Thread by @WePublicHealth

Day two is kicking off with a keynote by @KedarMate, President and Chief Executive Officer of Institute for Healthcare Improvement in the US @TheIHI, speaking on 'the opportunity to think differently: approaching the future with courage and trust' #GiantSteps22

Firstly, Kedar acknowledges the pain and suffering felt about mass shooting in Texas yesterday and reads out the 19 names of the children who died -@KedarMate #GiantSteps22

"If we are truly for health and justice, then we have to find the courage to stop the hate, violence and suffering wherever we find it" - @KedarMate @GiantSteps22

Kedar recounts an email from a colleague stating the fatigue and challenges felt from working in healthcare and alleviating other's suffering. Economic, political changes are part of it, but one statement impacted most .... @KedarMate @GiantSteps22

...."Inability to address social inequalities created moral distress and a sense of powerlessness".

Squaring contradictions & impossible choices one of the most challenging aspects of working in healthcare - @KedarMate #GiantSteps22

These challenges existed prior to the pandemic, but were greatly exacerbated by them. "The virus found out where systems were not prepared and exploited them" -@KedarMate #GiantSteps22

"The virus pried it's insidious fingers between the system and ourselves" - @KedarMate #GiantSteps22

Kedar speaks about burnout and the 1/5 healthcare workers in the US have left their jobs since COVID-19 hit - @KedarMate #GiantSteps22

Physicians and healthcare workers do not lack resilience...the problem is far more fundamental - @KedarMate #GiantSteps22
These sentiments echoed by @joanne_wrench yesterday who said burnout is a system issue.

How do we fix the problem? Kedar asks. "We, as healthcare workers, are the only ones who can successfully fix the problems, we are the ones who know the system and what needs changing" - @KedarMate #GiantSteps22

Every relationship (whether personal, professional, between patient and healthcare worker) that matters is based on trust - @KedarMate #GiantSteps22

"We count the number of the patients on a waiting list, rather than how long they have been waiting" - @KedarMate #GiantSteps22

Kedar has spent some time investigating trust - empathy, authenticity & logic are both where trust begins and where it can break down - @KedarMate #GiantSteps22

Kedar discusses ways to build trust:-
Building empathy - centre another, get curious, ask questions.
Logic - communicate, demonstrate capability & communicate - "sit down at the bedside, make eye contact, care about the answer" - @KedarMate #GiantSteps22

Authenticity - "you cannot be good at being anybody else" - be yourself & be consistent. For example, if your home self and work self are wildly different, you'll likely have issues building authenticity - @KedarMate #GiantSteps22

Unfortunately, Kedar says, we need more than trust to repair and rebuild our systems - we need courage - @KedarMate #GiantSteps22

Over the past few years we have heard many stories of courage from healthcare workers - we need that and more for what lies ahead - @KedarMate #GiantSteps22

A study identified racial inequities in access to specialised inpatient heart failure care at a US medical centre where Black & Latino patients were much less likely to be admitted to specialist care & outcomes much worse - @KedarMate #GiantSteps22

Healing ARC - a reparative approach to healthcare - Acknowledgement, Redress and Closure - @KedarMate #GiantSteps22

Kedar calls on healthcare workers to "seek out moments of contradiction & call them as we see them & face them in relationships grounded in trust & courage" - @KedarMate #GiantSteps22

First law of improvement - "every system is perfectly designed to get the results it gets". Again, emphasises that is up to healthcare workers to rebuild trust and change - @KedarMate #GiantSteps22

"You are entirely up to You" and "We are entirely up to Us"- @KedarMate #GiantSteps22

Taking action is restorative, Kedar says, if there's something you can't conscience, there's healing in taking action - @KedarMate #GiantSteps22

Many questions and comments in Q&A function and chat following Kedar's keynote highlight desire for change, but that many don't feel they have capacity or support to do things better - @KedarMate #GiantSteps22

"Goal should not just be to fix pot-holes but pave a new road" & obtain better population health - @KedarMate #GiantSteps22

Final comment - Kedar calls on healthcare workers to commit to calling out the question/contradiction/challenges - "Do not walk by - unless we stand up for that, the system won't change" - @KedarMate #GiantSteps22