Happy One-Year to Me and OC

I find it rather hard to sit down and write this final blog post. While this may be a result of my impressive procrastination skills or of the busy-ness brought on by the summer months, I believe what makes it so difficult is that it requires me to admit that my fellowship is nearing its end. It requires me to not only reflect upon my experiences this past year, but to embrace change and its accompanying uncertainties. It also reminds me of the people I am thankful for – my supervisor and coworkers at OrthoCarolina, the Davidson support system, my mentors and my friends – and that I have a lot still left to learn.

 

For this post, I am going to format it as a triple-entry journal. Several weeks ago we (the Impact Fellows) had our last conference call and discussed the importance of learning through reflection so it seems fitting now to employ such a technique. I am going to respond to the questions posed by the article we reviewed. (As the reader, you might appreciate the structure and focus it hopefully adds to my writing).

 

Observation. My fellowship began with OrthoCarolina (OC) at a unique time in U.S. healthcare. In 2010 the Affordable Care Act (ACA) was signed into action, and with it came an abundance of regulation seeking to improve quality, lower costs, increase access to affordable care and even transition the physician payment model from one based on volume, to value. Everything proposed in the legislation is of course well-intended, but carrying it out for individual healthcare organizations has proved much easier said than done.

As a physician-led organization; however, OC has been quick to respond to and implement these changes. And while working for the department at OC designed to facilitate these changes, I have watched OC grow over the course of this year… So much so that its leaders now mentor other orthopedic groups making similar changes. How cool.

 

Connection. That, however, is the view “from the hill” of my work this year. As I discussed in my previous blog post changing healthcare on a micro-level calls for massive shifts in culture and individual interactions, which is no easy feat. Most of the past connections I can make here have to do with my experiences as a patient, but also my experiences abroad. My independent research examining low-income access to healthcare in Tokyo, my assistantship in a maxio-facial surgery department in Germany, and my volunteer work in a regional hospital in Tanzania, together have helped me develop a critical eye for examining differences in healthcare institutions and their overall structure. I think it is the culmination of these experiences that have helped me to better analyze the challenges organizations like OC face to keep patients at the center of care while evolving standards that provide the best care at the lowest cost.

 

Personal relevance. I started at OC a year ago with the overarching goal of better understanding the U.S. healthcare system. And while I do have a better grasp of the influences on hospital decisions and patient care – federal programs, health policy, scientific research, individual physician practices, etc. – it is such a confusing and complex process. I believe it is this confusion; however, that pushes me to want to better understand and help to improve the healthcare system.

I am excited to say that I will be building upon this knowledge even after my fellowship ends. Next year I will be heading to Boston University School of Public Health. It is my hope that I can take the knowledge I will learn and apply it in my role as a healthcare provider one day and become a positive influence on the choices and decisions that make up the healthcare system as it continues to evolve.

This year, my Impact Fellowship with OC has helped me to grow professionally, personally and has continued to fuel my motivations and passions for making a difference in this world. I could not have asked for a more fulfilling “first year in the real world”. And to everyone who has made this experience possible, thank you.

The best way to predict the future? Create it.

1.            In 2004, Donald Berwick, physician and CEO of the Institute for Healthcare Improvement (IHI), challenged hospital administrators to save 100,000 lives in 18 months. In what became known as the 100,000 Lives Campaign, the IHI convinced thousands of hospitals to alter their behavior and institutionalize new standards of care. His team created an individualized step-by-step agenda to reduce medical error through process improvement. They provided research, instruction guides, and training. They opened up communication lines between hospitals to provide the opportunity for council. Altogether they saved 122,300 lives.

This was a massive change in health care. Not only because it challenged hospitals to change their traditional practices, but because it required hospitals to admit error and acknowledge that something in their system needed fixing. Dr. Berwick accomplished something that I am learning is rather hard to do within, let alone across healthcare organizations. Create culture change.

“Never doubt that a small group of thoughtful, committed individuals can change the world. Indeed, it’s the only thing that ever has.” – Margaret Mead

I haven’t personally saved 100,000 lives yet, but however small my role, I have helped the value-based services and quality department to make significant steps towards culture change at OrthoCarolina. I have helped OC to establish and maintain quality improvement processes in things like coordinated care and bundled payment care models. I have learned how to manage projects to test and create change in the clinic, I have helped implement a risk assessment for Medicare patients to better predict their care needs post-surgery, and most importantly, I have developed a keen eye for identifying areas of process change and quality improvement in healthcare. Every day I am inspired by my mentors and I am challenged to think of innovative and sustainable ways to improve the quality of care and the overall experience for our patients.  So on many occasions I think back to Dr. Berwick and the IHI… That’s what we’re trying to do here.

2.            Community involvement has become increasingly important to me during my post-grad life. Last year, Megan, the previous Davidson Impact Fellow, wrote of OrthoCarolina’s dedication to philanthropy and volunteerism. And to be honest, I underestimated how much I would truly value the experiences I have gained as a result of this commitment. Though now that my inbox is flooded with weekly educational and volunteer opportunities, I wouldn’t have it any other way. To the college students reading my blog—I encourage you to stay involved in the community when you graduate! The experiences you gain outside of the office, outside of the classroom, outside of your circle of friends, are so important. Trust me on this one. 

Some of the highlights of the last six months include: an all-day TedX event sponsored by OrthoCarolina where I heard from various local non-profits about their work towards social change in Charlotte, a day spent packing Christmas boxes with Operation Christmas Child, an afternoon baking cookies with residents at the Ronald McDonald house, and time spent helping to develop a specialized classroom program for our pediatric patients (more on that later!).

3.            In the beginning of February, I helped Davidson to complete the first-round interviews for six of the 65 applicants for the 2016-17 Davidson Impact Fellowship program. It is amazing to see so many students interested in the social sector! It was a long, but extremely rewarding day as I got to hear from various Davidson students about their passions and motivations for wanting to have a positive impact our society.

At the end of each interview, nearly every student wanted to know about the support system provided through Davidson and the mentor-ship component of the fellowship. As you may know, the program has monthly conference calls where we have the opportunity to update one another on our individual placements and seek any outside peer-support. We usually review an article related to philanthropy or non-profit work before the call then analyze the relevant topics on the call… It feels a lot like one of my old seminars, but I do really appreciate the opportunity for discussion. Another crucial part of the program and for me specifically, is that of the trifecta of mentors—the clinical quality manager at OrthoCarolina, a cardiologist at Novant Health, and a first-year medical student at Wake Forest. In my next blog I promise I will go into more detail about my mentors! The bottom line is that they are awesome and have provided me with opportunities that otherwise would not have been available to me. I often forget that this unique mentor-ship component is not as accessible to all Davidson graduates and it is something in which I am truly grateful.

4.            I just recently attended an ‘Evening with Dr. Atul Gawande’ talk in downtown Charlotte. Dr. Gawande is a general and endocrine surgeon who also happens to be one of today’s greatest innovators in healthcare and my personal hero. Needless to say, my friends and I were beyond excited! Like children waiting for autographs at the end of a major league game, we waited patiently following the talk to get our pictures taken with Dr. Gawande and our books signed. His talk paralleled some of the questions we grapple with on a daily basis here at OrthoCarolina. How do we fix the healthcare system? Are we doing what is best for the patient at this moment in time? How can we be better communicators and empathizers with our patients?

In reflecting on the talk, I keep returning to one comment in particular that Dr. Gawande made during the Q&A. A physician in the audience asked him about what hope Dr. Gawande has left for positive changes being made in healthcare. This physician was specifically reflecting on his experience with patients searching for the ‘quick-fix’ solution and being non-adherent to treatment plans. Dr. Gawande paused then he said, “This rests on the younger generation. As young people enter into medicine their question is, ‘What is the environment I’m going to be practicing in?’ My hope, and I’ve seen this with my residents, is that the younger physicians will not want to practice in an environment like this and they will do whatever it is they can to change it”.

5.            I know the list I have given you is quite a collection of unfinished thoughts, but my hope is that you are able to see the connections throughout and how these ramblings come full circle. I have not updated my blog in awhile so to the best of my ability I wanted to give you an update on everything that has been going on the past several months… which is a lot! All in all though, I truly feel that I am learning how to create step-by-step change in a healthcare system and how to best make a difference when I become a physician. That’s what I’m trying to do here.

 

What does it mean to be a Davidson Impact Fellow?

“So what exactly do you do?” When I first started here at OrthoCarolina (OC) I struggled to answer this question when my friends or even coworkers would ask. As a collective, the Davidson Impact Fellows share similar values and sometimes even the same goals, but individually, our job descriptions differ greatly. I found that each time I was being introduced to someone new, my title would change slightly or my responsibilities would broaden to encompass the work of many different departments within the hospital system. Clearly, I was not the only one who was unsure about my role. OrthoCarolina is a large, orthopedic practice and for ease of understanding, with most job titles, it is generally easy to infer what that certain job entails. But not for an Impact Fellow, and while at first this was an uncomfortable feeling, it is something that I have grown to absolutely love.

What does it mean to be a Davidson Impact Fellow?

Beginning my fellowship, I was fortunate enough to have the former fellow, Megan Garzon ’14, by my side to guide me through the introductions, to help integrate me into the workflow, and to ultimately, teach me what it means to be an Impact Fellow at OrthoCarolina. She has helped me to realize that the learning experience laid out before me is truly one in which I have the opportunity to develop geared towards my individual interests and one that will evolve over the course of my fellowship year. She has also helped me to realize the ways in which I can explore the areas in healthcare that are important to me and my journey to becoming a physician (thanks Megan!).

For those of you still reading and interested in health care, the rest of this article (I hope) is going to be very insightful. I am going to talk about patient needs, community values within the healthcare system, and a few other efforts towards sustainable healthcare solutions that I have stumbled across while working at OrthoCarolina. I’m going to describe to you what my ever-changing job description actually looks like at the moment. (And to those readers I lost at the first mention of ‘health care’, I bid you farewell and hope that you will take the time to read about the amazing experiences of the other Davidson Impact Fellows!).

So right now I am working on a number of innovative patient care initiatives with the Value Based Services team here at OC. I want to stress the importance of value-based as it is a huge part of my role and because it is a relatively new concept in healthcare that honestly, for the first several months of working here, I did not fully understand. The basic idea behind value-based services is to focus on patient values and aspirations rather than just expressed needs in order to better plan, monitor, and evaluate specific program initiatives.

The problem with focusing on needs rather than values is that in most cases solutions to these problems are neither sustainable nor empowering enough to create ever-lasting change. Essentially, you want to make sure you are asking the right questions (whether it is to your patients or fellow health care administrators, etc.) in order to provide answers that lead to practical actions and improvement. I help determine how to improve the health care process and patient experience, whether it is asking the right questions, creating new and innovative solutions to improve physician and patient reported outcomes as well as overall satisfaction scores, or simply helping to elevate the preexisting community.

Over the course of this year, I look forward to further involving myself in the community that is OrthoCarolina and also, updating you on the progress of the array of value-based projects that are quickly taking over my post-Davidson life. By the end of this year I hope to not only be able to give you a better picture of my role as a fellow is, but personally, to confidently answer the big, open-ended question, “Why do you want to be a Doctor?” A question that I am excited to see how OrthoCarolina and my mentors, including those supplied to me through the Davidson Impact Fellowship program, help me to answer. Until next time!What does it mean to be a Davidson Impact Fellow?

 

 

 

'Tis the season at OC

This holiday season has been the time to give back to the community in OrthoCarolina. OthoCarolina offers to pay for hours employees volunteer during work hours and I took full advantage. The first event I participated in with my OrthoCarolina team was Operation Christmas. A group of 12 went to pack boxes for children all around the world who cannot afford the type of Christmas we get every year. It was hard not to imagine the girl or boy who would be receiving the package you were stuffing with dolls, slippers, toothpaste, rings, balls, notebooks, pencils and crayons.  It was an energetic community service and one I haven’t done before.

'Tis the season at OC

The project I most recently participated in and am really excited to continue here with OrthoCarolina is a partnership with Camino Community. The event I volunteered for was their annual Turkey-giving event. The day started off with a small prayer before serving a meal prepared by the local staff and volunteers. Everyone was welcome to join. As people arrived they were given numbers to participate in the pantry “pan de vida”. We took individuals through the shelves and placed veggies, rice, beans, fruits, yogurt, eggs in their carts. The amount corresponded to the size of their family, which ranged from an individual to nine and at one point even 17 people. In the end, every family received a turkey, chicken or ham. I enjoyed being able to take the individual’s through the pantry and hear all about their families and stories. Midway through we started to run out of supplies in the pantry and OrthoCarolina team members ran quickly out to the store to replenish the stalks.  It was awesome to see so many people committed to a cause and have the OC team energized and ready to fill in any gaps. Although not everyone understand spanish (and trust me they heard a lot of it) you could tell that they were enjoying spending time with the community and helping out. I could see how much this experience created an impact on them.

At the end of the event, I got exciting news: from this volunteer opportunity emerged another. Dr. Murrey and Brent Shear talked to the directors of the center in an attempt to help set up a small clinic for orthopedic consults and physical therapy at free/small cost. They asked me to help as the mediator for this process. This New Year will be an exciting one! I am happy that OrthoCarolina found another way to give back to their community and I get to be actively involved. I appreciate how my role here in OrthoCarolina is slowly evolving!

 'Tis the season at OC

Part of OC

Let me tell you the first few months at OrthoCarolina passed by in a blur. On one hand I was focused on adapting to the lifestyle of working from 8 to 5 and on the other I was trying to keep up with my med-school goals. It was harder than I expected to graduate from college and enter the real world even though I was lucky that Charlotte was partly familiar to me and I was living with a friend.  The first few days on the job consisted of learning and remembering different passwords, protocols, benefits and a lot of terms I was unfamiliar with: Vanguard? What’s that? At home, I would research anything I didn’t know or, you know, asked my mother what they were talking about.  Every opportunity is a learning opportunity!

Part of OC

The first few weeks, I was sharing the office with my supervisor Carole, the VP of Clinical Operations.  Carole was amazing and would answer any questions I had and directed me to the people I needed to talk to in order to further along my project. She also took her time to get to know me and told me jaw-dropping stories of when she was training to be a nurse.  I have a feeling I will be looking back to her anecdotal stories when I am a medical student. Throughout the week, Carole kept sending emails left and right “introducing” me to people, which was a strange concept to me at first since I never actually met them until later. Finally, I got to meet someone new face-to-face: Susan from the OrthoCarolina Research Institute came to talk about helping me with the research component of my project. That same day, we all met with Dr. Murrey to talk about my purpose at OrthoCarolina.  I was a little nervous at first, but once the discussion started flowing I forgot all about it. I left Dr. Murrey’s office energized and ready to jump into developing this tool, but had to stop myself because that first required a lot of reading to get comfortable with the topic.

Part of OC

OrthoCarolina is committed to providing excellent care and service. They are constantly working on ways to make healthcare more affordable, understandable and tailored around the patient needs.  My project has to do with the latter. When a patient walks through the doors, they carry a certain set of expectations and needs. Satisfaction surveys give us more information on the service provided, but sometimes does not reflect the subjective needs of the patients that were not met. For example, a patient is glad the wait long to see the doctor was short, but felt they did not get enough information on how to minimize pain. When a patient is dissatisfied they might not comply with treatment or turn to alternative medicine and other providers to try and satisfy their unmet needs. Either way, a patients’ health could be compromised and lead to increased costs of care for patients. The purpose of my project is to develop a tool that will help identify the needs of patients and what they are expecting to receive from an appointment. Using this tool we hope to not only improve the patient experience and tailor the appointment to the individual, but hopefully make an encounter more effective and efficient. In other words, we are tackling that burning question in healthcare, what makes a patient feel healed?

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