When I heard the news about the latest shooting of children in Connecticut, I was like so many others, appalled and outraged. Echoing so many other reasonable people, I wonder when will all this end. As someone who writes about healthcare, I also thought, not only about the trauma to those poor children, teachers, and their families, but to all the healthcare workers who have to deal with this endless march of carnage. First responders, nurses, doctors, pharmacists, etc. For each person who dies and as well as who survives there are many who work in healthcare, trying to help others who are witnesses to this never ending tragedy of human cruelty and cowardice. The cowardice of political leaders — leaders in name only — in my view, far outweighs the cruelty of those who perpetrate these deeds. Indeed, this cowardice is an act of cruelty toward all the innocent victims of people who are clearly out of their minds. Read more >>
Yesterday I wrote about a conjugal culinary episode and its connection to patient safety. What I left out was the fact that my husband and I — novice and expert — failed to share the same mental model of the situation with which we were dealing. In healthcare — and marriage — you have to form teams and the hallmark of a team is that you share the same mental model. The AHRQ/DOD team curriculum TeamSTEPPS defines a shared mental model as “The mental picture or sketch of the relevant facts and relationships defining an event, situation, or problem.” It goes on to say that “shared mental models are sustained by the following:
The process of planning, team decision-making, and vocalizing.” (TeamSTEPPS 06.1 Situation Monitoring, p17.)
This is, of course, totally true. But another thing that a shared mental model depends on is experience. No expert can share the whole universe of consequences and implications that they envision and have gathered from years of mistake/success making. This is why it is so important to have the right blend of experts and novices at the bedside. Of course, it’s also important for the expert to explain as much as possible to the novice so that he or she can do the job correctly. I probably could have explained things to my husband in a way that helped him understand what was at stake. What one constantly has to be aware of is the fact of inexperience — or experience — and how that affects what the information that we need to share in order to create the shared mental model upon which high reliability depends.
The other evening, as we were having company for dinner, my husband burned the roasting pan. Completely and irremediably. I was cooking a roast and asked him to keep an eye on it while I went out to get a haircut. “Make sure you don’t let it get burned,” I instructed. I gave him a quick how-to on basting and left the stock near the stove. When I got back an hour later, he was sitting in the kitchen working on his laptop. As soon as I walked in the door I could smell the burnt odor. “What’s burning?” I asked. “Not the roast,” he assured me. That was true. It was the pan the roast was in that was burnt. I had a fit. He was furious. “Look the roast isn’t at all burnt,” he said defensively, as I pulled it out of the pan and stuck the latter, crusted in black in the sink. I continued to fume, he to feel injured. He felt he had done his job. I had mentioned nothing about the pan. The roast wasn’t burnt, and he was being ill used. He scraped off the charred remains, injuring the pan permanently. (It was an old one, coated with Teflon, that I liked but probably shouldn’t have been using. But now, scratched, with Teflon surely flaking off, I would have to get rid of it.) We continued cooking the roast in another pan. My sauce — which was to be made with the pan drippings — would have to be done some other way. I pulled it off. We had a nice dinner with friends, and the next I tried to do a debrief about the whole mess. Ordinarily, I wouldn’t be writing about such domestic trivia on a blog largely devoted to healthcare but what I found out about and reflected on does have something to do with our current health care dilemmas. Read more >>
If you want to understand the jobless recovery from the Great Recession of 2008, check out your local CVS or grocery store. I’ve been staying in Jamaica Plain, Mass for Thanksgiving. In JP there are two CVS’ within about ten blocks of each other on the main drag, Centre Street. About a year ago,( I may be wrong on my timing here) when I was at the CVS you could check out at a proper check out register, of which there were several, with a person helping out. Now at one CVS’ there is only one register with one human being, and three or four computer stations where you do the checkout yourself. At the other, there are two registers and four computer stands.
What does this mean? It means that on Centre Street a number of jobs have been lost, forever. Since these stores operate from 7am to 10pm, workers are needed for two shifts. According to a worker at one of the stores, they lost two part timers and two full timers. “Every year we lose more hours. We are down to bare bones and the work doesn’t lessen,” this worker told me. Which means increased job stress and strain, which has health consequences. Lost jobs may also mean lost healthcare benefits, which means more workers dependent on federal subsidies from either Medicaid or Obamacare, or some other state or federal problem if they are eligible at all. These jobs are filled by low wage workers who will have a very difficult time finding work elsewhere. Thus, as a society, we lose revenue in taxes and out of work people don’t spend money in our consumer driven economy.
But that’s the future. We do our own checkout at the drugstore, grocery store, seek out, purchase and then assemble our own furniture from Ikea,and we are told, at least by Ikea, that this benefits all of us because of lower prices. What it really benefits is the profit margins of large corporate chains.
I used to boycott the computers at the grocery or drug store. Now it’s becoming harder and harder. This morning, when I bought my newspaper at the CVS, I was forced to use the computer checkout. The clerk who manned or womanned the lone register was on a bathroom break. Pretty soon CVS won’t even need bathrooms because there will be no staff at all, but just robots roaming the aisles. Question is, who will be their customers?
Last Tuesday, I took a United Airlines flight from San Francisco to Philadelphia. It was a beautiful day and happily the flight was on time, boarded smoothly, and the doors closed and we were ready to go. Then a surprising thing happened. Just before leaving and before the safety announcement, the captain came out of the cockpit, stood at the front of the plane where everyone could see him (it was a pretty small plane), took the PA and welcomed us to the flight. He told us it looked like we’d have good weather and smoothe flying the whole way and that we should be on time. Then he left and went into the usual cockpit lock down.
Everyone around me, including my fellow seat mates, looked at one another. “That’s really unusual,” people commented. “Is this personal welcome, in full view, from the captain a new United policy?” we all wondered. We, of course, had no idea, but we were all quite pleased to get this pleasant introduction to the flight from the guy in charge. Read more >>