By David Mayer MD

First Posted at Educate the Young on 3/11/2013

David Mayer MD, Vice President of Quality and Safety for MedStar Health

David Mayer MD, Vice President of Quality and Safety for MedStar Health

As someone who has run a number of marathons in my life, I have come to appreciate the term hitting the wall. No matter how well a runner trains, or how good we feel during the run, “the wall” can still stop us in our tracks around the 18-20 mile marker. Speaking from experience, when a marathoner hits the wall there is a choice to be made. There is an overpowering urge to walk off the course and go home–it is a miserable feeling. But we continue, walking at times if we need to because we are so close to the finish line and reaching the personal goal we set.

Many of us who spend our time in quality and safety can also hit a similar wall at times – I know I do. There are times when it seems like we take one step forward and two steps back. We get frustrated when change comes slowly, or certain physicians push back, wanting to keep the status quo even when the evidence shows they need to change the way they do things because it is harming patients. People tell us changing culture takes time and we need to be patient, but it is not always easy to accept–especially when we watch patient harm continue.

Image Thanks to http://www.chicagomarathon.com

Image Thanks to http://www.chicagomarathon.com

When I hit that quality and safety wall, I turn to our next generation of caregivers – residents and students. They are my 5 hour energy drink, my Red Bull, my Jolt Cola. This happened to me recently…but two next generation, resident-driven quality and safety successes pulled me out of my “we will never change healthcare” funk, and re-energized me as it always does:

  1. First, seeing that the John Eisenberg Patient Safety and Quality Awards recognized the great work being done by a group of residents at the New York-Presbyterian Hospital/Weill Cornell Medical Center for their implementation of a Housestaff Quality Council (HQC). I first heard about this wonderful program when it was presented at an AAMC Integrating Quality meeting in Chicago a few years ago. Driven by a small group of committed residents who wanted to improve the quality of care being provided for their patients, they didn’t sit back waiting for their faculty to lead – they stepped up and led the work themselves. Because of their determined efforts even in the face of long duty hours, the HQC contributed to a number of hospital-wide sustainable care improvements for their patients. More information can be found in this Jt Comm J Qual Patient Saf article.

    via Joint Commission

    via Joint Commission

  2. Second, I was able to spend time with a number of friends from the Committee of Interns and Residents (CIR) a week ago in New York. Similar to the work being done by the HQC at New York Presbyterian Hospital, quality and safety leaders Hilary Corrigan, Justin Wood, Sandy Shea and Michael Kantrowitz shared some of the great quality and safety work CIR residents are doing across their system. CIR made a major commitment to resident quality and safety education a few years ago. Part of that commitment is the funding of ten resident leaders each year to attend the Telluride Patient Safety Resident Summer Camp. Many of you have read their reflections on the Telluride experience and about the work they are doing at their hospitals in this blog as well as Paul Levy’s blog–work that originated in Telluride. It is all resident driven work that is helping improve the quality of care being provided to their patients while saving lives.

Sometimes you don’t really need to “Educate the Young” – we just need to mentor them a little, provide support when they ask for it and then get out of their way. If the academic medical center culture is supportive (and not toxic), resident physicians can help us make significant improvements to patient care. They do this work because they know it is important and much needed. Without 20-30 years of growing accustomed to a certain way of doing things, and the lifestyle that comes with it, they don’t question what needs to change. They just roll up their sleeves and change it.