With the Medical Students

A few nights ago I spent the evening with 27 Post-Baccalaureate students from Johns Hopkins University. I had been asked by the director to join the students for dinner and then speak to them for an hour or so. I was to be joined by Rick Kidwell, who had been the lead attorney at Hopkins when Josie died and was now at UPMC, University of Pittsburgh Medical Center.

The Hopkins Post-Baccalaureate program is a year long program that prepares students for medical school. Hundreds of students from all over the country apply to this program, with only 42 acceptances for 27 positions. These students have earned their undergraduate degrees with an average of a 3.7 or above. More impressive than their high academic standings are the things they have done after college on the humanitarian level. Each one had an amazing story to tell. Some had spent time teaching in impoverished areas overseas. One spent a year with Dr. Paul Farmer, who is known throughout the world for his work and dedication in the poor towns of Haiti. Another student worked with the world renowned Dr. Benjamin Carson, a Hopkins pediatric neurosurgeon. One student worked as a teacher in the Mississippi Delta and then went on to teach children with AIDS in Africa. These life experiences shaped their young minds and led them to discover what it was that they truly wanted to become. Doctors. It is this dedication to public service, this humility and this selflessness that set these students apart from all others and landed them in the prestigious Hopkins Post-Bac program.

I always find it invigorating to be with medical students. They are so young and eager with bright minds that can be shaped. I can see the future in their eyes, and as I sat at my computer the day before and read all that they had accomplished and all that they had contributed to society and at such a young age, I knew that it was going to be a memorable evening.

Rick and I sat on folding chairs on stage and began our presentation. I started by sharing Josie’s story. I broke it down as if it were a case study and watched them as they began to put the pieces together, realizing that a little girl had died at one of the best hospitals in the world, not because of a misdiagnosis or a medication error. It was something far simpler: communicaton, or rather, a lack of communication. I continued to talk about the importance of disclosure, and what it means to a family to be told the truth, to have questions answered and to know that the problem will be fixed. Rick shared the hospital’s side of the story. He talked about how doctors and nurses are affected by medical errors. He told the students that when they become doctors, and if they make a mistake always to tell the family. “Don’t worry about a potential lawsuit,” he said. “That is the job of the risk manager.” The discussion led to error reporting systems, family involved root-cause analysis and more. They asked interesting questions, and they shared their thoughts.

Soon these students will be in medical school. They will be inundated with Biology, Chemistry, Physiology. The importance of communication might not be woven into their curriculum. This was my chance to sink a story into their hearts and hope that when they become doctors that they will remember how to listen and communicate. These students are going places. These are the ones who are going to win Nobel prizes and find cures for our diseases. They are going to save lives. I am sure of it. I was honored to be with them I wish them all luck, and I thank them for listening.

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It All Comes Back to Communication

In the nearly five years that I have been participating in this patient safety movement, I have met thousands of wonderful healthcare providers. I have visited hospitals all over the country. I have sat and listened to dozens of patient safety conferences and grand rounds. I have learned big words like nosocomial infections.

Through it all I have told Josie’s story and every step of the way I have tried my best to inspire caregivers to incorporate patient safety best practices into their everyday experience on the job. I have looked and listened, and have been amazed at all of the good I see, while also being confused as to why things can’t happen faster and why 98,000 people still continue to die from medical errors every year.

The thing that really continues to amaze me is the communication issue. Josie died because people didn’t listen. They didn’t listen to me, and they didn’t listen to each other. I can’t tell you how many stories I have on my computer from families who have been affected by medical errors, and there always seems to be a common thread, “They didn’t listen.”

Correct me if I’m wrong. Doesn’t the Joint Commission report that over 60% of all sentinel events are due to a breakdown in communication? I am not a doctor or a nurse. I am not at the bedside, and I am not an expert in the field of patient safety; however it seems to me that if people communicated better we’d all be safer. I believe in high tech solutions. It is where we are heading, but wouldn’t we get more bang for our buck if we communicated better?

I was in Pennsylvania a few months ago at a wonderful hospital by the name Abington Memorial. I was presenting at their Grand Rounds. After the presentation, I was lucky enough to join them on their Patient Safety rounds. The team consisted of two nurses, a doctor, and a board member. I was struck by two things:

The first was the presence of the board member. There is a lot of talk these days about getting board members involved, especially when it comes to safety and quality. It was so great to see first hand a hospital that was doing just that.

The second thing that struck me- Every unit we went to, the patient safety officer would ask the nursing team on the floor a question:

“If you could have anything you wanted on your floor to keep patients safe what would it be?”

Each floor had variations on the same response:

“I wish we could get into the doctors’ heads.”
“I wish we were more like a team.”
“I wish we communicated better.”

That is what they wanted. They did not ask for fancy equipment or the latest in technology. They wanted to understand what the doctors were thinking. They wanted better communication between the nurses and the doctors. The thing that amazes me even more is that I hear this everywhere I go. Communication- and it is not just between the doctors and the nurses. It is between the patients, their families and those who are caring for them.

It seems so simple, but I am learning that changing behavior is not an easy thing to do. I don’t know what it takes, maybe time, maybe another generation, hopefully not more deaths.

I will tell you one thing. The board member that day heard that message loud and clear and I bet she shared what she learned with her fellow board members, at least I hope she did.

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Introducing the Care Journal

Have you ever been a patient or had a loved one who was a patient in a hospital? Did you feel overwhelmed and scared? Was a lot of information thrown at you? I am guessing that your answers to the above might be yes. I know that I felt that way when Josie was in the hospital. I was in a new environment and I was scared out of my mind.

One thing I did that really helped was to write. I kept a journal. I kept track of everything from my parking space number to the names of the nurses on duty. I documented the medications she received and I wrote down questions and concerns I had for the doctor. Writing gave me a sense of control in a situation in which I had none. It helped me stay organized and on top of what was going on each day.

In my conversations with other patients and families over the years I have learned that they too often found comfort in writing. I decided that the Josie King Foundation needed to offer a journal that would help patients and their families manage their hospital stays. Each page would represent a day of health care, whether the patient is in the hospital or after they have been discharged. We call it the Care Journal.

It was time to take the Care Journal out for a spin in the healthcare industry. What I learned shocked me. I was having dinner with a wonderful group of nurses. I excitedly unveiled the Care Journal campaign and as I waited for them to tell me how great of an idea it was. All I saw were blank faces.

They told me what it felt like to them and their colleagues when they see a patient or family member writing. It makes them feel threatened. Healthcare providers think that patients are creating documentation so that they can later sue. However, they all agreed that when they or their loved one was in the hospital that, absolutely, the one thing they did was to write. I asked other healthcare providers if they felt threatened in the same way, and the majority of them did.

I had no idea that nurses and doctors felt this way. The last thing I wanted to do was to further alienate the nurses from the patients, but I felt so strongly that patients should have this tool. My nurse friends and I came up with the perfect solution. The Care Journal needed to come from the hospital. It needed to be a gift from the nurse to the patient or family member.

This made great sense. We could offer a handy tool AND we could help bridge the gap of mistrust between the healthcare provider and the patient. Now, instead of a nurse looking at a patient and feeling threatened that nurse can say, “Oh, I see you are writing in your Care Journal. That is great and don’t forget to write down your questions for the doctor when he makes his rounds.”

Right now, we’re working on the final touches of the Care Journal. We expect to have them in one month. If you work at a hospital interested in partnering with the Josie King Foundation to distribute Care Journals to your patients, I will send your hospital however many you would like. You can write up a personal note to your patients telling them that you encourage them to partner with you in their care and attach it to the inside of the Journal. All I ask is that your organization make a donation to JKF. Just contact me and we’ll get you started.

If you are a patient, the Journals will be available from our website in a few weeks. All the money from the Care Journal project will go back into this patient safety movement, funding great new ideas to improve the culture of healthcare.

I hope you like this project. Please email me at sking@josieking.org to learn how to partner with us, learn more about the Care Journal, or- very importantly- let me know your thoughts on the project.

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Welcome to Our New Website

Thanks for visiting us at the Josie King Foundation’s new and improved home on the web. I encourage you explore the various areas of the site, and also to send us your opinions on the site. As we worked to create this website, we were guided by the hundreds and hundreds of e-mails that I have received from patients, families, doctors, nurses, hospital administrators, medical students, and nursing students.

These e-mails came from all corners of the world and covered an enormous range of thought and emotion, but all had one thing in common- a passionate interest in and commitment to improving patient safety. These e-mails come from people like me who have been affected by medical errors in one form or another and are looking for ways to make their hospital safer.

This new website responds to your needs. It is a place that provides help and information. A place where people can learn from experts in the field. A place to find the latest and most helpful websites, books, and articles about issues related to patient safety.

The new website also fulfills a vital need of the Foundation- to share information about the successful patient safety programs that we have supported. Good things are happening in patient safety all over the country. We want to help spread the word so that these good things take root and replicate in new places where the need is dire.

We also wanted the site to be a place where people could connect with others. Why should the interesting, wonderful, and sometimes heartbreaking e-mails come just to my inbox? Wouldn’t it be great to pass them along so that thousands of others can read, react and connect? Maybe by creating this online community, doctors, nurses, and families can come together and solve problems or help each other.

I think this website will achieve some of those goals. It will continue to evolve as we react to your ideas and the progress shaping patient safety as a field. We would really love your feedback- good or bad. It all helps.

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