A Jolly Good Fellowship

By Melanie Powell, MD, Fellow for Quality & Safety
MedStar Institute for Quality & Safety

Imagine starting a new job. You immediately feel slightly stressed, right? Regardless of how adequately you’ve researched the company, or whether you’ve worked at the company for 15 years and are simply starting a new position, there is a feeling of uncertainty associated with a job change. What will the challenges be? Will I get to do what I love? Will I have support when I feel like things aren’t going as planned?

Now imagine starting a job that’s never existed in your company. Would you feel something more than stress?

While there exist other Fellows in Quality and Safety around the country (albeit a small number), there has never been an administrative Fellow in Quality and Safety at MedStar Health. It was the distinct vision of a select few at the MedStar Institute for Quality and Safety who created my position and continue to support my efforts and our collective vision.

This distinction affords me two things:

  1. Freedom
  2. Pressure

On any given day, I have the freedom to participate in activities that further my education, and to collaborate in real time with quality and safety leaders in the organization (at least once weekly I have one-on-one time with the Assistance Vice President of Quality and/or the Assistant Vice President of Safety at MedStar Health – invaluable mentorship that I cherish). This is important for several reasons: obviously the education, but also because safety events happen at 2am; event reviews are arranged within 48 hours of an event; disclosure happens within minutes; CANDOR and Patient Communication Consult training sessions and Clinical Quality and Safety meetings are scheduled throughout the week at widely varying times. There needs to be flexibility in the schedule of an administrative fellow.

For instance, this month (all with minimal notice) I attended an event review for a serious safety event, volunteered to interview providers in operating rooms at two separate hospitals as part of a project to reduce the incidence of retained foreign objects, scheduled a lecture to educate residents about just culture and high reliability, rounded with surgical residents to observe safety events and unsafe conditions, attended a conference to improve the diagnostic process and reduce diagnostic error, became the team lead on a project to develop measures to reduce diagnostic error with the Institute for Healthcare Improvement, joined a committee to develop educational interventions to improve the diagnostic process with the Society to Improve Diagnosis in Medicine, and on and on and on…

Now to the pressure. This particular fellowship is not accredited by the ACGME…yet. If I succeed in attaining my educational objectives it will further the case for ACGME accreditation; if not, we will have lost a huge opportunity to contribute to a formal Quality and Safety Curriculum in Graduate Medical Education. To maximize the likelihood of success, I spent a great deal of time researching other fellowships and looking at the credentials of leaders in quality and safety to create a robust list of goals and objectives. I will also complete a certificate program in Executive Leadership in Quality and Safety in the spring at Georgetown University, a passion project of quality, safety, and education leaders at the MedStar Institute for Quality and Safety. This Masters level certification will provide critical didactic knowledge to round out my practical experience.

So, while I do feel stressed, I also feel incredibly privileged. Every day I get to do exactly what I love. I also have the privilege and the pressure (as Billie Jean King likes to say, pressure is a privilege) of setting the tone for all future fellows who work at the MedStar Institute for Quality and Safety. It’s a huge responsibility. I think to myself, in 15 years what will the fellow(s) be working on? Will there be a fellow in Resident Quality and Safety education? A Fellow in High Reliability? A Fellow in Practice Improvement? The possibilities are endless…if this experiment succeeds.

What I do know is…when I go to residency programs and tell current trainees that they can complete a Fellowship in Quality and Safety, they sit up straighter and at least one set of eyes sparkles. I remember that feeling, and I know that any future Fellow in Quality and Safety at MedStar, because of the flexibility to seize all educational opportunities and develop projects with system-wide support, will make a huge difference at MedStar Health and beyond.