Day 3: Hike, Michael, HRO, and Negotiation 2

Brainstorming my own safety/QI project:

  • Curriculum
    • Introduce safety moment to weekly grand rounds.
    • OSCE module on disclosing medical errors
  • Start Institute for Healthcare Improvement (IHI) open chapter at home institution

Morning hike to the waterfall


  • Life isn’t about waiting for the storm to pass. It’s about learning to dance in the rain. – Anonymous

Movie: Michael Skolnik

  • Nothing about me without me
  • University of Utah hospital took it upon themselves to share reviews/comments about physicians by patients and publish star rating.
    • What a brave move to promote transparency of care for patients!
    • The way it happened according to my rudimentary understanding
      • Problem: doctors in hospital do not receive feedback about their care
      • Solution: allow patients to write reviews about their care experiences.
      • 3 Stages of implementation
        • First, the comments and star rating was only shared with the particular physician
        • Second, the visibility of the rating expanded to respective department. This allowed physicians to seek out those with higher rating, and promote peer learning
        • Third, the star rating and specific comments were made public on their very own website.
      • Aftermath:
        • In return for making those comments public, physicians were allowed to essentially censor the posted comments, giving them the full control.
        • However, after some time they realized that they no longer felt the need to review and censor comments.
          • Negative comments, whether deleted or not, provided critical learning points for improvement and change.
          • “Difficult patients” who would not be pleased no matter what they did were only a handful. After having obtained so many positive reviews, impact by such patients was minimal.
    • My home institution is considering adopting this practice, and I look forward to its effect on the transparency of care.

MedStar Health’s High Reliability Journey by David Mayer

  • This was exactly what I was looking for and I wish we had more of this!
  • I find that humanity is the common thread in high reliability tools. Reminding people about the ultimate reason of healthcare is what makes effective safety moments, rounds, huddles, Good catch Mondays, and so on. These tools reach the value held dear and deep by healthcare workers, love for fellow men and women.
  • How we respond at the most difficult times defines who we are
  • Root cause analyses are most often done incorrectly: oh my. I have attended many QI meetings in a hospital, and I cannot remember if I ever had one without hearing “re-education” or “policy change.”

Negotiation Round 2  by Paul Levy

  • Don’t negotiate against yourself
  • Negotiation is not only about getting more of them, but also offering more of me.
  • Money comes in different buckets
  • Trading on differences: consider what is high value to one party and low cost to the other party
  • Appeal to the underlying interests of the other party