Lessons Learned—A Book Review as a Small Test of Change
July/August 2013
Editor’s Notebook
Lessons Learned—A Book Review as a Small Test of Change
Writing book reviews on a regular basis is a goal I have failed to achieve for years. Wanting to write nothing but comprehensive, stimulating reviews, I too often don’t write them at all—a classic case of letting perfect be the enemy of the good.
A book of essays I started reading recently inspires me to try something new. One author talks about using “small tests of change,” working on improvement step by step, moving forward despite uncertainty and setbacks along the way. My small test of change will be to write about what I’m reading in a manageable way, sharing what I think as I go along, not holding back in favor of the perfect, New York Times-worthy book review. I intend to make this an ongoing series in print and especially online at www.psqh.com. Readers are invited to contribute either brief essays or full-fledged book reviews.
The book of essays is Lessons Learned in Changing Healthcare (Longwoods Publishing Corp., 2010), edited by Paul Batalden, MD. The book was made possible through financial assistance from The Dartmouth Institute for Health Policy and Clinical Practice in appreciation of the work of Batalden and his fellow authors—15 physicians in all.
In the first essay, Carolyn Kerrigan, MD, MS, describes seven lessons she’s learned as section chief of plastic surgery at Dartmouth-Hitchcock:
- Work smarter, not harder.
- Change is awkward.
- Measure.
- Innovate and customize.
- Walk the talk.
- Be tenacious.
- Engage the players.
Kerrigan brings these lessons to life by describing programs and challenges that provided the learning, such as a program of shared medical appointments (SMAs) she implemented in her surgery practice:
A group of patients, six to 18 depending on the setting, are seen together by one provider and their team. This is not a seminar or a lecture. It’s not like psychotherapy or group therapy. It is individual care but willingly done in the context of observers. The observers, rather than being family members or in addition to being family members, are other patients. Each patient gets an individual examination (private as the condition dictates), gives an individual history and participates in individual decision-making, but these are done in the context of a group, which really helps create a very rich environment for discussion and learning.
Kerrigan describes her discomfort with one aspect of SMAs: she asks patients to hold their questions for group discussion, which runs counter to her own training and instinct to be as helpful as immediately as possible.
At first, this felt extremely disingenuous, awkward, uncomfortable and patient un-friendly. But as I practiced it and got those questions into the group, I began to really believe in that statement and it became the new norm for me. When I see patients one on one and they ask a question, I honestly feel that they are being short changed by not being in an SMA, where the information exchange is much richer.
In this way, throughout her essay, Kerrigan’s reflections are honest, unapologetic, and provide a refreshing look inside the life and practice of a physician working on improvement every day.
Lessons Learned is available for purchase or to read online at www.longwoods.com/publications/books/22040.