Tracy’s guest on this episode of Lit Health is Dr. David Mayer, Executive Director of the MedStar Institute for Quality and Safety, where he leads quality and safety programs in support of discovery and learning and the application of innovative methods to operational clinical challenges. A cardiac anesthesiologist by training and a medical educator by passion, Dave has spent the last three decades fighting for a safer healthcare delivery environment and recently served as CEO of the patient safety movement Foundation, where he led global patient safety efforts and initiatives in sixty-four countries and over 4,800 hospitals. He’s currently at work on a memoir of sorts, detailing his walk across pandemic-hit America during 2020 to keep all eyes on the continued need to make healthcare safe for patients and providers.

Dave starts the episode with the story of starting his cross-country walk and how it was inspired by his frustration with the lack of progress in healthcare safety during his thirty-year career and his desire to do something out of the ordinary to draw attention to this crisis. He then explains that the COVID-19 pandemic hit just two weeks into his walk and discusses the things that surprised him most about the country’s response, including the social unrest in many cities and the polarized reactions people had to masks (including threatening Dave for wearing one). He also points out one of the best things about his walk—being joined by patients and families who had lost loved ones to preventable medical harm—and speaks about the impact patient advocates have had on his career, as well as his realization that focusing on personal stories and narratives is necessary to help people understand the importance of healthcare safety on a human level. Next, Dave discusses his summer camp program, the Academy for Emerging Leaders in Patient Safety, its history and development, and its impact in informing and training emerging and future healthcare leaders in advocating for and implementing quality and safety concepts in their organizations. He also talks about the need to include the softer sciences, such as communication, leadership, and teamwork, in medical education and how the medical profession can learn about this from aviation and other high-risk industries. Dave then returns to his book, sharing his hope that it will help readers connect the statistics on preventable medical harm with the personal stories he’s gathered and encourage more people to take action by asking their leaders why more isn’t being done to make healthcare safe for patients and workers. And he wraps the episode up by explaining the developments he believes are necessary to improve quality and safety, including setting up a National Patient Safety Board and increasing transparency in quality and safety outcomes so that patients can make informed decisions on who provides their care.

Highlights:

• Dave’s other achievements include founding and leading the annual Telluride International Patient Safety Roundtable and the Academy for Emerging Leaders in Patient Safety Summer Camp for the last thirteen years. He also serves on numerous boards and has been recognized multiple times for his leadership and work elevating safety and quality in medicine.
• Dave also co-produced the patient safety educational film series entitled The Faces of Medical Error… From Tears to Transparency, which won numerous awards, including the prestigious Aegis Film Society Top Short Documentary Award.
• In February 2020, Dave decided to walk across the country to raise awareness about healthcare safety for both patients and healthcare workers, planning to visit major league ballparks and take in a game at each one.
• Two weeks after Dave started his walk, the pandemic hit, eventually resulting in the book he’s working on, set during the worst pandemic we’ve had in a hundred years and a year which saw both political and racial polarization.
• The burning platform of the book is the need to raise awareness about the third leading cause of death in the US—preventable medical harm to patients—and the unsafe conditions of working in healthcare.
• The two most surprising things Dave encountered during his walk were the social unrest that erupted in many cities and the polarity of the country around wearing masks.
• One of the best parts of Dave’s walk was the patients and families who came out and walked with him, including those who walked in memory of their loved ones, trying to raise more awareness about the issues around health care safety.
• Dave has done a lot of work with patient advocates during his career, and many of them have become friends and colleagues, teaching side-by-side with some of the world’s top safety experts in many of the programs Dave offers.
• Dave credits two things with changing his approach around the power of stories and narratives: Rosemary Gibson’s book Wall of Silence and meeting Helen Haskell, whose fifteen-year-old son Lewis Blackman died as a result of preventable medical error.
• In 2004, as the Academic Dean at the University of Illinois, Dave wanted to build a curriculum around patient safety and quality but found there was next to nothing published. So he set up a group to research how to build the curriculum and published their findings in the journal Academic Medicine.
• In 2010, the group got a small meeting grant to run a workshop based on the curriculum, which eventually turned into four-to-five week summer camps in the US and around the world, training students and future healthcare leaders in the importance of patient safety and the tools and techniques to reduce risk and communicate about medical error.
• Now known as the Academy for Emerging Leaders in Patient Safety, the program had to shut down for two years because of the pandemic but is returning this summer with three weeks of camps.
• The Academy is one of Dave’s greatest pleasures, as its 1,500 alumni are now in positions not only to ask why safety concepts and techniques aren’t being implemented but to implement them themselves.
• Thanks to the examples of aviation and other high-risk industries, the healthcare industry is learning that what people refer to as the softer sciences (communication, leadership, teamwork, etc.) are all necessary components for an effective and safe healthcare system.
• Dave’s hope is that his book will help readers connect the data on deaths from preventable medical harm and the personal stories of real human beings whose lives have been changed by the unnecessary loss of their loved ones.
• The book is a call to action for people to start rising up and asking their congressional leaders and their politicians why more isn’t being done to improve patient and staff safety in healthcare.
• Dave and many others believe it’s necessary to create a National Patient Safety Board where healthcare workers can learn together and share that learning across the country with hospitals so it can be implemented. He also believes quality and safety outcomes should be reimbursed, and those outcomes should be more transparent.

Quotes:

“Crazy idea, I decided to walk across the country, trying to raise awareness about healthcare safety both for patients and healthcare workers. And I started in February of 2020, and one would say it was a crazy idea for a sixty-seven-year-old physician to try to navigate across the country in any year.”

“For thirty years, I’ve been standing on podiums, in front of podiums, I’ve been talking about urgency around preventable medical harm, and for thirty years, we hardly made a difference. The results and the outcomes were not changing. And I just decided I needed to do something different. I needed to do something so drastic, so out of the ordinary that maybe it would draw attention to this crisis.”

“We all knew that it wasn’t safe working in healthcare. The injury rates, the needlestick injuries, the workplace violence injuries made healthcare a dangerous profession to work in, and that was before the pandemic. And now with the pandemic, we’ve seen the issues and challenges of burnout, depression, increased suicide of healthcare workers because of the strain, both emotional and physical, that they’ve been under over the last two years.”

“I am at high risk for potentially capturing or catching the virus. I’m sixty-seven years old. When I started my walk, I had just finished treatment for two cancers. And so, I took whatever precautions I could to stay safe during the pandemic, be it here in Arizona or when I was walking through cities across the country. And there were times that I was threatened for wearing a mask. People would come up to me and literally say, ‘Get that damn mask off your face.’”

“There’s two things that really changed my approach around the power of stories and narratives. The first was reading Rosemary Gibson’s book, Wall of Silence—seventy-five different stories of patients and family members and what they wanted from healthcare after preventable medical harm. There wasn’t stats, there wasn’t data, it was just stories and narratives that really opened up your heart. Some of them hit you in the gut.”

“I always felt that we needed to introduce the students to the concepts of safety and quality early in their career. And I wasn’t the first to say that, there were a number of people in aviation who recommended this to the Institute of Medicine that if you’re going to change culture, you have to start early in the process when nursing students, medical students, pharmacy students enter into the profession and then build on it.”

“We’re going to have close to 1,500 alumni, who are now in leadership positions, who are now out practicing medicine in the healthcare arena, who have gone through our program and understand these concepts. And not only are they asking questions about why they aren't being implemented, but many of them are going out and implementing or leading their organizations in quality and safety. So that has to be one of the greatest pleasures I have is to push it forward, so to speak, and educate the next generation because that’s how you change culture.”

“The statistic of the British Medical Journal saying 251,000 people estimated die every year from preventable medical harm, by Marty Makary, that’s wonderful and important information. But people just see it as data points. They don’t understand, these are human beings whose lives have changed forever.”

“I’m hoping this book connects the reader to understand it’s not data and statistics and third, or fourth, or fifthly. These are real human beings that we need to take care of. We need to improve the safety of our health system so that future patients, future caregivers do not suffer or die needlessly.”

“Hospitals still get paid by the quantity and volume of the work they do. And very little, if any, gets paid by the quality and safety of those outcomes. So unless you change that metric, unless you make hospitals have more skin in the game to improve the quality and safety, more penalties when harm goes astray that they haven’t corrected, and it continues to happen over and over again, we’re gonna have the same thing.”

“Before I ended up finishing my 2,452 mile walk across the country from San Diego to Jacksonville Beach, Florida, I said if the walk saves one life through the close to eighty television, radio, and podcast interviews I’ve done about the walk, then it was well worth every step.”

Show Links:

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Dr. Mayer's Bio