Apr 17, 2016

Our blue and gold stars! Celebrating graduates of the 1st UC Davis Training Program in Health System Improvement

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime".

Depending on who and what you read, this quote has been attributed to Lao Tsu, Maimonides, the Bible, the Chinese, the Native American, my colleague Scott, and even to the Italians!

Regardless of the quote’s origins, it brings home the importance of promoting self-sufficiency to sustain change.  

On March 16 this year, 32 physicians, nurses, students, trainees, and staff graduated in the inaugural class of the UC Davis Training Program in Health System Improvement.

With the Class of 2016
The program is a way to learn about the science and art of improvement. As you might imagine, these are invaluable skills in our current health care environment.

The program teaches skills to enable learners to implement, evaluate and sustain population-level improvement initiatives. Our objectives are to increase learners’ ability to understand and apply tools and strategies to improve health systems, participate in teams to implement changes, and contribute to organizational change management efforts.

We used a blended learning style. A selection of online courses from the Institute for Healthcare Improvement Open School complemented interactive in-person learning at the 2-day intensive course on March 15 and 16.

A big hit at this year’s training was the Ball Toss Game where teams of participants formed a circle. Their goal was to toss a tennis ball to another team members – but not to the person right next to them – without dropping the ball. The game teaches participants how to reduce cycle time and to eliminate dropped balls (i.e., defects) using trial and error.

The Ball Toss Game in progress
Players stop at the end of each turn to assess their last performance and to tweak their next move based on their experience. They learn that they need to change process and system if they want true improvement. They find that getting closer to each other and communicating expectations in advance helps the team improve flow and less likely to drop the ball. They self-organize and discover that smaller teams do faster and better. And they also realize that a little fun and is a great way to build team spirit.

The Ball Toss Game is very physical. So it works well right after lunch or at the end of the day when energy levels are at a low-point.

Blue and Gold certificates of completion (UC Davis school spirit!) were awarded to 32 graduates at the 6th Annual UC Davis Quality Forum on the afternoon of March 16. We asked graduates what was the most surprising thing that they learnt from the training. Here are some responses: 
  • "I was surprised to learn that we have so many resources to help our efforts in our health system."
  • "How much financial waste can be avoided through quality improvement and streamlining processes."
  • "The significant reduction in preventable deaths since the initial Institute of Medicine report".
  • "The multitude of different tools (DMAIC, PDSA, etc.) that do essentially the same thing but with a slight twist."
  • "The amount of detail and research that should/is involved in quality improvement."

- Ulfat Shaikh (@Ulfat_Shaikh)

Jan 10, 2016

It’s all about that buzz! Running a tweet chat at the IHI National Forum

With the Don of healthcare improvement
(Don Berwick, of course)
The Institute for Healthcare Improvement's 27th National Forum last month was a standout event for many reasons. A learning expedition at Universal Orlando to learn about safety and reliability strategies (more about that in my next post), Magic Johnson talking about his HIV/AIDS advocacy work, running into old friends, and making some new ones.

One memorable experience was facilitating a buzz session on delivering high value care along with two fellow Californians - Lisa Schilling, Kaiser Permanente’s VP for Healthcare Performance Improvement, and Anna Roth, CEO of Contra Costa Health Services.

Part of IHI’s effort to increase interaction at their learning events, buzz sessions are “designed to stimulate thinking and draw on the collective experience of the audience”. We ran two buzz sessions titled, ‘Thriving in a Value-Based Environment’, and were blown away by the interest they generated. We had about 300 health system leaders, clinicians, policymakers and researchers at each of the two sessions.

With Anna and Lisa at our session
How do you generate a lively buzz, yet keep the conversation manageable and in a format where we could memorialize the discussion? About 10 minutes before our first session started, Lisa, who certainty cannot be accused of lacking spontaneity, suggested the idea of a facilitating a Twitter chat. Not wanting to appear uncool, I decided to play along. So Lisa came up with a hashtag on the fly (#27ForumValue) and added it to our slides, and were in business.

The brave souls at UC Davis Health System’s public affairs department have been working hard to get our faculty members to use social media in our work. Thanks to their Twitter 101 workshop, which I had attended a few months prior, I was all set to go. A few months prior, the American Academy of Pediatrics had even added me to their list of “tweetiatricians” – a cute little term for pediatricians who tweet.

The goal of our session was to identify approaches that health systems can take to thrive as they deliver high-value care. We began each session with an overall introduction to the topic and our plans for capturing the discussion. I led a segment on engaging front-line clinicians and staff in improvement efforts, Anna led one on ambulatory care redesign, and Lisa handled co-design / co-production with patients and families. We provided question prompts after each of these three sections, and the audience divided up onto groups of 10 to discuss each issue. 

Our audience then got to report out their key ideas verbally or by joining our chat. I honestly enjoyed the added connection with our audience that Twitter brought to our session, and cannot wait to host another tweet chat at our 6th Annual UC Davis Quality Forum coming up in a couple of months.

- Ulfat Shaikh (@Ulfat_Shaikh)

Dec 8, 2015

Surviving the School of Hard Knocks

I recently visited the National Archives in Washington D.C., which happened to be running the exhibit, ‘Spirited Republic: Alcohol in American History’. The exhibit delves into the history of alcohol in American society. It offers a look at the evolution of the Federal government’s policies, including how the government regulated, prohibited - and at one point even promoted - alcohol.

A couple of highlights that healthcare folks might find intriguing: A "gold cure" was one of the most popular treatments for alcoholics (or “dipsomaniacs” as they were called back then) during the late 19th century. You can also view a prescription for whiskey for I. F. Johnson, dated January 3, 1924. During Prohibition the Volstead Act allowed for medicinal use of alcoholic drinks by patients who obtained a prescription from a licensed physician. Whiskey was touted as the new wonder-drug, used in the treatment of conditions as varied as tuberculosis, anemia, pneumonia, and high blood pressure. Adults could obtain an ounce of whisky every few hours at a cost of $3 (equal to $40 today) with their prescription.

A 1918 quote by Governor Hanley of Indiana caught my eye. 'Why I hate the liquor traffic' states, "I hate the Liquor Traffic for the almshouses it peoples – for the prisons it fills – for the insanity it causes – for its countless graves in potters fields. I hate it for the grief it causes womankind, and for the shadow it throws upon the lives of children – its monstrous injustice to blameless little ones."

My visit to the National Archives was actually lunchtime detour from the American Academy of Pediatrics National Conference. A key Conference theme was identifying toxic stress in children and promoting resilience. Did you know that adverse childhood experiences (such as parental drug or alcohol addiction, child maltreatment, or exposure to domestic violence) increase the chances of physical and mental health issues in children that can persist into adulthood? The higher the number of negative experiences a child has, the greater the likelihood of these physical and mental health problems. A rough childhood even raises the risk of premature death in adulthood through changes in the genome, hypothalamus-pituitary-adrenal axis, and immune system.

The Adverse Childhood Experience (ACE) Study offers 10 questions that can help healthcare providers assess toxic stress. One of these questions screens for people in the child’s home with problem drinking, alcoholism, and drug abuse.

The HOPE, or Health Outcomes of Positive Experiences study, shows that emotional connections built during infancy (through activities such as reading together), childhood (providing opportunities to play, taking time to talk, and family dinners), and adolescence (developing safe and nurturing relationships with adults outside of the home, such as grandparents or teachers) build resilience. These connections buffer children against the storms of unsafe or unstable environments. They help children learn social and emotional competence, and build the experience of resilience.

So what is the one new thing I want to try out to help high-risk families in my practice build emotional connection and resilience? The HOPE study had many suggestions for clinicians, but one struck me as particularly intriguing and unique. Asking parents during clinical visits, “What are you most proud of about your child?” As a pediatrician and a mom, that question gave me pause – both professionally and personally.

To quote the great Dr. Seuss in The Lorax, “Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not."

- Ulfat Shaikh

Oct 30, 2015

Essential Qualities of Healthcare Leaders: The Four T’s

Dr. Catherine DeAngelis was practicing clinical quality improvement much before it became a buzzword in healthcare. It was my pleasure to host a reception on behalf of the UC Davis Women in Medicine and Health Sciences Program for Dr. De (as she is usually called) during her recent visit to UC Davis.

Dr. De is a remarkable role model on many levels for healthcare improvers, especially those who fall into my specific demographic of women in academic pediatrics and public health. She has been a nurse and a pediatrician, whose first faculty position was at the Columbia College of Physicians in New York in the early 1970's. There, she worked on improving healthcare systems in Harlem and Manhattan utilizing physician-nurse practitioner teams. She felt that nurses were often underused, and that they had the ability and training to work with physicians as a team and contribute more substantially to healthcare.

When asked about the essential qualities of leaders, she spoke about four traits that served her well

Jun 22, 2015

My week as a country doctor

Just got done with a week as camp doctor at a resident camp for children in Central California. I started volunteering as camp doc last summer, not just so I could clandestinely keep an eye on my own kids and take their pictures on the sly - but as a personal dare to see if I could do one of the most challenging yet rewarding jobs in medicine, being a country doctor.

At camp, I focus on keeping children healthy, and provide basic medical care wherever campers and staff need it - at our infirmary, by the lake, at the ropes course, or at lunch tables. I triage who should go to the emergency room 40 minutes away, or who needs some extra TLC for homesickness. I work with a camp nurse who dispenses prescription and over-the-counter medications four times a day. The camp doctor has office hours twice a day at the infirmary for sick campers and staff.

Being out here in the foot hills of the Sierras with a tightly knit community of about 300 children and 150 counselors and staff reminds me of why I went into primary care pediatrics. I don’t