New (or Last) Year's Resolutions...Realistic Goal Setting

New Year's always makes me reflect on what I could do both the same and differently for the upcoming year. Fortunately for me, I make some of the same forecasts in October when my birthday hits. This actually allows me a couple of months to see the realities of my goals and, essentially re-forecast for a more realistic achievement of these goals when the next year hits.

For 2010, I have the following goals & resolutions:

Family and Friends:
- Spend more time with my family & friends (although they may have resolutions to spend less time with me)

Health & Wellness:
- Train for a personal record (PR) time when I run the Boston Marathon in April
- Compete in my first triathlon by the Fall

Professional and Financial:
- Understand the impact of healthcare reform for St. Joseph Medical Center and our surrounding community
- Participate in more community events
- Work towards financial independence (after meeting with a financial advisor, I understand that I am just 45 short years away from achieving this goal)

This past year, St. Joseph Medical Center has performed well around our goals. Some of our resolutions include:

1. Improving our patient satisfaction scores to the top quartile
2. Bringing on additional physicians to further our growth efforts
3. Furthering our employee engagement and serving as an employer of choice

I was reading some information on New Years Resolutions and wanted to share it with you (Source: http://www.tellinitlikeitis.net/):

“A New Year’s resolution is something that goes in one year and out the other.” ~ Author Unknown

At the beginning of each new year, people begin thinking about making and keeping a new year’s resolution, only to discover within a short period of time that their good intentions fall by the wayside each and every year, “in one year and out the other”.

The top new year’s resolutions rarely change from one year to the next, and in case you haven’t noticed yet, new year’s resolution statistics are not on your side. Unrealistic resolutions are doomed to fail from the start, usually due to lack of motivation, not being specific enough, being too ambitious with a list of new years resolutions that are bad for your health, bringing on stress, anxiety, hopelessness and even depression.

Top New Years Resolutions:

-Lose weight
-Manage debt/save money
-Get a better job
-Spend more time with family
-Quit smoking
-Eat right/Get fit
-Get a better education
-Reduce stress
-Going greener
-Volunteer to help others

“Many people look forward to the new year for a new start on old habits.” ~ Author Unknown
Goal Setting
Forget about new years resolutions and start focusing on goal setting. What is goal setting? Goals setting is a process that allows people to specify then work towards their own objectives, commonly referred to as life goals.

Whether it be personal goal setting or business goal setting, the importance of setting goals that are challenging, tangible, specific, realistic and have a time targeted completion date cannot be overemphasized.

Some people don’t know how to set goals or achieve a goal already set, so when they decide on setting a goal of one kind or another, each goal is quickly given up on until new years resolution conversations begin all over again.

“New Year’s Day: Now is the accepted time to make your regular annual good resolutions. Next week you can begin paving hell with them as usual.” ~ Mark Twain

How to Set Goals
What are your goals to set? Are they short term goals, long term goals, or both? Are they personal goals, career goals or vague life goals? Effective goals are very specific and measurable, involving goal setting motivation, while very vague goals such as “I want to lose weight” or, “I want to be the best person I can be” are not specific enough to help you in achieving goals in the short term or long term.

Goals give us direction, telling us what needs to be accomplished. Both long and short-term goals provide direction, but short-term goals appear to have the greatest motivational effects for change.

Finding your motivation through goal setting involves understanding why you want or need x,y,z in your life and what the goal means to you personally or professionally, thereby giving you the needed power and motivation to accomplish your goals once and for all.

S.M.A.R.T Goals
Writing goals down and tracking goals with goal setting is advocated by many experts in the field of goal setting, being very specific with each and every goal you plan to accomplish. “Smart goals” stands for Specific, Measurable, Attainable, Realistic and Time-bound, which helps people learn how to write a top quality goal they can and will stick to.

Specific – your goal should answer the What, Where, Why and How questions, written as simply and clearly as possible. Use action words to explain WHAT are you going to do? WHY is this goal important? HOW are you going to do it, etc?

Measurable – If you can’t measure it, you can’t manage it. Choose a goal with measurable progress so you can actually see the changes you are making, otherwise how will you know when you have reached your goal?

Attainable – an attainable, agreed upon, achievable goal involves realistic goals that consider your current situation, financial and personal resources, as well as time available to achieve success. Set your goal to challenge and “stretch” you slightly, but don’t go too far out of your reach setting unattainable goals, otherwise you’ll become discouraged and give up, again.

Realistic – a realistic goal is a goal you can control and achieve, requiring effort on your part, a positive mindset, positive action, determination and consistency that will enable you to achieve and accomplish goals you set. Each time you achieve a goal, enjoy the satisfaction that goes with goal achievement, rewarding yourself appropriately.

Time-bound – a time-bound goal includes realistic time-frames, using dates and times as measurement towards successful completion of each goal. Setting a time frame for goals set gives you a clear and precise target to work towards. Without a set time limit, your commitment is too vague, open-ended, lacking a sense of urgency to take action now to accomplish goals.

If you are one of many who jump on the new years resolution bandwagon, make a New Year’s resolution to NOT make new year’s resolutions ever again. Instead, set goals that are not only reasonable and realistic, but measurable and attainable so that your current goals and any new goals can be accomplished once and for all.

Happy New Year everyone. I look forward to hearing about your resolutions and goals for 2010.

The Journey Towards Self-Actualization

For a majority of my healthcare career, I have worked in academic medical centers. More recently, I have moved into community settings. Once thing that I enjoyed in the academic settings was the constant push to better the medical center along with our own professional and personal development. It has been good to see a shift over the past several years for community settings as well...the academic mindset in a community setting.

There are constant challenges with increasing the percent of people engaged in the workplace. An old friend, Alan, told me years ago that he had very engaged employees. He would share with them, "Whether you are here by choice or necessity, you are here, and I am glad you are here. You will enter people's homes while they are in a state of panic and frustration. When you leave their home, it will be a better place for them to live.

Note: Alan ran a Pest Control Company.

I was reading some theories on motivation and came across a classic we all know... Maslow: Theories of Motivation
(Source: http://www.analytictech.com/mb021/motivation.htm)

Overview

At a simple level, it seems obvious that people do things, such as go to work, in order to get stuff they want and to avoid stuff they don't want.

Why exactly they want what they do and don't want what they don't is still something a mystery. It's a black box and it hasn't been fully penetrated.

Overall, the basic perspective on motivation looks something like this:

Needs ---->Behavior---->Satisfaction----->Needs

and so on.

In other words, you have certain needs or wants (these terms will be used interchangeably), and this causes you to do certain things (behavior), which satisfy those needs (satisfaction), and this can then change which needs/wants are primary (either intensifying certain ones, or allowing you to move on to other ones).

A variation on this model, particularly appropriate from an experimenter's or manager's point of view, would be to add a box labeled "reward" between "behavior" and "satisfaction". So that subjects (or employees), who have certain needs do certain things (behavior), which then get them rewards set up by the experimenter or manager (such as raises or bonuses), which satisfy the needs, and so on.

Classifying Needs

People seem to have different wants. This is fortunate, because in markets this creates the very desirable situation where, because you value stuff that I have but you don't, and I value stuff that you have that I don't, we can trade in such a way that we are both happier as a result.

But it also means we need to try to get a handle on the whole variety of needs and who has them in order to begin to understand how to design organizations that maximize productivity.
Part of what a theory of motivation tries to do is explain and predict who has which wants. This turns out to be exceedingly difficult.

Many theories posit a hierarchy of needs, in which the needs at the bottom are the most urgent and need to be satisfied before attention can be paid to the others.

Maslow

Maslow's hierarchy of need categories is the most famous example:

Self-actualization
Esteem
Belongingness
Safety
Physiological

Specific examples of these types are given below, in both the work and home context. (Some of the instances, like "education" are actually satisfiers of the need.)

Self Actualization
Home: education, religion, hobbies, personal growth
Work: training, advancement, growth, creativity

Esteem
Home: approval of family, friends, community
Work: recognition, high status, responsibilities

Belongingness
Home: family, friends, clubs
Work: teams, departments, coworkers, clients, supervisors, subordinates

Safety
Home: freedom from war, poison, violence
Work: work safety, job security, health insurance

Physiological
Home: food, water
Work: Heat, air, base salary

We have many employees looking to advance themselves personally and professionally. Many of our Emergency nurses are getting their Certification as an Emergency Nurse. Cynde, our CNO, is getting her PhD and Jane (#6), our Executive Assistant (both are pictured at right) just passed her certification exam and became a Certified Professional Secretary (CPS) through the International Association of Administrative Professionals, a test which looks harder than sitting for the Bar as a lawyer.

I would like to host a lunch in February with 10-15 people who are advancing themselves personally and professionally. Please let me know if you are interested. You can contact my office at 816.943.2680.

Merry Christmas

Christmas is a time of giving.This season can also be stressful with work, vacation schedules and many planned activities.

I had a chance to take my family to the beach this week and came across some of those very stressors we sometimes experience while on vacation. We had several flight changes leading up to the travel date and ended up with only a 35-minute layover between two flights...the planes were at opposite ends of a large airport. We were trying to come up with better alternatives prior to flying out but met a lot of resistance from the airline. Fortunately, here in our very own Kansas City, Sheila from Continental Airlines pulled me aside and let me know she had booked an alternative flight in case we didn't make the existing flight since every other flight to our destination was booked solid. She found another route that would have taken us a couple of hours extra but we would've arrived at our destination the same night. In this day and age, it is not often that we come across exceptional service and I wanted to share this.

On a service note, St. Joseph Medical Center has continued to see strong improvement on two of our medical/surgical units, 4 South and 4 West.

Our overall Outpatient scores have also continued to rise since last year.

I want to thank all our associates, physicians, volunteers and auxiliary for your continued support of SJMC and Carondelet Health.

Merry Christmas.

Hospital Environmental Services Workers Contribute to the Economy

I just read that research carried out by UK think tank New Economics Foundation (NEF) indicates that workers who clean hospitals are worth more to society than bankers. According to the study, bankers are a drain on the country because of the damage they caused to the global economy; they reportedly destroy $11.25 of value for every $1.50 they earn. In contrast, hospital environmental services workers create $16.00 of value for every $1.60 they are paid!

Some of the feedback I hear most about SJMC is how clean our hospital is. If you've ever been hospitalized, you know how important cleanliness is, both in terms of infection control and also in terms of general comfort. Here at St. Joseph Medical Center, we are all aware of the enormous value our Environmental Services (EVS) associates provide to our business. Our patients, their families and our staff depend on them and they do a fantastic job.

The NEF study also claims that advertising executives "create stress" and are "responsible for campaigns which encourage overconsumption."

We have been working diligently on reducing our consumption of the earth's resources here at the hospital. Our "Green Team" meets regularly and we recently celebrated our first pick-up of recycled paper – 3,000 pounds. This amount is not being sent to the landfill for disposal and equals money saved in disposal fees. Our Green Team certainly creates value and we appreciate their efforts.

What parts of your business don't just make money but also create value?

BR...I cut myself!

I recently read an interesting blurb in Modern Healthcare referencing a study conducted by the National Electronic Injury Surveillance System (NEISS). According to statistics, bagel-related injuries (BRIs) were responsible for 1,979 Emergency Department visits in 2008. After putting aside my surprise that such a surveillance system even exists, I thought about our own Emergency Department and our "big ticket items," especially at this time of year.

We see about 3,500 patients per month in our Emergency Department. A good number of these patients come to us for serious, life-threatening issues such as cardiac and neurovascular symptoms. Approximately 20 visits per month are for chest pain/cardiac symptoms and about 40 are for stroke symptoms. However, during the cold winter months, we do see an increase in falls on the ice, cold/flu and even, around the holidays, pumpkin injuries and chicken and turkey-related incidents (choking, lacerations from slicing).

This bears out the NEISS's statistic naming chicken as the Food Most Likely to Send You to the Emergency Room (3,463 ED visits in 2008). Bagels came in second and pumpkins third.

We are not likely to start collecting data around which foods are responsible for the most ER visits at St. Joseph, but for your own safety, I consulted bagel experts Steve and Nancy Kashman, owners of Kashman's Place in Scottsdale, Arizona. According to Nancy (AKA "Mom") the safest way to cut bagels is to put your hand on top of the knife, keep your fingers open and slice away from yourself. Since I don't have a video of the actual process of cutting a bagel, please follow these instructions at your own risk.

I wish everyone a happy and healthy holiday and watch out for those BRIs.

A Model Community

In a recent blog entry, I discussed the employee engagement surveys. The survey is taken across all Ascension Health ministries across the country.

Locally, we will develop our plans around the key priorities from this most recent survey.

In today's SJMC leadership and Town Hall meetings we will discuss one of Ascension Health's strategic goals under Call for Action-we are focusing on solidifying this goal at St. Joseph Medical Center:

Ideally, associates, volunteers and physicians will take their own gifts and values into these strategies and understand how they contribute to our mission.

The goal we share with Ascension Health is: To Serve as a Model Community of Mission-Centered, Health Associates or Inspired People.

Attributes of Inspired People:
Mission-focused
Capable
Flourishing

There are 8 focus areas on the way to achieve a model community and attracting and retaining talented, inspired associates:

1. Culture of High Reliability-ensuring safe and clinically excellent care
2. Formation, Learning and Development
3. Selection
4. Diversity (and inclusivity)
5. Engagement
6. Recognition
7. Health and Well-Being
8. Workplace Spirituality

I look forward to hearing how you inspire your associates or other important people in your life.

A 12 Year old is looking for his mom...Just a Drill

We performed a Disaster Drill today. The Joint Commission, the accrediting body for our hospital, requires two disaster drills per year. This was our second. The scenario was around a tornado with mass casualties. Thank you to Larry, Shirley and Mike for orchestrating the drill. Lee, you did an exceptional job as Operations Chief - especially just being on the job a few short weeks.

(L to R) Shirley, Larry, Mike and Lee

I was pleased with the level of participation especially given that the overhead announcement was not heard well at the start. There were certainly things we will improve as a result of this. A debriefing will take place this afternoon. After the holidays, we will have an in-service on things that make a real disaster run smoothly, radio etiquette and key staging areas.

In previous blog entries, I spoke about being prepared for any type of situation. Typically, I hear people say that things always work well in a 'real' disaster. In many ways, I agree. These drills have always helped prepare me further for situations which may arise at work and outside of work.

There was an odd occurrence...it seemed we had a 60+ year old serving as the "12 year old" trying to get connected with his parents and the parent wanted to know "her role" once she was with her child...never a dull moment during a drill with unpaid actors.

Constant Change

In the November 10th issue of Hospitals & Health Networks magazine, Molly Joel Coye, M.D.., the CEO of the Health Technology Center in San Francisco wrote an interesting article entitled, "From Ellington to Einstein: Leaders have the courage to ask why - any why not - and then to act." In one section she wrote, “Change that is big enough and important enough to matter is disruptive. It threatens long standing relationships and processes.”

This is an important issue to manage as we ride the “constant change” roller coaster in the healthcare arena and most businesses as well. And though we all know that change happens, it does not always make it easier when change arises. We have seen this through changes in leadership, physician groups, clinical protocols, vendors, etc. We even saw this with a certain vegetable soup we served (which I thought was outstanding). When we switched (to one that I thought was even better)...the "regulars" wanted the original version and back we went. Though this may not seem like much, it pales in comparison to changes that impact us more personally and on a daily basis - again, typically relationships and processes as Dr. Coye describes above.

The past two years, SJMC has realized a lot of changes (some have been referenced in prior blog entries). Though we also have “constant change,” we have a few constants: very loyal and dedicated employees; an exceptional nursing team that has achieved Magnet recognition and is praised daily by our physicians; a volunteer workforce that brings the equivalent of over 54 full-time employees to our hospital; a very strong and devoted medical staff; and people who I know will speak up at every Town Hall meeting to share what we are doing well and how we could do better as an organization.

In the November Workforce Management magazine, an article references a May survey by Watson Wyatt of 1,300 workers at large U.S. employers which found that the engagement levels for top performers fell close to 25% over the prior year. Employees overall experienced a 9% drop in engagement. According to the article, the most common step to improve this has been increased communication, which can be in the form of briefings about the organization’s financial strength, staffing plans and business goals. It stated that by and large, companies do not appear to be tackling the engagement issue in a comprehensive way that creates a more inspiring work climate and give employees what they want.

Our most recent Employee Engagement survey reflected some of these changes. Though there were several areas where we scored well, there were other areas where scores were lower than prior years and it was certainly disappointing to me. I will make sure that our senior executives and hospital leadership team continue to do the following:

- Offer additional forums for enhanced communication including more one-on-one communication with associates (e.g., Cynde, our CNO just completed her formal CNO rounds this past week and will schedule these on an ongoing basis)

- Listen more to associate ideas and ways to make SJMC the best place for our patients

- Continue to share the strategic direction of the organization (e.g., we have posted our mission vision and strategies in key areas throughout the hospital, we send out monthly highlights, provide bi-monthly town hall meetings and a new Carondelet Health system publication is underway).

Though it was not referenced, it will be my continued personal mission to ensure that everyone in our organization (associates, volunteers and physicians) understands his/her role and the importance of that role in helping SJMC advance and exceed the goals of our organization.

And while we have seen improvements in our facility, we will ensure that we are fanatical about the cleanliness (e.g, Kevin, our new Regional Director of Environmental Services and Linen Services has new plans, processes and training which will be put in place for everyone on his team).

More than 80% of our associates completed the engagement survey and I want to thank each and every one for their very direct and honest feedback.

As always, I look forward to hearing from you.

Rubber Bands, Anyone?

Last week, an email went out that read, "The Copy Center is in need of rubber bands. If you could please send any surplus rubber bands you have in a routing envelope to Chanda in Materiels Management, it would be much appreciated."

Our Chief Medical Officer let me know, in a light-hearted way, that if we need to ask for rubber bands, then we could be in trouble as an organization. I tended to agree at first. Then I thought about what we spend on supplies each year and how many of these rubber bands go right into the garbage. That's several thousand dollars each year.

In the Intensive Care Unit, Pam, our Unit Secretary, led the charge to have physician order forms and blank progress notes available for printing right through our intranet. This will provide over $5,000 in annual savings along with a more efficient and effective process.

SJMC spends almost $30 million each year on supplies alone or around 15.4% of our net revenues. Just think, for every 1% improvement we make, we would save $2 million dollars which gets reinvested in our services, employee education, equipment and facility needs just to name a few things.

Organizations typically need to make 4-7% in order to reinvest in capital each year. In your own household, if you made $30,000 after taxes, 4% would be $1,200 in savings. Out of that savings, you then take part of it for any capital needs (e.g., new dishwasher, car, home upgrades, etc). That money goes quickly and the list of needs seem unending in our personal and professional lives.

So thank you Pam and Chanda for serving as great stewards of our resources.

I look forward to hearing other ways you save on supplies while ensuring the quality of your organization (or home) stays strong.

And remember, if you have any extra rubber bands, just send them on over to Chanda.

Three Steps Forward...Two Steps Back

Many (or shall I say most) days, running a hospital is a balance of positive advances mixed with setbacks. Of course, the goal at the end of the day is to make sure we are a stronger organization than when we started.

Monday started out with some very good updates from our executive team. Following our Monday "stand up" meeting, Susan, our Regulatory Readiness Specialist, let me know that we had made some great improvements in our Regulatory focus areas. She indicated that we had several key performance improvement initiatives underway with time lines and accountable leads. This all refers to that "positive advancement" I referenced above.

Then I was informed by our Chief Medical Officer and Regional Director of Surgery that the first two cases of one of our surgeons was delayed--and it certainly could have been avoided. Needless to say this was a setback. No one, and I mean no one, seems to feel great when we "look into things" though it certainly is acceptable with prompt action and follow up. I was pleased to see that by day's end our Director had some of these issues addressed with a well-thought-out plan on how we would see through process changes in the next 30 days. Thank you Alan.

The evening was filled with evening rounding led by Cynde, our Chief Nursing Officer. I had a chance to round with Cynde, Jane, our Executive Director of Cardiac, Neuroscience and Vascular Services and Larry, our VP of Facilities Management. The evening group of associates was pulling together with some challenging patient cases and a busy ER. These folks are always very welcoming to us and asked to see us even more (some even mean it!).

By evening's end, it felt like we were truly making St. Joseph Medical Center a better organization than when we started, even though we experienced some setbacks.

We must all understand our role in the patient experience. In the next several months I will continue to discuss our strategies, direction, top priorities and focus for each department and with each employee, volunteer and physician.

I look forward to hearing from you.

Thanksgiving - Let the Holiday Season Begin

On Wednesday my family had a chance to host a pre-Thanksgiving dinner. Today, we will watch the parade, some football and will enjoy a Thanksgiving dinner with some friends. Then Friday and Saturday, we enjoy some leftovers and then enter Sunday with a Brunch. Clearly, I am off to a heavy eating holiday season.

My family went to visit some residents at Carondelet Manor, a skilled nursing facility and rehabilitation center which is affiliated with St. Joseph Medical Center. Our kids are all set for the entertainment and will visit residents who are not with their family this year - our kids read, and performed a magic show.

I understand that there are 3 million watching the Thanksgiving Day Parade live in New York and 40+ million watching on television. While millions of people are off today, there are millions still working to provide for our safety, health and entertainment. Who is still working today and what is still open: Our soldiers overseas, restaurants, coffee shops, movie theaters, the police, fitness centers, 6 professional football teams, our hospitals and healthcare organizations and many more.

It is easy to take for granted that everything must be 'closed' on Thanksgiving so we could spend time with friends and family. For us to do that, it takes just as many to make sure that our key services which support our safety, health and entertainment are still 'open' for business.

There are so many things I am thankful for this year...my family, health, friends, colleagues, St. Joseph Medical Center & Carondelet Health and much more.

Please make sure to extend a thank you to those who allowed you to spend some time with family, friends or just some time needed for you.

I look forward to hearing from you.

Happy Thanksgiving

Our CNO Rides a Harley

This weekend, I had the chance to see the Broadway series show, Wicked (thank you Larry and Suzanne). It was a great show. Without ruining it for those of you who have not seen it, the show provides a different side of the classic story of The Wizard of Oz - through the eyes of the Wicked Witch of the West and Glinda the Good Witch. It shared a perspective that certainly made you understand, appreciate and actually like Elphaba, the Wicked Witch.

As I get around the hospital, I hear so many interesting stories about those we serve including our patients, families, physicians, volunteers, auxiliary and, of course, the SJMC associates.

We all shoot for a balance in our lives. It's not easy to do and some definitely execute a better balance than others. There is certainly a line we keep between our work and personal lives. That being said (a line taken from the last episode of Curb Your Enthusiasm), we still spend a lot of hours together and it is natural that we learn more about each other. It also helps us appreciate each other for our gifts, talents and interests outside work. On some occasions, we could also tap into these same contributions and integrate them into our workplace.

I have heard people say that they are not defined by their work. Would it surprise you to know that people who work at St. Joseph Medical Center have the following interests outside of work?

- Role as mom, dad, grandparent, aunt and uncle
- Photographer
- Blogger (no, not me)
- Singer
- Teacher
- Musician (yes, we have had banjo playing in the hospital-thank you, Shirley)
- Hunter (no, we do not allow hunting in the hospital)
- Chef
- Athlete: Triathletes, Cyclocross riders, bull rider, ultimate fighter, golfer, ski instructor, etc. and...
- Our Chief Nursing Officer rides a Harley.


Obviously, there is a list a mile long. It is good to learn more about each other. People may not be so "Wicked" after all (sorry, but I could not resist). I look forward to hearing about some of the outside interests from you and your co-workers.

Great to see you...I'm Fried!

While rounding today, I could not help but notice how hard everyone constantly works. While it is never said enough, I am so appreciative for all the support everyone provides to St. Joseph Medical Center and Carondelet Health. It was great to hear stories on how much we support each other in order to provide the best care to those we serve. We are truly in this mission together.

Keeping this in mind, it is very important to ensure that 'burnout' does not occur and we have to watch after each other as we may not notice the signs when it happens to us.

What is Burnout?
According to Merriam-Webster's Collegiate Dictionary burnout is defined as: "exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration."

What Causes Job Burnout?
Here are some possible causes of job burnout:
* Working harder because of leaner staffs
* Working hard without feeling rewarded
* Being in an unsuitable career
* Not having enough time away from work

How Do You Know If You Are Burned Out?
If you are experiencing any of the following symptoms, burnout may be to blame:
* Fatigue
* Irritability
* Crying jags
* Anxiety attacks
* Weight gain
* Teeth grinding
* Increased drug, alcohol, or tobacco use
* Insomnia
* Nightmares
* Forgetfulness
* Low productivity at work
* Inability to concentrate

What Are the Effects of Burnout?
Burnout can affect your physical and mental health. It can lead to:
* Depression
* Anxiety
* Physical illness, i.e. stroke or heart attack

What Can You Do If You Are Burned Out?
Before you can cure your burnout you have to figure out what is causing it. You must also take into account the severity of your burnout. The more severe it is, the more drastic your fix will have to be. Here are some possible cures:
* Find more time to relax (I know - not so easy to do)
* Take a vacation (I know...need more money for that but certainly take time for yourself
along with time with family & friends)
* Minimize any overtime

Source: ("Job Burnout." VHI Healthcare .)

St. Joseph's has a wonderful walking route - 3 laps within the hospital is equal to one mile. We also offer massage services and classes through Well*Life. Take advantage of any free time to care your you.

I look forward to hearing from you.

Communication is not the top problem

The other day I asked my daughter Sydney what book she was reading. She said, "I don't like to read." I asked again since I know that she enjoys reading and she continued to declare, "I don't like to read." As one last try, I said to her that I don't understand because she reads all the time. She said, "Dad, I like to read. The book I am reading is called "I Don't Like to Read." It was a modern day Abbott and Costello routine and a lesson on improving communication.

Today, I had a chance to hear the update around our readiness to perform as a High Reliability Organization (HRO).

Health Performance Improvement, LLC (HPI) provided some information I found interesting. While communication is almost always cited as a primary problem in running our business, the statistics were a little surprising.

HPI identified five areas that cause individual "failures." The top problem? Breakdowns in critical thinking. An example of a critical thinking breakdown: a physician doesn't respond to changing laboratory findings because he/she was focused on the patient’s presenting symptoms. The doctor could be communicating like crazy with the patient, but if he misses a significant change in his/her labs, communication doesn't matter.

The second most significant problem was identified as compliance error. Example? A nurse changes a patient's dressing without consulting the physician because in the past the physician has ordered it. This could be categorized loosely as a lack of communication, but mainly it is a lack of compliance with procedures put in place to provide the safest, highest quality care for the patient.

Communication (lack of information exchange) tied for third with competency (lack of skills).

Speaking of communication, we also learned at the presentation today that the average baseline for serious safety events in hospitals reviewed by HPI was 1.19 per 10,000. I'm proud to say St. Joseph Medical Center's baseline is .45 with an ultimate goal of zero, of course.

I look forward to hearing how your organizations focus on improving safety.

It is with great pride that I share...

From time to time, we must proudly share the great work we are doing. While too many days I try not to "dwell" on the good and focus on how we can continue to improve, it is healthy to take a breather and reflect on the advancements made. During our annual Medical Staff meeting this week, Cynde Gamache, Chief Nursing Officer, provided an exceptional overview of some key accomplishments and advancements.

Quality, Safety & Compliance

Pneumonia Core Measure:
2009 Quarter 2 CPS 92.70% (HQID Top 10%-99.26%)

Pneumococcal Vaccination:
Oct-Dec 2007: 86.67 %
Oct-Dec 2008: 92.59%
Apr-Jun 2009: 93.94%

Service


Along with our sister hospital, St. Mary's Medical Center, we maintain our Magnet Accreditation through our next survey scheduled for 2012. Only about 6% of all U.S. healthcare organizations have achieved Magnet recognition. The Magnet Recognition Program® recognizes quality patient care, nursing excellence, and innovations in professional nursing practice. It provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive from nurses.

People

Paula Ising RN received the Alfred Soffer Research Award for her CHEST 2009 Conference presentation “Effect of Intermittent vs. Continuous ScvO2 Monitoring on Sepsis Bundle Compliance and Mortality.”

RNs Carol Mulvenon, Nancy Walrafen, and Kathleen Brewer presented their research study entitled "Sadly Caught Up in the Moment: Exploring the Phenomenon of Overt and Covert Maltreatment Among Registered Nurses" was presented at the Sigma Theta Tau International (STTI-the Honor Society for Nursing) Conference in October.

SJMC was awarded Medal of Honor from the U.S. Department of Health and Human Services for our organ donation conversion rate of over 75% over a 12 month period. This is the second year in a row that we were recognized (only 295 hospitals earned this distinction this year).

Operating Effectiveness

Emergency Department Diversion (the hours that we have determined we cannot accept additional patients via ambulances):

FY 2008: 1003.27 total hours /83.6 average hours per month
FY 2009: 137.26 total hours /11.44 average hours per month
FY 2010 (July-October FY YTD): 19.89 total /4.97 average hours per month

I look forward to hearing about your organization' s accomplishments.

Veteran's Day

We often take for granted the very things that most deserve our gratitude.
--Cynthia Ozick

On this Veteran’s Day, all of us at Carondelet Health would like to extend a heartfelt thank you to the men and women who have served our country to preserve and protect our freedom.

If you are a veteran, please accept our thanks for your service. If you know someone who is a veteran or currently serving our country, we encourage you to take a moment today to offer your appreciation

Chili Dogs and Patient Satisfaction

Last week, I had the chance to attend the Missouri Hospital Association's annual conference. First of all, I would like to congratulate and once again welcome Herb Kuhn, the new President and CEO. I had a chance to meet Herb and was extremely impressed by his leadership and plans for the direction of the MHA.

I always enjoy the drive down to the Lake of the Ozarks for the MHA conference. It gives me time to think and to enjoy and observe people. On one of my stops during the drive, I was amused to see a smiling group of people waiting in line for chili dogs. Clearly these folks have a high level of satisfaction with this particular chili dog stand - especially since it was 7:00 a.m.

The MHA conference opened with a speaker - Benjamin Zander, the conductor of the Boston Philharmonic Orchestra. He discussed his book, The Art of Possibility. It really spoke to how everyone can contribute to life's experiences. I was especially interested in his discussion about singing the Happy Birthday song. He focused on how key words, body language and tone can make a huge difference on the person's experience with that song. For example, when you sing the four sentences, does the enthusiasm build, stay the same or drop? Which words do you accentuate: Happy or You? Big difference.

All this brings me back to our patient experience and satisfaction in hospitals. We all know there are so many experiences a patient can have in the hospital.

We are measured through patient satisfaction surveys. St. Joseph Medical Center utilizes a third-party vendor, Healthstream, to complete our patient surveys. We also participate in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems); also known as the CAHPS® Hospital Survey). It is a standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. While many hospitals already collect information on patient satisfaction for their own use, until HCAHPS there was no national standard for collecting and publicly reporting information about patients’ experiences that allowed valid comparisons to be made across hospitals locally, regionally or nationally.

Our most recent HCAHPS scores were for January 2008 - December 2008. We were at the 61st percentile among hospitals in the Kansas City area. Obviously our goal is the 99+ percentile which is a journey in and of itself.

Our overall patient satisfaction score using Healthstream interviews (or Net Promotor Score) as of October 2009 is 68.5%. The average score for the state of Missouri is 65%.

Based on the feedback, we are extremely pleased with our nursing care, physician involvement and ancillary support. We will focus on improving the following areas, which should improve our patient experience and in turn improve our scores:

• Responsiveness


• Quietness of patient care environment
  
• Communication

We will stay clear of providing chili dogs at 7:00 a.m. however.

As always, I look forward to hearing from you and would appreciate knowing how your organization improves its satisfaction scores.

Delivering Excellence

For the past few months, we have been hearing great things about ICU Nurse Paula Ising’s research on severe sepsis and septic shock. Two years ago, Paula began tracking severe sepsis and septic shock patient data. She noticed a trend she felt was significant: in 2 years, we reduced severe sepsis/septic shock deaths by over 50% by implementing bundles & by improving identification and coordination of care. To put it in more human terms: these improvements in the care of septic patients resulted in 41 lives saved in 2008.

Paula wrote an abstract, “Effect of Intermittent vs. Continuous ScvO2 Monitoring on Sepsis Bundle Compliance and Mortality”, which was submitted to the American College of Chest Physicians (ACCP) for the CHEST 2009 conference (the annual meeting for ACCP). Not only was the abstract accepted for presentation at the conference but she is a semifinalist for an Alfred Soffer Research Award. This year they accepted over 800 abstracts and only13 authors were nominated as semifinalists for the award. Semifinalists are evaluated on the basis of their written abstract and the quality of their oral presentation during CHEST 2009. Award recipients are selected for their outstanding original scientific research by judges from the Scientific Presentations and Awards committee of the ACCP. Paula is one of 4 finalists to receive this award. The abstract has been published in CHEST Journal. Dr. Tim Smith from St. Joseph Medical Center and Dr. Steve Simpson from Kansas University Medical Center are working with Paula on a publication for CHEST.

Congratulations to Paula, Dr. Smith, Dr. Simpson and all of the staff on the critical care units. You truly personify our mission of integrity, compassion and unity

Surprise, Surprise

Halloween brings neighborhoods and businesses together in many unique ways. For instance, we hosted some trick or treaters in our food court a few days before Halloween (thanks to all our volunteer staff members who helped set this up)



I am always pleasantly surprised to see the various costumes which represent current and past events in our society. I saw costumes around H1N1, the Octomom and several 'reality' stars. There were the usual sports players and political figures as well. While the costumes may change from year to year, many of the candy options remain the same. Very few surprises here. My kids emptied their bags and immediately put aside any "unsealed" candies (something that I needed training on every year when I was a kid). Again, not looking for any surprises on whether things are safe or not. Our hospital is fortunate to have great nursing care and strong customer service. Over the past month we have even seen a decline in percentage of patient complaints - something we track on a weekly basis for trends. As I indicated in a previous blog, there are times then things do not go as we would expect, surprises, if you will---times when we fail to meet expectations.

Whether it is a patient who leaves our emergency room before getting discharged or a patient who does not receive outpatient care in a timely mannner, expectations may not be met. We strive to empower all our associates to address the issue right away and escalate to their manager as needed. This does not always mean things go as planned but St. Joseph Medical Center's employees look to take ownership of the care and service we provide.

(A hospital in Delaware had a "surprise" recently. Rest assured we are doing all we can to avoid this here at SJMC, though I think in the grand scheme of protecting our patients from harm, deer attack is pretty low on the list.)

Several improvements have taken place over the past couple months which I would like to share:

SJMC baseline energy usage was set in June 2008 at 38 (scale of 1-100). As of August 2009 our Energy Star rating is 46 which represents a 6.4% decrease in energy consumption. This fantastic outcome was accomplished by changing operating procedures, lighting retrofits, purchasing more efficient equipment and educating people on the importance of turning things off when not in use.
SJMC has started utilizing Endoscopic Ultrasound (EUS) in our GI Lab. EUS combines endoscopy and ultrasound in order to obtain images and information about the digestive tract and the surrounding tissue and organs. EUS provides detailed, cost-effective, nonsurgical assessment of certain diseases.

SJMC has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Silver Performance Achievement Award for 2009 – one of only 36 hospitals nationwide to do so. The award recognizes St. Joseph Medical Center’s commitment and success in implementing a higher standard of care for heart attack patients, and signifies that St. Joseph Medical Center has reached an aggressive goal of treating coronary artery disease patients with 85 percent compliance to core standard levels of care outlined by the American College of Cardiology/American Heart Association clinical guidelines and recommendations.

SJMC's rate of "Left Without Being Seen" (LWBS) in our Emergency Department has improved to below the national benchmark. While we are proud of this, we still have a goal of -zero- patients who leave our Emergency Department without being seen.

Most of us do not like surprises when it comes to our health. I look forward to hearing how your organization escalates issues in a timely manner and what you have learned from this.

And back to Halloween...when I dug into my kid's candy bags, it was certainly a welcome surprise to find some good ol' Whoppers and Mike & Ikes...always a welcome treat.

Exciting News from the Carondelet Heart Institute

I am pleased to share that Carondelet Health has entered into an employment agreement with Kansas City Cardiology Associates (KCCA) effective January 1, 2010. This employment agreement includes 14 cardiologists, as well as the existing office staff.

The Kansas City Heart Group has been dedicated to St. Joseph Medical Center for more than 20 years and has been responsible for making "Carondelet" a household name in the practice of cardiology in Kansas City. The physicians and staff of the Kansas City Heart Group will continue to be a vital physician practice at Carondelet Heart Institute. We envision the two physician groups working collaboratively to grow and expand the Carondelet Heart Institute.

KCCA has been involved at our sister hospital, St. Mary's Medical Center and it has been such a great experience for both parties, so taking the partnership to this next level is an excellent transition. Having a second outstanding cardiology group will help us achieve our long range goals for the growth and regional presence of the Carondelet Heart Institute at St. Joseph Medical Center and St. Mary's Medical Center.

KCCA will move its current Kansas City practice location to the St. Joseph Medical Center campus in early January. The exact location of that office will be announced as details are finalized. The existing practice locations in Lee's Summit and at St. Mary's Medical Center will remain.

The KCCA physicians are Lillard Ashley, Jr., MD; F. Douglas Biggs, MD; David R. Blick, MD; William Brodine, MD; Daniel H. Dunker, MD; James R. Eynon, MD; Eric S. Hockstad, MD; John McGarry Holkins, MD; Willie Edward Lawrence, MD; Mike Liston, MD; John Kenneth N. Lee, MD; Marco Mazzella, MD; James E. Sear, MD; Dan Sun, MD.

We will be working on this transition over the next two months, but I wanted to share this exciting news with you as soon as possible.

As always, I look forward to hearing your thoughts.

Life may not improve with a money tree, but it sure would help

From my home to the workplace to social events, I continue to hear about the need to reduce expenses.

As I discussed in a previous blog, the past 20 years that I have been in healthcare, we have always looked to delivering quality care in a more cost-effective way. I am always interested in wondering what we will discuss next year that we "forgot" to reduce this year. That challenge never seems to end.

In our own organization we have brought in a group that looked at our expense structure compared to similar organizations across the country. Essentially it served as a financial improvement performance initiative. Their focus on costs stayed within the following guiding principles:

· Improve quality, customer service and employee engagement
· Decrease cost, waste and redundancy
· Ensure that reduction initiatives are sustainable and not abandoned over time

The sustainability is always key as anyone could reduce costs short term. But to ensure that the other principles are met, more thought needs to go into the assessment and implementation.
I am very pleased to see that our system has 21 teams looking at ways to achieve these opportunities. While there is never an end point in our professional or personal lives (except as Jane aka #6 in my office states, "Yes, there is. Retirement and death."), it is great to see so many on board (some with encouragement, of course) to advance our organization.

The groups will develop business cases and implementation plans aimed at capturing the identified cost reduction opportunities for the focus area teams. Here is a brief description of the 4 roles involved:

Accountable Leader: (Member of the Steering Committee)
· Accountable for driving each functional area to a plan to achieve outcomes
· Removes barriers to making progress
· Drives acceptance across functions and business units

Team Lead:
· Primary responsibility for designing the business case and implementation plan to achieve the targeted outcome
· Identifies and completes additional analysis as required to identify tactics for improvement
· Drives day-to-day activities for project team
· Monitors the progress of the team and assists in resolving bottlenecks and barriers
· Communicates regularly with the Accountable Leader to ensure buy-in and enlist support

Team Member:
· Represents functional area / business unit; contributes subject matter expertise and/or customer perspective
· Responsible for direct support in the development of the business case and implementation plan

Project Management Office:
· Accountable to Project Sponsor and Steering Committee for supervising activities and progress of each focus area team
· Monitors the progress of the focus area teams and assists in resolving bottlenecks and barriers to achieving desired outcomes
· Communicates regularly with Project Sponsor and Steering Committee on the progress of teams

Back to my home life...there is no question that I try to follow the same principles at home. How many of you have your quarterly "State of the Union" meeting with your spouse or significant other? I know that I am not the only one.

I look forward to hearing some similar initiatives in your professional and personal lives.

Healthy Choices

Last week, I was stopped by some visitors asking why we serve unhealthy food options in our cafeteria. Later in the conversation they asked if I had considered adding a McDonald's or another fast food restaurant to increase revenue for the hospital...quite a contrast in requests.

The week before, we had a an employee celebration and served hot dogs and hamburgers. When I mentioned this at home, my son asked me why we were serving this to our employees. "Don't you care about your employees' health? You serving hot dogs and hamburgers is like the dentist serving candy." Quite a profound statement (if I do say so myself).

It is interesting to note that the majority of food purchased in our cafeteria and many restaurants are not healthy choices. Over the past 2 years, we have added substantial healthy options including vegetarian dishes, low calorie and high protein breakfast sandwiches, improved salad bar, soups and more. Yet, in a lot of ways, I agree with the concerns expressed above. In my blog entry from September 1, 2009, I made the following statement:

Though some causes of illness and injury are beyond our ability to completely control or manage, there is still much each of us can do to optimize our health and minimize costly interactions with the healthcare system. The improved lifestyle choices we each make every day can, collectively, have an enormous impact on the cost of healthcare in this country. It’s easy to dismiss such a claim – “Who cares if I supersize my fries, or if I spend another 30 minutes on the couch watching TV instead of taking a walk? It’s my life and my health, after all. And it’s not like what I do or don’t do is going to make or break the entire healthcare system.”

Recently, I sponsored a five-member team competing in the Fittest Executives Challenge this fall through Ingram's Magazine. Certainly, we will do our part to walk the talk. Our team includes executive members of St. Joseph Medical Center and St. Mary’s Medical Center. In the spirit of friendly competition, I extended a personal challenge to area hospitals executives, medical staffs and the healthcare community in Kansas City to get involved in the Fittest Execs and Fittest Companies Challenge. We will put the talents of our Chef, Karen Putman, the winner of the 2009 Great Lenexa BBQ Battle on the line, rolling out dinner—our treat—for the hospital or healthcare team that shows the greatest overall improvement and the team that ranks most fit in health metrics when the competition ends January 15th, 2010. For more information on the challenge (and to sign up if you want to form a team) go here.

While we cannot control the food choices people make, we certainly are pleased that we have added some healthy options for our newly renovated Café Josef. I am interested in your thoughts on other healthy options we could add to our Café and other ways which your organization promotes health.

CEOs Gone Pink

On Tuesday, we had a well-attended Breast Cancer seminar at St. Joseph Medical Center.
Thank you to all the individuals and businesses who supported the event.

Wendy and her team from Oliver's Hair Salon roped me into (no pun intended) a pink hair weave to show my support. These photos show the progression:

Later in the evening, I was in the elevator with a few employees. While everyone greeted me, they would not mention the new weave until I acknowledged it. They seem relieved that I was aware of my new look.

According to the National Cancer Institute the following are estimated new cases and deaths from breast cancer patients in the United States in 2009:

- New cases: 192,370 females and 1,910 males
- Deaths: 40,170 females and 440 males

To put that in perspective, there are 22 new cases every hour of every day and 4 deaths during the same timeframe. I learned tonight that women in their twenties have even been known to have breast cancer as well.

Screenings provide an opportunity to look for cancer before a person has any symptoms. It can help people find cancer at an early stage when it may be easier to treat.

I am very proud of our Breast Center and our clinical team for their great work. Thank you to Drs. Kuckelman, McCroskey and Geier for your presentations tonight. They were very well received and much appreciated.

I look forward to hearing what you or your organizations are doing to promote Breast Cancer awareness and screenings.

Student Volunteers

Last week I had the opportunity to attend the 2009 Junior Achievement of Middle America Greater Kansas City Business Hall of Fame dinner. Congratulations to the dinner's honorees: Tom Bowser of Blue Cross Blue Shield, Carol Marinovich, Former Mayor/CEO of the Unified Government of Wyandotte County and Kansas City, Kansas and the family of the late Jack Lockton, Founder of Lockton, Inc.

Junior Achievement, as many of you know, is a partnership between the business community, educators and volunteers. This important program provides students opportunities to practice their workplace skills, learn about business and ready themselves for careers. Junior Achievement is the world’s largest organization dedicated to educating students in grades K-12 about entrepreneurship, work readiness and financial literacy through experiential, hands-on programs.

Here at St. Joseph, we know firsthand how student workers can impact a workplace. I think I have mentioned in the past that St. Joseph Medical Center has a fantastic auxiliary/volunteer program. Our student volunteers are a big component of that.

This year we have 93 student volunteers working in many areas of the hospital. Our summer students served in 32 areas and our fall/winter students serve in 21 areas (including the CEO's office). The students have represented 27 different schools and more than half a dozen colleges and universities. We are proud to be a recommended choice for community service for several local high schools.

St. Joseph also provides scholarships every year to students who apply and have outstanding service records. We have provided these $500 scholarships to 17 students so far. A couple of years ago, we had the pleasure of seeing one of the first recipients of the student volunteer scholarship come back to us as a resident in training. Dr. Amy gave us 525 hours of volunteer service.

Our student volunteer coordinator stopped me in the hall the other day to let me know that one of our students was paired with golfer Tom Watson in a the First Tee Open at Pebble Beach over Labor Day weekend. A celebrity in our midst!

I am interested to hear how students are used and progress in your organization.

Cafe Josef

On October 1, we unveiled the name of our new food court: Café Josef. We provided a free meal to all our associates and volunteers and I, along with others on the SJMC Senior Team, helped serve. Somehow my food service hat just doesn't send the same message as those on the heads of our surgical team:

Sister Gabrielle gave the prayer and Ms. Lori and her team from Spiritual Care blessed the area - a tradition at our hospital.

Spirituality is one of our core values and one which enhances everything we do for our patients, their families, and our associates. In fact, the name Café Josef was suggested by our own Sister Margaret. The choice of the French word "café" is a tip of the hat to our founders, the Sisters of St. Joseph of Carondelet, whose roots are in France. The name Josef means "God increases" which fits nicely with our mission at Carondelet Health:

Carondelet Health is dedicated to the healing ministry of Jesus Christ. Our commitment to human dignity compels us to provide compassionate, quality health care for body, mind and spirit, with a special concern for the poor. We are responsible stewards serving the needs of all people from conception to death. We are united in this mission.

Thanks go out to Chef Karen and her team for providing a great Celebration Day meal to our associates and volunteers:

How Many Have to Die or Get injured to Change?

My last blog entry spoke to our seriousness about safety. I had the opportunity to enjoy the Chicago Marathon this past weekend. The cold weather helped for some good course times though the glove I used to wipe off my sweat took a beating on my face. I will save that picture for another day.

Many of us already are familiar with the Institute of Health's (IHI) 5 Million Lives Campaign. Their website states:

Do No Harm. It is a fundamental principle for health care providers: primum non nocere – first, do no harm. It is our duty, our responsibility. Patients ask and assume that the health care that intends to help them should, at the very least, not injure them. Despite the extraordinary hard work and best intentions of caregivers, thousands of patients are harmed in US hospitals every day. Hospital-acquired infections, adverse drug events, surgical errors, pressure sores, and other complications are commonplace. Based on data collected over several years from multiple partner institutions, IHI estimates that nearly 15 million instances of medical harm occur in the US each year – a rate of over 40,000 per day.

Back to Chicago:

Two years ago, 1 dead, 250 injured. On October 8, 2007, the New York Times read:

CHICAGO, Oct. 7 — As temperatures soared into the upper 80s, hundreds of runners in the Chicago marathon fell ill and at least one died on Sunday, prompting officials here to halt the annual race for the first time in its 30-year history...By 11:30 a.m., race officials, who were consulting with city fire officials, medical experts and the police, stopped the run, setting off waves of confusion and chaos in some parts of the course.

The Chicago Marathon now has an alert system:

They even had one vendor set up a mock M*A*S*H unit, called B*R*A*S*H.

Safety is always taken seriously during these events but you could sense a difference over prior years. If you lay down at some point during and/or after, you needed to be cleared by the medical staff. This is not something I recall from prior races. In the past, if you said you were ok, you could go on your way.

Organizations and events are coming up with improved "Alert" systems to improve awareness and outcomes around safety.

I am interested in hearing from you and what safety systems your organizations have put into place over the past few years.

Congratulations to Sammy Wanjiru who beat Khalid Khannouchi’s 1999 Chicago Marathon course record of 2:05:42 by one second to finish officially in 2:05:41 (around 4:48 minutes/mile for 26.2 miles).

I heard you have cancer...anyway, let's talk about me

Last night, a family member let me know that she went to a hospital (in another city) for care. The person at the front desk started complaining about how tired and depressed she was: she was not sleeping, she was fighting with her ex-husband, etc. She asked my family member if she ever felt that way. With that, my relative responded, "Why yes, I actually just found out that I have breast cancer, need additional surgery and will require chemotherapy. So I do understand how you feel."

Now I consider that a great cue to snap out of it - to become more engaged and consider how you might better serve the patient, but this did not actually take place. The employee continued to complain about her life. While this made me cringe and did not take place at our hospital, it could certainly have taken place at any organization.

A few weeks back, I read the following from Catholic Health World's September 15, 2009 Issue:

Delivering bad news well requires courage, patience and empathy

"Patients and families will forever remember that moment when bad news is given"

There are two things oncologist Robert Quadro never forgets when he is about to tell a patient bad news – Kleenex and his watch.

Highly trained chaplains also help patients work through the tough questions, said Mary O’Neill, vice president of mission and ministry at Maryhaven Center of Hope, a long-term care facility in Port Jefferson Station, N.Y. At many Catholic facilities, chaplains are a central part of a patient’s team.

Experience has taught O’Neill that how bad news is delivered has both medical and spiritual repercussions.

“Patients and families will forever remember that moment when bad news is given,” said O’Neill. “They will remember where they were, what was said, how the doctor said it. That can have a real impact on how the patient copes, and how a patient copes with an illness has an impact on the illness.”

When it comes to looking back at our professional lives, I think many of us will wish we engaged more. We’ll wish that we held that person’s hand, we’ll wish we hadn’t turned and walked out the door” after delivering a bad prognosis.

In the coming weeks, I will share stories from our staff and patient advocates on where we have served our patients & families well and where we could have improved. We will continue to stay focused on what our patients value most:

• Quality of care and safety
• Respect: an individual and his/her time
• Communication
• Pride and spirituality
• Coordinated care
• Facility
• Cost

I look forward to hearing from you. Please share the places that you feel provide the most exceptional care and experience to those they serve.

Serious About Safety

On Monday, our leadership team spent the morning review Serious Safety Events and learning about how to conduct a Common Cause Analysis (CCA). In the past year, Ascension Health’s leaders established a new direction that would build on the successes of the Call to Action for Healthcare that is Safe: Healing without Harm by 2014.

We discussed three types of Human Errors*:

Skill-Based (Auto-Pilot Mode): Errors made when performing acts or tasks that require limited or no thought attention

Rule-Based (If-Then Response Mode): Errors made when performing acts or tasks that require application of rules – accumulated through experience and training – to familiar situations.

Knowledge-Based (Figuring-It-Out Mode): Errors made when performing acts related to new or unfamiliar situations that require problem solving and for which a rule does not exist or is not known.

*based on the Skill/Rule/Knowledge classification of Jens Rasmussen and the Generic Error Modeling System of James Reason

It was interesting to know that for every Serious Safety Event, we should probably see 1,000 precursor events or near-misses (a "near-miss" is defined as any process variation in our health care delivery that could have led to an adverse outcome or sentinel event but for any number of reasons, did not).

An example of how to improve was around avoiding employee injuries and what industries and companies we should model (e.g., Fed Ex because of their heavy lifting in handling packages).

Back to the run…The car just stopped short of hitting us though Dr. Mark had his hands on the car and shared the importance of the stop sign with the driver (he risked his life to make a point—something I do not recommend for other runners). I would certainly consider this a “near-miss.”

Can We Talk?

I never thought at my age I would learn so many new languages. I am now fluent in Text, Skype, iChat, E-mail (so 2007), Tweet, Blog and even a little Spanish.

As leaders (that means all of us), we need to find the most effective ways to communicate. One thing is for sure: in-person, face-to-face, always seems most appreciated.

I look forward to your thoughts on the most effective ways you find to communicate and in what situation.

Faith, Love, Hope, Win

Last week I had an opportunity to golf in the 5th Annual Faith, Love, Hope, Win Foundation golf event. It was a perfect day outside and you could tell people were really pleased to be a part of the event.

The mission of the Faith, Love, Hope, Win Foundation is to win the battle against advanced prostate cancer (check it out: http://www.flhw.org/).

While we have busy schedules, not every activity, meeting or event is filled with the passion shown by David, the Event Chair and all the others who helped set up the day.

The statistics are startling for prostate cancer:

Every 2.25 minutes a man is diagnosed with prostate cancer.

Every 19 minutes, a man dies from the disease--that means during the five hours of golf, more than 15 men died from prostate cancer.

A quote from the Faith, Love, Hope, Win website reads:

When the world says, "Give up,"
Hope whispers, "Try it one more time."

Certainly, something that we would apply in our professional and personal lives.

Dr. Norm - thank you for letting us know about the event. Ginger, Tim, Bob and I really thought it was a special event. We are glad we could be a part of it.

As always, I look forward to hearing from you.

A Funny Thing Happened on the Way to the Basement

This week, my family had the chance to move again. This time the move was not too far but certainly but all the same burden on my wife...it was to our basement.

We had to fix a few things upstairs and needed access to alternative living quarters for a few days.

The move brought the family just a little bit closer. My son asked me for some funny stories from today. I told him that I did not have any offhand (or any that were appropriate for him to hear).

This was unacceptable to him. He suggested I have more fun at work and ask our physicians to meet with me and share some "funny stories" (that in and of itself cracked me up).

So I ask you, physician and non-physicians, I call our first "funny story" meeting together now. Do you have funny (and appropriate) stories you could share from your workplace?

I look forward to hearing from you.

The Song Remains the Same

As we all know, health care is extremely challenging and rewarding. Health systems and physicians are constantly challenged with building a practice and ultimately developing a succession plan to serve their communities and continue to meet its health needs. Let me share some excerpts from a St. Joseph Hospital Medical Staff Analysis:

Conclusions and Recommendations:

The present medical staff was analyzed on the basis of available historical information.
While projections are subject to a certain amount of error, it is clear that projected admissions per year are far below the estimated need. Analysis indicates that while some physicians will increase their practice, a number of physicians will probably decrease their practice and in many cases the decrease will be substantial.

The age distribution of the present staff, while not unusual at the present time indicates a problem within the next five to ten years. Replacement of Medical Staff to compensate for retirement in the future should be an ongoing concern.

The fact that 10% of the staff provides 58% of patient admissions could be a problem. The unexpected loss of two or three doctors could result in severe economic repercussions for the institution. Similarly, the sudden shift by a doctor of his patient admissions from St. Joseph to another hospital, for whatever reason, poses a problem to the institution if the concentration of patient admissions in a few doctors is significant. This analysis indicates a need for quick and decisive action to recruit sufficient medical staff to provide even a minimum acceptable occupancy level in the facility.

This analysis was written in December 1975; I thought you might enjoy!

In 1990, a similar analysis was performed with similar conclusions. On the final page of that report was a graphic showing the Hospital Board, Medical Staff and Management on the three points of a triangle, all pointing to a central goal-The Patient.

Our challenges were the same in 1975 and 1990 as they are today and, more importantly, our mission and values were the same in 1975 and 1990 as they are today. Indeed, these values have not changed since the Sisters of St. Joseph of Carondelet founded St. Joseph Medical Center in 1874.

One thing is for sure, while the challenges are similar throughout the years, it still feels, at any given time, that today's are the biggest challenges of our lifetime. Nevertheless, we continue to honor our commitment to our patients, our physicians and staff.

Janet S., a person I worked with early in my career, let me know that it would be like the movie Groundhog Day throughout my career. She told me not to throw away any projects because they always seem to come back into the picture every few years--I could just "dust them off" and revisit the assumptions.

I look forward to hearing some of your classic stories and lessons from years past.

Environmental Services & Housekeeping Week

This past week we celebrated National Healthcare Environmental Services & Housekeeping Week. I want to congratulate all our environmental services associates. They truly make a huge difference in our mission, vision and values and certainly impact the quality and service for our patients.

I look forward to hearing some value stories you have about your Environmental Services associates.

Understanding Failure to Achieve Success

It is always tough to accept failure and think of it as a learning opportunity or a sign of how we could handle different situations.

I was in the Catskill Mountains of New York this past weekend. We attended another family wedding. It was set for the outdoors and would not stop raining.

Before the wedding started, there were cloudy skies, mud was all over the field where the wedding was going to take place, the dance floor was already wet and had no chance of getting dry and the bride's dress was partly covered in mud. Back to the wedding in a moment...

While in New York, the buzz of Derek Jeter breaking the Yankees' all-time hitting record, held by Lou Gehrig, had quickly gone through the state and was the talk of the town. It was fun feeling a part of history, especially hearing the positives while remembering the horror of 9/11 just eight years back. Reading about the record in the newspaper, I was pleasantly surprised to see a quote from Dick Groch who recruited Jeter in 1992, "When you look at a player, you know he can play, you know he's got talent, but it takes an individual who is able to handle failure and that's why after I identified the tools - I know a player can play - I go out and I want to see him fail. I want to see how he adjusts to failure." The article goes on to indicate that is a sign of success and leadership.

Several months back, a neurosurgeon at St. Joseph Medical Center had a similar viewpoint, sharing that "you can't judge yourself by your successes without judging yourself by your failures."

We continuously need to look at our outcomes and the systems that support these outcomes. With so many priorities and limited resources, our organizations need the continued discipline to look at what we do well, what we could do better and possibly what we should not do. I am always impressed, as well, to see how people and organizations handle failure or tough times. In a comment from Rick R. in my "Training for Life" blog entry September 9th, he indicates the importance of "improving our discipline of gathering and reporting quality data" in a timely manner. Perhaps this is just one more way that we will continue to progress, and deal with success and take on "failure" with the right information at the right time.

Back to the wedding...it was a blast...I even was given the parking attendant role, along with Barry F., a long-time CEO from another health system and family friend and mentor. As for the weather and dealing with "failure:" the Bride and Groom could not have looked happier. Once everyone saw their attitude, the umbrellas went up, everyone was smiling, people danced in a group to avoid falling and kept the evening more festive. The Bride even smiled and enjoyed her 'two tone' wedding dress.

Seeing how we approach "failure" certainly is an indicator of our potential success.

I look forward to hearing from you and understanding how you have learned and prospered from your own personal and professional "failures."

Many Reasons to be Proud

My basketball game, singing prowess and ability to fix things around the house are just a few things I am not proud of in my personal life. But professionally I am so proud to work at St. Joseph Medical Center and I see the pride that others have as well. I spoke to Duane in Security soon after I started at SJMC about 15 months ago, and he shared that “employee pride” was something he wanted to see more of. I feel we have a lot to be proud of here at SJMC. A few examples:

Sister Margaret of our Senior’s Clinic was recently honored with a nomination for a Frontliners Award from the Center for Practical Bioethics. Criteria for the award include respect for the dignity of others, professional competence, willingness to provide compassionate care to all people and appreciation for ethical dialogue. Sr. Margaret is an outstanding example of someone who takes pride in her work and that pride spills over into excellent patient care and service to our mission.

The SJ Pulmonary Rehabilitation Program has obtained Certification from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). This process has been a two year venture with success achieved by the hard work of members of Pulmonary Rehab clinical and physician staff. With this recognition we are now the only certified Pulmonary Rehabilitation Program in Kansas City.

Our SJMC facilities department announced a few days ago that we had reduced our energy consumption by 5% over the past year. This translates into a benefit to our planet as well as our balance sheet.

We are all very proud of our newly remodeled Food Court and coffee shop pictured below. We are happy that we can offer such a beautiful and functional area for our patients, families and employees to enjoy a meal or a snack.

As I said, there are many things to be proud of here at SJMC. And yes, I will still try to work on my basketball game…but there is very little hope.

I look forward to hearing from you.

Training for Life

We are now finishing the first quarter of our fiscal year and are off to a good start as we look at the balance of our organization's health. When thinking about the right balance, most people automatically think of financial performance but that is only one aspect of our organization's health just as it is in our personal lives.

A few years back, I was with a running group in Cincinnati. At the time, we were running for a couple of hours and people started talking about what race they were preparing to run (it seemed that very few people in their right minds would run that long just for the sake of doing it). The best answer came from Jennifer who said that she was "training for life.'' She figured that if she could keep pace with a group that was preparing for a race, then she was always within reach of doing the same if needed. That reminds me of the "continuous readiness" mindset that health systems and many organizations need to meet regulatory compliance and overall performance day after day.

To keep the pulse on the health of our organization it goes beyond just financials. Some examples of what we measure include:

Compliance for all applicable regulatory agencies:

I am pleased to see our continued focus in this area. We have made great strides with issues that had been a concern in the past. Congratulations to our GI team that has had four months straight of 100% of charts with the appropriate signature, date and time, an issue toward which we have made great strides over this past year.

Quality and safety:

Our patient falls with injury have remained minimal, so we track patient falls in general. (I am pleased to see a reduction of almost 20% over last year.) Our team has made great strides through patient education and increased rounding.

Service & operating effectiveness:

Our Emergency Department (ER) has made significant strides in reducing diversion (closing the ER to ambulances). While last year our ER was closed for almost three hours per day to ambulances, that issue is essentially non-existent today. We have started to focus on overall length of stay in our ER with 85% of patients getting treated and released. In just the past four months, we have reduced our average length of stay by 17%.

I look forward to hearing from you on your company's status and examples of how you keep the pulse on your organization's overall health.

Positive Influence

Last night, I attended our employee of the month celebration. We celebrated Cheryl and it was really great to see how many of her co-workers came to share in the celebration...along with the cake. She had clearly made a real impact in their work life together.

I had a chance to speak with Dave, one of our Respiratory Therapists. He was retired from the military after 23 years. He became a therapist after reading about a Respiratory Therapist in the newspaper. Though he never met that person, she certainly shaped his career decision.

Jane (aka #6 - a blog entry for another time) is the Executive Assistant for my office. She recently hosted a membership meeting of the Missouri Health Care Executives (MHCEA) District 2 (Kansas City, Missouri area). The MHCEA is a professional organization for and run by executive assistants employed by Missouri Hospital Association member facilities. Several were able to attend from local healthcare organizations. After speaking with them, it was evident how much they impact the success of the senior executives.

In my opinion, leading through Influence is underrated in our everyday personal and professional lives. I hear so many people still talking about 'control' versus influence to achieve desired outcomes or balance. I am fortunate to work with such an incredible team. I have often said that while I may not personally give hands-on nursing care, order supplies or staff a unit, I certainly can provide influence for our quality of care, patient safety, compliance, financial performance and patient satisfaction. We all can influence the outcomes in our personal and professional lives. So why not be more intentional and thoughtful with this power?

I would challenge all of us to understand how we could further spread positive influence. Please share your stories. As always, I look forward to hearing from you.