[SPEAKER_00]: Hello and welcome back to ACRAC.
[SPEAKER_00]: I'm Jed Wolpa and I am thrilled to have a fabulous show for you today.
[SPEAKER_00]: This will be a really great follow up to the show we did a couple months ago on civility and health care.
[SPEAKER_00]: I've got with me to wonderful wonderful guests who are going to talk about
[SPEAKER_00]: a system called name claim aim and it's really about building teams making effective teams work and finding your voice.
[SPEAKER_00]: I'm really excited to learn more from them about this and I think this will be really useful for everybody.
[SPEAKER_00]: I've got Dr. Rebecca Meinhardt.
[SPEAKER_00]: She is an associate professor of anesthesiology at the Albert School of Medicine at Brown University as well as the chief of obstetric anesthesia at women's and infants hospital and the vice chair for faculty development.
[SPEAKER_00]: Rebecca has dedicated her academic and clinical career to establishing new educational techniques to foster more productive conversations in high stakes, time limited circumstances right perfect for what we're going to talk about today and also Dr.
[SPEAKER_00]: Lawn Settnik.
[SPEAKER_00]: Ron is an emergency physician and a simulation educator with over 20 years of experience in clinical care, leadership, and medical education.
[SPEAKER_00]: Currently, he serves as the director of clinical programs at the Center for Medical Simulation.
[SPEAKER_00]: He holds appointments as a part-time lecture in anesthesia at Harvard Medical School and Clinical Assistant Professor in Emergency Medicine at University of New England College of Osteopathic Medicine.
[SPEAKER_00]: His professional focus lies in advancing psychological safety, systems improvement, and experiential education to foster excellence in health care.
[SPEAKER_00]: I'm thrilled to have them both here.
[SPEAKER_00]: Thank you so much.
[SPEAKER_00]: So, let's start with maybe a story of where you have used this framework name claim aim recently.
[SPEAKER_00]: I think that'll be a way to help people understand what it is and then launch us into what we want to talk about it.
[SPEAKER_00]: Rebecca, do you want to tell us some way in which you've used it recently?
[SPEAKER_02]: I would love to.
[SPEAKER_02]: So, so for a disclaimer, like we started this work, oh, gosh, now, like eight ten years ago, and it has been evolving over time.
[SPEAKER_02]: And so I had used it in my prior job quite often, I was at the Massachusetts General Hospital for many years.
[SPEAKER_02]: and recently moved to Brown, and they weren't familiar with the name play maim paradigm at all, and so, but the beauty of it is that you don't need to be familiar with it in order to communicate and to organize your team really effectively.
[SPEAKER_02]: So I came in.
[SPEAKER_02]: We had, I was taking overnight call for women and if it's hospital, and we had an emergency cord prolapse that was coming to the operating room.
[SPEAKER_02]: And so I was alerted.
[SPEAKER_02]: I brought my team in the room.
[SPEAKER_02]: We met with the scrub nurses in the obstetrician who was coming in.
[SPEAKER_02]: And actually, there's been a culture shift in the group that since our group came in, the hospital now, we do more general anesthetics for these emergency cases than they used to.
[SPEAKER_02]: And so, but the culture is still adjusting to that change, although they're supportive of it.
[SPEAKER_02]: So when I came into the room, I sort of wanted to, it's just what I'm used to doing.
[SPEAKER_02]: So I said, I'm just going to name, this is an emergency cesarean delivery for court prolapse under general anesthesia.
[SPEAKER_02]: And I started to go through the other things, like the claiming the roles and the aiming of the team, like we'll induce general anesthesia.
[SPEAKER_02]: And then I will direct you when it's time for you to cut, which I like to use that clear language.
[SPEAKER_02]: And so that happened afterwards.
[SPEAKER_02]: The obstetrician came to me and said, oh my gosh, it was so amazing that you said that because in the moments when I came in the room, I actually wasn't sure what kind of anesthesia was going to be.
[SPEAKER_02]: I wasn't sure what kind of negotiation I would have to have with you because I saw this as a real emergency.
[SPEAKER_02]: And you just clarified everything up front.
[SPEAKER_02]: And we were on the same page and it was just such a beautiful thing.
[SPEAKER_02]: And I thought that that was really remarkable
[SPEAKER_02]: It showed a couple of things, first it helped the organization of the room during really a time-pressure circumstance, and second it built, I mean I didn't know her very well, and for her to come up to me and say like, you know, now we have this bond of strengthening the team because we're on the same page and it was so obvious to her that we were on the same page, and it just sort of promoted all of that good teamwork in the moment.
[SPEAKER_02]: So I think it was really impactful, and I loved it because it wasn't with a culture who
[SPEAKER_02]: You know, the the years and years of doing crisis resource management at my old place.
[SPEAKER_00]: Yeah, that's fabulous.
[SPEAKER_00]: I'm Lon, how about you?
[SPEAKER_01]: I had a experience where I received a burn trauma patient at a community hospital that's not used to receiving burn trauma patients.
[SPEAKER_01]: The patient had a head injury, he had IV access, but no vital signs had been obtained in root because it was too agitated.
[SPEAKER_01]: We were trying to get control of the scene and there were actually multiple patients at the same time.
[SPEAKER_01]: I was working with a group of
[SPEAKER_01]: teammates that I wasn't used to.
[SPEAKER_01]: I see you nurse and, you know, hospital resources or nurses.
[SPEAKER_01]: And I asked, we set up for everything, but I asked the nurse to just push some ketamine so we could get control of the situation and then get vital signs and then go step by step.
[SPEAKER_01]: About 30 seconds after you push the ketamine, the patient stop moving and stop breathing.
[SPEAKER_01]: Hold on, something has changed, the patient has stopped root, breathing, and stopped moving.
[SPEAKER_01]: I don't know what's going on.
[SPEAKER_01]: I think maybe he coded.
[SPEAKER_01]: I'm going to get us organized.
[SPEAKER_01]: I'm going to need everyone's help here, and so I directed somebody to get vital signs, get them on the monitor, and then I finished with, you know, what else am I missing?
[SPEAKER_01]: What should I know?
[SPEAKER_01]: And one of the nurses spoke up and said, I accidentally pushed Rocky, Ronin, and what as the flush.
[SPEAKER_01]: And so it was that that explicit request for speaking up for everybody participating in the understanding that saved us and actually there was no problem the patient we just first the rest of the ketamine and we were already set up to anticipate so what could have been.
[SPEAKER_01]: a real mess with a team not knowing what was going on starting compressions and potentially doing invasive procedures the patient didn't need just turned into okay now we know what the problem is now let's get on to the next task and so that really stood out to me as a quite a useful moment to put this into action.
[SPEAKER_00]: Yeah, that's an amazing story and two things strike me about that one clearly there's also I mean that there's a trust in the team there already or maybe this helped build it really quickly that she felt like she could say that like own up to what had happened and I do wonder and maybe it would not have happened if you hadn't made this space for it, right?
[SPEAKER_00]: So yeah, if if you just said, you know, look, I think they've coded and people start chest compressions and there's isn't really it's a lot more activation energy to kind of be like wait stop stop, stop chest compressions, I pushed rock.
[SPEAKER_00]: but because you opened up that space, it felt maybe a little easier for her to admit that.
[SPEAKER_01]: Exactly.
[SPEAKER_01]: And we know that in a crisis, we need to be relatively directive in creating the team.
[SPEAKER_01]: When there's chaos, we have to be relatively strong-willed, but that can unintentionally prevent the speaking of behaviors that we need.
[SPEAKER_01]: We can never know everything that all the other teammates know.
[SPEAKER_01]: being a strong organizer of the team and also explicitly getting people to continue to participate in the thinking and the speaking up and helping us know everything that we need to know.
[SPEAKER_00]: Yeah.
[SPEAKER_00]: Well, let's kind of talk about it's may seem obvious, but let's name some of the reasons why it's important to form a team quickly in these high-stakes situations.
[SPEAKER_00]: What comes to mind is why this is important.
[SPEAKER_01]: moments are full of times when people are coming together who often don't work together on the problem that they're facing and there are so many uncertainties in that moment and there are also there's so much that needs to get done and we can be working in a group but not be a team and so
[SPEAKER_01]: What we need is somebody possibly more than one person, but at least one person who's paying attention to how all the people are working together and are we pulling in the same direction?
[SPEAKER_01]: Do we have a shared mental model for what is actually happening right now and what our particular role is within the context of that emergency.
[SPEAKER_01]: And something that's in the literature right now is the idea of smash teams, where we have two teams that are intact, but get collided around a patient, like an anesthetic team, an surgical team, a trauma team, and an anesthetic team, and an emergency medicine team.
[SPEAKER_01]: And we often have different ideas of what needs to be done in the moment.
[SPEAKER_01]: pulling in different directions and not functioning effectively, and there are two big costs this.
[SPEAKER_01]: One is patient outcomes, but the second one is when we don't feel good about the teamwork and the care that we provided, we are also victims of the bad outcome.
[SPEAKER_01]: We go home from work, not feeling good, not feeling that we've done our best, and that's a tragedy that we can't afford to have in healthcare nowadays.
[SPEAKER_00]: Yeah.
[SPEAKER_00]: Absolutely.
[SPEAKER_00]: So this is really important.
[SPEAKER_00]: I think this is something people are hearing about all the time now is, you know, the importance of good communication and a good team work of support, of avoiding burnout.
[SPEAKER_00]: This is another thing this can help do, right?
[SPEAKER_00]: So let's talk about name claim aim.
[SPEAKER_00]: What if you had to describe it in one sentence?
[SPEAKER_00]: What would you say?
[SPEAKER_00]: What is this?
[SPEAKER_02]: It's essentially the ABCs of teaming, and so it's so straightforward, it can be used in any kind of circumstance.
[SPEAKER_02]: It's really flexible, it's a framework, it helps bring people together really quickly in high stakes moments.
[SPEAKER_02]: And so I think
[SPEAKER_02]: It captures and encapsulates everything that's needed about a rapid teaming moves in a very easy to remember Namanik that allows for shared mental models to emerge and for speaking up to occur just as Dr. Seneca said.
[SPEAKER_02]: And it just helps people feel like they're all instead of just a group working together, they're a team.
[SPEAKER_02]: You know, they have a goal or they have multiple goals, but they're
[SPEAKER_02]: It's essential for, it's like essentials of teaming, basically.
[SPEAKER_00]: And all right.
[SPEAKER_00]: A lot of you want to add to that.
[SPEAKER_01]: I love this framing of the ABCs of teaming.
[SPEAKER_01]: ABCs is helpful because it's a recipe that we all can pull on when we find a patient in-prices.
[SPEAKER_01]: It's not always exactly the right thing for what the patient needs, but it's a really helpful starting point.
[SPEAKER_01]: And I love how Rebecca described it as a supportive framework.
[SPEAKER_01]: So it's not meant to constrain you, but it is meant to support you.
[SPEAKER_01]: David Gabba and others describe the elements of crisis resource management.
[SPEAKER_01]: But how do you do them when you're overwhelmed and you're facing uncertainty and you look up and all of a sudden the room is full of people that you didn't expect to be there.
[SPEAKER_01]: doing crisis resource management in those moments is really overwhelming, but name claim aim is simple.
[SPEAKER_01]: And as we talk through it, you can see that there are some elements built in that are the actions of the crisis resource management principles kind of distilled into its essence, like Rebecca said.
[SPEAKER_00]: Yeah, and you know, and I, I find with some of these simple namanics, right, that people, when you're telling people them, and you're, of course, you're teaching this people or calm, they're well rested, they're well fed, right?
[SPEAKER_00]: You're sitting around the table, and people often think, well, I don't need that, that's so simple, right?
[SPEAKER_00]: But what I always tell the trainees is, yeah, you don't need it right now.
[SPEAKER_00]: But when you are in the middle of a crisis and you are stressed and you're 20 hours into a 24 hour shift and you are hungry and you haven't slept.
[SPEAKER_00]: then your brain will freeze right and you will need to have something to fall back on that you can very simply go through to make sure you don't forget things and so i think that is is really key so let's talk about some of the kind of common mistakes that happen in high pressure scenarios that would be why you need this when you are in those scenarios can you give me some examples of that
[SPEAKER_01]: So, one of the common mistakes is people start doing things that make them feel comfortable and helpful.
[SPEAKER_01]: And so, we walk into a room, we see a patient in crisis, and we have a particular skill set, whether we're an anesthesiologist or an emergency physician or a nurse.
[SPEAKER_01]: And we see, oh, there's an arm without an IV, I'll go put that IV in.
[SPEAKER_01]: But that might not be what the patient needs in that moment.
[SPEAKER_01]: And that might not be the right priority for our skill set.
[SPEAKER_01]: However, doing a skill that makes us feel comfortable.
[SPEAKER_01]: makes us feel like an effective teammate.
[SPEAKER_01]: And so we can be potentially stuck into doing things that are actually a distraction from what the patient really needs.
[SPEAKER_01]: And so it's a trap that we fall into quite frequently, actually.
[SPEAKER_01]: So that is as somebody helping a team, that is one of the key problems.
[SPEAKER_01]: And,
[SPEAKER_01]: when we have a way of organizing and putting organization on the forefront, then we can prioritize properly for the teammates.
[SPEAKER_00]: Yeah, that makes a ton of sense.
[SPEAKER_00]: Rebecca, anything you wanna add, any other examples?
[SPEAKER_02]: with experts, especially, you know, you have, I saw this repeatedly when I was teaching at the Center for Medical Simulation, as well, alongside Lawn, that you would have people who all had a really good idea.
[SPEAKER_02]: They felt like they had a really good idea of the situation of good handle, but then they would perform very redundant moves and leave areas of treatment way under populated.
[SPEAKER_02]: So, you know, it would be like everybody was trying to get the airway and
[SPEAKER_02]: Um, they didn't notice that there was no blood pressure anymore, and there was no, you know, harpy anymore, or whatever.
[SPEAKER_02]: And so, and actually what they thought they were treating was not actually what they were treating, because nobody could stood back and had a big picture of you.
[SPEAKER_02]: So I love this because it allows for accessible, like, sort of, it allows for correct distribution of tasks that allows for that bigger picture, um, idea to emerge.
[SPEAKER_02]: And even in situations where,
[SPEAKER_02]: a very free thinking.
[SPEAKER_02]: I would say culture and I've come into a culture that is more used to direction.
[SPEAKER_02]: And I have noticed a shift when I do use name claim name that people are thinking together.
[SPEAKER_02]: So it's not just, I think this idea that it's just hands help that we need is so, it's so bad.
[SPEAKER_02]: I always want that head with the hands.
[SPEAKER_02]: I always want the brain with the hands.
[SPEAKER_02]: So, so asking explicitly what other ideas do people have, not are there
[SPEAKER_02]: But what other ideas do people have is very intentional.
[SPEAKER_02]: And I think it's built into this model to allow for more of this dialogue to occur in a better picture to emerge.
[SPEAKER_00]: Yeah.
[SPEAKER_00]: I mean, it seems to me like the expectation, if the problem with an expectation that the leader is going to come in and just know everything, and maybe they need some sets of hands to do the things, is that that is the expectation that leaders need to know everything, and they cannot then draw on the expertise of the people around them.
[SPEAKER_02]: Yes, and something that Lawn said just struck me, which is that this idea of inserting uncertainty.
[SPEAKER_02]: So I think one of the failures of a team, especially when there's not this explicit model that includes a shared understanding of maybe what the situation is going on along with dialogue around are we correct or is there something else here?
[SPEAKER_02]: I would say that a lot of times people feel very certain about the crisis they're in.
[SPEAKER_02]: especially if it's something like hemorrhage or something like that, I found myself falling victim to this myself.
[SPEAKER_02]: Thankfully, I've learned from it, but actually by embedding this phrase and really getting a team together through inclusivity and asking questions, then you realize what you've been missing.
[SPEAKER_02]: So it's not just the one thing that you thought it was, it actually, oh, there's either there's things developing, because the code you start with is not always the code or the crisis that you end with.
[SPEAKER_02]: So it allows for that emergence to come into it and allows for a certain to be spoken where I think I think not a lot of people are used to hearing that maybe there is uncertainty, and I think it's really beneficial to the team to hear that, too.
[SPEAKER_01]: Yeah, absolutely.
[SPEAKER_01]: And there's another common, common mistake that I think we bring into these moments is that we just assume teamwork will happen.
[SPEAKER_01]: We're great clinicians, we are nice people.
[SPEAKER_01]: We know the names of the people we work with.
[SPEAKER_01]: And so some dynamic situation happens, and we just think, OK, we get along, we know each other,
[SPEAKER_01]: But it's not as consistent as we wish it was.
[SPEAKER_01]: And so sometimes we come out of those moments kind of scratching our heads saying, why didn't that go as well as we thought it would have?
[SPEAKER_01]: And a mistake is the assumption that teamwork will just happen.
[SPEAKER_01]: And we're people who work together.
[SPEAKER_01]: So we'll be a team.
[SPEAKER_00]: Yeah, absolutely.
[SPEAKER_00]: And I think you can even see almost the opposite too, which is that if you don't know anybody, it can feel like, well, I don't really know who people are and who knows what and who's in charge.
[SPEAKER_00]: And so I'm not going to say anything because I don't want to overstep or maybe you're the fellow and you're like, is there an attending here?
[SPEAKER_00]: I don't really know, maybe I'd better not say anything.
[SPEAKER_00]: I mean, that can also cause the team to fall apart or to never form.
[SPEAKER_01]: Absolutely.
[SPEAKER_01]: Yeah, I love that.
[SPEAKER_01]: And the final mistake that, well, I shouldn't say the final, but another mistake that happens a lot to us is we assume that the operator, the person at the head of the bed, the person who is on the airway, has to be the team leader, or they are the team leader.
[SPEAKER_01]: And oftentimes the procedure list can't focus on the teaming, and we need somebody else to pay attention to the teaming.
[SPEAKER_01]: It might be the case that the procedure lists is overwhelmed, and they shouldn't even be doing the procedure, but if they're in that setting, they really can't be, and we don't want them to be paying attention to the team.
[SPEAKER_01]: If you're dealing with a very challenging airway, and you're in the middle of your algorithm, and you're... We want you to be completely 100% focused in dedicated to that task, and not looking up.
[SPEAKER_01]: not maintaining situational awareness and not trying to figure out who's going to do what in the team.
[SPEAKER_01]: So we really fall victim to the trap.
[SPEAKER_01]: This happens in emergency medicine as well.
[SPEAKER_01]: The doc at the head of the bed is the one who needs to be organizing this team because it's their case.
[SPEAKER_00]: Yeah, yeah, and that's so important.
[SPEAKER_00]: And I have really tried myself.
[SPEAKER_00]: If I'm the one running the code to not also be doing the airway or the aline or the central aline or whatever, I mean, I do think that it just makes it so much easier to get the global view of what's happening and to, you know, divvy up rules.
[SPEAKER_00]: So let's talk about the name, claim, aim, framework.
[SPEAKER_00]: What, let's just go step by step.
[SPEAKER_00]: Let's start with name.
[SPEAKER_00]: What does that mean when we say name, what does that include?
[SPEAKER_02]: So I can take this fun.
[SPEAKER_02]: So naming is really about just narrating what you're seeing.
[SPEAKER_02]: So you want to have a succinct statement of the situation.
[SPEAKER_02]: And I believe, and I think a lot, but I know, I pretty much know a lot and believes too, that stating you're uncertainty with it.
[SPEAKER_02]: within that name is is actually really important.
[SPEAKER_02]: So I think it allows for people to sort of access their different scripts in their head about how do I treat XYZ.
[SPEAKER_02]: Oh yeah, that's okay.
[SPEAKER_02]: Yeah, okay.
[SPEAKER_02]: Now that makes sense.
[SPEAKER_02]: Even though I'm looking at the monitor and I'm a nurse and I know what an EKG looks like that doesn't look like what I think it's supposed to look like.
[SPEAKER_02]: I just can't
[SPEAKER_02]: I can't access right now what that is.
[SPEAKER_02]: And so when somebody names and even if they're on a certain, it gives people something to run off of and start to unlock unlock a frozen brain, I think, is what you're saying.
[SPEAKER_02]: And so I think actually it's probably the most important step.
[SPEAKER_02]: And so I tend to teach that even if you don't remember anything else from an inclaiming,
[SPEAKER_02]: Please just say something out loud.
[SPEAKER_02]: And so it can sound as easy as vital sign changes.
[SPEAKER_02]: I see patients hypotensive and tecacardic.
[SPEAKER_02]: I'm not sure what's going on, but we need to find out.
[SPEAKER_02]: We'll be working hard to find out here are the roles.
[SPEAKER_02]: You know, then the rest of the claim and aim, but the name and can be as much as just vital signs with explicitly saying I'm not sure why.
[SPEAKER_02]: And I think that that's enough.
[SPEAKER_02]: So,
[SPEAKER_02]: I can share a story, if that's okay.
[SPEAKER_02]: Yeah, please.
[SPEAKER_02]: The first time I ever used this was I was on call in the hospital.
[SPEAKER_02]: And I was, I heard stat call overhead and emergency call.
[SPEAKER_02]: So I went to the operating room.
[SPEAKER_02]: And when I came and I was met with the scene where it was in radiology, it was in the radiology suite, the hypnosis sort of the hybrid suite.
[SPEAKER_02]: And there was the anesthesiologist, I believe a CRNA who were physically working on looks like the patient's airway.
[SPEAKER_02]: And I'm looking around and I said, how can I help, which is my usual, you know, sort of like the routine like what do you did, how can I help?
[SPEAKER_02]: I'm here and no response for them and I The correctly realized that they were just so cognitively overloaded and probably
[SPEAKER_02]: You know, a little bit, like, I don't know, like, oh my god, what's going on, you know, and so, so then I look around and I'm asking the rest of the room what's happening and nobody's saying anything.
[SPEAKER_02]: And so I look up and I see in the, on the monitor, I see ST segment elevations.
[SPEAKER_02]: And so I said, I'm going to try to sell guys.
[SPEAKER_02]: because the rest of the room is just looking at me.
[SPEAKER_02]: I'm the only one who's late in Beijing.
[SPEAKER_02]: And they knew I was from anesthesia.
[SPEAKER_02]: So I said, guys, I think this is an ST elevation MI, or there's something going on like that.
[SPEAKER_02]: And I think as soon as they're done, it looks like they're doing the airway, I can help organize us.
[SPEAKER_02]: And then I went through the claim name.
[SPEAKER_02]: As soon as I said, as the elevation MI, everyone in the room started being activated.
[SPEAKER_02]: The one, one of the nurses ran out in the house.
[SPEAKER_02]: She's like, I'm going to go get the EKG, the 12th lead.
[SPEAKER_02]: So, so she brought it in.
[SPEAKER_02]: The other one is like, you want me to call the calf lab?
[SPEAKER_02]: I was like, yes, please.
[SPEAKER_02]: Like, and then the idea started flowing.
[SPEAKER_02]: Do we need nitro glycerin?
[SPEAKER_02]: Do you need aspirin?
[SPEAKER_02]: Do we need blah, blah, blah.
[SPEAKER_02]: So it was like,
[SPEAKER_02]: You know, I've got the cardiologist on the phone and it was, it was amazing and it may not have been the primary problem, but are certainly a place to start and it actually was exactly what that patient had to need as soon as the people and, and I had asked
[SPEAKER_02]: So to lawns earlier point about when you're the proceduralist and you know the most about the patient sometimes you're so stuck in the activity I had offered in that to go like relieve them and they could step back, but I think they were too hyper focused But eventually they did step back and in fact that was what it was but But it but it was like really interesting to be totally in the dark Except for being able to interpret the one vitals
[SPEAKER_02]: One vital sign on the monitor.
[SPEAKER_02]: But how powerful that naming was with just a few words, people were activated, and at least we were starting to get help in the room.
[SPEAKER_02]: Like the code cart came in the room, and the simulator came, so those kinds of things.
[SPEAKER_00]: Yeah, it's funny.
[SPEAKER_02]: Why do you have other things to add?
[SPEAKER_02]: Do you have other things to add, do I?
[SPEAKER_02]: Anything you'd like to share?
[SPEAKER_01]: I think I've heard people say it defibrillates the room when the room is stuck, and I love that phrase.
[SPEAKER_01]: It's a great representation of a room that's fibrillating.
[SPEAKER_01]: It's in action, but it's not really...
[SPEAKER_01]: moving progressively it's not moving blood right it's it's there's a lot of action taking place and naming what you know about what's happening helps to start to organize because now people know what their tasks are for Yep, yeah, I mean that it makes so so simple but see make so much sense why that would be so impactful and a couple questions so when you do this
[SPEAKER_00]: So let's use your example Rebecca you come in and you say, you know, hey, guys, I'm not sure what's going on, but it looks like maybe there's an SD segment elevation in my, would you introduce or like if it's a, you don't know anybody, let's just say you don't know, but would you say, you know, hey, I'm Dr. Mindhardt, I'm one of the NSC's theologist, I'm not sure what's happening, but like do you recommend that or do you just just go straight to like this is what I think is going on.
[SPEAKER_02]: I mean, I think that's always helpful to share who you are and what your expertise background could be.
[SPEAKER_02]: So, it helps to help people build trust in you, especially if they're not placing who you are.
[SPEAKER_02]: So, anytime you can use your own name or other people's names, I think that is really helpful for familiarity within the team.
[SPEAKER_02]: And so, I like that addition, sort of like naming yourself naming the situation.
[SPEAKER_00]: How about when you, I'm sure you guys must have some version of what we call an anesthesia stat, right?
[SPEAKER_00]: So this is an anesthesia team basically calls essentially a code, right?
[SPEAKER_00]: Like we need help right now and everybody comes.
[SPEAKER_00]: So you're in the know are and all of a sudden you get like, you know, eight attendings and everybody else.
[SPEAKER_00]: Everybody's showing up if you're one of those attending showing up like you know you walk in the room You don't really know like your people already looks like a lot of people already doing some stuff like do you do you try to say at that point like in that scenario?
[SPEAKER_00]: Would you say hey, you know, I mean you probably know everyone if it's your OR area So you may not introduce yourself, but you could and then say like I am not sure what's going on But it looks like we have a patient whose airway has been lost like does that make sense?
[SPEAKER_02]: Yeah, I totally agree with that.
[SPEAKER_02]: And I think even when it feels a little bit like, well, gosh, everybody should know this.
[SPEAKER_02]: It's sort of obvious to everyone in my overstating, the obvious.
[SPEAKER_02]: I just think that you can't overstate that.
[SPEAKER_02]: You have people coming in and out of the room, constantly during a crisis, there are nurses and surgeon and surgical helpers, whatever coming in and out with equipment or with people trying to understand the situation.
[SPEAKER_02]: And I don't think
[SPEAKER_02]: I don't think you can say enough what the evolving situation is.
[SPEAKER_02]: I mean, even if you were to say, it looks like they've moved to, you know, front-of-neck access for the airway attempt, you know, guys, I think we should be thinking about next steps.
[SPEAKER_02]: I think you can even help them plan ahead with
[SPEAKER_02]: It's, you know, it's, I think it's always a delicate balance when you're trying to come in and organize a team that you are just on the scene for at the beginning.
[SPEAKER_02]: So, I think, especially using those qualifiers of like it looks to me like I'm going to try this out.
[SPEAKER_02]: Let me give it a shot.
[SPEAKER_02]: You know, I think those are really helpful to help with the, the dynamic in the room already.
[SPEAKER_00]: And so doing this helps because it kind of gets everybody on the same page ready creates a shared mental model.
[SPEAKER_00]: This is what we think is happening.
[SPEAKER_00]: Other people could say well actually you know this or that right you can you can all chime in.
[SPEAKER_00]: But it's doing that and and other things like I know the things we know that this does in terms of helping us move forward.
[SPEAKER_01]: When there's a little bit of context that's contributing, it helps to direct how are we gonna organize the team?
[SPEAKER_01]: So the flow is what's happening, how are we gonna organize and who's doing what are our priorities?
[SPEAKER_01]: What's our big picture?
[SPEAKER_01]: And you can't understand how you're supposed to organize until you understand what's happening.
[SPEAKER_01]: There's a lot of emergencies that are simultaneously dual emergencies.
[SPEAKER_01]: We have cardiac arrest from the lost airway.
[SPEAKER_01]: Well, we've got two problems here.
[SPEAKER_01]: And the best team in that setting splits the team.
[SPEAKER_01]: One team focuses on cardiac resuscitation and one team focuses on the airway resuscitation.
[SPEAKER_01]: And so when we understand our context,
[SPEAKER_01]: And what is actually happening, then it helps us to understand how to organize.
[SPEAKER_01]: And a lost airway in CAT scan is such a different beast than a lost airway in the OR.
[SPEAKER_01]: And a lost airway in my rural hospital where I'm the only physician in the hospital is such a different beast than a lost airway in the OR at MGH.
[SPEAKER_01]: And so if there is important context, putting that in the naming,
[SPEAKER_01]: helps the team to organize and figure out what the next steps are.
[SPEAKER_00]: And I can absolutely see this really helping reduce the kind of cognitive load for the different members of the team because if I'm, you know, if someone hasn't done this and I'm doing the airway and I'm also trying to think about, okay, wait a minute, but what are we supposed to do for the cardiac arrest and is there another line that we need it?
[SPEAKER_00]: But if someone is saying, listen, you have got the airway, right?
[SPEAKER_00]: Like, here's what's going on and this, of course, gets us into the claim of how we're going to develop those roles.
[SPEAKER_00]: So let's, let's talk about that.
[SPEAKER_00]: What is the claim part of this mean?
[SPEAKER_00]: Stay with us.
[SPEAKER_00]: We'll be right back.
[SPEAKER_00]: All right, and we're back.
[SPEAKER_01]: Yeah, the claim is really what I'm going to, what is my role going to be in this moment?
[SPEAKER_01]: And it is designed to empower us.
[SPEAKER_01]: You know, one of the challenges for us is feeling that we deserve to be the Versusicitation Team Event Organizer, especially early in our career.
[SPEAKER_01]: And, you know, some of us take that claim easier than others, but this is designed to
[SPEAKER_01]: Help the team understand that our job now is to be the organizer or the event manager.
[SPEAKER_01]: It also helps us recognize that that's our job.
[SPEAKER_01]: So that we can focus, okay, my job is paying attention to the team in this moment and getting us organized.
[SPEAKER_01]: And I think the words don't just help those around us, but they help us.
[SPEAKER_01]: One of the most difficult elements for team to process is uncertainty, and social uncertainty is really, really big tax on our teams.
[SPEAKER_01]: Who's in charge?
[SPEAKER_01]: I mean, we've all seen the teams where the rooms where it's chaos, and somebody just says, who's in charge?
[SPEAKER_01]: And that defibrillates the team and somebody claims themselves as in charge, and that just changes the whole dynamic.
[SPEAKER_01]: And so we are trying to create that as a claim as a reliable part.
[SPEAKER_01]: It feels a little bit awkward because it's not normal that we will walk into a room and say,
[SPEAKER_01]: I think this is Nest the Elevation and my, I'm going to get this group organized, so it definitely feels socially awkward, but it actually really downregulates the social uncertainty of all the other team players and then they can start to focus on what their job is going to be because they know how we're going to relate to one another.
[SPEAKER_00]: Yeah, I love that.
[SPEAKER_00]: I have this very embarrassing memory, but I remember as it in intern.
[SPEAKER_00]: I can't remember if it was been sort of simulated scenario and we were supposed to be kind of like taking turns coming to a code and I think I'd heard someone do this and so I had kind of had it in my head.
[SPEAKER_00]: So I come in to this to the room and I kind of said, all right, you know.
[SPEAKER_00]: My name is Jed Wolpa and I'm running this code and my co-interns like just laughed and made fun of me for it, but like, and I think about the back and how embarrassed I was.
[SPEAKER_00]: But I, um, but I think that's not the worst idea, but maybe you would ask, you know, if you came into a room and there were already a lot of people there is like you said, is anyone, you know, who's in charge or who's running the code?
[SPEAKER_00]: And if nobody says anything, you can say, okay, like let me help out by by trying to get us organized.
[SPEAKER_00]: Does that make sense?
[SPEAKER_00]: So, one is nodding, yeah.
[SPEAKER_00]: Okay.
[UNKNOWN]: Yes.
[SPEAKER_00]: Yeah.
[SPEAKER_00]: Yeah, Rebecca.
[SPEAKER_02]: And I also, this sort of goes into the aims a little bit, but when we decide on actions and we assign roles.
[SPEAKER_02]: So like, for example, usually when I'm teaching this, we're teaching with a checklist, like an event manager checklist or an organizer checklist, where it's like think about somebody who can do IVs
[SPEAKER_02]: medications, if it were there, blah, blah, blah, blah, and it's pretty expensive.
[SPEAKER_02]: It allows people, especially if you're encouraging people to self-clean roles.
[SPEAKER_02]: It allows people to sort of showcase what they can do instead of what they might have trouble doing.
[SPEAKER_02]: So I think along with this assignment of roles and the uncertainty that comes with it is sometimes
[SPEAKER_02]: I don't always know who's in the room and what their skill sets are and so I think the claiming park can be kind of tough and so I do teach my teams to as much as possible if you hear and this is where when I do name claiming I might combine claim and name and ask for volunteers basically like who can do and I beat for me you know it's an experienced
[SPEAKER_02]: Because that's actually like it seems like a straightforward skill, but it actually can be the most critical on a difficult skill to have.
[SPEAKER_02]: So maybe I want to see your person doing that rather than my C1 or you know.
[SPEAKER_02]: So it's nice when you can promote people to speak up about their own comfort and skill sets and that actually helps the organizer or the team.
[SPEAKER_02]: We really reduce that.
[SPEAKER_02]: They're talking about trying to find the right people for the right jobs.
[SPEAKER_00]: Yeah, and you know, it seems like one of the real components I'm hearing from you guys about this that's so important is expressing that uncertainty right you are not the all knowing all powerful right you're just taking a role which is trying to organize things and so saying something like you know I don't know everyone in the room.
[SPEAKER_00]: I'm not sure what everyone's you know rules are what everyone's skill set is.
[SPEAKER_00]: Who could, is there someone who could get an IV?
[SPEAKER_00]: Is there someone who could start chess compressions?
[SPEAKER_00]: Is there someone who can, you know, try to get an A line?
[SPEAKER_00]: You know, whatever it is, and then let, you're saying, like let, let that both first of all be, you know, an expression of humility, like, I don't know.
[SPEAKER_00]: I'm asking for your help.
[SPEAKER_00]: Again, because we already did that in the name, right, of saying, like, I'm not sure what's going on.
[SPEAKER_00]: I would love to hear input from everyone.
[SPEAKER_00]: This is what I'm seeing.
[SPEAKER_00]: So each step of the way, you're kind of sharing your uncertainty and therefore inviting others to give their input.
[SPEAKER_01]: Exactly, exactly.
[SPEAKER_01]: So the claim, we hear different versions of it.
[SPEAKER_01]: Some people will say, I'll run this code.
[SPEAKER_01]: Some people will say, I'll be the event manager.
[SPEAKER_01]: That's what they do at the Brigham.
[SPEAKER_01]: And some people will say, I'd like to get us organized.
[SPEAKER_01]: Sometimes trainees will say,
[SPEAKER_01]: I'll be in charge until my attending gets here.
[SPEAKER_01]: And so there's a lot of good versions of this, but it's directed outwards.
[SPEAKER_01]: What can you expect from me?
[SPEAKER_01]: And also inwards, what is my role in this moment?
[SPEAKER_01]: It also starts to establish a culture for the team of explicit communication.
[SPEAKER_01]: And so we typically teach the claim to sound something like, I'm going to get us organized.
[SPEAKER_01]: And I'll need everyone's help, OK?
[SPEAKER_01]: OK, and so oftentimes you're required to say, OK, twice, because people won't say anything.
[SPEAKER_01]: They'll nod.
[SPEAKER_01]: And what that does is it starts to create the dynamic on this team that I expect is close-up communication.
[SPEAKER_01]: And so I kind of playfully teach this as you are the flight attendant and everybody else is in and everybody on the team is in the the emergency exit and they have to give you visual and auditory okay that and and it's your job to make eye contact with them because that's how you're going to communicate in the future too so you're kind of creating the norms for the team within just 10 seconds.
[SPEAKER_01]: And we'd like to think that our culture is established, but culture is established actually within every resuscitation.
[SPEAKER_01]: And this is an opportunity for you as the organizer to say, you know, the way I want this team to work is everybody's going to contribute.
[SPEAKER_01]: We're going to be explicit about our roles.
[SPEAKER_01]: We're going to close the loop.
[SPEAKER_01]: I'm going to use eye contact, I expect you to respond.
[SPEAKER_01]: If you can't do something, please tell me.
[SPEAKER_01]: So all of these things we can create in the moment for our team.
[SPEAKER_00]: Yeah, so a little twist on this that they can come up and let's say an academic centers, right?
[SPEAKER_00]: And I'm wonder how you would recommend approaching this.
[SPEAKER_00]: Let's say you as the attending show up, you're training whoever resident fellow, whatever's already there, they've taken this organized or roll.
[SPEAKER_00]: And you are
[SPEAKER_00]: You're like, okay, you know, let me let them, they're seeing like, all right, let me let them do this.
[SPEAKER_00]: I'm the here.
[SPEAKER_00]: But then you notice that maybe they're not doing it well, or they're giving some directions that are not what you think is the right move.
[SPEAKER_00]: How do you respond in a way that is not going to destroy their confidence, but of course you need to do what's right for the patient?
[SPEAKER_02]: So one of the things, and I'd love to hear what Lund does himself, but one of the things we used to do is offer up to be like a code whisper or a muse or something like that.
[SPEAKER_02]: So just to go up and just say, I want to support you, do you want to just discuss with me and can I help you think through the things and what's on your mind that you think is going on?
[SPEAKER_02]: So you can remain, this person can remain the outward facing and you're just there to support them.
[SPEAKER_02]: Um, explicitly played out on in teams that that have sort of more of that, like maybe in medicine, for example, the code, the code teams for medicine, they'll have the attending there, actually like promoting the senior, the met, met senior to be the leader of the code.
[SPEAKER_02]: And I think that's a beautiful way to explicitly teach these skills and support a trainee.
[SPEAKER_02]: who needs to learn them.
[SPEAKER_02]: I mean, the attending's don't, it's hard for the attending's to learn them, and we need to still be developing our own skills.
[SPEAKER_02]: And in some ways, it's like actually really wonderful if you can help support a trainee to do this, too, because they're going to need to go out and do these things as well.
[SPEAKER_02]: One, what do you do?
[SPEAKER_01]: I think that's great.
[SPEAKER_01]: The one piece I would just add onto that is sometimes you go in and you see somebody who's overwhelmed.
[SPEAKER_01]: And giving them choices and options and sometimes it might look like I've made several suggestions and they haven't been implemented.
[SPEAKER_01]: And so if in my assessment they are overwhelmed.
[SPEAKER_01]: I might say, hey, I'm wondering if it would be okay if I took over and ran this for now.
[SPEAKER_01]: And I want you beside me to help me.
[SPEAKER_01]: And so potentially depending on how great a here it's a be coping.
[SPEAKER_01]: That would just be the one nuance I would add to it.
[SPEAKER_01]: But that is my default.
[SPEAKER_01]: Hey, I'd love to support you, my job here's to coach you, I'm going to be right next to you, but you're in charge.
[SPEAKER_01]: And so the failure mode for me is when I start giving orders to the team.
[SPEAKER_01]: And then it's not clear who's in charge.
[SPEAKER_01]: Instead of helpful nudges to the person who's trying to run the room.
[SPEAKER_00]: Yeah, I love that.
[SPEAKER_00]: You know, I have this, when I started as an attending, an anesthesia attending, I was so determined to not be that attending who took procedures away from residents, right?
[SPEAKER_00]: And so I would let residents, I have this memory, you know, I'd let members, residents try forever on things not on airways, obviously, but you know, on things like airlines.
[SPEAKER_00]: And so I have this memory of one day,
[SPEAKER_00]: You know, just the resident, it must have been 45 minutes.
[SPEAKER_00]: This resident is going after this A line.
[SPEAKER_00]: And I was like, I'm not going to step in.
[SPEAKER_00]: And finally, I just kind of said to the resident, like, you know, do you do mind if I take a shot and the look of relief on their face was so profound.
[SPEAKER_00]: It completely, I realized I was way overdoing it.
[SPEAKER_00]: I was, I was actually, you know, making residents feel like they had to keep going long past when they wanted help, right?
[SPEAKER_00]: And so that completely changed my practice about this and how I handle it.
[SPEAKER_00]: But I think the same thing could be true here, right?
[SPEAKER_00]: You may be thinking, I don't want to hurt their feelings or make them feel like I'm pushing them aside.
[SPEAKER_00]: But if they're overwhelmed and you could probably tell, you know, they may be actually incredibly grateful if you step in in a kind way.
[SPEAKER_02]: And I had an exact exact experience like that, so you're in a good company.
[SPEAKER_00]: So yeah, yeah, it's fine.
[SPEAKER_00]: I was tell, you know, when my, like, say a three is coming to me, like, how do you make the adjustment to being an attending, you know, and I was like, like, like, one of, you're going to want to do two things around like that.
[SPEAKER_00]: You're either going to step in very quickly because you're very nervous, and you don't want to think bad to happen, or you're going to do what I did, which is never want to step in, because you don't want to be the attending who steals the procedures, right?
[SPEAKER_00]: And then you will moderate, and you'll find the middle some one way or the other.
[SPEAKER_01]: T.J. won't you're not too long or too short?
[SPEAKER_00]: Yeah, exactly.
[SPEAKER_00]: All right.
[SPEAKER_00]: So we've talked about the claim.
[SPEAKER_00]: Let's go to the aim.
[SPEAKER_00]: What does that mean?
[SPEAKER_00]: And let's go through that.
[SPEAKER_02]: So I like the aim to be the first three things that you can think of.
[SPEAKER_02]: So this is where you're going to start to plant seeds of like, what are the action steps that the team needs to take to get the goals met.
[SPEAKER_02]: And so the aim might look a little different.
[SPEAKER_02]: I don't know how long this is her rotation of this.
[SPEAKER_02]: It's mine and his evolved over time.
[SPEAKER_02]: And so I often will pair the claim and the aim.
[SPEAKER_02]: So I'll say like, I think we need to establish IV access.
[SPEAKER_02]: We need to call the blood bank and get the mass of transfusion protocol activated.
[SPEAKER_02]: And we need to get the code card outside the room or inside the room.
[SPEAKER_02]: And so who can do the, you know, who's who's our blood runner?
[SPEAKER_02]: Who's our IV person?
[SPEAKER_02]: Who's our who could fetch the code card?
[SPEAKER_02]: Oh, yes, you, you, you, you, whatever.
[SPEAKER_02]: And so, and then what are other ideas?
[SPEAKER_02]: So the thing about it is to not overload the room with all of the laundry list of things that need to occur in the very moment, but just to start people off.
[SPEAKER_02]: And, you know, as you're starting off, then the ideas will start to flow.
[SPEAKER_02]: And then you'll get, you'll get,
[SPEAKER_02]: sort of the most important things addressed and so I do like to I do think this is a skill to practice so so I often will have people practice in a certain emergency situation what are what are the critical things and what would you ask the first three things done to be and so I think this is something best done outside of a crisis like all of our preparation
[SPEAKER_02]: basically.
[SPEAKER_02]: But, but this is where, for example, like emergency manuals can really help and drill people into like, you know, remembering the first three things immediately and then being able to practice them and then the rest comes.
[SPEAKER_02]: So, um, law on, what are your thoughts about this, too?
[SPEAKER_01]: I think that's, that's beautiful.
[SPEAKER_01]: And it's all about the, the big picture, um, so
[SPEAKER_01]: things that need to be done.
[SPEAKER_01]: And you have this statement, like Dr. Manard said, that what else am I missing?
[SPEAKER_01]: And you can contextualize it, because our big goal here is X, Y, and Z.
[SPEAKER_01]: Then it helps people to speak up.
[SPEAKER_01]: What, oh, if our big goal is X, Y, and Z, then we are missing this step.
[SPEAKER_01]: And it brings us to another failure.
[SPEAKER_01]: We want the leader to think of everything, and it feels really great for us to offload all the thinking to the leader.
[SPEAKER_01]: But if the leader demands that we participate in the thinking part and they give us the big picture view of where we're trying to head, then then we can contribute in a meaningful way.
[SPEAKER_01]: I'm thinking about
[SPEAKER_01]: and how contextual the dosing of up an effort is.
[SPEAKER_01]: And it's quite common that we see teams say, okay, give some api.
[SPEAKER_01]: But if we don't connect what that, why we're giving the appie?
[SPEAKER_01]: If we think this is last, we want to give a different dose of appie.
[SPEAKER_01]: Even if it's a ventricular arrhythmia.
[SPEAKER_01]: And so in there are many other cases where you guys are going to titrate appie.
[SPEAKER_01]: If you're in the emergency department and you ask for appie, you're pretty likely to get one milligram of the appie regardless of what's happening with the patient unless you're very clear about why you're doing it.
[SPEAKER_01]: In your wisdom as somebody with experience, you're going to be able to titrate this, but a lot of times you need to give a little bit of the big picture of why we're doing what we're doing in the aim part.
[SPEAKER_00]: Yeah, so you're kind of identifying where do I think we're going?
[SPEAKER_00]: What are some of the key things we're going to try to do?
[SPEAKER_00]: And then how are we going to get there?
[SPEAKER_00]: Who's got a role in these things?
[SPEAKER_00]: And then what else?
[SPEAKER_00]: What am I missing?
[SPEAKER_00]: I need your brains too, right?
[SPEAKER_00]: So if you were, let's say, in the situation with, you think it's last, you want to just take us to what you would say,
[SPEAKER_01]: Yeah, so this is great.
[SPEAKER_01]: We'll be teaching our paint fellows next week.
[SPEAKER_01]: So we run this.
[SPEAKER_01]: So I would say something like folks, let's just stop where we're at.
[SPEAKER_01]: We just saw a change in ventricular rhythm.
[SPEAKER_01]: And it looks like we're in the middle of giving our our silly act of flexes block.
[SPEAKER_01]: I'm making something out of it.
[SPEAKER_01]: Maybe silly.
[SPEAKER_01]: I think we should stop what we're doing.
[SPEAKER_01]: And I'd like to get us organized.
[SPEAKER_01]: I'm thinking we're going to need to everyone's help, okay?
[SPEAKER_01]: I think the next things are, let's recheck a blood pressure, can we get a pulse?
[SPEAKER_01]: And we need to consider the differential for this ventricular rhythm change, could be last, could be other things.
[SPEAKER_01]: What else should I be thinking about?
[SPEAKER_01]: So that might be one example of how to do it.
[SPEAKER_00]: Yep, love that.
[SPEAKER_00]: And again, such an open approach, you know what what actually what I love about it.
[SPEAKER_00]: We often think that openness is disorganized, right?
[SPEAKER_00]: It's kind of like a loose.
[SPEAKER_00]: So it's like, I don't know guys, what are we going to do right?
[SPEAKER_00]: And this approach is both tight and open, right?
[SPEAKER_00]: It's actually really unique and that it's both.
[SPEAKER_00]: It's it's organized.
[SPEAKER_00]: It gets things moving, but it is also open to input.
[SPEAKER_02]: And I think it's easier to do when you're at my stage in my career.
[SPEAKER_02]: So I'm like 20 years in, 25 years in.
[SPEAKER_02]: And so I want to just give a nod to the fact that what you just said, Judd is so important in the whole in teaching this.
[SPEAKER_02]: So so when you think about how people build trust in the OR1,
[SPEAKER_02]: one-half of it is competence, how are they determining, how are they demonstrating their competence?
[SPEAKER_02]: And so that means they're actually like reliable, they're capable of building sure they're.
[SPEAKER_02]: And then the other half is like their intention.
[SPEAKER_02]: But when you're talking about competence and you're also demonstrating uncertainty and openness to other people's ideas, I think sometimes it leaves somebody feeling very vulnerable.
[SPEAKER_02]: I know I certainly felt vulnerable in initially saying these things because I didn't want to people to think I had no white deal with going on.
[SPEAKER_02]: I just didn't know right then.
[SPEAKER_02]: And so I felt like adding on phrases, we don't know right this moment what it is, but we will assuring you, you know, we will find out.
[SPEAKER_02]: So those kinds of things, I think, help ease that fear of looking completely incompetent while you need, because you need to be open and you need to be accepting.
[SPEAKER_02]: When I haven't been open in my resuscitations to other people's ideas, I miss big things.
[SPEAKER_02]: And that's true for everybody I know, so it doesn't go away.
[SPEAKER_00]: Yeah.
[SPEAKER_00]: Absolutely.
[SPEAKER_00]: So as you said, this can be challenging to do this, especially maybe for more junior people.
[SPEAKER_00]: So how can someone who's thinking, yeah, I want to do this, but maybe how do I use myself in?
[SPEAKER_00]: How do I start practicing this?
[SPEAKER_00]: What advice do you give them?
[SPEAKER_01]: So in our anesthesia courses, we've started to teach this by having just rapid cycle deliberate practice of just the skill of name coming in.
[SPEAKER_01]: So very short stem, and then what would I say with this very short stem?
[SPEAKER_01]: And so that can be a really helpful way of just practicing.
[SPEAKER_01]: If the patient were to have x-1 and z right now, what would I say to the team?
[SPEAKER_01]: And the other thing is we don't want to rehearse it and only use it in our most difficult moments.
[SPEAKER_01]: Number one, we don't have that many crises.
[SPEAKER_01]: So instead of viewing this as a process to use during a crisis, if we view it as a process to use when we're in a team,
[SPEAKER_01]: we have a lot of teaming moments just getting ready for a case just starting our day just organizing who's going to do what rooms today for my family figuring out what restaurant you're going to eat at in Disney World.
[SPEAKER_01]: And so we're surrounded by team moments.
[SPEAKER_01]: And when we look up and we think all these people need to come together to make progress towards a shared goal, I think we want to think that's when I need to pull out an employee name.
[SPEAKER_01]: And we practice it in the low stakes moments, running a meeting or, like I said, I give some other examples, it's going to be available for us when we need it.
[SPEAKER_01]: But if we save it for crises, we're not going to be able to pull it
[SPEAKER_00]: Yeah, I love practicing it in kind of everyday life.
[SPEAKER_00]: I've got a house full of girl, I've got three daughters, and it is like, you know, half the time.
[SPEAKER_00]: Someone's, someone's hurt, someone's feeling so someone's mad and someone's crying and it's it right.
[SPEAKER_00]: And just, I love it.
[SPEAKER_00]: This is such a good thing to use.
[SPEAKER_00]: Like, let me just name what I'm seeing, right?
[SPEAKER_00]: I'm neutral.
[SPEAKER_00]: I just got home, let me name what I'm seeing.
[SPEAKER_00]: All right, this is what I'm gonna try to get us organized about how to go through, you're gonna tell your side, you're gonna tell your side, you're right.
[SPEAKER_00]: What do we need, what else do we need to do?
[SPEAKER_01]: Yeah, that's fine.
[SPEAKER_01]: I had fallen victim to using my Zoom techniques at home, and my wife doesn't always appreciate it.
[SPEAKER_01]: But if you tell them that you're practicing something, then I think they give you a little bit of grace.
[SPEAKER_00]: Bye.
[SPEAKER_00]: I love that.
[SPEAKER_00]: So you can practice in non-crisis situation, you can practice in everyday situations, and this will help you be ready for the crises when they come, and you'll have already kind of been going through this.
[SPEAKER_01]: But I think a common teaching modality is, you're behind the curtains.
[SPEAKER_01]: everything's going well and you pull to a page in the crisis manual and you ask the resident what would you do if we went through you know the patient started to get you know malignant hyperthermia or whatever if you incorporate this into that so what would you say to the room yeah that's a great opportunity to practice it
[SPEAKER_02]: That's what I was going to say.
[SPEAKER_02]: And then the other thing is just to train your brain.
[SPEAKER_02]: So I think the thing that a lot of people may have trouble initially with is narrating what they're seeing.
[SPEAKER_02]: So narrating what I'm seeing is a very different school that I've had to develop over time.
[SPEAKER_02]: Because it's not just like,
[SPEAKER_02]: putting it in my head, you know, like looking with my eyes and hearing with my ears and then like thinking about it, it's actually just like coming right back out my mouth.
[SPEAKER_02]: So that so that I learn how to real time kind of put together and get used to speaking out loud when I'm still putting together a circumstance.
[SPEAKER_02]: And so that's I think I think to have people like I will have residents.
[SPEAKER_02]: in the operating room, I'll just say, Neri, what you see on the monitor, and so what do you think are the most important?
[SPEAKER_02]: Like if you look at this monitor, what are the most important things?
[SPEAKER_02]: If suddenly we have this situation, R, and what would you narrate and how would you do that?
[SPEAKER_02]: So it just gives on the spot a little bit, but that's how a crisis happens.
[SPEAKER_02]: You know, and it's nice because then we can actually, I can coach to it, and we can have a debrief about it a little bit.
[SPEAKER_00]: Yep, I love that.
[SPEAKER_00]: Yeah, you know, it is, I haven't thought about that, but I love what you both just said, which is this idea that if we said, I think for sure, if tomorrow and the OR I said to my resident, what if the patient went into cardiac arrest?
[SPEAKER_00]: What would you do?
[SPEAKER_00]: They would be like, I would call for help.
[SPEAKER_00]: I would start giving up an effort and I would get, you know, if it was a v-tacker v-fit, I would get the deperabilator on, um, right, and shock, but they would not say, I would name claimant, right, but that is such an important part and
[SPEAKER_01]: Rebecca, I'm putting it on a spot here, but you did some really interesting research on what anesthesiologist's view as a crisis.
[SPEAKER_00]: Oh, thank you.
[SPEAKER_01]: What a trigger is for using this, potentially, if what do anesthesiologists use as triggers for, you know, pausing the room and starting to go into something like this formally.
[SPEAKER_02]: Yeah, thank you so much for asking this.
[SPEAKER_02]: So this is work that is yet unpublished, but will be submitted again, or will be submitted for the first time because we've been working on it for qualitative research, which always takes like, it's so much longer than you think it's gonna take.
[SPEAKER_00]: Which you've heard it first on Accraq.
[SPEAKER_02]: the light bulb and so basically what's really fascinating is that we asked like 91 anesthesiologists like practicing anesthesiologists how to what are the elements of a crisis and what would trigger them to do this and and it's a lot of emotional load so so people feel panic people feel fear they were very honest about their emotional state of things they also had cognitive things like
[SPEAKER_02]: You know, when they felt either their brain was frozen, or they felt like too many thoughts, too many things to do.
[SPEAKER_02]: They couldn't see the trajectory where things were going, they felt very uncertain about the situation.
[SPEAKER_02]: Then those were the times when we were trying to get them to think about triggering this name play name, to just take a breath and trigger and start to, those are the moments.
[SPEAKER_02]: So when they call it a crisis is that,
[SPEAKER_02]: And it was really interesting because it is definitely different.
[SPEAKER_02]: It depends on the culture of the place.
[SPEAKER_02]: It depends on the skill set of the anesthesiologists.
[SPEAKER_02]: And so there were some modifications about whether they'd been in that situation before and where they could make market a timeline.
[SPEAKER_02]: for what they thought was going to happen next, but overall it's like something that is unfolding too fast with not enough resources to meet the need.
[SPEAKER_02]: And so I really like that definition and I like, you know, I like normalizing the fact that like it's a, if it's a crisis, if you're feeling like it's a crisis, then it has some valid points to it, whether or not.
[SPEAKER_02]: You know, afterwards, you feel like, well, I missed something, and I maybe I should have caught this or whatever, in the moment you didn't know, and that's the most important part in what you're doing by initiating this whole name claim name, as you're calling attention to the need for a dramatic increase in resources, and a dramatic increase in information that you just can't get for yourself.
[SPEAKER_02]: It's just impossible for nearly anyone I would argue.
[UNKNOWN]: Yep.
[SPEAKER_00]: fabulous.
[SPEAKER_00]: All right.
[SPEAKER_00]: This has been such a great conversation.
[SPEAKER_00]: Lots of great examples.
[SPEAKER_00]: I hope people are going to walk away from this and start doing this in their everyday life and for sure in their work life.
[SPEAKER_00]: Any last wrap up comments you each want to make before we move on?
[SPEAKER_02]: I love this work.
[SPEAKER_02]: I think we need to be doing more of this work.
[SPEAKER_02]: I think it's really hard to work to do so.
[SPEAKER_02]: So thank you to everyone who's like we're sort of we've built this on the back because of many, many greats and I feel so so honored to be part of this.
[SPEAKER_02]: And thank you so much for for having us.
[SPEAKER_02]: I just I'm so I'm so grateful for that as well.
[SPEAKER_01]: Of course, long.
[SPEAKER_01]: Yeah, I think.
[SPEAKER_01]: Each person has to develop their own voice and what being a resuscitation leader looks like to you.
[SPEAKER_01]: And we can make that process faster if we know what to say.
[SPEAKER_01]: Then we can start focusing on how do we want to come across.
[SPEAKER_01]: But it's too much to do both of those at the same time.
[SPEAKER_01]: And so I think you don't have to be perfect at name claiming if you just start.
[SPEAKER_01]: somewhere, then you will be able to get a little bit of momentum in your team, and you'll also start to be able to think, well, if I can just name what's happening, then I can think about how do I want to come across as a team leader in this moment, or as a team member in this moment, and I think this is a hopefully a tool for each person developing their really unique
[SPEAKER_00]: Yeah, awesome.
[SPEAKER_00]: And Lawn, I know you do some Moka training programs and you incorporate this into them, I assume.
[SPEAKER_01]: Yeah, this is a big part of our Moka training.
[SPEAKER_01]: So last year we did 24 Moka training programs at CMS.
[SPEAKER_01]: And so there are a couple of most months and people can get there.
[SPEAKER_01]: They get 7.5 hours of AMA level 1 credits and also their SENs patient safety credits.
[SPEAKER_01]: So it's a really efficient program.
[SPEAKER_01]: So people are interested in seeing what we do.
[SPEAKER_01]: They can come to our website and see a lot of programs or reach out to us.
[SPEAKER_00]: Fabulous, and we'll put the link to that program in the show notes.
[SPEAKER_00]: All right, this has been fabulous.
[SPEAKER_00]: Let's turn to the portion of our show where we make random recommendations.
[SPEAKER_00]: I'm going to ask you each to recommend something.
[SPEAKER_00]: The audience check out for fun, lawn, you want to start?
[SPEAKER_01]: I just read, we just adopted a new dog.
[SPEAKER_01]: And I read this book called The Other End of the Leash, which is a really interesting book about the psychology of us.
[SPEAKER_01]: and how we relate to our animals.
[SPEAKER_01]: And it is triggered this idea in my mind that we probably should write a book called Everything I Learned About Simulation.
[SPEAKER_01]: I learned from training my dog.
[SPEAKER_01]: But it's a short read.
[SPEAKER_01]: It's by a PhD behavior animal behavior and human psychologists.
[SPEAKER_01]: And she has just a great spirit to her.
[SPEAKER_01]: So if you're interested in dog training, it's a good explanation.
[SPEAKER_00]: Nice.
[SPEAKER_00]: Well, this is not a dog training book, but it is a very dog centered book.
[SPEAKER_00]: I've recommended it before, but on the show, but it's called the art of racing in the rain.
[SPEAKER_00]: Have you ever heard of that book?
[SPEAKER_00]: Oh, it's a fabulous book.
[SPEAKER_00]: I'm friend recommends to me maybe a year ago, and I read it.
[SPEAKER_00]: I shouted it out on the podcast a while back, but the art of racing in the rain is a really sweet, wonderful, easy read, but it has a dog as one of the main.
[SPEAKER_00]: It's kind of told through the eyes of a dog.
[SPEAKER_00]: So it's really, really nice book.
[SPEAKER_00]: Rebecca, how about you?
[SPEAKER_02]: Yes, so I've been returning to my roots as far as like reclaiming recipes from my grandparents.
[SPEAKER_02]: So, on one side, my grandparents were Ukrainian, but they grew up around along the Polish border.
[SPEAKER_02]: And I found, and then when they immigrated, they lived in Charlora, Pennsylvania.
[SPEAKER_02]: which is a really like poor coal mining town.
[SPEAKER_02]: So I just discovered a WWW.
[SPEAKER_02]: coal region, COAL, R-E-G-I-O-N.com, and it has recipes, and they are exactly my grandmother's recipes.
[SPEAKER_02]: And so I'm really excited to make, like, pro-gays and whole of, whole of, whole of, of keys and other things that if people have those roots, um, you know, it's there.
[SPEAKER_02]: So I would totally recommend checking it out.
[SPEAKER_02]: Um, and it's been a really fun activity to do with my kids too.
[SPEAKER_00]: That's awesome.
[SPEAKER_00]: Very cool.
[SPEAKER_00]: Well, I'm going to recommend a book.
[SPEAKER_00]: I am about two thirds of the way done with, but I do feel confident already that I can recommend it.
[SPEAKER_00]: It's Dan Brown's new book called Secret of Secrets.
[SPEAKER_00]: For those who don't know Dan Brown wrote the Da Vinci code, that was kind of his breakout book and he's written some books and it's, but this book is both a very typical, like, fun, page-turner, gripping kind of suspense novel.
[SPEAKER_00]: But also, it is blowing my mind in this theory, it talks about which is a real theory of non-local consciousness.
[SPEAKER_00]: This idea that what if our consciousness doesn't exist in our brain, it's like a force that's all around us, just like gravity, but our brains are evolved to tune into it.
[SPEAKER_00]: And just all the implications of that, it's so fascinating to think about.
[SPEAKER_00]: So check it out at the end-brown sequence.
[SPEAKER_00]: All right, Rebecca and Lawn, thank you so much for coming on the show.
[SPEAKER_02]: Thank you so much.
[SPEAKER_00]: Thanks for having us.
[SPEAKER_00]: All right.
[SPEAKER_00]: Hopefully you got as much out of that as I did.
[SPEAKER_00]: That was really fantastic.
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[SPEAKER_00]: All right, that is it for today for the Acrack podcast.
[SPEAKER_00]: I'm Jed Wolpa.
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