I can remember the last time I went to summer camp. I was still in grade school and I always looked forward to getting dropped off where the counselors would pump us full of sugar filled drinks and let us run around, playing games until we wore ourselves out. Now some 15 years later I find myself at the Telluride Sumer Camp, this time the setting is a little different. My camp peers aren’t from the same neighborhood, we come from all over the country with different professional paths and instead of us looking forward to getting dropped off and consuming sugar with some added water, we look forward to learning about patient safety from some of the industry leaders. We look forward to collaborating interprofessionally to discuss ideas around patient safety. We occasionally still play games but we never stop thinking about patient safety.
Two days into the Telluride Experience and I have learned more about communicating as part of an interprofessional team than I did working in healthcare for 4 years. We have been given so many powerful tools to work towards improving patient safety but none have made a bigger impact on me than communication. Communication both intra- and interprofessionally is what drives improvement, it is what drives transparency. In healthcare there are two options to communicate and to not communicate. As Paul Levy said today teaching us about negotiations, a specific type of communication, you want to know your BATNA (best alternative to negotiated agreement) as well as the other parties. The goal of negotiation is to determine how you can help solve the other parties problem. Bringing this back to transparency, we as healthcare professionals have built a system where the alternative of not communicating has been the best, mainly because of fear. If error disclosure truly relies on communication and optimal resolution, then we have a basic negotiation on our hands. The providers interests lie in providing the best care to their patients and the patients interests lie in trusting that they will receive that care from the provider. If all parties can communicate better I have learned we can improve proactively improve patient safety and retrospectively learn from mistakes.
In summer camp as a child we always played capture the flag. There are two “strategies”; 1. The free-for-all strategy where nobody has assigned roles as defender and attacker, and nobody coordinates with each other during the game. 2. The divide-and-conquer strategy where there are assigned defenders who have a plan for identifying threats and coordinating ways to tag them and the assigned attackers who have a plan to break the other teams defense. When you play capture the flag you can get any combination of these strategies on each side, but in healthcare I think we have had a free-for-all strategy in how we care for our patients and approach patient safety. If we think of the patient safety as the flag, it becomes obvious that we must have a system in place to successfully “win the game.” Of course as John Nance said today, “you can never eliminate errors, but you can have a system that catches the errors and stops them from becoming a problem.” So even with a perfect system you flag can get captured, all your attackers can get tagged out and errors can still happen. That is why we must have effective communication with each other interprofessionally and with our patients and their families. The only option in the negotiating error disclosure where both sides interests are met is one where errors are transparent, not only to those directly impacted, but to all parties who can learn from that error.
The Telluride Summer Camp has been an amazing experience so far, and while it is more serious than the summer camps I experienced as a grade schooler, the instructors here know we all still enjoy our sugar (thats why put candy in front of us all day) and that we all are invested by having an established mutual purpose to change the culture around patient safety. It starts with communication, and while we may not play capture the flag, these amazing instructors still find ways to engage us in games always involving communication with briefs and debriefs. I cannot wait for tomorrow where I can add more tools to my box to make a change in patient safety.