked diligently to take care of Ms. W. Every morning, I cheerfully greeted her, carefully checked her heart and lung sounds, confirmed the presence or absence of distal pulses, monitored the position of her endotracheal tube, checked every inch of her skin for signs of rash or pressure ulcer, and recorded her ventilator settings. As part of my morning ritual, I crossed my fingers before picking up her record book of ventilator settings hoping to see a positive trend towards recovery over time. I zealously poured over books and primary literature to understand the complicated management of her cardiac, respiratory, and renal disturbances. Perhaps it was selfishly motivated, but I felt committed to Ms. W. I strongly believed that if I could heal Ms. W, I could make up for my lack of understanding and inability to help my grandmother fifteen years earlier.

As the days passed, there were no signs of improvement and there were plenty of subtle hints that even a modest amount of recovery was unlikely. Managing her fluid status with changes in either direction only made things worse. Family meetings were initiated. I stood in the shadows as difficult conversations uncovered internal family tensions between honoring Ms. W’s understood wishes and managing Mr. W’s feelings of loss. With each passing day left without a decision about our next steps, Ms. W steadily and slowly declined. Her ventilator settings started to uptick towards the need for more aggressive support, her kidney function was slipping, and the color of her feet became mottled. It was finally decided that it was time to let Ms. W go. Because Ms. W was my very first patient, my senior resident insisted that I join the family as they said good-bye.

The family, hospital chaplain, senior resident, and I all gathered into Ms. W’s room. Slowly, one by one, the beeping and whirring of the machines helping Ms. W stay alive were shut off. The endotracheal tube was removed and the only sounds left were short exhales of air and muffled sobs from Ms. W’s family. The sight of Ms. W’s family quietly and lovingly saying good-bye to her instantly transported me back to my grandmother’s hospital bed. Without consciously being aware of my own thoughts, I too began to sob as little bits and pieces of the past and present intermingled. I was not there when my grandmother passed away. But, simply transposing my father and mother’s faces onto Ms. W’s daughters felt all too real.

In just moments, after a few sputtering coughs, Ms. W stopped breathing. As I stood alone in my corner of the room shifting in and out of my own thoughts, I remembered that it was my father’s birthday--an overwhelming coincidence that made things too personal. With this realization, I said my good-byes to Ms. W and her family and then stepped out of the room rushing to find some privacy. All of the bathrooms were occupied, so I dashed into an empty family waiting room. I closed the door. I grabbed a box of tissues in one hand and held onto my cell phone with the other as I began to cry and wail. While I rationally and clinically understood the importance of discontinuing aggressive treatment for Ms. W, I could not resist feeling like I had failed her, and by association, failed my grandmother.

After gathering some composure, I loosened my grip on my cell phone and called my mother. She was away in China, but I ignored the inconvenient time difference because I needed to hear her warm and comforting voice. She explained and described how hard it was for us to let go of my grandmother. My mother assured me that it was the right thing to do and it was not a failure. My grandmother never wanted to be in the ICU and we had already disrespected those wishes for 200 days. She was ready and as honorable children, my parents had to let her go. Hearing the words that I myself have advocated for in regards to end of life care while working in the area of quality improvement of health care delivery, I calmed down and regained my strength.

My month on cardiology was only the beginning of a year of dramatic change and growth. By the end of my cardiology month, my clinical knowledge had increased exponentially. But, I can’t confidently say that I achieved similar emotional maturity. Ms. W was only the first of a total of four patients I lost that month (I have since lost another three while on surgery and lost my dog whom I was medically managing remotely as she succumbed to mesothelioma). On one hand, I have learned to harden my heart, for self-protection reasons, as I have not shed another tear for my patients. But, on the other hand, my great exposure to death has not made leaving the hospital when I had an unstable patient or losing patients any easier. Of all of my patients, the faces and narratives of the patients I have lost are those that I remember most vividly. The clinical courses and what I could have done differently, to some extent, haunt me. Consequently, the feelings of failure are always hovering and have shaped all of my future difficult patient experiences. Selfishly, I am drawn to more aggressive and alternative treatments despite promised or lack of promised outcomes.

Will my beliefs and instinctual emotions ever align? As I continue in my training, perhaps I will achieve a better balance between the science of medicine and the humanistic relationships with my patients enough to step away from my own selfish discomfort with failure. Will more experience become the evidence I can depend upon when making future clinical decisions? Because death and dying are fundamental aspects of medicine, for the sake of my patients and my own well-being, I certainly do hope that time and experience will foster the strength to be my patients’ guide through difficult times. Of all things, this is the best medicine that I can provide.

Remembering the Match Day Madness

noreply@blogger.com (IHI Open School) — Mon, 19 Mar 2012 15:50:00 +0000

Joshua Liao, BA, BS

Editor’s note: Joshua Liao, a fourth year medical student at Baylor College of Medicine, participated in Match Day this past Friday, where he found out that he will begin his Internal Medicine Residency this July at Brigham & Women’s Hospital in Boston, MA.

Most students have heard about the raw emotions—from elation to disappointment to contentment—on display during Match Day. As several leaders shared remarks in the minutes before envelopes were passed out last Friday, this became absolutely true for me. I felt the nervousness rising inside my chest, and I couldn’t take my eyes off the Match Board, the enormous vehicle my school uses for “job notification.” At Baylor, each student’s name is printed on the board with a corresponding envelope stapled beneath. The board is then covered by wrapping paper and parked behind the speakers until the appointed time.

Eventually, the envelopes were unveiled, and the seconds after I opened mine were a blur. I remember clenching my fist in gratitude before my loved ones mobbed me with congratulations. Behind me, shouts of joy mixed with epic, celebratory music. On the outside, I sensed my lips drawing into a wide, irresistible grin. Inside, I was absolutely ecstatic. I had matched into an absolutely amazing internal medicine residency.

After percolating in the feeling for several moments, I phoned my parents (who live in China) and then moved into the courtyard, congratulating my classmates and seeking out key mentors to thank them for their help and encouragement. Photos were taken, but I forget how many. There were many more hugs and handshakes. By the end of the event, I was exhausted and content.

Now, even just days after the Match festivities, I am struck by several important lessons about the whole process:

First, the moment can pass quickly. Plenty of people warned me about the intense emotions, but none told me how rapidly the whole thing would move. It felt like only seconds between the speeches and the paper being torn away from the board. I moved through the crowd to the board and removed my envelope, all without fully realizing it was happening. Seconds later, I was hugging my friends and family, and the uncertainty and nervousness had suddenly given way to relief and joy. The moment was like the first seconds after a dive into a cold pool; I felt the weight of my own feelings before I even realized them.

Second, the event can be as much the reinforcement of the past as it is the beginning of the future. Most know and think of Match Day as the beginning of new chapters in our lives, and in many ways, they are right. But as I embraced, laughed, and exchanged the good news with classmates, I realized how the moment seemed to strengthen my feelings toward them and my desire to stay in close touch going forward. Along my path around the courtyard, I ran into friends with whom I’d shared long study sessions, call nights, difficult cases, and extracurricular activities. I was able to enjoy a few moments with my closest friends from my medical school class. I found myself not only congratulating many of them, but also hoping sincerely that we would continue to stay in touch—in person, for those who’d be in the same city as me; via regular phone or webchat meetings for the others. Ultimately, I knew well in advance that Match Day would be a time to look ahead to residency. But I didn’t know it would stir such a strong sense of camaraderie and the desire to intentionally preserve my meaningful medical school friendships through demanding residency schedules. The thought felt warm against my chest.

Third, and most importantly, Match Day can be a powerful reminder of all the friends, family, and mentors who helped shape us. Some say that no man is an island, and that idea was never truer for me than during Friday’s celebrations. The notification paper only listed my name and the program’s name, but I remembered all the thoughtful letters of recommendation, advice, and input that contributed to that pairing. Several loved ones, friends, and mentors were present, and I was able to look them in the eyes and share from my deep gratitude. I owe long, thankful phone calls or letters to those who were not in attendance. Regardless, they were all in my thoughts almost immediately after I opened my envelope, where they have continued to linger in the hours and days following.

So for now, I will bask in the moment, thankful for the supporters and friends who journeyed through medical school with me. I will replay the moment from Match Day in my mind a few more times, to remember the anticipation and aftermath of it. But after a few days of this, I must stop. I have many letters of appreciation to write.

Where did you get matched? Leave a comment below and let us know where you’ll be starting your residency.

Enjoying the Milieu of Matching: Reflections from a First Year Intern

noreply@blogger.com (IHI Open School) — Wed, 14 Mar 2012 18:31:00 +0000

The fourth year of medical school is a rather strange mix. You spend much of the months of November to January travelling all over, living completely out of a suitcase, and wearing the same dark suit for days on end. This is followed by whatever method you might choose for ranking the places that you would like to complete residency. Some people make endless lists of pros/cons, others continue to research every possible detail about programs, hospitals, cities, and the like. All of this leads up to filling out the rank list with NRMP (National Resident Matching Program), checking it a few (possibly a dozen) times, submitting the list, and waiting for almost a month.

Then comes Match Week – probably one of the most unusual ways ever to find out about one’s first job (or at least the first as an MD/DO).

The second week of March is filled with a roller-coaster of emotions for fourth-year medical students across the country. There’s the universal anxiety about receiving the email from NRMP on Monday morning – “Did I match?” – followed by a week of anticipation. Medical schools seem to handle Match Day in one of two main ways. Most medical schools convene students (often for the first time in many months) to celebrate the achievements of the class. Some schools (like mine) have students announce where they will spend the next 3-7+ years in training one-by-one in front of a crowd of classmates, families, and friends. Other schools (so I’m told) have students open their match letters all at once, allowing for a bit more private experience. In both situations, the primary motive is to celebrate the achievement of students completing the four years of medical school now embarking on the next part of their training.

As I look back on my own Match Day, I’d encourage those of you reading this to make sure you take the chance to celebrate. Take a little time to reflect on what you have accomplished and to enjoy a day with the people with whom you have worked throughout medical school. In addition, celebrate with attendings, faculty, and mentors alike. Match Day, for many students, will be one of the very last times that you spend with your classmates. Some classes decide to celebrate on the morning before Match Day with a makeshift “tailgate” (caution: rumor has it this can be dangerous), while others host parties afterwards for students and faculty. In whichever way you choose, take the time to enjoy your individual and collective accomplishments. The next few weeks and months will be filled with final rotations, travels to find a new place to live, and hopefully at least a little time to relax. Graduation will find most people in the midst of life changes, marriages, babies, moving, and that day will come and go rather quickly. Take the time on Match Day to realize what you’ve accomplished and to re-connect with the people who were alongside you on the lengthy journey from the anatomy lab, through the classroom, and onto the wards. It’s an exciting week; make the most of it. Good luck!!

- Ross W. Hilliard, MD, Internal Medicine Intern, Rhode Island Hospital and The Miriam Hospital, Brown University/Lifespan

The Excitement, the Nerves, the Uncertainty … it’s Match Day!

noreply@blogger.com (IHI Open School) — Mon, 12 Mar 2012 14:32:00 +0000

Editor’s note: Joshua Liao, a fourth year medical student at Baylor College of Medicine, takes us inside his thought process as he prepares for Match Day or, in his words, one “massive job notification party.”

There is a common theme to the unique experience called Match Day: Unlike every other transition we’ve had as students—from high school to college and from college to medical school—we are forced to consider our options and everything important to us without any reassurance of acceptance. Unlike the college or medical school selection processes in which we could definitively know our options and choose from them, the Match forces us to process our goals using potential scenarios and possibilities (which can be taxing mental exercises). The complexities of this process can be further amplified by well-meaning, but anxiety-inducing, relatives and friends.

If nothing else, Match Day is an extremely unique way to find your first job. As applicants (“soon-to-be physicians”), we start the process off by applying to as many residency programs as we want and then awaiting interviews from all, or a portion, of those programs. We then invest an immense amount of our own time, money, and energy visiting those programs on strictly required, non-negotiable (as I unfortunately found out several times) in-person interviews.

After a brief lull, we rank the programs we visited and enjoyed, and each program, in return, ranks as many of us as they want. This massive collection of lists is then inputted into a central algorithm that pairs students with programs, culminating in a large grid of “matches.” The matches are released all at once, all over the nation, on one morning in mid-March (this year it is on Friday, March 16). The event, or “Match Day,” is essentially a massive job notification party for the majority of medical students.

For many of us around the country, it can be anxiety-laden for a number of reasons:

For some, elements of their academic records have been questioned during interviews and give them cause for concern
For others, interview experiences and Match statistics that ought to reassure still don’t
For others still, specific personal and/or academic reasons can cause anxiety about getting into specific programs

I was determined to avoid all this. I spent a great deal of energy choosing which programs to apply to and then, after doing my best to take stock of my goals and values, selecting which ones to visit on interviews. Afterwards, I resolved to fully engage every program that felt consistent with what I wanted and not to mislead those that were not. I asked increasingly specific questions (including many about the presence of patient safety/quality improvement opportunities!), and gradually, my rank list came together. I revisited it numerous times. I felt consistent and content.

But as we approached the date for final list submission (February 22nd), a few unexpected thoughts formed in my mind:

Had I ranked everything the right way?
Was a one- or two-day visit really enough to assess my favorite programs accurately?

In very specific situations, last-minute list changes can sometimes be beneficial for students. But that wasn’t the case for me. As time passed, it quickly became clear that I needed to stand firm in my original convictions, a decision that required much more courage than changing my list. There was an undercurrent threatening to disorient and panic me, but I was determined to resist it. I took a few more long looks at my rankings, calmed the urge to tweak them, and submitted.

Now, I await Match Day with a surprising measure of excitement, and I’m thankful I remained true to my values throughout. On one level, I certainly hope I get my first choice, like every student does. But on another level, I hope that regardless of outcome, I will be content knowing that I handled everything along the way with serious thought, careful reflection, and honesty.

Because while I’m not sure where I’ll be come July, I know one thing beyond a shadow of a doubt: Match Day is an extremely unique way to find your first job, but it’s an even more unique and important way to find out more about yourself.

By Joshua Liao, BA, BS, Baylor College of Medicine jmliao@bcm.edu

Our experience at the Southeast Regional IHI Open School Forum

noreply@blogger.com (IHI Open School) — Mon, 27 Feb 2012 16:53:00 +0000

The Second Annual IHI Open School Southeast Regional Forum in Greenville, SC, was, in short, a fantastic experience. After cramming for—and taking—yet another med school exam, my co-attendee Paras and I drove about five hours down to Greenville for a conference that would remind us once again of the big picture of why we are in medicine.

After we settled in our hotel, we turned to a generous reception the conference offered and I found myself surrounded by other IHI Chapter leaders and experts in patient safety and quality. It was the start of two days of great networking. Just for starters, I learned how payments around patient safety were changing and how other Chapters recruited and raised awareness among their members.

The next day began bright and early, and once again the networking was genuine and extremely useful. HealthSouth founder and former CFO Aaron Beam's presentation was a very relevant cautionary tale about slippery ethics and risk factors. I'm sure I'll recall his story when I'll undoubtedly find myself and my colleagues faced with the temptation to cross ethical lines "just this once."

The presentation by South Carolina Hospital Association that followed delved into how one defines, creates, and maintains a "just culture" around medical errors and their reporting. Only by admitting our mistakes can we learn from them and prevent them from happening to others. I found the case study particularly compelling and useful in solidifying my understanding.

In all, I met some great people, and took away lessons that will help me:

1. Build a stronger IHI Open School Chapter

2. Foster a culture of open error-reporting in my career

Emily Ingram, Ryan Baker & Cassie Besten

University of South Carolina Columbia College of Nursing , 2012

And

Marisa Dowling

Duke University School of Medicine, 2015

What if hotels billed like hospitals?

noreply@blogger.com (Neel T. Shah) — Thu, 16 Feb 2012 22:31:00 +0000

Costs of Care put out a a viral video today to help announce a new curriculum being developed to help trainees learn how to make value-based medical decisions. What do you think?

Team: What’s Your Definition?

noreply@blogger.com (IHI Open School) — Wed, 15 Feb 2012 15:15:00 +0000

Writing a job description was not exactly what I imagined myself to be doing in the first week of a clinical immersion. (To many, this might not sound too interesting or even relevant to clinical as a nursing student.) However, it proved to be an extremely valuable experience and inspired a new thought process on defining roles among health care staff.

The task for the meeting was to draft a clear description and distinction for both the nurse and medical assistant. It turned into 2.5 hours of constructive debate about how to word the already understood roles so that they would be concise, clear, and representative of the values of the medical home – a team-based health care delivery model.

What stuck with me the most from participating in the composition of the job descriptions was the meaning of the word “team.” In the medical home model, an interdisciplinary team approach is critical. (In fact, there is even a position for a Team Coordinator.) During the meeting, we were contemplating changing the name of the job title of a Registered Nurse to Team Nurse and from Medical Assistant to Medical Team Assistant. What would be the implications of renaming the role? What does the word “team” really mean?

As I am sure many of you are familiar with, the word “team” is used endlessly in coursework. My field of study, clinical nurse leader, in fact, represents and advocates the importance of an interdisciplinary team. But does everyone think of the word in the same way? This idea was discussed and will be revisited in an upcoming meeting. In the meantime, I asked around at the center, inquired with fellow peers, family, and friends to compile a mix of perspectives on how to define the word “team.” Here are some of the responses I received:

“A group of individuals working cohesively in order to achieve a common goal”
“A team is people who make each other better than they can be alone”
“A group of people working together toward a common goal, sharing resources, skills, and responsibility”
“A group of individuals working toward a common goal with various different perspectives and approaches to reach that goal”
“A group of people working for a common purpose”
“A group of peers working together”

Key words in these definitions were “together,” “achieve,” and “goal.” I was pleased to see how many people chose to use those exact words or something very similar. I think the members of this task force will agree the word “team” will be well received and a positive addition to the job title and description at the center.
I’d love to hear from some of you. What does the word “team” mean to you? Does your clinical site or past sites use the word “team” in everyday practice?

- Jessica Hatch, Clinical Nurse Leader Student, University of New Hampshire

Editor's Notes: Learn more about Jessica—and her clinical nurse leader role—in her interview from the 2011 IHI Open School Student Quality Leadership Academy.

Advice From a Third-Year Medical Student, Part II

noreply@blogger.com (IHI Open School) — Wed, 08 Feb 2012 21:45:00 +0000

Editor’s note: Two weeks ago, Lakshman Swamy, an MD/MBA candidate at Boonshoft School of Medicine at Wright State University, shared some advice for other students that he picked up after his third year of medical school. Not just for medical students, the advice touched on humility and the urge to complain. More than 1,000 readers have viewed the post, which you can see here.

Now Lakshman presents Part II of his advice and, again, wants it to be clear that he has made ALL of these mistakes. No one is perfect, he says, but being conscious of these mistakes – and this advice – helped him grow throughout the year. Take it away, Lakshman:

Here are four more great pieces of advice I picked up during my third year in medical school:

1. Don’t Slander. Don't talk badly about other students or, well, anyone. There will be plenty of opportunities to do so because you will see people violating all sorts of rules and you will be infuriated by it. You’ll see other students slinking away and getting days off to study on flimsy excuses – or coincidentally getting all the best cases and the least of the scut work. Ignore it all. Focus on doing the right thing and creating the best image of you. Be an upstanding citizen, ignore what others do, and have a clear idea of your own expectations and stick to them. In doing so, you will stick out and look fantastic – and deservedly so!

2. Put Yourself Together. Don't look like you slept in the hospital even if you actually did. Take care of yourself because you WILL look unprofessional when you don't – and it is very obvious. You will forget things, drop things, make mistakes that affect your team and your patients, and it all ultimately reflects on you.

3. Be a Great Learner. As difficult as it is, don’t be solely focused on tests and grades. You will have a much better time if you try to learn what you need to know because you see it as your own responsibility, rather than trying to pick out the test questions. If you allow yourself to be geared toward that objective goal (the next test, the boards, etc.), you will cement that way of thinking for your entire career. There are two problems I see with this:

You miss out on the depth of the information, and when atypical problems arise, you will be less equipped to deal with them.
You’ll be miserable.

You’ll always be looking for some future challenge that needs to be surpassed, and you won’t be able to relax and experience what is happening right now, and to excel in the moment. I’ve personally missed out on things that I would have been so excited to be a part of because I was more concerned about the upcoming quiz or test.

4. Be an Asset. Be dependable to your team. Run to get data for them and really try to know everything about your patients – just trying will pay off. As Eric Greitens said in his keynote address at the IHI National Forum last December, your strength can come from knowing others rely on you. You'll be amazed at your energy and capacity when you feel like you are an important part of the team. Relish the basic chores you have to do – don't consider them beneath you.

As a student, you’re often the first one to meet a patient and gather their story. Long after you present it, knowing those details can really come in handy and make you look fantastically on top of things. One example: Recently on call, the residents were handed a new patient with a surgery. We were walking to the patient and the residents blanked on some of the details of the case. I had done the H&P, knew everything about that patient, and saved them the hassle of logging into the EMR to get the details. Little things go a long way.

- Lakshman Swamy, MD/MBA Candidate, 2013, Boonshoft School of Medicine at Wright State University

The Immunity to Change Health Care in America

noreply@blogger.com (IHI Open School) — Wed, 01 Feb 2012 21:14:00 +0000

Don Berwick, during his time at CMS, had the opportunity to hear about health care from the point of view of consumers. Many times, he noticed the irony that Americans who would benefit most from health care reform were most vehemently against it. The message that health care reform is not only bad, but evil, has aroused the most basic fears – including fear of death – in a distrusting public.

Meanwhile, the message that health care reform is good for our country is falling on deaf and unbelieving ears. Why is that?

IHI staffers recently had the opportunity to hear Robert Kegan speak. In his book Immunity to Change, he points out that there are hidden and powerful assumptions that stymie people from changing habits and attaining stated goals. The inability to reach these goals is due to the reality that our current behaviors are a perfect response to these hidden and powerful assumptions. For example, a child can understand that it's good to share, but if there is an underlying fear that there's not enough, the logical commitment is not to share. It is an emotional response to the assumption of "not enough."

Most people, when asked, would conceptually favor attainment of the Triple Aim – better care for individuals, better health for populations, and lower per capita costs. However, health care in the United States is strongly counterproductive to achieving this: technology and hospitals are overused with resultant waste, access to high quality care is inconsistent at best, and unsafe care remains a problem. What are the hidden assumptions that drive Americans to hang on so dearly to a dysfunctional and unsustainable health care system?

Americans have been led to believe that good health care is a life-giving, but expensive and limited consumer product. The assumption is that health care has to be purchased. It is not a societal right. "Don't take away my Medicare" is a response to the awareness that health care must be purchased. In contrast, we generally expect education to be provided, not purchased. In the United States, people have vastly different expectations of health and education. The assumption is that this is the way it has to be.

How do you think we can alter this assumption? In other words, how can we remove this immunity to change? And how can we create a message for better health care that Americans hear clearly?

- Warren Wong, IHI Fellow

Don't Be THAT Guy: Tips From a Third-year Medical Student

noreply@blogger.com (IHI Open School) — Wed, 25 Jan 2012 13:57:00 +0000

I've heard quite a few of my classmates comment that they discovered the “real personalities” of many of their colleagues in the third year of medical school, when students begin to practice clinical medicine. There are a number of pressures that push people to be petty, selfish, and annoying – academic pressure, the pressure to impress your residents and attendings, the attempt to get more experience than the next guy.

And it’s not just medical school. As pressure mounts in nursing school, pharmacy school, or whichever health care path you choose, unfortunate new attitudes and behaviors can rise to the surface. Everyone goes through this, and I think everyone makes at least a few mistakes through the process.

At the end of my third year, I put together this list of things I learned to be a better student (and a better person!). The people that stick to these principles are respected, well-liked, and I think, generally happier. I also think they are far more professional than their counterparts.
My hope in sharing these tips is to create some dialogue about the importance of professionalism.

Each week for the next month, I’ll share 3-4 lessons I’ve learned and invite you to share similar stories and experiences of your own.

(As a disclaimer, I’m sure I’ve made ALL of these mistakes and probably still slip up. No one is perfect, but being conscious of these mistakes has really helped me grow throughout the year.)

Without further ado, here are my first three tips:

1. Roundsmanship. Don't make your classmates/residents/anyone look bad. If you know an answer to a question that the attending is asking and your intern doesn't, don't jump in with it. If your classmate is slipping up, don't blurt it out. It will itch, and you will want to say it (because it feels great to actually know the answer), but it is an important and difficult skill to develop knowing how and when to say it to show your knowledge while not throwing others under the bus. Sometimes you won’t even realize that this is what you’re doing until later, but believe me, there is one right way to do it and many wrong ways.

2. Humility. Don't look down on anyone and find the fine line of respecting yourself and making yourself to be a respectable professional without overstepping your boundaries. (In other words, don't be constantly hiding in the shadows, but know how and when to speak; it is rarely about you). You’ll encounter people of all levels of training that treat you like dirt, and it should just go to show you that it has nothing to do with your experience or rank –everyone should be treated with respect. The classic example of this going wrong is the OR – scrub techs berating medical students, for example. Just roll with it and learn from it, and remember that people react the exact same when you do it to them. I found that just by being nice and acknowledging the roles that other people play, everyone was suddenly bending over backwards to help me out.

3. Don’t Complain. Ever. You will have to do a lot that you think is a waste or possibly beneath you. Don't complain about it. Everyone hates people that complain. You will become well known for it. In fact, you won't even realize that you're complaining until you are critical of yourself about it. Don't talk about things being unfair to you, or about how someone else got to do something, got time off, etc. Remember, the people you’re complaining to have probably dealt with much worse!

- Lakshman Swamy, MD/MBA Candidate, 2013, Boonshoft School of Medicine at Wright State University