 When I started my walk across America, I never thought about the idea of writing a book about it. I really was trying to raise awareness about healthcare safety, both that for our patients and for our workforce. Many people don't understand that workforce injuries and health related needle sticks and falls to nurses and physicians and pharmacists are extremely high. In fact, healthcare workers have one of the highest injury rates of all professions, including construction, and that was even before the pandemic. And then there's what we all know about patient safety and preventable medical harm, being the third leading cause of death in the United States. And I was really frustrated that we weren't making enough progress towards improving both those areas of patient safety and workforce safety. So I happen to have a couple of glasses of wine one Friday evening and watch Forrest Gump. And when he got up off the couch and started running across the country, I immediately stopped the video and turned to my wife and said, that's it. That's the crazy idea I'm going to do. I'm going to walk across America trying to raise awareness about healthcare safety. She thought I was absolutely crazy and said, you'll wake up tomorrow with a headache and realize this is a crazy idea. But it wasn't. And so I set forth on February 28th of 2020 in San Diego. I literally put my feet in the Pacific Ocean and then started my walk. And that day, the first day I did over eight miles, including a stop at Petco Park, which is the home of the San Diego Padres baseball team. I never realized two weeks later, really 10 days later, we would start shutting down the country and the pandemic would hit. So I guess when I look back on this, to walk across the country in any year might have been a crazy kind of big idea. But doing it during a year when we had the pandemic, when we had such social unrest, and we had such political divide. As I was walking, many of my friends said, you need to write a book about this. You need to be using. And I did all through my walk, a handheld recorder. And I recorded all my reflections, all the things I saw both great and not so great. And when I got finished in Jacksonville Beach, Florida, 355 days later and had done 2460 miles total, I had what was a really good draft of a book on my handheld recorder. And I started transcribing it. And lo and behold, a year later, the book is on the market now. I was going to do a walk across the country to raise awareness about healthcare safety. The media really wasn't interested. They were, yeah, okay, walk across the country, but we're not interested in healthcare safety, which totally disappointed me and highly surprised me. But then I decided because of my love of baseball, I would walk to all 30 major league parks. And I thought before the pandemic hit, I might even take in a baseball game. After the pandemic hit and baseball shut its parks down, all I could do was visit the park and walk around the outside. But the moment I said I'm walking to 30 major league ball parks, all the media started coming out, the TV stations, the radio stations. Oh, we want to interview when you get to the baseball park. We want to talk to you about your love of baseball. But I was able to effectively change the conversation. So when they would ask me how long have you been a Chicago Cubs fan, I would say all my life. But did you know that preventable medical harm is the third leading cause of death in the United States? And I was able to get that message across, get the message across about the struggles our healthcare workforce was going through during the pandemic. In fact, each day I walked of those 355 days, I walked in memory of either a patient or a health worker who died due to preventable medical harm. We were not prepared for this pandemic. We could have done a whole lot better. And unfortunately too many of my colleagues, people that I read about across the country, were going to work to heal and do what they wanted, what they always wanted to do from early in their lives and they were dying because of lack of equipment, lack of training, the resources that were needed and should have been there. I went into medicine. I've got to credit my mother for many reasons. One, she always thought I would be a good physician. I don't know why I was maybe 10, 12, 14 at the time when she would tell her friends, oh I know David's going to be a physician. And I kept telling her, no mom, I want to play center field for the Chicago Cubs. And as I joke in the book, she wanted to be aware of the long white coat and I wanted to wear Covey blue pinstrives. But my mother suffered a lot from healthcare conditions that unfortunately she had through her life and died at a relatively early age. And I found myself growing up learning about her illnesses. I would be there when she was in the hospital. I'd read the medical chart. That's the days when the medical chart used to sit at the foot of the bed on an aluminum tray and anybody who walked in the room could read anything out of the chart. But I got to learn about residents and nurses and physicians. I got to see who were good and who weren't so good. And I also learned that doctors weren't always right. So I've said in my book that I think my mother and her health taught me pre-medicine before I even went to college. And it just continued to interest me as her health continued to deteriorate. And I was very fortunate enough to get into the University of Illinois Medical School and then to create my career. People will ask, why did I get into patient safety? What was it that pushed me towards that? It wasn't that my mother had any specific air early in her career. But when I was a resident, I was involved in a medical error, a wrong-sided surgery case, and the team had done multiple hernia repairs through our careers. Me, I probably did 30 that year alone. And our hospital probably did close to 500 hernia repairs. It was a common procedure. And so we never had any doubt that the procedure would go wrong. However, due to some mixups in patients' names and other things, the incision was made in the left side of the abdomen versus the right. And people didn't realize it for about two, three minutes. So after the left incision was closed and the right hernia was fixed, we now have a patient with two hernia repairs on their abdomen. And there's got to be some explaining to do to the patient once they wake up from the general anesthetic. Well, an hour later, I'm called to the recovery room to discharge my patient and I'm dreading going to the recovery room. I know this patient's gonna give me the same disappointment and anger about us making a mistake. We promised we would take care of them and make things safe and provide a good outcome and we didn't deliver. And as I walked up to the bed, he looked at me and he started smiling. And I was totally shocked by that reaction. And as a good resident, I said nothing. And he looked at me and said, today's my lucky day. And now I'm really confused, but I continue to maintain my silence. And he says, yes, today is my lucky day because my surgeon told me that under general anesthesia, he discovered a small second hernia on the left side and was able to fix both hernias under one general anesthetic, meaning I only had to miss one day of work. Today's my lucky day. And I paused, which seemed like an eternity for me, but it was probably about 10 seconds and I looked at him and I said, yes, today is your lucky day. And I signed that gentleman out and turned around and left. Like I said, I still remember that case. It still haunts me. Not only was it morally and ethically wrong to lie to a patient, but we didn't learn from it. We learned nothing because we kept it hidden. We said, don't tell anybody because if we tell people, they'll think we're bad and we make mistakes and we're incompetent. Maybe we'll lose our license. Maybe I would lose my residency. And so we hid it. And what happened year after year after year is we kept having wrong-sided surgeries because no one was willing to be open and honest and to use those unintentional harms as a mean to learn and to improve the quality of care we provide. And when a healthcare worker makes an error that leads to preventable harm or injury to our patients, that case stays with us the rest of our lives. We don't forget it. We feel horrible. I've known many caregivers that I've read about that have taken their own lives because of a medical error. A nurse who gave a wrong medication that contributed to the death of a child without support took her own life 10 months after the fact. Again, there are numerous cases like that. People leave the profession for fear that they'll hurt somebody else. And these are good people. These are not people who were careless or doing things that were reckless. They were trying to do the right thing, but the systems and processes that are in place in healthcare still provide too many ways that heirs end up reaching patients and causing harm. Today, we've built programs that are called Care for the Caregiver Program where we do try to support those at the front line when an error has occurred, even if it hasn't caused injury. The thought of just making an error that could have harmed a patient is still devastating. We lose our confidence. We're fearful of making another mistake. In fact, there's data that shows that people who have made one mistake, if they're unsupported, are more prone to make another mistake because they are scared. They're just not reacting and they're always timid or just shy to do the right thing. And so we've got to find that support. And then historically, when patients or families have been harmed, we've put this process in place. It's very well known in the insurance and medical malpractice industry called Delay Denied Defend. When some harm occurs, many hospitals still will shut down and they create what Rosemary Gibson calls a wall of silence. That means patients and families now are trying to find out answers about why their father or why their spouse had a bad outcome or an outcome no one ever anticipated. And yet the hospitals, especially the care teams, are told don't talk to the patients, let our legal team talk to the patients, let risk management talk to the patients, and they're trained to kind of not return phone calls, to try to delay this out and make hopefully the patient or family give up and go away. If a lawsuit's filed, then now all of a sudden we come together and people are, it's like a jowse. How could we win at any cost possible? So we first delay and then we deny we did any wrong doing and then we defend it with high price lawyers. And many times these cases stretch out with depositions and in the filing of the lawsuits and everything. They could go five, six years before they ever see a courtroom. And many patients and family members unfortunately just give up. They want to move on or they don't have the resources to fight hospitals and health systems. And they go away. And that's unfortunate because that to me is a second intentional harm. While the first harm was very unintentional, the second harm we cause when we take delayed deny and defend strategies is very intentional. It's well resourced and no one wins except the attorneys. I think to change the culture of health care to one of open and honest communication and learning from preventable harm events and medical heirs is right up front solid top-notch leadership and a board of directors that gets it. I was very fortunate when I came to MedStar Health that our CEO Ken Samet was fully engaged, was trying to do this sort of work already. But we hadn't systematized it across 10 hospitals and 280 non-acute facilities. So I was blessed to have great leadership and great support at the board level and then given the resources to roll this out and to train up 28,000 people on high reliability and resilience science on open and honest communication. And look, we're still far from perfect. But when we know a preventable error led to harm, we respond immediately. We engage with the patient and family. We share everything we find as we find out about what happened. And then we try to resolve it without getting into the battles of plaintiffs' attorneys versus defense attorneys and everybody getting paid big dollars to win at all costs. We've been able to resolve cases many times without using the court system and that's so much better for not only the patients and families but it's better for the care teams because, like I mentioned, in one case there were 43 depositions of doctors, nurses, residents and they have to relive that over and over. They got to do the deposition sometimes two or three times. That's just not right. A lot of that can be avoided if we just know when to say we, our care was not up to the standards and this is on us and be open and honest about it. And one of the reasons we haven't been able to move the patient safety mission forward as quickly as we should have is because our incentives are still misaligned. Hospitals are paid for the quantity or volume of care they provide, not the quality or outcomes of the care they provide. And so if, as many CEOs and many hospital systems, especially during this time is with the pandemic, there are a lot of financial challenges and they need to drive revenue. They need to make money to keep the hospital doors open. And so the priorities are much more do more with less and that unfortunately sets up the stage for a bad outcome to happen because people are asked to do more. People are running faster, jumping higher and they're not taking the time to do what high risk industries do to lower risk and to maintain excellent safety records. So I think our incentives are still misaligned and I think they're the stakeholders. Many of them don't want change. They're very happy with the system as is and they don't want to see a change to something even though it's higher quality safer care because they're making the dollars and like I said, the defense attorneys, medical malpractice industry is a multi-billion dollar industry. I wanted to raise awareness about the patient safety crisis. I wanted to try to educate the public that they can be a partner in their health care to ensure safety. We can't do it as caregivers alone. We need to partner with our patients and families to optimize our care. We need to include them in discussions. We need to literally make this a care team that puts them in the center and we're all around them trying to optimize our care. We need them to ask questions about their care. What medication are you giving my mother right now? I know at four o'clock she's supposed to get her diuretic. Is that what she's getting? We love having that interaction. It captures things that maybe we missed. And so I wanted the public to read the book. I remember we did a couple national surveys through the Patient Safety Movement Foundation that showed one year 90% and four years later, 88% of the public didn't even know that there was any concerns related to safety when they entered the health care system. So just by raising awareness and creating better partnerships, I thought my book could help save some lives. And I also wanted caregivers to read it and to know that they needed support also. We need better legislation. We need better resources and support for our care teams so that they can provide the care that they come to work to provide every day that's safe, high quality care. And until we get all the stakeholders together, this isn't going to happen. And it's got to start at the highest levels where people just say enough's enough. Lucian Leap used to always say, and it's still true today, if there was a major jumbo jet airplane crash every day in the country, no one would allow this. We'd shut airlines down. We'd start doing investigations. I used the analogy in my book that the 737 MAX-9 had two crashes within six months. And we stopped that airplane from flying. And yet we have the equivalent of a 737 MAX-9 going down every day in health care. And all the people that can make a difference don't seem to care. Always struggle with why hospitals haven't embraced quality care and safety as much as I believe they should have. You know, Deming was right many years ago that if you improve the quality of the product you provide, I don't care if it's making cars or providing care to patients, you will lower your amount of defects, or in our case, mishaps, infections, wrong medications, and improve your bottom line by doing that. You spend less money on trying to deal with things after the fact than if you just corrected them first and foremost. And what we found with programs now like CANDR, which is the open and honest communication after preventable harm, and the learning that comes from it, in healthcare systems like MedStar, and there's a number of others that have started adopting this program now, you create a learning environment where you decrease the amount of serious safety events you have, you decrease the amount of preventable harm events you have, and then you decrease the medical liability payouts that you have to make when you have all these bad care cases. You end up saving millions of dollars, but most importantly, you're saving so many lives from either an unfortunate death or a severe disability because your system didn't protect them the way they should have been protected from preventable harm.