We’ve talked about a lot of essential topics over the past few days. From patient-centered care and clear communication to transparency and human error/high reliability approaches, these are all themes around which we can all agree. After all, we were selected for this conference because we were already doing things along these dimensions and thinking along these lines.

In scanning my notes for a worthy topic for my blog posts, I found “HOW??” written over 41 times. So far, we’ve discussed many of these concepts and approaches in theory and have discussed designing with the end in mind. But we haven’t really pushed too much until today on specific, practical strategies that we, in our current positions, can push forward. Tim did an excellent job of highlighting those today: developing practice scenarios on how to share bad news, identifying issues and reporting them, and encouraging feedback to reports to fight apathy.

Still, I have many unanswered hows:

  • It isn’t enough to say leadership is the answer to changing culture… how do we find appropriate senior allies and build alliances?
  • How do you identify at what level advocacy is most important/efficient/impactful?
  • How do we build coalitions around issues, given that we are often treated as indispensable and temporary as compared to long-lasting institutions that typically just wait for unsatisfied protesters to leave?
  • How do we gain access to better and more fully understand issues or get to a place where we can do something about it?
  • I do like that we are using patient safety, reducing error, and improving quality of care as rationales for this work, but how do we convince others that this is necessary, THEIR responsibility as well, and the way to do it?
  • How can we expect our largest hospitals, rated most successful based on their bottom-line, to change their ways and give up money to try this experiment with no promise of increased financial return or any return at all? The data only goes so far…
  • How do we circumvent the legal and political landscapes of healthcare that directly contradict everything we believe?

I hope we continue to understand these in our conversations, not just as idealistic themes that we can all agree to while dancing around a campfire, but in practice and context of our institutions and healthcare climate to which we will return.