CEO Update November 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.
November 1, 2007
What an interesting month for Stony Brook Pride! Three Health Care Heroes were recognized by the Long Island Business News; the University Health System Consortium notified us of an upgrade in our Quality and Accountability Performance Scores (from three stars to four); we received notification of a $2.85 million Phase 4 HEAL Grant from New York State for our work with the East End Hospitals in fulfilling Berger Commission mandates; our new Chief Operating Officer, Bruce Solomon, began working; and, we finalized the recruitment of a new Chief Information Officer, Linda Shanley (who arrives at SBUMC in early November). And this doesn't recognize the continued progress in the Major Modernization Program (doesn't the front of the Hospital actually look like a hospital and not just a construction site anymore?), the kickoff for Magnet and preparation of a Baldrige application. A great deal to celebrate! The Governing Body Committee also heard about remarkable progress in our patient safety program and strides achieved in the Cancer Services Program. A great month!
Congratulations to you all.
Five cross-cutting workgroups are well under way with respect to progress on our Strategic Planning. In addition, proposals have been solicited from clinical service groups. As a reminder, the five cross-cutting groups are:
- Enhancing patient satisfaction;
- Enhancing community physician relations;
- Preparing a regional outpatient strategy;
- Insulating SBUMC from major payers' reimbursement reductions; and,
- Enhancing physician recruitment and retention.
Thank you to everyone who has taken up the challenge of WASHING YOUR HANDS BETWEEN EVERY PATIENT! This is essential in our quest to keep our patients free from harm and reducing hospital acquired infections. We have already had nine units with 100% compliance Congratulations to 10 N, Non-Invasive Cardiology, Burn Unit and CPEP on October 5; Child Psych, Antepartum, GCRC, EEG, and Blood Bank on October 12. It is possible to get to 100% compliance in hand washing!
SBUMC Pride
Prestigious Safety Award to Anesthesiologists. Congratulations to Rishi Adsumelli and her co-authors for winning the Ellison Pierce Patient Safety Award for their Exhibit "Maternal Hemorrhage: A Proactive Multi-disciplinary Approach to Reduce Mortality and Morbidity." This award is for the best patient safety presentation at the American Society of Anesthesiologists (attended by about 16,000 members). Ellison Pierce is one of the grandfathers of patient safety and largely responsible for Anesthesia being singled out as the safest medical specialty by the Institute of Medicine. The presentation was commended for its multi-disciplinary approach to a very important and real problem with a high mortality.
Three Health Care Heroes Recognized October 18. SBUMC was well represented in a select group of Healthcare Heroes honored by the Long Island Business News. Of the thirty awards, SBUMC received three. Congratulations to Carol Gomes for recognition for Achievements in Health Care; to Suzette Smookler as a Health Care Professional; and to Todd Rosengart as a Physician Hero. Write-ups about these awardees will soon be available on the web and also in a special edition of the Long Island Business News.
University Health System Consortium (UHC) Presentations by Carol Gomes and Bill Greene. On October 12, 2007, at one of the largest audiences in history at the UHC Fall Forum -- over 700 attendees -- Bill Greene and Carol Gomes presented, "Using Dashboards and Scorecards: Setting Expectations for Board Members and Front Line Staff." We should all be proud of the patient safety work underway at SBUMC.
International Symposium. A symposium on the "Purposes and Priorities of Biomedical Technology Research" was hosted by Drs. Basil Rigas and David Ferguson on September 26, 2007. The Biomedical Technology for a Global Age symposium explored new challenges and the realities behind them - realities of the developed world, the developing world, and those at risk of being left behind by rapid global change and ascendant technology. Notable speakers included Dr. Anna Barker, Deputy Director for Advanced Technologies and Strategic Partnerships National Cancer Institute; Professor Colum de Sales Murphy, President, Geneva School of Diplomacy and International Relations; Joseph Checkley Director of Benefits, American Standard Companies Inc.; Joan M. McEntee, Chair International Group Baker, Donelson, Bearman, Cauldwell, and Berkowitz; Sergei Ordzhonikidze, Director-General, United Nations/Geneva, Permanent Representative of the Secretary-General to the, UN Commission on Disarmament
Cancer Registry Recognition. In a note from Maria Schymura PhD, Director from Department of Health NYS Cancer Registry, SBUMC was approved for our first annual "Recognition Certificate for Completeness and Timeliness of Cancer Reporting," for cases reviewed in 2006. The completeness and timeliness of the data enable "...cancer researchers, planning agencies and public health professionals...to accurately assess the burden of cancer on ... NY."
Important Conferences at SBUMC. On October 13, 2007, SBUMC, Drs. Rosengart and Brown hosted "Meeting of the Minds," a national meeting exploring emergent therapies in cardiovascular disease outcomes and evidence based medicine. On October14, Dr. Ricotta hosted an additional important conference entitled "Management of Combined Coronary and Carotid Disease."
Heal 4 Grant Announced for SBUMC. The Department of Health announced $362 million in grant awards this month. SBUMC will receive $2.85 million for work related to helping the East End Hospitals (Southampton, Peconic Bay Medical Center and Eastern Long Island) to meet the Berger Commission mandates. Funding for the grants was made available through the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) and the Federal-State Health Reform Partnership (F-SHRP). Brookhaven Memorial Hospital Medical Center, Eastern Long Island Hospital, Peconic Bay Medical Center, Southampton Hospital (Suffolk Health Network) also received a combined award of $24 million.
New York Organ Donor Network Award. The Organ Donor Medal of Honor was presented at the Transplant Growth and Management Collaborative on October 10, 2007. Stony Brook University Medical Center was among 392 hospitals nationwide that achieved the national goal of a 75% conversion rate for donors from August 05 to July 06. What the entire staff of SBUMC should be most proud of is the fact that from the 10 donors of the 13 possible we recovered 35 organs for transplant. This equates to an Organ Transplanted Per Donor rate of 3.5 organs per donor. The region recovery rate is between 2.31 and 2.57 organs per donor. Thank you for your support of this life saving program.
Two Important New Clinical Chairs at SBUMC. We are pleased to share in the arrival of two key clinical chairs. Please welcome Dr. Margaret McGovern as the new Chair of Pediatrics who joined us from Mount Sinai Medical School and Dr. Ken Shroyer, who joined us from the University of Colorado, as the Chair of Pathology.
Patient Safety
Four Star Rating! 2007 UHC Quality and Accountability Performance Scorecard Improves. University Health System Consortium (UHC) prepares an annual scorecard covering performance measures in mortality (35%), effectiveness (35%), safety (20%), and equity (10%) of patient care. (Efficiency and patient centeredness are also recorded although not specifically weighted in scores.) A ranking is then assigned and members are assigned to one of five groups: Group 1 has 11 members (five star rating-best in the nation); Group 2 has 20 members (four star rating); Group 3, has 21 members; Group 4, has 20 members; and, Group 5, has 10 members. This year, SBUMC moved from Group 3 to Group 2 with a Four-Star Rating. This occurred while other members aggressively improved their quality and safety, which indicates that improving rank is no simple feat. This elevated ranking is reflective of many programs in place to improve care at SBUMC, perhaps best demonstrated in the continued decline in raw mortality, now the lowest in Hospital history. Also of note, SBUMC was #1 in the UHC membership for equitable care. Congratulations to you all and thank you.
Patient Safety Council Planned November. The next Patient Safety Council meeting is scheduled on November 13. Patient Safety and Quality experts from all over the United States will share best practices and provide insight on improvement efforts. SBUMC representatives will have an opportunity to showcase progress from the previous meeting (March ‘07) as several Patient Safety Council recommendations have been implemented, including the formation of Patient Advisory Councils and increasing Pharmacy involvement on the units through rounding efforts. We look forward to a productive and informative meeting.
Quality Assessment and Review Board (QARB). The first QARB meeting was held on September 26, 2007. The minutes for the meeting will be posted to http://inside.hospital.stonybrook.edu/sbuh/intranet/ when approved by the voting members. Appointed by the SUNY Board of Trustees, QARB reports to the President and will provide advice regarding SBUMC's quality and credentialing programs. QARB will also prepare an annual report for the President which will also be shared with the SUNY Board of Trustees.
Five SBUMC Abstracts Accepted at national Institute for Healthcare Improvement Annual Meeting. The Continuous Quality Improvement Department had five abstracts accepted for presentation at the Institute for Healthcare Improvement's 19th Annual National Forum on Quality Improvement in Healthcare: "Achieving Increased Survival at SBUMC"; "Education and Compliance: SCIP to Best Practice"; "Perinatal Care Bundles: Decrease Variation and Increase Compliance"; "Surviving Sepsis: Increasing Detection and Standardizing Care"; and "Increasing Organ Donor and Tissue Donation Consent Rates". Congratulations to all of the team members involved in these efforts.
25 % Reduction in Mortality from Severe Sepsis. SBUH has for two years participated in the Surviving Sepsis campaign of the Society for Critical Care Medicine (SCCM) and the Critical Care Collaborative of the Institute for Healthcare Improvement. Under the leadership of Chris McMullan, Assistant Director of CQI, Dr. David Tomkins of the Department of Medicine who chairs the Sepsis Steering Committee and Dr. Margaret Parker, Director of the Pediatric ICU, SBUH has aggressively pursued improvements in early recognition and management of severe sepsis using guidelines form the SCCM. These efforts, most especially in the Emergency Department and the ICU's and now on the floors with the help of Nursing Education and the Rapid Response Team, have had very substantial effects including: a 25.5% decrease in mortality from severe sepsis in 2007 (to date) as compared to 2006 and a 2.7 day decrease in the average length of stay of severe sepsis patients admitted through the ED. We were also recognized by the IHI Collaborative leadership for being a world-wide leader in submitting our cases to the SCCM's on-line registry. Congratulations to you all.
Pediatric and Medical Early Warning Score Pilots Show Results (PEWS & MEWS). For several months the pediatric floors and, more recently, the medical floors have been participating in an evaluation of vital sign based "scoring" done by the nursing staff. It is intended to provide early evidence of patient instability requiring further monitoring or additional evaluation by senior nurses or by physicians. Early data are being analyzed but it is clear that the resulting scores, posted (by bed location) at the nurse's station in color codes (green, yellow, orange, red), has made it possible to appreciate, at a glance, how many and which patients are unstable and to what degree. We will be evaluating the frequency with which certain scores are generated, the follow-up responses to the calls and whether this approach decreases the number of Rapid Response Team and Code Blue calls.
Lisa Sokoloff Becomes Certified Practitioner. Please join me in congratulating Lisa Sokoloff for passing the National Association for Healthcare Quality's Certified Practitioner for Healthcare Quality Certification Examination.
Patient Satisfaction
Concierge Services Arrive at SBUMC Front Door. Beginning October 1, 2007, red-coated concierge attendants ("Stony Brook is RED hot") began greeting patients and visitors at the main entrance of the Hospital. Our Consierge staff helps patients find their way, provides assistance with transportation needs, and offers other services as requested.
Patient Satisfaction Plan Developed. As a component of the Hospital's Comprehensive Organizational Strategic Plan, a Patient Satisfaction Strategic Plan was developed and presented to the Strategic Planning Committee for approval. This plan identifies key pursuits which will help improve patient satisfaction when all components are systematically deployed. Key elements include: promote a culture of service excellence as an organizational priority; conduct administrative and management rounding to communicate with and obtain direct feedback from patients; ensure organizational participation in response to concerns and compliance and utilize the voice of the patient/family for service initiatives; improve employee interactions with patients and their families; and, reward and recognize employees for superior customer service. We look forward to continuing our efforts to improve patient satisfaction at SBUMC.
Cancer Center Patient Satisfaction Scores Rise. A number of initiatives have been undertaken by the Cancer Center staff which have had a direct impact on improving patient satisfaction scores: nurse managers are rounding daily on patients; there is consistent distribution of admission packets filled with important information; a family advisory group has been developed; and the Medical and Surgical Oncology Units are utilizing the "Yak Tracker" to help reduce noise on the nursing units. Radiation Oncology conducts "wait time studies" monthly so patients wait less than 15 minutes to see a radiation oncologist, and less than 30 minutes to receive treatment; Radiation Oncology also offers a patient education resource library. Inpatient Medical Oncology and Bone Marrow Transplant Units have embraced "family centered care," which promotes open visiting hours and encourages family members to stay overnight when feasible. The Medical Oncology and Surgical Oncology Units developed the role of a dedicated patient educator to assist patient and families to understand treatment options, treatment modalities, and surgical interventions. Both units now have ‘quiet rooms,' as a dedicated holistic and reflective space for palliative conversations with family.
Ambulatory Surgery Center Scores Remain High. The Ambulatory Surgery Center is celebrating it third consecutive quarter of 99% percentile performance, which means the ASC is ranked #1 amongst our UHC peer group. Congratulations! This high level of achievement is because of the team based, patient centered program developed and implemented by the entire ASC staff. Great care is taken to address every detail of the peri-operative experience.
Community Connections
Ceremony of Remembrance Honors Children Who Have Died. A moving ceremony of remembrance honoring children who have died was held in the Galleria on September 30. Coordinated by Virginia Coletti and many staff from SBUMC and the Schools of Nursing, Medicine, Social Work and Pastoral Care, there was an indoor program and a brief ceremony held in the Garden of Remembrance. If you have not seen the garden which is opposite the current construction site at the front of the Hospital, it is worth a visit and walk through.
Transfer Center Gaining Momentum. During the third quarter of 2007 (July - September) the Patient Transfer Center at Stony Brook University Hospital coordinated 903 patient transfers from other hospitals to Stony Brook, and referral of an additional 547 expected patients during this same time period. Located in the EMS Department, the Patient Transfer Center is staffed 24 hours per day, seven days per week and was established in July to provide a "One Call" process whereby referring physicians can arrange to transfer patients to the Hospital. Staff members in the Transfer Center connect referring physicians with the appropriate Stony Brook physicians, they assist with financial clearance as warranted, coordinate the appropriate inpatient bed and arrange for ambulance or helicopter transportation as needed.
The Patient Transfer Center also facilitates physician referrals to the Emergency Department. When a physician refers a patient to the Emergency Department from their office or from the patient's home, the Transfer Center will record data in a "patient referral" database. Once the patient arrives in the ED, staff have ready access to this data.
Berger Update. The Department of Health had a September 30 deadline for submitting progress updates related to the Berger Commission mandates. Peconic Bay Medical Center, Southampton Hospital and Eastern Long Island Hospital were to have formed a common governance structure by that date. Although the three hospitals are very close, and we continue to work with each individually, the ultimate governance for what is now referred to as E-SHN (pronounced e-shin) is a few weeks away from completion.
Journal Club Initiated at SBUMC. To support the growth and development of administrative, managerial and financial skills, under the guidance of Laurie Rafkin, Nancy Yen, Marilyn Haig, Mike McClain and Carol Gomes, a "Journal Club" has been formed. Plans are to meet every other month and review a relevant book or article. A more formal announcement with further details will be forthcoming.
Free Yoga Classes Starting in Mid-October for Cancer Patients. Classes are held on Monday evenings from 6:00 - 7:30 pm at the Outpatient Cancer Center Medical Oncology waiting area. For information call 638-1000. No registration necessary.
Community Breast Health Seminar Planned. Physicians and staff from the SBUMC Cancer Center conducted a community breast health seminar at the Ward Melville Heritage Organization facilities in Stony Brook on October 24.
Childhood Cancer Education. The School Re-entry Program is conducting a free one-day conference for school teachers, nurses, counselors, social workers, psychologists, other educators and parents on November 6, 2007 at the Wang Center. The conference will educate participants about childhood cancer, the effects of treatment, preparation for school re-entry, emerging technology and innovative distance learning for students with cancer.
Last Touch
Don Berwick writes about the experience his wife had while hospitalized. If you don't know him, Don Berwick heads the Institute for Healthcare Improvement, one of the world's most preeminent groups working to improve healthcare. He is also a pediatrician, who trained and worked in several Boston teaching hospitals.
Dr. Berwick's wife was quite ill. She had a life threatening neurological disorder, difficult to diagnose, requiring multiple hospitalizations in some of the most respected hospitals in the world. Things did not go well. There were moments of shear terror for both Dr. Berwick and his wife. Visiting hours separated them for hours at tension filled moments; she was left alone in cold corridors waiting for imaging tests; required to retell her medical history over and over again when transferring from one unit to another (was this intended as a check on her sanity?); and she was sleep deprived.
Unfortunately, a relative of mine was recently hospitalized in a prestigious New York City hospital. Things did not go well for us either. On reflection, it was not anyone's fault, but the way the "system" was set up. Or rather, how it was not set up.
The biggest challenge facing all hospitals is patients first!
It is time for Stony Brook University Medical Center to lead in change. Help us find better ways to educate and inform patients and their families about their health and their illness; be compassionate in all you do; let's eliminate visiting hours in favor of patients being supported and families staying together; and let's be a little kinder to each other. We can do better at SBUMC.
"Kindness is the language which the deaf can hear and the blind can see."
-- Mark Twain
"The individual is capable of both great compassion and great indifference. He has it within his means to nourish the former and outgrow the latter."
-- Norman Cousins
Let's change the world together beginning at SBUMC.
Steven Strongwater, M.D.
Chief Executive Officer
Stony Brook University Medical Center
Patients first-World class processes-Teamwork-Growth-Use resources wisely
