The best way to predict the future? Create it.

1.            In 2004, Donald Berwick, physician and CEO of the Institute for Healthcare Improvement (IHI), challenged hospital administrators to save 100,000 lives in 18 months. In what became known as the 100,000 Lives Campaign, the IHI convinced thousands of hospitals to alter their behavior and institutionalize new standards of care. His team created an individualized step-by-step agenda to reduce medical error through process improvement. They provided research, instruction guides, and training. They opened up communication lines between hospitals to provide the opportunity for council. Altogether they saved 122,300 lives.

This was a massive change in health care. Not only because it challenged hospitals to change their traditional practices, but because it required hospitals to admit error and acknowledge that something in their system needed fixing. Dr. Berwick accomplished something that I am learning is rather hard to do within, let alone across healthcare organizations. Create culture change.

“Never doubt that a small group of thoughtful, committed individuals can change the world. Indeed, it’s the only thing that ever has.” – Margaret Mead

I haven’t personally saved 100,000 lives yet, but however small my role, I have helped the value-based services and quality department to make significant steps towards culture change at OrthoCarolina. I have helped OC to establish and maintain quality improvement processes in things like coordinated care and bundled payment care models. I have learned how to manage projects to test and create change in the clinic, I have helped implement a risk assessment for Medicare patients to better predict their care needs post-surgery, and most importantly, I have developed a keen eye for identifying areas of process change and quality improvement in healthcare. Every day I am inspired by my mentors and I am challenged to think of innovative and sustainable ways to improve the quality of care and the overall experience for our patients.  So on many occasions I think back to Dr. Berwick and the IHI… That’s what we’re trying to do here.

2.            Community involvement has become increasingly important to me during my post-grad life. Last year, Megan, the previous Davidson Impact Fellow, wrote of OrthoCarolina’s dedication to philanthropy and volunteerism. And to be honest, I underestimated how much I would truly value the experiences I have gained as a result of this commitment. Though now that my inbox is flooded with weekly educational and volunteer opportunities, I wouldn’t have it any other way. To the college students reading my blog—I encourage you to stay involved in the community when you graduate! The experiences you gain outside of the office, outside of the classroom, outside of your circle of friends, are so important. Trust me on this one. 

Some of the highlights of the last six months include: an all-day TedX event sponsored by OrthoCarolina where I heard from various local non-profits about their work towards social change in Charlotte, a day spent packing Christmas boxes with Operation Christmas Child, an afternoon baking cookies with residents at the Ronald McDonald house, and time spent helping to develop a specialized classroom program for our pediatric patients (more on that later!).

3.            In the beginning of February, I helped Davidson to complete the first-round interviews for six of the 65 applicants for the 2016-17 Davidson Impact Fellowship program. It is amazing to see so many students interested in the social sector! It was a long, but extremely rewarding day as I got to hear from various Davidson students about their passions and motivations for wanting to have a positive impact our society.

At the end of each interview, nearly every student wanted to know about the support system provided through Davidson and the mentor-ship component of the fellowship. As you may know, the program has monthly conference calls where we have the opportunity to update one another on our individual placements and seek any outside peer-support. We usually review an article related to philanthropy or non-profit work before the call then analyze the relevant topics on the call… It feels a lot like one of my old seminars, but I do really appreciate the opportunity for discussion. Another crucial part of the program and for me specifically, is that of the trifecta of mentors—the clinical quality manager at OrthoCarolina, a cardiologist at Novant Health, and a first-year medical student at Wake Forest. In my next blog I promise I will go into more detail about my mentors! The bottom line is that they are awesome and have provided me with opportunities that otherwise would not have been available to me. I often forget that this unique mentor-ship component is not as accessible to all Davidson graduates and it is something in which I am truly grateful.

4.            I just recently attended an ‘Evening with Dr. Atul Gawande’ talk in downtown Charlotte. Dr. Gawande is a general and endocrine surgeon who also happens to be one of today’s greatest innovators in healthcare and my personal hero. Needless to say, my friends and I were beyond excited! Like children waiting for autographs at the end of a major league game, we waited patiently following the talk to get our pictures taken with Dr. Gawande and our books signed. His talk paralleled some of the questions we grapple with on a daily basis here at OrthoCarolina. How do we fix the healthcare system? Are we doing what is best for the patient at this moment in time? How can we be better communicators and empathizers with our patients?

In reflecting on the talk, I keep returning to one comment in particular that Dr. Gawande made during the Q&A. A physician in the audience asked him about what hope Dr. Gawande has left for positive changes being made in healthcare. This physician was specifically reflecting on his experience with patients searching for the ‘quick-fix’ solution and being non-adherent to treatment plans. Dr. Gawande paused then he said, “This rests on the younger generation. As young people enter into medicine their question is, ‘What is the environment I’m going to be practicing in?’ My hope, and I’ve seen this with my residents, is that the younger physicians will not want to practice in an environment like this and they will do whatever it is they can to change it”.

5.            I know the list I have given you is quite a collection of unfinished thoughts, but my hope is that you are able to see the connections throughout and how these ramblings come full circle. I have not updated my blog in awhile so to the best of my ability I wanted to give you an update on everything that has been going on the past several months… which is a lot! All in all though, I truly feel that I am learning how to create step-by-step change in a healthcare system and how to best make a difference when I become a physician. That’s what I’m trying to do here.

 

In the shoes of a therapist for kids who have caused sexual harm

(For your information: the following stories contain potentially heavy or upsetting material. They are modifications and conglomerations of stories from nearly 200 kids and families throughout North Carolina. The identifying information and situations are fictional and could not be linked to our clients, past or present.) Caleb, Stage II, Affect regulation and Attachment, Family Caleb [...]

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How Do We Achieve “Culture For All?”

The Arts & Science Council’s (ASC) mission is “ensuring access to an excellent, relevant, and sustainable cultural community for the Charlotte-Mecklenburg Region.” In this role, ASC strives to ensure that the cultural community is truly open to everyone, and not just a select few. Recently, ASC has adopted the tagline “Culture For All,” a clear [...]

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The LCSW’s (licensed clinical social workers), QP’s (qualified professionals), and LMFT’s (licensed marriage and family  therapists) are the staff members on the ground with our clients who have caused sexual harm. These TASK (Treatment Alternatives for Sexualized Kids) agents are less known to the rest of the world but celebrity to our kids and the [...]

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The Carolina Thread Trail: A Collection of Unfinished Thoughts

On my desk, there are at least four scrapped, partially written blog posts. Sentences scratched out, pictures scribbled on, quotes highlighted, bullet points listed. None of these drafts have made it past my legal pad (sorry Jeff) because I felt that they either didn’t properly describe my experiences, focused too much on one aspect, or [...]

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I show up to work at 8:45 or 9:15, never 9:00 am. This is not company policy of course but rather what seems to be my keen unpunctuality; something ingrained in my character during 4 years of Davidson where “international students arrive to class late”. In 2001, the USAID head of the time proclaimed that [...]

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Adversity Against Adversity

When I walked through the doors of the Education building at MAHEC, I wasn’t sure what to expect. I had never done an employee orientation of any kind before. ‘It’ll just be an extended series of PowerPoint presentations… right?’ Well, little did I know that said presentations would have such a great impact on my [...]

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What does it mean to be a Davidson Impact Fellow?

“So what exactly do you do?” When I first started here at OrthoCarolina (OC) I struggled to answer this question when my friends or even coworkers would ask. As a collective, the Davidson Impact Fellows share similar values and sometimes even the same goals, but individually, our job descriptions differ greatly. I found that each [...]

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Justice is not so simply dealt out: walking with kids who cause sexual harm

My name is Grace Watt. As I transition into my new job, which I will describe later, I have had to ask some complicated and emotionally distressing questions.  The following essay is part of an ongoing, maturing conversation with myself as I process what I am learning and how I might more effectively respond to the issue [...]

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Taking the Time to Reflect

DHC 4C Logo Blue Text

I just passed the halfway mark for my fellowship in June. This seemed momentous for several reasons: a) This is my first “real job,” thus I feel like a real adult with one work anniversary under my belt, b) I have less than a year to figure out my next steps, which still seem pretty [...]

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