Day 1: Lewis, Domino, and Sponge

Recap of what I applied to my learning and follow-up questions:


  • “Educate the young, regulate the old”
    • Witty and sensible to an extent, but does it work when the young have to work under the shadow of the old? Medicine is a top-down hierarchy, and bottom-up change is not only insurmountable but also often not sustainable.
    • At the same time, becoming a positive deviant has its own value that cannot be diminished. I just wonder whether there is concurrent top-down efforts.
  • What can I do with Institute for Healthcare Improvement (IHI)? I would like to learn more.

Movie: Lewis Blackman (patient) and Helen Haskell (mother)

  • The patients and families need to know that night times and weekends the level of care is not the same. It is recommended to have a caretaker at bedside, and why not admit the systemic weakness and invite them to be a part of the patient safety team.
  • Task-oriented vs goal-oriented culture
    • Elevated BP and advancing diet without considering pt intake:
      • focused on getting the task done, but not about what they are trying to accomplish
      • How can we get everyone involved to be goal-oriented vs task oriented?
  • Confirmation bias: filtering out findings contradictory to the conclusion
    • What measures are there to catch it?
  • Physicians value confidence over uncertainty. Dislike to display uncertainty.
    • Residents’ priorities for relationship with attendings over that with patients
    • How do you overcome this culture?
  • There was no system in place to do handle human errors and aftermath
    • Role of patient liaison/advocate needed. Remember that patient family sees the whole thing whereas we only see snippets.
    • Weekend/holiday coverage: how do other high-risk industries handle it?

Blogging and Reflection:

  • I am a blog trotter. I have been following the blog at for over two years.
  • In preparation for the Telluride Experience, I read Goal Play! by Paul Levy.
  • This morning, I followed my routine of scanning the headlines of blogs I follow and saw a familiar picture of our group at Telluride. It was only then that I realized that the two dots connect to the same person.

Domino game

  • Rushing is dangerous
  • Open communication, standardization, and assuming for the worst can overcome having to work with different team members all the time, which lacks the desired level of familiarity and trust.

Case of liver transplant and one sponge missing

    • You can’t tell them to count 4 times. You have to approach it differently and put process in place that eliminates human element.
      • Look for risk factors in own environment: e.g. nursing shift change, obesity, etc.
      • If any of the risk factor is present, must get pre-op and post-op x-ray by radiologist.

QI/Safety project ideas

  • EMR research: putting up the patient picture on order pop-up page to decrease the rate of wrong orders.

Mindful engagement:

  • Why am I here? I want to become a positive deviant, but I don’t know how. Over the years in med school I have learned tools and stories, but I have not seen the vision of sustainable positive cultural change that puts all these great things in one place.
  • What do I want to take with me? Feeling rejuvenated, empowered to start a change. I do not want just another toolbox, but I want to catch the vision.