Archive for October, 2010

McLeod Tower Façade Repairs and Improvements

Friday, October 29th, 2010

Work is currently underway to replace and repair the masonry mortar joints on the McLeod Tower.  Also, repairs are being made on the roof parapet.  The roof parapet is the low protective wall or railing along the edge of a raised structure of the roof.  The McLeod Tower opened thirty two years ago, on November 16, 1979.  It is now time to prepare the building for the next thirty years.  These enhancements will also provide a chance to make the building more energy efficient.

Work is currently underway to replace and repair the masonry mortar joints on the McLeod Tower.

A common maintenance task for brick masonry is the repair of mortar joints, commonly known as ‘repointing.’ Removing deteriorated mortar from the joints of the masonry wall and replacing it with new mortar will restore the visual and physical integrity of the masonry work on the McLeod Tower.  The most common means of water entry into a brick masonry wall is through de-bonded, cracked or deteriorated mortar joints. Repointing of the mortar will improve resistance to water penetration. Repointing deteriorated mortar joints is one of the most effective and permanent ways of decreasing water entry into brickwork.

The replacement of the existing roofing materials is expected to lower roof surface temperatures by as much as 100 degrees F. This work will result in improving weather proofing and energy efficiency.  By decreasing roof temperatures, the amount of heat transferred into the building is reduced.  Reducing the heat load transfer from the roof is expected to reduce peak load cooling demand by as much as ten to fifteen percent.  The cost to air condition buildings is the sixth largest demand for all electricity generated in the United States.

This work is expected to take approximately four months.  We appreciate your patience while we improve our facilities for patients.

Thanks,
Rob

Operational Effectiveness Event

Wednesday, October 27th, 2010

This week in the Pharmacy at McLeod Regional Medical Center in Florence, an Operational Effectiveness team is working through a process known as ‘6 S.’

6 S‘ is defined by McLeod as Sort, Set to flow, Scrub,  Standardize, Sustain and Safety.  ‘6 S‘ is the name of our workplace organization methodology that describes how items are stored and new order is maintained.  The decision making process that guides ‘6 S‘ comes from work with the team about standardization which seeks to build an understanding for the team on how work should be done.

The team’s ‘Reason for Action’ this week is to improve the efficiency of the Employee Pharmacy in order to have shorter wait times and more products available.  This will lead to overall lower unit costs for prescriptions and medicine for our people. It is anticipated that more McLeod people will want to use the Employee Pharmacy in the new benefit year beginning in January 2011. The team is also looking for ways to make ‘Payroll Deduction’ from the Employee Pharmacy more ‘user friendly.’

This is a mock up of the layout of the McLeod Employee Pharmacy, which allowed the OE Team to review the flow.

The Pharmacy Operational Effectiveness Team is composed of Chuck Rozak, Olivia Eitzman, Bryce Williamson, Lacy Brinton, Brandi Lane, Renee Anderson, Joan Ervin, Bart Watford, and Will McLeod.

Where does this work fit into the overall picture?

In two of our goals for improving the organization through Operational Effectiveness, we focus on (a) showing respect for people and (b) continuous improvement.  These ideas find themselves in our McLeod ‘Overall A3 or Reason for Action.’  Specifically, ‘To show respect for people by making the work more enjoyable’ and ‘To improve our use of resources to benefit our patients, our community and our people.’

We appreciate the work of this Operational Effectiveness Improvement Team.  The principles and methods learned this week will be applied to many areas of our work processes as we continue our quest for quality.

Thanks,

Rob

‘Raising the Bar’ in Dillon

Wednesday, October 20th, 2010

Cynthia Pernell, CRT/RCP, M.Ed., has been working steadily with the Cardiopulmonary team in Dillon to raise the bar by certification.  Due to the progress made by this team, we want to acknowledge the following note from Cynthia.

Rob,

It gives me pleasure to inform you that as of September 1, 2010, the Dillon Cardiopulmonary staff are certified in ACLS (Advanced Cardiac Life Support), PALS (Pediatric Advanced Life Support), and NRP (Neonatal Resuscitation Program)!!

We believe this is a first in the history of Saint Eugene and McLeod Medical Center Dillon for staff to hold all of these additional certifications.

Tiffany Davis, RRT/RCP, and Tammy Dixon,CRT/RCP (at left), review a patient's cardiopulmonary status.

What does this mean? With additional certifications we are assured that we have Cardiopulmonary staff who are capable and confident to assist in the management of critical patients from neonate to geriatrics.  The employees studied long and hard to receive all these certifications.  Again, we want to congratulate them on these prestigious certifications:

Aubrey Arnette
Penny Badgett
Patrick Chavis
Tiffany Davis
Jean Deese
Tammy Dixon
Anthony Ellerbe
Ida Jacobs
Tracy Johnson
Mandy Locklear
Pricilla McRae

Thanks,

Cynthia

I would like to share this news and thank the team for their work on these additional certifications.  I also want to recognize Cynthia M. Pernell, CRT/RCP, M.Ed., Director of Cardiopulmonary Services at McLeod Medical Center Dillon, for her leadership and encouragement to the staff. 

Thanks,

Rob

Listening

Thursday, October 14th, 2010

“In Wales there is a romantic village, Beddgelert, the name of which means, “The grave of Gelert.”  There is a famous legend about this Gelert, which was a dog, the hound of Llewellyn the Great.  One day, on returning to his castle, Llewellyn found his child lying dead, and the hound, Gelert, beside it.  Llewellyn at once plunged his sword into the poor animal, only to discover too late a huge wolf which had attacked the child, and which the faithful hound had slain.  In his blind rage, Llewellyn had killed a faithful friend.”  Such was one account of the legend of Gelert that I read the other day in J. Sidlow Baxter’s book, Awake My Heart.

While I paused to reflect upon the point the author was making with the legend of Gelert, I also thought of other examples of hasty responses. Some which, many of us, must often take notice of and refrain in making.

Listening is a skill we all need to learn… and a skill we all need to improve upon.  How many times through email or busy schedules or multitasking have we missed the point of someone’s communication, or worse, misunderstood the intent and filled in the blanks with our own ’story.’  Then in haste, we respond or act upon our misinformation, only to make the situation worse.  It takes time and experience to learn how to listen to one another.

There is a class in McLeod University which helps to understand our patterns of poor listening.  The class also offers positive changes which will improve our listening skills.  So, the next time you find yourself in a communication loop that has turned out poorly… and you see faithful Gelert trying to help you… know the problem and the root cause before you offer a solution.  You may also want to sign-up for the McLeod University class on ‘Listening.’

Thanks,
Rob

Operational Effectiveness Work

Tuesday, October 12th, 2010

Recently, a team worked on a Rapid Improvement Event (RIE) in the Value Stream (VSA) of Excellence in Bedside Nursing.  The goal of this work is to remove waste and unnecessary steps in our work so that the nurse at the patient’s bedside may have more time with the patient.  The leader of this work is Leanne Huminski, our McLeod Chief Nursing Officer. The Process Managers from Operational Effectiveness are Larry Adams and Bart Watford.

The most recent team worked to build an effective way to admit patients from ICU and PACU to the 9th floor.  Improvements in this pilot can then be spread to other similar nursing units.  The Team Leader for the week was Theo Willard.  The Implementer was Kelley Prevatte.  The RIE team members included April Davis, MST (7E), Chip Osborne, RN (MICU), Ester Thomas, RN (4E), Michelle Powell, RN (9th), Emma James, Sect (9th), Drew Hamilton (Corporate Compliance), Donna Bennett, RN (PACU), Linda Harwell, RN (TSCU), and Charrish Hugh, RN (11th).

I spoke with Drew Hamilton our Corporate Compliance Officer who served as ‘fresh eyes’ for the team.  I asked Drew to send me his thoughts about the time invested in the improvement work.  Here is what Drew shared:

Rob,

The Rapid Improvement Event (RIE) was absolutely a wonderful experience. The individuals on the team worked together tirelessly and had excellent experience in understanding the issues.  We knew what needed to be accomplished in order to achieve the goal of giving the nurse more time with the patients.  I gained an additional appreciation for the job our nurse’s accomplish each and every day in providing quality patient care.

One insight I found is that we become focused on our part of the health system … and often have limited awareness of other parts of the hospital.  I worked with several people who have been at McLeod for more than 10 years and have never visited the 1st or 2nd floor Day Hospital, Pre-admission Testing (PAT), PACU, and so forth.  I feel very blessed that my job in Compliance allows me to become familiar with many areas within the organization.   I also believe my participation in the RIE provides a benefit to our Compliance Program by allowing staff to see me more and get to know me. I think that this will  give them additional confidence about the Compliance Department.

I enjoyed the work in performance improvement,

Drew Hamilton

The ability to see our work and understand our walk from each other’s perspective personalizes our McLeod mission. I want to thank Drew for sharing his experience and am thankful for the profound difference these opportunities make in furthering the mutual respect for our calling to serve others.

Thanks for all each of you do daily.

Rob

Working Together for Better Patient Outcomes

Thursday, October 7th, 2010

Marie Segars, Senior Vice President and Administrator for McLeod Regional Medical Center, spent a day shadowing one of our new developments with the Rapid Response Team.  I thought her insights into our work … and what she learned directly from our staff … was helpful to our overall efforts to improve patient care.  It will give you a glimpse into the work of the Rapid Response Team and the difference this is making in patient care.

Often, the most discerning views are those observed from ‘the-outside-looking-in.’ That is one of the benefits of the clinical support to patients and staff from the Rapid Response Teams. 

‘Roving’ … to find potential issues in a pro-active mode … is a new component of the Rapid Response Team. The ‘rover program’ is a collaborative approach to identifying and managing at-risk patients in our medical center. The nurses who do this work are affectionately called ‘Rovers.’  Recently, I had the privilege to shadow one of these team members. It was an extremely rewarding experience to witness this impressive patient care in action.

Deanna Tedder, RN, with our Trauma Surgical Care Unit, allowed me to follow her for the day. She is a member of the McLeod Rapid Response Team with other ICU trained nurses. This concept of the ‘rover’ was initiated at McLeod more than a year ago in order to improve the care of patients who may be at risk for clinical deterioration. The RNs on the team ‘rove’ the hospital to work with the patient’s nurse to assess and identify patients at risk for changes in conditions.  The ‘roving’ nurse is also able to respond to a call for the Rapid Response Team.  The ‘roving’ work is based on patient criteria developed from our McLeod experience, as well as the medical literature.

Deanna Tedder, RN (at center) and Amanda Carter, RN (right) review Rapid Response Team progress notes with Marie Segars, Adminstrator of McLeod Regional Medical Center, who shadowed with the staff for the day.

The ‘roving’ nurse works with the patient’s nurse to review the clinical data, evaluate the patient, provide a critical care perspective, and coordinate transfers to ICU, if needed.  This is a pro-active approach to identifying patients who might be at risk for complications like:

-Patients just transferring out of any ICU;
-Patients on pain therapy, using Pain Controlled Analgesia (PCA);
-Any patient that the nurse is concerned about;
-Patients with heart rhythm changes as observed on telemetry; and
-Patients on the SAS protocol for Alcohol Withdrawal

We began our day together with routine visits to see patients and their nurse.  Some of the day is detailed below:

-A post-operative patient with a pain pump did not look comfortable. Deanna Tedder assessed the patient’s pain and reviewed the plans for care. The patient’s breathing appeared to be more shallow than desired. Deanna conferred with the patient’s nurse and through this interaction and collaboration, an adjustment was made to improve the patients oxygen saturation.

-A patient, withdrawing from chemical dependency, was observed by the nurse who was concerned for the patient’s overall health. The nurse discussed her concerns with Deanna and they agreed the patient was in need of new treatments. A review of this treatment resulted in calling on the doctor for new orders.

-Then, we were interrupted by a phone call for the Rapid Response Team.  Making our way from the McLeod Pavilion, 9th floor, we traveled to 4E, in the McLeod Tower. A large patient was having a life threatening irregular heart rhythm. Fortunately, he was better, but his physician was notified.  Deanna and the patient’s nurse talked about their plan should the patient have these irregularities again.

-We left 4E and went to see a patient on 7E in the McLeod Tower.  This patient was transferred from the ICU in the prior 8 hours.  Although there were no problems, the family thanked us for checking on the patient and being attentive to their needs. Then, we were called back by 4E, the patient with the arrhythmia was in need of another review.  Deanna spoke to the patient’s physician about the urgent need for a response. The nurse on 4E was very busy on this day. 

-While on 4E, the phone rang again with another call for the Rapid Response Team.  A patient on the 9th floor was experiencing severe chest pain. As we entered the next patient’s room, she looked very sick, her pain was at a 9 to 10 level, and nitroglycerin had already been given. The nurses on 9th floor were already on top of the situation, and Mary Allred, RN, was responding to the patient’s needs — with a heart monitor. Deanna, the ‘roving’ nurse ordered an EKG and some oxygen in accordance with her protocols.  Deanna assessed and administered a second nitroglycerin. Deanna checked the patient’s oxygen saturation, and called the physician who was caring for the patient. Deanna noted the patient had an order for a blood transfusion and suggested to Mary to go ahead with the transfusion. This action would help improve the patient’s oxygen level. After conferring with the physician and the cardiologist, the patient was moved to the intensive care unit.

In all these interactions and others I observed throughout the day, Deanna Tedder was very respectful with other staff, recognizing the daily challenges and complexity in caring for the individual needs of each patient.  Deanna worked on one of our Medical & Surgical Nursing Units before going to work on the Trauma Surgical Care Unit.  Deanna told me that she feels this ‘roving’ experience has also helped her to understand the best ways she can be helpful to the nurse taking care of the patient when on a call for the Rapid Response Team. Our nursing staff welcomed ‘the additional set of eyes and hands’ that Deanna offered during the day. Together, they embraced our responsibility of providing the best care possible for patients.  It was a busy day and one that served as a reminder to me of the extraordinary talent of our McLeod caregivers.  It was reassuring to see in action the truly lifesaving teamwork. My gratitude goes to Deanna for being such a great teacher for me and a really good sport for allowing me to tag along and learn.

Marie   

We continue to remain optimistic about the overall improvement in outcomes for patients and families as the Rapid Response Team assists our nurses in patient care.  We appreciate all the work that is done each day to make care safer and more effective.  I appreciate Marie’s ‘hands on’ approach to learn about ways in which we can improve our service as leaders.  Understanding the daily needs better can assist leaders in removing obstacles in the efficiency and effectiveness of our work processes.

Thanks,

Rob

Leaders at McLeod Learn from Canadian Visit – II

Friday, October 1st, 2010

McLeod Health, selected by The Centre for Health Quality Improvement in Toronto, Ontario as a partner for improvement in quality and safety for patients, was paired with a health system in Toronto, Trillium Health Centre to share information and clinical and operational effectiveness processes. Trillium visited McLeod in November of 2009 and their representatives were pleased with insights and models for improvement from our work that they could take back to Canada.

Members of our leadership team, (Dr. Fred Krainin, Medical Director of the McLeod Clinical Effectiveness Program and a cardiologist in the Pee Dee Cardiology; Donna Isgett, Senior Vice President of Quality & Safety for McLeod Health; and Fulton Ervin, Senior Vice President & CFO for McLeod Health).were able to return that visit to Trillium Health Centre and make their own observations regarding common challenges and initiatives shared by the two organizations.

The previous blog reflects responses from Dr. Krainin, from a physician perspective. These are thoughts from Donna and Fulton regarding their experience.

RC: What was one of the insights you gained from the visit to the Canadian healthcare system in Toronto, Ontario?

Donna Isgett: Visiting the Canadian system was similar to “getting to look through fresh eyes” at many of the ways we deliver care and how it could be more effective and efficient. Specifically, I was most impressed with the way they have engaged their patients as partners in their care to assure the best outcomes and functionality for the patient while reducing cost of care. An example of this was Trillium’s Congestive Heart Failure Clinic, which worked hand-in-hand with patients to teach them to self manage many changes in their condition and to utilize the less expensive outpatient options when they needed to see a physician or receive intravenous medications. This provided “better care, and engaged patient for much less expense”.

Fulton Ervin: Canada appears to have a very centralized system with significant and careful coordination between the government and among hospitals. They have tight guidelines regarding quality and they carefully monitor wait times.

RC: What good ideas did you see that we can study for improving our processes and patient care at McLeod Health?

Donna Isgett: The engagement and ownership of the employees was remarkable. They felt it their responsibility to save time and money in all that they do so the resources can be utilized to care for the patients. There was strong involvement from the leadership team “in the work”. The unit leaders were very engaged and visible in daily improvement around efficiency and safety. Specifically, they had created “Safety Crosses” to display both publically and to the other staff the outcomes of care around hospital acquired decubitus ulcers (bed sores), infections and falls by nursing unit. Everyone including support staff understood their role in eliminating hospital acquired conditions.

Fulton Ervin: They have done a significant amount of research in other health systems, bringing back the best ideas for their hospital. They have rapidly rolled out ‘lean’ improvement projects in delivering nursing care at the bedside, as well as improving flow in the Emergency Department and through the hospital.

RC: Is there anything about health care reform in America that may be similar to what you learned in Canada?

Donna Isgett: In health care reform, the concepts expressed in an Accountable Care Organization are very similar to the Canadian Healthcare System. It was actually very encouraging to see how this model could actually result in tremendous improvements in patients outcomes that were much less expensive. It gave me hope that we can actually make changes in our current systems that will be both good for our country and our patients. The push to have patients in the most effective, least costly location eliminated current difficulties that are often found in discharge planning and home health care. In addition, the innovative use of outpatient clinics to manage much of what is currently handled on an inpatient basis while increasing patient satisfaction was impressive. Finally, the integration of physicians and hospital leaders working towards common goals for the patients was inspiring.

Fulton Ervin: There are many similarities between our proposed Accountable Care Organizations and the system in Canada.. They have mastered taking a ‘pool of dollars’ and allocating it to deliver care to their constituents in the most cost efficient manner while at the same time delivering quality care.

RC: Is there anything else you want to share about the visit?

Donna Isgett: We have much to learn from our Canadian friends, and I hope our relationship with Trillium is a long one for the journey.

Fulton Ervin: I believe Trillium could be a great partner for McLeod Health as we move forward into health care reform. They have tremendous insight in how to operate with finite resources and how to coordinate services. They are skillful at rapidly deploying ‘lean’ projects to remove waste from the delivery system. They have partnered with the University of Toronto to produce an impressive leadership development program. For example, each of their Directors is partnered with their physician Medical Director and complete the leadership program together. Each team works through seven to eight projects that have been designated by the hospital.

We have much to learn in our quest for quality and safety. We look forward to continuing the learning journey with other leading health systems.

We appreciate the Centre for Healthcare Quailty Improvement for sponsoring this exciting exchange program. For more information about our colleagues at Trillium Health Centre, their website is http://www.trilliumhealthcentre.org.

Thanks,
Rob