Post Telluride Roundtable Reflections: Process Improvement-Real-Time Results by Julie Morrison #TPSER8

Upon returning to UT medical center from Telluride, I was filled with motivation and a new sense of purpose. Something had changed in me out there. I used to be more of a ‘thinker’ (forever told I would be good as an internist) and not so much of a “doer.” I struggled with this during my third year of medical school because I saw so many areas of improvement but often sat near the sidelines gathering information rather than jumping in and stimulating change. At Telluride I was so encouraged by the perspective of the senior faculty; the fact that they found similar aspects of the clinical world frustrating or inefficient and were looking for a collaborative team to face these challenges reinforced my perspective and encouraged me to take action. Telluride gave me a better vision of the organization and hierarchy of a hospital as well as the tools to accept such a call to action. I realize now that a vision cannot be translated into change without the support of various members of the care team and hospital administration. A good idea can fester forever within someone without ever seeing the light of day or be implemented without the correct support and flop because of a lack of motivation or proper support.

On the third day of the conference, we broke into small groups and discussed real life changes we would like to see in our hospitals. My team came up with a “bedside communication white board” that would list the care team (nurse, attending, residents, medical students, PT, OT, RT etc), their expected procedures and daily care plan. It would also serve as a place for the patient or their family to list questions and concerns. We envisioned that this tool would empower the patient to engage in their healthcare by making them informed participants and serve as a stop-gap from wrong procedures. When I returned to campus I was excited to stimulate change but tempered this excitement in order to stimulate the proper support for my ideas, as I didn’t want to be run over by resistance. I scheduled a meeting with the CMO of our hospital system and settled into my clinical rotation.

The first day I spied portrait covered papers in several patient rooms before a nurse manager came by and left a stack on the cart we were using for rounds. I immediately picked them up and found a paper form of our “bedside communication white board!” I almost couldn’t contain my excitement. I followed the nurse down the hall and asked her about this innocuous sheet she left. We engaged in a great conversation and she invited me to sit in on the quality improvement meetings that she attends. I took over the responsibility of filling out these sheets for each patient as we rounded for the rest of the week. I did so silently at first. And then I started getting questions from the other members of our team. In the past I would have been uncomfortable explaining my actions, I would have been concerned that it wasn’t a big enough idea, or that they would find it frivolous or frustrating. But not now; because of Telluride and the perspective of the senior faculty I spoke with confidence and clarity of vision. I knew that this tool would make a difference and I educated the other students, residents and even our attending so that they could see its value as well. By the end of the week I was receiving really good feedback from the patients having them say things like “oh I was waiting for this” or “this is so helpful, thank you” and even had the senior resident thank me for utilizing the sheets. I think it is going to stick, and I think we will have it implemented across the hospital by the winter!