What Do You Think Makes a Hospital Great?

This article called “What Makes a Hospital Great” appeared yesterday in the NY Times. Click here to read it.

It talks about what makes a great hospital. Now I know we have talked about this many a time but it was so interesting to see that the "little things" are as important to people as the big things. This also coincides with me attending the AIDET training hosted by Family Faculty this week. You need to attend the training to find out what AIDET stands for but so much of all of the best practices are common sense.

I often think about needing the fancy equipment and the best of everything for our patients. What the article basically asserts is that customers expect that you will have all of those things but what makes you stand out and gain their trust is the basics - communication, respect, and a focus on listening.

I would be interested in what you think makes a great hospital - either from your experience here, or as a patient, or what you have seen in caring for family members.

Clearing the Skies

I have been back 48 hours from vacation and I have already had 5 people say to me that there is a black cloud over us because so much sadness is happening. Deaths, personal illness of staff, really tough cases with our patients who are struggling with their anger and lashing at staff - Just a lot.

When I got divorced, there were days that I literally didn’t want the sun to come up the next morning. I didn’t want to face one more day. Of course we all know that time is the ultimate healer, but it also took the support of family, friends and church, commitment to keep running to clear my head and seeking outside expertise to help show me the skills I had that I couldn’t see because the pain was so hard to work through.

How do you find your way through tough times? Are there things you could share that might help others?

Thanks for taking the time to post. You never know when your advice could be that suggestion that gives someone else strength that they so desperately need.

Winter Weather and Responsibility

Many of you know both my parents are retired teachers. So when winter came around, they would have their snow chains out and they would to call all of the teachers to make sure they picked them up on the way to school. The biggest issue was trying to decide whether or not to cancel school and what the implications for meeting state mandates on school days attended and the safety of the children. It never dawned on me until I married a police officer that in some worlds, such as police and hospitals, there are no such things as snow days.

I have had a couple of questions on the rumor mill, but more I have heard on the under current and grumbling about why we don't close sites and why we won't just give you the days off. Obviously you assume it is because we don't care about your safety as to why we have this policy.

So let's put it out there - we are a hospital.

While some of our services are emergent, for that family has waited 6 months to see Dr. Janvier, our decision to keep the centers open is not an insignificant decision.

Like it or not, we signed on for a higher order - we care for children. As an outpatient therapist, many of you proactively reschedule patients when you know the weather is bad. For those of us who don't have clinical function, our clinical staff depends on us to be there to be able to do the clinical work if needed, or assist in any way possible to maintain the appropriate level of care.

So, it is not that we don't care about your safety. We do and we give you the chance to make the decision about taking TOP, with your supervisor approvals.

At the end of the day, we are here to serve the kids and like me to support the people who serve the kids

Proud to be at CSH

Recently one of your colleagues shared with me that after reading a weekly wrap up, that she wanted to let me know the CSH Autism program “Friends Like You, Friends Like Me” has reached her neighborhood.

Her daughter came home from school not too long ago with a book all about autism and how children should treat each other. She was so excited about this for two reasons: first she was clearly excited because as she said to her teacher and class "My mom is a nurse at Children's Specialized Hospital and she helps kids there!"

I loved that! Secondly, their family has a relative with a mild form of autism and her daughter was very happy that other kids would be taught how to properly interact with children with autism without as she put it "making them feel like they are different.” Her daughter read through the book given to her and questioned her mom on what she was told and was really happy with what her class was taught.

So it made me think - do you all have a way CSH may have touched your personal life when you least expected it and it made you proud to work with your colleagues?

True Spirit of the Season

Well my last few wraps up had to move to twice a week to accommodate all of the amazing things that you did for the people in the community and then the things that people did for us. I have another wrap up to fill with more things that were done Christmas and through our terrible snow storm but I thought it would be fun to ask you to share your favorite holiday story at the hospital. It can be something you participated in, something you saw given, or just something you want to share.

There were so many to choose from but for me it was Christmas eve when Lori Velasco and her family brought dinner for the inpatients in New Brunswick. Lori had already told me that she had made a promise when her son was in the hospital over Christmas, she promised herself that she would come back and help patients and parents through the holiday. Her family brought in all the food and then she introduced to her family friends. These weren't people who were related, but really close friends. When I thanked them for joining the Velasco's, this particular Mom said to me, “we sat on the other side of the bed praying for a miracle following the accident. Our prayers were answered and now there is no place we should be on Christmas eve.”

Of course I was fighting back tears. I get it. I am the one who tells everyone I can that you guys create miracles, but to hear it from someone who had been a visitor and supporter in the Velasco's journey reminded me of the amazing impact we have on people's lives.

So what is the story you would like to share? It can be silly or serious. Thanks in advance for sharing!

Thanksgiving Challenge

Thanksgiving is my favorite holiday. Not just because so much care goes in to the preparation and the gathering of family but because it is the one holiday that all Americans celebrate. It is a day that our forefathers created to make us purposefully stop and think about all the things that we have to be thankful for and especially for what people gave up to start this most amazing country.

I have been following the posts on Facebook of my friends who have taken a pledge of giving thanks for something each day. Some of them are serious, some of them are funny, some are memories of loved ones lost and some are thankful for the bounty they have been given. So, I thought it would be fun to start a thankful list on the blog. It could be big or small but I would ask that you try and relate it to something or someone you are thankful for at Children's Specialized.

For me, I have so much to be thankful for. Children's Specialized allowed me to jump onto this amazing wave that you had going. Seven years ago when I got here, you were a couple years into a strategic plan that envisioned growing outpatient services and building a new hospital at the same time implementing values that would help us through good times and bad. As I look back seven years later, we have done much of what was in that plan. We have had great people join our ranks; over 300 new people have come to CSH in the last seven years. We have said goodbye to some friends and welcomed some back. The days are filled with both a lot of hope for the future and a lot of work to be done. I am thankful that I was selected to come into the CSH family and allowed me to be part of the amazing work that we do.

And you?

Sharing the Changes of Healthcare

There are times when the healthcare industry is in an uproar and I may only share information with you sporadically. Partly because maybe I am trying to not make you worry or maybe it is because I assume if I am hearing these things, you are hearing them too. This year we did not make the Best Places to work from Modern Healthcare. From the comments on the Modern Healthcare Survey, it is clear that we need to do a better job of communicating what is going on in our hospital industry. So here it goes - Here are some of major changes that have happened in the 2010 in the hospital industry that have affected many hospital employees and people who receive care.

RWJ Rahway in July of this year reduced management’s salary by 10% across the board and all other employees by 5%. They took back a week of vacation from all management employees and have stopped the hospitals contribution to the 403B plan.

RWJ Hamilton and St. Peter's Hospital in New Brunswick were forced to lay off 200 employees each or not fill positions that were currently open due to their decreased census. St. Barnabas announced the sale of all of their long term care services, impacting 600 employees.

Many hospitals throughout the state have frozen wages and have stopped any contribution to their 403 B plans.

State employees had to agree to seven furlough days, (meaning they can’t work, nor will they get paid for that day) In addition, a new law requires an increase in their health benefits contribution.

Beginning January1, Medicare will reduce its payments to NJ acute care hospitals by $1 BILLION a year, each year, for the next 10 years.

Economists say that the recession is over, but the financial growth may never reach the levels of before September 2008.

The State of the NJ is facing a $12 BILLION loss in 2011. The Governor has committed that he will not raise taxes and this loss is after his difficult reductions made in last year’s budget.

So why do I tell you all of this? There will be more hard times ahead for the State of NJ and for all of the healthcare industry. Besides continuing to deliver high quality care and make wise management decisions, we must continue to distinguish ourselves with our positive culture, delivery of high quality care and your commitment to our children and their families. It is being able to live our values each and every day, even though there may be chaos and tumult going on all around us. As much as we can, this Senior Leadership team is going to work hard to mitigate the pressures of the outside world but we are going to need to make changes in order to do that.

In 2010 we began an effort to systematically review every thing we do - every process, every contract, every thing to ask our selves are we doing this in the most efficient way for our families and our staff? There have been great things that have come out of that review, and we have uncovered many opportunities to make more improvements. That work will be part of what we do each and every day - not a one time project. It is much like the changes we have made in reference to quality improvement. This process is not to make “more” money for the organization but knowing that our reimbursement is going to be flat or reduced, we need to make sure we have money to continue to meet increased salaries, health insurance and reward employees for your superior work.

So what does this all mean for you? It means that the work that we have done to date, improving the quality of care we give, including our families in helping solve problems, being focused on becoming the most efficient organization we can be, all are a strong foundation for the challenges that we will face. I am absolutely confident that we will come out the other side of these challenges an even stronger organization, more resolute on doing all that we need to for our kids.

What I need from you are your thoughts on how best to engage all of you in this constant change that is going on. I truly want you focused on continuing to do great work but I know you need a context to understand why we are doing the things we are doing. Please give me your suggestions on how best to connect with you and make sure we are doing the best job possible to align all of our goals with the realities that we are facing.