- Gary Frank
1. You are the Chief Quality and Patient Safety Officer at Children’s Healthcare of Atlanta, and you developed the “One is Not Zero” initiative. Please tell us more about your work with this initiative.
Not long after my first child was born, I was listening to an Institute for Healthcare Improvement (IHI) keynote address. During the talk, the speaker advocated for the ambitious goal of getting to zero serious harm in healthcare. At the time, we were launching some patient safety work at Children’s Healthcare of Atlanta, and the concept “One Is Not Zero” seemed to resonate. One Is Not Zero reminds us that no child should suffer preventable harm in our hospitals. In those days, I often showed a picture of my son and asked the audience to ponder what it would feel like if their child or family member were injured by a medical error. If we don’t aim for zero serious harm, then what is an acceptable number of preventable injuries? One Is Not Zero has become a mantra at Children’s Healthcare of Atlanta, but we are not the only hospital to rally around a journey to Zero harm. Target Zero (Children’s Hospital Colorado) and Zero Hero (Nationwide Children’s Hospital) are a couple other examples of how Children’s hospitals are incorporating this concept into their patient safety efforts.
2. In addition to your previously mentioned work, you are also a member of Solutions for Patient Safety, a network of children’s hospitals committed to eliminating harm in pediatric healthcare. What advice would you give to a pediatric hospitalist interested in improving quality and safety at their hospital? Anything small we should all start doing today?
At its core, quality improvement science is about small, rapid cycles of improvement. This is something we can all do, even without a lot of resources. Find something you want to improve. Figure out a way to measure it. Implement a small change. If the change works, keep doing it. If not, it’s ok to stop. The biggest mistake that we make in quality improvement is we start too big, and we fail to stop if things don’t improve.
If you are interested in learning more, the Institute for Healthcare Improvement has an online open school, which I highly recommend. Also, find out if your hospital is a member of Solutions for Patient Safety (SPS). More than 140 children’s hospitals are members, and SPS provides outstanding resources and terrific learning opportunities.
3. You received the American Board of Pediatrics’ Paul V. Miles Fellowship Award in 2019—congratulations! Can you tell us more about the award?
Receiving the Paul V. Miles Fellowship Award was one of the greatest honors of my career. This award recognizes a mid-career pediatrician dedicated to improving the quality of health care for children. As part of this fellowship, I had the opportunity to talk about quality and patient safety at pediatric grand rounds at the University of North Carolina and Duke University. I also had the opportunity to meet with staff and leadership at the American Board of Pediatrics. After this experience, I have an even greater respect for the work that the Board does on behalf of pediatrics and pediatricians.
4. As one of the editors of The Philadelphia Guide: Inpatient Pediatrics, how do you stay up-to-date with the ever-changing medical literature and what you need to know as a pediatric hospitalist?
Keeping up with medical literature is an ongoing challenge and can be a source of anxiety as the unread journals begin piling up on the coffee table. Dr. Stephen Ludwig was my residency director, and I will always remember the advice that he gave related to medical literature. He encouraged us to pick a handful of journals that we considered to be important and relevant. He then advised us to immediately discard all other journals. When we receive the journals that we consider important, he suggested that we immediately scan the index and highlight the articles that we think are worth reading. Then, when we have some time, he advised us to read only those articles that we had previously highlighted. I have found that this approach helps make the best use of my time and greatly reduces the pile of unread journals on my coffee table.
5. Your background is in engineering—you have a bachelor’s degree in engineering from Dartmouth College and a master’s degree in Engineering Management from Stanford University. How does this background help you in your work as a pediatric hospitalist?
Before college, I always thought that I would become a physician. However, in college I began exploring other interests and was particularly fascinated by engineering. I considered a number of other career options but ultimately realized that my true calling was medicine, so I finished up my pre-med requirements, took the MCAT and applied to medical school. As a resident, I realized that taking care of patients was my true passion, but there was a problem-solving side of me that wanted to do more. I was fascinated by clinical informatics and my first job out of residency was fifty percent hospitalist and fifty percent clinical informatics. When I moved to Atlanta, I continued to work as a hospitalist and an opportunity became available in the Quality department, which is where I have spent the past 15 years. I feel so privileged to have the opportunity to take care of individual patients and to work at the local and the national level to improve the quality and safety of pediatric healthcare.
6. You have been a reviewer for Pediatrics and Hospital Pediatrics—what advice do you have for someone submitting an article for publication?
Writing an article for publication can be a tremendous amount of work. Before you begin, ask yourself some tough questions. Is this work worthy of publication in a peer-reviewed journal? Is the study design sound, and is the sample size large enough? Are the results statistically significant and clinically relevant? If you are not sure, ask one of the journal editors if this is the type of work they would consider for publication. Taking the time up front to answer some of these questions might save you a lot of effort down the road.
7. As a co-author of “Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency” in Pediatrics, what role does feedback to providers have regarding their practice patterns? How can we use this to improve our care as pediatric hospitalists?
I often reflect on how much time we spend putting information into the Electronic Medical Record and how little information we get back to help inform our practice. Moreover, as physicians most of us are not used to getting critical feedback. Thus, we tend to practice in a vacuum. This is unfortunate, as even the most senior and accomplished physicians have opportunities to learn and get better. My advice is to consider feedback, even if it is critical, as a gift. Don’t be afraid to ask your colleagues for help or suggestions. You will find that it will help you get better, and it will make those around you more comfortable asking for help as well.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
It’s been incredible to see the growth of pediatric hospital medicine from its infancy to becoming a board-certified subspecialty. I cannot imagine a more rewarding career. I had the opportunity to intern in several industries in roles ranging from engineering to management consulting prior to starting medical school. I never felt as fulfilled as when I became a pediatrician and started working in a Children’s hospital. After all, what could be more meaningful than helping sick and injured children?
Not long after my first child was born, I was listening to an Institute for Healthcare Improvement (IHI) keynote address. During the talk, the speaker advocated for the ambitious goal of getting to zero serious harm in healthcare. At the time, we were launching some patient safety work at Children’s Healthcare of Atlanta, and the concept “One Is Not Zero” seemed to resonate. One Is Not Zero reminds us that no child should suffer preventable harm in our hospitals. In those days, I often showed a picture of my son and asked the audience to ponder what it would feel like if their child or family member were injured by a medical error. If we don’t aim for zero serious harm, then what is an acceptable number of preventable injuries? One Is Not Zero has become a mantra at Children’s Healthcare of Atlanta, but we are not the only hospital to rally around a journey to Zero harm. Target Zero (Children’s Hospital Colorado) and Zero Hero (Nationwide Children’s Hospital) are a couple other examples of how Children’s hospitals are incorporating this concept into their patient safety efforts.
2. In addition to your previously mentioned work, you are also a member of Solutions for Patient Safety, a network of children’s hospitals committed to eliminating harm in pediatric healthcare. What advice would you give to a pediatric hospitalist interested in improving quality and safety at their hospital? Anything small we should all start doing today?
At its core, quality improvement science is about small, rapid cycles of improvement. This is something we can all do, even without a lot of resources. Find something you want to improve. Figure out a way to measure it. Implement a small change. If the change works, keep doing it. If not, it’s ok to stop. The biggest mistake that we make in quality improvement is we start too big, and we fail to stop if things don’t improve.
If you are interested in learning more, the Institute for Healthcare Improvement has an online open school, which I highly recommend. Also, find out if your hospital is a member of Solutions for Patient Safety (SPS). More than 140 children’s hospitals are members, and SPS provides outstanding resources and terrific learning opportunities.
3. You received the American Board of Pediatrics’ Paul V. Miles Fellowship Award in 2019—congratulations! Can you tell us more about the award?
Receiving the Paul V. Miles Fellowship Award was one of the greatest honors of my career. This award recognizes a mid-career pediatrician dedicated to improving the quality of health care for children. As part of this fellowship, I had the opportunity to talk about quality and patient safety at pediatric grand rounds at the University of North Carolina and Duke University. I also had the opportunity to meet with staff and leadership at the American Board of Pediatrics. After this experience, I have an even greater respect for the work that the Board does on behalf of pediatrics and pediatricians.
4. As one of the editors of The Philadelphia Guide: Inpatient Pediatrics, how do you stay up-to-date with the ever-changing medical literature and what you need to know as a pediatric hospitalist?
Keeping up with medical literature is an ongoing challenge and can be a source of anxiety as the unread journals begin piling up on the coffee table. Dr. Stephen Ludwig was my residency director, and I will always remember the advice that he gave related to medical literature. He encouraged us to pick a handful of journals that we considered to be important and relevant. He then advised us to immediately discard all other journals. When we receive the journals that we consider important, he suggested that we immediately scan the index and highlight the articles that we think are worth reading. Then, when we have some time, he advised us to read only those articles that we had previously highlighted. I have found that this approach helps make the best use of my time and greatly reduces the pile of unread journals on my coffee table.
5. Your background is in engineering—you have a bachelor’s degree in engineering from Dartmouth College and a master’s degree in Engineering Management from Stanford University. How does this background help you in your work as a pediatric hospitalist?
Before college, I always thought that I would become a physician. However, in college I began exploring other interests and was particularly fascinated by engineering. I considered a number of other career options but ultimately realized that my true calling was medicine, so I finished up my pre-med requirements, took the MCAT and applied to medical school. As a resident, I realized that taking care of patients was my true passion, but there was a problem-solving side of me that wanted to do more. I was fascinated by clinical informatics and my first job out of residency was fifty percent hospitalist and fifty percent clinical informatics. When I moved to Atlanta, I continued to work as a hospitalist and an opportunity became available in the Quality department, which is where I have spent the past 15 years. I feel so privileged to have the opportunity to take care of individual patients and to work at the local and the national level to improve the quality and safety of pediatric healthcare.
6. You have been a reviewer for Pediatrics and Hospital Pediatrics—what advice do you have for someone submitting an article for publication?
Writing an article for publication can be a tremendous amount of work. Before you begin, ask yourself some tough questions. Is this work worthy of publication in a peer-reviewed journal? Is the study design sound, and is the sample size large enough? Are the results statistically significant and clinically relevant? If you are not sure, ask one of the journal editors if this is the type of work they would consider for publication. Taking the time up front to answer some of these questions might save you a lot of effort down the road.
7. As a co-author of “Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency” in Pediatrics, what role does feedback to providers have regarding their practice patterns? How can we use this to improve our care as pediatric hospitalists?
I often reflect on how much time we spend putting information into the Electronic Medical Record and how little information we get back to help inform our practice. Moreover, as physicians most of us are not used to getting critical feedback. Thus, we tend to practice in a vacuum. This is unfortunate, as even the most senior and accomplished physicians have opportunities to learn and get better. My advice is to consider feedback, even if it is critical, as a gift. Don’t be afraid to ask your colleagues for help or suggestions. You will find that it will help you get better, and it will make those around you more comfortable asking for help as well.
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
It’s been incredible to see the growth of pediatric hospital medicine from its infancy to becoming a board-certified subspecialty. I cannot imagine a more rewarding career. I had the opportunity to intern in several industries in roles ranging from engineering to management consulting prior to starting medical school. I never felt as fulfilled as when I became a pediatrician and started working in a Children’s hospital. After all, what could be more meaningful than helping sick and injured children?