CEO Update July 2007

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.

180-Days Update
July 3, 2007

The dream of the Major Modernization Project is becoming a reality. The Women and Infant’s Pavilion is nearly fully enclosed and looks like a real building. All phases of campus upgrades are moving ahead on schedule. And, in spite of what could be considerable disruption, the Emergency Department has realized their highest patient satisfaction scores in SBUMC’s history.  Congratulations to all who have pulled together working to bring us to the next level of excellence.

As we begin a physical campus renewal, we have also begun strategic planning. The process – just underway – has representatives from the hospital, Schools of Medicine, Dentistry, Nursing, Health Technology and Management and the Clinical Practice Management Plan (CPMP). As part of this effort, we have begun to examine our Mission, Vision and Values. The Mission represents our core reason for existence; The Vision is what we ultimately hope to become and Values define how we should behave.

Using thoughtful input gathered from approximately 100 people from many disciplines and departments across the Medical Center, we are considering updating our Mission, Vision and Value statements, the goal of which is to more accurately reflect who we are and what we do. At the same time, they are also meant to be practical, actionable and measurable. We share these with you and seek your reaction and input.
 
Proposed new Mission, Vision and Values:

Mission

Stony Brook University Medical Center improves the lives of our patients, families, and communities, educates skilled healthcare professionals and conducts research that expands clinical knowledge.

Vision

Stony Brook University Medical Center will be:

• A world-class healthcare institution, recognized for excellence in patient care, research, and healthcare education


• The first choice of patients for their care and the care of their families


• An academic medical center that attracts educators and students with the desire and ability to provide and receive the highest quality, innovative education


• One of the top federally funded institutions for scientific research and training

Values

Based upon overwhelming support from all participants in this process, the Medical Center's values will remain—I CARE.

Integrity
Compassion
Accountability
Respect
Excellence

Please send your reactions and comments to UH_CEO@stonybrook.edu

Patient Satisfaction

• Emergency Department Patient Satisfaction Scores Rise. Patient satisfaction in the ED improved this quarter to the highest rating in the history. This improves our rank to above the 50th percentile in two of the three comparative databases. This is the 2nd quarter in a row the ED is above the 50th percentile in the University Health System Consortium database despite extensive construction and the opening of a satellite on the fifth floor to care for children.


• Patients and Families Directly Call Rapid Response Teams. With some anxiety, the direct calling program began on May 1, 2007 on 15N and 15S. The team is creating a schedule for hospital-wide implementation and we are in the process of finalizing a patient/family brochure that will help roll it out.


• Patient Activity Schedule (PAS). Thank you all for your continued assistance in making the PAS a reality. We have made remarkable progress, yet there remain gaps in uniformly obtaining and sticking to a predictable schedule for patients. Thank you all for your cooperation and brainstorming to sort this out. It is not easy, but will greatly improve our patients’ experience.


• Last Touch Shared With Medical Staff and New Chief Residents. In an effort to assure consistency, at the annual medical staff meeting on June 12, 2007, we distributed the Five Simple Rules of Work and the Last Touch Initiative. These programs were described to approximately 150 physicians. Likewise, on June 25, we met with the new chief residents and did the same. Thank you for continuing to enable open communications with your patients by asking at the end of a patient encounter… I have time, is there anything else. It does make a difference.

Patient Safety

• SBUMC Scores Well in 2006 AHRQ Inpatient Quality Indicators. In reviewing Agency for Healthcare Research and Quality (AHRQ) measures from 2006, SBUMC was significantly better than the NY State rates for vaginal birth after cesarian section (VBAC), mortality rates for acute myocardial infarction, congestive heart failure, percutaneous coronary angioplasty and volume rates for bypass surgery, esophageal resection, pancreatic resection, and below the threshold for carotid endarterectomy. Please congratulate your staff for achieving such excellent results - especially for mortality rates (we were better than the state rate for four measures). This is consistent with the feedback we have received from the University HealthSystem Consortium (below).


• Stony Brook Recognized by UHC for Most Rapid Decline in Mortality Amongst All Members. Mortality rates have steadily decreased at SBUH since 2003. Stony Brook has been recognized by University HealthSystem Consortium as "most improved" due to multiple performance improvement efforts primarily associated with the Institute for Healthcare Improvement's Saving 100,000 Lives Campaign and the Clinical Documentation Improvement Project.


• “Exemplary Clinical Unit” Sought to Become High Reliability Organization. An interesting concept, extensively developed and applied, initially, at Dartmouth Hitchcock Medical Center is that of the Exemplary Clinical Unit (ECU). In brief, it is the idea that each clinical unit is a “microenvironment” in which, by proper planning, education, patient and staff involvement and use of technology, care processes and outcomes can become idealized. In a sense it is a framework by which a clinical unit can become its own “high reliability” organization (HRO). Clinical units that welcome this challenge should speak with Dr. William Greene, Carol Gomes or their Associate Director. There will be further information and education over the summer as we begin to proceed on the path of becoming an HRO.


• Pediatric Early Warning Scores (PEWS) and Modified Early Warning Systems Developed. These “scores” are derived each time the Primary Nurse’s Assessment is done (at least every eight hours). They include measures of behavioral, cardiovascular and respiratory conditions. The greater the score the greater the concern about the patient’s stability. The scores are graded by color (green, yellow, orange and red) and displayed on a white board in the nursing station core, bed by bed, with appropriate colored magnets. An algorithm that is the basis of education for nursing staff delineates what to do should the score turn from green to something else but the essence of the response to scoring changes is to get help by bringing to the bedside a more senior level caregiver such as a nurse or physician. A pilot of this is ongoing on Pediatrics (11 North), and will continue in July before further extension on to pediatrics. Additional comments from nursing and physician staff note how easy it is to appreciate how “sick” the floor is by looking at the board and in helping to determine which patients to see first.


• MEWS. We are anxious to begin MEWS on one of the adult medical or surgical floors. The principle is the same as for PEWS but the elements and scoring will differ. Quality Management will be consulting with Nursing on how best to proceed but if there are any clinical units who seek to be an “early adopter” please contact Chris McMullan, Assistant Director of CQI, your Associate Director or Dr. William Greene, CQO.


• Failure Mode and Effects Analysis (FMEA). You may recall from the last update that SBUMC seeks to become a high reliability organization. This requires ongoing assessments of risks and plans to assure positive outcomes. FMEAs are one tool to move us closer to the goal of an HRO. Several FMEAs are currently underway. The Pediatric Medication Process FMEA team and the Tubing Misconnection FMEA teams are currently implementing risk reduction strategies. Preventing Workplace Violence FMEA in Mental Health recently finalized its recommendations and action plans. To study risks associated with chemotherapy, the Chemotherapy FMEA team continues to meet and will finalize risk priority scoring and identify additional risk reduction strategies for key failure modes. We expect every unit to identify high risk areas for future FMEA teams. Please discuss potential risk prone processes with your unit managers.


• House Staff Communications Targeted for Improvement. Over the past year the criteria used to call the Rapid Response Team have generally become the basis for requiring house staff to call their attending physician. In addition to these general criteria, the Graduate Medical Education Committee (GMEC) has adopted three other approaches to improving communication by and with residents.
  
  
  • Department Specific Criteria. Extending the RRT criteria approach, the GMEC mandated each clinical department develop and adopt department-specific criteria that warrant the resident calling his/her attending. We ask each resident and attending to monitor this on an ongoing basis.
  
  
  • Condition Specific Warnings. The residency program directors (through the GMEC) agreed upon the development of procedure (or condition) specific warning criteria. These are gradually being rolled out by incorporating these criteria into procedure-specific order sets as they are adopted. The latter is being done with the assistance of the Clinical Pathways group.
  
  
  • All Resident Conferences. The GMEC endorsed the creation of the All-Resident Conference (ARC), jointly sponsored by the hospital Division of Medical and Regulatory Affairs and the School of Medicine Dean’s office. It has frequently been noted how difficult it is to communicate with resident staff because of the large number of different training programs, schedules and sites. The ARC tries to overcome this by having the same lecture given late one day and early the next, once per month for 10 months starting in September. Topics will be those appropriate to the broad nature of the group and generally will be elements of the Systems-Based Practice and Practiced-Based learning competencies required by the Accreditation Council for Graduate Medical Education.


• Safety Huddles. We continue to deploy and measure the effectiveness of unit based safety huddles. These are quick meetings used to modify treatment plans and staff assignments to effectively support the needs of patients. Thank you for your support and cooperation as we make this part of our routine work.

Community Connections

• Improved Discharge Communications. The hospital's call center, HealthConnect®, has begun to fax copies of patients' discharge orders to referring and primary care physicians in the community on the next business day after discharge. The program has been implemented on 15N, 17N and 19, and will soon be deployed throughout the hospital. Several departments, including the Emergency Department and Radiology already fax information about hospital tests and treatments to physicians in the community.


• Increasing Organ Donations. Stony Brook University Hospital is an active participant in the U.S. Department of Health and Human Services' Breakthrough Collaboratives. These programs are designed to increase the number of organ donors and the number of viable organs recovered from each donor. The hospital's referral rate and consent rate are higher than regional averages. During the first quarter of 2007, more than four organs were recovered from each donor at Stony Brook, which is 13% above the Collaborative's target.


• The Twenty-sixth Annual Auxiliary Meeting and Senior Volunteer Awards Luncheon was held at the Three Village Inn on June 18, 2007. Each year, more than 400 members of the community volunteer 35,000 hours of service to the hospital. At the ceremony, 34 of our volunteers received the United States President's Volunteer Service Award. Barbara Delfyett was re-elected to another term as President of the Auxiliary and the new officers were sworn in. I am grateful to all our volunteers and Auxiliary members who generously contribute their time to provide an extra margin of excellence for our patients.


• Surgical Robot is Coming! Perhaps you have heard about robotic surgery. This allows for smaller incisions, less tissue injury and as a consequence faster healing, and in many instances, much more accurate surgery. We are in the final phase of acquiring the robot to bring robotic surgery to SBUMC. In September, we anticipate the arrival of a new surgeon, Dr. Rahuldev Bhalla, a urologist and robotics specialist, to join our faculty. We will differentiate ourselves from other Suffolk County hospitals by providing this service to the community.


• Interventional Stroke Program. Dr. Henry Woo will be joining the faculty with a dual appointment in Neurosurgery and Radiology to initiate an interventional stroke program. Dr. Woo is dually trained in interventional radiology and neurosurgery. Although the brain is different than the heart, this program has the potential to do for strokes what angioplasty has done for heart attacks. Specifically, Dr. Woo has the ability to physically remove blood clots from clogged arteries in the brain, open clogged blood vessels and place stents in brain arteries. We anticipate his arrival in August. Combined with existing medical stroke management program headed by Candice Perkins, MD we will be offering unique services not available elsewhere in Suffolk County.


• SBUMC raised more than any other Long Island hospital, including Schneider Children's Hospital and Good Sam in the March of Dimes Challenge. We are fortunate for the leadership of Kim DeCristofaro, Susan Robbins and many others. Overall the MOD collected over $25,000 as a result of this hospital competition.

Last Touch

Let me share with you an email I received this month….

“Just witnessed something wonderful.

Two women are near the main elevator on L5 on their way to ED. They were visitors not patients... I think they had a family member in the ED. They were headed in the right direction but it was obvious that they did not know their way around, as they were headed to one of the service elevators. A distribution employee nearby pointed out to the ladies that they needed to use the other elevators. They said they were headed to the ED. She picked up right away that the women were unsure about where they were going and asked if they would like her to escort them. They said yes and she took them to the ED.

It may have been the only time in my 15 years that I have seen an employee do that. It is one of the things that routinely happens at world class enterprises and often mentioned in patient satisfaction readings and seminars. I don't know if the employee decided to do it on her own of if you've made it part of her job duties, but it was great. I wish all employees would strive to do it. Imagine if all 4000 employees did that just once a day.”

This kind of behavior is what makes SBUMC special. Every person at SBUMC plays an extraordinary part in the care and recovery of patients and their families--no matter whether you are a physician, nurse, or a distribution employee. Thank you for extending these extra courtesies.

One last, Last Touch. Becoming world class is hard, but remember….“Surfers don’t do all that work just to get to shore.”

Enjoy the journey to becoming world class…. And thank you all.

Steven L. Strongwater, MD
Chief Executive Officer
SBUH