 This next panel is one of the highlights of the patient safety movement every year. A discussion with media and patient advocates about how these stories are told and how to better shine a light on good practices and how to discuss difficult situations like the one you just saw. Transparency or fake news. Hospital rankings or independent journalism. The politics of healthcare versus the boring substance of healthcare. Engagement with the sharks, I mean the media, or playing defense. Publishing hourly or spending months getting a story right. Telling your family's tragedy to the world or healing in silence. Change versus more of the same. These are the questions that journalists and advocates face every single day. There's a famous old philosophical question that I often think about. If a tree falls in the forest and no one hears it, does it make a sound? In a similar thing in our context, if a medical error occurs and no one knows, how does change happen? In the age of 144 character stories and top 10 lists, how do you tell a story as complex and challenging and ever emerging as healthcare? These panelists deal with these issues every single day. I'd like to welcome some of the best journalists in the world to the stage. Please come up. Okay, so I'm going to briefly do introductions so we can skip past this and I'm going to read from this because these are all super impressive people. Elizabeth Aguilera is the healthcare reporter for CalMatters who can answer the ultimate question why does California matter and in healthcare maybe it matters more than the federal government right now. Jamie Thomas King is one of my favorite actors and should never have canceled tutors and just had the amazing story we all just saw and we look forward to talking to Jamie. Sean Linteren is Senior Patient Safety Correspondent. That is an amazing title, how come we can't have that in the United States? For Health Services Journal and writes lots of stories that drive my clients, the Prime Minister of the UK, crazy. Jane O'Donnell is healthcare policy reporter for USA Today and was on the panel a couple years ago and was so amazing we asked her to come back. No pressure, Jane. And then last, Spencer Woodman, reporter for the International Consortium of Investigative Journalists. That's a full title. All right, Jamie, let me start with you. We've talked on the phone and a little bit earlier. You had a really tough choice to make after all those things happened. Do you publicize this? You had the whole world wanting to talk to you because of who you are and because of the story. You really pieced through how you dealt with this. Can you just tell us that story a little bit? Well, I think the first thing to say is that after Benjamin died, I just assumed that the most important thing for the hospital would be to figure out what had happened so that they wouldn't make the same mistake again. And perhaps I was naive, romantic about all of those things, but I really believed that the truth would be more important than anything else. And it was only when I was sitting in the inquest, when I realized that that was not going to happen. And when it came out that there was some degree of attempt to cover up, we had to stop the inquest and there was a police investigation. And this was just before Christmas 2016. And I, over that Christmas period before I was going back to do the second inquest, I just absorbed as much of this issue as I could. I read Sean's work. I read James Tickham's book. And I suddenly realized that the issues that we were experiencing were the norm. And actually in some ways, having a coroner's inquest and a lawyer to represent us, we were lucky. There were a lot of people reaching out that had nothing. They had no support. There was just a brick wall of silence. And just the more I became aware of it, the more important it was to me to only ever speak about this in a way that would be part of the solution and not part of the problem. And there were some journalists who I felt would ultimately just sensationalize the story. And so I really haven't, I actually haven't spoken much. This is sort of the beginning of that for me. And when I found the movement and the foundation, it seemed to me a very safe place to come to learn of how I can best make a difference. That makes total sense. Sean, when I was talking to you, you had this great way of talking about your work, which is finding individual stories like this to talk about bigger issues. Can you talk about some of that stuff? Because, you know, I know, as Jamie said, he really looked at your writing. And you are someone who is both powerful in the UK, but also, I think, thinks of himself as an advocate as well. Yeah, I definitely do. Some people describe me as a campaigner, which I don't really like. I'm actually just a journalist doing his job. And if a journalist isn't campaigning, then naturally, something's quite wrong there. But as you alluded to, my work with the Health Service Journal is largely what I try to do is find stories like those like Jamie where, yes, they're a tragic individual story and there is actually no need to sensationalize those. But what I look for is to take those stories when they pose a question to the system, to the wider culture and the processes that the National Health Service in England works under. And if we can do that and we can make that bridge between the individual and the systemic, we can actually pose questions to the system and hold the mirror up in a way that sometimes can be a bit of a cold hard slap to the face of the clinicians, the nurses, the doctors, and also the politicians and policymakers who run the system. And you can deliver some real change. And I've been fortunate enough to be at the forefront of some reporting that has delivered some change in the UK. But as everybody in the room will know, the work never stops. And there are always new systemic errors we can expose. But with patients being prepared to talk to responsible journalists, we can work together as a team, I think. And when you find the right kinds of clinicians and hospital systems and leaders as well who want to work with you, we can all get to the place that everybody wants, which is to reduce harm and reduce avoidable error. I want you to talk about one of those stories in a second. But I want to go back to Jamie. Jamie, when you kind of looked to your point about all the different kinds of reporters, and there's folks in the room who have really difficult stories who are going through the same process you are, can you give them advice? Can you talk a little bit more about that journey and why this way felt right to you and how you kind of think about exploitation is the wrong word, but sensationalism versus really telling a story to get to what Sean's talking about real change? Well, it's a really good question. I think it would be disingenuous of me to not say that I'm doing this because it helps me. It helps me in my grief. It helps. It's an antidote to despair. When you see that kind of behavior and sitting in that courtroom and watching all the people that I had been for two, three days, been quite close with, unable to... And they would grief-stricken themselves. You could see it. You just can't help but see that this is not individuals. This is a system that does not empower truth to be the most important part. And to me, you can't help but want to make the world a better place. And I suppose the energy and the hopes and dreams that I had for Benjamin I was determined that they wouldn't just die when he died. They had to evolve and they had to change into something else. And that's why I sent something along the lines of, this is the way that we parent Benjamin. Because we all know that when people die, the relationship goes on. And I feel like it can't have been a terrible thing that shouldn't have happened. And that's the end of that. It can't be that. I just don't see it as that. Thank you. This is really difficult. Sean, can you give an example of some of the reporting you've done where you took an individual story like that and ended up making change across the UK and pissing off my bosses? Chief troublemaker, I like to think of myself. So there have been several stories where we've garnered government inquiries and investigations, which is nice. But I think one of the ones most people in the room will be familiar with and the story that really started me off on my Specialism in Patient Safety was the scandal at Mid Staffordshire Hospital in the UK, which was, a lot of people would say, is one of the worst care scandals in the NHS's history. And began very much with me reporting at a local newspaper level the stories of local families. But to cut a very long story short, that resulted in a public inquiry, which I gave evidence to, along with some of the families. And in the past five years, as the UK government has responded to that inquiry, we've seen a whole raft of changes that have been introduced, new regulations, new laws around duty of Canada, for example, and when errors happen. And there's been a lot of those changes are still bedding in. And in fact, I don't think I would, I'm not going to hold my hands up and say, we fixed the NHS, this work will always continue. And there are always changes. But there have been improvements made since that story, since those series of articles I wrote, which I think has nudged the healthcare system in the UK to a better place. But the, as I said, the work goes on. And I think one of the challenges for the UK and the debate we're having at the moment is around developing a just culture, which is something there's a lot of emphasis on. And I think a lot of clinicians need to wake up to the scale of harm that they are involved in as an industry. And that's the next challenge really is to get some of those issues tackled with, to get the right culture. Because that's how we make the biggest improvement. And I'm writing a lot about that at the moment and hoping to, to continue to nudge the system in the right direction. Jane, you write for a very small publication called USA Today, the largest subscription and largest print in the country. You have an interesting kind of middle ground between new media and old media. Because you guys publish every hour and you have the biggest website and you have a huge base, but you also publish shorter stories. Walk us through how you think about patient safety and these healthcare stories and how you get some of these stories. Sure. Fortunately, I have a job that's kind of halfway in between the folks on the investigative team where I don't have the intention span to work at that pace, which is that they often spend a year or more in the case of the maternal mortality series delving into that. We'll see, in light of all the talk of hostile takeover of my company and all that, we'll see whether that gets to continue. But there's some great work being done there. And then there's some people that have to really churn it out. And we were talking earlier about some of the things that Jamie wanted to avoid, being part of that kind of sensationalizing. And there's a real risk of that when you're one of those people. I get to spend weeks or months on stories. My beat is around mental health, behavioral health, which is addiction, as most of the people in this room would know, trauma. And I continue to write about patient safety because I find it so important and interesting. I think about it as telling a larger story. My editor's been bothering me to say that this, not bothering me, but insisting that I, this second part of a domestic violence project that I've been working on, the second part of storytelling has to tell a larger story. I just think that the story is so compelling. But I have to tell a larger story. So I have to tell a larger story, had to tell a larger story a year and some ago when I wrote about a doctor who was, pardon me, for sensationalizing, but sometimes the details sensationalize themselves, anally raping his patients allegedly. That was a tip I got from while looking into a patient who had been harmed and was one of many through a procedure at the Cleveland Clinic. I thought about that as something that was, wow, it's telling a larger story about the doctor and patient sex during the Me Too. So we took advantage of that. So I was going to answer a question you asked earlier. And it's pretty cool, as a reporter, that it led to some big changes at the Cleveland Clinic. Some people might say, hey, you're USA today. What do you care about one colorectal surgeon in Cleveland? Well, it changed the way the Cleveland Clinic looks at these kind of accusations because they were getting a load of crap from the particularly female doctor saying, I've been referring patients to that guy for years and you had an out-of-court confidential settlement with a patient and then another woman come along. And then like a month ago, she spoke before the second patient, spoke before the Federation of State Medical Board's sexual assault committee. And they're coming up with new, excuse me, sexual boundary committee. That was even more interesting because it does kind of break a boundary when you ain't only rape a patient allegedly. So anyway, so that's the result. So I want to tell a larger story. The word sensationalize is interesting because sometimes these stories, particularly patient safety, they sensationalize themselves. I've done several pieces on a big hospital. It was part of a larger chain in my area that had persistent sewage leaks on the floor of their operating room that kind of sensationalizes itself. Jane, everyone would love to get their story in the USA today because it is a way to make change. How do you get your stories? How do you work with patient advocates who come to you and say, here's an idea, give us a little bit more insight on how we get our stories in your paper? Well, for patient advocates, it has to tell the larger story. I actually became interested in the Cleveland Clinic story because I was at the Consumer Reports. I was asked to speak actually about the sewage leak story at a Consumer Reports Patient Advocate Group. And as somebody who'd been a reporter since the 80s, but in auto safety, it just blew me away. It was the walking wounded. And I mean, they were such compelling stories. It was just unbelievable to me. There was a woman with brain damage and a guy with diapers and this one. And it just was unbelievable to me. So I wanted to tell all their stories, but which one told the larger story. And frankly, it does help if they could make it part of a larger trend. I would like to tell hospital stories, too, on the changes that they're making. But it's very difficult, as I think Spencer said, to get a lot of hospitals to talk, perhaps, because they're so afraid of the bad publicity. Yeah, we're going to get there. I want to talk about that from all of you. Spencer, you have this terrifying title called Investigative Journalist. And in politics, when you get a call from the investigative journalist, you immediately go to the bar because you're probably screwed. With the journalist, maybe? Probably not with the journalist, just by yourself. And Spencer, I know you're working on a kind of year, big, long thing about the medical device world. And just talk to us about the process of covering an industry like this, covering a sector like this, and really diving deep into figuring out all the things that my clients don't want to tell you. Sure. I mean, it starts with calling people, saying my job title, and getting hung up on. But, I mean, you know, we started this project with basically an idea, the idea that the medical device sector is a large and growing area in healthcare. And there are big differences in how it's regulated around the world. So in some countries, medical device companies can essentially hire their own regulators. They can get devices approved by private and quasi-private entities. Journalistically, that's fascinating. So we dove into it. There's been a lot of talk about sensationalizing and what is actual data and what is anecdote. So it was our kind of biggest priority from the outset to find real stories and make sure that we weren't taking freak accidents and portraying them as something more systemic. So we started with data. We pulled literally millions of public records through various Freedom of Information Act requests. One of the largest data sets we obtained was from the FDA, and that's the adverse event reports, the MDR, medical device reports that a lot of people in this room might be familiar with. That's an imperfect data set, but it was a starting point for us to really look at what the trends are and start identifying devices and types of devices that we should be focusing on. So from the outset, we started with data and then made our way to the patient groups and talked to a lot of experts in between. That makes total sense. Tell us some interesting things you've found out that we don't have to wait for you to publish. Sure. So I published a story in November and basically it followed this same trajectory where I was looking through primarily this FDA data and we kept seeing for this one type of device, a drug infusion pump, just a lot of adverse events. In some cases an outlier, the limitation of this data or one of the limitations of this data is that there's no denominator, and I can talk about that a little bit more, but what I mean by denominator is that you don't, because the companies don't release the information about how many devices of any given brand or in circulation, you can see the error number but you don't get the error rate. Anyhow, after digging into this data about this specific infusion pump, it's a pain pump that basically gets installed in your abdomen and goes up into your spine. This pump, for many people, it's a great device and it does hold the promise to treat otherwise untreatable pain by, with micro doses of opiates and other pain killing drugs. However, it seems to have been a difficult device to perfect by industry. So after looking at this device for a while, we found a Justice Department filing from, a U.S. Justice Department filing from 2015 where basically the FDA had the Justice Department intervene in the selling of these pumps and had to bring Medtronic into the device's manufacturer. There are a few different manufacturers, Medtronic's one of the primary ones, under a consent decree to have them stop selling the pumps. This story to me was almost a comment on how few investigative journalists there kind of are poking around out there because this consent decree was public and more than 200,000 of these pumps had been implanted in the spines of people around the world and it had really never been written about. So I set out to essentially tell the story of what happened to those hundreds of thousands of patients who had this device implanted, this type of device implanted before the Justice Department had this device largely taken off the market pending corrections. And a few, after we had been asking the FDA questions about the device for a couple months and a few days before my story published, the FDA published a safety communication about the device as regarding off-label use that mentioned the high level of adverse event reports. So that was almost the kind of full circle of data, patient work, expert work, and then we published a story and there was a regulatory, at least a regulatory communication that coincided with it. We can't take credit for it but the timing was interesting. I'm dying to read that. Elizabeth, I want to go to you. It's interesting, I'm going to be non-political here for a second. With the federal government not doing much, in fact right now, not even being open, a lot of the innovation is happening in California and you cover this every single day. Talk to us about trying to explain policy to readers and trying to find stories and how, so that's one. And then two, talk to us a little bit about how you weave in patient stories into a bunch of covers because for those of you who don't read her stuff, not only does healthcare, she also does immigration. Two very small non-political issues dominating the entire world. So CalMatters, and CalMatters is a state-wide policy based in Sacramento and so I cover healthcare like Jim said and some immigration which initially was not part of my coverage because it's not a state issue, people say, right, it's a federal issue. But of course it's been a big issue in California and a lot of it is the California Attorney General sort of pushing back on the federal government on immigration issues and also on healthcare issues in terms of taking the lead on some litigation regarding the ACA and what is going through the courts right now. But yeah, California has really sort of taken the lead. We have a new governor as you know who has really sort of come out of the gate on healthcare with efforts to try to get some single-payer work done and universal coverage which doesn't necessarily, I mean it all includes patient safety and so when I think about these initiatives, I think about also where the patients come into this. Where do Californians come in? In a few months, California is expected to hit 40 million people and so when you think about providers and insurers and how that system works and how they're caring for those communities is for me really important to try to figure out where the policy meets the people and so covering it from Sacramento's perspective in terms of proposals but then what is that going to mean for the average Californian who is trying to even just figure out how to have coverage, how to afford it and then once you get beyond the coverage issue, how do you make sure you get quality care and access to care which is a huge deal in California. So in Sacramento of course there are many proposals especially now with this new governor. There were lots of proposals in the last several years that some that made it through some that didn't with our previous governor who was much more concerned I think about finance and making sure that the state was fiscally solid. So this governor definitely wants to bring some healthcare to the fore and we're going to see what happens. Sent a letter to the federal government asking for some waivers to see if there may be some movement towards single-payer. I was talking to some folks yesterday who still have a lot of hope that that might happen. No one has a clear infrastructure of what that would look like or what that would mean for providers, for insurers and so I'm sure people in this room are probably thinking about this if it starts here in California because of course then there's a the question about where does it go from there if it's here. It is the 8th largest economy in the world right and so trying to figure out how to make the funds work for that and how to create the system for it. I wanted to just go back for a minute because you asked Jamie the question about you know how do you talk to the reporters about this and one of the things that I try to encourage people because I'm looking for those patient stories sometimes people have the natural inclination to say no to you. It's a private story in the same way that hospitals and doctors who are on the who are part of that story also have the natural inclination to close the door on you as Jane mentioned like no one wants to talk about this and I find that sometimes it's for especially for families to say you have a right to ask the reporter you know to sort of interview the reporter in a sense before you say no or before you decide you're not going to to find out if that's really the person you want to talk with. I think as a journalist you know for people who are private citizens I find that that's for me been a learning curve to say you know you can ask me questions you can find out what it is that I'm trying to do or or read my stories and decide then if you want to talk to me. And I just just to pick up on that I mean I think the best is when it's collaborative right when when because as we we've heard you know information doesn't always come from the sources that you expect it to and if the mission we all agree on the mission then we will have our own unique skill set that we bring and if a sharing of information I mean you've worked so closely with with patient advocates. Yeah I mean for me a little bit I was really interested when you said interview the reporter I always approach my work with families and in fact I do a lot of work with whistleblowers and staff within the health system and I always begin by saying to them you know we are effectively in a partnership with this I won't do anything until we agree to go on the record and everything that you say to me between now and then is between us and keeps private and so I do sort of have a bit of a compact with the people I work with. Not all journalists do as I'm sure the whole panel would agree there are those in our industry that we would prefer not to be in our industry but I think I hold myself to a high standard in the way that I work with families and that's always paid dividends for me. Well and it demystifies the process for the families or even for physicians or staff members anyone really that you speak with I consider who is not say an elected official or an executive because I feel like elected officials and executives just sort of understand what this relationship is and what you do and how it may benefit everybody involved in terms of a story but for people like advocates family members you know you demystify a little bit to understand that like Jamie said you can work in partnership once we both understand where where we are what our roles are in the process and of course they need to understand that like I admit the word mission it makes some of us I'm sure I would assume all of us except you're a little uncomfortable you know so it's not it's not really like we're on a mission with you we want to tell your story accurately and you can it's certainly um you're prerogative and right and you should ask you know what the journalist is trying to accomplish but you know I've gotten in the chat in a situation and I'm having it now with the domestic violence victim I mean she wants to get her abuser deported and that isn't my goal you know if that happened I suppose it'd be good for her but like I can't get I'm not getting everything in the story that she wants I'm trying to tell the larger story and I just wanted to come back to policy which happens to still be in my title and I'm based in Washington because that's where USA Today in Geneta based but almost everything comes back to policy but like you want to make a difference and you want like transparency and things like that that that CMS is doing you know it's is um a big part of what what I the story I want to tell and I and I want to get information out to people so they can make smart decisions maybe not to go to that hospital or or certainly whether to you know what kind of delivery to insist upon like that would be what I would have wanted one of the hardest parts of my job and the thing that keeps me up at night is saying no to some patients oh yeah it's heartbreaking people and I have a woman that wants to kill herself because it'll because like she hasn't she wants her story told so bad but she won't let her name be used yeah and it's kind of a narrow thing it's a complicated cultural thing to explain that yeah between as you you talked about Jane the larger story what's going to sort of shed light on some larger story or trend versus maybe a different or a different kind of story that's heartbreaking there's an interesting lesson for all of us here and uh and actually for the people in the room because it this reminds me there's a there was a quote from the chairman of the inquiry into the midstaffer to scandal and he said a great line which I wish I thought of myself and he said there was a tsunami of anger coming towards the health system uh from patients who had been harmed and in fact uh and if we don't do something about it we'll all get washed away by that anger and actually I think for journalists as well the world is different now with social media patients can connect with each other yeah they can tell their own stories without any involvement of a professional journalist and everybody in the room and us on the stage need you know we can all be swept away by that tsunami and it's that we all need to be considerate of how patients are connecting with each other and telling their own stories these days becoming activists almost without any professional involvement I did not pay you to say this but this leads perfectly to my next question I want to ask jamie jamie you're an actor you tell stories for a living and I think Sean's point about you know these stories kind of really taking life of their own you know do you have advice about telling these stories do you know as you thought about social media versus the long form you did hear versus talking to a reporter versus you know some of the more cable tv you and I were joking about a uk television journalist neither one of us like um who we wouldn't want to tell the story through them um talk to the folks a little bit about how you tell those kind of stories and how you think about it from an acting perspective well I mean I suppose there are two two separate things I mean me me using my story to to raise awareness to the issue is is I suppose one one side of it and I think what I found I mean contrary to popular belief you know not all actors are really out there confident you know public people I'm actually kind of a shy sensitive dude and so I was never on social media before I was never interested in any of that um I think I just found it all too overwhelming um but when but after that first inquest I I you know it I started to dip my toe in and realize that this was where it was all happening this is people that experience what we what I've experienced were going on there to chat and use it you know use each other and and and join forces and um and you know that that aspect of it is obviously tremendously important um for you just to tell your story to be heard so that you're not suffering in silence I mean I think you know I also realize that um you know that the um there are so many people that that have suffered that have never had any sense of this you know in the morning after Benjamin was born um we went into the hospital and I and when everyone was stable and I was taken into a room with the consultant who had made the decision to send us home early and she said you know you mustn't blame yourself and in my mind I'm like I'm really not blaming but I'm so not in that headspace where I can even think about it on that on that level but she just planted the narrative you know and I always thought to myself of people that that don't get an inquest that don't get a lawyer and that they have that narrative planted in their minds I mean to say don't blame yourself you're basically saying you're probably blaming yourself right which is to give someone a life sentence when they've already suffered the greatest loss that you could imagine it's it's unconscionable um and so I I mean you know as a storyteller I feel like I feel like you know and a similar thing just to pick up what you said you you have you don't have a responsibility for the mission you have a responsibility to hold a mirror up and and allow allow the problems to to resolve themselves and none of this stuff is going to happen overnight I think a lot of people who are very angry when they've suffered is that they feel like if there is some restorative justice then that will help them in their loss and there's an element to that that's true but it doesn't happen quickly and you so you have to find different ways to to heal you know to grief I feel you know I feel compelled to tell a film to tell a story about this and I an amazing guy that Sean helped in in his story called James Tickham who faced the most extraordinary systemic cover-up you know stonewalling and he didn't give up and seven seven or eight years of a campaigning really changed things in the country and I feel like his story is a story that needs to be told that holding up the mirror the transparency is kind of what Joe started patient safety to do right that kind of transparency can continues on all right this is a little bit of a tough segue but I want to go to it so every year I do this panel and every year to Elizabeth's point I say to the providers and hospital folks you need to engage more you do engage more and every year someone comes up to me afterwards and says Jim that's just not reality every story you guys just talked about were bad stories and there aren't good stories happening and Jane I'm going to pick on you because in your earlier your first remarks you said I want to tell the good stories too so give some people advice here how to get good stories told because I think a lot of the stories we all write and we've been talking about our negative stories and there are some amazing work getting done and you know the fact that the world doesn't know what this movement's done in five years drives me crazy because millions of people our lives are better because of it so Jane I'll that's actually a good segue to something I was going to say anyway and I was going to interrupt I was just in audience training a couple days ago at work and it's you know a lot of older journalists such as myself often go oh they don't even like to talk about that or how much traffic something's getting but it is a fact of life that you want to do the stories that people want to read that people are reading and two things that they said our readers or the readers we have and the ones we want want are stories that help them become better parents so something that would save their children certainly it fits with certainly my diction coverage but also they like storytelling they like something so so every story needs like a person you know in it and it can be a victim but something that comes to mind I did do a piece after a few months several months maybe after I was here a couple years ago about sepsis and I have another story on sepsis that I've been wanting to do that that got pushed aside because of some other coverage but I met a couple of women by getting more involved I went to a sepsis survivor event and one woman her life was saved at this local hospital near me and another woman nearly died so if you had people because your sepsis protocols I would find the people like this woman who will be in my story and and she she was treated properly and I can't even remember which hospital it was but it's not important but it was one of my local Virginia hospitals you know she is a great story and sometimes you know if you put her in the press release and all that it's it can be unfortunate you know it gets reporters might look past it but I would have those people available when people call you and say they're doing stories on sepsis it doesn't mean I'm not going to write the story about the person that didn't get the proper treatment but if you have a you know a sepsis protocol that you're doing at your hospital and you have a person that that was saved because of it you know was treated immediately and and it and was okay that that's a story to tell so I would I would find those real people and and make sure that they're available and and not send out how to hire an outside public relation firm to to put them in a blast email because then you nobody cares but you know work with the individual reporter in my company owns 110 properties around the country you know whoever the people are if you're in Indianapolis Sherry Rudofsky or Laura Unger and Louisville you know and and have a person ready that a couple of people ready that tell great stories about your hospital okay we have 11 10 minutes left we need to go to questions there's lots of questions so I'm just going to kind of pick them here Spencer a couple for you I'm going to read you to and you can have at it for Spencer what is the perspective on Netflix film the bleeding edge and for Spencer despite the reporting and consent decree you did the reality was that Medtronic was still able to sell the pump and I'm unsure if there was any material improvements to the product despite it still being available is this right um so I'll take the second one first uh you know there there were limitations to what I could report on that pump um and one of those limitations was its current status I mean the Medtronic did make a lot of changes during the consent decree to the pump it is now a redesigned pump that has certain features such as it communicates with a basically an iPad to let the physician and the patient know what what sort of dosage it's giving overdoses and withdrawals were a problem prior to the consent decree and I just don't have the data to determine what the performance is although I know that a lot of changes were made in some of them like that that performance monitor are pretty cool seeming the bleeding edge was you know I found it to be a tell people what it is oh right so the the bleeding edge is a is a Netflix documentary about the medical device industry that made the argument that that basically the the device industry is poorly regulated and therefore bad devices are getting put on the market and harming patients it you know it focused on some of the same devices we did I won't go into those um because we're running out of time but you know it was it there was a lot of blood and guts I mean you know a lot more than in our investigation and there were a lot of facts that were accurate and true and good to good to put out there in the public and there were some um there's some reporting methodology items that I had issues with so I found it to be mixed but ultimately it was certainly a gripping piece of film Sean you and I kind of got a couple um rebukes here health professionals also want to help patients Sean how can you include health professionals in your story so we can contribute to the improvement and the movement it's a fair challenge and of course I would totally agree I think we can all agree no no healthcare professional goes to work to harm patients but there is a there is a simple fact that whilst they go to work with the laudable ambitions they still do and it still happens um and what I find is that clinicians aren't honest about that sometimes um and you know we're in a room here with hundreds of people who are all signed up to improve care and improve patient safety but there is a disconnect between the people in this room and the nurses and doctors working 12 hour shifts every day in hospital wards are they really uh clued up and tied in with the agenda that we're all discussing today and I think that's the challenge for the industry and my job as a journalist is to hold up the mirror and to show the ugly side of it to prompt those conversations and debates and hopefully get the message to go beyond this room to those staff who are working every day so that they are thinking about it as well that's how we will change culture in healthcare getting the attention if I could just mention I overheard someone when I was getting coffee earlier talking about you know the great goals that I've been hearing so much about just since I've been here but but that all the budget cutting that's gone on and you know and and how overworked the nurses are and and all that so it it's um I I want to write just as my colleagues do you know help consumers figure out what to what to make of all this where to take you to where to go for care and how to do the research because it's so hard well journalists can be the friends uh to clinicians who want to make improvements and change talk to us help us out you know I get lots and lots of whistleblowers from the NHS who contact me because they want to make the change so for those of you out there who want change but are scared of the media find a journalist you can work with and uh and open that dialogue and trust them well this making those people available sometimes yeah those people are willing often to share their experiences but they're these gatekeepers that sort of and say no you can't speak to those uh direct providers or they're not available or they don't want to and I often wonder if the request even ever gets to that person versus someone making that decision and saying no we don't want to because they do often I think want to share their perspectives or their challenges or what they're passions are um similarly this kind of follow-up to your point Sean um how can we get reporters to hold hospitals accountable for not embracing zero harm goals versus simple versus simply random harm stories I think data is really important so Spencer talked very well about how he used data and we use data at the health service journal as well and you know that's how we will challenge providers and in the NHS we have a universal healthcare system so um we should have a we have the best opportunity to mandate safety changes to to the entire country and one go um but of course we don't manage to achieve that because they're even within a national health system there are still politics and variability um so for us the difference is challenging those organizations who who are the outliers and one thing I know very well in the NHS is nobody likes to be an outlier um so we publish league tables on certain data um and you'll always see those that are at the bottom uh they will they will take action to improve because nobody wants to be those those outliers so that's a for me that's how I do it with a national health service next question takes fair umbrage with me saying Jim we don't need more happy stories 200 000 live loss each year and five million worldwide why is there not a story each day on this to inspire change the way airplane crashes get covered can I so uh will you talk to Jane about how to get stories in into the media and I think one story I did um last year was about maternal deaths and investigations and and Jane was absolutely right it began with a story uh a pretty tragic story but what we wrapped around that was a hospital that took this was around CTG heart monitoring fetal heart monitoring issues and we had a trust that um had turned around their performance by investing in human factors research multidisciplinary training for their staff a whole load of things and we put that in the story wrapped it around the whole narrative and um it was one of our most popular read stories um and that hospital was inundated with requests for other hospitals to go and visit it so I think everybody's familiar with the man bites dog sort of uh issue with a story and what I need is a man bites dog positive story and I think what I often get pitched are improvement projects and stories which are lacking that that initial genesis there is a reason the hospital is making these improvements but they don't want to talk about what that reason is and there's an element of you'd been needing to be brave about doing that but if there's a positive outcome why wouldn't we write about that why isn't there a story every day because until like six months ago I was the only helpful time health reporter at USA today so you can imagine what's happened in the newsroom there's more job cuts next week so in mind across my company that's ahead of the hostile allegedly the alleged hostile takeover so there just aren't enough reporters and but they're thank god there's you know foundation funded journalism out there and and um well we could have a whole session on the problems with the media industry right and the demise of specialist journalists yeah it's so hard to yeah and the older people that actually I've only covered healthcare for five years but we lost Liz Zabo a great reporter to Kaiser health news we're still using her stuff but you know the institutional knowledge is gone oh you know and one piece of this maybe is that when we published our investigation the the medical device industry they I mean they couldn't stand it and one of their kind of primary lines of attack to try to discredit our reporting was to um say that we were using back to this kind of first point we were talking about um they accused us of using anecdotes focusing on anecdotes of bad things that happened to patients and that that was not only bad journalism but it was actually dangerous because by highlighting stories of patient harm we would scare patients away from life changing or life saving devices um and you know as a journalist I kind of can't accept that because that if the logical extension of that would be that the medical industry or the medical device industry should be exempt from any critical coverage so I just you know I think it would be it would be great to you know if if there's an adversarial or develops an adversarial relationship during a story process between a device company or a drug company and a and a journalist that is sometimes inevitable but I think I think telling patient stories is legitimate and I think the industry should uh yeah I I some some recognition of that would be great we could do a workshop on all the stupid stuff you shouldn't say after a story comes out I mean I mean they could do one on the next year right yeah seriously because I mean I I think you you compound the issue and I saw that with with both with certainly one in big hospital entity that I wrote about like the and in the internal communication was was blatant lies and I was getting it so it's just amazing if we don't write the negative stories we're complicit in the myth that doctors and nurses are perfect angels who and health care is safe you know health care is as everyone in the room will know health care is a high risk uh industry it's a safety critical issue to get that right and people the public don't necessarily certainly in the UK where we have a sort of religious fervor for the NHS we we need to communicate properly with people that being in hospital is not necessarily a safe pastime and you I know that's out but you can criticize the ratings but um I mean ratings are one of the few things we have as journalists and as consumers to look at so stop complaining about the ratings and improve what you're doing all right we are out of time and it's a bummer because we have a couple homework assignments I think uh your point Sean about you know helping get positive stories to you guys to tell like why these things is a is a reasonable challenge to the movement but at least be a sidebar to the negative story absolutely and then Jimmy briefly talked about this we didn't even talk about social media and social media is more act more honestly driving sentiment and consumer sentiment out there than almost anything else right now I tell my political clients stop looking at polls and look at social listening devices that show you what's moving online and as you started your research you saw that as well um let's give a huge round of applause to our very honest guests thank you