James B. Conway was adjunct lecturer at the Harvard T.H. Chan School of Public Health in Boston from 2006 to 2016. From 2006 through 2009, he was senior vice president of the Institute for Healthcare Improvement (IHI) and, from 2005-2011, a senior fellow at IHI. Conway was executive vice president and chief operating officer of Dana-Farber Cancer Institute (DFCI) in Boston from 1995 through 2005. Before joining DFCI, he had a 27-year career at Boston Children’s Hospital in radiology administration, finance, and as assistant hospital director. His areas of expertise and interest include governance and executive leadership, patient safety, change management, crisis management, and patient-family-centered care. Conway, coauthor of “Respectful Management of Serious Clinical Adverse Events” (IHI; 2011), holds a Master of Science degree from Lesley College and is a frequent lecturer.
1. Betsy Lehman Center: As you reach retirement, you’ve been sharing a personal story about medical error. What happened?
Conway: In August 1980, I was working at Boston Children’s Hospital and I received an emergency page to come to the front desk. It was my sister on the phone and she said, “Jim I think you have to come home, Dad is dead.” So I left for our home in Dorchester and there my father was dead in his favorite recliner. It was so very confusing to us. My father had been to the hospital that day — he hadn’t wanted to go, like the tough Irishman that he was. But he was having radiating arm pain up and down his arm.
He was taken to the local hospital, and he was sent home with a med, and shortly afterward he died in his chair. It made no sense to us what had happened. So my mother said to me the three questions that would dominate my life going forward. She said, “Jim, I just want to know three things: What happened, why it happened, and what’s being done at the hospital to make sure it never happens again.”
They agreed to conduct an investigation and we were informed that my father was treated for the radiating pain as a muscle pain and he was not treated for the heart attack. So when he took the muscle med on top of the attack it killed him. The hospital president said “you can sue us” and my mother’s answer was “it won’t bring him back.”
So throughout my whole career, in the deepness of my family, there has been this longtime focus on patient safety.
2. Betsy Lehman Center: What insights did you experience early on in you patient safety work?
Conway: In 1995, I went to the Dana-Farber Cancer Institute in the tragic aftermath of the death of Betsy Lehman, and the first thing I learned was that all of us in health care carry the burden for the harm that occurs under our watch, and we should. But carrying the burden isn’t enough. We have a responsibility to learn everything we can to prevent it from happening again. We understood that if we had the courage to use this tragedy in the spirit of a bold aim, that in the next three years we would be seen as a leader nationally and internationally in measurable improvement of patient safety. And that unleashed this unbelievable power and tension for change and improvement that carried through.
3. Betsy Lehman Center: What message would you send to your colleagues?
Conway: First, the exquisite responsibility of leadership over all quality and safety issues and matters. The second is the need for relentless vigilance in the service detecting the potential for risk in preventing error and harm. People had been talking about these problems for a long time, but finally someone with a preoccupation with data saw the same data and chose to do something with it. The third is addressing the multiple victims of error: the patients, the family members, and also the staff — the last thing they wanted was to come in to work and harm or kill a patient. Fourth, we must put in place systems to support safe practice and mitigate the chances of harm reaching the patient. The power of Interdisciplinary practice follows and it’s all underscored by the power and privilege of patient- and family-centered care.
In my early years at Boston Children’s Hospital, I learned that there is no force in the world stronger than a mother in your face advocating for her child. When you stop and listen to the mother, father, patient, family, there is an amazing amount to learn.
4. Betsy Lehman Center: What’s the best strategy for getting things done?
Conway: If you try to accomplish everything, you accomplish nothing. We have to try to focus, to prioritize. What I often look at is: “What’s the theory of the work? What are the measures you are going to use to achieve your goals.” You may have lots of good ideas but they may not solve your goals. A few weeks ago I was reading an article in my wife’s copy of AARP on how the health care system can harm you. Sitting in my favorite chair, I was reflecting on the fact that for all we’ve accomplished together there is just so much more we have to do. One of my favorite quotes is, “To do things differently, we must see things differently, because when we see things we never saw before we can ask questions that we never thought to ask before, and this is a lot of what the patient safety journey is all about.”
I have often been asked, “Aren’t you ever satisfied?” And my answer is always: No. As leaders, you have to have a preoccupation with failure. I learned that I always had to have a preoccupation with failure. Because all of us in the institution bear the burden and responsibility for what happens under our watch.
5. Betsy Lehman Center: Is there one thing you would like to stress the most?
Conway: In my 50 years of learning the thing that is most important is respect. There is nothing more important than the respect we have for the patients and the families we are privileged to serve and partner with, with the communities that they come from, and with out colleagues. Nothing trumps the power of respect.