August 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, 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.
August 2008
Over the past several months we have introduced a series of concepts:
- Baldrige
- High Reliability Organization
- Five simple Rules of Work
- Patient and Family Centered Care
This could get confusing! How do these all fit together?
Last month we had a site visit from Bill Thompson, Sr. Vice President of Strategic Development and Dr. Kevin Johnson, VP for Medical Affairs and Quality at SSM De Paul Health Center, a Baldrige winner. To refresh your memory, Baldrige is an award of excellence. Fundamentally, Baldrige asks a simple question: are you doing what you believe to be important 100% of the time (are you fully deployed)? SSM is among a highly select few hospitals in the nation to achieve Baldrige recognition. Why?
Medicine is a highly complicated but loosely coupled system. By its nature, therefore, it is prone to errors. The more steps, the more complicated a process, the more people involved in that process, the more risk there is of an error. Years ago, a single physician did everything for a patient (remember Marcus Welby?). Nowadays, there are specialists, multiple diagnostic modalities, nurses, nurse practitioners, aids, therapists, pharmacists...it has gotten much more complicated. Fortunately, most of the time patient care goes very well. If you get sick and have to come to a hospital, wouldn't you want to be absolutely sure care is error free? Wouldn't you want what you needed 100% of the time?
The goal of becoming a High Reliability Organization (HRO) is the goal to be error free. The external validation of achieving this goal is a Baldrige Award. When SBUH wins the Baldrige, we will more than likely have used a variety of approaches to get there: for instance, Nursing's plans to achieve Magnet status; many failure modes and effects analysis (FMEA) will be done on risk prone processes; FOCUS PDCA projects will be completed; medical and pediatric early warning scores (MEWS and PEWS) will identify patients at risk, etc.
How we behave and treat each other at work every day sets our culture, which, at SBUMC, is characterized by the Five Simple Rules of Work: patients first (a focus on patient satisfaction and the highest quality of care); world class processes (full deployment of best practices); teamwork (helping each other in a safe and supportive environment); growth (personal growth as well as organizational growth); and, using resources wisely. Yet behavior alone is not sufficient for achieving a goal. Achieving a goal requires focus, will, skill, resources and a plan to get there.
By tradition, medical care can roughly be characterized as an evaluation of symptoms, initiation of treatment and observation of results. Does this model miss anything? One dimension of care is certainly medical...we cured the infection. How people feel while being cared for is equally important. Was I treated with respect? Did people at SBUMC take into account my special concerns, my cultural and religious beliefs? The human and spiritual side of healing is not an explicit part of the medical treatment paradigm. The introduction of the Patient and Family Centered Care Initiative, spearheaded by Lee Xippolitos, is SBUMC's attempt to address these very important human needs.
To achieve the best medical outcomes; to assure safe care; to respect human needs; to be supported and respected; and for the staff to be recognized for their excellent work is what SBUMC is all about. We want to be certain if you or your families need care, you would come to SBUMC. Becoming an HRO and practicing Patient and Family Centered Care will get us there. For the rest of the world to know we have arrived, we need to win a Baldrige Award. Following the five simple rules of work is the foundation for the journey.
STONY BROOK PRIDE
Stony Brook Recognized as a Leader. In July, representatives from Stony Brook University Medical Center presented a web conference for the Health Disparities Collaborative that focused on using the Plan-Do-Check-Act (PDCA) cycle to improve the median referral-to-listing turnaround time for transplant services. The cornerstone of the efforts focused on patient and family involvement and enhancing communication processes. As a result, the median referral to listing time in days improved from 394 in June 2007 to 86 in June 2008. Congratulations to the team!
Stony Brook Physicians Make ‘Best Doctors' List. Our physicians make enormous contributions to Stony Brook University Medical Center every day, and continuously work hard, along with our nurses and staff, to ensure that our patients receive high quality and compassionate care. Congratulations to the 29 Stony Brook University full-time and voluntary faculty named to the New Yorkmagazine annual list of "Best Doctors." The list, which is based on the annual guidebook, Top Doctors: New York Metro Area, is published by Castle Connolly Medical Ltd., a New York research and information company. Each year, Castle Connolly conducts a peer-review survey and polls medical professionals asking, who, in their judgment, are the best in their fields and related fields, especially those to whom they would refer their own patients and family members. The 1,434 doctors selected this year represent approximately one-quarter of the top 10 percent of New York-area physicians, as determined by Castle Connolly. In alphabetical order, they are:
Carole Agin, M.D. - Pain Medicine
Mary Andriola, M.D. - Child Neurology
Thomas Biancaniello, M.D. - Pediatric Cardiology
David Brown, M.D. - Interventional Cardiology
Steven Carsons, M.D. - Rheumatology
Eva Chalas, M.D. - Gynecologic Oncology
Harris Cohen, M.D. - Diagnostic Radiology
Alexander Dagum, M.D. - Plastic Surgery
Deborah Davenport, M.D. - Obstetrics & Gynecology
Raphael Davis, M.D. - Neurological Surgery
Irving Gomolin, M.D. - Geriatric Medicine
Alan Kaell, M.D. - Rheumatology
Arthur Klein, M.D. - Infectious Disease
Dorothy Lane, M.D. - Preventive Medicine
Thomas Lee, M.D. - Pediatric Surgery
Sharon Nachman, M.D. - Pediatric Infectious Disease
Brian O'Hea, M.D. - Surgery
Robert Parker, M.D. - Pediatric Hematology-Oncology
Michael Pettei, M.D.-Pediatric Gastroenterology
John Pomeroy, M.D. - Child & Adolescent Psychiatry
Eric Rashba, M.D. - Cardiac Electrophysiology
Lesley Rechter, M.D. - Family Medicine
Michael Richheimer, M.D. - Allergy & Immunology
John Ricotta, M.D. - Vascular Surgery
Todd Rosengart, M.D. - Thoracic Surgery
Maisie Shindo, M.D. - Otolaryngology
Richard Sosulski, M.D. - Pediatrics
Thomas Wilson,M.D.- Pediatric Endocrinology
Michael Zema,M.D.- Cardiovascular Disease
Dr. Kier Wins Prestigious Award. Please join me in congratulating Cathy Kier upon her receipt of a Cystic Fibrosis Foundation Learning and Leadership Collaborative Award which is designed to enhance the CF Center. This award will allow her to interact nationally with CF Centers and it is an honor to have been selected for participation in this important program.
SBUMC Signs Hospital Affiliation with Southampton Hospital. As a part of our broad east end strategy, SBUMC has signed an affiliation agreement with Southampton Hospital. (SHH previously had an affiliation agreement with Columbia Presbyterian.) SBUMC now has formal affiliation agreements with all three east end hospitals: Peconic Bay Medical Center, Eastern Long Island Hospital and Southampton Hospital.
Emergency Department Passes with Flying Colors! The NYS Department of Health Emergency Medical Services Division paid an unannounced site visit to our Emergency Department for a full service inspection. This entailed reviewing paperwork, policies and procedures, and physically examining our vehicles to ensure compliance with State regulations. The SBUH ER passed this inspection and will not be subject to another full service inspection for five years. Congratulations!
Vascular Neurology Receives Longest Possible Fellowship Accreditation. The accrediting body for allopathic fellowships is the American College of Graduate Medical Education (ACGME). The Vascular Neurology Fellowship was just reviewed and approved for five years. Our compliments on your excellent measurable outcome commendation as well!
SBUMC Transplantation Administrator Selected as Speaker. United Network of Organ Sharing (UNOS) is sponsoring David Bekofsky, Administrator of the Transplantation Program, to speak at the National Improvement Leaders Meeting in Boston on August 11 as the Region 9 Regional Collaborative Leader. Dave's topic: "The Regional Strategy - Keeping the Collaborative Alive: Regional Team Actions and Commitments." Working with UNOS, SBUMC created a survey to see what topics are of interest to Region 9 regarding Health Resources and Services Administration (HRSA) type collaborative events. Managing the waitlist for organ transplants and decreasing the time from referral to waitlist are both of high interest and SBUMC is becoming a leader in both of these areas.
Ventilator-Associated Pneumonia Prevention Project. The Healthcare Association of New York State (HANYS) recognized Stony Brook University Medical Center as a leader in patient quality and safety for its participation in the Ventilator Associated Pneumonia Prevention Project.
New Faculty Recruits Since January 2008 in the School of Medicine. We are excited by the many new faculty who have joined SBUMC and the skills they bring to Suffolk County and to Long Island. Of special note, joining the staff at SBUMC are:
Dr. Stephen Post, best-selling author and Director of the newly established Center for Medical Humanities, Compassionate Care and Bioethics in the Department of Preventive Medicine, who joins us from Case Western Reserve University.
Dr. Jonathan Buscaglia, the new Director of Endoscopy joining us from Johns Hopkins University School of Medicine.
Our new Physiatrist, in the Department of Orthopaedics, Dr. Svetlana Ilizarov, is joining SBUMC from the Hospital for Special Surgery. She is the daughter to the theoretician who developed the limb lengthening "distractor" known as the "Ilizarov apparatus" used by orthopaedic and trauma specialists world-wide.
These are just a few faculty appointment highlights in a long list of 31 exciting new hires. Look for briefs on each through the summer as our Media Relations Department introduces them more formally to the community.
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Please join us in warmly welcoming these new faculty members to SBUMC.
PATIENT SATISFACTION
New Interpreting Services: NICU Safety Huddles Lead to Plans that Improve Communication. Spanish patients and families will now have an option to be connected directly to a Spanish interpreter when they call the hospital's main phone number. Ken Piorun and the Communications Department acted quickly from a suggestion raised during NICU's Safety Huddle to change the voice menu greeting to include an option to select Spanish from the main menu. More importantly, the NICU staff needed a way for families to have an interpreter on the line before calling the unit so that the families can receive information on their babies as quickly as possible. We now have two 800 numbers that the families can call (one for Spanish speaking families, one for other non-English speaking families) that will enable them to connect with the interpreter first and then call the unit. Great idea! Great team work to put this into action.
Food Services Enhancing the Employee and Visitor Experience. The Marketplace Café introduced two new exciting programs to enhance the service and selections for our guests; an Organic food program and Spitfire.
- The Organic program offers customers a wider variety of natural and organic choices. Featured items include: beverages, yogurts, salads, and snacks. The New Year will bring an enhanced marketing program to inspire increased purchases.
- Spitfire is the Marketplace's branded rotisserie concept. Spitfire features daily selection of fresh roasted menu selections. Our culinary staff created mouth watering rubs, marinades and sauces for chicken, ribs and turkey. A marketing program was created and debuted during August.
Housekeeping Services Improving at SBUMC. Housekeeping Services has increased their Annual Mean Score for Cleanliness to 82.8 (year end 2007) in the Press Ganey Patient Satisfaction Survey. This is the eighth consecutive year we have increased the mean score in Patient Room Cleanliness (highest Annual score achieved to date). In addition, scores improved for courtesy to 87.7 (year end 2007). This is the fourth consecutive year we have increased the mean score in Courtesy of the Housekeeper (highest annual score achieved to date).
PATIENT SAFETY
Performance Improvement Priorities Identified for 2008-2009. The Senior Executive Group, Executive Staff, Quality Assessment Review Board, Quality Committee of the Governing Body and Governing Body has approved Performance Improvement Priorities for 2008-2009.
- Dashboards. Development of Executive Level, Service Line, Public and Special Purpose and Joint Commission dashboards.
- High Reliability Unit. Development and spread of the Exemplary Clinical Unit to CACU and to at least three other units (at least one other ICU, one medical floor unit and one surgical floor unit).
- Five Star Quality Rating. University HealthSystem Consortium (UHC) Quality & Accountability Report: Maintain four stars in 2008 and attain five stars in 2009.
- Core Measures. Appropriate care measures of 95% for all core measure sets.
- Attain top decile, compared to National Safety Healthcare Network (NHSN) in adult ICU Ventilator Associated Pneumonia (VAPs) and Central Line Infections and in surgical site infections for cardiothoracic, colon and rectal and orthopedic implant procedures.
- Agency for Healthcare Research & Quality Outcomes. Attain green and double green circles in all AHRQ adult and pediatric safety indicators.
- UHC Benchmarking Initiatives. Enroll and participate in:
- Patient Care Handoffs
- Handoff Communication
- Discharge Handoffs
- Obstetrics/Perinatal Safety (HANYS)
- Customer Service/Patient Satisfaction Focus
- Decubitus Ulcers
- Post-Operative Respiratory Failure
- Excellence. Integrate Baldrige Workgroups into Performance Improvement Efforts.
Standardized Central Line Education and Certification in Effect. Since July 1, 2008 all entering residents are required to pass a standardized central line education and certification program in which they must: 1) review and successfully complete an on-line educational module; 2) demonstrate competency under the supervision of a certified practitioner in the insertion of a line using a simulation; and, 3) demonstrate competency under the supervision of a certified practitioner in the insertion of 5 central lines at the bedside before they are permitted to insert lines independently. This program is expected to increase resident confidence and decrease complications associated with central line insertions.
DVT Prophylaxis Implementation Program Underway. National studies indicate many preventable hospital deaths are attributable to Deep Vein Thrombosis (DVT). A new DVT patient risk assessment form will be trialed in August 2008, followed by a house-wide roll out in September. Discharge Instructions and a DVT risk and prevention brochure is being developed to educate inpatients and their loved ones. The DVT Task Force is working with Information Technology and Clinical Informatics to incorporate the use of forms in an electronic environment.
Continuing the Baldrige Journey. Congratulations to the Category Workgroups responsible for completing Baldrige self-assessments for Leadership, Strategic Planning, Patient/Customer Focus, Measurement, Workforce and Process Management. Now that the gap analyses are completed, the next step is to formulate action plans to address the gaps using world-class practices and evidence-based literature to support process changes. A Baldrige Retreat is planned for August which will focus on the results that will be used for the application content. In addition, Baldrige Liaisons (individuals assigned to the Category Workgroups to facilitate team efforts) are in the process of writing the first draft of the application. The primary focus of these efforts is to continually improve processes and develop an organizational framework for excellence.
Transparency: Sharing Outcomes on the Hospital Internet Site. Recently, a public dashboard was created for placement on the Medical Center's internet and intranet sites. In an era of transparency, we will share our quality and patient satisfaction outcomes with the public. More information to follow next month!
Core Measure Outcomes Available. The Hospital Quality Alliance (HQA) Preview Report for the 1st through 4th quarters of 2007 is now available. Based upon the data, SBUMC achieved results in the top 10th percentile for the following indicators: Acute Myocardial Infarction: Adult Smoking Cessation Advice/Counseling (100%); Heart Failure: Adult Smoking Cessation Advice/Counseling (100%); Pneumonia: Oxygenation Assessment (100%); and, Surgical Care Improvement Project (SCIP): Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery (96%). Benchmarks provided include state and national averages, as well as top 10th percentile results for core measures.
Progress in Standardizing the Medication Process. Standardization of floor stock inventory is being coordinated and implemented by the Standardization of Medication Process Team to minimize the risk of accidental medication administration. Specific medications are being removed from general floor stock inventory, such as high dose Heparin and other high risk medications, and will be available via Pyxis or Pharmacy distribution. The Team meets weekly to discuss inventory assessments and best practice recommendations, then collaborates with unit leadership prior to implementing changes. Ten adult Medical/Surgical units went live on May 19, 2008, with roll-outs planned for the Pediatric & Mother-Infant units in August, and the ICUs in September. Additional areas will follow.
Medication Room Design is being explored by the Standardization of Medication Process Team with input from the Nursing Staff Advisory Team and other staff nurses. The nurses were asked to provide feedback on the physical layout, use, and function of the medication rooms with consideration of improving efficiency, safety and staff satisfaction. A final summary containing staff input, evidenced-based practice, and design recommendations will be presented to the executive leadership.
Emergency Equipment Rounds to Improve Code Blue Outcomes. The Mock Code Blue Committee recognizes a need to enhance education surrounding Code Blue events. "Emergency Equipment Rounds" are formatted to heighten staff awareness on the importance of prioritizing activity and being prepared to immediately treat life-threatening arrhythmias during a code blue event. The front line staff will be provided a demonstration on how to successfully prioritize their response from the critical time a patient is identified as unresponsive to first defibrillation. "Hands on" demonstration/return demonstration with emergency equipment is the primary focus of the rounds. Discussion and questions regarding any aspect of code blue response, documentation, available supplies and resources will be encouraged. The education is planned as a non-threatening "hands on" approach to improve retention and comfort level of RN's using emergency equipment on their units during the initial minutes of a code blue event. The Mock Code Blue Committee members will provide a unit-by-unit education opportunity for staff on July 17, 24 and 31 from 6AM - 10AM and on August 6 and 13 from 7 - 10AM.
COMMUNITY CONNECTIONS
Physician Town Hall Meeting Dedicated to Getting Connected. On June 30, approximately 40 community based physicians attended our Community Town Hall Meeting where updates regarding the Major Modernization Program, Strategic Plans, Information Technology and general questions and answers were provided. Hands on training for Cerner and the E Health Network (regional health information organization-RHIO) were provided. For questions regarding IT, please call 444-HELP.
Diversity Council Presentation. Dr. Strongwater presented an update of SBUMC Community Connections to the President's Campus Multicultural Advisory Council on June 17, 2008. The report was very well received. Plans for Patient and Family Centered Care were discussed, and members from the Diversity Council volunteering for this initiative. The full report can be found at http://inside.hospital.stonybrook.edu/.
Cancer Center Program is the beneficiary of a $100,000 Gift. An anonymous donor has made a major gift to benefit the Cancer Center in tribute to their loving family. This gift is truly inspiring for those who have been diagnosed and those whose lives have been affected by cancer. We are grateful for the generosity that will enable our team of dedicated physicians, nurses and caregivers to do what they do best...meet the challenges that treating cancer presents, and provide patients with exceptional and compassionate care.
Third Annual Kids Health & Safety Expo a Great Success. Stony Brook University Medical Center hosted about 700 community members at this annual event in St. James. More than 35 Stony Brook departments provided informational displays, interactive exhibits, and health screenings. The magic shows, face painting, and other activities provided children and their caregivers a day full of education and amusement. It was a fun and educational opportunity for parents and children to learn tips on how to keep kids safe during the summer months and year round. We continue to receive positive feedback from community members, including from the mother of a 5 year-old who reported that her son has committed to spending a few hours a day being active because he "promised Ronald McDonald that he would."
Save the Date: Walk for Beauty, Walk for Life on October 5. This year marks the 15th anniversary of the "Walk for Beauty, Walk for Life." The Walk is a combined effort of community volunteers and Stony Brook University Medical Center and raises crucial money for breast and prostate cancer research here at Stony Brook University. Mark your calendar and put on your shoes. Call (631) 444-4000 for more information.
Dr. Augustus Mantia Selected as Critical Incident Police Surgeon for the Suffolk County Police Department. On July 17, Dr. Gus Mantia, Clinical Associate Professor of Medicine and Family Medicine was installed as a Critical Incident Police Surgeon by Commissioner Dormer following successful completion of critical training in FEMA Incident Management, Weapons of Mass Destruction, Police Department field operations and protocols, and your certification as a Field Physician by the Suffolk County Department of Health/Division of EMS. Dr. Mantia has been on the SBUMC medical staff since April 25, 1980. Congratulations.
Ongoing Community Events. SBUMC professionals continue to provide lectures, screenings, and support groups to community members. During the month of June, our staff provided free blood pressure, glucose, cholesterol, and prostate cancer screenings, smoking cessation counseling, and education on breast cancer, diabetes, fire safety and women's health throughout Suffolk County.
Leaders at Every Level. Congratulations to the fifty-eight Stony Brook supervisors who celebrated their graduation from Leaders at Every Level this past June. Offered by the Office for Corporate Education and Training, the program provides continuing education for both new and experienced supervisors and managers. The curriculum consists of seven hands-on and interactive modules that include the basic competencies needed to be an effective supervisor or manager. To date, 217 have completed the program. For information about Leaders at Every Level, call Corporate Education and Training at 4-9805, or visit the Hospital intranet.
LAST TOUCH
Some things are best done by yourself. Like reading or painting. Other things need to be done in groups. When you work by yourself, you define the outcome. When you work in a group, what happens is entirely dependent on the people in the group, or is it? Working in a group, when you have an important goal is something more than casually getting together. It requires teamwork. For teams to work successfully, each person must contribute.
Individual and team learning as well as team successes have been carefully studied. Effective teams are enabled when there is safety in seeking feedback, sharing information, asking for help, and talking about errors where experimentation is encouraged (mental tryouts).
Teams can also be dysfunctional and fail. The reasons for failure may include (a) a belief that it is not safe to share information; (b) that team members believe they will be attacked for novel ideas (which may be radical); or (c) that self reporting an error may result in them "being put on trial". The characteristics of teams and their members also differ-some are open and encourage sharing (thank you for bringing forward a risky situation, e.g. medical error), others are definitely not (this is the way we do things around here, so get in line!).
All this can get very personal. What you and your colleagues believe greatly influences your team-based behavior(s). Indeed, fear of losing your image (image cost), fear of loss of face, fear of appearing incompetent by admitting a failure (perhaps putting at risk promotions, raises or project assignments) and fear of giving up ground (threat rigidity) all inhibit learning and successful teamwork.
"...people tend to act in ways that inhibit learning when they face the potential for threat or embarrassment."
-- Chris Argyris
One characteristic of nearly all successful teams is there is a leader. Interestingly enough, the leader may not be the "officially designated" leader. In many cases, the manager on a work unit will not be the team leader. Think about how this works in your own family. For some activities, you may be the leader (i.e. planning the family vacation), but for others, your father becomes the leader (building a deck onto your house).
The role of leader, in highly successful organizations, falls to the person with the requisite skill set for success. Likely, the leader will changes from one situation to the next. For maximum success, the "official leader" (i.e. unit manager) needs to transfer their support and authority to the person most likely to succeed. This is not always easily done for fear of losing control, and sometimes for fear of failure.
Why must there be a leader? James Surowiecki, who wrote "The Wisdom of Crowds," and studied what makes for successful group outcomes, has described the need for an "integrator" - someone who takes a groups input and assimilates it and then points in a direction, hopefully the right direction -aka a leader (whether so designated officially or unofficially).
There is another interesting organizational dynamic about teamwork. Some successful teams hoard their success. Indeed, they are often the groups that are consistently celebrated. Have you ever wondered why some nursing units are so successful? Why don't they just tell everyone else how to do it? It is actually far more complicated than a reluctance to share. It involves, for example, the personalities of the people on a unit, work demands, complexity of care provided, and much more. Unfortunately, hoarding may cost the rest of us.
TEAM should mean-Together Everyone Achieves More.
SBUMC seeks to encourage team success. This means it must be safe for you to share ideas, perceptions and fears. Play your role in making teams succeed. At the same time, SBUMC will maximize your chances for success by creating and supporting a climate that encourages interpersonal trust and mutual respect, leading us closer to becoming a world class organization!
Enjoy the journey to world class.
Steven L. Strongwater, MD
Chief Executive Officer
Stony Brook University Hospital
Patients first-World class processes-Teamwork-Growth-Use resources wisely
