It’s morning in Telluride, and I have four pages of notes from yesterday. Arrows and question marks scattered across each page.

There is a shared conviction here that as clinicians, we are all entangled in something. That our focus on the immediate demands of our work in healthcare is consistently failing our patients. And that describing the frustrations and restrictions that keep us from providing the care we expect is not enough. We’re here to learn how leadership to change a process or two can make a real difference. And while we do have to start there, regaining control over one part of our practice is not a way out. There is a looming realization that the way out will be through.

Where do we build a culture willing to see past the services we have been well trained to deliver and keep a focus on the safety and outcomes of the people in our hospitals? When we all know that even with perfect care, there are things in life and death beyond our control.

How do we learn to use self-doubt as a way to better care every day? When that also means living with that doubt in plain view. Who could teach that? Who is in a place to show what it looks like in a student or young faculty?

Who will be the first here to acknowledge their own unsafe behavior and complicity in the tangles of our workplace?

How quickly do principles like transparency and communication become just another process to avoid in the interest of other pressing demands? When changing the perspective and culture of a community is so much more difficult to measure or understand.

I’m feeling the language I have been using to grip our projects in Atlanta slowly losing its hold. And this is the place for that: to embrace the questions that are most disorienting for a moment, to find new ways of ordering my thoughts.

Can’t wait to see what the next three days hold.