Lit Health

Integrating AI into Healthcare with Raj Ratwani

Center for Healthcare Narratives — Thu, 11 Jan 2024 03:30:00 -0500

Today, Raj Ratwani, Vice President of Scientific Affairs at the MedStar Health Research Institute, Director of the MedStar Health National Center for Human Factors Engineering in Healthcare, and an associate professor at the Georgetown University School of Medicine, joins Tracy Granzyk to explore the intersection of patient safety and data in our U.S. Healthcare System. They explore the vulnerabilities introduced by electronic health records (EHRs) and artificial intelligence (AI) in healthcare, as well as the opportunities to improve the delivery of care using both tools. An expert in patient safety, digital health, and cognitive science, Raj engages in an informative and insightful conversation with Tracy highlighting patient safety, workforce readiness, and equitable AI applications in healthcare technology.

Raj begins by acknowledging President Biden's forward-thinking AI Executive Order, emphasizing its significance for healthcare and the need for proactive adaptation to AI integration. Central to the conversation is patient safety in the AI landscape, with a focus on establishing a comprehensive patient safety framework for AI. This framework centers on data collection, analysis, and dissemination to address AI-related patient safety concerns. The challenges of preparing the healthcare workforce, the importance of imparting essential AI knowledge, understanding potential challenges, and maintaining expertise in both traditional and AI-augmented healthcare are also discussed. Additionally, our duo touches on AI's broader impact across industries, emphasizing the importance of individuals acquiring AI-related skills to remain relevant in their careers. While addressing the fear of technological change, they highlight the opportunities that come from embracing AI and actively shaping its narrative. They also underscore the vital role of public-private partnerships in advancing AI while maintaining a balance between providing guidelines and fostering innovation in the dynamic AI landscape. Join Raj and Tracy today as, together, they guide us through the transformative era of AI in healthcare, prioritizing patient safety and excellence to ensure a safer and more equitable future.

Highlights:

Patient safety and EHRs
Interoperability challenges
AI impact on healthcare
Equity in healthcare tech
Stakeholder collaboration
Monitoring and regulations
Patient-centered care
AI readiness and innovation

Quotes:

"We have to make sure that these clinical algorithms have the right data sources that are underlying or leading to the development of them so that we have safe and equitable care for everybody."

"Patient safety is not always top of mind for people. To see that explicitly called out in the Executive Order, I think is fantastic."

"We have to look at this as an opportunity and latch onto this and figure out the right ways of integrating things that we're doing and take the best parts of it."

"We want to take all the things that humans are good at and preserve it and complement it with the computers and the artificial intelligence that can take care of all the things that we're not so good at."

"If we are going to take another decade to figure out AI from a safety perspective, we're in a lot of trouble."

Links:

LitHealth Homepage

MedStar Health

Raj Ratwani's LinkedIn Page

Converting Personal Tragedy into Healthcare Safety for All with Armando Nahum

Center for Healthcare Narratives — Thu, 26 Oct 2023 03:30:00 -0500

Joining Tracy for today’s episode is the truly remarkable Armando Nahum, a former patient advocate who has transitioned into an tremendously influential healthcare activist. Armando's inspirational story and educational presentations born out of his own family’s tragedy have left a profound mark on hospital administrations and frontline caregivers across the nation. Among his many achievements, he has become widely celebrated as the co-founder and president of Safe Care Campaign, an organization dedicated to infection prevention in hospital settings. He also holds key positions on various healthcare advisory boards and councils, including the CDC Council on Infection Prevention and the Georgia Hospital Association Advisory Board. In addition to being instrumental in establishing Patient and Family Advisory Councils (PFACs) aimed at enhancing quality and safety at hospitals across the country, Armando, in a highly significant achievement, was appointed to the Presidential Advisory Council for Combating Antibiotic Resistant Bacteria in February 2020. Most recently, he is a founding member of Patients for Patient Safety US in partnership with the World Health Organization (WHO), where he is leading influential healthcare policy change driven by patients and families.

In today's episode, Armando shares the patient advocacy journey that he and his wife, Victoria, embarked upon back in 2006 following a series of infections that impacted their family across three different hospitals in three states, and which tragically resulted in the loss of their son, Josh. He also shares sage insights, emphasizing the pivotal role of patient and family engagement in healthcare. The conversation delves deep into Armando's personal experiences and explores broader themes of patient advocacy, PFACs, and the critical importance of transparency within healthcare. Vitally important topics covered in this enlightening discussion also include the necessity of cultivating a culture of safety and the unification of patient experience and safety. Armando's remarkable journey from personal tragedy to impactful advocacy serves as a powerful reminder of the need for change and improvement in healthcare. Through education, transparency, and the establishment of a culture of safety, he advocates for the construction of a healthcare system characterized by integrity and compassion. Armando's legacy is a resounding call to revolutionize healthcare for the betterment of all individuals involved.

Highlights:

Armando's journey
The power of patient advocacy
Patient and Family Advisory Councils (PFACs)
The need for full transparency in healthcare
Culture of safety
Patient experience and safety
Patients for Patient Safety US (PFPS US)

Quotes:

"You need to be aware that healthcare events can happen to anyone. It's not just a select few."

"In healthcare, we tend to spend more time on ‘after the fact’ than ‘before the fact’. We should spend more time before."

"The patient experience has to encompass quality and safety. The minute you separate them, that's when trouble starts."

"People need transparency in healthcare. There's no reason for institutions to hide behind their attorneys."

“If you have a PFAC, you're not using it correctly unless they go out in the community and start educating. To me, education is at the forefront.”

Links:

LitHealth Homepage

Patients for Patient Safety US

Amplifying Patient Voice to Improve Care with Martin Hatlie

Center for Healthcare Narratives — Wed, 30 Aug 2023 03:30:00 -0500

Tracy welcomes esteemed patient safety advocate and President/CEO of Project Patient Care, Marty Hatlie, to the podcast today for a conversation that delves deeply into the core of patient safety and the integral roles patients and families play in elevating healthcare outcomes. Together, they engage in a timely dialogue which underscores the urgent call for a healthcare landscape that treasures transparency, equity, and the voices of marginalized populations. Marty's personal journey from a lawyer advocating for doctors to a fervent patient safety advocate is also unveiled, highlighting the challenges and potentials within patient safety.

Emphasizing the significance of systems thinking and accountability as catalysts for enduring transformation, Tracy and Marty reinforce the critical value of patient engagement and federal leadership while offering a revolutionary perspective for a new era of patient safety and equity. The episode also explores COVID-19's impact on patient safety and healthcare disparities, and introduces The Academy for Emerging Leaders in Patient Safety focusing on its mission to connect patient narratives with education to foster cultural change. As the episode concludes, our duo rallies listeners to partake in such patient advocacy and transparency endeavors as Patients for Patient Safety US. Join Tracy and Marty here today to gain crucial insights into this noble initiative to revolutionize healthcare for the betterment of all individuals and embrace a holistic vision of well-being, safety, and equality in the healthcare realm.

Highlights:

Marty Hatlie's leadership and career evolution from medical-legal defense attorney to his staunch patient safety advocacy and work reforming patient safety
Addressing decades of slow moving improvements in healthcare safety with a call to address the stagnation in patient safety advancement of late
The urgent need for openness in healthcare
Connecting patient safety with health disparities
Healthcare transformation via federal leadership, accountability, and culture change
Fostering change through systems thinking and safety science in healthcare education
Recognizing the role of patients and families in driving innovation and accountability
COVID-19 Insights

Quotes:

"We've lost the belief that the healthcare system can fix itself. It's just not going to. What we need is that paradigm shift towards systems thinking and transparency."

"The conflation of safety and equity is going to be a very exciting part of our next chapter, really looking at the data and looking at how some people just don't get the kinds of fairness in the healthcare system that we all deserve."

"This is a system that's supposed to work for me. And if it doesn't work for me, I'm entitled to speak up and say something about it."

"It shouldn't be our job ethically as patients and family members to be the agents for change. But again, it's been 20 years. We haven't seen it happen."

"We still fight with people just to get safety even on the agenda of the undergraduate curriculum."

"The challenges of driving transparency in healthcare are immense, particularly when the system resists change."

"COVID-19 exposed vulnerabilities within the healthcare system, particularly in nursing homes, leading to discussions about infection control and the importance of patient advocacy."

Links:

LitHealth Homepage

Project Patient Care

The Academy for Emerging Leaders in Patient Safety

Patients for Patient Safety US

Advocating for Mom and Medical System Reform with Steve Burrows

Center for Healthcare Narratives — Fri, 20 Jan 2023 03:30:00 -0500

Steve Burrows is a writer, director, performer, and producer who began his career in Chicago, joining Second City director Dell Close as a member of the critically acclaimed and groundbreaking improvisational comedy group ‘Baron's Barracudas’. After relocating to Los Angeles, Burrows began his film and TV career with an award-winning short film, "The Soldier of Fortune." Since then, he has gone on to win over 75 awards for writing and directing television commercials on five continents.

After Steve’s mom was harmed by medical care in Wisconsin, he took time out from his successful film career to advocate for her. In this episode of Lit Health, he touches upon his fascinating career, why stories matter, and delves deeply into his experience with the medical system, its need for policy reform, and the role he has taken on as an advocate in this space with our host, Tracy Granzyk.

Highlights:

Steve’s background in comedy and storytelling
His experience with the medical system while advocating for his mom
His award-winning documentary film, Bleed Out
The need for change in the medical system
The need for more accountability in the healthcare industry
The importance of patient advocacy and how patients can protect themselves
The role of the media in bringing attention to healthcare issues
The potential for change in the medical system and the need for policy reform
The power of stories to drive change

Quotes:

"The medical industrial complex is so large and so powerful, it's hard for the average person to navigate."

"If you don't have a voice, you don't have a choice."

"We need more accountability in the healthcare industry."

"Patient advocacy is not only a right, it's a responsibility."

"The truth is the only thing that will set us free."

Links:

LitHealth Homepage

Steve Burrows

HBO Documentary: Bleed Out

Advocating For Your Best Life with Clarinda Ross

Center for Healthcare Narratives — Thu, 29 Sep 2022 03:30:00 -0500

Tracy’s guest on this episode is Clarinda Ross, mom of three and accomplished actress, writer, and special needs advocate. Clarinda began her journey as a patient advocate thirty-three years ago when her daughter Clara was found to have developmental delays, the experience of which she channeled into her one-woman show Spit Like A Big Girl. Clarinda begins the episode discussing her experience parenting a child with special needs and navigating the healthcare system two years before the Disabilities Act was signed into law. She describes how the challenges of getting the right care for Clara forced her to develop real gumption in ensuring that her daughter could live her best life, including letting her go when the time was right. She also discusses how forming an advocacy team, including speech and occupational therapists, helped ensure Clara’s needs were understood by the school and healthcare systems.

Next, Clarinda talks about Spit Like A Big Girl, how it developed from her experiences in childhood and parenting Clara, and the impact it’s had, particularly in making healthcare professionals rethink their approach to special needs patients and their families. In particular, she discusses the tendency for special needs diagnoses to be framed as death sentences and argues that while your child may have a different life than you imagined, it can still be one filled with joy. Tracy then asks Clarinda to talk about how she’s extended the skills she’s gained as an advocate for Clara into advocacy for other family members, including her mother and husband. Clarinda explains that while the healthcare system is improving in terms of listening to patients and sharing records, it’s still wise to take a trusted person with you when meeting with healthcare professionals to have someone who can take down all the details and back you up when necessary. And finally, Clarinda closes the show by sharing a little about how Clara’s doing today, at age thirty-three, settled in a group home, and living her best and most independent life.

Highlights:

Becoming a parent to a child with special needs
How Clarinda ensures she and Clara live their best lives
Learning to let go when your child has special needs
The impact of Spit Like A Big Girl
Becoming a patient advocate for other family members

Quotes:

“Somewhere around two, when I got some really definitive tests saying that the gaps were not going to close all the way, and this was going to be a lifelong care situation, I did not sit down. I did not, you know, cry. I thought, okay, well then what can I do to give her the best life? How can I do that? And I just… I just pushed on.”

“I came out the stage door, and there was an older man waiting there for me. And he was a doctor, and he just had tears in his eyes. And he said, ‘You made me think. You made me think about the way that I talk to mothers.’ He was a pediatrician there in the town, and I said, ‘Well, good. Yay! I’ve had a great day’s work.’”

“This play is a love letter to occupational therapists. I have a whole section in there that I call ‘the Church of Occupational Therapy.’ I used to be a Methodist, but now I am devoted to the Church of Occupational Therapy because it works.”

“It doesn’t have to be a death sentence. What it has to be is… it might not be the life that you thought your child was going to have and the relationship that you were going to have with this child, but it can be full of joy.”

“If it’s not like that, if it’s not you’re in a life-threatening situation, and especially if they are wanting to operate on you, take a minute before you do anything invasive. And ask questions, and get that person to come and sit with you, and get that other opinion, and another opinion.”

Show Links:

LitHealth Homepage

Clarinda's Homepage

Spit Like a Big Girl

A Walk Toward Healthcare Safety with Dr. David Mayer

Center for Healthcare Narratives — Mon, 27 Jun 2022 03:30:00 -0500

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:

LitHealth Homepage

Dr. Mayer's Bio

Finding ‘Grace in the Carnage’ with Author Deanne Stillman

Center for Healthcare Narratives — Mon, 10 Jan 2022 03:35:00 -0500

Author Deanne Stillman, a widely published, critically acclaimed writer of literary nonfiction joins Tracy on the podcast today. Her latest book, Blood Brothers, won the 2018 Ohioana Book Award for nonfiction, received a starred review in Kirkus, and was excerpted in Newsweek. The book they’ll be discussing today is Deanne’s 2001 work Twentynine Palms, an LA Times bestseller and Best Book of the Year, which Hunter Thompson called “a strange and brilliant story by an important American writer.” Twentynine Palms tells the story of the murders of Mandi Scott and Rosalie Ortega by Marine Valentine Underwood, recently returned from the Gulf War. Through this tragedy, the book takes a deep look at socioeconomic health disparities through the lives of those who choose to call the desert home, living in the shadows of the world’s largest Marine base at the edge of Joshua Tree National Park.

Tracy begins the episode by talking about Twentynine Palms’ relevance to healthcare, pointing out its focus on social determinants of health, specifically the poverty that underlies the book’s desert community. She then hands the discussion over to Deanne, who speaks about her lifelong connection to the desert and its status as a sanctuary for many people looking to start their lives over, before setting out the story of Twentynine Palms and how she came across the murders of Mandi and Rosalie. Tracy points out the link between location and health and wellbeing, and Deanne speaks about the fatherless, rootless desert community depicted in her book and how its real focus is America’s working class. She also points out that, just like the desert, the US military provides escape from dire circumstances for people all over the world, including those women who marry into the armed forces. Tracy and Deanne discuss the #MeToo movement, how sexual violence affects women of all classes, and how important it is for everybody to have a voice in society. Deanne also relates the story of the Mandi Scott Scholarship, set up by Mandi’s mother, Debbie, and discusses how even a seemingly small amount of money can make a huge difference to a young person wanting to change their life. Finally, Deanne gives us a look at her new project, Ghost Cats, a book focusing on the last mountain lions of Los Angeles. An important conversation with a truly ‘important American writer’, today’s episode is one you absolutely do not want to miss. You can find 29 Palms via Angel City Press

Highlights:

- According to a recent Blue Cross Blue Shield survey, zip code predicts up to 60% of our wellbeing and our health. San Bernadino County has California’s highest rate of poverty relating to single mothers.

- Deanne’s essays have appeared in Lit Hub, The Independent, The New York Times, LA Times, High Country News, and The LA Review of Books, where she was formerly a columnist.

- She found her way into Mandi and Rosalie’s story after a hike in Joshua Tree when she stopped in at a local bar and overheard some gossip about two girls who had been “sliced up” by a Marine.

- Mandi’s family came west with the Donner party and managed to survive, settling in California; Rosalie’s family is Filipina, her mother grew up in a shack in the jungles of Batangas, marrying into the military as a means of escape.

- Absent or neglectful fathers are a theme that runs through the book, along with the nationwide epidemic of sexual violence against women.

- The murders took place on dollar drink night at the local bars, which occurs every two weeks on Marine payday and is a night that violence in town spikes.

- Some of the women and girls Deanne talked to had married members of the armed services because that was the only way they could get health insurance.

- Deanne takes on private students—you can reach out to her via the email address on her website.

- Deanne’s next project is a book called Ghost Cats, which is about the last mountain lions of Los Angeles (the only city in the world apart from Mumbai that has mountain lions living on its perimeter).

Quotes:

“I started living inside that poem and traveling along with that night across the wide-open spaces of the desert sands and galloping along with him across the Red Rock Mesas and into this enchanted land called Eldorado.”

“I had never been to the desert, I was living on the mostly frozen shores of northeastern Ohio, which I wasn’t crazy about. You know how you know when you’re born into the wrong place? I just, I don’t know, I never really felt acclimated to it. And I just always longed for wide-open spaces.”

“There’s the military, where men and women are trained to protect the country, but also in many uses of violence. Then there’s this incredible beauty of Joshua Tree National Park. It’s just a stunning place. And the Joshua Tree itself is this very magical cactus, which kind of looks like a radar station. And I feel that, you know, if you get quiet out there and listen, you can hear certain incoming messages.”

“I wanted to give them names and tell their stories.”

“Something I always look for in the stories I tell is, ‘where is the grace in the carnage?’”

“To me, it’s not a story of hopelessness that I was telling. It’s a story of what people do to endure.”

“Everybody has a legacy that can propel them, or maybe it’s hard to shake or both.”

“In a lot of ways, my book is all about class, which is America’s dirty little secret.”

“They took care of Marines. Before they were deployed, they babysat their kids, they cooked for them, they partied with them. They sent them off to war, they greeted them when they came home, and then they ended up being killed by one. So they are collateral damage, and they are patriots, and their bodies were left on the field in a sexual warzone.”

“I would say at any given time, one-third of my female students were writing about sexual violence, being raped, or, you know, other terrible tales involving their lives. And I’ve been hearing these stories, I would say, going on fifteen years now - so a nationwide epidemic of this kind of thing. And as you say, it pervades all classes.”

“Something I look at in my book is, ‘How can we get back to what’s sacred and how can we reconnect with the land?’ You know, it’s really important, and that’s why the desert is a main character in my book because it does, it provides comfort and beauty and solace.”

“One of the reasons I started PLEASE SEE ME, that online lit mag, is to really elevate the voices of vulnerable populations and those who care for them who haven’t had a voice. Everyone should have a voice when it comes to their health and have access to some type of quality care.”

“People would come into the bar where she was working during the months prior to the awarding of this scholarship, and they would donate, like, matchbook collections and food stamps, and it was really amazing. And this was all in service of raising $1,000.”

“That was the idea of this scholarship fund that, you know, was giving away $1,000 to help an average girl get out of town. I mean, that’s all it took. And that, to me, is a beautiful thing. You see what I’m saying? When I say I look for the grace in the carnage. There it is.”

“What’s sacred, and the land, wildlife - those are things that run through all of my work.”

Show Links:

Deanne’s website

Deanne on Twitter

Structural Racism in Healthcare with Dr. Ronald Wyatt

Center for Healthcare Narratives — Mon, 10 Jan 2022 03:30:00 -0500

In today’s episode, Tracy is joined by Dr. Ronald Wyatt, a global healthcare patient safety and quality improvement expert, and well known health and healthcare disparity and equity champion. Dr. Wyatt is also a Senior Fellow at the Institute for Healthcare Improvement, former co-chair of the IHI equity advisory board, and currently serves as faculty for the IHI Pursuing Equity Initiative and facilitator for the ACGME Equity Matters collaborative. During his illustrious career, he has held the position of Chief Quality and Patient Safety Officer at Cook County Health in Chicago, and was the first Patient Safety Officer at the Joint Commission, as well as the first African American Chief Medical Resident in 1987-88.

The episode starts with Dr. Wyatt’s story of his experience with racism during an encounter with police in 1970s Alabama, a subject on which he wrote a paper describing the event. He talks about how that experience has stayed with him and how it relates to current issues around inequity, disparity, and structural racism, particularly regarding trust. He quotes surveys that demonstrate the low levels of trust the Black communities have in healthcare systems, and suggests that the disrespect experienced by these communities within the healthcare system prevents trust. Moving on, Dr. Wyatt addresses the challenges involved in getting those in leadership positions to acknowledge and address issues of structural racism and how, while there is still a long way to go, some progress is being made by medical institutions and governing bodies. He mentions initiatives that are attempting to educate the healthcare world on these issues and suggests that a major part of getting people’s attention is to make addressing inequity and disparity a prerequisite of accreditation. Dr. Wyatt points out the low representation of Black physicians and how that plays into disparities in healthcare quality. Finally, on a positive note, Tracy and Dr. Wyatt discuss one of the initiatives he’s involved with that is making significant progress in this area and how important it is to keep fighting and to believe that change is coming.

Highlights:

- The Kaiser Foundation’s “Undefeated” survey demonstrating the low level of trust Black and Latinx communities have for institutions such as the police and hospitals.

- Another survey showed that younger Black people, in particular, tend to have much lower levels of trust in health and healthcare.

- Dr. Wyatt’s biggest challenges in his career have been around getting people in leadership roles to accept and address the problem of systemic racism.

- Governing bodies, including CMS and the NCQA, are beginning to take steps to address racism, and Dr. Wyatt is hopeful this will lead to a national patient safety goal.

- Dr. Wyatt participates as a facilitator at the Accreditation Council for Graduate Medical Education in Chicago and sits on an Equity Matters collaborative there, supported by insurers Blue Cross and Blue Shield of Illinois.

- This initiative aims to educate healthcare workers about topics including inequity, disparity, racism, allyship, and the impact trauma has on inequity. It also focuses on how graduate medical education can evolve to address issues of structural racism.

- Dr. Wyatt points out that attaching financial penalties to ignoring inequity and disparity is the most effective way to get people’s attention.

- When Dr. Wyatt was at the Joint Commission, he witnessed care teams reporting incidents of racism because they felt they had nowhere else to go.

- The number of Black physicians in the US is ~5%, with the total number practicing medicine at 3%—the same number it was in the late 1800s, however the number of black medical students is increasing.

- Dr. Wyatt states that the ability to sit with people who don’t look like them and come to a proper care management decision should be a clinical competency for any clinician.

- By January, Dr. Wyatt hopes to publish a document he co-authored about the role of trust and addressing inequity and racism.

Quotes:

“I had this odd sensation, and I slowly turned to my right. And when I turned, I saw that the other policeman had his handgun pulled, he was actually leaning through the window with his handgun pointed at my head.”

“To this day—and this happened in the mid-70s—whenever I meet a police car, or a police car pulls up behind me when I’m driving down a street, road, highway, interstate, I do experience some visceral anxiety about that police car in my rearview mirror or approaching me.”

“Here’s a guy who says, ‘I’m trying to do the right things. I’m trying to eat right. I tell my friends, you shouldn’t smoke, but then I go on for health care, and I feel disrespected.’”

“Not just the flavor of the month, but sustainable change, so that when we look back a decade from now, we will say that was a moment that became a movement that truly did lead to lasting change.”

“People are being asked to get results on a system of inequity, a system of disparity, a system of structural and institutional racism when even the leadership doesn’t understand how it works as a system, yet they’re saying, give us some results.”

“If we say, as a part of your accreditation, as a condition of participating in CMS, that you must address these issues, then I think we will continue to move it forward.”

“We know that the hospitals and healthcare systems in lower-income communities are lower quality, they have fewer resources, less capacity, are understaffed, don’t have the supplies and equipment that are needed to provide quality care in these communities. We know that there are pharmacy deserts, and they’ve been mapped out right there in Chicago. So those are the structural things that communities are challenged with.”

“This is about going from strategy to organizing to action. And part of action is to hold people, organizations, institutions accountable.”

“So there’s a lot of movement that gives me nothing but hope and more optimism than I’ve had on these topics in over a decade. But that said, we have to continue to fight, push, struggle, and I always go back to the business of medicine, where they typically say, ‘If there is no margin, there’s no mission.’ That, I totally reject. This is what I say about that: if there is no mission, there is no margin. If there is no mission, there is no soul.”

“Those of us who are involved with this work begin to understand that it’s going to seem slow, it’s going to seem tiring, it’s going to be frustrating, there will be setbacks. But, you know, honestly, as the Old Testament says, ‘Wait on it, wait on it, because it’s going to come.’”

Show Links:

Dr. Wyatt’s LinkedIn Page

America’s Prescription Drug Dependence on China with Rosemary Gibson

Center for Healthcare Narratives — Mon, 03 Jan 2022 03:30:00 -0500

On this inaugural episode of Lit Health, host Tracy Granzyk is joined by Rosemary Gibson, author and Senior Advisor at the Hastings Center. Rosemary’s most recent book, China Rx, highlights the centralization of globally supplied medicines in a single country and the implications of this in the event of a global pandemic, natural disaster, or geopolitical event. Published in 2018, China Rx has been recognized as prophetic in the wake of the COVID-19 pandemic, and Rosemary’s expertise has subsequently been sought by the House Energy and Commerce Health Subcommittee, the CIA, and all fifty states’ emergency preparedness directors.

First, Rosemary discusses how she researched the then-untold story of US dependence on other countries for the supply of medicines. She traces the history of outsourcing drug manufacturing to China and the lack of standards there, which led to long supply chains (a particular problem during a global pandemic) and problems with the quality of medications. She also reveals that hospitals in the US suffered shortages and had to ration some medicines over the last year as global demand spiked and that this is directly related to the lack of generic medications manufactured domestically. Rosemary then discusses the problems with quality control of foreign-manufactured drugs, the harm that has been done to patients as a result, and the importance of being an engaged patient when dealing with prescription medications. Finally, she calls out US companies for prioritizing cheap products over high-quality ones and expresses her concerns at the diminishing power of the FDA to assure the quality and safety of medicines sold outside the US.

Highlights:

- Rosemary’s impressive resume.

- China Rx came about as a result of Rosemary searching for her next book topic and discovering how great the US’ dependence on other countries for medicines was, as well as how this affects patient safety.

- The early-to-mid-2000s push to outsource production of generic drugs to China, where there were virtually no standards.

- Long supply chains have become the norm, but they don’t work during a global pandemic.

- In 2020, the US was weeks away from not having access to sedatives that help people on ventilators and was rationing antibiotics.

- Allegedly, the US was dependent on China for about 90% of the core materials to make basic drugs used in hospitals, especially during COVID.

- The US does not make medicines including penicillin, aspirin, and even vitamin C. However, recently it was announced that a company based in Tennessee will buck this trend by making penicillin again.

- China has threatened to withhold medicines from the US, creating a national security issue.

- China Rx has had an impact on the drug industry, with companies making different and better decisions about their supply chains because of it.

- Medical harm due to poor prescription medication quality is hard to track, so the number of patients who die as a result of them isn’t known.

- The FDA couldn’t keep up with the onslaught of companies wanting to sell hand sanitizers to the US, with the result that some products containing methane slipped through and blinded customers.

- There are 900 footnotes in China Rx, and nobody has refuted anything in it.

- Rosemary is concerned by the diminishing role of the FDA in setting global standards.

- How to protect you and your loved ones from poor-quality medications.

- Country of origin is often missing from medicine boxes to avoid objections from customers.

- Find a pharmacist you can talk to and trust about these issues.

Quotes:

“There was the infant formula scandal, and even that, which happened around 2007 and 2008, that did not stop Western companies from outsourcing production to a country that had virtually no regulations.”

“This really is a concern that people have from all walks of life, and we have to make sure we have the medicines that people need, and that they’re safe, and that we can get them when we need them.”

“When the toilet paper is unavailable on the shelf, that’s one issue. I mean, that seemed like a crisis. But if you’re in the hospital, and you can’t get the drugs that you need when you’re in a critical care situation, that’s a whole ‘nother level. It’s public safety.”

“It has to be made exactly right. Every pill, every vial, every time.”

“We can’t make penicillin anymore. We can’t make aspirin anymore. We can’t even make vitamin C and so many other vitamins. That’s how bad it’s gotten.”

“Who would be counting toothpaste as a cause of harm? You wouldn’t think that, because we don’t even know where our toothpaste is really made.”

“Every time you go to the pharmacy, you have to ask questions, you really do. You have to be an engaged patient.”

“None of us are safe if our supply chain is being mismanaged.”

“Your research just validated things that people have known about and let happen. And that’s what blows me away. I mean, a lot of those people have probably retired and have boats.”

“People don’t understand the magnitude of the problem. I think they see a way to profit, and they forget about the downstream consequences of a short-term gain.”

“We’re becoming every day, more and more a global society. And if we are going to truly be global partners, we all have to have the same commitment to quality, to safety in the products we put out into the world.”

“The world looked to the FDA. And now what we’re talking about, it’s being proposed in Washington, is doing inspections of manufacturing plants by Zoom.”

“Engaging with a partner who’s alert, who’s aware of this, you’re absolutely right, you’ll do much better with a pharmacist and pharmacy, who’s attuned to this.”

“I hope people will take a look at the book China RX. We donate proceeds to good causes, and it’s written so my mother could read it.”

“We have made a lot of progress. But boy, we have so much work to do, and we have to get moving quickly.”

Trailer

Center for Healthcare Narratives — Thu, 12 Aug 2021 03:30:00 -0500

Welcome to Lit Health – lighting a fire underneath the status quo of healthcare through interviews with authors, healthcare leaders, and policymakers who are working to create a healthcare environment that is equitable, transparent, and that welcomes the needs of every patient – especially our vulnerable populations including the mentally ill, people of color and women who feel they are at risk in our current system, and anyone who feels bias or the isms affect their health and quality of life.

Join us to stoke the fire! We want to hear the health-related stories from our listeners on both sides of the bedrail, the courtroom, and the aisle.

I’m Tracy Granzyk, host of Lit Health, Executive Director of the Center for Healthcare Narratives at the MedStar Institute for Quality & Safety, and Editor-in-Chief, of Please See Me, an online literary magazine looking to elevate the voices and health-related stories of vulnerable populations and those who care for them.