CEO Update February 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.

February 2008

In mid January, I was invited to discuss why Stony Brook University Hospital should become a high reliability organization (HRO). This is an interesting concept. Are you familiar with HROs?

Have you ever had an experience that exceeded your expectations? Where just about everything went better than you expected? Mine was when I got a new musical instrument that fit my hands perfectly. It seemed so much easier to play and I felt like I was a much better musician. Perhaps, you are one of the lucky owners of an "I-phone", which provides heretofore unimaginable connectivity-with access to the internet, music, email and more. How could we have possibly lived without this technology? I'm sure we can all think of at least one example of something or some experience that was nearly perfect. Great memories. How about in healthcare? 

Is perfection in health care more difficult to achieve because of its complexity? Should our patients expect that when emergent care is needed, emergent care is received - without waiting? That staff will respond promptly when a nurse call button is pushed? That our staff will be sensitive to cultural concerns? That we will have no errors in the process of delivering care (i.e. no medication errors, no wrong site surgery)? That we will communicate effectively?

The reality in healthcare across the country is that we fall short. In fact, errors occur which can hurt patients. It is estimated that thousands of lives are lost because of medical errors.

A high reliability organization (HRO) is an organization fixated on getting it right. In quality jargon, HROs have error free operation over time.

SBUH must become an HRO. 

To become an HRO, everyone directly or indirectly involved in patient care must become a patient safety advocate. It requires understanding what steps lead to a "clinical outcome"; it requires finding the best process to maximize these outcomes. It requires physicians, nurses, pharmacists, transporters, receptionists and many others work closely together. Every role, every service provider, is important. Just as it takes one musician to strike a wrong key in orchestra for the performance to suffer, it takes one aspect of healthcare delivery for a patient to have a negative experience.

Becoming an HRO requires we change. HROs focus relentlessly on measurement because it is hard to know how you are doing without measuring it. Measuring can be scary. Some may be concerned that quality and safety measurements will be used punitively. To the contrary, we need to embrace measurement to know if we are getting better and to understand just how good our care is.

We have taken our first steps on SBUH's path toward becoming an HROwith a pilot in the Cardiac Intensive Care Unit (CICU). The CICU hosted a highly interactive kick off on January 10 to launch our first high reliability unit. More than 20 interdisciplinary staff members, including members from medicine, nursing, administration, social work and care coordination attended the presentation. Dr. Lee Xippolitos, CNO, also shared the concept of the Patient and Family Centered Care Model which will be incorporated into this pilot.  We will take lessons learned here and deploy them through the rest of the hospital. Thank you for supporting this important initiative.

Stony Brook Pride

SBUMC Celebrates 50 New Faculty. Since January of 2007, 50 new faculty have joined Stony Brook University Medical Center: nine in the Department of Medicine, seven in Pediatrics, five in Surgery, five in Emergency Medicine, four in Anesthesiology, with smaller numbers in Family Medicine, Urology, Ophthalmology, Radiation Oncology, Neurology, Neurosurgery, Pathology, Anatomical Sciences, Obstetrics & Gynecology and Psychiatry. Four faculty have transitioned to emeritus status; one retired; one passed away. Thirteen have left to pursue careers at other academic medical centers or in private practice; three were not renewed.

Growth and strengthening SBUMC's faculty are essential for building a sound foundation to achieve our academic and clinical mission, particularly at a time when the medical school class size is expanding by 40 percent.

Stony Brook University Hospital Impact on Economy Approaches $1.4 Billion. HANYS (Hospital Association of New York State) recently forecast the economic impact of SBUH. Payroll contributed approximately $795M, supply purchases approximately $527M, and capital spending approximately $64M.

Village Times Herald Recognizes Many from Stony Brook University. The December 27 edition of the Village Times Heraldrecognized Wayne Waltzer as the Physician of the Year, the Chaplaincy Program at SBUMC as People of the Year in Religion; and, President Kenny as Woman of the Year. Also of note, Senator John Flanagan was recognized as Man of the Year; Gloria Snyder (a strong supporter of SBUMC) as Volunteer of the Year; Jim Fiore, SBU's Athletic Director, as Man of the Year in Sports; Clinton Rubin, Chairman of SBU's Biomedical Engineering Department, as Man of the Year in Science. Stony Brook University has a lot to be proud of!

Renal Transplant Team Ideas Embraced. Ginny McBride, Director, Breakthrough Collaborative Initiatives of the US Department of Health and Human Services, Health Resources & Services Administration, Division of Transplantation, invited David Bekofsky and SBUMC's Transplant Team to present at the "All Collaborative Conference Call" on January 8. This has been followed by an invitation to present at the national meeting of the transplant collaborative in March. This followed a presentation of SBUMC's ideas on how to increase the number of potential renal transplant donors.

SCCM Distinguished Service Award to Marc Shapiro. Marc Shapiro, Chief of General Surgery, Trauma, Critical Care and Burns, will be recognized this month with a Distinguished Service Award from the Society of Critical Care Medicine for his 12 years as an officer. The SCCM Distinguished Service Award recognizes SCCM members who have made exceptional leadership contributions that have furthered the vision and mission of SCCM over a period of time. With 13,000 members in 80 countries, SCCM is the only organization that represents all professional components of the critical care team. It is the largest multi-professional organization dedicated to ensuring excellence and consistency in the practice of critical care.

Stem Cell Grant Awarded to SBUMC Scientist. Peter Brink, PhD, Professor and Chair of  Physiology and Biophysics, has just received a state grant of close to $871,000 to do collaborative research on stem cells. The program involves a number of people in the Medical Center and, like other front end research, offers great promise for our patients.

Mike Porembski and Pamela Noack selected as National Association of Public Hospitals and Health System (NAPH) Fellows for 2008.  Both are among many outstanding candidates who were nominated from NAPH member hospitals.  NAPH have admitted approximately 37 leaders from safety net institutions across the country, representing (26) NAPH member institutions. Congratulations!

Lisa Clark, New Born Nursery Nurse Practitioner invited to "Capitol Fly In." Lisa Clark, NP, was invited to participate by NAPNAP (National Association of Pediatric Nurse Practitioners) in its "Capitol Hill Fly In" to present health care concerns from the advanced nurse practice perspective to the Health Policy Committee. Lisa chairs the Legislative Action Council as part of the Nursing Governance Structure here at Stony Brook University Hospital. 

Thirteen Teaching & Research Nurses to Begin Fellowship in Quality. The Nursing Quality Management Department in collaboration with Risk Management and Hospital Quality Management welcomed 13 Teaching and Research Nurse IIs to the new Fellowship in Quality and Patient Safety this January. These 13 nurses are being given an opportunity to learn first hand the elements of Stony Brook's Quality and Patient Safety programs. The program offers didactic an experiential learning opportunities. Upon completion of this program, these nurses will incorporate what they have learned into clinical practice.     

Abstract Accepted to National Association of Healthcare Quality Meeting. Jean Mueller's abstract "One Academic Medical Center's Efforts to Maintain Normothermia in the Post-Operative Orthopedic Patient" has been accepted for a poster presentation at the annual Educational Conference of the National Association for Healthcare Quality in September 2008. This project has been a joint effort between Nursing Quality Management and the staff of peri-operative services in the orthopedic unit. We are proud of their accomplishments.      

Patient Satisfaction

To Enhance Patient Satisfaction. Support Services will be renamed Patient and Guest Services and the staff and functions in areas that deal with our patients, family and staff as a core part of their job will come together. We will bring together Patient and Guest Relations, Customer Relations, Patient Satisfaction, Volunteer Services, and the Main Lobby Information Desk with key service areas including Housekeeping, Concierge, and Food and Nutritional Services. Mike Maione and Theresa Netter will now report directly to Diane Carillo. 

Patient and Family Centered Care (PFCC) to be Incorporated into SBUH Care Model. SBUH has made a commitment to move to a standard of care that places patients and their families first. This clinical initiative is called Patient and Family Centered Care. PFCC is defined as an innovative approach to the planning, delivery and evaluation of health care grounded in mutually beneficial partnerships among health care patients, families and providers. The core concepts of this care model include dignity and respect, information sharing, participation in care decisions, and collaboration. Integrating processes explicit to PFCC into our system will require a paradigm shift. For instance where this model has been implemented, all hospital committees have patients/family members as routine participants. Consistent with the road map laid out by the Institute of Medicine, our goal in moving toward PFCC is to improve safety, quality of care and operational efficiency. The patient and family become equal and important members of each health care team. If you would like to participate in the planning of PFCC, please contact Dr. Lee Xippolitos at 444-2780.

$50,000 from ALSA & Ride For Life for Comprehensive ALS Care. The ALS (amyotrophic lateral sclerosis) Comprehensive Care Clinic under the leadership of Rahman Pourmand, MD, received a $50,000 grant from the ALS Association, Greater New York Chapter, made possible by "Ride For Life, Inc.," to expand its multi-faceted care for patients with the progressive neuromuscular disorder, also known as Lou Gehrig's disease. "Ride for Life" is the ALS fundraising organization started 10 years ago by 15-year ALS survivor Chris Pendergast. The ALS Comprehensive Care Clinic offers a multidisciplinary program of medical treatment, rehabilitation techniques, and psychological support. The clinic includes experts and care in areas such as neurology, occupational therapy, physical therapy, respiratory therapy, nursing, speech pathology, social work and nutrition. It is the only ALS treatment program on Long Island that provides same-site, multidisciplinary services for patients.

Patient Safety

Safety Initiatives in the Pharmacy Department.The Pharmacy processes over 3,000 medication orders each day. Pharmacists review orders, identify potential drug interactions, allergies, appropriate use, and dosing, and when necessary, intervene to prevent errors. Pharmacy uses state-of-the-art technology to assure automated, standardized approaches to the compounding and dispensing of pharmaceuticals. A system of redundant checks helps ensure correct medications are prepared. Bar code technology helps ensure the correct drug is dispensed. Efforts to standardize and streamline drug dosing has allowed for the hospital-wide automated dispensing cabinets containing over 80 percent of an area's medication. This system has improved the time to administration of medications reducing waiting for patients. Pharmacists also take part in Institute for Healthcare Improvement or IHI rounds. An integral aspect of patient safety involves our Pharmacists' role in implementing the use of Smart Pumps. These intravenous infusion pumps have built-in safety checks to prevent errors. The pumps are able to provide safety checks because pharmacists program correct doses for critical medications, maintain a drug library and perform quality reviews using data provided by these pumps. And in July of 2007, two residents were enrolled in a newly-established Pharmacy Residency program. These Residents spend the majority of their time providing pharmacist services at the bedside. 

Baldrige Planning Moves to a New Level. SBUH has embraced a plan to apply for a Baldrige Award as a measure of excellence. The Senior Executive Group recently met to discuss the development of a plan on the journey to Baldrige. Workgroups will be formed for each of the process categories:  Leadership, Strategic Planning, Focus on Patients and Customers, Information Management, Human Resource Focus and Process Management.  The Results Category will be addressed by the leaders of the Workgroups. A gap analysis will be conducted which will lead us on the path of identifying action plans to improve organizational performance. Loretta Gvazdinskas and Mike McClain will work on the journey to Baldrige with Carol Gomes and Bruce Solomon.  

SBUH A Leader in Pneumonia Prevention. Margaret Parker, MD, Bernadette Valente, RN, and Christine McMullan were invited to present two Ventilator Associated-Pneumonia Prevention Project sessions at the Nassau Suffolk Hospital Council and American Bar Association as HANYS faculty members. SBUH is considered to be a leader in the downstate region of hospitals currently participating in a HANYS collaborative.  Congratulations to all involved!

SBUH A Leader in Surviving Sepsis.William Greene, MD and Christine McMullan were invited to present at a HANYS sponsored webinar on Early Sepsis Identification and Rescue in January 2008.  HANYS is working with the Institute for Healthcare Improvement to support the Surviving Sepsis Campaign. SBUH was identified as a leader in this initiative within the state of New York.

Community Connections

Save the Date…A Town Hall Meeting for Community Physicianswill be held on Wednesday, February 13, 2008, from 6 pm to 8 pm at the Watermill in Smithtown. Please call Debbie Lang at 638-4040 or e mail Debbie Lang@stonybrook.edu if you plan to attend.  

Nurse Navigators at the Cancer Center. During the last year, we have greatly expanded the Nurse Navigator program in the Cancer Center. Most cancer disease teams now have a dedicated Nurse Navigator. The goal of this Navigator is to help patients and referring physicians get through the system in a timely fashion, and to optimize the care of our patients with cancer. This includes getting imaging studies done, pathology reviewed and appointments with physicians. The Navigator and Disease Team do not "take over" care of the patient, but work with the primary team. Please do not hesitate to contact them for assistance. Lung Cancer Evaluation: Eileen Zaoutis 444-6993; Breast Cancer: Lynette Leepack 638-0693; Leukemia, Lymphoma: Emily Locher 444-3810; Upper GI: Patty Zirpoli 444-8052; GU/Prostate: Melanie Dale 444-1948; Head & Neck: Gerty Fortune 444-8410; Melanoma & Sarcoma: Claire Smith 444-1244; Pediatric Oncology: Deborah Giugliano 444-7720; GYN Oncology: Linda Mahler 638-1000.

SBUMC Connects with the Three Village Chamber of Commerce. On January 16, Dr. Strongwater met with approximately 70 members of the Three Village Chamber of Commerce. During the meeting, he reviewed SBUMC’s progress in developing new programs (e.g. surgical robotics, interventional stroke), provided an update on the Major Modernization Project, and discussed numerous safety initiatives. SBUMC is committed to working closely with the community as part of its four part mission of patient care, research, education and community service.

Pharmacists Helping the Community. Pharmacy is committed to insuring the appropriate and safe use of medications. To help educate the community, Pharmacy participates in Mall Walkers lectures at Smith Haven Mall, provides talks on medication safety to the local Senior Centers and Assisted Living Centers, participates in the annual Kid’s Health and Safety Expo, and “Building Bridges to a Healthy Community Health Fair” in Brentwood.

SBUMC Forms Development Council. We are pleased to announce the formation of the SBUMC Development Council, a group of prominent individuals who understand the importance of raising funds in support of our goal becoming a world class organization. The Council will meet this month and work to increase community connections and philanthropy in support of the Medical Center's vision.

Faculty Forum. On February 26 at 5:00 pm, Drs. Fine and Strongwater will hold a Faculty Forum at Faculty Senate meeting.

Medical Student Outreach. Al Jordan, Associate Dean Student Affairs reported on January 8 that 30 SBUMC medical students have completed their training and have begun to provide HIV/AIDs education in Suffolk high schools. SBUMC has been providing educational services for many years and it has been well received.

Auxiliary Donates New Monitoring Device to SBUH . We are proud to announce the SBUH Auxiliary donated a Deltex CardioQ monitor to the surgical intensive care unit in January. The device, which is valued at $11,000, is a non-invasive way to measure the cardiac performance and fluid status of our critically ill patients. It will significantly reduce the risk of harm to patients as well as lower costs and reduce length of stay. This gift is just one of several that the Auxiliary plans to make to the hospital. I encourage everyone to join the Auxiliary as a member. Call 4-2699 for a membership application.

Last Touch

February can be depressing. The days are short and the weather is gloomy. The holidays are behind us. On the other hand, there is a great deal to look forward to. What are you looking forward to?

SBUMC has defined our simple rules of work: patients first, world class processes, teamwork, growth, using resources wisely. Growth is meant to reflect your personal growth.

Said differently, we hope you will reflect upon your dreams. Dreams are essential.

“In the long run, men hit only what they aim at. Therefore, they had better aim at something high.”
-- Henry David Thoreau

Are you clear about what you hope to achieve? Are you working at it?

We are all leaders. As such, the life path you define can make an important difference inside and outside of Stony Brook University Medical Center. Be an active participant in making your dreams come true. Just as working to become an HRO is hard – but very worthwhile – so can working to achieve your dreams.

 “A kind and compassionate act is often its own reward.”
 -- William John Bennett

Steven Strongwater, M.D.
Chief Executive Officer
Stony Brook University Medical Center

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