Apparently, It's Just Not That Simple!

In our previous post regarding surgical checklists, we asked the question "Can it really be that simple?" The answer is -- apparently not!

For a lively and informative discussion, see Paul Levy's blog post (including the comments) on the same topic. Barriers to change include a "broken" medical education system, a physician culture that resists "standardization," and a lack of consumer/patient input. Also, it seems that if the medical community cannot adopt such system changes (like the use of a surgical checklist) relatively soon, the likelihood of further burdensome regulation and legislation is very real. While the exchange is fascinating to read, I found it quite dizzying trying to sift through the differing perspectives and important issues raised!

I guess the appropriate question then would be -- Are we making any real headway or just continuing to spin our wheels?

Simple Checklist Can Make Surgery Safer

A Harvard School of Public Health study indicated that deaths and complications from surgery dropped by one third when operating room teams used a simple 19-step checklist. While the results of the study are certainly promising, doctors, nurses, and institutions may still be reluctant, for various reasons, to adopt the entire checklist.

As with any patient safety initiative, the authors of the study note that a strong commitment by hospital leadership is required to effect this kind of change. Check out the full text of the article in today's Boston Globe.

Can it really be this simple?

A No Cost Gift Idea with Lots of Benefits

Frank Federico, Executive Director, Strategic Partners at IHI and former MITSS Board Member, was kind enough to send along a wonderful and useful idea for holiday giving --

Medications are the most common intervention in health care. It is estimated that over half of older adults take 5 medications or more. In addition, many may be taking over-the-counter and/or herbal remedies. When these patients visit a hospital or their doctor’s office, it is difficult for them to remember all of their medications. The names of the medications do not make this task any easier.

Jennie Chin Hansen from AARP came up with a great idea. Encourage people to give their loved ones a list for Mother’s Day and Father’s Day. I am jumping ahead. Get started right now. For Christmas, why not ensure that each member of your family, immediate and extended, has an up-to date medication list. Imagine how much easier it will be for the patient to remember the medications he/she is taking, and for health care providers to review when providing care. And, promise to help keep that list up to date.

There are many formats to choose Check out http://www.macoalition.org/initiatives.shtml (Medication List) or visit the Institute for Healthcare Improvement (www.IHI.org ) for examples from participants in the 5 Million Lives Campaign (key word search: medication list).

By the way, if you or your loved ones do not take medications, how about a card that indicates that you do not take medications. In the event of an emergency, healthcare providers will not have to spend time trying to collect information about your medications.

Frank Federico
Executive Director, Strategic Partners
IHI

MITSS and CarePages

In our most recent newsletter, you may have noticed that we had an announcement about MITSS and CarePages new partnership. We have done these to offer patients, families and clinicians a free, private web page to journal and share their experiences during a time when support maybe needed. At MITSS, we have come to appreciate the amazing healing power that comes with chronicling one's story. Setting up a CarePage is also a great way to share photos, news, and updates. A CarePage can be created and used at any stage of care, and it doesn’t have an end date. So,visit www.carepages.com/mitss today and click on “Create” to start your own journal. In order to have the MITSS logo on your web page you must create through the above web page. Linda Kenney, the president of MITSS has created her own web page that chronicles her ankle replacement surgery and the subsequent infection. She will continue to update as she progresses and you can access her page by going to http://www.carepages.com/carepages/LindaKKenney .

If you know anyone that may benefit from using this tool, please pass it along.

Let us know what you think.

Arrogance and Etiquette

There are two interesting pieces in the New York Times today on physician's attitudes and communication in the workplace, and the effects on quality of care.

"Arrogant, Abusive and Disruptive - and a Doctor" discusses how the intimidating and aggressive attitudes of some doctors lead to errors in care. Staff working with aggressive physicians feel they do not have the right to speak up about problems with care and may be shouted down if they do. The article also discusses institutional responses to the problem, including communication requirements in medical schools and increasing enforcement of hospital codes of conduct.

In a related column, "The Six Habits of Highly Respectful Physicians", Michael W. Kahn, a Boston area psychiatrist, advocates for basic etiquette training for physicians.

It's nice to see these key issues of communication receiving some attention from the press.

ENGAGE WITH GRACE

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in a hospital. More than 80% of Californians say their loved ones know exactly or have a good idea of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences. But our end of life experiences are about a lot more than statistics. They are about all of us.

So the first thing we need to do is start talking. Engage with Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we are asking people to share this One Slide -- wherever and whenever they can -- at a presentation, at dinner, at their book club. Just One Slide, just five questions.Lets start a global discussion that, until now, most of us haven't had.

Here is what we are asking you: Download The One Slide and share it at any opportunity --with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together. (To learn more please go to http://www.engagewithgrace.org/)
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As a side note, the origins of this movement are chronicled in a very interesting article in today's Boston Globe. Check it out.

Fox Guarding the Chicken Coop? In the Bag?

There was a story in last Friday’s Globe about Jason Fox, a young child who died at Children’s Hospital, and the investigation surrounding his death. Just looking at the picture of this beautiful baby boy, one can’t help but feel enormous sympathy for his grieving family. The loss of a child is an unimaginable tragedy.

There are serious allegations of withheld medical records, substandard care, and so on. We won't comment on the facts of the case as there is a great deal of investigation going on by a number of parties, and it is unclear from the article exactly what happened. What is clear, however, is that a family has been devastated. We know, too, that the clinicians (the doctors, nurses, and everyone else involved in Jason's care) must also be significantly affected by Jason's death.

Sometimes events like these can have a polarizing effect, and they serve to trigger strong emotions on all sides. This is especially evidenced in the online reader comments to the story. Unfortunately, we can still see an “us against them” mentality. At MITSS, we recognize that adverse events have significant consequences for ALL involved, and we advocate for patients/families, clinicians, and healthcare institutions to work together to find common ground and work toward effective solutions. After all, we are all human, and we all have a stake in safe, quality healthcare.

One reader comment stuck out for us especially, and we felt it important to comment. Sconiico writes…

Classic example of the fox guarding the chicken coop…

- heck, the lay group formed to help such victims (Medically induced trauma support services aka MITSS) has its office rent paid by Brigham & Womens Hospital. Everyone is in the bag!...


In the interests of complete transparency, we’d like to offer the following response:

As a small non-profit, MITSS relies on the generous donations (financial and in-kind) of organizations and individuals from both in and out of healthcare. Brigham and Women's Hospital has generously provided us with an in-kind donation of office space. They, like our other donors, support our mission and share our vision. However, we remain an autonomous organization governed by our own independent Board of Directors. We would invite anyone to contact us at (617) 232-0090 or visit our website at http://www.mitss.org/ and would welcome the opportunity to clear up any other misconceptions.

Appropriately, the theme of our annual event last week was Together, Moving Forward!, and that is our sincerest hope for the upcoming year.