Reflections from Day 1 of AELPS17 (Napa)

Anyone reading this, follow me on twitter @cjeffrun27 as I’m trying to post a bunch! You’ll also see posts from the SMACC conference in Berlin #dasSMACC and HPRCT conference in Toronto last month #HPRCT.
Wow, what an incredible group of people in this space. I’m continually stepping back and recognizing how lucky I truly am to be here. And I’m so grateful to Giovanna (2nd yr psych resident at USC) for encouraging the medical students – those with the freshest eyes in the room – to share their thoughts. Those of us with years of experience have undoubtedly developed some beliefs and biases over time, which aren’t necessarily bad (in fact, it’s called experience for a reason!), but… what I wouldn’t give for a beginner’s mind on many things 🙂

I took pages and pages of notes from today’s talks and games. So many ideas, reflections, take-aways. I’d never seen the Lewis Blackman story. Like Elaine Bromiley’s tragic death, and Josie King’s tragic death, Lewis’ story brings light to a constellation of ‘symptoms’: poor communication, hierarchies, commander mentality, systems designed for its own benefits, confirmation bias, premature closure, fixation, and the list goes on. How many of these stories do we (the healthcare profession) need to be told before we are moved to institute a massive culture change?

I almost just wrote how lucky I am to have worked at institutions which have not experienced a tragedy like Lewis’, Elaine’s, or Josie’s. But then I thought – how would I know if we did? With so many medical malpractice suits filed and deemed “futile” (no payouts to the plaintiff), we would only hear about the ones that made it to the news. And what if the victim wasn’t an all-star athlete who lit up everyone’s life? Would the news run with the story to change hearts and minds?

A few one-off thoughts:
-we need to be careful of our word choice. we have the power to influence others’ level of concern by (non)verbal cues, others’ bias by labelling a patient/family/trainee, etc
-we need to be aware that experience facilitates competence. staff working in oncology might miss something important about a fresh post-op patient. junior providers are not necessarily incompetent, but they don’t know what they don’t know.
at the same time, we can’t belittle these people when they make a error (of commission or omission), because we come to work with the best of intentions.
-at the end of the day, care is delivered 1:1. i love this, because it reminds us to see a person in front of us, not a patient, not an appendectomy. our attention is our greatest gift to give; by its very nature it validates another human’s existence and honors their story as having meaning. we have the right to expect that attention from others in our lives, being mindful that everyone is doing they best they can given their circumstances.
-errors of omission really make me think. how can we illuminate items at great risk for being omitted? thinking re: handoff of care. i think the ‘next steps’ part of a handoff tool is a good opportunity to say, “do you see what i see?” and validate&verify the patients’ needs.
-re: a wrong-count situation in surgery, this is a perfect test of work as imagined (WAI) vs. work as done (WAD). not-passing the closing sutures until a correct initial closing count is obtained is a neat idea for a forcing function. with or without that protocol though, if the count is wrong, eventually the surgeons still have to close the surgical site. what to do? we imagine that counting sharps and soft items is going to protect the patient, but at best it will illuminate the possibility of a problem, perhaps. and then we cross our fingers and go on with the next case. i want to think more about this.
-giving a giraffe toy as a “stick your neck out” award to staff is brilliant. i’m definitely going to introduce this at my hospital!
-however, is it not a fundamental attribution error to reward staff for sticking their necks out when it resulted in a good outcome? what if a nurse stuck his/her neck out, were overruled, but eventually their concerns were validated by a bad outcome? we can’t be seen celebrating in the face of a bad outcome, but the nurse’s actions were the same as in the good outcome. what to do?

Looking forward to Day 2! Many thanks to everyone who sponsors and organizes this workshop/conference/intensive/academy.