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.