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.