September Message from Steven L. Strongwater MD, CEO

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 satisfaction, patient safety, and community connections.

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September 2009

Working in an academic medical center is exhilarating partly because every year there is a great sense of renewal with new students, house staff (interns, residents, and fellows) and faculty. This year is no exception. In July, 197 new house staff and fellows began at Stony Brook University Medical Center (SBUMC). In September, 124 new medical students will enter the class of 2013. In addition, over 60 new faculty have or will start at SBUMC before January 2010. Faculty have joined nearly every department at SBUMC. Several have been hired specifically to enhance the Programs of Distinction (Cancer, Cardiac, Neurosciences, Women and Children, Geriatrics, and Trauma/Emergency Medicine).

To complement SBUMC’s evolving strength in the Neurosciences (Neurology, Neurosurgery, Sleep, Pain, Alzheimer’s, Psychiatry, etc.), specialty faculty have been hired in Anesthesia (Dr. Christopher Page), Neurosurgery (Dr. Barry Lieber), Radiology (Dr. David Fiorella), Neuro-oncology (Dr. Agnes Kowalska) and Orthopedics (Dr. Brian Morelli). They will help establish a Neuro Intensive Care Unit, expand basic research in neurovascular conditions, and expand the interventional stroke and spine programs.

Six faculty have joined the Department of Emergency Medicine (Drs. Asher Baer, Sabine Brouxhon, Cara Choy, Carl Kaplan, Nicholas Palamidessi, and Taku Taira), including faculty to establish a Pediatric Emergency Medicine Division.

Dr. Sei Iwai, a midcareer advanced electrophysiologist, most recently working at New York-Presbyterian/Weill Cornell, will join Dr. Eric Rashba and four other electrophysiologists to round out the Electrophysiology Division within Cardiology. Dr. Sandeep Gupta will join the cardiothoracic surgery team. He most recently completed fellowship training at the Cleveland Clinic and will bring advanced skills in cardiac valve surgery.

In the Women and Children’s Program of Distinction there have been 12 faculty recruitments, nine in the Department of Pediatrics (Drs. Janice John, Megan Kasnicki, Rahul Panesar, Aruna Parekh, Sherine Patterson, Laurie Profitlich, Esther Speer, Katarina Supe-Markovina, and Suzanne Van Benthuysen) and three in Obstetrics and Gynecology (Drs. Michael Demishev, Mikole Ostrov, and Winfred Tovar).

A number of newly hired surgical faculty will augment the Cancer Program of Distinction, including Drs. Christine Rizk (Breast), Paula Denoya (Colorectal) and Jason Ganz (Plastics). Additionally, surgical faculty have been added in Otolaryngology (Elliot Regenbogen), Trauma/Critical Care (Dr. Jared Huston), and Vascular Surgery (Dr. David Landau).

Medicine has brought on nine faculty in Nephrology (Mersema Abate), Hospitalists Medicine (Drs. Michael Huang, Cezarina Mindru, Vladimir Stamoran, and Michael Zema), and Gastroenterology (Dr. Gina Sam and Dr. Satish Nagula), as well as those already mentioned in Cancer and Cardiology.

These recruitments will continue to build clinical, as well as academic strength at SBUMC to serve the needs of Suffolk County. Please see the “Pride” section for a complete list of new faculty.

STONY BROOK PRIDE
SBUMC receives an award for overall excellence in clinical care. Two years in a row!  A well-known independent rating company of hospitals and physicians has recognized SBUMC in its 2010 rankings, and ranked SBUMC among the top five percent in the nation for overall clinical excellence. We were also recognized in 2008 for the 2009 rankings. In addition, SBUMC was recognized for excellence in the provision of care for women’s health and pulmonary and cardiac conditions, being ranked #1 in New York State for cardiac services. Congratulations to all those who have worked so hard to improve the quality of care to our patients.

Stony Brook University Hospital (SBUH) is first hospital in nation to sign a “green” agreement with the U.S. Environmental Protection Agency (EPA). Under the terms of the “Comprehensive Green Memorandum of Understanding” between the Hospital and the EPA, the two institutions will work to mutually reduce the Hospital’s environmental footprint. The agreement will lead to the implementation of various environmentally beneficial efforts including conserving energy and water, reducing waste, and increasing the use of environmentally friendly products throughout the Hospital. SBUH will also adopt or enhance strategies promoted by EPA voluntary programs such as ENERGY STAR and WasteWise in its efforts to ramp up its “going green” efforts with the goal of sustainable development within the institution.

Prostate Care Program receives New York State proclamation for screening outreach in Suffolk County. Assemblyman Robert K. Sweeney presented a proclamation honoring the SBUMC Prostate Care Program to Dr. Howard L. Adler, Medical Director of the Program, Arlene Shaw, RN, Nursing Director, and staff at a ceremony, held during a screening at the North Lindenhurst Fire Department on August 3. The program has screened nearly 14,000 men in Suffolk County for the disease since the outreach program began approximately 15 years ago.

Dr. Todd K. Rosengart appointed Chair of the Department of Surgery. Congratulations Dr. Rosengart! He has been the Interim Chair of the Department since August 1, 2008, and also serves as the Chief of Cardiothoracic Surgery and Co-Director of the Heart Center. Dr. Rosengart is a tenured professor who is a highly skilled technical surgeon, program leader, scientist, and clinician who has published extensively and is actively involved in teaching residents and medical students.

SBUMC nurse selected 2009 Nurse Practitioner of the Year. The Nurse Practitioner Association of Long Island (NPALI) named Jeanne Martin, NP, Department of Urology, recipient of this prestigious award. Jeanne has been involved in many facets of NPALI’s governance, particularly as pertains to nursing and the nurse practitioners at Stony Brook, in addition to performing her duties as a nurse practitioner. Her efforts also extend to issues concerning nurse practitioners on both state and federal levels. Jeanne will be honored at an award dinner in October. Congratulations, Jeanne.

The Heart Center announces the winners of the Most Valuable Person (MVP) awards for 2008-2009. The awards were created to honor members of the Heart Center who go above and beyond the call of duty on a daily basis to create the very best environment for patients. The MVP awardees are Teresa Spencer, the Patient Care Specialist for the cardiology physician clinic in Islandia, and Meiyee Lee, RN, the nurse clinician in the Electrophysiology Lab. Congratulations Teresa and Meiyee.

New faculty recruits as of January 2009 in the School of Medicine. We welcome new faculty whose expertise will benefit our patients and further our goal to becoming a world-class organization.

PATIENT SAFETY
SBUMC presents poster at Harvard Colloquium. Dr. William Greene attended The Eighth National Quality Colloquium at Harvard University, billed as the “Leading Forum on Patient Safety, Quality Enhancement and Medical Error.” He presented “First Do No Harm,” which focuses on proactive quality improvement efforts to reduce mortality rates. Nationally recognized quality and patient safety experts were on hand to participate at the conference, including Leah Binder, CEO from The Leapfrog Group, Dr. Carolyn Clancy, Director for the Agency for Healthcare Research and Quality, and Dr. Brent James, Executive Director for the Institute for Healthcare Improvement (via teleconferencing).

Crew Resource Management (CRM) used in surgery. CRM activities for the Department of Surgery, specifically Vascular Surgery, are under way. Strategies to enhance communication include the use of an Operating Room surgical safety check list; vascular service personnel assessing and educating patients pre-operatively regarding their risk of surgical site infection and strategies to minimize occurrence; and cross-monitoring techniques to ensure care is within evidenced-based guidelines, and daily review of staff responsibilities and expectations to prepare for patient discharge readiness.

Patient Safety Dashboard is developed. The Patient Safety Committee implemented the use of a patient safety dashboard, based on the National Patient Safety Goals, as a means of assessing SBUH’s overall safety. The dashboard contains at least one measureable item for each National Patient Safety Goal. Data are compiled and reviewed monthly at the Patient Safety Committee. Items on the dashboard include specimen mislabeling, unapproved abbreviations, anticoagulation measures, handwashing compliance, infection rates, medication reconciliation compliance, falls, and survival rate related to Rapid Response Team (RRT) calls. The intent is to utilize measures to drive improvements aimed at enhancing patient safety.

Patient Safety Walk Rounds. Dr. Joseph Decristofaro and Carolyn Santora, RN, visit Hospital units to solicit ideas and feedback from both staff and patients to improve safety. The purpose of these Rounds is to increase mutual understanding between senior leaders and frontline staff about patient safety. Introduced in May 2008, many action items were successfully implemented, including the purchase of wireless call bells for hallway patients, installation of appropriate outlets in hallway for equipment, centralization of patient identification bands, adding medications to guardrail profiles in the “Smart Pumps,” purchase of chair alarms for falls prevention, and purchase of additional blood pressure cuffs to allow for more frequent monitoring of vital signs. In recent months, Dr. Strongwater, Kathy Holzmacher, or a member of the Clinical Informatics staff, have joined in the rounding.   

Transfer processes improved. A task force consisting of representation from PICU, AICU, and the OR met to define and standardize the OR/AICU to PICU transfer process. The process incorporates crew resource management tools to ensure a safe and appropriate hand-off of the patient. These tools are being tested informally by the identified units. A defined transfer policy was submitted to the OR Committee for its review and approval.

Institute for Healthcare Improvement (IHI) requests input from SBUMC. SBUMC was one of several hospitals asked to prototype IHI’s Improvement Map, scheduled to be launched world-wide in September. SBUMC’s Quality Improvement staff was asked to test the map and provide feedback regarding its use. An IHI representative recently contacted the staff to request publication of our feedback in an upcoming IHI newsletter.

Electronic communication monitor is available on Pediatric Unit. The monitor displays slides about hospital services along with pediatric, pediatric ICU, and pediatric hematology/oncology services. The information available on the monitors will allow for enhanced communication to staff, patients, and families.

Visitors from George Washington University Medical Center to focus on Emergency Department patient flow. During the first week of September, several members from the Center for Health Care Quality at George Washington University Medical Center, along with the Health, Research and Educational Trust, are scheduled to conduct a three-day site visit in our Emergency Department to interview SBUMC staff and to observe ED processes designed to improve patient flow.

SBUMC presents at the Information Quality Industry Symposium. Elisa Horbatuk, Decision Support Services, presented at the Information Quality Industry Symposium at the Massachusetts Institute of Technology in July, providing an overview of the many methods Decision Support Services and other hospital personnel use to insure the quality of data across the various systems at SBUMC. The presentation also included examples of how these data are then used as a basis for many of our quality improvement activities, including improvement on The Joint Commission/Centers for Medicaid and Medicare measures.

SBUMC physician invited to speak at the National Patient Safety Foundation (NPSF). For almost a decade, Dr. Mark L. Graber, Chief of the Medical Service at Northport Veterans Affairs Medical Center and Professor and Associate Chair of the Department of Medicine, has been working on diagnostic errors in healthcare with the goal of improving patient safety by making medical diagnosis reliable and timely. He was recently invited to talk on preventing diagnostic errors at the NPSF Annual Meeting, and the key points of his presentation were summarized in an article in the NPSF’s “Focus on Patient Safety” newsletter. Dr. Graber will also chair the second international conference on “Diagnostic Error in Medicine—2009,” which will be held this fall in association with the Society for Medical Decision Making and sponsored by the Agency for Healthcare Research and Quality.

Failure Mode & Effect Analysis (FMEA) process used to improve ability to call critical laboratory values. At July’s Department Head meeting, Dr. Eric Spitzer and Michele Gilleeny-Blabac shared a presentation that focused on how an interdisciplinary team, facilitated by Pam Boremski, CQI, modified workflow and changed processes to improve the process for calling critical lab values for outpatients. Potential failure modes were studied and as a result, several risk-reduction strategies were identified for implementation. Strategies focused on reaching the correct physician (both community physicians and SBUMC faculty), better use of the pager
system for emergencies when clinics are closed, and ensuring that phone numbers are updated and correct.

PATIENT SATISFACTION
New Pediatric Emergency Unit is scheduled to open this fall. A ribbon cutting ceremony will be held in October to announce the opening of the new nine-bed Pediatric ED, staffed with board-certified pediatric emergency medicine specialists. The ED will include a separate marquee and entrance for walk-in patients, waiting room, and triage area.

Units honored for success in Press Ganey patient satisfaction surveys. Cookies and letters of congratulations were sent last month to recognize units for having received patient ratings better than other Hospital units surveyed in the second quarter with the Press Ganey survey. The units were Mother/Baby, Cardiac, Radiation Oncology, Sleep Lab, and CT Scan in the Imaging Center.

Pediatric Family Advocacy Board update. Filming for the Pediatric Family Advocacy Board DVD began in August. The Board plans to use the DVD as a recruitment tool for future parent advocates, and as a method to communicate to patients and their family members the importance of patient- and family-centered care. Parents can now stay with their child during procedures performed at the bedside in the Pediatric Intensive Care Unit (PICU). This opportunity for improvement was identified and advocated for by the Pediatric Family Advocacy Board. PICU staff also identified this improvement in a self-assessment designed to measure the Hospital’s commitment to patient- and family-centered care.

COMMUNITY CONNECTIONS
Welcome President Samuel L. Stanley Jr., MD. The Inauguration of Stony Brook’s fifth President Samuel L. Stanley Jr., MD, will take place on Friday, October 23, in the Sports Complex Arena. The ceremony begins at 2:00 pm, followed by a reception from 4:00 pm to 5:00 pm. A weeklong celebration, October 21 through 27, commemorating the Inauguration will include academic symposia, musical performances, a Seawolves football game, and a Community Town Hall meeting on October 25, following the Heart Walk. For more information, visit www.stonybrook.edu/inauguration.

Join the SBUMC team for the Start! Suffolk County Heart Walk. The Walk takes place on Sunday, October 25 with registration beginning at 8:30 am and the ribbon cutting ceremony/walk start at 10:00 am. As the signature fundraising event for the AHA, the Walk promotes physical activity and heart-healthy living in a fun, family environment. This year’s event will include a 5K walk around the campus, music, give-a-ways, and a health fair. Meet Dr. Samuel Stanley Jr., Stony Brook University’s new president, at a Community Town Hall Meeting following the Walk. To register, visit www.longislandheartwalk.org.

SBUMC’s branding campaign, “Home of the Best Ideas in Medicine,” returns. Launched in September 2008 and on hiatus since mid May 2009, the campaign has been re-released. The overarching message of Stony Brook’s unique expertise as an academic medical center will be featured on cable TV; in print in The New York Times, Newsday, Times Beacon Record group of community newspapers, and Long Island Pulse magazine; on NPR radio and 97.5 WALK FM radio; and online. To view the entire campaign, visit www.BestIdeasInMedicine.com.

Orthopaedics faculty establishes endowment. The SBUMC Department of Orthopaedics has established an endowment to advance research and support musculoskeletal education. Drs. Lawrence C. Hurst, Marie A. Badalamente, and Edward D. Wang recently contributed to this endowment fund with a $10,000 gift that stems from a national award that the group received from the American Academy of Orthopaedic Surgeons (AAOS) earlier in the year for their innovative research over the past decade on the use of collagenase in the treatment of two fibroproliferative disorders—Dupuytren’s disease, a debilitating hand disorder, and frozen shoulder.

The 16th Annual Walk for Beauty, Walk for Life will take place on October 4. To date, the Walk for Beauty, has raised $950,000 for breast and prostate cancer research at Stony Brook University. Women who cannot afford wigs and prostheses have also benefited from the funds raised by the Walk. For more information or to register for the Walk, call 444-4000.

SBUMC is hosting a Bone Marrow and Stem Cell Donor Registry Drive. The Medical Center is partnering with DKMS Americas in the fight against leukemia by registering bone marrow and stem cell donors. For eligibility requirements and more details, visit dkmsamericas.org. Three drives will be held: Thursday, November 5, 10:00 am to 4:00 pm in the Galleria, located on the third floor of the HSC; Saturday, November 7, 9:00 am to 3:00 pm, in the Cancer Center; and Tuesday, November 10, 10:00 am to 4 pm, in the University’s Student Activities Center.

SBUMC specialist participates in “Day of Hope” Symposium for patients with cancer. Robotic surgery expert, Dr. Rahuldev Bhalla, will take part in a Roundtable of elite East End oncologists on September 26 at the Bay Street Theatre in Sag Harbor to share information and discuss medical advances and patient empowerment with the hundreds of patients and family members expected to attend. This free event is presented by Fighting Chances, a counseling and resource center for patients with cancer, which this year provided round-trip transportation (from home to the Cancer Center) to 56 of our patients.

SBUMC pediatric patients get a kick out of “Rough Riders” visit. Players from the Long Island Rough Riders, which includes men’s and women’s traveling soccer teams, spent time at the Medical Center to visit with patients in each of the pediatric units at the Hospital. The players were joined by the Rough Riders mascot Teddy Roosevelt.

SBUMC provides community education. In observance of September as National Cholesterol Education Month, SBUMC staff will make community presentations on diet and cholesterol, and provide free cholesterol screenings in the community and at the University’s Student Activities Center. Additionally, faculty and staff are providing free community lectures on medication safety and pain management. For information about arranging for a member of the Medical Center to make a presentation, call 444-4000.

Teleconferencing and videoconferencing potential at SBUMC. Through grant funding, telemedicine equipment was recently purchased. Carts with a stethoscope, dermascope, and otoscope were purchased for SBUMC, Southampton, Peconic Bay Medical Center, and Eastern Long Island Hospital for potential use to assess patients from a distance. Although there are numerous logistics to be worked out, and further study of applicable laws must be conducted, the potential for telemedicine is considerable. In addition, videoconferencing capabilities are available for these hospitals, which allows representatives from each institution to participate in discussions and meetings in the comfort of their conference rooms. 

Last Touch
What motivates people to do the right thing? For that matter, who decides what the right things to do are? When we were young, it was easy, your parents told you. What about now? To some extent, societal norms in America are defined by the Judeo-Christian ethic and enforced by the rule of law. But, there are so many things left unsaid, unstructured, and unclear. Even more confusing are the generational differences that are reflected in different perspectives about fundamental beliefs like loyalty, teamwork, and even the need for face-to-face discussion.

Market researchers have defined the characteristics of four living generations: the “Great Generation,” the “Baby Boom Generation,” “Generation Xers” (or “Baby Bust” generation), and the “Millennial Generation.” The Great Generation is characterized by people born between 1920 and 1945. They are typically trusting, respect government and education (i.e., degrees are important), and respect authority; they also tend to be team players. Boomers, born between 1946 and 1964, grew up during the social unrest of the ’60s and all that followed:  Vietnam, women’s liberation, drug experimentation, the discovery of the computer, and much more. They are more individualistic, likely to challenge authority, change jobs (less loyal), and be a bit more confrontational. However, Boomers have a remarkable work ethic and believe they can accomplish great things as a result of hard work. They accept the need for delayed gratification and understand you have to work hard to earn your place in society. Gen Xers, on the other hand, born between 1965 and 1985, have been very protected their entire lives (many of their parents were afraid of child abductions), need more attention and nurturing, are tech savvy but can live without the gadgets, are more likely to need/want praise, and believe the world should respond to their needs (information is just a click away). They are also generally impatient as it relates to waiting for success (i.e., higher salaries that ordinarily come through promotions), and are more prone to change jobs for their personal gain. Millennials (also referred to as “Generation Y” or “Echo Boomers”) were born after 1985, and have a much greater focus on “me.” Lifestyle issues are far more important to this group than all prior generations. They might work hard, but expect to go home and relax. Whereas, for instance, doctors from the great generation may have sacrificed family time to medicine, millennials will not. Millennials are also very tech savvy—they cannot live without technology. They have never lived without computers or the Internet.

How you view the world is therefore going to depend upon when you were born and the experiences you have faced, even for those living in the same house-hold. Malcolm Gladwell, staff writer for The New Yorker Magazine, and author, has described a similar phenomenon in Outliers. In it he recounts how people born between 1950 and 1959 have had special opportunities and world views: people like Bill Gates (1955), Christopher Michael Langan (1952), and J. Robert Oppenheimer (1954). 

Interactions among generations, therefore, requires certain skills and sometimes a special art. Success is enabled by understanding each other’s frame of reference. At SBUMC, we are fortunate to enjoy the richness associated with interacting with multiple generations. At the same time, this can lead to misunderstandings or worse. What may “work” for one generation may be totally inappropriate for another. Understanding the differences between Gen Xers and Millennials can help in motivating people. The definitions of “success” will clearly vary from person to person.

To assure the collective success of SBUMC, we have delineated goals that need to be internalized and supported by all generations, such as our goal to become a high reliability organization (to develop error-free operations over time). Additionally, as part of our strategic plan, we have embraced the need to deliver world-class care. This necessitates measuring what we do (something many of us fear) in order to compare to best performers and surpass them. From the perspective of defining SBUMC’s culture, we have adopted five simple rules of work: patients’ first, world-class process, teamwork, growth, using resources wisely. We have committed to developing a limited number of strategic programs, referred to as Programs of Distinction (PODs), in Cancer, Cardiac, Neurologic Sciences, Geriatrics, Women and Children, and Trauma and Emergency Medicine. Our collective success requires the smooth, almost orchestral interaction of all our staff—no matter the generation—to achieve these goals.

Some pursue happiness, others create it.
—Anon

Everyone, without exception is searching for happiness.
—Blaise Pascal

The first rule is to keep an untroubled spirit. The second is to look things in the face and know them for what they are.
           —Marcus Aurelius

She could not separate success from peace of mind. The two must go together.  
            —Daphne du Maurier

Thank you for taking the time to understand your colleagues’ perspectives in viewing the world.  And thank you for making SBUMC a better place on our journey to become a world-class organization.

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

Patients First—World-Class Processes—Teamwork—Growth—Use Resources Wisely