CEO Update January 2008

fThe 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.

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January 1, 2008

Welcome to 2008.  It’s a New Year. So much to look forward to…

I have now been at SBUMC for a wonderful, full year. The year of 2007 went by in a blur. Are you aware of some of our highlights and accomplishments from the year 2007?

• Inpatient mortality reduction of more than a 25%;
• 27% improvement in survival among patients with severe sepsis diagnosed in the Emergency Department;
• More than a 60% reduction in the Medical Intensive Care Unit in ventilator associated pneumonia (VAP) rate in 2007 over 2006;
• Improved outcomes for neonates;
• Fewer skin ulcers for our patients;
• Core electronic record systems installed; improved medication safety;
• Higher patient satisfaction scores;
  Implementation of many patient concierge services;
• Recognized for safety via an Environmental Safety Award
  (US Environmental Protection Agency);
• A new Quality Assessment Review Board (to help us further improve our outcomes),
• A Stony Brook Patient Safety Council;
• Improved collaborations with SUNY Upstate and Downstate;
• New programs in Surgical Robotics, Interventional Stroke, Survivorship and Supportive Care;
• First Responder Program in Eastern Long Island (Manorville/East Moriches & Riverhead/Mattituck); and a
• Patient Transfer Center at SBUH to simplify patient transfer via a single phone call.

It is now time to set out New Years Resolutions for Stony Brook University Medical Center…

• SBUMC will finish our coordinated strategic plans (SBUH, CPMP, and SOM);
• SBUMC will further improve the patient and family experience, as measured by higher patient satisfaction scores;      
• SBUMC will improve our patient and staff safety and work toward becoming a high reliability organization;
• SBUMC will improve retention and recruitment of faculty and relationships with community based physicians;
• SBUMC will increase our collaborations with east end hospitals; and,
• SBUMC will increase our local and regional reputation as measured by market based data.

Stony Brook Pride

UnitedHealth Designates SBUH Premium Cardiac Specialty Center. Stony Brook University Medical Center has been designated a UnitedHealth Premium Cardiac Specialty Center for 2007 to 2009. This designation means that SBUMC has met rigorous quality criteria based on nationally recognized medical standards and expert advice. UnitedHealthcare developed the UnitedHealth Premium Specialty Center designation program to give its members information about, and access to, cardiac hospitals meeting rigorous quality criteria. The designation is based on detailed information about specialized training, practice capabilities and proficiencies that we submit to UnitedHealthcare and is designed to help consumers make informed decisions about where to seek cardiac care. Congratulations to our cardiac team!

Institute for Healthcare Improvement (IHI) Recognizes SBUH’s Success in Reducing Mortality in Keynote Address. On December 10, at the 19th Annual National Forum on Quality Improvement in Health Care, Dr. Donald Berwick, the President and CEO of the IHI and one of the nation's leading authorities on health care quality and improvement, used Stony Brook University Hospital's mortality rate trends in his keynote speech as an example of how Rapid Response Teams and other IHI initiatives save lives. Congratulations to all who improve patient care using evidence-based practices.

Vaccine Drive Success! Employee Health Services, under the leadership of Maria Loret De Mola, provided flu vaccines to 2,675 employees, a sixty percent increase over the prior year! A tremendous effort that protects the health of our employees and our patients. If you didn't have an opportunity to get your flu shot please call Employee Health at 631-444-7767 to get one. It’s not too late!

Stony Brook Blood Collections for the NY Blood Drive Exceed Last Year by 220 Units! The Holiday Blood Drive held December 10 was a huge success with 105 pints of blood collected in just over five hours. SBUMC is forecast to collect almost 700 units of blood, exceeding last year’s total collections of 471 units. Watch for the next opportunity to donate or call 631-444-2634 Monday to Saturday.   It is almost painless. I promise (I speak from experience). A heart felt thank you to those who were part of this wonderful effort.

SWEET Awards. The Patient Safety Committee recently sponsored the “Safety Will Ensure Excellent Practice,” or, SWEET Awards. The first awards were given at the December 6, 2007 Department Head Meeting.  

• "Lifesaver Awards" (a large glass container filled with assorted Lifesavers candy) were given to the units which had achieved 100% compliance on their hand washing audits in November.  These units were: General Clinical Research Center, Cardio Thoracic ICU, Child Psych, and Non-Invasive Cardiology.
• Special "Supporting Player" lifesaver awards were given to Francina Singh, Donna Keehner-Nowak, Mary Catalano and Kathy Scheriff for supporting the Hand Hygiene Campaign.  On Halloween they stood in the corridor between the Operating Room and the Emergency Department, dressed as "germs" proffering antimicrobial foam to encourage staff and visitors to wash their hands.

In the future, other SWEET Awards will be granted including the "M&M" Award for decreasing morbidity and mortality related to falls, pressure ulcers, sepsis and other hospital complications, and the "Chips" Award presented to areas that have best "chipped away" at improving Press-Ganey scores related to the Patient Safety Categories.

Ventilator Associated Pneumonia (VAP) Rates Fall to Zero in SICU in October! With a great of deal work, protocol adherence and commitment, the Surgical Intensive Care Unit has been successful in eliminating ventilator associated pneumonia the entire month of October. Congratulations to the Dr. Marc Shapiro, Sharon Kearney and the staff in the SICU.

A Life Saved. Elena Pastoriza, the coordinator of the Hospital's Community Resource Center in Stony Brook Village, was featured in the December 13 edition of the Three Village Times for helping to save the life of a local resident. An 86-year-old man, a regular visitor to the center, confided to Ms. Pastoriza that he was not feeling well. After taking his pulse and blood pressure, Ms. Pastoriza convinced him to go to the emergency room immediately. She called 911. He was transported to Stony Brook and was found to have a heart attack. After he was successfully treated, he sent Ms. Pastoriza a letter, describing her as "very efficient, very helpful, very gracious and charming" and thanking her for helping to save his life. 

Patient Safety

Retinopathy, Nutrition, Lung Maturation Improve in the Neonatal Intensive Care Unit (NICU). Through the implementation of a series of care bundles, use of daily goal sheets, multidisciplinary rounds, attention to noise in the NICU, the number of babies with retinitis of prematurity has fallen by 60% since January through June of 2005 to January through June of 2007. Mortality for infants weighing 750 to 1500 grams (the highest risk premature babies) has fallen by 3.4%. Because of increased protein intake, weight has increased faster and head circumference has significantly increased, which correlates with fewer developmental delays.

SBUMC Presents Five Papers at Institute for Healthcare Improvement Annual Conference.
1)"Achieving Increased Survival"
2) "Surviving Sepsis: Increasing Detection and Standardizing Care"
3) "Education and Compliance: SCIP to Best Practice"
4) "Increasing Organ Donor and Tissue Donation Consent Rates"
5) "Perinatal Care Bundles: Decreasing Variation and Increasing Compliance"

SBUMC Quality Abstracts Printed. The Healthcare Association of New York State (HANYS) printed two abstracts from Stony Brook University Hospital in its publication, “Leading the Quest for Quality: 2007 Profiles in Quality and Patient Safety". The two selected abstracts were, "Enhancing patient Safety and Improving Outcomes with a Rapid Response Team" and "Modifying and Applying Best Practices Recommended by the Society of Critical Care Medicine and Embraced by the Institute for Healthcare Improvement for the Treatment of Severe Sepsis".

Dr. William Lawson Invited to Present Abstract at National American College of Cardiology Meeting. Dr. Lawson has been invited to present an abstract entitled "Operator dependence of door-to-balloon times in STEMI". This outlines some of the dramatic improvements in the time it takes for a patient with myocardial infarction who presents in the SBUH Emergency Department to arrive in the cardiac catheterization laboratory and achieve stent placement. This type of analysis can point the way toward even further improvement.  In this case, time saved is heart muscle saved.

Medical Early Warning Scores Update. A prevalence study was conducted on November 13, 2007, to determine the efficacy of the MEWS assessment. Ten patients were followed on each of the medicine units (15 N&S, 16N, 19N and 13N), totaling 124 assessments over a 24- hour period. After review of the data it was determined that respiratory rate parameters were too narrow and triggered unnecessary elevated (yellow) scores. The respiratory rate parameters were modified on the assessment tool. The study also found that a physician needed to be called for only 9 patients in 13 instances. Another 24-hour prevalence study will be conducted on the medicine units mid-January. Once the assessment tool is deemed effective in identifying patients at risk, the MEWS initiative will be rolled out to the surgery floors. Thanks to all who are participating in this effort as it truly improves patient care.

The Quality Assessment Review Board met on December 18 to review quality and patient safety performance, credentialing and privileging processes at Stony Brook University Medical Center. As recommendations are shared with hospital leadership, action plans will be developed to continually improve our outcomes.

Cardiac Acute Care Unit (CACU) Reduces Patient Falls Risk. CACU has successfully reduced the patient fall rate as a result of implementing the “Days Without A Fall” program. Denise Westman TRIII/Unit Educator has created a brightly decorated bulletin board to educate staff on how to keep patients safe from falling. The day shift and night shift staff are keeping track to see which shift can go longer without a patient fall. The day shift is currently up to 54 days without a fall and the night shift is close behind at 38 nights without fall. This motivational metric was adopted from a presentation given by “The Advisory Board” entitled Data Driven Nursing Enterprise:  Inspiring Frontline Action.

Cardiac Unit as a High Reliability Unit. Beginning in January 2008, Peg Duffy, Interim Associate Director of Nursing, Cardiac Services, Dr. David Brown, Chief of Cardiovascular Medicine, and Justin Swearingen (our administrative fellow) are working together with Diane Marrone and the clinical and quality staff to develop Cardiac Intensive Care Unit (CICU) as the first high reliability unit for our hospital. Additionally, this unit will incorporate the elements from the Patient and Family Centered Care framework into the foundation of their delivery of care model. This innovative approach to the planning, implementation and evaluation of health care is grounded in mutually beneficial partnerships among health care providers, patients and their families. The staff on CICU are excited to have been chosen to participate in this pilot and hope to lead the way for others.

Community Connections

SBUMC Journal Club Launched. The Journal Club is off and running. Last week two facilitated sessions were held to discuss the book "Raving Fans" by Ken Blanchard and Sheldon Bowles. Those who attended shared ideas about how we can change the way SBUMC behaves toward our patients and how we can determine what our patients want and deliver "plus one percent".  Ideas from these sessions will be widely shared. Thanks to all who participated as we all grow through shared knowledge. If you would like to participate, please call or email Laurie Rafkin or Carol Gomes.

Opportunity to Improve Vaccination Rates. There is an opportunity to improve our pneumococcal/influenza vaccination rates for inpatients, especially for patients diagnosed with community acquired pneumonia.  Recently, a medical director order for the flu/pneumococcal vaccine was made available which allows us to ensure that we systematically vaccinate all patients who do not have contraindications prior to discharge. Increasing the vaccination rate will save lives.

Auxiliary Donates a New Ambulance to SBUMC. The Board of Directors of the University Hospital Auxiliary has authorized the purchase of a new ambulance for use by the hospital's Emergency Medical Services. The donation is valued at almost $140,000. The ambulance will be equipped with a hydraulic lift to enable the transport of critically ill infants in isolettes. It will also feature a new safety package that allows medical personnel to remain strapped in while caring for a patient in transit. The gift from the Auxiliary is the latest installment on $2 million pledge made by the Auxiliary to the Hospital.

Deserving Children & Make a Wish Foundation. On December 3, Karine Hollander, President and CEO of the Make-a-Wish Foundation of Suffolk County, visited the Medical Center in an effort to boost the number of children who are referred to Make-a-Wish. She was accompanied by representatives of Estee Lauder, one of their corporate sponsors. The foundation grants the wishes of children (aged 2 1/2 to 18) with life threatening conditions who live in Suffolk County. Stony Brook University Medical Center is one of the Foundation's most active referral sources. If you would like to refer a child to the Make-a-Wish program, please call Joanne Coppola at 631-585-9474.   

Reaching Out. Each year, during the holiday season, patient representative Patricia Boyce Fazzino opens her home for a holiday luncheon for over twenty members from a group home sponsored by the Association for the Help of Retarded Children (AHRC). The group comes to eat, visit with Santa (another family member), play games and sing. This is a great example of SBUMC staff giving back to our community.  Not only does Ms. Boyce Fazzino open her heart and home, but she has made it a traditional family celebration.  

SBUMC Ambulatory Care Pavilion Adopts Unit in Iraq. The Ambulatory Care Pavilion adopted the Battalion # 494 Transport Company 1st Platoon stationed in Iraq. A total of 200 pounds (eight boxes) of personal care items, food, portable CD players, postage stamps, and much, much more, were sent to Iraq and were received by our soldiers on December 20. A poster was also sent that was signed by all participating staff.

Giving Inspiration, Fighting Together (GIFT). The Gift program provides support to patients diagnosed with cancer. GIFT sent groceries to 20 financially challenged patients and families who have a cancer diagnosis. The program will continue through New Year’s Day. Anyone who wishes to donate, please contact Linda Bily at 631-444-1386 or Cynthia Lombardo at 631-444-8035. 

Pediatric Oncology Helps Family of Eight. The Staff of Pediatric Oncology in the Cancer Center has adopted a family of eight who were in need for the holiday season. Items donated by the staff included personal items, toys for the children, groceries, and clothing.

Donations to SBUH. A recent grateful patient mailing introduced more than 300 new donors to the Medical Center. Donors who were so moved by their experience here that they felt compelled to do something- to give back.  Contributing to the hospital is a concrete way of improving the fate of others while satisfying the need to show gratitude. These gifts have improved the lives of many through the purchase of items like isolette covers for the cribs in the Neonatal Intensive Care Unit, murals and art in waiting areas, toys and children’s programs, electronics like televisions and video games and even life-saving medical equipment. Private support has the power to transform an institution and these gifts will become increasingly important to our continued progress. We are grateful for this support and hopeful for continued success.

Last Touch

Are you a positive deviant?

Progress most often happens slowly, through gradual, incremental change. Sometimes, change happens much faster, with great excitement in a whoosh (quickly). Why is it that some things change quickly, some slowly and some things almost never change? This is a tough question. I am convinced we all resist change. It moves us out of a comfort zone and creates stress. In fact, it is why I often say, “…all change is good, unless it affects me”.

Our instinctive reaction to change, especially unexpected change, is to resist it. We tend to isolate differences created by change and try to get rid of them. Think about a simple change, like someone who wears odd clothing styles. When we see them, we make fun of their attire or worse, we walk away….

Deviants are defined by the Princeton Web Dictionary as “markedly different from an accepted norm; "aberrant behavior"; "deviant ideas".

So what is a positive deviant?

Positive deviants are people or things that advance something inherently good; i.e., the discovery of antibiotics, the understanding that hand washing can prevent the spread of disease, how to improve patient healing.

How do we react to positive deviants? Oddly enough, from a distance we might celebrate and embrace a positive advance as human beings. When positive deviants impact us personally, more often than not we react to them the way we do to negative deviants – we push them away. Perhaps this is why new discoveries take so long to come in to common usage. Did you know it takes 17 years for a newly discovered drug to come into common use? From a health care perspective, this is appalling. Think of how many lives we could save if we could accelerate this change.

Our dilemma is how to recognize and support positive deviants at Stony Brook, especially when they advance new ways to improve care, reduce work loads, or improve job or patient satisfaction. Where are you, positive deviants? We need to find and enable you. And for most of us, non positive deviants, when someone presents their next new idea, listen harder. Keep an open mind. Try it out.

Never doubt that… “A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has.”
-  Margaret Mead.

Also from Margaret Mead:

“I must admit that I personally measure success in terms of the contributions an individual makes to her or his fellow human beings.”

And,

“Our humanity rests upon a series of learned behaviors, woven together into patterns that are infinitely fragile and never directly inherited.”

SBUH’s focus on becoming a high reliability organization will foster opportunities to adopt best practices from our staff and other places, and to improve outcomes. This is exactly what we must do, accelerate and embrace positive change. Not change for change sake, but to improve the care of our patients, the staff, our environment and our collective satisfaction.

Thank you for your help. Becoming a high reliability organization is a long journey….

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

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