April Message from Steven L. Strongwater, MD, CEO

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, MD. Dr. Strongwater distributes a monthly update that 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 safety, patient satisfaction and community connections.

March has been quite an experience—and it wasn’t just the unseasonable weather or unpredictable basketball season. Over the past several weeks, we have been as proactive as possible as we learn the latest on the New York State budget and how it would impact Stony Brook University Medical Center (SBUMC).

To recap, the initial proposed executive budget eliminated all State support for University Hospital, amounting to a $55 million cut—this is before any reductions from the Medicaid Redesign Task Force. The $55 million State support is not a subsidy, rather it is funding for SBUMC’s special programs, including our 24/7 trauma and emergency psychiatric programs, our HIV program and many others. It also supports the costs of State sponsorship, such as required work rules, vacation and pension payments. On top of this executive budget cut, there was another $5 million cut from reduced Medicaid support, for a total of $60 million in cuts. There was much speculation as to why SBUMC and, for that matter, all of SUNY had been targeted with such severe reductions. But rather than dwell on why, we focused on trying to reverse these cuts. Although a very fluid situation, we were optimistic that these cuts would be substantially restored.  At the same time, we felt a responsibility to put plans in place in the event that restoration did not occur.

So what did we do? With the valuable input of Hospital team members throughout all levels of the organization, leadership developed plans for a worst-case scenario (in the unlikely event of no restorations). The plan relied heavily on growth and investment in SBUMC aimed at protecting jobs and ensuring the quality of patient care.

Fast-forward to present day. Although information from Albany remains vague and nothing will be certain until the budget is signed by the governor, we know that there has at least been partial restoration of funds.

But what does this mean specifically for SBUMC and for you? We can avoid realizing the worst-case scenario, and we will continue to implement cost-saving measures and revenue-enhancing initiatives that will allow us to weather the current budget storm. However, since funding has not been fully restored, we will still need to make difficult decisions as we prioritize patient care services. Throughout the process, we have tried to keep you as informed as possible, and we will continue to do so. If you have any additional questions or concerns, please call the Budget Hotline at 638-4141.

As challenging as this is, there are some bright spots worth sharing. The community has taken up our cause, as firefighters, mental health workers, social service agencies, County government, the Nassau-Suffolk Hospital Council, individual patients, unions and more have spoken out on our behalf. We are indebted to everyone who has made clear how important SBUMC is to the health, safety and quality of life on Long Island. We are also indebted to the Long Island State Delegation (our elected officials), which has spoken persuasively on our behalf.

Despite the budget crisis, SBUMC’s future is bright and is exemplified by our many accomplishments, such as our recent accreditation by The Joint Commission as the only certified VAD Program (ventricular assist device to extend and improve the quality of life for patients with heart failure) on Long Island. Our programs in neurology, cardiology, cancer care, gastroenterology, imaging, trauma and the like are receiving increasing recognition. Most recently, Stony Brook University Medical Center was ranked 10th in the U.S.News & World Report’s “Best Hospitals” Metro Area ranking. We can all be proud of these and many other achievements—thank you for your dedication and support.

STONY BROOK PRIDE

Stony Brook ranks 10th in the New York metropolitan area in U.S.News & World Report’s “Best Hospitals” Metro Area rankings. The new rankings recognize 622 hospitals in or near major cities with a record of high performance in key medical specialties, including 132 of the 152 hospitals already identified as the best in the nation. There are nearly 5,000 hospitals nationwide. For the full list of metro area rankings visit www.usnews.com/hospitals.

The Ventricular Assist Device (VAD) program at Stony Brook University Heart Center was awarded national accreditation from The Joint Commission after an intensive two-day review by a team of Joint Commission surveyors. Stony Brook’s program has the distinction of being the only accredited VAD program on Long Island. The program’s “certification of distinction” is for a two-year period, with a performance review at the end of the first year. Once used as a temporary device for patients with heart failure awaiting transplants, VAD now helps more patients extend and improve their quality of life. To achieve accreditation, VAD programs must demonstrate conformity with clinical practice guidelines or evidence-based practices. They are also required to collect and analyze data on at least four performance measures related to clinical practice guidelines until more standardized performance measures are identified.

Stony Brook physician is first on Long Island to use minimally invasive robot-assisted surgery for ENT procedures. Ghassan J. Samara, MD, Division of Otolaryngology–Head and Neck Surgery, with the assistance of Mark F. Marzouk, MD, completed three ENT surgical cases in late March with the da Vinci® S HD™ Surgical System, a state-of-the-art robotic system. In ENT procedures, the da Vinci robot allows for better access to some areas of the throat without the need for more invasive open surgery. Other advantages to using the robot include better visualization, enhanced precision, and the ability to complete microsurgery and sew in areas not previously accessible. According to Dr. Samara, the robotic system will be used by ENT surgeons for many conditions, especially to help treat cancers of the mouth, throat and tongue, and expects to expand use of the robot for other oral surgical procedures, such as for sleep apnea and related conditions.

Stony Brook received approval from the American College of Radiology Imaging Network to participate in a landmark international multicenter trial on the use of coronary CT angiography (CTA) in the evaluation of patients with stable angina. The trial, known as RESCUE (Randomized Evaluation of Patients with Stable Angina Comparing Utilization of Noninvasive Examinations), will randomly assign study participants either to coronary CTA or to single photon emission tomography-myocardial perfusion imaging (SPECT-MPI) for the diagnosis of symptoms potentially related to coronary artery disease. This is Stony Brook’s second multicenter trial in the past 12 months.

Stony Brook’s Department of Radiation Oncology has been awarded a three-year accreditation as a result of a comprehensive review by the American College of Radiology (ACR). The ACR awards accreditation to facilities for achievement of high practice standards after a peer-review evaluation of the practice. Stony Brook’s site survey was conducted by a board-certified physician and medical physicist. Areas reviewed during the site visit included the qualifications of the personnel and the adequacy of facility equipment, quality control procedures and the department’s quality assurance program.

Stony Brook Rounds, a new physician newsletter, has been launched. Community-based physicians and Stony Brook medical staff and faculty received the inaugural issue on Doctors’ Day, March 30. This electronic newsletter will be sent weekly to share information that is valuable to physician practices and their patients, including news about enhanced clinical services, recent faculty hires, special events and more. It is intended to keep physicians engaged and informed, and to share information with other physicians. For more information or to suggest content for consideration, please contact Therese Xeller, Editor, Department of Publications, at Therese.Xeller@stonybrook.edu or 444-4883.

Phase I of the Medicine Expansion began last month. During this phase, the Medical Intermediate Care Room (MICR) relocated to 16 North, and the Respiratory Care Unit and the Medical Intermediate Care Unit joined to create a unit with 15 monitored beds. 16 North is now a 15-bed step-down unit and a 12-bed medical telemetry unit, maintaining a complement of 27 beds. Additionally 9 South opened to accommodate 8 medical telemetry patients with plans to expand to 16 beds within the next few months.

The new Post-Anesthesia Care Unit (PACU) is now open. The PACU is located next to the Pre-Surgical Admissions area, and patients can be brought into the new area from the entrance near the OR Pharmacy. Access from the outside hallway will require ID access similar to the door into the Pre-Surgical area from the same hallway.

Anesthesia Department excels in Surgical Care Improvement Project (SCIP) Metrics. Results released from the third quarter 2010 Hospital Core measures show that the Anesthesia Department did extremely well in the areas of administration of timely antibiotics and preoperative beta blockade. For timely administration of antibiotics, the Department was ranked number one overall and number one in all surgical categories among the 124 hospitals involved in this report. The Department’s beta blockade data far exceeded those for previous periods and was above the Department’s target.

Carol Gomes, MS, FACHE, CPHQ, Director of Operations, has been recertified as a Fellow in the American College of Healthcare Executives. Established in 1933, the American College of Healthcare Executives is a professional society dedicated to ensuring competence and leadership among healthcare executives.

Congratulations to the April Employee of the Month. Mei Cobb, Assistant Director of Computing Services in the Department of Clinical Information Systems, was selected as the Employee of the Month for April. Ms. Cobb willingly takes on challenges and is creative in her efforts. Her skills are an asset to the organization, especially with respect to the implementation of the electronic health record, and she is a tremendous help to all. She is extremely dedicated to her work and her colleagues. Described as knowledgeable, innovative, and someone who treats every idea and suggestion with respect, Ms. Cobb through her calm demeanor fosters discussion and alleviates frustrations. She is considered by many to be an invaluable resource to the Medical Center.

Stony Brook’s Dental Anesthesiology Residency Program has received the accreditation status of “Approval Without Reporting Requirements” from the Commission on Dental Accreditation (CODA). This is the highest accreditation status provided by CODA.

The Stony Brook University School of Dental Medicine is leading a multicenter national clinical trial to evaluate whether treatment of chronic periodontitis will help improve diabetes control. Sponsored by the National Institutes of Health, the Diabetes and Periodontal Therapy Trial monitors blood sugar levels of those with type 2 diabetes after periodontal therapy. The trial is the first of its kind in the United States.

Stony Brook pharmacology researchers uncover new role for mitochondria during RNA processing. Michael Frohman, MD, PhD, Chair of the Department of Pharmacological Sciences at the School of Medicine, and colleagues have discovered a new role for mitochondria during ribonucleic acid (RNA) processing. This latest finding, reported in Developmental Cell, may hold clues to some causes of male infertility.

Stony Brook University medical students learn of residency assignments during School of Medicine’s “Match Day.” The 116 Stony Brook students were among the largest total number of students matched ever—more than 26,000—to residencies nationwide on March 17. Stony Brook students matched to a variety of healthcare institutions in New York State, 17 other states and Washington, D.C. In total, the students matched to 19 specialty programs. Internal Medicine was the top specialty choice. Other top choices included Emergency Medicine, Pediatrics, Anesthesiology and Surgery.


PATIENT SAFETY

National Patient Safety Awareness Week celebrated at Stony Brook University Hospital March 6 through 12. Activities were held during the week to educate staff and patients, and call attention to the many processes in place aimed at keeping patients safe. The highlight of the week was a keynote address given by Sorrel King, the author of Josie’s Story, which was attended by more than 200 people. Ms. King’s personal, moving story reinforced the message that patient safety is Stony Brook’s primary focus. The Patient Safety Fair held on March 9 was extremely successful with more than 400 staff and community visitors participating. There were stations for health screenings, an “Ask the Pharmacist” booth, information on the National Patient Safety Goals, a “Safe Kids” table and information on programs including the Rapid Response Team and deep vein thrombosis (DVT).

The National Patient Safety Awareness Week poster contest once again demonstrated the staff’s creativity and innovation as it relates to safety. The posters were voted on by participants at the Patient Safety Fair. Those with the three highest number of votes won prizes, and new this year there was a “Judge’s Choice” award.

First Place: PACU, “PACU Has a Hand in Patient Safety”
Second Place: Care Management, “Going Down the Rapids of Healthcare”
Third Place: 16N, “Invested in Patient Safety”
Judge’s Choice: Respiratory Therapy, Risk Management and Clinical Informatics, “Tracheotomy Care of Patients in Non ICU Areas of the Hospital”

Patient Safety Fridays becomes Patient Safety First. In March, Stony Brook University Medical Center (SBUMC) celebrated the first anniversary of Patient Safety Fridays. The goal of the initiative set in 2010 was to continuously enhance the safety culture within SBUMC in a measurably significant way. The initiative is now known as Patient Safety First to reinforce the 24/7 patient safety state of mind. The Patient Safety First model has evolved to include the convening of quarterly evening/night sessions attended by all of leadership, the dedication of an evening/night team and a Wild Card team that visits units during the week. Physician participation was felt to be particularly important and so, from the beginning, physician teams have been an integral part of this initiative to improve and ensure safety within the organization. A long list of accomplishments has resulted because of the efforts of the participants and the feedback obtained from staff. This includes the purchase over 300 pieces of medical equipment, hundreds of physical plant repairs, resolution of housekeeping issues, electronic medical record solutions, numerous process changes, and improvements in hand hygiene, Rapid Response Team outcomes and improved pain management.

SBUMC receives “Special Recognition” by the Healthcare Association of New York State (HANYS). Stony Brook’s “Standardization to Prevent Venous Thromboembolism” process was described and lessons learned were detailed in the HANYS publication, “2010 Profiles in Quality and Patient Safety.” The process was submitted for consideration to HANYS by the Department of Continuous Quality Improvement.

Stony Brook Long Island Children’s Hospital takes top award for poster presentation at National Association of Children’s Hospitals and Related Institutions (NACHRI) conference. Stony Brook Children’s presented a poster detailing the Hospital’s initiative to decrease central line associated blood stream infections at the NACHRI Creating Connections Conference. The poster titled “Central Venous Catheter Infections in Pediatric Oncology: An Educational Strategy to Minimize Rates and Embed Practice Change” demonstrated an 84 percent reduction in central line infections since baseline surveillance was begun in 2008. A collaboration of Kammy McLoughlin, DNP, Grace Propper, RN, Jeanne Greenfield, NP, and Devina Prakash, MD, the poster was presented at the conference by Kammy McLoughlin and Barbara Berry, RN.

Stony Brook poster was accepted for presentation at the National Patient Safety Foundation (NPSF) Annual Patient Safety Congress. The poster titled, “Healthcare Dashboard: A Powerful Tool to Monitor and Improve Patient Care Quality in Real Time,” will be part of the poster session at the NPSF annual meeting, which will be held in May.

Stony Brook receives best S3 score ever (again!). The Strategic Surveillance System, or “S3” quarterly assessment and comparative report provided by The Joint Commission has been released for the last quarter of 2010. The report provides a series of risk assessments. Risks are given points and the lower the point total the better the risk score for the hospital. The S3 risk score for Stony Brook continues to trend down and is at the lowest level since receiving these reports in 2007. The fourth quarter 2010 report attributes to SBUMC a total risk score of 28, which is 33 points lower than last quarter (the lowest prior score). This score places Stony Brook below the national, state and academic medical center averages, and is lower than the average scores for the U.S.News & World Report’s “Best Hospitals” and Magnet® hospitals. Comparatively SBUMC is among the best hospitals in the country.


PATIENT SATISFACTION

Patient satisfaction in the Emergency Department (ED) increased by three points in the first quarter of 2011. ED patient ratings are well above average and the highest they have ever been since surveying patients. Alison Rowe, ED Nurse Manager, attributes the increase to a number of initiatives that are underway. They include hourly rounding by staff and leadership; Lightning Huddles, which are frequent RN/MD meetings to review patients’ plans of care so that consistent information is shared with patients; shift report at the patient’s bedside; post-discharge calls; service recovery; and the addition of an ED attending physician during the night shift. The ED is above the 50th percentile in all peer groups.

Hourly rounding improves patient care and patient satisfaction. The Hospital, in collaboration with the School of Nursing and working with the American Association of Colleges of Nursing and The Dartmouth Institute for Health Policy and Clinical Practice, used a clinical microsystems approach (a small, interdependent group of people who work together regularly to provide care for specific groups of patients) to refine and evaluate the impact of hourly rounding on patients on 19N, an inpatient medical oncology unit. The project helped staff on 19N conduct more reliable and effective hourly rounds that contributed to better communications with patients, better patient satisfaction, fewer falls and fewer pressure ulcers in the first quarter of 2011. The unit also uses other proven strategies to help patient satisfaction including post-discharge calls, bedside report, nurse manger rounds and service recovery. In the first quarter, 19N has higher patient satisfaction than any other SBUMC unit.

The First Touch Program piloted on 15N. The Office of Patient Guest Relations and Patient and Family Centered Care is implementing a new program designed to encourage patients to discuss their needs and concerns at the beginning of their hospital stay. As part of the program, a patient representative visits daily with all newly admitted patients. Following the meeting, the representative shares important information with the healthcare team that will allow the team to give extra focus to issues highlighted by the patient during the session.


COMMUNITY CONNECTIONS

A Town Hall meeting to address the New York State budget will be held for all SBUMC employees. The next Town Hall meeting is scheduled to take place in April and will be broadcast to the following locations: Lecture Hall 6, HSC, Level 3; OVP Conference Room, HSC, Level 4; North Dining Room, Adjacent to the Skyline Deli, Level 5; 3 Technology Drive, HR Conference Room; 31 Research Way, Conference Room A; Ambulatory Surgery Center Conference Room; Cancer Center, Conference Room, Level 1; and Flowerfield Conference Room. For those unable to attend, a video recording will be available on the Intranet following the Town Hall meeting. Employees who have questions regarding the state budget can call the Budget Hotline at 638-4141. Those who would like a direct personal response should provide a phone number and email address. To ask a question anonymously, please call the hotline using an outside line. Select questions and answers will be shared via email with all employees.

Stony Brook Long Island Children’s Hospital announces the launch of a new website. Months in the making, this highly accessible and user-friendly site is designed for consumers, referring physicians and other members of the community, and provides information on pediatric subspecialties, one-of-a-kind programs, family support, community outreach, education, research and state-of-the-art technology. Visitors to the site will learn how to use the dedicated pediatric Emergency Department, prepare for a hospital visit, find a physician and navigate an inpatient stay. Also included on the website are quick links, contact and referral information, definitions, community resources and links to other programs in the Stony Brook system. To visit the website, go to www.StonyBrookChildrens.org.

Former patient brings video game system to Burn Center on his birthday. Nearly two months after a space heater accident severely burned the right leg of Devin Stinsman, he and his family returned to the SBUMC’s Burn Center with a gift. In gratitude for the treatment Devin received as an inpatient at the Burn Center, the Port Jefferson Station family donated an Xbox 360 video game console as a means of diversion and entertainment for inpatients. Devin presented the Xbox to the Burn Center on his own 10th birthday on March 7.

The 9th Annual Michael A. Maffetone and Community Service Awards Ceremony will be held on Thursday, April 7, 3 pm, in the HSC Galleria, Level 3. The individual award will be presented to Susan Isca, a credentialing specialist in the Managed Care Department, and the organizational grant will be awarded to DATOP Family Association’s DPEP program. The awards honor employees of Stony Brook University Hospital, Stony Brook University School of Medicine, Health Sciences Center and the Long Island State Veterans Home who demonstrate outstanding community service in education, healthcare, human services, arts and culture, diversity, safety or injury prevention. Also honored during the ceremony will be approximately 400 SBUMC employees who have given their time and talents to volunteer in the community on behalf of the institution in 2010.

Organ Donor Council and Center for Medical Humanities, Compassionate Care and Bioethics host conference. Titled “Thinking about Consent and Procurement in Organ Donation: Some Lingering Issues in the Areas of Ethics, the Law and Public Perception,” the conference will be held on Monday, April 11, 9 am to 12:30 pm, in the HSC, Level 2, Lecture Hall 2. Topics to be covered during the conference include Presumed Consent, Individual Consent and Family Resistance, and Organ Donation by Cardiac Death. To RSVP for this free event, please contact David Harris at 444-4710 or David.Harris@stonybrook.edu.

The Third Annual 5K Run/Walk and 1K Fun Run to help fight pediatric cancer and benefit patients being treated at Stony Brook Children’s will take place on May 7. The 1K Fun Run starts at 8:45 am and the 5K Run/Walk starts at 9:30 am at The Bench Bar & Grill, located at 1095 Route 25A. This year’s run will also include a division for individuals in wheelchairs. Pre-race registration is $20 per person, and registration after May 3 is $25 per person. Registration includes a New Balance performance running shirt for the first 600 to register. For more information and to register visit www.sunrisefund.org, or contact Ray McKenna at Raymond.McKenna@stonybrook.edu or 444-6169.

The 6th Annual Kids Health & Safety Expo will be held on Saturday, May 21. The Expo, to be held at Country Fair Entertainment Park in Medford, provides an excellent opportunity to promote SBUMC services and conduct a variety of demonstrations and free healthcare screenings for the community. Any areas or services that would like to participate should contact Yvonne Spreckels, Director of Community Relations, at Yvonne.Spreckels@stonybrook.edu or 444-5250 by Friday, April 15.

Stone Soupe donated luncheons for patients and visitors in the Cancer Center. Three free soup luncheons were hosted by Stone Soupe, located in East Setauket near Tech Park, in March. Patients and visitors enjoyed a hot meal and had an opportunity to share time with staff members.

Adult and pediatric oncology patients enjoy music performance. RxRhapsody, an acoustical music troupe composed of Stony Brook pre-med students, performs bi-weekly at the Cancer Center for the enjoyment of patients and the staff.

A new Bereavement Support Group will be hosted at the Cancer Center monthly. The support group is open to all patients, family members and staff who have experienced the passing of a loved one from any cause, and meetings are held on the second Tuesday of the month from 7 pm to 8 pm. To attend, please register in advance by calling 444-4000.

Zumbathon fundraiser was held for Stony Brook Children’s. Over 200 Zumba® enthusiasts attended the Zumbathon, organized by NICU nurse and Zumba instructor Kristi Tramposch, on March 13 at the Student Activities Center on the Stony Brook University campus. All $2,000 raised at the event was donated to Stony Brook Long Island Children’s Hospital. 

Breast cancer survivors select SBUMC as the beneficiary of $20,000 from the A&P Foundation. The foundation hosted a luncheon on March 10 in support of programs for patients with breast cancer and their families. Two $10,000 grants were awarded: one to Sue Bello, who was honored in 2009 as the “A&P Survivor of the Year” and the other to Linda Bily who was the “A&P Survivor of the Year” in 2007. Both are directing their grants to SBUMC in support of the Housecleaning Program for patients who have had a mastectomy and the GIFT Program. The A&P Foundation has raised more than $1 million to battle breast cancer impacting the lives and families throughout the Northeast. In-store sales promotions, special discounted products and other fundraising events at the A&P Family of Supermarkets, including A&P, SuperFresh, Waldbaum’s, Pathmark, The Food Emporium and Food Basics have contributed to this effort.

Lombardi Family hosts fundraising event for Stony Brook’s MS Comprehensive Care Center. More than 150 people attended the first-ever fundraiser for the Multiple Sclerosis (MS) Comprehensive Care Center on March 4 at Villa Lombardi’s. Patricia K. Coyle, MD, Director of the MS Comprehensive Care Center, and David Perlmutter, MD, of Perlmutter Health Center, were honored for their contributions to the study and treatment of MS. The event, hosted by Development Council Member Filomena Lombardi and sponsored by In the Mood DJ Productions, Paesana Foods and SBUMC, raised more than $50,000 for the MS Comprehensive Care Center.


My Last Touch

As it turns out, most human beings have consistent routines. We work, we play, we enjoy family events and special holidays, and we enjoy hobbies and dining out. Over time, these activities form our unique routines. If these routines become uncomfortable, we change them. The routines themselves are an anchor not only for us but for our families. After all, isn’t it helpful to be somewhat predictable? Disruptions in these routines on the other hand, can be disorienting: a sickness, a natural disaster, loss of a job, divorce, etc. These disruptions can make you quite literally sick, depressed and sometimes worse. Is it possible to systematically prepare for the unexpected?

Some people like surprises. Sometimes the surprise is unexpected news, good or bad, or an unexpected guest. Sometimes you surprise yourself with your own skills in facing a new situation and mastering it. Unexpected events can be lighthearted, like an unexpected gaffe from someone famous. However, surprise can also be anxiety provoking when there is fear of the unknown. How can the same event generate enthusiasm and excitement in some people and exactly the opposite in others? How well would you do in predicting how you would react? Malcolm Gladwell explores these questions in his book, Blink (2005).

Many of you have likely heard of speed dating. Here is how it works. A group of men and women assemble in a comfortable setting. Daters are given badges, numbers, a short form to complete and then a scorecard containing a series of check boxes. Each dater is given six minutes to have a conversation with another dater. Each then checks the box off of those people they would like to date. Within 24 hours, if there is a match, the email address of the potential date is exchanged. The rest is up to fate. This works pretty well as a way to meet large numbers of people very efficiently. How well do you think potential daters predict who they are most likely to select during a six-minute date? Shouldn’t they predict perfectly, because, theoretically they each know their own minds? But it turns out that pre-prediction is often wrong! Columbia Business School professors Sheena Iyengar and Raymond Fisman have been studying this question in an effort to understand how well we know our own minds. In these studies, daters rate people on six scales: attractiveness, shared interest, sense of humor, sincerity, intelligence and ambition. It turns out, however, that most of the time, the dater picks someone other than the ideal person outlined in his or her wish list of the ideal date (that takes place prior to the six-minute date). Why? It appears you, as a person, or the real you, is actually only revealed in your actions and not necessarily by your words.

To some extent this proves we all have a subconscious mind that runs in the background, like some function on a computer, but that our actions are actually determined by a combination of our conscious and unconscious mind. Psychologist Daniel Goleman has described something called “emotional intelligence” which very much mirrors what Iyengar and Fisman have outlined. Emotional intelligence is the sum total of life experiences that enable a person to make judgments. When you walk into a room of perfect strangers, emotional intelligence enables you to decide who it is safe to talk with. You might struggle to explain exactly why you chose to talk to someone in particular. Your subconscious mind is at work.

How does this relate to surprises and dealing with the unexpected? It turns out that your subconscious mind, or your emotional intelligence, actually determines how you will react to stressful situations with surprise, joy or fear. Gladwell relates this to our ability to make split-second decisions. We are all capable of taking in an awful lot of information in just the blink of an eye. We do it all the time.

To prepare for the unexpected then requires that you develop insights into how you actually think, as opposed to the way you think you think, and then to train (your subconscious mind) to accept that new situation. Gladwell describes police officers interviewed after a shooting. Consistently, police describe common experiences using extreme visual clarity, tunnel vision, diminished sound and a sense that time is slowing down. This is how the human brain reacts to extreme stress. Our mind drastically limits the range and amount of information that we have to deal with for the sake of immediate survival needs. Sound and memory and broader social understanding are sacrificed in favor of heightened awareness of an immediate threat. There is a certain range in which stress actually improves performance. This occurs when your heart rate increases to between 115 and 145 beats per minute. But, if your stress levels drive your heart rate above say 145, bad things begin to happen. Complex motor skills start to break down. At 175 beats per minute, cognitive processing or your ability to think logically, breaks down. Behavior becomes inappropriately aggressive. Have you ever tried to have a conversation with an angry or frightened human being? This is why seemingly intelligent, well motivated people often do very stupid things, which in retrospect they themselves do not understand. People under stress can act irrationally. This is important to understand in stress filled situations.

You can train to deal with stressful or unexpected situations. Indeed, healthcare providers do it all the time. It requires practice and turning the unexpected into the routine: cardiac arrest, emergency baby deliveries, etc. Preparing for the unexpected in safe environments turn stressful situations into routine ones. True, it may not be possible to completely eliminate all stress, but you can greatly reduce anxiety and stress, and improve performance through training and anticipation. This works in just about all situations, at home as well as at work. It is always helpful to prepare for the unexpected. Rehearse with your spouse about how you will deal with the next meltdown with your children, or the next outburst from your in-laws or even the next crisis at work.

A Scout is never taken by surprise; he knows exactly what to do when anything unexpected happens.
—Robert Baden-Powell

All creative people want to do the unexpected.
—Hedy Lamarr

I have learned, that if one advances confidently in the direction of his dreams, and endeavors to live the life he has imagined, he will meet with a success unexpected in common hours.
—Henry David Thoreau

Good luck on your personal journey to world class.

Steven L. Strongwater, MD

Chief Executive Officer
Stony Brook University Hospital