Archive for March, 2010

McLeod Chest Pain Center

Wednesday, March 31st, 2010

Members of the team who were instrumental in preparing McLeod for the review of the Chest Pain Center included Dick Tinsley, Dr. Peter Hyman, Bob Hinshelwood, Tony Derrick and Daphne Heffler.

I want to thank Bob Hinshelwood, Daphne Heffler, Dick Tinsley, Dr. Peter Hyman, Tony Derrick and the teams who stand with them, serving to support patient care in the McLeod Chest Pain Center.  This includes the staff in our Emergency & Trauma and Heart & Vascular programs, as well as EMS caregivers.  Recently, our Chest Pain Center hosted the Society of Chest Pain Centers, in order to review all aspects of our Chest Pain Center and Program.

The independent, external review was led by representatives from the Society for Chest Pain Centers who spent time reviewing standards, policies, procedures and the medical service related to caring for patients with chest pain or a diagnosis of heart attack (MI).  The stringent review began with the patient’s first point of health care contact – the arrival of EMS on the scene or with patients who come to the Emergency Room with symptoms.  Next, the surveyors followed the patient through diagnosis and treatment from the Chest Pain Center to the Cardiac Catheterization Labs.

The Society of Chest Pain Centers examined the preparation and training of our people in order to measure where McLeod stands in relation to national standards and guidelines for Chest Pain Centers.  Specifically, we want to thank those in EMS, Emergency Department, and the Cath Lab – who come together daily as a single team, with a single focus – to care for the patient. 

As an evaluation of the effectiveness of the work, the surveyors also reviewed the outcomes of care for the past twelve months.  This included a national standard known as “door to balloon” time.  This measurement is the time it takes for a patient diagnosed with a heart attack to get from the door of the Emergency Department to the Cardiac Cath Lab, where they undergo a procedure to open the blocked vessel in the heart. 

The national standard is to be under ninety minutes, seventy-five percent of the time.  We are pleased to report a “door to balloon” time at McLeod of eighty-six percent, exceeding the expectation and requirement of the Society for Chest Pain Centers.  This success is the result of teamwork.  Our Cardiologists and Emergency Physicians are leading all members of the team – from EMS through the Cath lab – in a quick, clinically effective approach for patient care.

Most significantly, we appreciate the McLeod Chest Pain Center team participating in the voluntary review of our service to patients with heart disease.  While our Chest Pain Center has been operational for many years, it is good to submit the program to national standards in order to find additional ways to improve services and outcomes for patients.

Thanks,
Rob

So What Did You Learn?

Monday, March 29th, 2010

I was asked by a member of our team what we learned at the Quality Academy recently held at the Institute for Healthcare Improvement. (More information is related on this past week’s international education meeting in my previous blog).  I thought it was a good question.  While we participated in the faculty, sharing some of the improvement initiatives at McLeod… we are also students ourselves, always seeking to learn from others.

For example, one presentation prompted a thought… in comparing McLeod to other leading hospitals, we could be more patient and family oriented in the delivery of care.  We have good patient satisfaction scores and we continue to work diligently toward the consistency of service across departments with the Ten Service Standards. However, at times, many of our efforts tend to be based on our technical knowledge of survey data integrated with our experience. This is a definite strength and also needs to be more informed by patients and families.

Jim Reinertsen, MD, a Senior Fellow with the IHI, and Jim Conway, Senior Vice President at the IHI, both encouraged Quality Academy attendees to use a self assessment tool developed by the Institute for Family Centered Care. In particular, the results should be shared not only with leadership but with a Patient and Family Council as well.

In healthcare, there is a growing realization that care is fragmented. However, when medical care is optimally organized around the patient the results are:
• better continuity of care;
• more optimal office visits;
• less waste, harm and inefficiency; and
• families, who are part of the process, better follow through with the
prescribed regimen of care.

Significantly, increased patient and family involvement is not only the right and respectful thing to do… it is also what clinicians want; it is why they went into health care.

Jim Conway with the IHI summarized the point by sharing what the research reveals within a patient’s perspective.  Patient’s want:
• to be listened to, taken seriously and respected as a partner in care;
• to have things explained fully and clearly;
• to receive an explanation and an apology if things go wrong;
• to have information communicated to all members of their care team with timely documentation which is available when requested.

At first glance, it is also what we want for patients and ourselves.  At second glance, we tend to become defensive and try to explain the complexity of the fragmented healthcare system.  However, let’s not let ‘best get in the way of better.’  There are ways to prioritize and continue working toward the ideal.

So, in this quarter, April to June 2010, we will perform an organization-wide ’self assessment’ with a tool developed by the Institute for Family Centered Care, share the results with leadership and a Patient and Family Council.

If you have thoughts, articles or interest in learning more about this effort to increase our patient and family focus, please let me know.

Thanks for all you do for patients and their families.  Let us continue to partner with patients and families as we seek to improve the health and well being of the people in our community.

Thanks,
Rob

Quality Academy

Friday, March 26th, 2010

Jim Reinertsen, M.D.


Donna Isgett, Senior Vice President for Quality and Safety, and I had a chance to participate in the Institute for Healthcare Improvement’s Quality Academy. We assisted Dr. Jim Reinertsen, a Senior Fellow with the IHI, as part of the faculty leading several sessions on leverage points for strengthening a focus on improvement across the entire organization. The overall aim of the international meeting, held in Boston, was to enhance the ability of leaders in health care to achieve measured quality improvement at the level of the healthcare system. Seven leadership leverage points were offered as design principles.

Leadership teams, composed of Physicians, Board members, Nursing, Finance and Administration, from seven hospitals and three physician organizations participated in the three day meeting. Two of the seven hospitals were from Canada. The physician organizations were from Connecticut, Ohio and Hawaii. It was interesting to review and discuss ways to improve healthcare with this diverse group of leaders and organizations.

McLeod Health was asked to serve on the faculty because of our team’s experience in the Robert Wood Johnson/ IHI effort known as, Pursuing Perfection. In 2002, McLeod was among the six hospitals chosen to participate in a national three-year project on improving healthcare. The lessons learned during Pursuing Perfection were the subject of an IHI Innovation series authored by J.L. Reinertsen, MD, Maureen Bisognano and Michael Pugh.

To read a copy of IHI Innovation Series that formed the basis for the Quality Academy discussion, please visit the IHI website at IHI.org and search for the ‘Seven Leadership Leverage Points.’

http://www.ihi.org/ihi

Thanks for your work on behalf of the patients. Thanks for giving us the opportunity to share the results of your improvement work with other healthcare organizations.

Thanks,
Rob

Health Insurance Reform

Tuesday, March 23rd, 2010

This is a historic time for the American people as we anticipate the provision of health insurance coverage for many by 2014. Both the Patient Protection and Affordable Care Act (H.R. 3590) and reconciliation package (H.R. 4872) are projected to extend health insurance coverage to about 32 million people, with estimates of 92% of all U.S. residents. It is reported that the Congressional Budget Office estimates the legislation will cost $940 billion over 10 years.

At McLeod, our focus continues to be on improving the health of northeastern South Carolina through prevention, treatment, advancements and service. Now that Congress has acted, our hope is that the discussion will turn to a renewed effort on improving health — to partner with people, employers and others to work on the reasons for higher health care costs. Specifically targeting concerns like obesity, smoking, exercise and nutrition, managing blood pressure and cholesterol, diabetes and the need for all to have a primary care physician.

Throughout the changes ahead, the mission of McLeod Health will be constant – - to care for patients with a continued commitment of excellence in providing services for our region’s health care needs.

Thanks,
Rob

Improving Our Work

Friday, March 19th, 2010

Karen Worrell, Susanne Owens and Tiffni Shealy review the submission of Improve the Process forms. At McLeod, we continue to look for ways to improve our process with new ideas from our people.

In our journey to foster excellence at McLeod Health, we have changed how we gather and encourage suggestions from the entire team to improve processes. The intent continues to be a meaningful way to provide better care to our patients and serve each other, without fear of retaliation for sharing these ideas. During the last decade, we stopped using “generic screens” and “incident reports” to improve processes. Before, generic screens were basically used to communicate a complaint, often about a person, and incident reports were about actual events, (someone fell or was injured, etc. ). These changed to the more positive approach of submitting “Improve the Process Forms.” The tool provides for more details and information involving the “who, where, when, what and why,” something happened.

Our people do not get “in trouble” for reporting something through an Improve the Process form. These suggestions can also be anonymous and do not require approval to be submitted. We get better by learning. We want to encourage people to alert us to concerns, and also to let us know about accidents that may be waiting to happen. The Quality and Safety Department is responsible for responding to these forms, reviewing what and why a concern occurred, conducting a root cause analysis, and coming up with a solution to be implemented in order to resolve it.

In our busy health care environment, with the demands of our work, we can’t fix something we don’t know about, so we need to depend on the entire organization to be the eyes and ears to tell us what needs improvement. We welcome the opportunity to make changes that make our service better or more efficient. Employees can submit Improve the Process Forms manually on paper or electronically to the Quality and Safety Department. Forms are located on the intranet under the Forms Tab and printable forms. The Quality and Safety team receive a number of these forms each month which provide us with ideas for improvement as well as suggestions for correcting a concern or potential error. The receipt of these forms is an indicator we use to access how safe our people want us to be.

Thanks,
Rob

Improve the Process Form – General

Information Systems: Supporting our Business Processes

Thursday, March 11th, 2010

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

State Budget

Wednesday, March 10th, 2010

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

Linking the Past to the Future in Dillon

Tuesday, March 9th, 2010

Dillon community and hospital leaders break ground

I was in Dillon on Monday’s spring-like afternoon to attend the Groundbreaking Ceremony for the new Emergency Department expansion, and many citizens from the Dillon community were present with us to celebrate.

During this economic downturn, it is encouraging, as well as affirming, to have others stand shoulder to shoulder with us in such an endeavor.  Each person present at the groundbreaking was a link to the past.  The hospital has a unique and distinct heritage built upon community support from its founding to the present.  Additionally, the presence of those attending was also a link to the future.  Together, may we continue to be good stewards of the resources with which we have been entrusted to improve our community.

Clink on this link to see the news article from the Dillon Herald newspaper.

Thanks,

Rob

Heart & Vascular Institute

Friday, March 5th, 2010

“Any updates?” is a question several people have asked me in the hallway this week regarding the new Heart & Vascular Institute.  “We can hear drilling, hammering, and moving sounds, but where are we on the project? When will it be finished?” In response, I would like to share a brief construction update:

UPDATE – The demolition has been completed in the former Operating Rooms in the McLeod Tower. The metal stud framing work for the walls is currently underway.

EXPECTED COMPLETION DATE – February 1, 2011

The Heart & Vascular Institute will be constructed in an area of the McLeod Tower, formerly occupied by Operating Rooms (which were relocated in 2007 to the McLeod Pavilion).

With the ultimate goal being a central location, construction of the Heart & Vascular Institute is focused on meeting the special needs of patients with heart and vascular disease. The new center will allow patients and family members to come to an easily recognized area where they can receive diagnostic testing, treatment, surgery, and recovery. Both patients and staff will be able to receive and give care in a more streamlined, efficient manner.

Construction will facilitate relocation of the cardiac day hospital, currently on the third floor of the McLeod Tower, into the main section of the Heart & Vascular Institute. The new cardiac day hospital will have twenty pre-operative rooms, five post-op rooms, five rooms that can be used for patients before or after surgery, two isolation rooms, twelve procedure rooms, two ultrasound rooms, as well as a work area for electrocardiogram studies.

With this relocation, the cardiac day hospital will be adjacent to the cardiac and vascular surgery operating room suites, cardiac catheterization labs, CVICU, and other cardiac services, facilitating more efficient operations and improved patient care.

Thank you for your patience during the construction as we work to enhance our services to the community.

Thanks,

Rob

An Update on Parking

Thursday, March 4th, 2010

A sketch of the Central Parking Deck currently under construction.

Temporary Parking in front of the McLeod Tower

This temporary parking in front of the McLeod Tower will provide patients and visitors with additional parking relief during the construction of the Central and West parking decks. The rain and winter weather conditions in February delayed our progress. However, the asphalt work should take place this week. An additional 40 spaces will help with parking as this ground level parking lot finishes and becomes available within the week.

Central Parking Deck

Again, weather has not been our friend, nor did we expect it to be in February. There are typically twelve to thirteen actual work days in February on construction sites because of the short month and because of our typical February weather. Even with the weather, we are now doing the site work…relocating the fiber optics cables underground, re-routing storm drainage (complete), cutting for footings (nearly complete), re-routing and replacing the grease trap, etc. This is slow, time consuming work and given the weather, progress has not been bad. We also have just taken subcontractor bids and are ready to recommend awards this Thursday at our weekly Planning meeting. Once complete in seven months, an additional 340 parking spaces will support both the McLeod Tower and the McLeod Pavilion.

Thanks for your patience,

Rob