On Wednesday, I attended our weekly meeting for Information Systems. The term, Information Systems, does not just refer to technology. It is expansive and refers to the interactions between people, processes, data and technology. The emphasis here is on the way in which people interact with this technology in support of business processes. Regularly, the meeting includes each of the Information System Directors, as well as others who may have issues or need resources for current projects involving information technology or systems. With eighty-five (85) different applications that all need to ‘talk’ to one another and function smoothly on our computer network, there is always an upgrade, new install or system performance review evaluation to consider.

Since these efforts are so important and the results impact our people, service and success, I wanted to give you a glance into the work. The agenda for the meeting this week included:

A. A review of the major expenditures for capital equipment based on the budget plan for 2009-2010.

B. A proposal to develop a more robust Employee Communication Portal for remote access from home for a variety of reports and information.

C. An update and time line from McLeod Physician Associates on the selection process for a new electronic health record and practice management system for physician practices.

D. An update on the new documentation system, Peribirth, for the Women’s Hospital.

E. Project Status and Updates from each Information System Department:
• Network Services, Jay Carter
• Executive Information, Lisa Lee
• Financial Systems, Larry McElveen
• Information Technology Governance and HIPPA, Shari Donley
• Medical Information, Mavis Turner
• Clinical Systems, Eddie Legg

It is hard to describe the scope and number of projects that are ongoing to help us improve patient care. Our business processes exist as defined by our work. We want our information systems to support and provide control for as many of these processes as are practical. If you have any questions about these projects or others, please let me know your thoughts.

Most importantly, I want to thank Jenean Blackmon, our Chief Information Officer, and the team in Information Systems for their work on behalf of our patients and our desire to improve care and business processes.

Thanks,
Rob

In our news-saturated world, may I encourage you to closely watch the local news where the debate on the South Carolina state budget intensifies. As this national recession runs longer than expected, many states are continuing to experience a short fall in tax revenues, creating gaps in the state budget. Most states have implemented budget cuts as well as exhausted all available federal funds to keep vital services operating. Our state is no exception. We can expect budget cuts in education and healthcare since it occupies a large part of the state’s budget.

Newspapers across the country are describing some difficult situations with state budgets in this recession. Predictably, all of us in health care will be impacted by this next round of state budget reductions. As stewards of McLeod Health, we need to diligently serve our patients well, watch our expenditures, and creatively look for opportunities to grow.

For a first look, see this news clipping from the South Carolina Hospital Association and the article below from ‘The State’ newspaper:

“Strapped state budget to move forward”

Members of the S.C. House next week will start debating a strapped $5 billion state budget that could cause big cuts to state employees. Up to 2,300 state employees, including 1,000 who help the disabled and a hundred who deal with parolees, could lose jobs, according to media reports. More in Statewide below.

SC spending plan could cut almost 2,300 jobs
By JIM DAVENPORT – Associated Press Writer

Many thanks for your ideas and offers to help with the Haitian relief effort.  An email was set up for the purpose of receiving and reviewing your ideas …  Haiti.Relief@McLeodHealth.org.

Prior to the devastating earthquake, several physicians in our community – Drs. Mark Reynolds and John Mattheis and Chamaine Brooks – were already scheduled for a February  medical missions trip to Haiti.  We also know that Dr. Steve Adams is completing  two weeks of medical service there.  Please pray for their safety.  Please give thanks for their willingness and availability to help the people of Haiti at this time.  

Unquestionably, there continues to be a critical need in Haiti for a broad range of supplies and medicines. McLeod Health and other member hospitals in the South Carolina Hospital Association (SCHA) are teaming up with the South Carolina-based Haiti Children Project (HCP) to get supplies directly to those in need, bypassing the congestion at the Port-au-Prince airport.  You may view the website of this organization (http://www.haitichildrenproject.org) to learn more about their work … pre- and post-earthquake.

The HCP flights are landing on dirt strips in rural areas of the country to place critically needed supplies directly into the hands of caregivers and emergency responders.  Earlier this week, two planes filled with approximately two tons of desperately-needed medical supplies and medications — donated by SCHA member hospitals, landed in Jérémie, Haiti.  Additional flights are planned to take life-saving supplies directly to earthquake victims and those trying to care for them.

Photo courtesy of the SC Hospital Association.

The port city of Jérémie, Haiti, is the capital city of the department of Grand’Anse, in Haiti, with a population of about 31,000 (2003 census). It is almost isolated from the rest of the country. Although Jérémie has been cut-off from food and supplies, it continues to receive a steady influx of severely injured Haitians from surrounding areas.

McLeod Health’s response to the Haitian disaster has been planned and deliberate — carefully coordinated with the help of the South Carolina Hospital Association. We realized that other organizations have responded quickly by moving masses of basic supplies to the disaster areas, which, according to news reports, in many instances has been slow to reach care givers in the field. We also recognized that as response teams were better able to more carefully assess specific needs, there would be significant demand for specific, crucial medical provisions, which were in short supply.  Reports indicate that there would be an on-going demand for these materials, particularly in remote areas.

By awaiting the return of the first HCP pilots from Haiti this week, we have identified very specific supplies, which are vitally important but are in short supply in the region. By planning a response to meet the needs of care-givers and emergency responders on the ground, we have been able to specifically match their need for vital medical supplies.  In response, McLeod has, at this time, donated $10,000 dollars of critically needed medical supplies:  topical antiseptics, orthopedic supplies, wound care supplies, IV fluids,  suture material and external staplers for secondary wound closure.  These items have been delivered from our warehouse supplies to Columbia, South Carolina and are being flown directly to emergency responders and care givers in Jérémie.  Thanks to the team in Procurement Services for preparing and transporting the supplies, as well as others who have been involved in this effort so far.

Lashawn Mumford and Entran Mack load the supplies from McLeod which are bound for Haiti.

Thank you for exhibiting the hearts of servants, exemplified by your prayers, acts of support and kindness, and your willingness to serve others.  We will continue to work on the ideas that you have for this relief effort.

Thanks,
Rob

Athletes compete against the clock.  Runners, skiers and swimmers strive endless hours to shave seconds off their race times.  Unquestioningly, the need for swiftness in a medical emergency is of paramount importance. Internal teams of nurses, physicians and professionals must constantly scrutinize their own response times to meet critical life and death emergencies.

For some time, a vital component of our patient care safety net has been our Rapid Response Team — known by some as METs or Medical Emergency Team. The heroic efforts of these teams are well known and are often forwarded to my attention.  However, in our desire to consistently strive for excellence, we sought to improve the process of the teams. Using the Operational Effectiveness approach, we targeted our response times for Code II’s and Rapid Response calls.

Recently, we held the first Rapid Response improvement event (RIE).  This was the first of six RIE’s on this improvement effort. The first RIE focus was on the flow of information and timely arrival of the first responder to a Code II or a Rapid Response call.

The team was led by Brenda Raynor, TSCU. The implementers were Kathy Sims, 10th floor and Trish Handley, CCU/Telemetry. The other team members included: Angela Marlowe, Respiratory Therapy; April Sheppard, 4East; Amy Edmund, CCU; Paula Hrobak, Anesthesia; Julie McKissick, Operating Room; and Kelly Lawson, Nursing. Larry Adams is the Process Manager for Operational Effectiveness facilitating this work.

Larry Adams and Brenda Raynor review flow chart on patient care

The RIE team spent all day on Monday and part of Tuesday understanding the “As Is” state or what is currently happening when we activate a Code II or a Rapid Response Team.  Next we developed the “Desired State” or what the ideal process should look like. By the end of Tuesday, the team developed several (PDCAs) Plan Do Check Act – - to test for improvement.

The RIE team began with a goal of having a ‘first responder’ for a Rapid Response Call or Code II Call arrive within five minutes of the request. The ‘As Is’ state was an average of twelve minutes for the first responder to arrive. By looking closely at each step, the RIE team standardized the process to call the Code II or Rapid Response through the Switchboard; thus, reducing the team’s arrival time by eight minutes.  We will now seek to educate and make responders aware of the new process so that this move toward ideal can be maintained.

As we improved response during the initial week, several Physicians provided positive confirmation. Notably, one physician stated “That was the best arrival time and rapid response I have ever witnessed.” This comment confirms that a change in process is better when it involves a team approach — including the people who ‘do the work.’ This is one of the design principles of Operational Effectiveness.

The next Rapid Improvement Event (RIE) is scheduled for the week of February 8th. This team will focus on “defining the role of each responder to a Code II or Rapid Response request by standard work and policy.”

In our use of Rapid Response Teams, we have found a team approach to nursing with subsequent improvements in patient care and outcomes: improvements in planning, which include:
- assessments, treatments and goals;
- improvements in communication – patient-to-staff, staff-to-staff and staff-to-physician; as well as
- improvements in recognizing subtle changes in a patient’s condition.

We greatly appreciate the work of this team and look forward to other breakthroughs during the next five months as they focus on each step in the process.

Thanks,
Rob