Tano’s 10th Annual Telluride East Reflections

Mon Jul 28, 2014

  • Not going to lie, I was a little nervous about what and who to expect at Telluride East
  • I am very grateful for the generosity of the The Doctors Company Foundation and MedStar Health for providing the funding support necessary for the amazing upcoming 4 days
  • Thank you to Stacy for her organizational ability in facilitating travel; Aside: I got a free upgrade to first-class on my Air Canada flight from Toronto to Baltimore and all the glorious extra leg room that came with it.
  • I have been energized already before even reaching Turf Valley; my airport shuttle companions consisted for the inspirational Dr. Paul Levy and fellow participant who shared my interests in improving transitions of care and readmission outcomes for heart failure patients
  • What a wonderful welcome reception at Maria’s. Finger food especially the crab cakes with wine made for a great start. It was a pleasure to start to get to know students and faculty at Telluride East this week.

Tue Jul 29, 2014

  • What stood out for me on this very first full day of Telluride East was the Teeter Totter game
  • This is definitely an activity that I plan to take back to my institution perhaps as an experiential activity which would work well in small groups of 30 students
  • This is definitely IHI Open School chapter activity material as well
  • Strengths of my team’s efforts:
    • Immediate selection of a leader
    • Leader elicited group ideas in a systematic fashion and kept everyone on task
    • The team had an excellent briefing prior to the group task
    • Leader delegated clear roles: timer, balance coordinator, quality control officer
    • Leader empowered everyone to speak up, “Does anyone think we are unbalanced?”
      • considering how the group consists of recently acquainted individuals
      • this leadership stance increased team comfort level with each other
  • Things my group could have worked on:
    • Debrief session, but this was limited by time constraints to head back to the classroom; perhaps this is something to be brought up when the residents attempt the challenge

Other honourable mentions:

  • It was such a treat to be introduced to the diversity of experiences and backgrounds of students and faculty
  • My goal is to engage fellow participants who share my interests in heart failure outcomes and patient safety & quality improvement undergraduate medical education curriculum
  • Lewis Blackman’s story introduced me a new technical term, “premature closure” in that confirmation biases can exist when providers jump too quickly to conclusions without giving other legitimate possibilities serious consideration
  • Mindfulness is one way to mitigate the risk of that bias, simply ask, “What’s the worse this could be?”
  • Dinner at Dick’s in Baltimore’s beautiful harbor was what I call the royal treatment.

Wed Jul 30, 2014

  • The Domino game really enlightened me with new insights into how despite our best subjective beliefs that our communication is ‘flawless’; there is always room for clarification and improvement
    • for example, in making a mindful effort to describe a domino’s orientation (vertical/horizontal) and number, directionality (left, right, up, down) was often omitted
  • In complex world of healthcare, there is an even greater onus to seek clarification and repeat back information in a closed-loop fashion

o   “Little girl… I want you to do something very important, all right?”

o   “Ok.”

o   “I want you to run home, and I want you to call the ER of North Bank general hospital. 932-1000. Tell him to set up O.R.6 immediately and contact anesthesiologist Isadora Turek 472-2112 beep 12. Have him send an ambulance with a paramedic crew, light I.V D5NW-KVO, you got it?”

o   “E.R North Bank General Hospital 932-1000 setup O.R6, contact anesthesiologist Isadora Turek 472-2112 beep 12. Ambulance with paramedics and light I.V. D5NW and KVO.”

  • Furthermore, in this Domino game, my team also experienced a problem very similar to “sound-alike medications” in healthcare. I misinterpreted two and (line) a blanks as two blanks.
  • With my new insight on the challenges of communication, I now have a new attitude in circumstances where delegation of tasks to fellow team members breaks down. Instead of erupting in frustration and taking on the task myself, I resolve to know appreciate these moments as opportunities for eliciting feedback on my communication skills and engaging in new strategies to improve my communication of instructions
  • This is definitely another game to share with the IHI Open School chapter


  • Arlington Cemetery was a momentous occasion for me on this day as well. Thank you to David Mayer and Paul Levy to delivering such a beautiful ceremony!
  • I felt an ethereal surge as I learned about the history and people of America and how the supreme sacrifice made by those who rest in Arlington cemetery in the name of freedom
  • As a student in the medical profession, I now realize that I too have a significant role to play in reducing the number of patients’ lives lost due to medical error

Thurs Jul 31, 2014

  • Terry Fairbanks and his talk on human factors was such a treat
  • his talk really reinforced the message to me how one solution is not a fit all for problems
    • e.g. policies, in-services, discipline, training, vigilance, mindfulness, accountability, culture, and labelling strategies don’t work for skills based error
    • only certain errors can be mitigated with intensive education, counselling, etc.
  • his insights on the lack of progress since To Err is Human were very helpful to me
    • culture of safety: still reactive and not proactive
    • too much emphasis is placed on reducing human error of front-line providers
  • in healthcare, it’s really not about competency because there is a high standardization of competency
  • I am going seriously enjoy using the new technical term I learned from Terry, “inadvertent actuation”, meaning accidental activation of a system function (e.g. hitting the off button on a defibrillator when you met to shock)
  • A enhanced understanding of Just Culture: pledging non-punitive reporting; helps system become proactive in mitigating safety risks and harm to patients; failing to draw the line appropriate drives safety culture underground


  • The story of Michael Skolnik is a tremendous gift that I will never forget
  • I have a much stronger grasp on informed consent and shared-decision making now
  • I have always struggled to recall all the components, but not any more
  • This emotional story has inscribed the components so clearly to my mind now: risks, benefits, risk of doing nothing, opportunity for questions + need, values, and preferences of patient and family


  • What a privilege to learn about negotiations from Paul Levy
  • This was an astounding session and important area of my professional development that I would not get elsewhere in my training
  • I made some huge mistakes in my negotiations but making these mistakes in this safe environment was very instructive and educational for me
  • I now have greater confidence moving forward in future negotiations and a framework to fall back on

Fri Aug 1

  • It saddens me that this is the last day but all good things must come to an end and what a spectacular end that was
  • David delivered an inspirational session on how to move healthcare toward the level of other high reliability organizations
  • I plan to incorporate safety moments in more things that I do; this intentionality will raise the visibility of patient safety and quality in my institution for me
  • Before this session, I thought leadership safety walkarounds were a superficial formality but boy was I pleasantly corrected
  • These walkarounds by senior management help practice transition from “work as imagined” to “work as reality” [neat tie-in with Terry’s talk the day before]
  • I also plan to adopt David’s “5 complements and a criticism” when communicating and interacting with other people
  • I also loved his advice on using short sentences consisting of simple words for optimal understanding.


  • Of course, I am proud to be part of the tribute to David’s 10 years of dedication to Telluride
  • I couldn’t think of a better way for everyone to celebrate David’s achievements
  • He is an inspiration to us all
  • It goes to show that it doesn’t matter how much you know. It’s all about how much you care.