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.