CEO Update April 2008

The information below is an employee update of activities at Stony Brook University Medical Center prepared by Stony Brook University Hospital CEO, Steven L. Strongwater, M.D.  Dr. Strongwater distributes a monthly update which is sent to all hospital faculty and staff to communicate initiatives and activities undertaken at the Medical Center to reach goals in the areas of patient satisfaction, patient safety and community connections.

View Past CEO  Updates

April 2008

We just completed a wonderful series of Town Hall Meetings in March. Thank you for joining us! I learned a lot about the character and pride at Stony Brook University Medical Center . Throughout the month we held five Town Hall Meetings, covering every time of the day and night and many locations. The meetings were great. More than 700 people attended and provided feedback.

If you missed these forums, a brief recap. We discussed (a) the goal of becoming a high reliability organization (a hospital with failure free operations over time, said otherwise, a hospital with no errors), (b) our goal of becoming a best place to work in America, (c) our goal of working toward a Baldrige Award (a reflection of excellence, of world class status), (d) our information technology plans, (e) our plans to implement Family and Patient Centered Care and (f) we shared many patient safety achievements.

The energy at SBUMC is palpable. As President Kenny would say, Stony Brook is Red Hot!  

Continuing our journey toward world class status is at once easy and challenging. We must...

• Keep patients first!
• Support great ideas
• Eliminate hidden agendas
• Support each other
• Eliminate skepticism (there appears to be no shortage of this in NY)
• Celebrate our successes
• Create an environment rich in cultural openness
• Challenge the status quo

Do you know what SBUMC's vision is? To be...

A world class healthcare institution, recognized for excellence in patient care, research and healthcare education. The first choice of patients for their care and the care of their families. An academic medical center that attracts educators and students with the desire to provide and receive the highest quality and most innovative education. One of the top federally funded institutions for scientific research and training.  

Stony Brook Pride

SBUMC Transplant Milestone . SBUMC has achieved a new milestone, having transplanted more than 1,000 kidneys since the inception of the program in 1981. Please join us in congratulating the entire transplant team, led by Drs. Waltzer and Darras. The impact on patients and their families as a result of these life saving organs is tremendous. Congratulations!

U.S. Surgeon General Gives Presidential Lecture at SBUMC. Save the date! On Thursday, May 1, Stony Brook University Medical Center welcomes a very special guest for a Presidential Lecture. Rear Admiral Steven K. Galson, M.D., M.P.H., who received his Baccalaureate Degree from Stony Brook University in 1978, and is currently Acting Surgeon General of the United States , will speak at 4 pm on Thursday, May 1, Level 2, Lecture Hall 1 in the Health Sciences Center . More information to come.

Stony Brook Med Students "Matched" to Top Residency Programs . Congratulations to the 111 School of Medicine students who recently matched to programs at major hospitals and healthcare facilities throughout the US and Canada at Stony Brook's annual "Match Day" ceremony. Match Day is a national event conducted by the National Resident Matching Program, during which fourth year medical students at institutions throughout the country assemble to learn where they will be assigned for their residency training following graduation in May. Dr. Fred Schiavone, Associate Dean for Medical Education said that Stony Brook students matched to residencies at top institutions all over the nation, including to Yale-New Haven Hospital , Brigham & Women's Hospital in Boston , University of Chicago Medical Center, and Harbor-UCLA Medical Center in California . This year 44 men and 67 women matched to sites. There were three sets of couples who matched, one match to Canada ( McGill University ), and one military match ( Walter Reed Army Medical Center ). Ten students matched to Stony Brook University Medical Center . We look forward to working with you in this new capacity!

Dr. Robert Parker Recognized by the American Cancer Society. Please join us in congratulating Bob Parker on his selection for a Lane Adams Quality of Life Award which is presented by the American Cancer Society (ACS) for leadership, innovation and excellence in cancer care giving. Bob will receive this award in May in Los Angeles at the ACS meeting. This award is a testament to the care provided by our pediatric oncology group under Bob's direction and to his strong commitment to attending to all aspects of the impact of cancer on the lives of pediatric patients. It is a great honor and one that is well deserved.

Stony Brook Med Student Awarded AATS Summer Internship . Congratulations to Aryeh Keehn, first year medical student, who was selected by the American Association for Thoracic Surgery (AATS) to receive the 2008 Summer Intern Scholarship in cardiothoracic surgery. With the selection of Aryeh, Stony Brook University School of Medicine joins a list of institutions such as Johns Hopkins, Harvard Medical School , Columbia University , and Stanford University , that have produced AATS summer intern scholarship recipients. Established by the AATS to introduce the field of cardiothoracic surgery to first and second year medical students, the scholarship includes spending 8 weeks in a cardiothoracic surgery department and a grant of $5,000 for living expenses. Under the mentorship of Dr. Todd K. Rosengart, Professor and Chief, Division of Cardiothoracic Surgery, Aryeh will work on a research project based around understanding the inflammatory response to open heart surgery. The study will compare the body's inflammatory response mechanisms in patients undergoing mitral valve surgery via standard median sternotomy or mini thoracotomy, which has been associated with less bleeding, less coagulopathy, and faster recovery.

Three from Stony Brook Honored by Town of Brookhaven . We celebrate the careers and successes of three Stony Brook University professionals who received the highest recognition by the Town of Brookhaven Office of Women's Services at its 22nd Annual Women's Recognition Night on March 13. Honorees Kathryn A. Koshansky, M.S., ATC, Assistant Athletic Director for Sports Medicine and Athletic Training, Nanci Rice, Ph.D., Vice Chair, School of Health Technology and Management, and Kanokporn (Noy) Rithidech, Ph.D., Associate Professor of Research Pathology, were among the 15 Brookhaven residents recognized for making significant contributions to the quality of life in Brookhaven through their excellence in a variety of endeavors in their respective fields. An award was given in 15 professional categories. Ms. Koshansky was the awardee for Sports, Dr. Rice for Education, and Dr. Rithidech for Science.

National Patient Safety Week Celebrations A Great Success. SBUMC celebrated National Patient Week from March 10 through the 15. Patient Safety Week has ended, but we continue to get positive feedback from many participants.  Over 400 staff members participated in the Patient Safety Fair and two day lecture series.  More participated in the "roving" safety cart rounds.   Of the abstracts submitted for review, four were recognized for excellence.

First Place : Cardiac Thoracic Surgery Intensive Care Unit for "Hand in Hand We Took the High Road and Made IV Insulin Administration a SAFE Practice for Both Patients and Staff"
Second Place : 15 North & South for "Discharge Room: The Journey to Patient Safety"
Third Place : 16 South for "A Road Taken Together; Working Hand in Hand on 16 South"
Honorable Mention to the Neonatal Intensive Care Unit (NICU) for "Are You My Mother?"

Other abstracts submitted:

• 17N: "Spotlight on Hand washing"
• Mother/Baby: "Jaundice Revisited: Identification of Hyperbilirubinemia"
• Pediatric ICU: "Hand Hygiene, Infection Control and Patient Safety Go Hand in Hand in the PICU"
• Cardiac ICU: " Patient Safety A Road taken hand in Hand: What is an HRO?"
• MRN: "No Fall Zone: Decreasing Falls in a Tertiary Hospital using a Restraint Free Bed Alarm Monitoring System"
• 16N: "Teamwork and Education are the  Goals of Patient Safety on 16N"
• Non-Invasive Cardiology: "The Road is never Long if taken together and we ALL arrive Safely Hand in Hand: Directions for a Safe Trip"
• Legal Affairs: "Transparency in Communication: Honoring the Patient's Perspective"
• Perinatal Services: "Perinatal Hepatitis B Prevention: Goal: Healthy Mother - Healthy Baby"
• Med Oncology & Ambulatory Infusion Center : "The Road to Chemotherapy Safety"
• CQI: "Achieving Increased Survival at SBUMC"
• Maternal Child: "Does A Standardized Assessment Identify Women who Hemorrhage?"
• Trauma Service/CQI: "Failure Mode & Effect Analysis: Patient Unidentified"
• CQI: "SBUMC's Participation in the Surviving Sepsis Campaign"
• Dialysis: "Home Medication for Complex Medication Regimes"

Pharmacy Reaccredited by Accreditation Council for Pharmacy Education . Congratulations to the Pharmacy for achieving continuing education accreditation from the Council for Pharmacy Education. The accreditation extends to Jan 31, 2009, with interim updates due in October 2008.

Disaster Testing a Success at SBUH . On January 28th the NYS Department of Health (DOH ) ran a multi-hospital exercise examining the readiness of Laboratories for potential disasters. SBUH's submission had no deficiencies.  Out of the 23 hospital-based laboratories on Long Island , 57% or 13 out of 23 had at least one deficiency. Our Lab staff demonstrated their outstanding capabilities. Please congratulate them all.

Selective Head Cooling for the Treatment of Newborn Brain Injury . Brain injury related to hypoxic ischemic encephalopathy (lack of blood flow and oxygen to the brain) can cause long term brain injury and death in newborns.  The frequency of this type of injury is 1-2/1000 live births.  Clinical trials have shown brain cooling can decrease brain injury and prevent death in newborns with certain clinical criteria. These include gestational age of 36 weeks or greater,  an Apgar score of less than or equal to 5 at 10 minutes, cord or one hour blood gas with a pH <7.00, a base deficit of greater than or equal to 16, physical evidence of encephalopathy and specific amplitude integrated EEG patterns.  Critical to improving outcome is its application to the newborn prior to six hours of life. The program will be in place beginning in May in Stony Brook University Hospital 's Neonatal Intensive Care Unit.

SBUMC Surgeon Trains Others Worldwide Via the Web . On Tuesday, March 18, an internet broadcasting company, ORlive, filmed Stony Brook University Medical Center colorectal surgeon Dr. David Rivadeneira while he performed two operations which will air on the internet in about six weeks. Dr. Rivadeneira will answer questions about the procedure and the device from surgeons and others tuning into the program. The segment will include interactions with surgeons around the world, who will benefit from learning about the procedures done at SBUMC. The ORlive segment will showcase SBUMC as a center of excellence in colorectal surgery throughout the world. Look for news in my next update when the segment is scheduled to broadcast.

Patient Safety

Pediatrics Celebrates Many Safety Successes . The Pediatric Service at Stony Brook University Hospital has undertaken a diverse and innovative set of initiatives to improve the safety and quality of care provided to our smallest and most vulnerable patients. In particular, the Pediatric Service and its caregivers have:

• In the Neonatal ICU, as part of that collaborative, adopted highly original approaches to the prevention of retinopathy of prematurity (a major risk for very low birthweight infants) (ROP) and to improving neonatal nutrition;
• In the Pediatric ICU, been part of an Institute for Healthcare Improvement Collaborative on Improving Critical Care for several years with the adoption of "bundles" of best practices for the prevention of central venous catheter infections, ventilator associated pneumonia and for the early recognition and treatment of severe sepsis;
• Initiated in the ICU's and elsewhere the use of daily goal sheets and multidisciplinary rounding to improve communication among caregivers;
• Been among the leaders in the field of pediatrics in putting into place early warning systems by which to detect deterioration at its earliest stages. In particular, we have adopted the use of a Pediatric Rapid Response Team (RRT) that can be called to the bedside by any caregiver or family member if a patient seems to be worsening. Beyond that, we have also initiated the Pediatric Early Warning Score (PEWS) which is calculated every time a patient's vital signs are taken and can alert a caregiver to a deterioration even before an RRT is needed;
• Undertaken an extensive effort on Child Psychiatry to reduce the use of restraints and seclusions for children who are agitated and/or combative;
• Been part of the state-designated group of Regional Perinatal Centers serving as a resource for and backup for other hospitals' newborn services; and,
• Recently joined the Vermont-Oxford Network, the premier neonatal benchmarking collaborative in the US .

These efforts have resulted in a number of remarkable achievements. In particular:

• The pediatric mortality rate has fallen slightly over the past 5 years even as the severity of illness of the patients we care for has substantially increased (as judged by a risk-adjusted "expected" mortality rate);
• ROP has been absent in 3 of the last 5 quarters (prior to the initiative there was never a 3-month period without ROP);
• Neonatal nutrition has improved with increased protein and calorie intake, increased growth and decreased time to nipple feeding among our very low birth weight infants;
• There has been a dramatic reduction (99%) in the use of restraints and seclusions on child psychiatry and a comparable drop in staff and patient injuries; and,
• Our NICU was, in 2006 (last data available), consistently among the regional perinatal centers with the lowest rates of hospital-acquired infections , at all birth weights.

EMT Simulation Center .  The Emergency Department has created an Emergency Medical Technician (EMT) simulation center on a live ambulance. The premise behind this project is to enable pre-hospital care providers to complete simulations in an environment in which they normally work. With Dr. Henry's support, an ambulance with 250,000 + miles was refurbished to appear nearly new. Now equipped with a 50" plasma TV, a four person medical crew will begin simulation exercises on a manikin outside the vehicle, load the "patient" and continue care during transport.  Four TV cameras will track the simulation. At the conclusion of the scenario a critique will be conducted using the digital recording. The manikin, a HAL 3000, is a fully self contained advanced simulator.  We plan on using this vehicle to provide simulation training at EMS training programs throughout the County as well as at local EMS agencies.

Patient Satisfaction

Silent Hospitals Help Healing (SHHH!) A byproduct of many medical advances has been the steady rise in hospital noise. Noise disturbs patients and staff members, increases the risk of medical errors, slows the pace of healing and contributes to stress and burnout among hospital workers. SBUMC is initiating the Silent Hospitals Help Healing (SHHH!) program , set for kick-off April 3rd to combat noise. We will use "Yacker Tracker" decibel readers, quiet hours, provide free ear plugs to patients, ask electronic devices be set to vibrate, and more. Designated quiet time will be at 1PM, 9PM and 2AM. Concern over noise should be reported to the Department of Patient and Guest Relations (ext. 4-2880). Reducing noise levels in our hospital will help our patients receive quality rest and aid healing while providing staff and visitors with a less stressful, calmer environment. Our thanks to Justin Swearingen, Administrative Fellow, for spearheading the development of this important program.

Patient Satisfaction Improves in Many Units . Congratulations to all staff on 16 North, the Ambulatory Surgery Center, Preadmission Testing, Islandia Cardiac Testing, Imaging Center CT, and Radiation Oncology. Press Ganey patient satisfaction surveys show significant improvement. Well done!

Senator Flanagan Secures Funds to "Splash Hope" on Pediatric Units . Splashes of Hope, a grass roots organization that brings inspirational artwork to hospitals throughout the world, "splashed" the pediatric unit with the aid of funding secured by Senator John Flanagan. The underwater themed murals and paintings, which took one month of in-studio preparation and one week of installation, bring color and cheer children who are receiving medical treatment and care and their families who are frequently on the unit. Thank you to Senator Flanagan and Heather Buggee of Splashes of Hope. Also planned for the unit is a new fish tank to be installed in the waiting area across from the elevators. Sure to be a great hit with our patients and their families.

Patient Guest Relations Expands Program. The Patient Guest Relations Department has expanded staff rounding to include the Emergency Department, 15 South & 15 North to proactively improve the patient experience. Patient Representative can be reached by dialing extension 4-2880 from inside the Hospital or by calling (631) 444-2880 using an outside line. We recognize that being ill and in the hospital can be a difficult time for patients and families and we want to assure patients and their families of our commitment to offer our assistance should the need arise. 

SBUH Compliments Rise . The number of compliments received by SBUH increased as measured by the ratio of patient compliments to complaints. In January our ratio improved from 1.47 to 1.91.

Patient Comments Added to Web Site . We have established a new page on the website where letters from grateful patients are posted. "Patient Comments" can be found under the "Patient Service" icon at StonyBrookMedicalCenter.org - or https://webvpn.uhmc.sunysb.edu/body.cfm,DanaInfo=www.stonybrookmedicalcenter.org+?id=1314

Improved Patient and Family Services . The Information Desk is now staffed and managed by the Concierge Services. Concierge Services is also providing copies of USA Today on the day of admission as well as daily with patient breakfasts.

"Voice of the Customer" Project Launched. SBUH has started the Voice of the Customer Project which is a program that will allow us to measure patient, physician and employee satisfaction. Phase I, already underway, entails designing questionnaires, setting up a steering committee and setting up a tracking data base.

Community Connections

Auxiliary Supports Important Patient & Family Program.   The Auxiliary has donated $5,000 to support the Auxiliary SNAC (Stony Brook's Nutritional Assistance Card) program. The program will provide meals to indigent family members of our inpatients.  The Board's motion to fund the program includes a provision that Mr. Swearingen, SBUH Administrative Fellow, who developed the SNAC program, present an evaluation of its effectiveness after three months.

Vial of Life Program Sponsored by SBUH Auxiliary . The Auxiliary, with special credit to Carolyn Gassner Levine, has spearheaded the Vial of Life Program at SBUMC. This program provides information to emergency medical providers about the health history of people in distress. A magnet is placed on your home refrigerator directing EMTs to a medication bottle in the refrigerator which contains patient history and medication lists, so that safe treatment can begin as quickly as possible. The Auxiliary donated $5,000 to kick off the program.  The hospital's Planning Department has been coordinating the launch. 

A Collaborative Approach to Saving Lives.   It's true we are celebrating the 1,000th kidney transplantation at SBUMC. And while that is a great cause for celebration, did you know there are nearly 98,000 individuals waiting for a life saving or life-altering transplant in the United States? Paradoxically, there are less than 15,000 donors annually to provide these much needed organs. Please join the SBUMC (award-winning) Organ Donation Committee and the New York Organ Donor Network on April 24 when they co-host "A Collaborative Approach to Saving Lives." It's a full day program featuring guest speakers from the University of Kansas Medical Center - one of the leaders in providing services to the families of potential donors - and members of the Stony Brook faculty. The objective is to work towards eliminating the drastic shortage of organ donation and to give us a better understanding of the Kansas experience to help our region develop best practices surrounding organ donation. The event is open to the public and has been approved for CME credit. Call 444-4000 if you're interested in learning more.

First Responder Program Expanded to Center Moriches Area. The first responder vehicle that is currently providing response in Manorville and East Moriches will also begin to provide service to the Center Moriches area effective as of March 18, 2008.  The second vehicle continues to provide service to Mattituck and Eastern Riverhead.

Town Hall Meetings A Success . During the week of March 10, five SBUH Town Hall meetings were held spanning every shift and covering both SBUH and Technology Park. The program was targeted to educate the faculty and staff about our goals of becoming a High Reliability Organization (HRO's are hospitals which have failure free operations over time), introduced the Patient and Family Centered Care Program, reviewed plans to become a "best place to work", reviewed recent and planned information technology plans and described the approach we will take in applying for a Baldrige Award. Over 700 people attended the meetings. http://inside.hospital.stonybrook.edu/

"Rising Stars" Talent Show on Sunday, April 27.   Children being treated for cancer or blood disorders sing, dance, and display other talents at "Rising Stars" talent show, an annual fundraising event to benefit the Sunrise Fund, which raises awareness and money for the Pediatric Oncology Program at Stony Brook. Organizers are still looking for talented students, faculty, and others to join the children on stage. Kids, doctors, nurses and other staff at Stony Brook University Medical Center who have participated in past "Rising Stars" shows have exhibited an array of talents, ranging from singing solos, to piano performances, instrumental ensembles, and Irish step-dancing. For information call 631-444-2899. The show takes place on Sunday, April 27, starting at 2:00 pm at the Student Activity Center on the main campus of Stony Brook University.

My Last Touch  

Understanding that all outcomes are a result of a series of actions is a simple concept. For instance, knowing that to get to work on time requires that you have to wake up, get dressed and find your way to work, sounds simple. But, sometimes you may be late or, worse, you may always be early. Why are some things more predictable than others? Can things be made to be more predictable? If you accept that there are predictable steps to reach an outcome, then you can control your destiny. You can control your destiny!

Aristotle understood this concept. " We are what we repeatedly do. Excellence, therefore, is not an act but a habit."

It is possible to make great things happen. It requires carefully teasing upon the elements and steps that lead to any given outcome, whether this relates to your home life or work life. When skeptics claim things never change, you now know why. They have not worked to change the steps. Change requires examining and modifying the steps in that process.

Our journey to a high reliability organization rests on understanding this simple concept.

Taking the time to think through issues in your work or home life may profoundly affect you and your family's future. Take a minute and pick something to work on. The rewards will be worth it. And remember....

"Great spirits have always encountered violent opposition from mediocre minds."
-- Albert Einstein

"What you see and hear depends a good deal on where you are standing; it also depends on what sort of person you are."
-- C.S. Lewis

Be an enthusiast. Be an optimist. Enjoy the journey...

Steven L. Strongwater, MD
Chief Executive Officer
Stony Brook University Hospital

Patients first—World class processes—Teamwork—Growth—Use resources wisely