Archive for December, 2009

The Heart & Vascular Institute

Tuesday, December 22nd, 2009

Every Thursday at our McLeod Health Planning meeting, we focus on the needs and plans for our patients within each of the service lines. Last week, the team identified opportunities and enhancements for McLeod Heart & Vascular Institute services. We are assisted in this effort by Ben Rook and Bill McLellan, architects with Design Strategies of Greenville, South Carolina. Working with these experienced architects and planners, we are implementing the details for improving and growing heart services. Physicians, Nurses and leaders developed these plans in 2008 and 2009. These plans will enhance medical care for patients with heart and vascular disease.

The vision of this effort is to create the appropriate setting for the Heart & Vascular Institute located within McLeod Regional Medical Center. At present, these heart services are located in a variety of places throughout the McLeod Tower. With the ultimate goal a central location, patients and staff will be able to receive and give care in a more streamlined and efficient manner. A physical space will create a stronger identity for this service and help patients with ‘wayfinding.’

The Heart & Vascular Institute will continue to be located on the first floor of McLeod Tower, in an area formerly occupied by the Operating Rooms. The physical space in the McLeod Tower will span from the central loading dock and Radiology, (east and west) and from the CVICU to the central hallway, (north and south). Upon completion, the new Heart & Vascular Institute will be accessed by patients and families through a new entrance at the lobby of the McLeod Tower. The Heart & Vascular Institute will include: cardiovascular and vascular surgery, CVICU, cardiac catheterization labs, cardiac services with EKG and echocardiography, a new day hospital, pre- and post- procedure rooms and combined support areas for staff.

Demolition of the old operating rooms in the McLeod Tower began in mid-November 2009 by our Engineering and Construction teams. Utilizing the expertise of our internal team helps to control costs, the timing of the work and the safety of the area. Because the Heart & Vascular Institute is a renovation of existing space, the project was reviewed and exempted from the Certificate of Need (CON) process by DHEC.

Construction of the area will begin in February 2010. We plan to use the internal team from Engineering and Construction along with local subcontractors for most of the work. It is estimated that construction will be completed by February 2011. More details will be released in McLeod News. (more…)

The Touch of Gold

Friday, December 18th, 2009

Outside DoorDoes anyone recognize the door handle in this photograph?

This is the employee entrance near the CVICU.  Each day, for many years, members of our team  use this entry on their way to work. Notably, the door handle has worn ‘gold’ from use by our team –- polished by the dedicated and gifted hands of McLeod employees. It is a daily reminder to me that we come to serve others with our touch.

In a wonderful way, each and every day we combine our intellect, our hearts and our hands to reach out serve another.  Are you aware of the power your touch has to turn things to gold?

As we pause at the portal of a new year, it is important to reflect upon the blessings of the past, I wanted to personally thank each of you for your faithful service and dedication.

Thanks,

Rob

Patient Rounds

Thursday, December 17th, 2009

The dawn of every new day is an opportunity to pause and reflect upon what is really important, to recalibrate our compass as well as to adjust our path. Each morning at all three hospitals – – McLeod Regional Medical Center, McLeod Health Darlington and McLeod Health Dillon – – the senior leadership team for each hospital gathers for a morning huddle and ‘Patient Rounds.’ We begin the first thirty minutes of our day with patients. In the huddle each team reviews some information and then the group visits a nursing unit or department. The primary reason for this ‘standard work’ is to open our day with the reason we are all here … our patients. It is a reminder to begin each day with purpose. The second reason we follow this daily initiative is to speak with staff in the area who are caring for the patients. Leaders gain a new perspective about the pace of the work and insight regarding the ‘real people’ who deliver the medical care and services for patients.

Today, I visited with the leadership team at McLeod Regional Medical Center. We made Patient Rounds on the nursing units of 4East and MICU. I met a family in the MICU waiting room and had a chance to talk with Lilly Wing, RN, about patients with renal disease. Coincidentally, just this week I have received two letters from patients who received their care in these units. The letters were affirming as well as encouraging. They conveyed a fresh perspective on the honor and privilege we have of caring for patients and families. One letter was from the wife of a patient who was transferred from Carolina Pines in Hartsville. She expressed her thanks for the care he received in the MICU and her experience with Dr. Vinod Jona, a pulmonogist at McLeod. “Dr. Jona was always honest with me about my husband’s prognosis. There were many times when I was at my breaking point and Dr. Jona would show up and give me his shoulder to cry on and give me moral support.” It is great to have physician leaders who point us to the best way by their example. Thank you, Dr. Jona!

When you see us on Patient Rounds, please know that we are there to learn from you as well as the patient. These Patient Rounds each morning do not replace other opportunities we have to visit throughout the hospital; instead they provide a positive and continuous focus for the leadership team. In this season of thanksgiving and hope, may we find encouragement in our service to others.

Thank you for your compassion and commitment,
Rob

Learning Together

Thursday, December 3rd, 2009

Here is a note from Judy Bibbo, Vice President of Patient Services.  I spoke with Judy about the day she worked in the MICU to observe caring for patients in an intensive care setting.  This direct observation of the care process and gathering a perspective close to the patient will help us make better decisions and continuously improve patient care.

Rob,
Recently I was able to step away from my routines and spend time in the MICU observing the staff and Dr. Asem Abdeljalil as they worked together in providing care for the 16 patients in the unit.  For me, anytime I am able to work with staff and physicians at the bedside it is such a powerful reminder of what a great staff we have.  I watched Sherry Wilson as she juggled many interactions, needs and opportunities to coach her staff. I was so impressed with her willingness to get involved and help the staff in problem solving or with moving a patient from Hemodialysis to MICU.  I watched as it was evident each decision she made was focused on what would be best for the patient.

The day I worked in MICU, both nurses who were recently honored with the 2009 Joseph G. Sylvester awards were also working.  Elizabeth Wright, RN, was precepting Stephanie Mitchell who is a new graduate and recently started at McLeod.  Listening to Elizabeth Wright as she discussed the orientation process I observed the ease of the dialogue between the two of them. The professionalism as an experienced ICU nurse, who wants to be sure she is doing all she can to mentor a new nurse in being prepared to give the best care possible, was obvious.

Kristin O’Neal, RN,  who is the 2009 Sylvester award recipient, was working with a very complicated patient and needed the support of others from the MICU, Respiratory and Radiology Teams.  Tommie Powell and Craig Larrimore from Radiology came to MICU to discuss the potential options for working together to obtain the radiology access needed for this patient.  I could observe their demonstrated commitment to Service Excellence. The transporters, Celeste Howanich and Steven Lee, knew just how to move the bed and all of the equipment. Respiratory Therapists, Shannon Wall and Tara Brookens, were also involved in moving Kristin’s patient.  I observed the values of caring and patient safety.  Each of these staff members worked together in a difficult situation as a team for a common goal of excellent care for this patient.  I was impressed as they paused to be sure that they involved the patient, reassuring he and his wife of the treatment plan and safety steps in the transport.

Judy on MICU

Judy Bibbo and Kristin O'Neal, RN, listen to Elizabeth Wright, RN, as she discusses a patient's care with Dr. Grant Breazeale in MICU.

As I watched the nurses and other staff members from different areas such as respiratory, environmental services, hemodialysis and wound care, it was easy to see Service Excellence standards in their everyday activities.  For example, when a visitor came to the unit door looking for a patient who was in a different area, a nurse paused in what she was doing and walked the visitor to another nursing station.  I also witnessed staff communicating to patients and family members about treatments and plans for care.  I observed these communications as complete and with care for the patient.

For me, an opportunity to work with our staff is such a powerful experience because we have such a great team who come together to live our McLeod Values of Caring, the Person, Quality and Integrity in such a natural way.  It shows they are living these values.

I want to thank the MICU Team (Deidre Young, Eugene Myers, Cassie Crowley, Crystal Carnes,  Mallory Broach, Lenora Evans, Tara Marshall, Kristin O’Neal, April Page, Joanne Rose, Effie Willing, Elizabeth Wright, Jayson Grice and our new team members: Amanda Ham, Samantha McAllister and Stephanie Mitchell) for allowing me to spend time with them and for providing excellent care for our patient and families.
Judy

I have heard from many of you who are reading the weblog.  While I am unable to post all of the direct observations that are taking place as we learn together, I want to thank you for the time you give to learn more about some of the work in the organization.

Thanks,

Rob

The Spirit of Improvement

Wednesday, December 2nd, 2009

Nursing at the Bedside

On Tuesday morning at the Quality & Safety Meeting, we have a weekly agenda of ongoing work in Clinical Effectiveness, Operational Effectiveness and Service Excellence.  This week, the update was about some exciting work ahead of us in Nursing.  An Operational Effectiveness (OE) Team has been appointed to improve the work flow of the nurse at the bedside by removing wasted steps and motion.  The goal or desired state of the work will be to create a patient care process that allows the nurse to guide the patient through ‘milestones’ in care that ensure quality and safety for the patient and efficiency for the staff.  The effectiveness of this improvement work will be measured by:  (1) increased time for the nurse with the patient, (2) a reduction in rework for the nurse and patient, and (3) a more efficient length of stay for the patient.

Recently, a team assembled to define the scope and nature of this improvement work.  This part of our process in Operational Effectiveness is called a ‘Value Stream Analysis’ (VSA).  The Value Stream defines the parameters of the improvement work in a particular process.  The Value Stream also identifies the bottlenecks and potential places of waste in a process.  Next, the Value Stream Analysis plans for a series of month-after-month Rapid Improvement Events (RIEs).  These RIEs seek to remove the bottlenecks and waste in the process.  This Value Stream for Nursing at the Bedside will be referred to as ‘Excellence in Bedside Care.’ After the VSA was complete, the team recommended twenty-three (23) RIEs, one per month.  The RIEs will carefully examine the processes and move toward improvement in each step.

The ‘gap’ between the present state and the desired state is defined by the VSA team in the following sentences: The current patient care process does not flow well.  The process includes multiple rework loops and redundancy in both work and documentation by the nurse. There is the need for more Standard Work in the patient care process.  Many ‘Milestones’ are not transparent nor used to plan the work so that it can be more efficient.  We need to stabilize the process, standardize where possible and improve the process.

The VSA team includes: Leanne Huminski, Kelley Prevatte, Todd Hazzard, Cecilea Wingate, Sabrina Capell, Bradley White,  Trena Addison, Lisa Hagberg, Shamika Goodson and Will McLeod.  Many more people will be involved in the twenty-three (23) monthly RIEs over the next two years.  A team of nine will be assembled the third week of January 2010 to work on the first RIE: ‘Supplies at the Point of Use.’  Over the next twenty-three (23) months, an RIE team will be assembled each month to improve various parts of the patient care process.  This work is being modeled after a national project, ‘Transforming Care at the Bedside.’

Below is a process map of a Value Stream Analysis.

as is

The 'yellow and pink' notes define the parameters and steps of the improvement work in a particular process. The slips also identify any bottlenecks or waste in a process. This tool is used by the VSA team to identify and track the work plan over time.

Thanks for all your work and dedication to efficiency and excellence in patient care.

Rob