Bringing the family into rounds

The idea of bringing daily ICU rounds, even once or twice a week, into patient rooms is a concept best described in the pediatric critical care literature.  It’s something that last year our group tried to start in our burn ICU, and I will openly confess that I’ve been a dismal failure at it.  It’s not that I’m uncomfortable with getting into the room and talking with patients and families about what’s going on- anyone who works with me knows it’s quite the opposite- but simply that I have struggled to figure out “best practices” and workflow to make these type of rounds effective for all of the parties involved in our interdisciplinary care team.  Every time I think about it, I find myself both challenged and overwhelmed, largely because my perception is that our daily interdisciplinary rounds (not always at the bedside) work just fine, though they are admittedly not patient and family centered.

So, the theoretical benefits of family-centered rounds:  increased family involvement and understanding, trainee role modeling, and enhanced team communication.  And the theoretical down sides? Physical barriers, trainee apprehension, and time limitations.

Interestingly, physician interest in conducting family-centered rounds seems to be driven by the physician’s perception of the efficacy of rounding in this way:  there’s an association between a belief in the benefits and the likelihood to do them, and there’s an association between perception of barriers and not conducting them. And, of course, the conduct of family-centered rounds requires that the physician leading them have tremendous situational awareness and an ability to manage the environment in order for them to be most effective.  Then there’s the whole sticky wicket of the fact that family-centered rounds may provide a foundation for family-centered care, they cannot alone insure that family-centered care is delivered.

After reading all of those things, I was still ambivalent at best.  I want to believe, and I want to deliver on our group’s agreement.  But how do we do this best?  How can I do this in a way that doesn’t feel contrived for me?

Fortunately, some guidance is present in this study, which provides descriptions of the “art” of bedside rounds as conducted on the medicine service.  While it’s not 100% relevant, I definitely see some tips in there I can employ- and in some ways I am motivated to “start small” by keying on a handful of patients rather than the entire ICU for each session.

So, here’s my late summer and Fall teaching and communication goal, out here for all of you to see.  I have a few weeks off service to ponder this and see what it will really look like, and a resident interested in education to help me pilot it starting in August.

Will it succeed, or will I at least overcome my antipathy?  Stay tuned!

Mid-Career: Stagnation, Generation, or a new path forward?

It’s been almost 6 months since I headed to Austin for the 2013 AAMC Mid-Career Women Faculty Professional Development Seminar.  Parts of the three days were tremendously helpful to me- in particular, sessions on interpersonal communication, conflict resolution, and the importance of sponsorship (as opposed to mentorship) for career progression.  The networking was tremendous, both in terms of some relationships it built with other women surgeons at a similar career stage and a few new folks I met who aren’t surgeons but who are inspirational. Some parts weren’t terribly helpful to me at all; I’ve long been aware that my temperament is one that is driven by creativity and possibility and thrives on relationships- no surprise to anyone who knows me or works with me.  And yes, I understand the ramifications for that in group settings since I become absolutely non-functional when thrown into a dysfunctional group.

The six-month mark seems a good time point to take inventory and consider what my best take-home messages were from the meeting.  Fortunately, I was easily able to find my concept map that I drew on the last day:

Mid-WIMS Concept Map

What does this photo tell me without me having to go back and read pages and pages of notes?  I definitely left Austin better prepared to lead than when I got there.  Why?

  • The seminar was an opportunity for me to refine skills that are crucial to being a good leader.
  • I gathered some new ideas from the seminar (all of which I need to try, though I did write something that approximates a PAR/ CAR statement recently).
  • Participation helped me to clarify my vision of what I am doing and where I would like to head professionally.

The greatest reminder was that I haven’t explicitly tried any of the new ideas that I left with, all of which have some merit for career development and organizational growth.  While it will require some thought, applying a mission/ value grid- or the related idea of a mission- core competence (MCC) decision matrix– to some of my administrative activities may help me to be more strategic in how I am running my portion of our department’s education enterprise.  I can and should write a PAR statement for each dimension of the work that I do- clinical, education, research, and administrative.  The hidden benefit of generating PAR statements is that they allow us to look at obstacles that have been overcome and skills/ traits employed in so doing; looking at those skills and traits will allow me to insure that I’m really using my “best” skills in the roles I’m playing.  Finally, I know I could use a personal consulting team on a few career progression issues, and perhaps it’s time to formally convene one for some wisdom (and for me to listen to the feedback they provide, which can be the hard part).

Hopefully in six more months I can come back to my concept map to let you all know that I did try out these new ideas- and to recount their successful implementation.