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