For seven years now, multiple units within University of Iowa Health Care have supported a yearly celebration and presentation of its culture of patient safety and quality improvement into a day-long symposium. In recent years, Quality and Safety Symposium (QSS) organizers have worked to reach beyond the borders of the hospital toward other colleges at the University of Iowa with similar investments and interest in collaboration.
Not only has its reach broadened each year, but its format has been its own model of continuous improvement. This year, the planning committee settled on splitting the day-long presentations in half, wrapping them around the symposium’s poster session. Numerous benefits recommended its implementation, not least of which was the chance to provide two keynote addresses rather than just one.
Wednesday afternoon began with a brief welcome from Brooks Jackson, MD, MBA, dean of the Carver College of Medicine. Jackson offered congratulations for attending and encouragement for continuing to prioritize quality and safety. Teri Brennan, MD, chief medical officer at University of Iowa Hospitals & Clinics, followed and broke a little bit of news by revealing that a new incident reporting instrument would be introduced in 2020.
After those theme-setting welcomes, the conference shifted into quick “TEDesque talks.” In just about ten minutes each, four different presenters described problems in a system, the process of solving them, and the results of that effort. Lynnette Kenne, RN, MSN, shared the story of the STICK program, minimizing time between exposure to human fluids and post-exposure prophylaxis. Bill Millard, CHESP, and Oluchi Abosi, MBChB, MPH, shared their efforts to reduce C. difficile infections from contaminated hospital room surfaces. Alison Pauley, RN, MSN, revealed how a team streamlined the discharge process, freeing up valuable bed space in the hospital. Finally, David Papworth, MD, described the purpose, makeup, and value of the COPE team, which helps staff manage emotionally challenging events on the job.
Then it was time to discuss the health inequities that people who use drugs must navigate, the causes, and the impact not only on the person, but also on the providers who are unable to provide stigma-free care. Sarah Ziegenhorn, the founder and executive director of the Iowa Harm Reduction Coalition (IHRC), and Daniel Runde, MD, MME, chair of the IHRC board of directors, presented compelling data and heart-wrenching anecdotes to underline their case for reforming the way providers treat and even talk about people who use drugs.
The next day began with some more refreshments and another welcome from QSS co-chairs Mike Brownlee, PharmD, MS, and Krista Johnson, MD, MME. They introduced Suresh Gunasekaran, MBA, CEO of UI Hospitals & Clinics, who also offered words of encouragement to continue pursuing change that makes a difference in people’s lives. Chief Quality Officer Mike Edmond, MD, MPH, MPA, introduced associates who also serve on the hospital’s Quality Improvement Program team, each of whom briefly offered updates on ongoing initiatives. Brownlee followed with an in-depth review of what is driving up the costs of medication, how the UI health system is responding, and what options may be available to patients, including consultations with representatives from the pharmacy. Brownlee directed the audience to do some research on apps available to patients and even passed around a wildly expensive–and empty!–tiny bottle of a particular cancer treatment.
As she organized the poster session, Wendy Fiordellisi, MD, MS, also chose four abstract submissions and invited them to deliver their presentations to all the attendees. Irrespective of whether judges chose them as winners, Fiordellisi chose them based on creativity, variety, and interest level. Whether it was integrating service lines, finding ways to decrease patient wait times, or increase participation in biorepository submissions, each presenter told compelling stories of simple changes producing dramatic results.
After a brief break, the symposium revisited a theme first touched on the previous afternoon by Ziegenhorn and Runde, how we should talk to one another. David Moser, PhD, and Monique Galpin, BLS, provided concrete examples of how to recognize and work to counteract implicit bias, which leads to health care inequalities and often-disastrous outcomes. Then, as an introduction to that day’s keynote, Paul Leonard, MD, PhD, and a full complement of assistants, described how to put “just culture” into practice. Videos and models of difficult conversations were presented, and then pairs got the opportunity to practice “approaching with curiosity” themselves while being observed and coached.
Reconvening and armed with a box lunch, attendees returned to Medical Alumni Auditorium for the second QSS keynote from David Marx, JD, CEO of Outcome Engenuity and the creator of Just Culture. After a couple photos with the previous evening’s poster session winners, Marx took the floor. Over the course of an entertaining hour, he labeled a variety of behaviors and encouraged practitioners of its tenets on how to avoid pitfalls that prevent improvement and growth. After, Marx was on hand to sign copies of his book Dave’s Subs, which each attendee received as a gift.
Special thanks to all the sponsors, planning committee members, and the University of Iowa community for attending this year’s event!