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My visit to the Royal College of Surgeons Ireland... In which I delve deeper into the intriguing history of barber-surgeons

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“All things change except barber, the ways of barbers, and the surroundings of barbers. These never change. What one experiences in a barber’s shop the first time he enters one is what he always experiences in barbers’ shops afterwards till the end of his days.”  - Mark Twain, in About Barbers.
All I learnt about barbers from Mark Twain was about to be proven wrong during my up close and personal tour of the Royal College of Surgeons in Ireland (RCSI), graciously provided by Frank Donegan, Head Porter of RCSI.


A big thank you to my gracious hosts, Siobhán McCarthy and Ciarán O'Boyle from the RCSI Institute of Leadership. It was fun talking to your students and faculty about building a career in health care quality improvement and patient safety.


The historic RCSI building on St. Stephen’s Green was seized by rebels of the 1916 Easter Rising. Reminders of the revolution can still be seen here in bullet holes in the façade of the building and in a door that I found myself standing too c…

Building bridges at ISQua 2016 in Tokyo

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“The older I get, the more clearly I remember things that never happened.” - Mark Twain
I try and distill my three main action items after conferences as soon as I get back home, so that I can commit them to memory, or at least to paper. This report on The International Society for Quality in Health Care (ISQua) 2016 conference, as you can see, took a little longer to write! I would like to think that it was because I was still basking in the warmth of Japanese hospitality, or was busy networking with all the fabulous people I met at ISQua for months afterwards.
Why memorialize just three things, given that I learnt tons of new information over a span of 5 days at ISQua Tokyo? The rule of three says that messages or action items in threes are more likely to be remembered. Examples that come to mind are the Three Musketeers, Goldilocks and the Three Bears, Three Little Pigs, and Three Billy Goats Gruff. Messages such as Stop, Drop and Roll (fire safety), and Faster, Higher, Stronger (the …

You must be this tall to ride the process geek bus

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On a pleasant December morning in Florida, 200 or so clinicians and health care administrators attending the IHI National Forum disembarked a bus at Universal Orlando. 
At least one of them (yours truly) suffered from a longstanding and deep fear of roller coasters. What followed next was a day devoid of Doctor Doom's Fearfall or The Incredible Hulk Coaster, but nonetheless a thrill ride. These eager individuals were treated to a backstage look at how Universal Orlando keeps thrill ride junkies safe and their parents who stay on the ground taking pictures reassured - a day only a process geek could love.
Universal Orlando employs about 15,000 people and welcomes anywhere between 20,000-60,000 visitors a day. Despite its high volume and complex operations, the resort has an enviable safety record, not only for its visitors but also for the hundreds of actors and stunt people it employs.
The goal of our day was to identify examples of safety and reliability in a high performance non-…

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

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"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.
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, participa…

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

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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 o…

Surviving the School of Hard Knocks

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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. …

Essential Qualities of Healthcare Leaders: The Four T’s

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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…