Thank You Fridays

In my last wrap up, I mentioned that we are designating summer Fridays as “Thank You Fridays” You can wear jeans every Friday through the summer, but in exchange, you need to thank someone you work with who you appreciate and who has helped you in some way. I LOVE this idea because there is nothing better than showing appreciation for each other. It doesn’t have to be the "you saved my life" thank you but the little things people do each day.

We will do it on the honor system, but my only request is you have to thank someone different each week. You may also post your thank yous here on my blog.

Can't wait to see the blogs or hear the stories! Thanks, James Marotta, for the great idea!

Here’s an example of a thank you I received from Geetha Bharathan - Geetha, sent me a small embroidered pouch. In the pouch it contained "worry dolls" the legend is that if you "give your worries" to these dolls each night, you will be able to start each day anew. She was concerned about how much I worried about each of you and our children and she wanted me to have some relief. I was so touched by her kindness and as a way of trying to relieve my stress.

Please share your words of gratitude below.

Laughter Is The Best Medicine

So it was one of those days where I just couldn't catch a break. The stress and worry of running 13 kids down this week on the inpatient unit and being behind on the outpatient volume has left my nerves frayed.

Have you ever noticed that when you are at wit’s end, there is something that happens that makes you laugh at yourself?

So in the middle of trying to figure out how we are going to tell of our Board of Trustees we are going to turn around a 500K loss for the year when the census is so far off and I know June will only make the hole bigger, Rose comes in and says "we have a problem". Never a good sign.

Stephanie Jones was on the phone. EZ pass was threatening to fine us $500 because one of our CSH vehicles was not accurately registered. Carl Gelormine and my name are on the account and they would only speak to one of us. Great. Carl is on his sick bed and so it was left to me. We had to get the secret code from Carl and the vehicle information from Kevin Sullivan.

I was finally able to sit down to make the call last night. I push the buttons and get to a live person. She asks me a series of questions - account number, security code, address on the account and the license plate number.

Then she says "Ok. I can help you. What type of vehicle is it?"

I stop dead knowing I don't have the right information - so all I can come up with is, "It is a blue truck with a Children's Specialized sign on the side." Like she really cares about the color and signage!

"Is it a Ford a Chevy? Two doors or four doors?" she asks.

Again, I’m dumbfounded and can’t muster anything else to say but, “It is blue."

We both crack up and she says she’ll list it as “unknown.” We both start laughing so hard we can't stop.

So at the end of a rough day, without a lot of answers, a little humor never hurts.

Got a funny story to share?

Unexpected Gifts

Thursday of last week was a particularly difficult day. It was what I call a "three-fer". I had committed to too much on my schedule, I wasn't as prepared as I wanted to be and it was a 200 mile day driving myself all over the state. So you know what happens, I don't sleep the night before, fretting that I am not ready for all of it, having those repeating comments in my head which alternate between why didn't I prepare more? And you are a loser for not being at the top of your game. Neither thoughts are helpful in getting the sleep I need for what will end up being a 15 hour work day.

So, I get through my first meeting. Gave my presentation and hit it out of the park. Late to the next conference call and had to leave early. I didn't really fulfill my duty as I should have on the call but was able to skate.

Jumped in the car, late, to drive 51 miles and needed to arrive in 57 minutes. You are getting the picture right? Get to location for the speech that I was still changing the slides during the previous conference call. Speech is to 100 really smart people, on the future of health care in NJ.

And it happens.

I get my cadence. I never played team sports because I was the nerd, but I imagine that is what the sensation is like - when you just know there is nothing that is going to slow you down. It was a home run.

At the end of the speech, a woman was waiting to see me. She said " I heard you give a speech in 2004 with similar themes, including about knowing how to define the end of life,” the woman said. "Within 6 months of you giving that speech, my 88 year old mother entered the hospital and the doctors started talking about opening her chest for cardiac surgery and that she would be able to survive on a vent I heard your voice. You said – ‘you need to love them enough to celebrate their lives instead of fighting their deaths.’ She died peacefully the next day and I wouldn't have done that if I hadn’t heard you speak."

There is a reason we are sent on certain days to do certain things - even when we don't know it at the time. My guess is that this has happened to you before - a gift that comes when you need it the most and expect it the least.

Do you have any similar stories?

Beating the Blues

Ok - so I need your suggestions.

There are times in all of our lives, work and personal, where the weight of it all, meaning the things we need to manage, just seem overwhelming. In health care, it has been especially difficult because we know our reimbursement is going to remain flat or even go down, when every other cost we have is going up - including wanting to increase salaries.

There is so much to be excited about - the great work we do, the friends and family we have, that we live in a great state where you can be in the mountains or at the beach in an hour or less but I have to be honest, there are days I just want to pull the covers over my head and make it all go away.

I have told you before that I go running to clear my head, but sometimes that isn't enough. Unfortunately I usually end up in DSW buying some really high heel that is going to make my feet bleed, but look really pretty on. That is the price we pay for fashion and a little retail therapy. My rock of course are my parents, who are never seem to tired of giving me that hug and that reassurance that this too shall pass. In the end, I know they’re right, but hearing it from them always seems to make it better.

So what do you do when you are trying to shake it all off and refocus on the good?

Any tricks can you share?

The Art of Negotiation

Next month I will be doing a panel discussion at the Governor's Council on Women and the topic is the art of negotiation. I started my career as a social worker and negotiation is at the core of what we often do with and for the people that we serve. Trying to negotiate services, trying to negotiate with clients to identify their needs and create plans that they will actually follow to improve their lives. Most people think about negotiations like a lawyer around one specific issue. I would argue that we all should think about negotiations in terms of our daily life - work and personal.

Some of you may have heard me say, in a tongue and cheek way, that I think life is all about the accumulation of points. There are some days that you are doing good deeds or favors for others and you are ringing up "good will points” - not that you need something right now, but you know there will be a time when you need something and you can pull on those points, or favors, to be able to get you through a tough time. See, most of us do really well in times of crisis. We can rally and step up and show our best. Sometimes we don't always do well on the day to day.

This week a long time employee was telling me she finds herself on the receiving end of what can only be described as verbal abuse from her colleagues about how they have had enough of "her" demands and they aren't going to do it anymore. When I push to identify who these people are so we can give coaching about our values and culture of caring, she says she isn't comfortable because she has to work with them every day and doesn't want to be seen as "ratting" them out.

This conversation made me so sad at so many levels. Sad that she did not feel like she could tell her colleague to stop yelling. Sad that her colleague was so frustrated that her only tool to manage the stress was to yell. Sad that even after all the discussions about creating a non punitive workplace where we hold each other accountable, we still are uncomfortable doing it, And last but not least, most sad that the child who needed our care was being delayed by our internal issues.

So I will continue to "negotiate" with each of you about creating an environment that allows you to hold each other accountable for the behaviors that we all signed up to uphold when we joined Children's and we will live to fight another day.

Our kids need us.

We must.

The Big Pink Elephant

As you know we did not make the Top 25 Best employers in the State this year. We have received the actual survey results and comments.

In most companies feedback like this would normally be the “big pink elephant” in the room that no one wants to talk about. But the only way things get better is to put them out in the open and have a plan to make it better.

These statistics and comments help our senior leadership gauge how well we’re doing on employee satisfaction. There were many positive comments and negative as well. Our raw score dropped overall by 10 points and in each individual category by an equal or greater amount.

Your feedback was very telling about what you were unhappy about and what you would like to see addressed. It is also clear that there are some misunderstandings about all sorts of things from how we make money to how some of our benefits work. Here are a few noteworthy comments:

1. A few people didn’t understand why we are expanding our outpatient sites if we were having money problems.

Here is some clarity: Our Foundation raises money dedicated specifically for renovations of current or new locations, and then we hire staff to serve more patients. The only way we can make more money is to see more kids. There is no other way for us to be able to cover our increasing costs without continuing to grow.

2. Someone wrote that they were unhappy the tuition reimbursement was eliminated.

This one is just not true. We did not eliminate our tuition reimbursement program. We just put a cap on how much we will reimburse and that an employee must continue to work at CSH for a specific period of time after they complete their course. It’s unfortunate, but we had people get their degrees and resign after their graduation.

The examples above speak to a bigger issue of miscommunication and access to information. While we have the weekly wrap up, this blog, children's chatter and the intranet where a lot of information is posted, face to face interactions makes all the difference. This is an area where we can improve, and will!

I have asked Senior Leadership to start attending staff meetings to reinforce that you have access to have your questions answered at any time.

We will also be implementing “lunch and learns” given by Senior Leaders. We will advertise the topic and you can bring your lunch and learn more about all sorts of topics that were identified in your comments.

Many comments also referred for the need for more employee recognition and events we can do together. You ask, we provide.

We are going to have a get together during rehab week in September. We will also use this as the chance to recognize the employees who celebrated their milestone years this year and last (5, 10 15 years of service). In addition we will be pulling the stars that have been given out at each site and the person who has had the most Press, Ganey comments written about them by site and creating special recognition for them.

While I am disappointed that we did not get the recognition, not because of the award, but because it was your way of saying that you aren't happy.

While some will argue that it is not a surprise given that we aren't giving raises and we had to make a lot of hard choices about changing benefits in order to avoid layoffs, the bottom line is that your comments and scores tell us that you didn’t think we handled the changes in a way that was appropriate for you and I own that. No excuses.

You have given us feedback of the things you want changed. Some we can fix; some we can't. But through it all we will keep talking and using your feedback to make us a better organization and a better place to work.

Your ideas and comments are always welcome.

Amy

Defining Quality

One of the ongoing discussions in the health care industry is how do we define quality?

In acute care hospitals, the government has established report cards and uses those as a measure of quality. Most consumers/patients do not read these report cards before they go for services. They simply ask someone who they liked and whether they were "good" or not.

This is a sticking point between my parents and I. We continuously battle about which is the “right way” to choose a care provider. My father defines quality by whether or not he likes the doctor - meaning is he/she personable. My mother makes her decision based on whether or not the person will tolerate her eight million questions, give her all of the tests and prescriptions she wants and whether or not her office bills correctly so she doesn't have to fight with her insurance company.

We know that one of the ways people judge quality is based on our Press, Ganey surveys. How does the parent feel about the care we gave? Some would argue that like my Dad, the doctor may be really nice but is that really the way to judge the care given?

Our parents rely on Children's Specialized Hospital to do the screening for them. To find the highest qualified staff who will provide the best quality of care. We wouldn't hire people that weren't high quality and therefore that is something they don't worry about.

The question of how we define quality is often subjective. We observe practice patterns. We rely on supervisors to model and mentor and yes, we use Press, Ganey surveys to give us an indication if something is not going well.

The federal government has told us that they are going to pay hospitals more if they have good quality. Since we don't have a federally accepted report card, many of you are working on "proving" that our care is high quality. This is going to require us to delve more into research and partner with others in order to validate what we do. I know we can do it!

Another pressure we are facing is that quality is now tied to price. Can your hospital operate with what you are reimbursed? If you can't, there is an assumption that your hospital is not efficient and that signifies a problem. We can argue that as a pediatric rehabilitation provider there are a lot of nuances and differences for the cost issue. The State of New Jersey is looking at a $10 billion budget deficit, they aren't going to care about our differences. They are telling us the money has run out and we are going to have to do with less, unless we prove our worth and our outstanding of quality care.

So, we are looking at all of these aspects of quality. Looking at identifying things we can do differently, smarter, with more efficiency and to get better outcomes for our children and our employees.

The major reason we moved to an electronic medical record was to improve the quality of the care we delivered and to hopefully make all of our lives easier in using one system. We know in December that we had NO missed doses or medical errors with pharmacy. Some would contend that our new bar coding system is working. Outpatient therapists are telling me that there are definite improvements in being able to do evaluations and get their billing done.

So let me ask you - are there things that we can do to improve quality? Are there things we can do today to improve our efficiency?

These are conversations your directors are going to have with you over the coming weeks. They will look to you to give them great ideas and guidance so we can continue our move to excellence.