Through It All

This has been an awful eight days. I know for many, you still have no power and are just beginning to figure out how to rebuild your lives. I don’t want this blog to diminish any of the pain you are going through. I want to provide an opportunity for people to share what they have been part of or have seen given during these last eight days.

Having a bird's eye view in the command center, I saw more than I wanted to at times! I saw amazing acts of generosity - Bobbi Jo Pansier organizing work crews at the homes of two staff members to pull out their carpets and get their stuff out of their homes before the mold set in.

I saw people take coworker’s cars to go sit in gas lines so they would have gas to get home. I saw Phd trained professionals vacuumed floors and clean bathrooms because it needed to be done. I saw people bring in food from home for our inpatient staff, so they didn’t have to eat sandwiches one more day. I saw people who stayed 48 hours straight, sleeping at the hospital so kids would have care. In the devastation we had some fun. Every baby they gave me to feed, I put to sleep before they finished their bottles! I saw Pastor Baker walk in to Stevens Road and then a miracle - the power came back on! Beth Anne M. Dobosh showed up on Halloween with the best looking witch hat I have ever seen!

And in it all, I saw love. Love for our children. Love for each other and a desire to give and do more. Please share you stories about what you experienced and how you are feeling through it all.

Half Way There

We have now finished more than half of the employee meetings and we have had some really good dialogue around the topic of “us and them.” While the specifics are different depending on the site or the shifts, so many of the issues are rooted in a failure to communicate or to communicate with candor and directness. Let me share some examples.

- One of the respiratory therapists told me that she was so frustrated that every night she comes in and the oxygen tanks are empty. She was convinced that someone was doing it intentionally to start her shift off on the wrong foot. When asked if she had told anyone, the answer was no.

- When talking to the therapist about their frustrations, they have consistently messaged that they are being asked by the parents an update on the reauthorization is in progress. The therapist just know they sent it to PAS, but they have nothing to say week after week. PAS on the other hand is on the phone each and every day fighting with the insurance companies to get the reauths and if they are taking calls from 400 therapists looking for updates, then they can’t get the reauths.

- My manager has no idea how hard it is to reach productivity levels and I shouldn't be punished for no shows and cancellations.

In each situation, how much easier would it be if we could just talk through these things? If there is a way to hard wire communication to make sure people have what they need to respond to our families and your colleagues – we need to find it. In the situation of the oxygen tanks and the reauthorization, an automated process, maybe a checklist or information being included on the mini, would help get the most current information to the therapist and the parents.

How many times do we get paralyzed, or angry, and let it impact morale because we assume that people do not understand what the other person is going through?

When I ask people if they have communicated often I will hear "no" or "I can't "or "I am afraid". So here is my short answer, if you are not giving that information to someone in a position where the rationale can be explained to you or we can improve what is going on, then we are destined to remain living with this frustration. I for one don't find that acceptable. Part of our culture of caring is to communicate directly with the person you have an issue. HR can help coach you on how to do this if you are not comfortable, but not dealing with the issues and putting your head in the sand, does not help anyone.

One of the vehicles you have to express how engaged you are as an employee is the survey that begins on November 5 - 15. While we ask you to complete the survey, it really is about your direct supervisor. There are open ended questions where you can comment about me or any other member of leadership, both positive and negative.

So I ask you again, please let me know if there are ways to facilitate these conversations to deal with the issues that prevent you from providing the best care or services possible.

Why Didn’t I Think of That!

Have you guys checked out Pinterest.com?  It’s a new social media site where people post pictures of their dream houses, travel destinations, recipes, or even helpful hints.  This had me thinking, why not do a little sharing here about tips and tricks that have made your life easier, stress reduction or just helping you remember something important – either at home or at work. 

When I was at Medical Day Care last week, Jennifer Bobadilla started singing itsy bitsy spider. When I asked her about it she told me she sings the song twice through while she washes her hands.  They used to use the birthday song, but the kids would get so excited thinking it was someone’s birthday!  When the survey team came in for long term care, they cited us for hand washing because we were washing our hands but not long enough outside of the water. Now, I find myself thinking of those two things every time I wash my hands.  Singing a little song in my head – easy to remember. 

Trish West Lowe, PT Toms River, had shared with me that she lost weight by increasing the speed of her running. She didn’t want to add more time to her workout but wanted to get more out of it. Trish instituted a process where she would run full out and then walk and then run full out again and practiced over and over again until she could run it the whole time. She cut time off her run and lost weight.  Win win!

It made me start to wonder whether or not there are helpful hints that you would share that could help others. They could be fun or serious, personal or at work - but in the end I know we’ll all be grateful for a few tips and tricks to make our lives easier. 

Please share!

Amy

Power of Positivity

My friends who are dedicated to yoga tell me that part of the importance of the meditation process is to be able to visualize yourself somewhere that brings you to a place to alleviate the pressures of the day. Today it is harder than ever to "turn off" those constant electronic and external stimulus or things going on in your own head.

A friend from church shared with me that her daughter was being bullied on Facebook by other girls. The things that we all know teenagers say, but when I was a kid, I went home and my parents could spend the time talking to me and helping me clear my head and reposition my thoughts. Now, the kids come home and get on line and all of the pressure of the day are there right where it was in school. Finding the way to turn off negative things in our life is a really important tool to give us perspective.

It is just as important to understand how your words here at work or online, can impact all who are around you, not just our kids or their folks, but also the people we work with each day.  In our Culture of Caring, we stress the importance of using a caring, compassionate tone at all times.  Because of this, we also have an official HR policy (HR-56) that explains in detail the use of social media on your own time off premises.  The policy details our expectations and the importance of understanding the written word posted online has the same negative effect, if not more, as it does if it is spoken within our buildings. 

Staying positive can have a profound effect on the people you interact with.  Judy Potter recently approached a little boy waiting for an outpatient appointment and he said to her, "Tomorrow I am going to hit a home run!"  Just out of the blue - Isn't it amazing how just one little sentence can set the tone for your attitude in how we live our day?

Judy's wondered what we could say to ourselves each day as an affirmative statement – here are a few of her suggestions, I think they’re great!

"Today I am going to comfort a parent”

“Today I am going to mentor a team mate”

“Today I am going to say something that makes someone feel appreciated.”

How might you answer that question?

Is there someone who has shared something with you that has changed your day or given you a new perspective?

“Today I am going to …"

Much More Than a Walk

As I drove to Johnson park on May 19, I thought about how blessed we are that we have people talented enough to figure out how to encourage 2,000 people to come out and support us and our kids. When I pulled in, I parked next to a car full of people with white t-shirts which said on the front 'miracles happen’ and the back ‘Team Ariana,’ for our own Ariana McQuire, CMNH Miracle Child. As I walked to the "gathering place", I was overwhelmed by the huge crowd of PSEG employee's. The chair of the team had made a personal commitment that she wanted this to be their best year ever and they won in 2 categories, largest corporate team and most money raised. They were so proud of themselves and their smiles could have lit up the park at night.

While I had met Coach Stringer before, I never had the chance to really talk to her. To share how important it is for us to be able to celebrate the success of our children and continue to raise funds that are so important for our continued success. She saw the commitment and excitement that people had to be there but more importantly, the love we have for each other and our children.

Over and over again I saw children who had been with us as inpatients, now home with their families, continuing to thrive and accomplish things that I couldn't have imagined when they arrived on ventilators and so frail. To watch them run around and be defiant of their parents made me laugh out loud at how "success" is seen differently based upon where you sit!

Then I saw many of you. Coming with your spouses, your children and even, your dogs! Joanne Hunt won for the most money raised by an individual and it helped put Team Mountainside over the top. But team New Brunswick had the largest number of members, taking that honor!

You gave of yourselves again, as you do each and every day.

So I offer this with my deepest thanks. I would love for those of you who were at this walk, or past walks, to share what was notable to you.

For me, it is the chance to have a little less formality and to see each other with a "humanness" that sometimes gets lost in our day to day work.

Sharing Your Voice

Last week I was in Washington for the public policy council of the Children's Hospital Association. We heard from national experts giving their thoughts about what was going to happen with the Supreme Court on their ruling of the Healthcare Law, and the outlook of the Presidential campaign. While the experts offered many different views, what struck me was one common theme.

All agreed that regardless of who is elected President, or who controls the Congress, the federal deficit will be addressed in 2013. Cuts will be made in all federal programs and they will be severe. No if’s, and’s, or but’s about it - severe cost cutting will happen. This means that Medicaid, the program so many of our children rely on will be cut. The question is not if it will be cut - but by how much.

Staff from Congress came to speak to us. They reminded us that when Medicaid was created, it was intended to support the healthcare needs of the poor - not what it has evolved into, it is now the program covering the massive long term care expenses for the elderly. (In NJ most of the $6 billion spent in Medicaid is spent on the elderly in nursing homes.) They said we must be able to have an honest, thoughtful conversation about how to restructure the program or else the program will be cut irrationally, and arbitrarily.

My gut wrenched. It is time to sit down and be an adult. Not just an advocate who says, “you can’t cut me; go look somewhere else,” but instead asking for real solutions.

It took me immediately back to what we have been talking about over the last 2 years. I have told you that we are not going to get paid anymore in reimbursements. The president of the American Hospital Association said last week when he spoke at a private meeting of NJ Hospital CEO's, "What you get paid today, is the most you will ever be paid. You have to do more with less, and if you don’t figure it out, someone else will."

This wasn’t news to me, and shouldn’t be to you because it’s something I’ve been discussing over and over again. But just like a recent conversation I had with a staffer who shared their concerns, “How do we have the courage to put ideas and real changes on the table that might hurt for a short time, but protect our entire program for years to come?”

I thought about examples of changes we made personally or professionally and wondered if we had the benefit of hindsight, we might have personally done things differently. There is no argument that whether you call what we have been through since the crash of the stock market in 2008 a recession or a depression, we know that 1 in 10 people are unemployed and the numbers of those underemployed are 1 in 19. People are hurting. Some have lost their homes, or are working two jobs. Some of you have shared the challenges your spouses and family members have faced and are still facing. Your children have moved home or you are helping support other loved ones who have fallen on hard times.

At some level, we knew that the "good times" couldn't last forever - right? Our houses were worth twice what we paid for them, by doing no additional improvements; we were getting salary increases every year, even though we were losing money and we were consuming. Consuming products and stuff (iPad’s, computers, houses …who would ever pay more than $50 for a purse in 2000?). We were buying bigger houses and as a people, Americans were running up huge debt. And then it happened. The bottom fell out. What would you have done differently if you knew then what you know now?

And that is how I am looking at the conversation last week in Washington. The experts tell us “it” is coming. Congressional staffers, off the record have said, you have to give us something to restructure the programs you depend on or you are going to end up having people who don’t understand what you do as well as you do, restructuring the program for you. I am now talking to my colleagues about putting tough questions out there and trying to give them the hard medicine but at least we can prepare for how to live with it.

That is what the 100 day work outs are about and why we continue to ask you for your ideas on restructuring our business and becoming more efficient. We have to change. We will not get paid any more for the services we deliver, and in some cases we will get HALF of what we get today. We can be mad that we are in this financial time or we can use this time before the cuts happen, to figure it out and be ready.

If you don’t engage in this process and give ideas to your supervisors and directors, then the cuts will come and we may not make the "best" decisions, or the ones you think we should but I am asking you now - get engaged.

Even if it is in other departments - often it is hard to see how to change when you are in the middle of it. Right, that is why we go to personal trainers or counselors, we need people to help us think through and work through. We hired consultants who helped us get started on the 100 day work out process, but now it is on us. What should we do? How can we make changes? We had this discussion during the employee meetings but most of the conversation was about doing more, spending more money, which is ok but it does not get us ready for what is certainly coming.

So I ask you - what is that our senior leadership is not doing that we can do better to get you engaged in this process, of putting real ideas on the table for significant change? Because it is coming, and changes have to be made. If you want to be part of what the change looks like, now is the time.

You have a voice in this. Make it heard.

Stepping Out… of Your Comfort Zone

In the course of our lives, we all find ourselves in situations that I will describe as outside of our comfort zone. Things that if we weren't required to do it, or love the person who asked us, or felt like we "had" to do it, we would never other wise do. For me, that was last weekend. The Friends (formerly known as the Auxiliary) asked me to help them with their fundraiser. I said yes and then they told me it was to 'dance' in a ‘Dancing with the Stars' contest. I still have never seen the show but you guys get the drift - beautiful women dancing with men who can dance and then getting voted on.

To set the picture for you - my friends call me 'Grace' not because I am graceful but because once a year I take a nose dive when I am out for a run at 5 am and end up bloodied and battered - which is really attractive. So when I realized I was going to 'dance' in front of an audience - I was looking for the door. But, I had made a promise and I was going to figure it out.

So I go to Joanie Roop, an amateur dancer, RN Education Dept, who has won competitions and hooks me up with a dance instructor who will do this with me. After 19 lessons in just 8 weeks, I am dancing in front of 200 people. My goal - don't throw up and don't fall. I hit my goal, but I tied for third place out of four.

The process reminded me of how many things we ask our kids and families to do on a daily basis. On the inpatient unit, their pain is palpable and we are asking them to walk and talk in excruciating pain. In outpatient, we are trying to get them to keep coming when the continued progress is not always apparent but has to be built over months, not days. In LTC, parents give their children to us...virtually turning them over to us and leaving. These are incredibly difficult things - much more difficult than dancing and we all take it for granted. Just like the people who watched me dance. It was terrible for me. Not fun, just torture. Am I glad I didn't embarrass myself? Yes. Was I proud of what I did? Not really. I just got through it. I could never 'embrace' it because I was so uncomfortable. How many of our kids face the same challenge? Or their parents not being able to accept and love their 'dancer' in the way they want to?

It was humbling and in some ways defeating that I couldn't get out of my own way. But you know what - I did it. The Friends raised money and everyone who loves me was there by my side, cheering me on. That was the gift. Not the gift of dance, but the gift of love from friends and family and most of all, humility.

So, I shared mine - I am human. Sometimes, being human isn't enough - but it is all I could give and the next day - the sun still came up.

I’d like to think by sharing my story, I’ve helped others think about how they approach their own personal or professional challenges.

Would you like to share about being in situations that are outside of your comfort zone and how you overcame it?

Cultural Change

Last week I had a chance to spend a week with people from all different countries, and industries, for a course on managing change. While the framework of the basics was the same as we all know – I did learn you have to have a specific vision about where you want to take your company and do a thorough implementation plan and then check the execution. Implementing a change in the operations of the organization and implementing cultural change is tremendously different. I am preparing to share my conference experience in a clinical rounds presentation soon but this experience made me think about each of you and how you have managed a "cultural" change in your life.

In our personal lives, “cultural change” would be something that is a permanent immersion or approach to a different way of life. For example, a “culture change” could include becoming a vegetarian, or adopting a new healthy lifestyle or maybe moving to a new part of the country. Of course having children and getting married mark changes as well.

If I had to name just one cultural change in my personal life, I would say it was adjusting to being divorced. It wasn’t just not being married anymore, it was really learning how to be comfortable in my own "skin." That means being alone and not just filling time, but really learn to be thankful for the time I had alone and finding ways to embrace the change. Like most things in our lives, I was resistant at first and gradually began accepting this new way to live - not just a way of life - but a way to live. So as always, I am interested in what cultural change you have made in your life and how you adopted it.

You can be anonymous! I truly believe sharing some of your personal experiences or best practices are helpful for your friends and colleagues and they may certainly apply at work too.

Talks of Hospital Mergers Begin

Yesterday, five North Jersey hospitals announced plans to sell, explore a merger, and seek a new buyer to help solidify their existence in this turbulent health care market. Children’s Specialized nor our partner RWJ were among them. Take a breath.

We knew this was coming.

Is Children’s Specialized talking with other health systems or hospitals about mergers or acquisitions? As a member of the Robert Wood Johnson Health System, we stand strong under their powerful umbrella of services. The system is in constant state of conversations with many because of their strong market position. We provide such specialized care that our services will always be unique and the talk of us “merging” with another pediatric rehabilitation hospital is non-existent. We have a 120 year history of providing services for children with special needs and we will see it through for another 100 years.

What does this mean for you? Change is happening all around us and the best way we can remain in the forefront of this evolution is to remain vigilant at responding to doctors and hospitals who want us to care for their kids, improve our processes, cut expenses and continue to improve the quality of our care. Even if our services are so unique, we still are a “health care service provider” and we are faced with the same challenges as all hospitals. Our reimbursement rates are decreasing, our federal and state funding is diminishing and the funding we do receive will be based on the quality of the service we provide and patient satisfaction.

Below is an article that was in today’s Star-Ledger detailing the news about the mergers.

I will continue to share this information with you and give you an opportunity to ask questions. Please don’t hesitate to contact me or your supervisor.

We will discuss this further as we pick up another round of our employee meetings. Keep an eye on the intranet for a schedule. Meetings to begin in late February.

- Amy

Star-Ledger/NJ.com - Thursday, February 02, 2012, 7:35 AM

Big hospital merger plans part of dizzying day for N.J. medical industry
By Susan K. Livio and Seth Augenstein/The Star-Ledger

It was a dizzying day for the hospital industry Wednesday, as executives from five North Jersey hospitals announced plans to sell, explore a merger, and seek a new buyer to shore up their stake in the state’s competitively "harsh" health care market.

Industry experts said even more sales and consolidations were looming as hospitals brace for the financial consequences of the federal health care reform law — insuring more people while cutting costs — which will take effect in two years.
Kerry McKean Kelly, a spokeswoman for the New Jersey Hospitals Association, said health care reform was driving a lot of the discussions about consolidation and partnerships. "There might be a single payment for an ‘episode of care’ that would be divided between home health aides, physicians, nursing homes, hospitals," she said.

In addition, she said New Jersey’s "harsh marketplace," with high costs and limited reimbursements, was also forcing hospitals to rethink their business model.
The state Department of Health and Senior Services must approve any hospital sale or merger.

According to Wednesday's announcements:
• Hackensack University Medical Center and its investment partner, LHP Hospital Group, announced the purchase of Mountainside Hospital in Glen Ridge for $190 million — $160 million more than owners Merit Health Systems paid in 2007. Hackensack and LHP are already awaiting state approval to reopen Pascack Valley Hospital in Westwood.

• Ascension Health Care Network of St. Louis, Mo, the nation’s largest Catholic hospital system, confirmed that it is talking to St. Mary’s Medical Center in Passaic and St. Joseph’s Regional Medical Center in Paterson, for the "potential creation of a new Catholic health care system in New Jersey," a spokesman for Ascension, Joe Orlando, said.

• Prime Healthcare of California dropped its bid to buy Christ Hospital in Jersey City. "Christ Hospital must now work through very difficult financial challenges, and it remains to be seen if there is another viable way forward," said Peter Kelly, the hospital’s president and chief executive.

• St. Luke’s Hospital and Health Network announced it would add Warren Hospital in Phillipsburg to its roster of facilities in of Lehigh Valley, Pa., with plans of reviving maternity services and investing up to $6 million in its intensive care unit.

Industry insiders also expect an announcement soon regarding Barnabas Health, the state’s biggest hospital chain, which has held lengthy talks with the University of Medicine and Dentistry of New Jersey over University Hospital.

The two said in a statement that they were pursuing an affiliation, but that any change would "preserve the clinical, academic and research alignment between The University Hospital and the UMDNJ New Jersey Medical School." Industry observers have said this simply means Barnabas Health would run University Hospital.

The new owners of Mountainside told employees there would be no layoffs, and that services would be expanded if the state Department of Health and Senior Services approved the sale.

"There will be no impact to staff at all — everyone will be hired for the same positions and same salary,’’ a spokeswoman for the hospital group, Pat Ball, said. "There are no plans to discontinue services."

The collapse of talks involving the purchase of Christ Hospital by Prime Healthcare — which is under investigation in California — was welcome news for the nurses’ union, which publicly fought the sale

"This welcome withdrawal of Prime Healthcare from its intended purchase of our community hospital represents a new opportunity to protect access to quality health care for our patients and residents," said Ann Twomey, president of the Health Professionals and Allied Employees.

Ascension’s arrival would preserve the dwindling presence of Catholic hospitals in the state, said Donald Malafronte of the Urban Health Institute. "St. Mary’s has been marketed around for awhile," he said, while St. Joseph’s is carrying a lot of debt.

Always Room for Improvement

Great news - The employee engagement survey is back and as promised you gave us very important feedback that will help us improve our life at Children's Specialized.

Your Managers and Directors will discuss the data with you in early February for your specific area. There were some important themes that I would like to share with you ahead of time and also ask for your input to help me understand how we can improve our employee engagement.

Our overall scores showed us in the 86th percentile compared to the other Children's Hospitals surveyed.

We scored the highest on – “Would I recommend Children’s to my friends or family who need care.” To me, this speaks volumes and is the highest possible endorsement anyone can give to an organization or business.

This is the EXACT question our federal government will evaluate from our patient satisfaction surveys of Medicare patients. We should all feel very proud of this because it reflects our performance of our core business, the exceptional care we deliver to the children who we are privileged to treat.

We scored higher than our comparative group in the areas where we spent a great deal of attention on improving since our last survey. These were questions that dealt with communication by your Manager or Director, working cooperatively between work units and being respected by the person you report too. This has been a very important focus to us and the results of this survey showed you valued our improvements.

The survey identified two areas where we need to reestablish focus: recognition of the work you do and career development.

It would be really helpful to hear from you, besides more money, what would be recognition that would be most meaningful to you? In the same vein, understanding that in health care, frequent title changes or promotions are not the norm. We will be using the 100 day work out to begin to identify solutions to improve these areas for us.

In that same way, we will be doing the survey again in 2012. Just as we have moved on the speed to change and respond in our quality and efficiency, we need to do the same with employee engagement. We must measure where we are, create changes to improve, and then measure again.

Please share your thoughts on the blog about recognition and career development. Your suggestions are always so helpful and the blog could provide a forum to get different opinions out there.

Many thanks as always.

Gifts – Good, Bad, Hilarious!

Happy New Year! I hope everyone had a joyous holiday with their family and loved ones.

One of my friends got a new Ipad for her birthday and she is totally enthralled with all of the things it does. She told me about an "app" that she called "Shazam" that will match the music that is playing and tell her what it is. Think of how many times we have heard a new song, or even an old song that we hadn't thought of for years, and you want to find it but can’t remember the name. This technology gets you the song just by listening to it and will allow you to buy it on Itunes immediately.

So it started me thinking, let’s have a little fun surrounding the holiday season and talk about some of the great or funny gifts we each received this year. Did you get a really great gift over the holiday - new technology or something that makes you smile? Or something that made this holiday extra special?

My cousin gave me "dysfunctional family bingo" - haven't opened it but it did make me laugh. I’ve also heard of families passing around the same gag gift every holiday – is this part of your family’s tradition? If so, what do you pass around?

What about that present that just made you go, “Hu?” You know, when Aunt Nancy gives you a lovely baby sweater, but you don’t have any kids. Or Uncle Charlie gives your 9 year old son a pair of pink bunny slippers?

Let’s have a few laughs and enjoy our gifts a little longer by sharing our stories.