Lindsay Chase
1. You are the webmaster and creator of the SOHMlibrary.org. How did the idea for the website come about? What is something people don’t know about the site?
I wouldn't say I'm the creator. The original site was established well before I became involved. I'll blame Brian Alverson for the "idea" of my involvement. I love projects and this was a big one. Despite complete lack of IT training, I became involved in improving the SOHMlibrary site and creating the PHMfellows site. Thanks to Paul Fu who patiently guided me through initial (and ongoing )issues). I hope others don't let perceived lack of skill or knowledge limit their possibilities. If somethings sparks your interest get involved!
2. As someone who has had a leadership role in patient throughput and bed flow at multiple hospitals, how has this impacted your clinical practice? What role do you see hospitalists playing in this field nationally? How do hospitalists at your institution play a role?
Understanding and appreciating the impact of each individual patient and care decision on flow, throughput and capacity is near and dear to my daily life. If you multiple an extra hour in the hospital x hundreds of patient encounters per year, you're talking about the capacity to care for more children. I bring this to bedside care and education of trainees. A lot of what we as hospitalists bring to the table is efficient care delivery and understanding of the impact of inefficient care on the broader system and other patients. Thanks to great work by Ashley Sutton and Mike Steiner, our UNC hospitalists basically run the show in terms of patient flow coordinating flow throughout children's hospital (within adult hospital) and coordinate admissions and transfers across all pediatric medical services (and sometimes surgical as well.
3. You were part of the 2019 PHM planning committee, and are part of the current SOHM Executive Committee. What characteristics do you think that a good leader should have? Additionally, you are a self-proclaimed introvert. How did you get involved in national leadership and what tips do you have for other introverts out there?
I just rotated off the SOHM Exec Committee as well as the PHM Conference planning committee. Both were rewarding experiences. A good leader needs to be able to listen and see all sides of issues and ideas as well as be able to know how to incorporate a lot of conflicting inputs into a harmonious approach to vision for the future. I am extremely introverted so even doing these questions is a tremendous challenge. For others like me, recognize what is meaningful work to you and realize you may have to go outside your comfort zone to impact positive change. I had wise mentors (Geeta Singhal, Ricardo Quinonez) that encouraged me to get involved. When working in these larger groups nationally, I always build in some alone time to recharge which makes me able to have the stamina and strength to actively participate in meetings and interactions. I truly enjoy the actual work so focusing on that also helps.
4. As co-author of an editorial in Hospital Pediatrics in 2014 entitled “Making an Omelet,” you reference the old adage, “You can’t make an omelet without breaking some eggs.” The concept was referring to resident autonomy and the point was that “to give residents any real autonomy, they will sometimes be placed in situations in which they can make mistakes." As an attending and someone with an interest in patient safety, how do you balance promoting autonomy with minimizing patient harm (and sleeping soundly at night). What tips do you have for junior faculty who may feel uneasy with providing autonomy so early in their supervisory career?
Learn to secret spy/stalk-- this is soooooooo much easier with the EHR! You can see what the residents are doing (or not doing) much more easily and without them knowing. No more having to go to the bedside to look at the chart or secretly call the nurse or pharmacy to checkup on things. Then you can ask questions about care plan or lack of progression of care as a teachable moment-- rather than telling them exactly what to do. It is time consuming and hard to do but so worth it in terms of seeing growth of your learners. Autonomy does NOT mean go home and let the residents do whatever they want with only interaction and oversight being passing judgement on rounds-- it is assessing and allowing for attempts and independent care decisions with appropriate supervision for patient safety and also feedback to trainees about what they are doing. Sometimes that's agreeing with their care plans, other times it's agreeing but offering potential alternative ways for future patients and other times it's disagreeing, implementing a different plan and most importantly exploring WHY behind all care decision. The WHAT we are doing is always less important to me than the WHY behind it. Robotically following guidelines and care plans that will continue to change does not set up our learners for long term success as high quality physicians with commitments to ongoing learning and continuous improvement. I strongly believe supervision and autonomy and presence are all different entities that supervising faculty must understand and be thoughtful about. We must be present to provide oversight and observation to give constructive feedback to learners and ensure safe care for our patients who are becoming more and more complex every year. I guess a followup piece is probably needed to explore these concepts further--- anyone interested in co-authoring?
5. In 2018, you gave a grand rounds talk entitled “Taking the Danger Out of Discharge: Current Efforts to Improve the Safety of the Transition Home from NC Children’s Hospital.” Can you elaborate on what measures are being taken to improve the transition home? What areas do we have for improvement/future study?
We focused on standardizing the discharge processs and I specifically focused on discharge medication reconciliation. We don't do it well anywhere. All of use should take the time to read the actual paperwork that goes home with our patients and think about whether you would be able to safely take care of the child as the parent if provided those papers and whatever is printed on medication bottles from pharmacies (which may or may not be different from our paperwork). Having manually reviewed hundreds of these papers, we can and need to do better. Some of it is cumbersome EHR workflows and limitations, but a lot of it is vigilance and conscious approach to what we are doing rather than blindly clicking along and assuming what's there is correct.
6. You are known for rounding efficiently and effectively and have won numerous teaching awards. What is the secret to being efficient?
As my husband just said to our 8 year-old yesterday, practice doesn't make perfect. Perfect practice makes perfect. Seeing lots and lots of patients over years and really paying attention to what I am doing when I am doing it has helped. So mindfulness and presence in current task is key. If you start thinking about the 15 other patients, plus manuscript draft, 250 unread emails, 3 meetings, etc. you'll never get anything done and if you do it likely won't be done well. I can't believe I'm writing this but essentially practice "mindfulness" in everything you do. I also like to figure out how processes work (or don't work) and then strive to make them more efficient. If something isn't efficient, I ask why and work to make it better for providers as it enable use to better care for patients. I also feel strongly that I will not ask someone I'm supervising to do something I don't know how to do. I push myself to continuously learn new skills so that I can teach and supervise others. Conscious approach to workflows in addition to thinking about how we think rather than traditional medical knowledge is what I'm most passionate about teaching our trainees. If we want to set folks up for long-term career success and minimize burnout we really need to focus on these skills more explicitly in training. What used to be implicitly taught just by moving through residency training, likely needs a well thought out explicit curriculum.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
"Own" yourself-- your strengths, your weaknesses, your patients, your successes, your mistakes. Don't expect others to be the same as you. We are all unique and valuable; if we are all the same things would be incredibly boring. Expect and help them to be their best selves. Don't settle for the status quo. Push yourself and others around you to be and do better.
I wouldn't say I'm the creator. The original site was established well before I became involved. I'll blame Brian Alverson for the "idea" of my involvement. I love projects and this was a big one. Despite complete lack of IT training, I became involved in improving the SOHMlibrary site and creating the PHMfellows site. Thanks to Paul Fu who patiently guided me through initial (and ongoing )issues). I hope others don't let perceived lack of skill or knowledge limit their possibilities. If somethings sparks your interest get involved!
2. As someone who has had a leadership role in patient throughput and bed flow at multiple hospitals, how has this impacted your clinical practice? What role do you see hospitalists playing in this field nationally? How do hospitalists at your institution play a role?
Understanding and appreciating the impact of each individual patient and care decision on flow, throughput and capacity is near and dear to my daily life. If you multiple an extra hour in the hospital x hundreds of patient encounters per year, you're talking about the capacity to care for more children. I bring this to bedside care and education of trainees. A lot of what we as hospitalists bring to the table is efficient care delivery and understanding of the impact of inefficient care on the broader system and other patients. Thanks to great work by Ashley Sutton and Mike Steiner, our UNC hospitalists basically run the show in terms of patient flow coordinating flow throughout children's hospital (within adult hospital) and coordinate admissions and transfers across all pediatric medical services (and sometimes surgical as well.
3. You were part of the 2019 PHM planning committee, and are part of the current SOHM Executive Committee. What characteristics do you think that a good leader should have? Additionally, you are a self-proclaimed introvert. How did you get involved in national leadership and what tips do you have for other introverts out there?
I just rotated off the SOHM Exec Committee as well as the PHM Conference planning committee. Both were rewarding experiences. A good leader needs to be able to listen and see all sides of issues and ideas as well as be able to know how to incorporate a lot of conflicting inputs into a harmonious approach to vision for the future. I am extremely introverted so even doing these questions is a tremendous challenge. For others like me, recognize what is meaningful work to you and realize you may have to go outside your comfort zone to impact positive change. I had wise mentors (Geeta Singhal, Ricardo Quinonez) that encouraged me to get involved. When working in these larger groups nationally, I always build in some alone time to recharge which makes me able to have the stamina and strength to actively participate in meetings and interactions. I truly enjoy the actual work so focusing on that also helps.
4. As co-author of an editorial in Hospital Pediatrics in 2014 entitled “Making an Omelet,” you reference the old adage, “You can’t make an omelet without breaking some eggs.” The concept was referring to resident autonomy and the point was that “to give residents any real autonomy, they will sometimes be placed in situations in which they can make mistakes." As an attending and someone with an interest in patient safety, how do you balance promoting autonomy with minimizing patient harm (and sleeping soundly at night). What tips do you have for junior faculty who may feel uneasy with providing autonomy so early in their supervisory career?
Learn to secret spy/stalk-- this is soooooooo much easier with the EHR! You can see what the residents are doing (or not doing) much more easily and without them knowing. No more having to go to the bedside to look at the chart or secretly call the nurse or pharmacy to checkup on things. Then you can ask questions about care plan or lack of progression of care as a teachable moment-- rather than telling them exactly what to do. It is time consuming and hard to do but so worth it in terms of seeing growth of your learners. Autonomy does NOT mean go home and let the residents do whatever they want with only interaction and oversight being passing judgement on rounds-- it is assessing and allowing for attempts and independent care decisions with appropriate supervision for patient safety and also feedback to trainees about what they are doing. Sometimes that's agreeing with their care plans, other times it's agreeing but offering potential alternative ways for future patients and other times it's disagreeing, implementing a different plan and most importantly exploring WHY behind all care decision. The WHAT we are doing is always less important to me than the WHY behind it. Robotically following guidelines and care plans that will continue to change does not set up our learners for long term success as high quality physicians with commitments to ongoing learning and continuous improvement. I strongly believe supervision and autonomy and presence are all different entities that supervising faculty must understand and be thoughtful about. We must be present to provide oversight and observation to give constructive feedback to learners and ensure safe care for our patients who are becoming more and more complex every year. I guess a followup piece is probably needed to explore these concepts further--- anyone interested in co-authoring?
5. In 2018, you gave a grand rounds talk entitled “Taking the Danger Out of Discharge: Current Efforts to Improve the Safety of the Transition Home from NC Children’s Hospital.” Can you elaborate on what measures are being taken to improve the transition home? What areas do we have for improvement/future study?
We focused on standardizing the discharge processs and I specifically focused on discharge medication reconciliation. We don't do it well anywhere. All of use should take the time to read the actual paperwork that goes home with our patients and think about whether you would be able to safely take care of the child as the parent if provided those papers and whatever is printed on medication bottles from pharmacies (which may or may not be different from our paperwork). Having manually reviewed hundreds of these papers, we can and need to do better. Some of it is cumbersome EHR workflows and limitations, but a lot of it is vigilance and conscious approach to what we are doing rather than blindly clicking along and assuming what's there is correct.
6. You are known for rounding efficiently and effectively and have won numerous teaching awards. What is the secret to being efficient?
As my husband just said to our 8 year-old yesterday, practice doesn't make perfect. Perfect practice makes perfect. Seeing lots and lots of patients over years and really paying attention to what I am doing when I am doing it has helped. So mindfulness and presence in current task is key. If you start thinking about the 15 other patients, plus manuscript draft, 250 unread emails, 3 meetings, etc. you'll never get anything done and if you do it likely won't be done well. I can't believe I'm writing this but essentially practice "mindfulness" in everything you do. I also like to figure out how processes work (or don't work) and then strive to make them more efficient. If something isn't efficient, I ask why and work to make it better for providers as it enable use to better care for patients. I also feel strongly that I will not ask someone I'm supervising to do something I don't know how to do. I push myself to continuously learn new skills so that I can teach and supervise others. Conscious approach to workflows in addition to thinking about how we think rather than traditional medical knowledge is what I'm most passionate about teaching our trainees. If we want to set folks up for long-term career success and minimize burnout we really need to focus on these skills more explicitly in training. What used to be implicitly taught just by moving through residency training, likely needs a well thought out explicit curriculum.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
"Own" yourself-- your strengths, your weaknesses, your patients, your successes, your mistakes. Don't expect others to be the same as you. We are all unique and valuable; if we are all the same things would be incredibly boring. Expect and help them to be their best selves. Don't settle for the status quo. Push yourself and others around you to be and do better.