Dr. U's Quality Views

Defining success

2008-04-01T16:54:00Z

Last week I was at the Epic (our new IS majority vendor) demo/kickoff. The event was notable to me for several reasons. First, I think that Jamie Franklin (our Chief Project Management Officer) has second career possibilities in stand up comedy. Second, it was great to hear and see what Epic has allowed other facilities to do and what our future holds.

Finally, I was impressed by Jamie's comments about what the "end game" is. His goal after 7 years is not to have a "successful implementation of a software product." Rather the goal is to make caring for our patients safer, more efficient, more timely, more equitable - in other words, meeting well defined clinical, operational, and financial goals.

It is good sometimes to reflect on our different goals and how we define success in attaining those goals.

“The Leadership Principles of Atilla the Hun."

2008-01-30T05:37:00Z

I was recently on an airplane sitting next to somebody reading something similar to the above title. There are loads and loads of books written about leading. The interesting thing is how few books are written about "following." And yet following is something that almost all of us have to do.

In healthcare, following is not always easy. We certainly have a chain of command and a physician who makes the final decision about patient care. At the same time, we have an obligation to our patients to speak up if we see something concerning regarding patient safety. The physician expects this which in turn allows him or her to deliver high quality, safe care. Expect to hear more about this concept as LifeWings training is on-going at CRMC in the surgical area. Our goal is to expand this training to all of our facilities in multiple other service areas. One of the mantras of this program is, "See it, say it, fix it." Perhaps this is a good place to start as we think about following.

Who knows – maybe Atilla’s followers had a similar mantra.

"Drive safe."

2007-11-27T18:06:00Z

At the YMCA where I work out, one friendly gentlemen always says goodbye to everybody ending with "Drive safe." When I asked him about this, he related that after driving a truck for 25 years he had seen some pretty terrible things on the highway. Having worked in a trauma center, I can relate. This also struck a chord with me as I read the below link about another highway tragedy that occured locally. This story speaks to loss and the great care/service we provided along with the CTDN.

Our most valuable resource here at CMC are our people - those who directly provide care and those who provide the support to do so. And so during the hectic upcoming holiday season I ask you to preserve this resource (you) and please.............."Drive safe."

http://abclocal.go.com/kfsn/story?section=local&id=5781160

Going bare?

2007-10-12T05:23:00Z

Going bare?

Sometimes (in fact a lot of the times) the best solutions to a problem are the most simple. Take for instance the issue of health care associated infections – the simple solution here is hand-washing - for more information about this go to the Hand Hygiene policy and procedure in the Infection Control manual.

Another interesting and simple solution may be coming soon in regards to hospital acquired methcillin resistant Staphylococcus aureus and Clostridium difficile. In the UK, next year they are hoping to decrease the rate of spread of this infection by requiring health care providers to go "bare below the elbow" as well as eliminate white coats, neckties, and jewelry. As you might guess, there has been some pushback, nonetheless, the Brits are moving forward.

We’ll see what happens in further research and wait until the Central Valley warms up again, but who knows – perhaps going bare is in our future.

“YOU’RE AN IDIOT!”

2007-07-20T23:27:00Z

This is hardly considered professional dialogue. Unfortunately, it happens, even between colleagues in healthcare. However, this type of dialogue should not be tolerated by any of our staff. Whether RN to RN, clerk to PCA, or MD to staff, etc. - respect should be the cornerstone of all of our interactions. The more we understand that high quality, safe healthcare is a team sport, the better. As any of our risk management staff can attest, communication (or lack thereof) is a contributing factor in nearly all of our problematic occurrences. It is obviously difficult to have meaningful exchange of information if one is fearful of, or subjected to, being yelled at or chastised.

The Medical Staff is in complete agreement with this concept. Let me quote to you from the Medical Staff Policy regarding Disruptive Behavior, “It is the policy of the Medical Staff of CMC that all individuals within its facilities be treated with courtesy, respect, and dignity.” Incidents that are contrary to this policy are taken seriously by, and acted upon, by the Medical Staff.

The CMC Corporate Harrassment policy also has similar language. You can read both of these policies in their entirety through Lucidoc – and I encourage you to do so. The soon to be released Target 100 Standards of Service Excellence will also address this issue.

There is certainly a subjective element to defining “disruptive behavior.” Nonetheless, I would encourage you to follow the above policies anytime you believe your ability to care for one of our patients is hindered by another’s behavior.

"They're here"

2007-05-29T18:29:00Z

How many of you somewhat dated individuals remember the movie the above phrase came from? On May 22, 2007, "They're here" meant that CMS had arrived at our CRMC campus to do a for-cause Conditions of Participation survey. While I cannot divulge the specifics surrounding the survey, I would like to convey that at the end of the investigation the surveyors were very impressed with our facility and our care and had no findings. The folks that interacted with the surveyors did an awesome job - Laura McComb, Marge Beekman, Linda Bates, Berj Apkarian, and Jo Gehringer to name a few. But beyond that, all the folks that give care and document in the medical record (Nurses, Physicians, Ancillary and Clerical staff, etc.) are to be commended as many medical records were reviewed. Surveys (announced, unnannounced, for cause, etc.) have become a way of life for health care facilities. I am excited to work with folks who are putting systems into place that deliver and demonstrate the high quality care we give to our patients.

Btw - I believe the above line came from the 1982 movie, "Poltergeist."

Brad Isaac R.N.

2007-05-16T18:00:00Z

“Lot’s of ‘Discharge magnets’ available.”

For anybody who spent time in the VMC/UMC ED, the above statement is likely to have meaning. In the days that our ED’s had magnetized boards, this is the quote that Brad Isaac RN, ED Coordinator, would use to encourage docs to dispo patients. It is with a heavy heart that I write about Brad as he recently died in a car collision.

From his weekend potlucks to his unique way of answering the phone, Brad was one of the key ingredients in the glue that holds together our Level 1 ED. He was a stabilizing force in an often chaotic environment. Brad had a lot to do with building the concept of “family” in the ED. It was also obvious how important his own family was to him. I will never forget the pride with which he would bring out some of his wife Terri’s award winning cookies or carrot cake to one of our potlucks. Brad was also very proud of his service in the Navy – often reminding us of this background with statements such as “Belay that order.” I could go on and on about Brad and how his consistent leadership and the love he had of his work, our patients, and his fellow employees will be missed – but I’m guessing you get the point. There are many things we will not understand in this life – the tragedy of losing Brad at this time would be one of them.

Please join me in offering condolences to the Isaac family – including his wife Terri, and children – Marshall, Nicole, Brandon, and Jacob. A Celebration of Life service will be held Friday, May 18 @ 10AM in the Rose Garden located between the 10 Story and TCCB buildings.

For details regarding the service celebrating Brad’s life, please contact Deonna Villegas-McPeters @ 260-9168 or Chaplain Grimaldo Enriquez @ 488-8800.

What's your work-around?

2007-05-03T22:29:00Z

In my last blog I talked about operating in the “legal/illegal” AKA “illegal/normal” space. The concept proposed that there are times we, as healthcare providers, operate outside, or on the fringes, of policy and procedure, potentially comprising patient care, – because we’re too busy or we don’t understand the rationale behind the policy or we’ve just gotten used to doing it the ‘easy’ way. The other reason we may not follow policy (i.e. use a work around) is simply because the policy doesn’t make sense – maybe it is dated, overly complicated or written by someone unfamiliar with clinical realities. If this is the case in your world, I would encourage you to consider avenues to change/simplify any of our Policies/Procedures that are overly burdensome and/or do not reflect everyday practice. A long time ago, Dr. Gene Kallsen verbalized to me what a Policy and Procedure Manual should be – “a living, breathing document that guides care and is easily accessible to those delivering care.” So… every once in awhile, open up Lucidoc and review a P&P that is supposed to guide what you do. If this isn’t your reality, decide if you should change….or the policy should change.