A Snowflake in Remembrance of Nicole this Christmas

While I was rounding at the hospital today and sharing my gratitude with our staff for giving up their time with family on Christmas to care for our patients, amidst the cheerfulness observed by most there was one particular unit that was with a heavy heart. One of our nurse's aides from ICU-South, Nicole, was in a car accident this past Sunday and is not expected to make it through this Christmas day. Nicole has been part of our team for at least seven years and was just about to finish her nursing degree. While I can't say I personally knew Nicole well, I do remember seeing her smiling face in my rounds throughout the hospital and from the reaction of her teammates I can certainly say she will greatly missed. The bittersweet irony of all of this is that Nicole works in the ICU that cares for our transplant patients and the nurses working today were waiting for that call to let them know that someone special would be receiving the gift of life today as their friend and co-worker Nicole passed. On such a special day for many, its hard to fathom others great loss and sorrow. I know all of our prayers will be with Nicole's son, family, and friends this day.

Elsewhere in my rounds a nurse on 8-Heart & Lung made me this snowflake and I thought of how perfect it looked. At the same time, I couldn't help but think of Nicole. Everyone of us is perfect and unique in our own way while we are here on this earth. I would hope that we could all remember and treasure that thought, because like the snowflake we don't know when our time will come. Godspeed Nicole, our thoughts and prayers are with you this Christmas day.

A Snowflake in Remembrance of Nicole this Christmas

It's not too late to Engage with Grace...

Over this past Thanksgiving weekend the second annual Engage with Grace Blog Rally took place and generated quite a lot of interest amongst healthcare bloggers across the globe (see attached link). Somehow I ended up a little behind in my reading and missed it, but I never think its too late to join in on a good cause! So for all of my readers who are looking for something meaningful to discuss this holiday season, I wanted to pass on this post promoted by two fellow bloggers I recently met, Matthew Holt, author of The Health Care Blog and Paul Levy, author of Running a Hospital.

Last Thanksgiving weekend, many of us bloggers participated in the first documented "blog rally" to promote Engage With Grace - a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations - our closest friends and family.

Our original mission - to get more and more people talking about their end of life wishes - hasn't changed. But it's been quite a year - so we thought this holiday, we'd try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We've included them at the end of this post. They're not easy questions, but they are important.

To help ease us into these tough questions, and in the spirit of the season, we thought we'd start with five parallel questions that ARE pretty easy to answer:

Silly? Maybe. But it underscores how having a template like this -just five questions in plain, simple language - can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we've included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there's been a lot of discussion around end of life. And we've been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife's preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that's fulfilling in all the right ways.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. ) --If you want to reproduce this post on your blog (or anywhere) you can download a ready-made html version here Matthew Holt

It's not too late to Engage with Grace...

A Thanksgiving Toast

As we officially begin the holiday season today with Thanksgiving, I thought I'd share a fitting editorial I read from the New York Times.

As we all recount what we are grateful for this day, I will also be looking forward to what l will have to be grateful for tomorrow as unexpected as it may be...Happy Thanksgiving!

A Thanksgiving Toast

ACE Update: Early signs of progress!

A few weeks ago, I wrote about our "ACE" Plan. Periodically, I will try to keep everyone informed about the progress we are making as well as continue to solicit your ideas and thoughts about how we can continue to improve. Since first writing about the ACE plan, I have multiple people come up to me and ask if I really think that working with these consultants and this plan will be helpful to the hospital (the latest instance being just last night). My very emphatic answer to this is YES. I absolutely believe that this plan will take the organization where it needs to be in terms of improved stability and viability, not just financially, but from a quality and strategic perspective as well. The actions we are taking are things that most of us already know needed to be done, but we have lacked either the time or expertise to make them happen. With the help of the consultants that are here with us, over the course of the next year, we will likely achieve about 5 years worth of improvements as a result of the diligent focus we have around the ACE Plan.

In efforts to help keep everyone informed about our progress with the ACE Plan, Janice James, our Transitional System CEO has created a new communication tool and I wanted to share an excerpt from her recent memo with everyone...

On progress: "As of mid-November, 133 dollar saving initiatives have already been identified. Of those, 25 have been completed for a total savings of $3,260,419. In addition, we have identified more one-time savings opportunities, bringing us to seven, for a total savings of $2.5 million."

More of Janice's memo can be found here and as always, I welcome hearing about your thoughts and suggestions!

ACE Update: Early signs of progress!

Do we need a Joint Commission Linebacker?

Do we need a Joint Commission Linebacker?

Help boycott peacocks!

As I make my rounds through the hospital, I'm always on the look out for something new to catch my eye. Recently I have been seeing these posters around the hospital and stopped one of nurses today to ask her what this was all about. She informed me that in efforts to help keep our doctor's in compliance with signing and dating their orders they have been "flagging" the side of the charts with various colored reminder tabs. Some of the doctor's have complained and commented that the charts are starting to look like "peacocks"! So hence the sign...help keep our charts in order and those peacocks will disappear! Great out-of-the box thinking!

Help boycott peacocks!

Thoughts on transparency and the Mentor I've now met...

As I have mentioned to many people before, my entry into the blogosphere was heavily influenced by Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston and author of the blog, "Running a Hospital". Paul's blog has an international following of people that log in from around the globe to see what he and the Beth Israel are up to in the healthcare world. Personally I have learned from his stories and views about healthcare and I have looked up to him as the "mentor I've never met." Yesterday, I was fortunate enough to be able to attend a conference where he was speaking about transparency in healthcare sponsored by the University of Kentucky's Center for Enterprise Quality and Safety. Afterwards we had some time to catch up and discuss all sorts of topics ranging from hospitals, quality, and transparency to name a few.

Over the past few years, Paul has emerged as an authority figure on transparency in healthcare if for no other reason than so few other people within our industry are actually doing it right, if at all. He shared with us the story of how his hospital has embraced transparency not because it was a great marketing tool, or because of the public's demand to know, but rather as a practice to hold themselves accountable for the care they deliver to their patients and community. In his presentation, it was noted that hospitals are now the fourth largest public health hazard in the United States, yet despite that fact, so many still have yet to embrace the best practices available to us and publicly discuss our shortcomings so we might learn from our mistakes. We also discussed the general culture of the healthcare industry and the reluctance there seems to be about aggressively embracing the changes that would lead to significant improvement in patient safety and quality.

In reflecting on this conversation it seems to me that competition and fear have actually become our core competency and focus in healthcare, and the question is at what expense? In the quest for attracting more patients and physicians, we are constantly promoting all of the good things we do while trying to hide our areas of imperfection. As medical professionals we are trained not to make mistakes which makes admitting them that much harder. So while transparency has certainly become a buzz-word in healthcare as of late, if we took a hard look at ourselves, I would have to admit that we have only really been translucent at best.

In just the past couple of months we have experienced both a surgery "never event" and "near miss" related to two issues which we consider to be the most sacred "Red Rules" within our hospital (Active Time Outs and Positive Patient Identification). Surely this is not the type of recognition we want to attract at the hospital, but at the same time if we do not acknowledge the fact that these events happened, I not only fear, but know that we will be at risk of something similar happening again. In both of these instances, we were fortunate to have had positive outcomes for the patients involved, but I feel strongly that we must take the time to learn from these events to ensure that future patients in our care do not encounter these same mistakes.

In talks throughout the hospital, I think most of us are embarrassed by these incidents and may be in disbelief that this could have happened on our campus. From what I've learned, I can assure you that we are certainly not the only hospital that has made such a mistake, but we are among the few who are brave enough to admit it. By openly acknowledging and understanding what has occurred, we will be better able to create processes that will strengthen the hospital and protect our patients from future harm. I'm also counting on the fact that it will help us to re-focus on what is most important, the safety and well-being of our patients.

Still, many fear what might happen if someone outside the hospital found out about these events. People worry that if discovered, our competition and critics will undoubtedly try to use these events to disparage our organization or raise doubt about the quality for which our institution has been known. To that I say, we "call." We've shown our cards, now let's see yours. While its difficult to admit when your not perfect, I'm confident that our patients will both gain trust in us and reap the benefits of our transparency in the long term.

Thanks Paul for the continued inspiration and encouragement to do the right thing. It was my pleasure to have finally met you!

Thoughts on transparency and the Mentor I've now met...

The faces behind the words of Modern Healthcare magazine

Yesterday, I had the distinct pleasure of traveling to Chicago to be part of a CEO round-table discussion for an upcoming issue of Modern Healthcare magazine.  The topic focused on trends in Outpatient healthcare and I was fortunate to be joined by two great leaders in our field, Randy Oostra (President and CEO of ProMedica Health System in Toledo, Ohio) and Michele Molden (President and CEO of Piedmont Heart Institute in Atlanta, Georgia).  David Burda, Editor of Modern Healthcare (MH) facilitated the discussion and we all had the chance to see just how similar our trends, challenges and strategies are despite the wide disparities that exist between the geography and makeup of our individual healthcare systems.   

Equally impressive though, was the chance to get an insiders look into just how much effort it takes to produce the high-quality product that we have the pleasure of thumbing through each week as MH hits our in-boxes.  The afternoon started with a quick de-briefing of what to expect in the broadcast studio.  Yes, I was bit  surprised that I was being "videotaped" for a magazine article, but that just goes to show the ever-present effect of the internet on business and the need to create digital as well as print content.  With all of us lined up and seated in front of the green screen, we did our sound and video tests and were on our way with the interview.  We had a nice conversation for about an hour and then wrapped things up.  While my part is complete, now is where the fun begins.  The staff now has the challenge of trying to edit the conversation (and all of the words that I stumbled upon) in order to turn the production into an interesting piece for the website and magazine.  While I know everyone always says that you are always your own biggest critic, I can certainly say they have their work cut out for themselves!  Fortunately, they are experts and I'm looking forward to see if they can make me sound at least half-way intelligent.    

After all was done, I got a chance to see the news room where all of the magic happens.  I love getting to go behind the scenes and see how things really work. Amidst the sea of cubicles, there is a small area that humbly displays the numerous awards they have earned alongside a wallpaper-like collage of all of the magazine covers from recent history.  However, as interesting as the environment was, getting to meet the staff was what truly made the afternoon.   Everyone from the journalists and graphic artists to the publishing team were extremely personable and dedicated professionals.  And they all work for the toughest boss around - 'time'.  Time takes no excuses when it comes to deadlines and this talented group is charged with finding what's news in healthcare and reporting it each and every day online and each week for the news stand.  I truly have a much greater appreciation for all of the work that goes into "telling" the news.  Thank you all for the opportunity and the hospitality, it was a wonderful experience! 

PS.  To our marketing team - I hope I didn't say too much "on the record!"

The faces behind the words of Modern Healthcare magazine

'Progress Notes' - ACE Plan

Below is the internal communication I have sent out detailing the ACE plan I referenced in my last post.  I'm looking forward to hearing your feedback!

"Janice James, Jewish Hospital & St. Mary's HealthCare's Transitional CEO, has introduced a plan for improvement for our organization.  This plan, The ACE Plan, which stands for Actions for Continued Excellence, is going to focus around making quality, financial and process improvements that will give our hospital and system long term sustainability.  We've made great strides with our focus in recent years, and with the focus on The ACE Plan, I know we will continue to make more. 

You'll be hearing a lot about The ACE Plan and the results it is driving in the upcoming months so I want to make sure each of you understand what the plan entails and how it affects you as team members.  There are five Action Teams under the plan that will focus on a deep dive into specific areas.  Those Action Teams, along with the JHSMH leader driving their mission are:
Labor and Productivity, chaired by myself
Non-Labor, chaired by Tom Gessel
Human Resources, chaired by Ed Farmer
Revenue Cycle, chaired by Ron Farr and
Physician Services, chaired by Debbie Molnar

In addition, our Chief Medical Officer. Dr. Lynn Simon, will be leading an Action Team focused on Quality and David Laird, our Senior Vice President for Strategic Planning will lead a group focusing on strategy.

Each of these committees is reporting out frequently about the improvements they are making.  These updates are being communicated with your leader who will be sharing them with you.

You may be looking at the above list and wondering what our purpose is in doing this and what it means to you.  Our purpose, as always, is to improve the lives of those we are fortunate to serve.   The ACE Plan will allow us to make operational, quality and financial improvements.  When we have
improvements to our bottom line, that in turn allows us to reinvest back into you, our team members, as well as into our capital budgets, which allows for new technology to improve patient lives.  In the end, every operational improvement we strive to make is for the ultimate benefit of achieving our mission in providing the best in patient care. 

You may also be looking at the list and wondering "what do I need to focus on?"  We've had many shifting priorities in recent years and want to make the focus clear and simple for you over the next several months.  If you grouped the Action Teams into 3 areas, you would have Operations, Quality and Strategy. These are the areas we need to focus on.  
As team members, we don't work actively in strategy— however, we do work actively every day in Operations and Quality.  I ask you to focus your
efforts on these areas.  What process improvements can we make to best
utilize the resources of you and your team?  Where are we currently not being good financial stewards of our resources?  What supply changes can we make that don't harm our patient care in any way but would save the organization money? 
Similarly, I ask you each to refocus your efforts on patient safety and quality.  As I have shared with you, we recently had a surgical "never event" take place within our OR and since then experienced another "near miss" in our ICU.  Sometimes these errors occur because a process is broken that we need to fix, but other times, errors are made simply because focus is lost or a process that is in place is not followed.  The Hippocratic Oath says "first do no harm" and I ask that we all focus and rededicate ourselves to being patient-centered and bringing patient safety to the forefront of our minds every single moment of every single day.  When it comes down to it, our patients are our most important priority.

This is a great deal of information to take in.  In the upcoming weeks and months, I will be sharing with you what improvements we are making and how the ideas you are bringing to us are playing a part.  Please remember that our ultimate mission remains to provide the very best in patient care and these improvements are aligning our efforts and resources in such a way that we can be assured that we will be doing so for years to come."

'Progress Notes' - ACE Plan

Actions for Continued Excellence - The "ACE" Plan

With all of the challenges facing hospitals today, we find ourselves constantly trying to evaluate and re-evaluate what we are doing and why we are doing it in order to preserve and enhance the mission of our organization. Over the past 18 months we have taken on numerous initiatives focused around patient safety, satisfaction, quality, and "balancing our checkbook" as a hospital.  With that focus, I'm pleased to report that we have made a great deal of improvement in each of these areas.  Our infection rates have continued to decline putting us in the top quartile nationally, our CMS core measures scores have improved markedly across the board, our length-of-stay initiatives have shortened patient stays by over a half-day (with a rising acuity at the same time), and the financial performance of our hospital and system has once again returned positive. 

I hope each of our team members and physicians are as proud of these accomplishments as I am because none of these would have been possible without your tremendous input, support, engagement, and teamwork.  Together, we have climbed a very tall mountain in a relatively short time which I know will prepare us well for the challenges that still lie ahead. 

It's no secret that the environment in which we operate today is challenged by a troubled economy and the threats of what health reform will mean to our hospital and our patients.  From my perspective, regardless of the outcome our treatment plan remains the same: seek continued strong alignment with our medical staff and together focus on improving the quality, safety, and efficiency of the care we provide to our patients.  If we do these things correctly, we will be positioned as well as anyone to succeed in the future. 

With that aim in mind, our system has created a new plan to simplify our focus and prioritize those actions that are most important to our long term success.  Appropriately, we have named this the "ACE" plan which stands for "Actions for Continued Excellence."  This plan which I have explained in the latest issue of our internal 'Progress Notes' communication (and posted in separate post here) will serve as our guide over the upcoming year and beyond to keep us focused on quality, operations, and the strategy to lead our system forward. 

As you can probably guess, your comments, thoughts, and ideas will be just as important to our continued success as in the past and I can't wait to hear what you have to say!  Please let me know your Ideas that we can together turn into Actions for Continued Excellence.  Thank you!
 

Actions for Continued Excellence - The "ACE" Plan

Survey Question: How do you spell communication?

Out of curiosity, when you hear the words "Facebook," "Twitter," "YouTube," or "Blog" what comes to mind? These applications which have become synonymous with the overarching term of "social media" have become so pervasive they can be found in nearly every aspect of life. I have heard of these applications talked about everywhere from the news, talk shows, and magazines, to everyday conversations between friends and even in church. No matter where you go, it is hard to find a situation in which these terms don't emerge in some way, shape, or form. In fact, many speculate that social media will become the preferred method of communication and marketing in the coming years dethroning conventional methods of advertising such as TV and commercials. Is this a surprise? Maybe, but when you think about it, its entirely plausible and this shift is arguably already taking place.

So why is this happening, and why do some still resist joining in on this movement? As with most any significant change, there are always multiple camps of people. The early adopters (who are always trying to stay on the forefront of where the world is going and figuring out how they can be part in shaping it), the naysayers (who will find a way to criticize, discredit, or dispel any change that threatens their own status quo), and the fence-sitters (who are waiting to see which of the two previous groups will prevail). So it is not a surprise that while social media has invaded most every aspect of our lives and so many are participating, there are still those who are "holding-out" and refusing to buy in to where the world is going.

This poses an interesting a challenging dynamic to manage in the workplace. While there is a clear new direction in which the world is moving, not everyone has gotten on board yet and we have to find meaningful ways of remaining connected with everyone regardless of where they fall on the social media adoption curve. Seeing that our hospital is on the leading edge of healthcare organizations that are trying to utilize social media tools in the workplace, my professional association, the American College of Healthcare Executives (ACHE), has asked me to participate in a educational panel discussion next week on how to best utilize social media in healthcare.

In preparing for my presentation, I have done a lot of research on the topic, but more importantly I wanted to solicit your opinions on this topic and see if your thoughts and ideas match up to what my perceptions have been thus far. Since my first blog post in January of this year, I have considered this to be an "experiment" for both myself and our hospital. From my perspective it has been a very worthwhile endeavor, but I would like to know what you think.

While I always appreciate your comments (which can be left by clicking on the "comment" link at the bottom of each post), I would also greatly appreciate a few minutes of your time to complete a quick survey. One of our marketing team members is finishing her Master's degree and has developed this survey (click here) as part of her graduate thesis to better understand how people are using social media to communicate in their everyday lives and at work. It only takes a few minutes to complete and your feedback will help us to be more effective in connecting with our team. Clear and effective communication is key to how successful we can be as an organization. Please help us get it right! (And don't forget to connect with me on Facebook and Twitter!) Thank you!

Survey Question: How do you spell communication?

Research!Louisville Accolades

On Friday I had the pleasure to represent our hospital at the Research!Louisville's Awards Celebration.  For those of you who are unfamiliar with this organization, its aims are to promote excellence and public awareness of health sciences research in the Louisville area. 

The program started off with a keynote address from Dr. Ronald Kahn, Vice Chair of the Joslin Diabetes Center in Boston and Professor of Medicine at Harvard University.  He gave a very interesting talk on the diabetes and obesity epidemic in the United States from a molecular science perspective.  While its been quite awhile since my pre-medicine days learning about biology and biochemistry, it is certainly apparent that the field of medicine continues to evolve at a very rapid pace in trying to better understand the challenges we are faced with today and finding answers to those challenges. 

The event concluded with recognizing an outstanding group of individuals who are on the forefront of developing tomorrow's answers in advancing the field and practice of medicine forward in ways we could have only dreamed of in the past. 

Congratulations to all of this year's winners and read more about them on their website at researchlouisville.org! 

Research!Louisville Accolades

A great job in helping the AHA fight heart disease!

A couple of weeks ago I wrote to our team asking for help in raising funds for the American Heart Association's Heart Walk. Our goal was to support the effort to help fight heart disease which is the number one killer among men and women in the United States.

With cardiovascular disease being one of our signature service lines, this is a cause that I think we can all relate to both personally and professionally. Over the years, our organization has made great strides in advancing research in this key area of medicine ranging in part from the implantation of the first Abiocor total artificial heart to our most recent announcement of the first cardiac based stem-cell trial which is aiming to restore damaged heart tissue after a heart attack. None of these milestones could have been achieved though without significant support and funding which is where the American Heart Association steps in.

While I know many of you were able to participate in this years walk, for those that didn't, I wanted to share what a tremendous effort the team put forth this year. This year was our most successful event ever with 578 walkers (the most of any company in town) and we raised $38,588.87 (also our best effort ever)! This total far exceeded our $25,000 goal and put us in second place in the city (behind Kindred Healthcare) among all companies who raised funds for the walk.

Given this effort, I cannot tell you how proud I was to represent our system in front of all of our great team members and the community at the walk. Your contributions are making a huge difference in helping to find a cure and I sincerely want to thank all of you who participated with your time and donations!

In addition to all who contributed to this sucess, I especially wanted to recognize Lisa Mullins for her time and efforts as our head captain and cheerleader in making this such a successful event! Her efforts truly helped make the difference for our team! Thank you Lisa and I will be looking forward to working with you all in setting a new record again next year! Great job Team!

A great job in helping the AHA fight heart disease!

Top 50 Hospital Blogs by Nurseblogger

I received an email recently to let me know that my blog was listed as one of the top 50 hospital blogs by Jimmy A. aka Nurseblogger. I am very honored to be considered amongst such a prestigious list of individuals and hospitals. This is a great resource list for anyone looking for information about what's happening in the hospital world - I'd encourage you to check it out. I have followed many of these blogs myself, and think I may have found a few more to add to my list! Thanks for the mention Nurseblogger, I appreciate it!

Top 50 Hospital Blogs by Nurseblogger

Anything is Possible - Social Change

On Friday afternoon, I had a chance to get away from the office for a couple hours and attend the Idea Festival at the Kentucky Center downtown. I was intrigued by a session called the "Abundance Farming Project" the brainchild of Paul Osterlund, a retired engineer. The project enables rain-dependent farming families in developing countries to increase crop yields, so subsistence farmers facing water scarcity can grow their way out of poverty.

By distributing a product called Zeba(TM) to farmers, they are able to increase the output of their harvest significantly which can mean the difference between success and failure to these farmers that are completely dependant upon the rain for their crops to grow and to live on. Zeba is a starch-based biodegradable superabsorbant soil product that can hold 500 times its mass in water. Just one teaspoon placed around a plant in soil can absorb 1 liter of water when it rains, then it slowly releases the water over a lengthy period between rains, and then repeats. For areas with scare rains or draughts, this product will allow farmers to grow crops many times the size they would otherwise be able to grow.

Paul's hope is that over time these farmers will literally be able to grow their way out of poverty in areas where now they are stuggling merely to survive. The project and the technology behind it is fascinating in itself (which you can read more about at abundancefarming.org), but just as important is Paul's focus on creating meaningful social change.

Some have said that if you can dream it, you can do it and Paul has taken that mantra to heart. He used to say that "somebody ought to think about getting this stuff (Zeba) into the hands of poor farmers" and now he is the one driving that key project and helping poor farmers to become self sufficient.

Paul talked in his presentation about the power of "declaration"... he said "Possibility is something that is spoken from our mouth and from that declaration it comes into existance." I think this is true in life and at work. All too often though we keep our thoughts to ourselves and we are disappointed when nothing happens. To create the change we want to see in our lives, in our job, and in the world, we first have to be brave enough to talk about it and then do something about it. Then anything really is possible!

Anything is Possible - Social Change

Staying focused on the (soccer) goal

On Saturday, soccer season kicked off for my middle son and the family staked out our usual seats up close on the sideline. We are blessed that our son is a naturally gifted athlete and were excited as we cheered him on to score the first goal of the season for his team. The pure joy for the game at this age (7 years old) is exciting to watch, especially when one of them is lucky enough to score a goal! My son has a a post-goal celebration that begins with raising his hands in the air and then proceeding to run down the sideline giving everyone who stretches out their arms a high-five along the way.

In watching their game, it got me thinking about our goals at the hospital and how much similarity can be drawn to watching a youth soccer game. There are a few key steps that the team goes through each game and then they repeat, over and over.Achieving our goals at the hospital doesn't seem all that different in retrospect.



1. Planning: Before the play begins, the team huddles and discuss their goal and how to position themselves around the field to be ready to score.


2. Execution: As the play begins, the players are communicating with each other and are constantly re-aligning themselves to be in position to make or receive a pass from a teammate as they move the ball down the field.



3. Persistence: Many shots are taken at the goal for every one goal that is scored. For every missed shot at the goal, the team doesn't give up, but instead regroups, reposition themselves, and they try again to take closer aim at the target. With enough practice, patience, and persistence, they eventually score and achieve their goal.

4. Celebration: While not all celebrations are as elaborate as my son's, the team take a moment to congratulate each other on getting the ball down the field and scoring a goal. They recognize, even at a young age, that it takes the whole team to score a goal and they celebrate together briefly, before getting lined up again to make another score.

And then the cycle repeats. Again and again.

While our goals in the hospital may be more complex, or at times may seem more daunting, the steps to achieving them are really not all that different. However, it never fails to amaze me that when we come up short on achieving a goal how many of those steps we failed to take or failed to take seriously. We set high goals for ourselves, but then fail to devise a realistic plan on how to achieve them. Instead of taking responsibility for executing against our plans, we expect someone else to make the effort to cause things to happen. Sometimes, even with great planning and execution, we still sometimes come up short and instead of regrouping and learning from a missed attempt, we simply give up. And when we do achieve our goals, we all too often fail to stop and take a moment to celebrate with each other on a job well done.

As we look forward on the rest of this year, and the goals we have set but have yet to achieve, I hope that we can all take a moment to go back to the lessons taught by watching a group of 7 year-old kids playing soccer. I'm certain we will be successful and just maybe have a bit of fun while doing it!

Staying focused on the (soccer) goal

A Story of Peace

We have all spent a lot of time recently reflecting on the heroic efforts that have been undertaken to care for the patients displaced by the flood at St's Mary & Elizabeth Hospital and to restore hospital services to South Louisville. The efforts have been truly amazing and we continue to hear the many positive stories that have resulted from an otherwise devastating event. Today, however, I would like to re-focus some of that attention on another positive story that arguably does not get the same level of attention, though the stories are no less remarkable.

Our Lady of Peace (OLOP) is a psychiatric hospital in our system that also happens to be the largest provider of adolescent inpatient behavioral services in the country. Despite this, there are many people in our own health system who are unaware of this hospital, let alone the rest of our community and our Commonwealth. Perhaps it is because this is not a particularly "high-tech" environment or perhaps it is because of the stigma that is often associated with mental illness that OLOP does not get the attention or recognition that it deserves. But the truth is, there has been something very special happening in this facility each and every day for the past 58 years, that many people have not known or heard about. Across the country, many people with psychiatric and behavioral disorders go uncared for due to the lack of healthcare funding and support for these needed services. However, today there are about 180 children and teens at OLOP each day receiving treatment and help for some of the most challenging and difficult psychiatric illnesses that exist due to the caring physicians and team members of this facility.

Today was a particularly special day as OLOP unveiled its newest program and identity to the community - the "Children's Peace Center." Several special guests were in attendance to share their words and support of the Children's Peace Center including US Congressman John Yarmuth, State Representative Jim Wayne and Louisville Metro Councilman Jim King. Perhaps most touching though was the story told by Melinda, one of our Team Members. OLOP holds a special place in Melinda's heart because her daughter happened to be one of its patients. Melinda shared a very personal and heartfelt story of how her and her daughter's life had been saved by the staff at OLOP from the Oppositional Defiance Disorder that had taken over her daughter for four years. However, this life was not saved as a result of some breakthrough technology, or miracle cure, it was saved through a very personal and "high-touch" approach of people caring for people. While I have always had a soft-spot for kids, I don't think there was anyone in the room who wasn't moved by the story Melinda had shared with us. I commend her on her courage and bravery to share such a deeply personal story for all the world to hear.

The hope though, is that this won't be the last story that we will all be hearing. There are 180 stories in progress right now, and by building awareness for the Children's Peace Center, we will be able to help countless other children who are suffering and in need of help. It was great to see what a wonderful asset we have in our system and to hear about how we are improving the lives of our patients. Thank you for being such a great role model in living out our mission!

A Story of Peace

The show must go on!

Just two weeks after the flood that closed Sts. Mary & Elizabeth Hospital, its doors have reopened to inpatients in the South end of Louisville.  For the past week, services have rapidly been coming back online due to the heroic efforts of our team members and their dedication to the hospital and its patients.  And in just a few days time, Louisville's second largest Emergency Department is already nearly back to its pre-flood volumes!

I had an opportunity to tour the hospital last week which was already well into the clean-up phase, but even still I was able to gain a better appreciation for the amount of damage that this flood had caused.  Inside, team members were busy putting the hospital back together after a total cleaning had taken place on one of the units. I have never witnessed a hospital closed due to conditions such as this, but I am so proud to see how well the entire organization has come together to support each other in this most unusual time of need.  

Wave 3 News recently aired a story that summarized the status of operations and the efforts underway to restore the hospital.  Special thanks as well to our marketing team for their efforts in keeping everyone well informed and in the loop on the progress being made each day.  Great photos and comments can be found on Facebook, Twitter, and the hospital's blog.

The show must go on!

Thoughts on flood, six words only!

This has been a tremendously challenging week, and yet one for which I hope everyone is very proud. Our census has continued to rise each day this week and yet we still keep finding new ways and places to take on new patients and care for those displaced by other hospitals in the community. Two major Emergency Department's in town have been closed since Tuesday which has effectively closed the front door to these hospitals. We have certainly felt the pressure and demand to compensate for that effect and I am happy to see how well our team has responded. Every department has been working overtime to make sure that our patients have been cared for, and cared for well! This is an event unlike anything we have ever seen or gone through, and we have sailed through it quite gracefully.

I was touched by the letter that I posted the other day and I was interested in what others were thinking and feeling. Given that many are not apt to write lengthy letters, I had an idea based on a recent blog posting on Harvard Business Review. The post talked about the essence of simplifying a given thought or feeling on a subject in a very simple and memorable way - using just six words! The post was based on a project that originated out of Smith magazine's Six-Word Memoir.

Given the week we have had, I thought it would be a fun way to wrap-up by seeing what each of you thought about the week in just six-words. Click on the "comments" link below and give it your best shot. To up the stakes a bit, I will treat the best 6-word memoir to lunch with me (although some may not consider that a prize I know!). Of course, to win you must identify yourself so I know whom to contact! Have a great weekend, and let the comments roll!

My six words to our team: Thank You! Your effort sincerely appreciated!

My six words on the week: Flash Flood + Great Team = No Problem!

Thoughts on flood, six words only!

Team Members - Fully Present

After drying out after yesterday's flash flood, I wanted to share a note I received from one of our Critical Care Nursing leaders after reflecting on the day's events. I couldn't have said it better myself, and appreciate her taking the time to capture the teamwork and selflessness we have seen over the past couple of days. Thanks to our entire team for the heart and dedication that you have shown and the spirit that defines the essence of Jewish Hospital!

Reflection (Written by Joris K., night of August 4 and morning of August 5^th following record rainstorm which closed St. Mary’s Hospital)

We know that customers want our full attention when we are with them. How frustrating it is to purchase a product in a store and have the store clerk answering the phone, while dealing with other issues, when all you really want is to check out and be on your way. It is also frustrating to go to a restaurant and have your meal arrive only to wonder, “how did I get that-it wasn't what I asked for?”

I see this in healthcare so often. Team members bring "personal problems", and other stressors to the job-our attention is just not 100% there, and our patients feel this so strongly. I believe what patients really want is someone's full attention to assure they are getting what they need to feel better.

Yesterday was such a great example of why I am so proud to work at Jewish Hospital. We came together-giving every bit of our attention as health care providers to open units that had been closed for weeks, and to assure that everything was 100% ready for whatever rolled into our door from St. Mary's. We gathered supplies, checked emergency equipment, rebooted computers, made beds, mopped floors, and did everything in our power to assure readiness. I saw a unit make a banner to welcome St. Mary's and their patients, I observed nurses offer their St. Mary's colleagues rides home and money for unexpected emergencies when their purses and money were left behind. I saw team members lined up at the nursing units entrance welcoming the stretchers carrying the misplaced patients and confused families to our facility. One director came to assist a unit and did things like putting batteries in dead telemetry packs, finding water pitchers and urinals; one AVP put on scrubs and assisted in getting meals to patients who had not been able to eat all day due to the water in the kitchen at St. Mary's. Throughout the entire day and evening, I never heard anyone say, "I don't have time". Instead we washed away all the lines that usually differentiate us from different professionals and departments and came together to provide whatever the patient and our new teammates needed. Yesterday we were not nurses, we were not pharmacists, we were not radiology technicians, instead, ­we were all team members bonded together to assure that our patients were safe, and protected during a very vulnerable time.

We were fully present, not just physically present. Sometimes healthcare is about profound moments, sometimes it is about pills, bedpans, and dressing changes, but it is always about being there for people who need you. We sure came together to do that yesterday-my sincere wish is that our St Mary’s patients and colleagues feel this warmth and welcome on the last day they are here as strongly as they did on their first day here.

Team Members - Fully Present

When it rains, it pours!

Here's something you don't see everyday! A city transit bus driving up to our Emergency Department bay bringing us 20 patients from our sister hospital after it had to be evacuated due to a flash flood in Louisville today. The storm dumped a record 6.5" of rain in one hour in one of those rare 30-year floods. All things considered, we "weathered" the storm without any serious injury or harm to our patients, but by the end of the day almost 100 patients had to be transferred out of St. Mary's hospital via bus and ambulance. We absorbed the majority of those patients and gratefully the nurses and staff to care for them as we opened every available unit to accommodate this need.

It was a true testament to the teamwork and innovation of our entire team. From nursing to engineering, dietary to transport, accounting to care management and everyone in between, it was literally an all-hands-on-deck adventure to accommodate a 20% increase in our census in a matter of a few hours. During times of need, our team really knows how to deliver and it makes me proud to be a part of this team! On behalf of our grateful patients and system, I want to give you all a big THANK YOU!

When it rains, it pours!

Habitat for Humanity - Joy's House

What a difference a few months can make! On Saturday I had the pleasure to attend the dedication of our Team Member Joy's new home that I wrote about back in February. Through the hundreds of hours of volunteer service of Joy and all of the Habitat for Humanity volunteers, what was a demolished shell of a house just a few months ago is now a beautiful home for Joy and her son JaShawn.


Its amazing to see how much things can improve when a group of dedicated individuals come together as a team, put self-interest aside, and work towards a common goal. While Joy admitted to us at the dedication that everything didn't always go as planned, through hard work and perseverance her goal was achieved and she is now out of her parents house and a proud, self sufficient home owner! She didn't let obstacles get in her way or get her down she just kept hammering away at them and turned them into memories that she will forever cherish. I'm pretty sure there is a lesson for us all to learn in this....Congratulations on your new home Joy!

Habitat for Humanity - Joy's House

Frazier's Locomotor Training Help Man to Walk After Paralysis

On Thursday, ABC's Good Morning America aired a story entitled, "Incredible Journey: From Paralyzed to Helping Others Walk." The story featured the incredible turn of events surrounding the tragic accident that happened to Janne Kouri of Hermosa Beach, California in 2006. After unknowingly diving into a shallow sand bar, Kouri found himself paralyzed after being rescued by an off-duty EMT. Doctor's told the NFL prospect Kouri that he would never be able to walk again. Seaching for answers, he found Dr. Susie Harkema at our Frazier Rehab Institute. With the assistance of the 'Locomotor' training that Dr. Harkema has been developing at Frazier, Kouri began down the path of recovery. Through a grant of the Christopher and Dana Reeve Foundation, of which Frazier Rehab is a NeuroRecovery Network center, Kouri got a grant to bring the locomotor training equipment to California through a non-profit rehab center. Today (3-years later), Kouri is taking his first steps as a result of his continued training and therapy and helping others with spinal cord injuries to do the same. Good things are happening in Louisville! We are proud to have Dr. Harkema and her entire research and clinical staff as part of our team. Together, we are doing great things!

Frazier's Locomotor Training Help Man to Walk After Paralysis

If Disney ran our hospital?

After a much appreciated vacation and break, I am back to my blog. Lately I have been spending a lot of time discussing patient satisfaction with many different groups of people ranging from front-line team members, to managers, to other hospital executives and consultants. Everyone has a theory on how to improve it, but no one has quite been able to put all of the pieces together into a concise package.

All of these talks and my recent vacation with the family to Disney World has brought my memory back to a book written by Fred Lee entitled, "If Disney Ran Your Hosptial: 9-1/2 Things You Would Do Differently." What Fred discusses in his book however is not a focus on patient satisfaction, but on patient loyalty. Having never been to Disney World before this trip, it was hard to relate to what Fred was writing about. After this trip though, I now understand the message that he was trying to convey. What Disney does so well is that it is not just another theme park, but a complete experience that surrounds their guests from the moment they step on property. Everything from the hotel registration process and meals, to the parks themselves are focused on creating a "magical" experience for all to enjoy. My boys enjoyed the rides at the parks, but I was amazed at the amount of intricate detail and thought that is put into every attraction that a guest encounters. We also took a 3-day cruise on the Disney Cruise Line and there too everything was a notch above the ordinary fare right on down to their "Disney-fied" lagoon on their private Castaway Cay island, complete with the Flying Duthman ship from Pirates of the Caribbean and an underwater Mickey and Minnie Mouse aboard the sunken ships that can be seen while snorkeling. I have to say that I am a now a convert and can understand why Disney has been a destination that so many people flock to each year and keep going back for more.

As it relates to the hospital then, the question I have is how to create that same experience for our patients? While most of our patients (and payors) hope that our guests don't have return visits, our goal should certainly be to create that same loyalty and experience that people know, trust, and seek out in their time of need. "Patient Satisfaction" is one of the hospitals' "Pillar Goals" and has been a key focus area for our organization for years - in fact it should be seen as one of our core competencies. While we have made good progress in attaining this goal, we must realize that patient satisfaction is both a continuous journey as well as a series of individual events. Every aspect of care that a patient touches adds to the complete experiecne we provide. The question is how do we shape our culture to attain that high level of desirability by our patients? More to come on this topic...

If Disney ran our hospital?

Red Rules - First Do No Harm!

Hospitals are complex organizations. One one hand, its nothing short of amazing that we can orchestrate dozens of departments to work in concert with each other to provide care to literally hundreds of patients each day with relative ease. On the other hand, it takes hundreds of policies, procedures, and protocols to make sure that each that each patient gets the right care at the right time and in the right manner. Given that these are mainly human processes, there is obviously a high potential for things to go astray despite everyone's best efforts. At best, this can create a service delay or dissatisfaction, but at worst, the results can be catastrophic. Therefore, we must have a way to both navigate and differentiate the multitudes of rules that we depend upon to make our organization run.

With that thought in mind and in recognition of National Time-Out Day, today we officially kick-off our first organizational "Red Rule." Our first Red Rule addresses pre-procedural time-outs within the hospital. While not a new concept, this is one policy and practice that when done right has been proven to save lives in hospitals across the country and one that we feel is of utmost importance to the hospital and our patients.

Below is a copy of a communication I recently sent out to our team at the hospital. I would be interested in hearing how others are dealing with this same issue or thoughts on how we can continue to improve.

"As many of you are aware, our organization, led by Chief Medical Officer Dr. Lynn Simon, has embarked on a goal of achieving “Zero Harm” to patients by 2013. While this is an aggressive goal, it is a worthwhile one and one that we are focused on reaching. When patients trust us with their care, our objective should not only be to get them well and home soon, but to also have no harm done to them while they are in our care.

One way that we will be focusing on achieving this goal is through the creation of “Red Rules.” Red Rules are non-negotiable behaviors that are expected and supported throughout the organization. As such, the rules are not difficult but we must have complete compliance to be effective. Sanctions will be administered to any individual— including physicians and team members —who do not support and adhere to these behaviors. The purpose is not to be punitive, but rather to instill accountability in our team for practicing safe behaviors in helping our patients.

Our first Red Rule is to require all departments to conduct an “active time out” prior to the start of a procedure. We’ve found that previously, many departments had different definitions of what an “active time out” is so we have clarified by developing a consistent definition that will be used across the facility. The steps of an active time out are:

1. Announcement of the “time out.”
2. Verification: all other activity stops and the patient’s name, site/side and procedure are stated and confirmed.
3. Verbal confirmation: each person involved in the procedure in any way confirms.
4. Announcement of “time out completed.”

Part of being able to enforce Red Rules is having a culture to give team members the freedom to stop a procedure at any time if they feel that the process has not been appropriately followed or the patient’s safety is at risk. Let me take this moment to reassure each of you that you have my, and the rest of Administration’s, utmost support in this initiative. While it may not always be comfortable to have a confrontation of this sort with a fellow team member or physician, it is what is in the best need for the patients we serve and as a result, you need not fear being reprimanded if you are simply ensuring that a Red Rule or patient safety is being followed. In fact, I would argue that this is not only what is allowed of you, but what is expected.

Achieving our goal of Zero Harm by 2013 is going to be an aggressive target—but I am confident that through the Red Rules and our culture, we can absolutely achieve it! Please feel free to reach out to me at any time should you have concerns or suggestions about the adherence to Red Rules. Our patients are depending on you. Thank you for your support."

Red Rules - First Do No Harm!