Patient Advocacy Training
As I prepare to spend a week at an out of state hospital with a friend who is going for surgery, I reflect on all I have learned about patient safety and what I can do to be sure she is safe and receiving the best quality of care. Sadly, I recognize that her fate is ultimately in the hands of the professionals who will be treating her.
There are many things I can do for her comfort, the things I teach patient’s families to do. As a professional, things I would rarely do, as a friend, things I look forward to doing.
Making sure the patient is comfortable but also, spending the time to disinfect anything that is touched. The door knobs, TV remote and side rails to the bed. These things may be cleaned before a new patient comes in but also need to be done often while the patient is there. Especially, when there is surgery and wound care. Being sure the patient understands treatment, after care has all her questions answered. I will be keeping lists, lots of lists. She will only have to think about getting well.
Each time I do this it is a learning experience. There is no school for teaching patient advocacy as much as there is for living it. When I teach it next time, I will be using experiences I have from this trip, I’m sure. Positives and negatives that will become part of my next lesson.
I am deeply honored to be part of this experience. I am a lucky person.
Tuesday, June 15, 2010
Thursday, May 27, 2010
Conversation About the Diagnosis
The Dreaded Diagnosis
I sat with the mother and her son when the doctor was about to give his diagnosis following a series of tests. The young adult child’s physical appearance and need for help with small tasks like caring for himself, cutting his food and even walking were becoming more and more apparent. A series of tests and doctor visits became a tradition for this mom and her oldest son.
She requested I attend the follow up visit with the neurologist to be an extra set of ears. I planned to take notes and help think of questions during the conversation and following it. None of us had any warning to what the doctor might say.
He listed many possibilities including Lupus and Multiple Sclerosis. I was quit taken back now picturing a person in a wheelchair or with a walker. I looked at the mothers face for an expression – there was none.
The doctor allowed for time to ask questions, take notes and while the mom had her conversation, I wrote down my questions. I didn’t want to interrupt her train of thought. I was, after all their guest. As the mom searched for words, I wondered to myself how someone is supposed to come prepared with questions after this diagnosis. One can’t prepare themselves.
As the mom searched for time and was thinking of more questions, I asked “may I ask some of my questions now?” She agreed to allow me to ask my list of questions and that gave her time to clear her mind and capture more time with the doctor. When I was done asking, she once again had her list of questions. The first sign that she was ready to resume her conversation, I stopped talking.
She needed to plan for additional tests and follow up appointments. After that there would be additional opportunities to meet with the doctor and do some more planning..
Being alone in the doctors office, especially when you might hear bad news, is never a good idea. But, knowing who the helper might be is just as important.
I sat with the mother and her son when the doctor was about to give his diagnosis following a series of tests. The young adult child’s physical appearance and need for help with small tasks like caring for himself, cutting his food and even walking were becoming more and more apparent. A series of tests and doctor visits became a tradition for this mom and her oldest son.
She requested I attend the follow up visit with the neurologist to be an extra set of ears. I planned to take notes and help think of questions during the conversation and following it. None of us had any warning to what the doctor might say.
He listed many possibilities including Lupus and Multiple Sclerosis. I was quit taken back now picturing a person in a wheelchair or with a walker. I looked at the mothers face for an expression – there was none.
The doctor allowed for time to ask questions, take notes and while the mom had her conversation, I wrote down my questions. I didn’t want to interrupt her train of thought. I was, after all their guest. As the mom searched for words, I wondered to myself how someone is supposed to come prepared with questions after this diagnosis. One can’t prepare themselves.
As the mom searched for time and was thinking of more questions, I asked “may I ask some of my questions now?” She agreed to allow me to ask my list of questions and that gave her time to clear her mind and capture more time with the doctor. When I was done asking, she once again had her list of questions. The first sign that she was ready to resume her conversation, I stopped talking.
She needed to plan for additional tests and follow up appointments. After that there would be additional opportunities to meet with the doctor and do some more planning..
Being alone in the doctors office, especially when you might hear bad news, is never a good idea. But, knowing who the helper might be is just as important.
Thursday, May 20, 2010
The Symphony and Leadership
Learning Leadership Through Music
What can a symphony orchestra teach us about leadership? Plenty, as I learned this week at the NPSF 12th Annual Congress in Orlando Florida. Over 700 attendees sat in the magnificent ballroom amongst many of the instruments to take part in this plenary session ready to kick off this meeting full of patient safety leaders.
As Conductor Roger Nierenberg led the orchestra, The Music Paradigm, through some magical sounds the audience of medical professionals, hospital administrators, patients and families sat amongst many of the players as the symphony shot music through our very soul. There to learn about patient’s safety, as a recent (just 2 days) graduate of the American Hospital Association, National Patient Safety Foundation Patient Safety Leadership Fellowship, I wondered if we were going to learn more, or just be part of this magnificent sound.
Abruptly, the music stopped. As the conductor, wearing a tuxedo with a white bow tie asked us all to choose a member of his orchestra to watch. Watch how they move, see where their eyes go and just pay attention to one. The music started again and I watched one of the violinists.
As the conductor called on audience members, they shared comments like the intensity of some members of the orchestra. As the 90 minutes like this went on, I saw how this was a powerful lesson in leadership, motivation, encouragement, observation and planning.
“Notice the skill of their hands, their movement” he told us. “but still it is one voice”. Teamwork and coordination is what makes this sound as spectacular as it was. As he encouraged members of his orchestra to play their own way, we were listening for how it sounded when each of them got caught up in his or her own “expertise” instead of participating as part of the team.
The conductor asked one musician on the trumpet to play a piece of music. The sound was only one note. “imagine studying music for thirty years” he said “and that’s what you have to do?” The audience laughed, a nervous moment as we all recognized ourselves as often feeling underutilized but still we must keep the spirit. No one here can separate from the team.
He brought some audience members on to the stage so they could hear the sound differently. They could see the whole orchestra as they were scattered throughout the audience. Another time he brought a physician up and held her hand while she conducted. Allowing him to gracefully move her arm, she explained later that she was there only to support. The best leaders are often there only be a supporting role.
Leaders are dedicated. There are many dedicated people who can stand out and lead. Then there are those who are part of the team who will do as little as possible without getting caught. He asked one of each of the instruments to play their best. The rest he suggested would get sloppy. Be lazy but look like you are working hard, he told them. As the cameras scanned the orchestra I could see some were not working as hard. The music still sounded fabulous. He knew the music sounded good. He explained that the goof offs get hidden in the crowd. “dysfunction hides while the best carry it for the others”. It just makes the hard workers work harder.
What can a symphony orchestra teach us about leadership? Plenty, as I learned this week at the NPSF 12th Annual Congress in Orlando Florida. Over 700 attendees sat in the magnificent ballroom amongst many of the instruments to take part in this plenary session ready to kick off this meeting full of patient safety leaders.
As Conductor Roger Nierenberg led the orchestra, The Music Paradigm, through some magical sounds the audience of medical professionals, hospital administrators, patients and families sat amongst many of the players as the symphony shot music through our very soul. There to learn about patient’s safety, as a recent (just 2 days) graduate of the American Hospital Association, National Patient Safety Foundation Patient Safety Leadership Fellowship, I wondered if we were going to learn more, or just be part of this magnificent sound.
Abruptly, the music stopped. As the conductor, wearing a tuxedo with a white bow tie asked us all to choose a member of his orchestra to watch. Watch how they move, see where their eyes go and just pay attention to one. The music started again and I watched one of the violinists.
As the conductor called on audience members, they shared comments like the intensity of some members of the orchestra. As the 90 minutes like this went on, I saw how this was a powerful lesson in leadership, motivation, encouragement, observation and planning.
“Notice the skill of their hands, their movement” he told us. “but still it is one voice”. Teamwork and coordination is what makes this sound as spectacular as it was. As he encouraged members of his orchestra to play their own way, we were listening for how it sounded when each of them got caught up in his or her own “expertise” instead of participating as part of the team.
The conductor asked one musician on the trumpet to play a piece of music. The sound was only one note. “imagine studying music for thirty years” he said “and that’s what you have to do?” The audience laughed, a nervous moment as we all recognized ourselves as often feeling underutilized but still we must keep the spirit. No one here can separate from the team.
He brought some audience members on to the stage so they could hear the sound differently. They could see the whole orchestra as they were scattered throughout the audience. Another time he brought a physician up and held her hand while she conducted. Allowing him to gracefully move her arm, she explained later that she was there only to support. The best leaders are often there only be a supporting role.
Leaders are dedicated. There are many dedicated people who can stand out and lead. Then there are those who are part of the team who will do as little as possible without getting caught. He asked one of each of the instruments to play their best. The rest he suggested would get sloppy. Be lazy but look like you are working hard, he told them. As the cameras scanned the orchestra I could see some were not working as hard. The music still sounded fabulous. He knew the music sounded good. He explained that the goof offs get hidden in the crowd. “dysfunction hides while the best carry it for the others”. It just makes the hard workers work harder.
Thursday, May 13, 2010
The Infectious Disease Doctor
The First Sign of Infection
I gave a presentation yesterday to a group of caregivers for mentally and intellectually challenged children and adults. The presentation was our Family Centered Patient Advocacy Training recognizing that these caregivers, who almost all were social workers, are often the support and / or advocate for the entire family. When they bring a client to the hospital, their skills are perfect for the patient’s needs but what about helping the hospital staff understand their needs and the patient’s safety?
When we discussed the part about infection, I explained that if there is any sign of infection or possible infection, that they need to insist on seeing an infectious disease doctor. Pharmacists, I explained specialize in medication and many doctors have their specialty but an infectious disease doctor specializes in infections.
A nurse in the audience, who was obviously in the business a long time commented. “Infectious disease doctors are always called in if there is an infection” she told us. She explained that it is the policy of hospitals to do that. I reminded her that if policies and procedures were always followed, I wouldn’t be there talking about errors and how to help prevent them. She continued expressing her concern that I may be poisoning the audience (my words not her) with what I was teaching.
Just earlier, a young woman asked how she can find out who the doctor in charge is when her family member was hospitalized. “I kept asking who was in charge and the group of doctors said they are all in charge working together”. I explained that this was probably the resident physicians protecting the attending physician from allowing you to get to him or her. There is an unspoken rule in healthcare that the residents should handle the problems and questions.
Thankfully, a woman with me, who is part of our Patient Safety Advisory Council, just saw last week the movie about Lewis Blackman who died because of just that reason. Lewis’ mother tried to get the attending physician to look at her son who was declining fast but instead, the new, young doctors, with less experience allowed Lewis to slip away until it was too late. I told the group about the movie and assured her that there is always someone in charge. If one person won’t take responsibility, keep going until you end up in the CEO’s office.
Back to the nurse; I let her know that some hospital staff, maybe the residents trying to protect the valuable time of the infectious disease doctor, may try to handle the problem themselves. With all good intentions, the residents may unknowingly be causing more harm by not getting the “experts” in fast. She was not satisfied and explained further, “Almost always the infectious disease doctor is called in”.
“That almost” I told her, “is why I am here”.
A woman on the other side of the room added to the conversation. Her father went in to the hospital last November for hernia repair, got an infection with all the symptoms, but it took a week to call in the infectious disease doctor. Her father died a short time later.
I rest my case.
I gave a presentation yesterday to a group of caregivers for mentally and intellectually challenged children and adults. The presentation was our Family Centered Patient Advocacy Training recognizing that these caregivers, who almost all were social workers, are often the support and / or advocate for the entire family. When they bring a client to the hospital, their skills are perfect for the patient’s needs but what about helping the hospital staff understand their needs and the patient’s safety?
When we discussed the part about infection, I explained that if there is any sign of infection or possible infection, that they need to insist on seeing an infectious disease doctor. Pharmacists, I explained specialize in medication and many doctors have their specialty but an infectious disease doctor specializes in infections.
A nurse in the audience, who was obviously in the business a long time commented. “Infectious disease doctors are always called in if there is an infection” she told us. She explained that it is the policy of hospitals to do that. I reminded her that if policies and procedures were always followed, I wouldn’t be there talking about errors and how to help prevent them. She continued expressing her concern that I may be poisoning the audience (my words not her) with what I was teaching.
Just earlier, a young woman asked how she can find out who the doctor in charge is when her family member was hospitalized. “I kept asking who was in charge and the group of doctors said they are all in charge working together”. I explained that this was probably the resident physicians protecting the attending physician from allowing you to get to him or her. There is an unspoken rule in healthcare that the residents should handle the problems and questions.
Thankfully, a woman with me, who is part of our Patient Safety Advisory Council, just saw last week the movie about Lewis Blackman who died because of just that reason. Lewis’ mother tried to get the attending physician to look at her son who was declining fast but instead, the new, young doctors, with less experience allowed Lewis to slip away until it was too late. I told the group about the movie and assured her that there is always someone in charge. If one person won’t take responsibility, keep going until you end up in the CEO’s office.
Back to the nurse; I let her know that some hospital staff, maybe the residents trying to protect the valuable time of the infectious disease doctor, may try to handle the problem themselves. With all good intentions, the residents may unknowingly be causing more harm by not getting the “experts” in fast. She was not satisfied and explained further, “Almost always the infectious disease doctor is called in”.
“That almost” I told her, “is why I am here”.
A woman on the other side of the room added to the conversation. Her father went in to the hospital last November for hernia repair, got an infection with all the symptoms, but it took a week to call in the infectious disease doctor. Her father died a short time later.
I rest my case.
Thursday, April 29, 2010
Hand Wahing and Patient Safety
Oh No, Another Hand Washing Story.......
Well, I'm pretty sure offended another medical professional. I hate when that happens. I am generally a nice person and would never purposely hurt someone’s feelings – even if I didn’t like them. But when this nurse came through like a whirlwind and took the patient’s temperature I couldn’t stop her.
When she reached for the tools to do a throat culture, I jumped into action……..
“Excuse me, you will wash your hands first right”? Saying anything else, delaying the words “wash your hands”, and she would have torn through the huge q-tip wrapper to be used for a throat culture and, as far as I’m concerned, possibly contaminate it.
“I washed before I came into the room”.
“You touched the pen and the clip board. I’m sure they weren’t washed”. I felt the tension rising and saw her body tighten as she put down the still wrapped tools.
As she walked over to use the antibacterial lotion, she told me in a tense voice “I’ve worked in the emergency room for 30 years and never got anyone sick and never got sick”.
I wanted to say she didn’t know that but realized she was defending her action of not washing - so I let it go.
“I’m sorry if I offended you” I told her.
She said she wasn’t offended. "It takes a lot to offend me".
She has been doing this a long time. Still, I could tell that she was upset.
When she completed her task, and left the room I got a “high five” from my young buddy that turned out to have a pretty bad infection which ended him up in this after hour’s clinic.
When the doctor arrived to do the complete exam, I told her “Before you even start, I am going to ask you to wash your hands before you examine him, even though I’m sure you did.” She looked at me oddly. “But” I went on “ I think I offended your nurse so I am giving you advance warning”. The doctor walked over to the sink and scrubbed up – no offense taken.
Well, I'm pretty sure offended another medical professional. I hate when that happens. I am generally a nice person and would never purposely hurt someone’s feelings – even if I didn’t like them. But when this nurse came through like a whirlwind and took the patient’s temperature I couldn’t stop her.
When she reached for the tools to do a throat culture, I jumped into action……..
“Excuse me, you will wash your hands first right”? Saying anything else, delaying the words “wash your hands”, and she would have torn through the huge q-tip wrapper to be used for a throat culture and, as far as I’m concerned, possibly contaminate it.
“I washed before I came into the room”.
“You touched the pen and the clip board. I’m sure they weren’t washed”. I felt the tension rising and saw her body tighten as she put down the still wrapped tools.
As she walked over to use the antibacterial lotion, she told me in a tense voice “I’ve worked in the emergency room for 30 years and never got anyone sick and never got sick”.
I wanted to say she didn’t know that but realized she was defending her action of not washing - so I let it go.
“I’m sorry if I offended you” I told her.
She said she wasn’t offended. "It takes a lot to offend me".
She has been doing this a long time. Still, I could tell that she was upset.
When she completed her task, and left the room I got a “high five” from my young buddy that turned out to have a pretty bad infection which ended him up in this after hour’s clinic.
When the doctor arrived to do the complete exam, I told her “Before you even start, I am going to ask you to wash your hands before you examine him, even though I’m sure you did.” She looked at me oddly. “But” I went on “ I think I offended your nurse so I am giving you advance warning”. The doctor walked over to the sink and scrubbed up – no offense taken.
Tuesday, April 20, 2010
President Obama Nominates Dr. Don Berwick
Don Berwick's Nomination
President Obama has nominated Dr. Donald Berwick president and chief executive of the Institute for Healthcare Improvement to head up Medicare and Medicaid programs. CMS, with a budget in the trillions, it is the largest U.S. healthcare agency and will undergo major changes following the healthcare system Obama recently signed into law.
Medicare and Medicaid are the federal medical programs for elderly and low income Americans and pending senates confirmation, will extend coverage to millions more Americans with Obama’s healthcare plan.
Dr. Berwick, a professor of pediatrics and health policy at Harvard, a leader in patient safety, led the nation in the 100k Lives Campaign which was aimed at giving hospitals and medical professionals the tools to improve outcomes by using proven methods that work.
There is no doubt that patient safety advocate’s, like myself are excited about this nomination. Even with just the nomination, patient safety is on the radar again. Every chance to discuss the importance of safety and quality in healthcare is important. This has started the conversations going again.
But, I do have concerns if Dr. Berwick took this position. Will he be able to keep safety and quality as the center of his work? I am afraid not. He will be taking on a big job and working for the government. If he worked for the government as a Patient Safety Officer I would say he would and could do great things for us. But he won’t. He will have many departments, a huge budget and many people to answer to. He will, in fact have to dilute his work in patient safety to cover other areas.
As I look for my own work in patient safety (yes, I still need a job), I am careful not to forfeit my values. There are diseases and people who don’t have healthcare but does that mean they don’t deserve safe care or quality care? If we ever get to a place that we are glad we have medical care but we don’t need to monitor their work or demand safe, quality care, hospitals will become an even more dangerous place to be.
I am mixed on my excitement on Dr. Berwick’s possible move. I am excited over this recognition for him but I fear if he takes this position, we may have to start looking for another Don Berwick to keep us safe.
President Obama has nominated Dr. Donald Berwick president and chief executive of the Institute for Healthcare Improvement to head up Medicare and Medicaid programs. CMS, with a budget in the trillions, it is the largest U.S. healthcare agency and will undergo major changes following the healthcare system Obama recently signed into law.
Medicare and Medicaid are the federal medical programs for elderly and low income Americans and pending senates confirmation, will extend coverage to millions more Americans with Obama’s healthcare plan.
Dr. Berwick, a professor of pediatrics and health policy at Harvard, a leader in patient safety, led the nation in the 100k Lives Campaign which was aimed at giving hospitals and medical professionals the tools to improve outcomes by using proven methods that work.
There is no doubt that patient safety advocate’s, like myself are excited about this nomination. Even with just the nomination, patient safety is on the radar again. Every chance to discuss the importance of safety and quality in healthcare is important. This has started the conversations going again.
But, I do have concerns if Dr. Berwick took this position. Will he be able to keep safety and quality as the center of his work? I am afraid not. He will be taking on a big job and working for the government. If he worked for the government as a Patient Safety Officer I would say he would and could do great things for us. But he won’t. He will have many departments, a huge budget and many people to answer to. He will, in fact have to dilute his work in patient safety to cover other areas.
As I look for my own work in patient safety (yes, I still need a job), I am careful not to forfeit my values. There are diseases and people who don’t have healthcare but does that mean they don’t deserve safe care or quality care? If we ever get to a place that we are glad we have medical care but we don’t need to monitor their work or demand safe, quality care, hospitals will become an even more dangerous place to be.
I am mixed on my excitement on Dr. Berwick’s possible move. I am excited over this recognition for him but I fear if he takes this position, we may have to start looking for another Don Berwick to keep us safe.
Saturday, April 17, 2010
Patient Centered Care
Patient Centered Care; Born With the Knowledge or Learned?
As I sat next to the elderly patient, who was being prepared for surgery, I watched doctor after doctor come in to speak with her. Alone, if not for my presence, I realized how overwhelming it is to be bombarded by questions by many different strangers, especially when she left her hearing aids at home, as she was told to do.
The surgeon, a physician’s assistant student, the registered nurse, a surgery resident, the anesthesiologist all came through with their own list of questions.
“When did you last eat?”
“What are your past surgeries?”
“What are your allergies?”
“What are your medications?”
The list went on and on. When it seemed to come to an end, the PA student lingered. She chatted with the patient about the patient’s family, travel and life. The surgery resident soon came over to listen and also engage in conversation. Though extremely tired from tests and procedures earlier that morning, the patient was happy to tell stories of her very full life.
I had the opportunity to ask the young medical staff, still in training, if they have ever heard the term Patient Centered Care. They both shook their head and replied “no”.
They asked what that was and I explained that it is treating the patient, not as a disease or illness, but as a whole person. Actually, there are many definitions, that’s the one I chose to use at the time. It is being practiced and talked about in the “patient safety world” I told them.
An article in Family Practice Management explains Patient Centered Care as “treating patients as partners, involving them in planning their health care and encouraging them to take responsibility for their own health” While an article written for Robert Wood Johnson Foundation describes it as “speaking with your patients in their preferred language—at least during critical moments”
By listening to the patient for the extra 5 minutes, these doctors were learning more about the patient’s life and lifestyle. This may be a big part of how the patient will heal after surgery and how she will be cared for. The better the outcome for the patient, the better reputation the doctor will have.
These young people in medicine are learning about the body and how it works, how it fails us and how they can, with their incredibly difficult and long hours of training, can help fix it. I credit them for their skill, their commitment to healing and helping.
I hope that when they realize that their listening skills, empathy and compassion is not just a trait they were born with but also presently a taught skill in patient safety, often not taught until much later in their career, they will continue this practice of Patient Centered Care. I am just surprised this lesson was coming from me.
As I sat next to the elderly patient, who was being prepared for surgery, I watched doctor after doctor come in to speak with her. Alone, if not for my presence, I realized how overwhelming it is to be bombarded by questions by many different strangers, especially when she left her hearing aids at home, as she was told to do.
The surgeon, a physician’s assistant student, the registered nurse, a surgery resident, the anesthesiologist all came through with their own list of questions.
“When did you last eat?”
“What are your past surgeries?”
“What are your allergies?”
“What are your medications?”
The list went on and on. When it seemed to come to an end, the PA student lingered. She chatted with the patient about the patient’s family, travel and life. The surgery resident soon came over to listen and also engage in conversation. Though extremely tired from tests and procedures earlier that morning, the patient was happy to tell stories of her very full life.
I had the opportunity to ask the young medical staff, still in training, if they have ever heard the term Patient Centered Care. They both shook their head and replied “no”.
They asked what that was and I explained that it is treating the patient, not as a disease or illness, but as a whole person. Actually, there are many definitions, that’s the one I chose to use at the time. It is being practiced and talked about in the “patient safety world” I told them.
An article in Family Practice Management explains Patient Centered Care as “treating patients as partners, involving them in planning their health care and encouraging them to take responsibility for their own health” While an article written for Robert Wood Johnson Foundation describes it as “speaking with your patients in their preferred language—at least during critical moments”
By listening to the patient for the extra 5 minutes, these doctors were learning more about the patient’s life and lifestyle. This may be a big part of how the patient will heal after surgery and how she will be cared for. The better the outcome for the patient, the better reputation the doctor will have.
These young people in medicine are learning about the body and how it works, how it fails us and how they can, with their incredibly difficult and long hours of training, can help fix it. I credit them for their skill, their commitment to healing and helping.
I hope that when they realize that their listening skills, empathy and compassion is not just a trait they were born with but also presently a taught skill in patient safety, often not taught until much later in their career, they will continue this practice of Patient Centered Care. I am just surprised this lesson was coming from me.
Wednesday, April 7, 2010
Collaborative Law
Collaborative Law and Patient Safety
Patient safety isn’t just for medical professionals anymore. My entry on March 24 was about my invitation by a medical malpractice law firm to hear Dr. Paul Gluck speak to a room full of almost all lawyers. Besides a few administrators for healthcare and a small handful of doctors, that audience of about 100 people were all lawyers.
Today I spent the day in California at a symposium organized by Kathleen Clarke, who over the years has become a good friend from long distance and a great colleague in the patient safety movement. Kathy practices Collaborative Law. Although she has always talked about it and written about it, I never really understood it. So, when I found out I could come out to California and support her work as well as learn about collaborative law, I counted my pennies and hopped on a plane.
Dr. Mark Graber Chief of Medicine of the LI VA Hospital was a speaker. He started his presentation talking about the day we met 10 years ago at a National Patient Safety Foundation conference in Missouri. He said that it was our conversation there that got him interested in patient safety. I didn’t realize that. He told the audience of about 80 people, mostly lawyers, that he said to me after I spoke at that conference, that I must have been glad that the lawsuit about my son was over. I said it was never over. I then told him it wasn’t about the money and he said he never knew that that was how patients and families felt. But, in most cases it’s never about the money. I didn’t need the money. No more birthdays or no college for my son who no longer was alive. What I needed was answers, acknowledgment and possibly a conversation with the doctor who, just days earlier, I trusted with my son’s life. I needed to feel trust again.
Dr. Graber talked about disclosure and how important it is to talk to patients and / or their family immediately following a bad outcome. Organizations practice open disclosure in many states. It makes them obligated to investigate the problem he told us. Only about 5% of hospitals actually practice disclosure.
Actor James Woods was live with his lawyer on video feed to talk about the settlement of his case against Kent County Hospital. The CEO of Kent, Sandy Coletta opened the discussion telling the story of how Michael Woods died in the Rhode Island Hospital that she herself said was in really bad shape when she took over the job as CEO following the death of Michael Woods. A sincere apology, not taking the advice of the hospital lawyers and instead, showing genuine empathy and remorse for the untimely death of the 49 year old father of two, is what was needed by James Woods to end this long drawn out lawsuit. That, and the development of the Michael J. Woods Institute at Kent teaching patient centeredness.
I wiped my eyes more than once while listening to Sandy Coletta tell her story. Partly jealousy that this family had acknowledgment from the hospital while others never get that. I also felt relief that we have moved so far ahead that this hospital administrator actually was open and honest I also realized that we treat these people like heroes because they are being honest about what happened to a patient.
Any way you look at it, collaborative law needs to be our future. Put in the room all interested parties; lawyers, doctors, patients, families and have a conversation. Put all interests up front, gather all the information, develop the options and negotiate a resolution. Everyone is needed at this table and needs to be a “collaboration”. How have we forgotten this part after all these years.
Patient safety isn’t just for medical professionals anymore. My entry on March 24 was about my invitation by a medical malpractice law firm to hear Dr. Paul Gluck speak to a room full of almost all lawyers. Besides a few administrators for healthcare and a small handful of doctors, that audience of about 100 people were all lawyers.
Today I spent the day in California at a symposium organized by Kathleen Clarke, who over the years has become a good friend from long distance and a great colleague in the patient safety movement. Kathy practices Collaborative Law. Although she has always talked about it and written about it, I never really understood it. So, when I found out I could come out to California and support her work as well as learn about collaborative law, I counted my pennies and hopped on a plane.
Dr. Mark Graber Chief of Medicine of the LI VA Hospital was a speaker. He started his presentation talking about the day we met 10 years ago at a National Patient Safety Foundation conference in Missouri. He said that it was our conversation there that got him interested in patient safety. I didn’t realize that. He told the audience of about 80 people, mostly lawyers, that he said to me after I spoke at that conference, that I must have been glad that the lawsuit about my son was over. I said it was never over. I then told him it wasn’t about the money and he said he never knew that that was how patients and families felt. But, in most cases it’s never about the money. I didn’t need the money. No more birthdays or no college for my son who no longer was alive. What I needed was answers, acknowledgment and possibly a conversation with the doctor who, just days earlier, I trusted with my son’s life. I needed to feel trust again.
Dr. Graber talked about disclosure and how important it is to talk to patients and / or their family immediately following a bad outcome. Organizations practice open disclosure in many states. It makes them obligated to investigate the problem he told us. Only about 5% of hospitals actually practice disclosure.
Actor James Woods was live with his lawyer on video feed to talk about the settlement of his case against Kent County Hospital. The CEO of Kent, Sandy Coletta opened the discussion telling the story of how Michael Woods died in the Rhode Island Hospital that she herself said was in really bad shape when she took over the job as CEO following the death of Michael Woods. A sincere apology, not taking the advice of the hospital lawyers and instead, showing genuine empathy and remorse for the untimely death of the 49 year old father of two, is what was needed by James Woods to end this long drawn out lawsuit. That, and the development of the Michael J. Woods Institute at Kent teaching patient centeredness.
I wiped my eyes more than once while listening to Sandy Coletta tell her story. Partly jealousy that this family had acknowledgment from the hospital while others never get that. I also felt relief that we have moved so far ahead that this hospital administrator actually was open and honest I also realized that we treat these people like heroes because they are being honest about what happened to a patient.
Any way you look at it, collaborative law needs to be our future. Put in the room all interested parties; lawyers, doctors, patients, families and have a conversation. Put all interests up front, gather all the information, develop the options and negotiate a resolution. Everyone is needed at this table and needs to be a “collaboration”. How have we forgotten this part after all these years.
Friday, March 26, 2010
Patient Safety?
Patient Safety For All
How do you tell a mom whose child is strong and violent that she must also remind the healthcare providers to wash their hands? How do you tell a mom whose child is scared of loud noises, bright lights and is nonverbal that she must also make sure her child is cared for safely in the hospital? Now tell a parent who can’t control their child’s outbursts that they will have to sit in a waiting room in a doctor’s office with other “normal” children and control her own. These are some of the conversations I had this week with the people of local community organizations learning about patient safety.
Many people are avoiding the healthcare system because of the problems they see going into it.
How do you tell a young woman who doesn’t speak English that she can ask for a second opinion when she can’t even explain what the problem is to the doctor? A woman shares the story of how, when she first came to this country and didn’t speak English, she struggled with the nurses aid in the hospital who made her get up, even though she was in terrible pain. The nurse’s aid didn’t understand how much pain she was in and the wound from her abdominal surgery opened causing severe problems to the patient.
A woman, who doesn’t speak English, tells me, through a translator that she had a lot of pain. She could only get an appointment for three months later. She had a urinary tract infection and was pregnant. The infection spread and they took the baby. She said she felt the baby was alive but no one understood her. Through her sobs she told the translator that she couldn’t make herself understood the urgency of her pain. She still has kidney problems from neglecting the infection.
These are just some of the stories I am hearing about our medical system as it relates to patient’s safety. Focus group after focus group I am learning more than I can possibly teach these people who only want what we all want, safe, quality healthcare. Story after story I am informed of how communication or lack of training keeps patients and providers from focusing on the patient’s individual needs.
Whether disabled, lack of language skills or any number of reasons patients don’t seek care, we need to know that we, as a nation must focus in on the individual needs of the patients before our whole system collapses.
We all want and need affordable healthcare but if the words safety, and quality aren’t part of the dialogue, the costs will rise worse than we can ever imagine and everyone will suffer.
How do you tell a mom whose child is strong and violent that she must also remind the healthcare providers to wash their hands? How do you tell a mom whose child is scared of loud noises, bright lights and is nonverbal that she must also make sure her child is cared for safely in the hospital? Now tell a parent who can’t control their child’s outbursts that they will have to sit in a waiting room in a doctor’s office with other “normal” children and control her own. These are some of the conversations I had this week with the people of local community organizations learning about patient safety.
Many people are avoiding the healthcare system because of the problems they see going into it.
How do you tell a young woman who doesn’t speak English that she can ask for a second opinion when she can’t even explain what the problem is to the doctor? A woman shares the story of how, when she first came to this country and didn’t speak English, she struggled with the nurses aid in the hospital who made her get up, even though she was in terrible pain. The nurse’s aid didn’t understand how much pain she was in and the wound from her abdominal surgery opened causing severe problems to the patient.
A woman, who doesn’t speak English, tells me, through a translator that she had a lot of pain. She could only get an appointment for three months later. She had a urinary tract infection and was pregnant. The infection spread and they took the baby. She said she felt the baby was alive but no one understood her. Through her sobs she told the translator that she couldn’t make herself understood the urgency of her pain. She still has kidney problems from neglecting the infection.
These are just some of the stories I am hearing about our medical system as it relates to patient’s safety. Focus group after focus group I am learning more than I can possibly teach these people who only want what we all want, safe, quality healthcare. Story after story I am informed of how communication or lack of training keeps patients and providers from focusing on the patient’s individual needs.
Whether disabled, lack of language skills or any number of reasons patients don’t seek care, we need to know that we, as a nation must focus in on the individual needs of the patients before our whole system collapses.
We all want and need affordable healthcare but if the words safety, and quality aren’t part of the dialogue, the costs will rise worse than we can ever imagine and everyone will suffer.
Wednesday, March 24, 2010
I was invited by Steven Pegalis Esq. of Pegalis and Erickson to attend a lecture at NY Law School in Manhattan hosted by his law firm. More and more medical malpractice firms are showing concern for patient's safety. The speaker, Dr. Paul Gluck is a founding member of the National Patient Safety Foundation and an OB/GYN from Florida. Hardly the person I would expect to see on the agenda as a guest of a medical malpractice law firm. Although I don’t always agree with Dr. Gluck he has always been respectful, friendly, warm and welcoming to me as we both are on the board of the National Patient Safety Foundation and I thought it would be nice to surprise him.
Expecting this to be an interesting evening, I invited Steve Goodstein, a registered nurse, professional mediator and a board member of PULSE to join me. Assuming there would be conversation around law suits and blame, I was hoping we could see what doors would be opening for alternatives to litigation through this program.
I was greeted warmly by Dr. Gluck and was genuinely glad immediately that I made the trip to see him. The room was filled with attorneys with a scattering of medical professionals, judges and hospital executives.
The information Dr. Gluck shared, how errors happen, the history of patient safety and studies of how no one is usually at fault seemed to be better suited for other medical professionals. I’m not sure this was an audience who wanted to steer away from lawsuits.
I was told ahead of time that I would be called upon to speak following the presentation so I was a bit concerned when I was called upon to introduce myself and then told that the opinions would come from the “professionals” in the audience. Suddenly, with this new audience, my opinion wasn’t important. But, when the conversation following the presentation went to the lawyers vs. the doctors, I couldn’t be stifled any longer.
No one was asking the patient if they wanted to sue, no one is giving them (us) a choice. I explained that when my son died I had no choices, sue or don’t sue was it. Lawyers didn’t want to take the case of a little boy who died from a tonsillectomy and they still don’t. There is no financial compensation to cover the cost of a lawsuit. So, no one talks about it, no one learns and no changes are made to improve future care.
When a lawyer greeted me later and said he would have taken my case, I snapped back, as respectfully as possible, “what if I didn’t want to sue?” I didn’t need the money. There were no more birthdays or holidays. What I needed, and so many patients and families need is answers.
First, I explained, we need to know what the term “I want to make sure it never happens again” means. To patients and families it can mean making changes. To others it means hitting them in their pocketbook.
Either way, it needs to be the choices the patient and / or family makes, not society looking in at half the story. Maybe some doors will open - even in New York.
Expecting this to be an interesting evening, I invited Steve Goodstein, a registered nurse, professional mediator and a board member of PULSE to join me. Assuming there would be conversation around law suits and blame, I was hoping we could see what doors would be opening for alternatives to litigation through this program.
I was greeted warmly by Dr. Gluck and was genuinely glad immediately that I made the trip to see him. The room was filled with attorneys with a scattering of medical professionals, judges and hospital executives.
The information Dr. Gluck shared, how errors happen, the history of patient safety and studies of how no one is usually at fault seemed to be better suited for other medical professionals. I’m not sure this was an audience who wanted to steer away from lawsuits.
I was told ahead of time that I would be called upon to speak following the presentation so I was a bit concerned when I was called upon to introduce myself and then told that the opinions would come from the “professionals” in the audience. Suddenly, with this new audience, my opinion wasn’t important. But, when the conversation following the presentation went to the lawyers vs. the doctors, I couldn’t be stifled any longer.
No one was asking the patient if they wanted to sue, no one is giving them (us) a choice. I explained that when my son died I had no choices, sue or don’t sue was it. Lawyers didn’t want to take the case of a little boy who died from a tonsillectomy and they still don’t. There is no financial compensation to cover the cost of a lawsuit. So, no one talks about it, no one learns and no changes are made to improve future care.
When a lawyer greeted me later and said he would have taken my case, I snapped back, as respectfully as possible, “what if I didn’t want to sue?” I didn’t need the money. There were no more birthdays or holidays. What I needed, and so many patients and families need is answers.
First, I explained, we need to know what the term “I want to make sure it never happens again” means. To patients and families it can mean making changes. To others it means hitting them in their pocketbook.
Either way, it needs to be the choices the patient and / or family makes, not society looking in at half the story. Maybe some doors will open - even in New York.
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