It’s been quite a while since I’ve had time to blog. For those of you that have been on another planet for the past two years, the pandemic has kept me quite busy. That, combined with the typical end of year CMS billing changes and the need to staff the ICU left basically no time for other activities. However, there were two blocks of time that I did take away from my administrative and direct clinical responsibilities, both involved maintaining proficiency and each generated very different emotions.
As part of my employment, there are a series of institutional compliances that I must complete. Some of the compliances are annually done to maintain proficiency, some are simply part of the hiring process. Additionally, as a pilot, I make an effort to undergo a flight review every 6 months with an instructor, to evaluate my skills and address any bad habits. This is a common practice in the airlines and is one of the many reasons commercial airline service is so safe. The former, I do because I’m compelled to. I like my job and want to keep it. The latter, I do because I want to. I want to be the safest pilot possible and replicate the process the highest performing flight organizations use to ensure passenger safety.
What is strange is how I reacted to being compelled to undergo a formal review of my central line placement skills. This was a required element of my employment to be able to do my job. When I first heard about this, I was indeed, a bit indignant. Over five years of residency and fellowship, and then 12 years of practice, I placed literally hundreds of lines. The thought I would need to have my skills reviewed felt like an affront to my training, practice, and competence. However, it was a part of my job, so I made the appointment, and went to the simulation lab for my evaluation.
Coincidentally, the day before I went for this review of my central line placement skills, I went flying for my flight review. My instructor took me through a series of maneuvers, pushing the aircraft to speeds and attitudes we never intend to operate at during standard flight. We ran through how we would manage emergencies, using the checklists, and making sure when the engine quits mid-flight, I would push forward and not stall the aircraft putting it into a spin. Everything was reviewed by the book using a standardized approach that is known to be a safe way to operate N191LN.
With my central line compliance, I was actually pleasantly surprised with the entire process. I was expecting to have someone that wasn’t even a practitioner give me instruction on things I ready knew how to do. Instead, I was welcomed by a fellow faculty physician that explained the reason for the program. The institution wanted a standardized method of placing, securing, and maintaining central venous access with the thought that it would reduce complications from the catheters. He reviewed the accepted technique, and I did indeed pick up a few differences from my prior practice. These were not “wrong” but led to downstream management of the line that would not be standardized and increase the risk of complications. The final part of the exercise was a recorded simulated line placement using the approved technique for the institution that was reviewed by one of my peers. It was not about my competence in placing the line, but in my ability to conform to another standardized approach that was safe.
While I’m attempting to draw parallels between the two separate reviews, I think the key element to take away is, like so many other things, the messaging involved. While I didn’t see them as being with the same intent to start with, I ultimately realized that the two separate reviews are very similar in what they are attempting to achieve. Both clearly assess proficiency, but that is not the goal. The ultimate goal is to go beyond proficiency to standardization that provides a system that is the most likely to achieve desirable outcomes. It has been found time and time again in process management in both aviation and healthcare that standardization is a key element in obtaining and maintaining results. That message resonates well with most professionals, and rather than being incensed at being evaluated, the idea of being involved in process improvement will more likely be embraced and something those professionals want to do.