Recently, a man and his daughter came to see me in my office. They were upset because their wife and mother had fallen and broken her hip while an inpatient at GBMC. She had come in for an elective surgical procedure and was a bit disoriented post-operatively. A unit staff member had helped the patient out of bed in the middle of the night and had then assisted her back into the bed. Sometime later, the patient tried to get out of bed again to visit the bathroom and fell, fracturing her hip. It seems that the staff member who helped the patient out of bed had forgotten to reset the bed alarm so that when the patient got up on her own, the alarm did not sound and the staff was not alerted to the impending danger. The staff had correctly identified this patient as high risk for falls and had the appropriate equipment for fall prevention in the room.
Reliability means what should happen, happens, and what should not happen, doesn't. In this case, a woman under our care fell and sustained a serious injury. This should not happen. But why did it happen and what should we do to make sure it doesn't happen again?
Our Falls Team has dramatically reduced the number of falls at GBMC. Preventing falls in the hospital, especially among the physically compromised, is very difficult. It requires vigilance among the staff, and standard work using evidence-based care to do this. One miss, as in this case, can cause serious injury. Until a few months ago, we had high defect rates in the use of all of the important safety devices (alarms, socks, wrist bands, and signage) on some days on some floors. Now, it is very unlikely that a high fall risk patient doesn't have all of the equipment in place. But even with the equipment in the room, most of our beds have alarms with a design flaw: to take a patient out of bed safely you first shut off the alarm, and when you put the patient back in the bed you have to remember to turn the alarm back on.
These bed alarms are examples of active safety devices. The problem with such devices is that they require an action on the part of a human to operate correctly. But humans are not perfect and they sometimes forget, especially when busy caring for many patients at once. If our nurses care for 80 patients a day with bed alarms, and the patient gets out of bed five or six times a day, that’s almost 500 times a day the staff must remember to reset a bed alarm. Our nurses and technicians work so hard it is easy to see how one of them could get distracted and forget to reset the alarm. But if we get it right 499 times out of 500, and the one time we miss results in a patient injury, we still have to find a way to get to perfection.
In the old days, our reaction here would have probably been to reeducate the staff on the importance of resetting the alarm. This action is silly at best. When our staff gets something right 99% or more of the time, is it that they don’t know that they should reset the alarm? Of course not, it’s that they forgot, so education is not likely to fix the problem.
High reliability organizations search for passive safety devices – ones that don’t require human action and therefore are much less likely to fail. As a pediatrician who has treated a number of drowning victims, I recall when gates in fences around pools used to require an adult to remember to pull the gate shut to keep young children from wandering into the pool area unattended. Now, most pool gates have a spring that pulls the gate back into the closed position and a self-catching lock…the gate shuts itself after someone enters. Our falls team recognized that even the smartest, hardest-working staff member will eventually forget to reset the bed alarm. GBMC is now beginning the replacement of our beds and purchasing new beds that have alarms that reset automatically. We now have a number of these beds already in place. In the interim, the Falls Team continues to test ways to “catch” that someone has forgotten to reset the alarm.
To err is certainly human; but as humans and as healthcare leaders, we have the ability to redesign our systems so that common human errors are blocked or mitigated before they cause harm. We must study every event and find new ways to make our GBMC HealthCare system safer every day.
Let me thank everyone in the GBMC family for helping us get to higher reliability and closer to our vision.
More Thoughts on Cold Training: Biology Chimes In
Tuesday, August 27, 2013
Now that the concept of cold training for cold adaptation and fat loss has received scientific support, I've been thinking more about how to apply it. A number of people have been practicing cold training for a long time, using various methods, most of which haven't been scientifically validated. That doesn't mean the methods don't work (some of them probably do), but I don't know how far we can generalize individual results prior to seeing controlled studies.
The studies that were published two weeks ago used prolonged, mild cold exposure (60-63 F air) to achieve cold adaptation and fat loss (1, 2). We still don't know whether or not we would see the same outcome from short, intense cold exposure such as a cold shower or brief cold water plunge. Also, the fat loss that occurred was modest (5%), and the subjects started off lean rather than overweight. Normally, overweight people lose more fat than lean people given the same fat loss intervention, but this possibility remains untested. So the current research leaves a lot of stones unturned, some of which are directly relevant to popular cold training concepts.
In my last post on brown fat, I mentioned that we already know a lot about how brown fat activity is regulated, and I touched briefly on a few key points. As is often the case, understanding the underlying biology provides clues that may help us train more effectively. Let's see what the biology has to say.
Biology of Temperature Regulation
Read more »
The studies that were published two weeks ago used prolonged, mild cold exposure (60-63 F air) to achieve cold adaptation and fat loss (1, 2). We still don't know whether or not we would see the same outcome from short, intense cold exposure such as a cold shower or brief cold water plunge. Also, the fat loss that occurred was modest (5%), and the subjects started off lean rather than overweight. Normally, overweight people lose more fat than lean people given the same fat loss intervention, but this possibility remains untested. So the current research leaves a lot of stones unturned, some of which are directly relevant to popular cold training concepts.
In my last post on brown fat, I mentioned that we already know a lot about how brown fat activity is regulated, and I touched briefly on a few key points. As is often the case, understanding the underlying biology provides clues that may help us train more effectively. Let's see what the biology has to say.
Biology of Temperature Regulation
Read more »
Labels:
brown fat,
overweight
sometimes God comforts and encourages our souls quietly, through scripture and prayer, and for me, through song. but sometimes He sends tangible gifts, from new found friends from afar, to bless you and reassure that He does really care. and He cares in the details. i love that so much. some people make this world a better place just by being in it. that's you, @nataliecreates ! you are a treasure and my heart was so full from this thoughtful, carefully planned package. His love to me through you. :). i wanted to share my devotional this morning with you all, too. it encouraged me so much. || when we experience difficult or even devastating events, we may be tempted to wonder if things will ever be right---if we will ever be happy again. but we serve a God who transforms the past, replacing mourning with joy, and sadness with praise. there are no circumstances which dictate that we are doomed to a life of regret and emptiness. instead God promises that as we come to Him, He will replace pain with HOPE. because of His death and resurrection, we can find freedom from the pain of the past and HOPE for a beautiful and glorious future. || "to give them beauty for ashes, the oil of joy for mourning, the garment of praise for the spirit of heaviness; that they might be called the trees of righteousness, the planting of the Lord, that he might be glorified." isaiah 61:3 amen. xo
Friday, August 23, 2013
GBMC’s Annual Goals – How We Know If We are Getting Closer to Our Vision
Wednesday, August 21, 2013
The GBMC HealthCare System has a vision of perfection. Our vision is to deliver the care that we want for our own loved ones to everyone, every time. Since we are human and our designs are created by humans, we know that we will never truly get to perfection, but we accept that we must keep getting better. So, how do we know if we are getting better? We see where we are at the end of every fiscal year, we set goals for ourselves, and we then measure our performance on a regular basis (at least monthly) - and we keep score!
At GBMC, we work throughout the year to improve in our four Aims (the areas that best describe the care that we want):
1. Best health outcomes
2. Best satisfaction
3. Least waste
4. Most joy for those providing the care
As we begin this new fiscal year this summer, it’s a good time to look back over the last couple of years to see how far we have come. I am happy to report that year over year, GBMC has seen improvement in most of our aims, but not for every measure, and we still have a lot of work to do:
Under the Aim of “Best Health Outcomes,” we saw significant improvement in the number of “good catches” and reported events that allow us to ensure patient safety and implement important safety measures. We also reduced total incidents of harm from 190 incidents in FY’ 12 to 96 in FY’ 13, and our plan is to decrease the number of incidents even further in FY’ 14. Again, this reduction is due in large part to the safety processes and redesigned systems put in place by our team members.
If you look at the aim of “Most Joy,” we are focusing efforts not only on reducing employee injuries but also improving our employee and physician satisfaction. We know that when our employees and physicians are satisfied and happy with their work and work environment, our patients truly benefit. We’re still waiting for FY’13 actual scores, but I’m confident that we will meet our goals in this area.
Meeting our annual goals, and in some cases exceeding them, is a result of the hard work and dedication of our staff as well as new processes and redesigned systems that have enabled us to work more efficiently and effectively for our patients. The results show that new initiatives and redesigned systems help us ensure better health outcomes, while improving patient satisfaction, reducing waste throughout the system, and increasing the joy our staff experience delivering the high level of care.
I thank all GBMC employees for doing their part to help ensure we keep moving toward our vision, and ask that everyone continue to work toward even better results in FY’14.
Finally, I’d like to welcome to the GBMC team, Tanya Townsend, who recently joined us as Vice President and Chief Information Officer. She comes to us from Wisconsin where she was the Chief Information Officer at the Eastern Wisconsin Division of the Hospital Sisters Health System in Green Bay. Tanya’s background as a leader in healthcare IT and her experience with standardizing systems will surely benefit our organization. Please join me in welcoming Tanya to the GBMC family.
At GBMC, we work throughout the year to improve in our four Aims (the areas that best describe the care that we want):
1. Best health outcomes
2. Best satisfaction
3. Least waste
4. Most joy for those providing the care
As we begin this new fiscal year this summer, it’s a good time to look back over the last couple of years to see how far we have come. I am happy to report that year over year, GBMC has seen improvement in most of our aims, but not for every measure, and we still have a lot of work to do:
![]() |
GBMC annual goals- Click image to enlarge |
If you look at the aim of “Most Joy,” we are focusing efforts not only on reducing employee injuries but also improving our employee and physician satisfaction. We know that when our employees and physicians are satisfied and happy with their work and work environment, our patients truly benefit. We’re still waiting for FY’13 actual scores, but I’m confident that we will meet our goals in this area.
Meeting our annual goals, and in some cases exceeding them, is a result of the hard work and dedication of our staff as well as new processes and redesigned systems that have enabled us to work more efficiently and effectively for our patients. The results show that new initiatives and redesigned systems help us ensure better health outcomes, while improving patient satisfaction, reducing waste throughout the system, and increasing the joy our staff experience delivering the high level of care.
I thank all GBMC employees for doing their part to help ensure we keep moving toward our vision, and ask that everyone continue to work toward even better results in FY’14.
Finally, I’d like to welcome to the GBMC team, Tanya Townsend, who recently joined us as Vice President and Chief Information Officer. She comes to us from Wisconsin where she was the Chief Information Officer at the Eastern Wisconsin Division of the Hospital Sisters Health System in Green Bay. Tanya’s background as a leader in healthcare IT and her experience with standardizing systems will surely benefit our organization. Please join me in welcoming Tanya to the GBMC family.
Reflections on the 2013 Ancestral Health Symposium
I just returned from the 2013 Ancestral Health Symposium in Atlanta. Despite a few challenges with the audio/visual setup, I think it went well.
I arrived on Thursday evening, and so I missed a few talks that would have been interesting to attend, by Mel Konner, Nassim Taleb, Gad Saad, and Hamilton Stapell. Dr. Konner is one of the progenitors of the modern Paleo movement. Dr. Saad does interesting work on consummatory behavior, reward, and its possible evolutionary basis. Dr. Stapell is a historian with an interest in the modern Paleo movement. He got some heat for suggesting that the movement is unlikely to go truly mainstream, which I agree with. I had the opportunity to spend quite a bit of time with him and found him to be an interesting person.
On Friday, Chris Kresser gave a nice talk about the potential hidden costs of eradicating our intestinal parasites and inadvertently altering our gut flora. Unfortunately it was concurrent with Chris Masterjohn so I'll have to watch his talk on fat-soluble vitamins when it's posted. I spent most of the rest of the day practicing my talk.
On Saturday morning, I gave my talk "Insulin and Obesity: Reconciling Conflicting Evidence". I think it went well, and the feedback overall was very positive, both on the content and the delivery. The conference is fairly low-carb-centric and I know some people disagree with my perspective on insulin, and that's OK. The-question-and-answer session after the talk was also productive, with some comments/questions from Andreas Eenfeldt and others. With the completion of this talk, I've addressed the topic to my satisfaction and I don't expect to spend much more time on it unless important new data emerge. The talk will be freely available online at some point, and I expect it to become a valuable resource for people who want to learn more about the relationship between insulin and obesity. It should be accessible to anyone with a little bit of background in the subject, but it will also be informative to most researchers.
After my talk, I attended several other good presentations. Dan Pardi gave a nice talk on the importance of sleep and the circadian rhythm, how it works, how the modern world disrupts it, and how to fix it. The relationship between sleep and health is a very hot area of research right now, it fits seamlessly with the evolutionary perspective, and Pardi showed off his high level of expertise in the subject. He included the results of an interesting sleep study he conducted as part of his doctoral work at Stanford, showing that sleep restriction makes us more likely to choose foods we perceive as unhealthy.
Sleep and the circadian rhythm was a recurrent theme at AHS13. A lot of interesting research is emerging on sleep, body weight, and health, and the ancestral community has been quick to embrace this research and integrate it into the ancestral health template. I think it's a big piece of the puzzle.
Jeff Rothschild gave a nice summary of the research on time-restricted feeding, body weight and health in animal models and humans. Research in this area is expanding and the results are pretty interesting, suggesting that when you restrict a rodent's feeding window to the time of day when it would naturally consume food (rather than giving constant access during both day and night), it becomes more resistant to obesity even when exposed to a fattening diet. Rothschild tied this concept together with circadian regulation in a compelling way. Since food is one of the stimuli that sets the circadian clock, Rothschild proposes to eat when the sun is up, and not when it's down, synchronizing eating behavior with the natural seasonal light rhythm. I think it's a great idea, although it wouldn't be practical for me to implement it currently. Maybe someday if I have a more flexible schedule. Rothschild is about to publish a review paper on this topic as part of his master's degree training, so keep your eyes peeled.
Kevin Boyd gave a very compelling talk about malocclusion (underdeveloped jaws and crowded teeth) and breathing problems, particularly those occurring during sleep. Malocclusion is a modern epidemic with major health implications, as Dr. Boyd showed by his analysis of ancient vs. modern skulls. The differences in palate development between our recent ancestors (less than 200 years ago) and modern humans are consistent and striking, as Weston Price also noted a century ago. Dr. Boyd believes that changing infant feeding practices (primarily the replacement of breast feeding with bottle feeding) is the main responsible factor, due to the different mechanical stimulation it provides, and he's proposing to test that hypothesis using the tools of modern research. He's presented his research at prestigious organizations and in high-impact scientific journals, so I think this idea may really be gaining traction. Very exciting.
I was honored when Dr. Boyd told me that my 9-part series on malocclusion is what got him interested in this problem (1, 2, 3, 4, 5, 6, 7, 8, 9). His research has of course taken it further than I did, and as a dentist his understanding of malocclusion is deeper than mine. He's a middle-aged man who is going back to school to do this research, and his enthusiasm is palpable. Robert Corruccini, a quality anthropology researcher and notable proponent of the idea that malocclusion is a "disease of civilization" and not purely inherited, is one of his advisers.
There were a number of excellent talks, and others that didn't meet my standards for information quality. Overall, an interesting conference with seemingly less drama than in previous years.
I arrived on Thursday evening, and so I missed a few talks that would have been interesting to attend, by Mel Konner, Nassim Taleb, Gad Saad, and Hamilton Stapell. Dr. Konner is one of the progenitors of the modern Paleo movement. Dr. Saad does interesting work on consummatory behavior, reward, and its possible evolutionary basis. Dr. Stapell is a historian with an interest in the modern Paleo movement. He got some heat for suggesting that the movement is unlikely to go truly mainstream, which I agree with. I had the opportunity to spend quite a bit of time with him and found him to be an interesting person.
On Friday, Chris Kresser gave a nice talk about the potential hidden costs of eradicating our intestinal parasites and inadvertently altering our gut flora. Unfortunately it was concurrent with Chris Masterjohn so I'll have to watch his talk on fat-soluble vitamins when it's posted. I spent most of the rest of the day practicing my talk.
On Saturday morning, I gave my talk "Insulin and Obesity: Reconciling Conflicting Evidence". I think it went well, and the feedback overall was very positive, both on the content and the delivery. The conference is fairly low-carb-centric and I know some people disagree with my perspective on insulin, and that's OK. The-question-and-answer session after the talk was also productive, with some comments/questions from Andreas Eenfeldt and others. With the completion of this talk, I've addressed the topic to my satisfaction and I don't expect to spend much more time on it unless important new data emerge. The talk will be freely available online at some point, and I expect it to become a valuable resource for people who want to learn more about the relationship between insulin and obesity. It should be accessible to anyone with a little bit of background in the subject, but it will also be informative to most researchers.
After my talk, I attended several other good presentations. Dan Pardi gave a nice talk on the importance of sleep and the circadian rhythm, how it works, how the modern world disrupts it, and how to fix it. The relationship between sleep and health is a very hot area of research right now, it fits seamlessly with the evolutionary perspective, and Pardi showed off his high level of expertise in the subject. He included the results of an interesting sleep study he conducted as part of his doctoral work at Stanford, showing that sleep restriction makes us more likely to choose foods we perceive as unhealthy.
Sleep and the circadian rhythm was a recurrent theme at AHS13. A lot of interesting research is emerging on sleep, body weight, and health, and the ancestral community has been quick to embrace this research and integrate it into the ancestral health template. I think it's a big piece of the puzzle.
Jeff Rothschild gave a nice summary of the research on time-restricted feeding, body weight and health in animal models and humans. Research in this area is expanding and the results are pretty interesting, suggesting that when you restrict a rodent's feeding window to the time of day when it would naturally consume food (rather than giving constant access during both day and night), it becomes more resistant to obesity even when exposed to a fattening diet. Rothschild tied this concept together with circadian regulation in a compelling way. Since food is one of the stimuli that sets the circadian clock, Rothschild proposes to eat when the sun is up, and not when it's down, synchronizing eating behavior with the natural seasonal light rhythm. I think it's a great idea, although it wouldn't be practical for me to implement it currently. Maybe someday if I have a more flexible schedule. Rothschild is about to publish a review paper on this topic as part of his master's degree training, so keep your eyes peeled.
Kevin Boyd gave a very compelling talk about malocclusion (underdeveloped jaws and crowded teeth) and breathing problems, particularly those occurring during sleep. Malocclusion is a modern epidemic with major health implications, as Dr. Boyd showed by his analysis of ancient vs. modern skulls. The differences in palate development between our recent ancestors (less than 200 years ago) and modern humans are consistent and striking, as Weston Price also noted a century ago. Dr. Boyd believes that changing infant feeding practices (primarily the replacement of breast feeding with bottle feeding) is the main responsible factor, due to the different mechanical stimulation it provides, and he's proposing to test that hypothesis using the tools of modern research. He's presented his research at prestigious organizations and in high-impact scientific journals, so I think this idea may really be gaining traction. Very exciting.
I was honored when Dr. Boyd told me that my 9-part series on malocclusion is what got him interested in this problem (1, 2, 3, 4, 5, 6, 7, 8, 9). His research has of course taken it further than I did, and as a dentist his understanding of malocclusion is deeper than mine. He's a middle-aged man who is going back to school to do this research, and his enthusiasm is palpable. Robert Corruccini, a quality anthropology researcher and notable proponent of the idea that malocclusion is a "disease of civilization" and not purely inherited, is one of his advisers.
There were a number of excellent talks, and others that didn't meet my standards for information quality. Overall, an interesting conference with seemingly less drama than in previous years.
Lactose-free peach melba fairy cakes
Monday, August 19, 2013
By Rebecca Almond
![]() |
Just peachy! Lactose-free cupcake |
For those of you who are lactose intolerant or know someone who is, you’ll be familiar with the problems often faced when searching for lactose-free recipes. So it’s great to hear top London cookery school L’atelier des Chefs has teamed up with Lactofree to offer a series of cookery courses to inspire lactose-free cooking.
From 6 September to 9 November, you can learn how to create favourite dishes – from curries and French cuisine to cakes and bakes – using Lactofree’s cream, spread, dairy drinks and cheeses. And the good news is, it couldn’t be easier! The products can be used just like their lactose-containing equivalents – it’s just a matter of making a straight swap.
We went along to test the claim for ourselves and whipped up a batch of peach melba fairy cakes.
‘If anything, baking with Lactofree Spreadable is easier than butter,’ says head chef Neil Matthews. ‘It has a softer consistency so can be used straight from the fridge. The spread does make a looser cake mixture, but the quantities and cooking times are exactly the same.’ And they taste like the real deal, too.
To whet your appetite, the chefs at L’atelier have kindly shared their Lactofree cupcake recipe, exclusively for HFG blog readers! Why not give it a go, then visit atelierdeschefs.co.uk/en/cooking-classes/themes/1375-lactofree-cooking.phpto see their full range of Lactofree cookery courses.
Peach melba fairy cakes
Prep: 15 min + cooling Cook: 15 min Makes: 24 cupcakes
For the fairy cakes
250g Lactofree spreadable
250g caster sugar
250g self-raising flour
4 eggs
1tsp baking powder
50g fresh raspberries
A few drops of red food colouring
For the peach compote
50g caster sugar
30g fresh peaches, cut into 1cm pieces
100ml dry white wine
For the icing
250g icing sugar, plus extra to dust
100g Lactofree soft cheese
150g Lactofree spreadable
A few drops of red food colouring
20g fresh peaches, chopped, and 50g fresh raspberries, halved, to decorate
1 Preheat the oven to 180C/fan 160C/gas 4 and line 2x12-hole fairy cake trays cupcake cases. In a mixing bowl, whisk together the Lactofree spreadable and 250g sugar until light and creamy. Add the eggs, one at a time, whisking after each addition until well combined. Sift in the flour and baking powder, then gently fold to combine. Add the food colouring and mix gently, then add the fresh raspberries and mix well. Spoon the mixture into the cupcake cases, then bake for 12–14 minutes.
2 Remove the cupcakes from the oven and leave to cool completely on a wire rack. Meanwhile, prepare the filling. Heat the caster sugar in a saucepan over a low heat until it turns into a dark caramel. Remove the pan from the heat, then stir in the peaches. Add the white wine, then return the pan to a medium heat, stirring continuously, for 1 min or until the peaches soften. Remove the mixture and set aside to cool completely.
3 To make the icing, sift the icing sugar into a mixing bowl, then add the Lactofree soft cheese, Lactofree spreadable and food colouring and whisk until smooth and combined. Spoon the icing into a piping bag with a star nozzle attachment.
4 Using a small knife, cut a small piece from the middle of each cupcake and set aside. Spoon some of the peach compote into the middle of each cake, then pipe in a little of the icing. Replace the cake pieces, then pipe on a little more icing. Decorate with the raspberries and fresh peach pieces, then dust with icing sugar.
Tip: When using coloured butter icing, use disposable rather than fabric piping bags as the food colouring can stain.
Per cupcake
222kcal
2.3g protein
12g fat
5.5g saturates
27.2g carbs
20.6g sugar
0.6g fibre
0.3g salt
45mg calcium
0.4mg iron
For more on lactose intolerance and the Lactofree range, visit lactofree.co.uk
Labels:
baking,
cookery lesson,
dairy,
lactofree,
lactose intolerance
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