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.

January 2011

As we enter a new year, we maintain our steadfast commitment to improve patient safety at Stony Brook University Medical Center (SBUMC). There is clearly a nationwide battle underway to improve the safety of patients. Over the past few weeks, several authoritative studies, including one published in the November 25 issue of the New England Journal of Medicine, have reported disappointing results. The NEJM study showed no meaningful progress in improving hospital safety over the past decade. This is despite enormous public attention, governmental and Joint Commission regulation, and substantial investments made at most hospitals. SBUMC has, however, made remarkable improvements in areas like reducing mortality, improving survival from sepsis, reducing morbidity in neonates (retinopathy of prematurity), reducing central line blood stream infections, embracing bundles of care and checklists, and more. Care has gotten better and safer, but there is so much more to be done. These recent studies remind us that we must redouble our efforts. You can make the difference.

James Reason, a safety expert, describes four subcultures to facilitate improvement in patient safety. Roughly paraphrased:

1. Reporting Culture. The need to reinforce a safe environment for reporting if something or someone makes an error or experiences a near miss. We must thank and recognize, in the most positive way, people who come forward to identify or point out potential weaknesses in our systems. This is the reason we have put into place the Patient Safety Net, an online tool via our Intranet, to report potential or actual adverse events. (Events can be reported anonymously should anyone be concerned about being the messenger.)

2. Just Culture. The need to avoid apportioning blame when something goes wrong. It is so easy to blame the messenger, especially if you don't like the message, and then ignore the problem. We can’t do that if we are to achieve our goal of total commitment to patient safety! We must adopt a culture of heightened awareness to potential or real problems. It is too easy to continue familiar routines, even if they do not lead to the best outcomes—a potentially dangerous philosophy.

3. Flexible Culture. The need to ensure that people can adapt to sudden and potentially radical changes and incremental changes in pressure or stress, pace, and/or intensity. This requires transferring authority for decision making during times of stress to the most capable individual, regardless of his or her role in a management hierarchy.

4. Learning Culture. The need to ensure that people can apply lessons they have learned from one situation to effect change in processes, procedures, and operations so that the lessons learned benefit the entire organization going forward. Said otherwise, we must keep an open mind and accept that we not only can change, but we must change in response to a changing environment.

These four elements describe a highly supportive work environment: a place that values and supports individual talent, contributions, and leadership. In healthcare, more than in almost any type of work, every individual is critically important to the care, safety, and healing of a patient.

Please join the patient safety battle. We must change and embrace these cultures. Thank you for your engagement and help.

STONY BROOK PRIDE

Stony Brook celebrates the opening of the Cerebrovascular Center. The Cerebrovascular Center was dedicated on December 17 as part of the Institute for Advanced Neurosciences. The Institute is a comprehensive clinical and research center dedicated to the diagnosis and treatment of acute stroke, brain aneurysms, atherosclerosis, AVMs, and blood vessel disorders of the brain and spine. The celebration highlighted the Center’s advanced diagnostic, treatment, research, training capabilities, and state-of-the-art facilities. Congratulations Drs. Henry Woo, David Fiorella, and Raphael Davis!

Stony Brook renames and dedicates ALS Center. At a poignant ceremony on December 16, SBUMC’s ALS Center was renamed the Christopher Pendergast ALS Center of Excellence, one of only 34 certified by the ALS Association nationwide. Diagnosed in 1993 with ALS amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease, Ride For Life founder Christopher Pendergast was the major force behind opening SBUMC’s ALS clinic in 2002. Attended by more than 275 guests, the ceremony was emceed by Elizabeth Hashagen, Co-Anchor, News 12 Long Island, and featured the participation of David Cone, former New York Yankees pitcher and honorary chairman of the Ride for Life Foundation, as well as Dr. Pendergast and his family.

SBUMC received the American Heart Association/American Stroke Association’s Get With The Guidelines® (GWTG) Stroke Gold Plus Performance Achievement Award. This award recognizes SBUMC’s commitment and success in implementing excellent care for stroke patients. To receive the award, SBUMC achieved 85 percent or higher adherence to all GWTG-Stroke Performance Achievement indicators for 24 consecutive months and achieved Plus level by reaching 75 percent or higher compliance with 6 of 10 GWTG-Stroke Quality Measures. These measures include aggressive use of medications, such as tPA, antithrombotics, anticoagulation therapy, DVT prophylaxis, cholesterol reducing drugs, and smoking cessation, all aimed at reducing death and disability and improving the lives of stroke patients.

The Lung Cancer Evaluation Center (LCEC) successfully passes audit. The audit was conducted by the National Cancer Institute for programs registered with the American College of Surgeons Oncology Group. The LCEC remains the only integrated multidisciplinary center for lung cancer in Suffolk County.

Stony Brook physician awarded top honor by the Medical Society of the State of New York. Lawrence C. Hurst, MD, Professor and Chair of the Department of Orthopaedics, has received the 2010 Albion O. Bernstein, MD Award from the Medical Society of the State of New York (MSSNY). The award is given to a physician or scientist who has made “the most widely beneficial discovery or developed the most useful method in medicine, surgery, or disease prevention” during a calendar year. He was presented with the award at the Society’s Council Meeting on December 9 in recognition of his role in discovering and developing a new injectable form of the enzyme, collagenase, to treat Dupuytren’s contracture, a debilitating disease caused by progressive accumulation of collagen that deforms hands and fingers.

Long-established community-based cardiologist, joins the Division of Cardiology. Lloyd Lense, MD, founder and former president of Three Village Cardiology in East Setauket, has joined the SBUMC faculty as an Associate Clinical Professor. As a full-time faculty member, Dr. Lense will treat inpatients at the Medical Center and see patients at two Cardiology outpatient office locations in East Setauket and Islandia. Board certified in cardiovascular disease and a Fellow of the American College of Cardiology, he has served as voluntary faculty at Stony Brook University Hospital since 1983. Dr. Lense has appeared in “Castle Connolly Best Doctors in the New York Area” for the past 13 years, and in 2006 received the AOA Volunteer Clinical Faculty Award from Stony Brook University School of Medicine.

Stony Brook physician elected Governor of American College of Cardiology (ACC) for Downstate New York. Smadar Kort, MD, Director, Noninvasive Cardiac Imaging, and Director, Echocardiography, will serve as Incoming Governor-elect until April 2011, and will then assume the duties of Governor-elect from April 2011 to March 2012. Located in Washington, D.C., the ACC advocates for quality cardiovascular care through education, research promotion, and the development and application of standards and guidelines. In consultation with the leadership of the ACC, the New York State Chapter functions, among other things, as an advisor to local and state governmental and professional organizations regarding issues related to cardiovascular disease.

Stony Brook bioethics professor receives award for neuroimaging research on generosity. Stephanie Brown, PhD, Associate Professor, Center for Medical Humanities, Compassionate Care, and Bioethics in the Department of Preventive Medicine, is one of nine researchers from the United States and Great Britain to receive the 2010 Science of Generosity Award, issued by University of Notre Dame. Dr. Brown received the award for her research that will use neuroimaging to test whether generosity is related to parental instincts. The award includes a two-year $150,000 grant, effective December 1, 2010.

Organ Donor Council poster presented at Institute for Healthcare Improvement (IHI) Conference. In early December at the Institute for Healthcare Improvement’s National Forum, Ken Olmer, RN, representing SBUMC’s Organ Donor Council, presented a storyboard titled, “Improving the Organ Donation Conversion Rate at an Academic Medical Center Using Quality Improvement Methodology.” The storyboard demonstrates how improvements made in the referral process have led to a decreased number of missed referrals and an increased number of organ donors. 

Employees provide valuable feedback through the Employee Partnership Survey. Thank you to all employees who have submitted surveys through the mail or online to share their perspectives about working at SBUMC. Press Ganey is currently analyzing these responses and will generate a report summarizing the results to be presented to the Hospital this month. Following the report presentation, work will begin to develop action plans based on the survey results.

PATIENT SAFETY

SBUMC receives recognition from Nassau-Suffolk Hospital Council for patient safety efforts. SBUMC was recognized with two Honorable Mentions for the Nassau-Suffolk Hospital Council’s 2010 Excellence in Patient Safety Award.  The entries, submitted by the Quality Management Division, were “Fostering Organization-Wide Use of Failure Mode and Effect Analyses” and “Standardization to Prevent Venous Thromboembolism.” The award recognizes member hospitals’ distinguished achievements in patient safety and quality improvement. Of the 33 applications received for consideration in the Nassau-Suffolk region, SBUMC’s initiatives stood out as one of the very best.

Patient Safety Friday poster ranked at the American Society of Health System Pharmacists (ASHP) Conference. Under the supervision and direction of Edmund Hayes, PharmD, Associate Director of Pharmacy and Residency Program Director, two pharmacy residents, Zunaira Sharief, PharmD PGY1, and Natasha Mehra, PharmD PGY 1, presented a poster at the 45^th Annual ASHP Midyear Clinical Meeting in Anaheim, California. Their poster titled, “Patient Safety Friday (PSF) a 24/7 State of Mind—An Innovative Approach to Foster Patient Safety in the Hospital Setting,” was one of the few posters selected by ASHP judges to be ranked, an honor extended to those posters that are unique and show new concepts in pharmacy practice. The poster authors were Edmund Hayes; Natasha Mehra; Carolyn Santora, Associate Director, Patient Safety and Regulatory Affairs; Zunaria Sharief; and Jeannene Strianse, Director of Pharmacy.

Prominent Patient Safety and Quality Council meet. SBUMC’s Patient Safety and Quality Council met to discuss key quality issues relating to serious safety events, data sharing, and transparency with respect to quality metrics, and how to reduce mortality using best practices. Prominent quality and patient safety experts from all over the country gathered to brainstorm and share best practices. In addition, sister State University of New York (SUNY) hospitals from downstate and upstate participated in the discussions. These meetings are held annually at Stony Brook and allow the Hospital the opportunity to network with the best and the brightest in the country.

Using Lean principles to enhance reliability. The staff on 18N will be pioneering the use of 5S (Sort, Set, Shine, Standardize, and Sustain) at SBUMC, a Lean methodology for workplace organization and standardization to assess and improve the use of its clean utility room. 5S results in a stable, consistent, and predictable workplace and provides improved control, efficiency, and visibility for staff. 18N staff will focus on sorting through the items in its clean utility room, removing what is not needed, making a permanent home for those items that are needed, establishing standards for the area, and developing a system to sustain the accomplished work. 

PATIENT SATISFACTION

Patient satisfaction in Endoscopy improved dramatically this past year. The improvement in the unit’s patient satisfaction can be attributed to process improvements brought about by a Management Action Team. The team meets weekly to review data and streamline processes and procedures, especially those that streamline patient flow. The Endoscopy Unit also now uses a blanket warmer to help make patients more comfortable and has increased the use of volunteers in the waiting room, where new furniture was recently installed. 

12S (Medicine) has identified three areas of focus to drive higher patient satisfaction. The areas are: keeping patients informed, prompt response to call bells, and demonstrating to patients that the entire staff works together to deliver care. A variety of proven best practices are being employed, such as nurse reports at the bedside, hourly rounding, and post-discharge calls. Other strategies used include interdisciplinary rounds and a more frequent updating of the white boards that help patients know who is taking care of them. 

Questions about the Emergency Department (ED) experience added to the inpatient survey. More than half of all Stony Brook inpatients are admitted via the Hospital's ED. And, while patient satisfaction for patients treated and released has improved dramatically since the second quarter of 2009, patient satisfaction for inpatients admitted via the ED is lower than it is for inpatients not admitted via the ED. To help evaluate our inpatient's ED experience and identify areas where the ED can help the Hospital improve overall inpatient ratings, several questions were added to the inpatient survey including a question about wait time.

COMMUNITY CONNECTIONS

“Dine Out for Kids” initiative supports Stony Brook Children’s. From January 9 to January 16, participating restaurants located throughout Suffolk County are offering a special $29.95 prix fix menu and allocating $5 from each meal to Stony Brook Children's. A growing list of participating restaurants can be found at www.StonyBrookChildrens.org.

First annual “Harvest Luncheon” benefits pediatric MS research at Stony Brook. “A Season of Giving” was the theme at the luncheon, which raised funds to help support the Stony Brook University Hospital Auxiliary in its efforts to help the hospital promote the health and welfare of the community, and the National Pediatric MS (Multiple Sclerosis) Center at SBUMC, where vital medical research is conducted to find the answers to MS. During the event, held at the Watermill on November 18, Lauren Krupp, MD, Founder and Director of the National Pediatric MS Center, was honored as a “Woman of Distinction” and recognized for her distinguished career in MS.

Thank you for supporting the Blood Bank this holiday season. Close to 2,000 men, women, and children in the community, including those with cancer, those undergoing transplants and surgery, trauma victims, newborns, and many others need blood transfusions each day. As in previous years, there is a shortage of blood during the holiday season. In response, Stony Brook employees gave the gift of life at the recent Winter Blood Drive, where 68 units of blood were collected. Thanks to all who participated.

NY Islanders play Santa and visit pediatric patients at Stony Brook. On December 14, NY Islanders defensemen Travis Hamonic and Milan Jurcina, and forwards Jesse Joensuu and Matt Martin, visited the inpatient pediatric floor and the pediatric unit of SBUMC’s Outpatient Cancer Center to bring some holiday cheer to patients and their families. The players signed autographs, posed for pictures, and delivered toys. The visit was organized by the Child Life Program at SBUMC and the New York Islanders.

Long Island Ducks visit Pediatrics for the holidays. QuackerJack, the Long Island Ducks professional baseball team mascot, made his way around the inpatient Pediatric unit on December 20 delivering toys to patients. Joined by former New York Mets shortstop and Ducks’ co-owner Buddy Harrelson, the visit was part of the Ducks’ annual Holiday Toy Drive.

"Major Mod" crew makes gift to the Little Angel Fund. Members of Gilbane Building Company's construction crew and its subcontractors, who have been working on projects throughout the Medical Center, raised a total of $1,250, which they presented to Jenny Tranfaglia, founder of the Little Angel Fund. The Fund raises money to help provide support for families of babies being cared for in the NICU. Jenny and her husband Joe founded the Little Angel Fund in memory and honor of their daughter Amanda Rose, born 16 weeks premature, and who received care in the NICU. Jenny has been named the Honoree for this year's March of Dimes March for Babies, which will take place at Stony Brook for the very first time on May 1. 

Medical students take time to entertain. The Lymph Notes, an a cappella group composed of Stony Brook medical students, visited the Hospital in December. The groups sang special holiday songs in the lobby for visitors and staff to enjoy, and then visited units to entertain patients at their bedsides.

SBUMC Physical Therapy conducts training study. Individuals with lower extremity limb loss (amputation) have difficulty walking, even after rehabilitation. To further assist these individuals, the Department of Physical Therapy is conducting a training study to see if a large amount of walking practice on a treadmill can reduce some of the difficulties experienced by these individuals on a daily basis. The program requires volunteer participants to attend 15 sessions over 10 to 12 weeks with a total time commitment of 13.5 hours. The entire program includes 12 treadmill training visits that take place three times per week for four weeks, a post-training testing session one week after completion of the training, and a follow-up testing session four weeks after completion of the training.

E-Health Network of Long Island hosts lecture on health information exchange. Guest speaker Micky Tripathi, PhD, MPP, President and Chief Executive Officer of the Massachusetts eHealth Collaborative (MAeHC), a non-profit collaboration of 34 leading non-profit healthcare organizations based in Massachusetts, will visit Stony Brook on January 26 to provide his perspective on the national landscape of health information exchange. The lecture will be held in the Health Sciences Center, Lecture Hall 5, from 10:30 am to noon. To register, call 638-4000.

Renew your commitment to keep Stony Brook smoke free. As we ring in the New Year, we remind you of Stony Brook’s commitment to maintain a smoke free environment. It has been two years since we instituted an expanded smoke-free policy in an effort to eliminate smoking in and near the Medical Center, including the surrounding grounds. For those of you who wish to take that all-important step to quit smoking, Employee Health & Wellness (EH&W) offers free smoking cessation classes to employees. Call EH&W at 444-7767 to register for the next six-week class that begins on January 24, 11:00 am to noon. Smoking cessation classes are also available in many locations, including Tech Park. For information on these programs, call 853-4017. Free nicotine gum is available to employees and can be obtained by visiting EH&W during regular business hours. To refer to the smoke free policy, visit http://sbumc-sp-document/sites/admin-pnp/environment/EnvironmentofCareHospitalView/EC0002.pdf.

Starbucks extends hours. In a continuing effort to improve services, a pilot program has been launched to extend the hours of Starbucks (located in the Hospital main lobby) until midnight every night.

My Last Touch

David Walker, the president of the prestigious Peter G. Peterson Foundation, a billion dollar foundation focusing on issues related to fiscal sustainability, often discusses financial “stewardship,” particularly as it relates to issues like the federal deficit, entitlement programs, and tax policies—all important financial concerns. Stewardship, as it relates to healthcare, on the other hand, is a term we don’t spend much time thinking about, but perhaps we should. What is stewardship?

Merriam-Webster’s Dictionary defines stewardship as “…the conducting, supervising, or managing of something; especially the careful and responsible management of something entrusted to one’s care.” Wikipedia defines stewardship on another level: “an ethic that embodies cooperative planning and management …” There are other forms of stewardship to be sure, like stewardship of religion, land development, corporations, fundraising, and the like. Indeed for some, what first comes to mind when thinking about stewardship is what we will pass on to our children, the legacy and lifestyle we leave behind.

Stewardship has its roots in the Middle Ages when servants were required to bring food and drinks to castle dining halls. In more contemporary times stewardship has evolved to mean an employee’s responsibility for the care of passengers’ domestic needs on a ship, train, or airplane, and/or managing the services provided to diners in a restaurant, or overseeing ones domestic affairs.

The World Health Organization (WHO) has extensively studied stewardship and embraced the notion that there should be stewardship for the health of our nation. In 2000, a WHO study focused on health stewardship by drawing attention to population- based medicine and in particular, to making population health a core responsibility and essential role of good government. The WHO called for government to “formulate health policy, exert influence and assure accountability” through monitoring for health outcomes.

Since 1979, the United States has set a series of health goals through the “Healthy People” process sponsored by Secretary of Health and Human Services. “Healthy People has set and monitored national health objectives to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of our prevention activity.” These guidelines have helped shape public policy and called attention to important public health issues like obesity, cancer, disability, health disparities, food-borne safety, and the like. Some of the leading indicators from “Healthy People 2010” include: physical activity, weight, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to healthcare. Improvement in several domains has been made, while in others progress has been very slow, if at all. We remain challenged by our inability to design interventions to deal with problems like obesity, diabetes, and smoking. In fact, 20 percent of adults continue to smoke despite widespread knowledge of the health risks to the person smoking and the effects of secondhand and thirdhand smoke on others.

As individuals and healthcare providers, perhaps we can view these gaps as a call to arms for greater "health stewardship." More so now than in any time in the recent past there is an opportunity to embrace this responsibility. Health reform has laid fertile ground to examine new and innovative opportunities for improvement. You can help.

Thank you for accepting your role, our “health stewardship,” in improving the health and wellness in our communities. 

The only thing you take with you when you’re gone is what you leave behind.
—John Arbuthnot

The goal is to avoid surprises and instill good stewardship.  
—Bill Swanton

We are a continuum. Just as we reach back to our ancestors for our fundamental values, so we, as guardians of that legacy, must reach ahead to our children and their children. And we do so with a sense of sacredness in that reaching.
—Paul Tsongas

Enjoy the journey to world class and my best wishes to you and your families for a healthy, happy, and successful new year.

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