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The Quality Issue Carilion MedicineSPRING/SUMMER 2018 In partnership with the Virginia Tech Carilion School of Medicine and Research Institute THE QUALITY ISSUE contents CARILION MEDICINE SPRING/SUMMER 2018 Departments 2 FROM THE CMO 3 IN BRIEF Nancy Agee takes the helm of the American Hospital Association; reflections on history and the future 7 GRAND ROUNDS Education initiatives both classic and with a twist 44 THE ART OF MEDICINE: A CONTAGION IN LAUGHTER The medical school’s most recent art show honors a beloved Roanoke physician. 46 CHEERS FOR PEERS 30 Carilion clinicians achieve recognition DOUBLE STANDARDS: Roanoke City, which has one of the lowest health 48 BACKSTORY: THE RESILIENCY CODE rankings in Virginia, is enclosed within To do their jobs well, physicians must be able Roanoke County, whose health ranking is to open themselves up to pain—and then one of the highest. That discrepancy has caused Carilion Clinic to look beyond the figure out how to bounce back. traditional boundaries of health care. BY GARY R. SIMONDS, M.D. SPECIAL REPORT The Quality Issue Features 10 12 18 24 30 36 40 INTRODUCTION: CHASING THE HUMAN PLAYING A TALE OF ADJUSTING KEEP CALM TO ERR IS HUMAN ZERO FACTOR THE PATIENT TWO CITIES FOR GROWTH AND CARRY ON Stakes in the medical world are In its efforts to eliminate A team of experts at Carilion The Virginia Tech Carilion Carilion Clinic partners As the demand for care grows, Virginia Tech Carilion Research high for patients and clinicians patient harm, Carilion Clinic is Clinic are researching School of Medicine’s with local organizations Carilion Clinic is expanding Institute scientists record the alike. The need for speed amid demonstrating that medical perfection in health care— standardized patients help to find innovative ways the role of advanced clinical first clear evidence of the inter- uncertainty can trigger human errors are not as inevitable as and implementing their medical students sharpen to help medically under- practitioners to improve play between serotonin and error, yet a just culture can offer once believed. findings in real time. their clinical skills. served communities. patient access to quality care. dopamine in humans. divine forgiveness. BY DAVID BUMKE BY CHARLES SLACK BY CATHERINE DOSS BY JESSICA CERRETANI BY VERONICA MEADE-KELLY BY ASHLEY WENNERSHERRON COVER ILLUSTRATION: NEIL STEVENS; ILLUSTRATION: GRACIA LAM (ABOVE) a recent study reported that medical errors are the third leading cause of death in Carilion Medicine the United States, ranking just behind heart President and Chief Executive Officer disease and cancer. While much has been Nancy Howell Agee On the pulse of the done to reduce medical errors and improve Chief Medical Officer and Carilion Clinic community patient safety, mistakes can still happen. Executive Vice President Often circumstances beyond anyone’s Patrice M. Weiss, M.D. control render a bad outcome inevitable. Editorial Advisory Panel in brief Patients and their families—the first Nathaniel L. Bishop, D.Min.; Cesar Bravo, M.D.; victims—aren’t the only ones affected. John Burton, M.D.; Kimberly Carter, R.N., Ph.D., Clinicians are too, and the effects of being a R.N.; Julie DeLoia, Ph.D.; Kimberly Dunsmore, M.D.; Evelyn Garcia, M.D.; Mark Greenawald, ASSUMING THE MANTLE “second victim” can be devastating. M.D.; Daniel Harrington, M.D.; Cynda Johnson, Years ago, I knew of a young intern caring M.D., M.B.A; Donald Kees, M.D.; Wilton Kennedy, It was a hike with her Girl Scout troop for a pregnant woman with severe preeclampsia and insulin-dependent D.H.Sc., P.A.-C.; Michael Nussbaum, M.D.; John that led Nancy Howell Agee to a career diabetes. The mother was being induced under the care of the attending Pastor; Paul Skolnik, M.D.; Robert Trestman, M.D., that most recently culminated in being Ph.D.; Fidel Valea, M.D. physician and the intern. The attending left the room, with the expectation the top elected official of the American that the intern would be closely following the patient. When the attending Chief Administrative Officer Hospital Association. Jeanne Armentrout returned, she could see multiple subtle decelerations in the fetal heart rate, Agee, then 15, tripped and slid down indicating decreased oxygenation. The baby was delivered by emergency Vice President a small mountain. Although the clinicians Mike Dame at the emergency department found no C-section and whisked away to the NICU. broken bones, they did diagnose a tumor I want you to consider two possible outcomes for the intern. First, his Executive Editor Linda Staley in her knee. It was the care she received superiors could have blamed and reprimanded him. Or they could have over the next two years that inspired her given him support, recognizing that he could be emotionally affected by his Editor to become a nurse—and an impassioned Paula Byron oversight and encouraging him to learn from the experience. advocate for patients. Throughout my career, I’ve witnessed adverse events, some more serious Art Director Decades later, Agee, president and Laura McFadden PLEDGE TO SERVE: “Our commitment to excellence demands our continual focus on than others. And I’ve learned a great deal about what it means to be a chief executive officer of Carilion Clinic, making care better and more affordable for our patients,” said Nancy Howell Agee in her second victim. Special Thanks assumed the chairmanship of the investiture ceremony. “They are the reason we are here and why we do what we do.” It turns out that more than 40 percent of providers are second victims Joe Castiglioni, Mark Lambert, Josh Laukaitis, American Hospital Association’s Board Alison Matthiessen, Karen McNew McGuire, of Trustees. Although she began her “The doctors and nurses who cared In her role as chair, Agee will work to and about one-third of them experience emotional distress, placing them at Laura Mitchell, Anne Shaver risk for depression, burnout, and feelings of guilt and shame that can be long tenure in January, her official investiture for me then inspired me, and the work of advance health care nationally and to be an lasting. They may also experience shock and hopelessness, sleep disturbance, CARILION CLINIC ceremony took place at the association’s caregivers all across this country inspires agent for change in health care. During her 1906 Belleview Avenue Annual Membership Meeting in May. me now—inspires me to make a differ- address, Agee spoke about the association’s social avoidance, intrusive thoughts, and nightmares. Interestingly, these P.O. Box 13727 Agee opened her investiture address ence to the patients who put their trust in Value Initiative, which provides thought emotions and reactions can be similar to those of post-traumatic stress Roanoke, VA 24036 by describing her experiences as a teen- us,” Agee said. “In my opinion, there’s not leadership on the issue of affordability. She disorder. Recovery can take years, and some clinicians never rebound. CarilionClinic.org 800-422-4842 age patient. much that’s more important.” also touched on the association’s commit- Hospital systems’ internal review processes for medical errors often ment to drive excellence. compound the problem. They can too easily devolve into a “name, blame, “We cannot sit on the sidelines as shame game.” We need to move beyond that to a just culture, one that meeting health care changes around us,” Agee said. differentiates between competent professionals who make mistakes and Carilion Medicine is published twice a year at: “We must lead—for all our patients. We those who behave recklessly and should be punished. 213 McClanahan Street, Suite 200 Medical School to Host International Conference must lead for our teams, the caregivers and staff who demonstrate care and compas- We physicians all pledge to avoid harm, and we are often held to standards Roanoke, VA 24014 The Virginia Tech Carilion School of Medicine will host the 23rd Annual Meeting of Phone: 540-266-6586 Fax: 540-266-6608 sion every day. Together, with open ears of perfection by society, peers, and, above all, ourselves. Yet we are only the International Association of Medical Science Educators (IAMSE). Set for June 7–11, Email: [email protected] and eyes and hearts, we will be the catalyst human. We deserve empathy and support after a stressful outcome or event. 2019, the meeting is expected to draw more than 500 basic science and clinical educa- Web: CarilionClinic.org/carilionmedicine for change in a sector that is ripe for it.” When we put on our white coats, let’s not turn off our hearts. tors from across the globe to Roanoke, Virginia. Agee, who has served as Carilion’s Carilion Clinic is a nationally ranked integrated health “The event organizers saw the school successfully hosted a large conference a president and CEO since 2011, joined the care system headquartered in Roanoke, Virginia. Its few years ago, the 2015 Collaborating Across Borders conference, which attracted flagship, Carilion Roanoke Memorial Hospital, is the American Hospital Association’s Board of nearly 700 health care professionals from across North America to Roanoke, and clinical affiliate of the Virginia Tech Carilion School of Trustees in 2015, serving on its Executive, Medicine and Jefferson College of Health Sciences. they felt confident we could accommodate this annual meeting,” said lead orga- Operations and Audit Committees. She has nizer Richard Vari, Ph.D., senior dean for academic affairs at the medical school and Patrice M. Weiss, M.D. © Copyright 2018 by Carilion Clinic. No part of this also served on the association’s Health Care publication may be reproduced or transmitted the current president of IAMSE. Chief Medical Officer and Executive Vice President Systems Governing Council and represent- in any form or by any means without written “I look forward to bringing my peers to the place I’ve called home for the last Carilion Clinic permission from Carilion Clinic.
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