The Patient Patient

Have you ever thought about the definition of the word "patient?”  Because I am such a geek, I actually looked it up and this is what I found;

adjective: patient - able to accept or tolerate delays, problems, or suffering without becoming annoyed or anxious

noun: patient - a person receiving or registered to receive medical treatment.

The definition of the adjective made me laugh and then get uncomfortable because I am sure the origin of the word came from people having to wait to see their doctor! 

So here is my question to you - do specific terms/words or labels really matter?

Within the adults with disability movement, there has been a lot of debate, discussion, and change based on the "terms" The Association for Retarded Citizens is now the ARC. Instead of "disabled people" or "the disabled," people with disabilities have asked us to put the "person" first and not their disability.

Within the medical field, a discussion has begun about what it means to call someone "our patient."

Research has shown that how we live, what we eat, how we treat our bodies actually can influence our health outcomes to a greater extent then our DNA. Scientists will argue over how much, but the impact is there and I have seen numbers as high as 90% - as what you do to yourself vs. the genes you are given.

So if that is true, shouldn't the language being used in healthcare empower people to take control of their own health? Not to "accept or tolerate delays," as the definition of “patient” describes; but to proactively take control of their health and their bodies. The words we use and how we encourage people to activity participate in their care is a huge issue in pediatrics. When we talk about the patient - sometimes the best treatment is purely engaging the family in the care of their child. How are we "partnering" with parents and what are we doing?

Our efforts in patient and family centered care has been about developing that partnership. Finding ways to share clinical information and then providing a plan of care that will help the parent be part of the best outcome for their child. There is often much work that must be done outside our walls to get these amazing outcomes that have been achieved. You have inspired the families to dream of what is possible and be willing to put in the work to achieve, sometimes the impossible.   

You have heard me talk about the next wave of consumerism in healthcare. My parents wait for hours to see their doctors and hang on their every word. Conversely, I won’t wait 10 minutes and after the appointment I immediately go to the internet to check their diagnosis or treatment.  Think about how the use of technology is going to change the delivery of care. In the adult world, people now want the concierge service, access their physicians whenever they need them and they pay big bucks to do it. Telemedicine is not only being used in far away places to bring in specialists, but it is also being used on a "regular" basis for follow up visits and for people who are willing to pay for access.

I share all of this to ask you to think about how we might begin to meet the needs of the children who come to us seeking an enhanced experience and outcome.

Think about how the language we use impacts how families partner with us and also look for areas we should change right now - to make the rest of the world catch up to us.

While I don't know what the future looks like for healthcare, I know one thing for sure - it will be different than it is today. The need for quality outcomes combined with technology and the pressure to be much more efficient is definitely going to cause change. The only question is will we be driving that change or chasing others? The decision is ours.

Preparing for the Unthinkable

"Cop assisted suicide" - I have never heard that expression before and now I have heard it twice in one week. The first time I heard it was when the New Brunswick Detective was preparing us for an active shooter drill. Kevin Sullivan partnered with the New Brunswick Police Department to perform a simulation of a person entering our hospital that was armed and was shooting randomly. The police said the profile on these individuals is that they are looking to be killed in the middle of such a horrific act of them randomly killing people – hence the table “cop assisted suicide.” We took the drill very seriously and the staff did a magnificent job protecting our children and each other. When the code was called, staff responded very quickly and there was absolute silence on the floor as we waited for the code clear to be called. The police warned us that it could take hours for an all clear to be called because they would have to not only track down and neutralize the shooter, but also make sure there was only one shooter and not a group. As I woke this morning and heard the announcement that the Garden State Plaza was on lock down and they were searching for a shooter, I was immediately taken back to being on the second floor in New Brunswick, gathered in the eerie silence as we were waiting for the code clear to be called. The lock down in the mall began at 9:30 p.m. and by 3 a.m. all mall-goers were still locked inside. In writing this, we now know that the shooter took his own life and that there were no other injuries, while the police said he clearly had several opportunities to injure many more people. As I write this, the emotions I have are many. I am comforted knowing that we successfully completed the drill and we are better prepared than we were the week before. I am disheartened that the only way that this young man saw his way through whatever tortured him, is to cause this kind of panic and to ultimately take his own life. And then lastly my deep sadness over the night of fear and torment the people who were locked down and the families who waited for them must have felt. We must continue to prepare for those situations we pray will never happen. We also need to work to provide treatment for those who find themselves unable to find the words to ease their pain instead of resorting to violent acts of terror. If you feel compelled to share your comments, please do so. Any comments about participating in the drill; any feelings you have after hearing the news of the mall shooting – this blog is meant to be an open dialog and platform for sharing.

Trust

A national consulting agency's recent survey indicates that 40% of employees trust their boss.

Talk about stopping me in my tracks...this means 60% do not. Can you imagine what would happen if 60% of the parents who brought the children to us for treatment didn't "trust" us? Our jobs would be SO much harder. We can ring our hands about why this statistic exists or we all can take the "acknowledge it, own it, change it" approach.

Influenced by the last employee engagement survey and focus groups which were designed to learn more about your feedback, your senior leaders are working on how we can become better leaders, individually and as a team. We realize that to truly change our culture and make lasting improvements we have to “start at the top”.

Ok, stop the eye roll. You know how this works - change is a lot easier when your leaders are working together to address both organizational issues and team issues. And let me tell you, the work is personally hard! Not hard like learning how to talk and walk again, but hard because you have to "own" the things as a leader you bring to the table that affects your team and then find ways to address it to make improvements.

So, full disclosure here - For me my issues are around trust, once someone or something that I have invested in breaks my trust, it is very hard for me to trust again or reinvest in the same way. Usually it happens with the State or Insurance companies but it happens with individuals too. This gets in the way of getting the work done because I am constantly looking for ulterior motives. I wait to be disappointed again or even worse, find ways to work around people or issues. Because I am afraid of being disappointed I simply take the issue away from happening in the first place.And you know what? It takes a lot of energy that is not positive. And it doesn't bring out the best in me.

So what am I doing about this besides acknowledging it to 1200 people? I am taking it in steps. Being authentic with people and telling them when whatever the interaction that happened didn't feel right, or my perception of how it was going to go versus how it went didn’t match up. I am trying to talk through it - not stew in my own head but finding ways to discuss whatever the issue is.

This takes a leap of faith – a shift in my thinking about why something happened and most importantly, it requires trust that together we can move the organization forward in a more successful way than working separately.

All of us on the senior leadership team are working on how we lead individually and as a team - you will see the results of this work play out in many different ways through our employee engagement efforts, in direct response to your valuable input. New communication and feedback vehicles, more training and mentoring opportunities, and more thank you's for the great work done every day, consistently to stay on our journey to be the best we can be.

This work is not about a quick fix or the latest management book fads. Building trust through authentic listening and communication is a cornerstone to a positive culture. It takes time and focused effort to see the results but we are committed to taking this path together.

You will be hearing soon and regularly from Randy Blackmon, our employee engagement and service excellence officer, reviewing again the details of the last survey results, current and upcoming employee engagement efforts and how we are implementing improvements through our Operation Excellence performance model. The Engagement League (I see capes and super powers in our future- no really) have made a strong commitment to keep you better informed year round. Stay tuned.

Not sure if any of this resonates with you but if you have suggestions for me or the team, I would welcome your thoughts and suggestions. I will repost this on the blog so you can share your thoughts with your colleagues.

Humbled

Humbled - is the word that continues to be in the forefront of my mind lately. In DC last week, I was humbled watching a family who has created a "typical" life for a child who requires so much medical care and attention. Their entire family’s life decisions center around Lily's care and how to make sure they create a full family with their 3 younger children and include Lily where no one feels she is different, but everyone understands that sacrifices have to be made to make sure she has a full life.

Humbled is what I felt when I learned that one of our therapist had been named the sponsor for one of our patient’s first communion. The bond was so strong that she would ask her therapist to go through this momentous occasion with her and will remain connected to her for her entire life.

Humbled when I saw the photos of a patient and her family that were invited to a therapist’s wedding shower because they have become so close.

Some have heard me say that I have the best job in the world. We get to do amazing work each and every day - being invited into families’ lives to try and make it all better. Or sometimes just to make sense of what is there. And we have assembled a team of people who are both highly talented and are selfless, compassionate souls who will do anything to help a child reach their full potential.

People spend their whole lives looking for what we sometimes take for granted, a company with heart.

Now does this mean we are perfect? No. We all can be better and we need to be for our kids. But every once in a while it helps to take a step back and be humbled by the work we do and the people we get to do it with.

Humbled and proud....

2012 Highlights

Well, we have closed the books on 2012 and what a year it was! We have a whole lot to be proud of. I want to use this post to talk, in some detail, about our success and how we got there as well as discuss the goals for 2013.


Vision
Let's start with a refresher. We have a vision and a mission that drives our organization. Our vision is, "To create a world where all children can reach their maximum potential." For me, this means that every child deserves our absolute best to ensure they achieve all that is possible, regardless of how sick or challenged they may be. And we, as clinicians, are often the people that give them, and their parents, the tools to help on that journey. It may not come in conventional ways, but we must never stop looking for ways to innovate and give hope.

Mission
Our mission is that "we are going to be the preeminent provider for specialized health care services for children." There are two phrases in here that we selected deliberately but that we have a lot of feedback on and that is forcing us to review this.

First is, “preeminent” - people say what does it mean? To me, it means the best of the best. We are going to set the bar high and everyone else is going to be learning from us on how to get there. We are going to do this not just as the biggest, but by looking for innovation and examining what the families’ needs are, not just with clinical success. The second is, “specialized healthcare services.” We are not serving the "typical" rehab child anymore. Most of our children have habilitation needs - children with autism or with developmental delays - we are helping them achieve goals for the first time not as "rehabbing" them to regain a skill they had before. Although people continue to tell me that no one knows what those words mean, our efforts to clarify may be muddying the waters. Something we are actively looking at.

Four Pillars

We do all of this by breaking our annual corporate goals into four pillars that drive all of our work. Those pillars are Quality, Employee and Community Engagement, Service Excellence and Profitable Growth. The six corporate goals then fit into these categories, and then they cascade down to each of your individuals E 3 goals to help us achieve the corporate goals each year. Each of the corporate goals has metrics under them: threshold, target and maximum. The threshold is what we need to accomplish just to get through the year. Target helps us take a breath and say we did better than we thought, and then aspiration is just that - the goal we aspire to achieve in a year.

In 2012, we achieved five of our six corporate goals. Four at the aspiration level, one at target and one not at all. It is important to discuss how we achieved them as much as what was achieved.

Quality - We achieved the aspirational goal for our Quality goal in 2012. The Quality goal is measured by our Quality Report Card, which is located on the intranet LINK http://mtapsp10/Pages/Hospital-Announcements.aspx. We achieved the aspirational goal by achieving six out of seven of our quality goals established.

Goal #1
Flu vaccine - In 2010, the JCAHO, the federal agency that accredits us, said that hospitals must vaccinate 90 percent of all employees by 2020. Many hospitals instituted policies that said you can't work at the hospital if you aren’t vaccinated. Others did what we did which was to say that for new employees we would make it a condition of employment, therefore, telling people, right upfront it wasn't negotiable on a go forward basis. By achieving this goal early, we have demonstrated to JCAHO our achievement of their aspirational goal eight years early. I couldn't be prouder of achieving this goal.

Goal #2
WeeFim Score Change – We use a tool, WeeFim (Functional independent measure, Wee is for kids) to measure an effectiveness score. We use the tool to measure children’s functioning on admission and on discharge and the change score is measured against similar facilities. We achieved better than benchmark.

151,000 people die each year in hospitals from things that could have been prevented and even more acquire new illnesses in the hospital due to things the hospital or their staff did. The remaining four goals on our report card related to these issues, or preventing these issues: hand washing, blood stream infections, medical errors, and sentimental events (patient death).

Goal #3
Hand washing - I know this one seems like a "no brainer" but when you think about the fact that one nurse on a 12 hour shift might have to wash her hands hundreds of times on a busy day, you start to see how hard it can be. Every time you touch a child, you need to make sure you wash first. This is to reduce the spread of germs from one to the next. We have a very aggressive secret shopper program who observe what staff are doing and then calculate the percentage of times we achieve the hand washing goal. In 95 percent of the cases, we achieve our goal! We will continue to strive for 100 percent, but this is a great accomplishment. When JCAHO comes, they will be observing every interaction our children have with staff and they will track whether or not we accomplished this in 100 percent of the cases.

Goal #4
Medication errors - Of course we would like to say we have ZERO medication errors but the team of Pharmacy, Physicians and Nursing has driven the number to an astoundingly small number that we are almost there! Over 400,000 doses given on the inpatient unit, we only had 20 errors, and none caused harm to the patient! This is a phenomenal rate, and one we are so proud of.

Goal #5
Blood stream infection rate - We have been consistently working to drive down our blood stream infection rate. This is something that they call a “high risk, low volume” situation for us because we have very few children who could even get a blood stream infection because we virtually have no chance to cause an infection, except for children who are receiving a special type of nutrition through a TPN process. This means we don't do it very often, which means we are at greater risk for something going wrong. The children on TPN, are very, very fragile medically, and getting this blood stream infection could prevent them from getting a needed transplant or other life saving intervention. It is further complicated by the fact that the child could have picked up the infection in the sending hospital but it doesn't appear until the child gets to us. While we did not achieve our goal in this area for this year, we have redoubled our efforts to examine every opportunity to improve on this, including sharing our best practices with the referring hospital and partnering with them to keep the child infection free because we are both committed to the whole child - not just when they are within our care.

Goal #6
Sentinel Events - This means an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. The goal is to have none of these types of events. We had no sentinel events this year, and therefore, achieved our goal.

Goal #7
Reduction of trach decanulations - Nursing and Respiratory on LTC Mountainside did a great job of making considerable reductions, exceeding our goal. By working together they identified opportunities for both product improvement, (we ordered different trach ties) as well as examined how we transferred kids from their bed to their strollers or chairs, when we examined the data, it revealed this is when they occurred most frequently.

Reducing Cost Per Unit
Under profitable growth was reducing our costs per unit of service by 10 percent. We reduced our cost per unit by over 5 percent, which is a great accomplishment but below our goal. The cost per unit means we need to reduce what it costs us to see a child in all settings. This can happen by eliminating waste - meaning stop doing things that take time, but don't add any value. It also happens by increasing the number of children we are seeing and spending the same amount of money. An easy way to think about this is through all of the automation we have done. When we automate a process that used to take people hours to do, that allows those people to do other things at the same cost we were spending before. We need to be focused on this because we know that neither the government nor insurance companies are going to pay us anymore to provide services and in order to keep giving raises, doing more training, buy new equipment, we have to figure out how to live within a smaller budget, even though our expenses are going up. I often say I would rather be ready when the cuts come, then scrambling to figure it out. We are definitely doing the work now to be ready.

We achieved the aspirational goal under profitable growth for our combined operating margin. We measure this by combining the Hospital and the Foundations profit margins. It is important to look at these two numbers because we set up our processes very differently as a non profit hospital than a for profit, due to our charitable commitments. The work that we do in the hospital allows the Foundation to go out and inspire donors make us their charity of choice. The Foundation's ability to raise funds is directly related to how we care for our patients, the programs we offer and how we operate. Due to the success in eliminating waste from our hospital functions through the 100 Day Work Out process and an exceptional fund raising year by the Foundation, especially due to team Children’s Miracle Network Hospitals team, we made a 3.8 percent profit. This has allowed us to continue to expand our services and continue programs that we otherwise wouldn't have, including opening in Egg Harbor Township and soon to open Newark in the Summer. Our continued focus on the 100 Day Work Out process and on our path to Excellence will help us during the uncertainty of healthcare reform.

Profitable Growth
The second Quality goal besides the report card was achieving the aspirational goal of serving 20,495 children. We were able to reduce our neurodevelopmental wait list from 2,500 to 270 children waiting for an appointment today. This is an amazing accomplishment that was done by every part of the outpatient team working together. The physicians made dramatic changes to their schedules, we hired more docs, streamlined our authorizations, improved scheduling and it has resulted in improvements in this goal of improving access and profitability for the organization. This was truly transformational!

Employee Engagement
We achieved the target goal in our employee engagement. We ranked in the 88th percentile of all Children's Hospitals who take the same survey. While we are very proud of this score, increasing 2 percent over last year, you have told us there is still work to be done. We have been doing so many good things but you have told us that you want understand our direction and progress in a more uniform way. So we will be expanding our 100 Day Work Out process, focused on improving quality and eliminating waste into a process which we have named Operation:Excellence. This is adapted from GE's process they used to achieve great success. I will be telling you more about it during the employee meetings in June. Our effort is to address the direct feedback that you don't have context for the decisions that we make or how the work you are doing day to day fits in to our overall strategic goals.

Service Excellence
We achieved our aspirational goal of our net Promoter Score with Press Ganey. This is the score that the federal government looks at to determine the level of satisfaction of your customers. They look at one question - "Would you recommend this service to others?" They then apply a formula that subtracts your 1’s and 2’s from your 5’s and divides by your total number of surveys. The federal government says you need to be at minimum of 50%; we had an average of 80.3% which is an exceptional score! It also means there are still people who are not sure they would recommend us. For us, in examining the data, this comes from people giving us 4's instead of 5's. We will continue to pursue how to move those scores. While we are doing well, we know that the federal government will increase their score, and again, we want to be ahead of the curve.

So what does all of this mean? We should be very proud that our hard work paid off and we are achieving the goals that we set for ourselves. All of the goals are focused on preparing us for the future. A future where quality and price is going to decide whether we will get to even treat the child. We must be the provider with the highest quality and lowest cost in order to continue the excellent work and relationships we have with our children.

I look forward to sharing the goals with you for 2013 at the employee meetings in the coming months. Thank you for your continued dedication and hard work. It is an honor to work with each of you.

Please feel free to comment or ask questions below.

Amy

The Power of One

Can one person make a difference?

I know this is rhetorical question but as I have watched the "Fiscal Cliff" discussions it has struck me just how one person can really play a pivotal role and also, how important the personal relationships are in that person making a difference. It also has made me start to think about how each of us could be that person who makes a difference in the lives of the children we serve, with our colleagues and people in our own community.

During the last 72 hours, one of the most powerful men in the country, Minority Leader Senate Mitch McConnell reached out to his former Senate colleague, now Vice President Joe Biden to ask him to step in and try to broker a deal. McConnell served with Biden and while they are of opposite parties and big differences in political ideologies, he trusted Biden and he knew they shared the same values. They valued the institution of the US Senate and what they were sent to Congress to DC to do. He knew that if we had gone over the "cliff" that the financial devastation and the public's disgust with Congress would never be restored. While the President and Speaker Boehner could not find words to communicate because they had no underlying relationship or trust, they couldn’t put together a deal.

The issue of trust is a tough one. It can not be "ordered" or mandated, it has to be earned. We ask our parents to "trust" that we have the right diagnosis and expertise to help their children but it is only after they see that their children improve that we begin to earn their trust. It is about how we deliver for our families and for each other that trust begins. It isn't about saying "I told you so" (although sometimes we want to say that) but it is acknowledging that what you said you would do you did or what you said would happen has happened.

Another example of the power of one is NYC Mayor Bloomberg. He is entering is last year as Mayor. People are starting to review his accomplishments during his tenure. He has had many accomplishments - streets are safer, public education is restructured, put calories on fast food menus, and maybe most surprising, obesity rates are down, attributable to his changes in transfat cooking. Bloomberg has made millions in business and brought that acumen to being Mayor. He knocked down all of the individual offices and set up a "bull pen" where everyone works together in one room with open cubicles. He forces people to interact and work together.

This week, one of long time patients from Mountainside LTC will be going home. It has been 12 years of her living with us - she has never lived at home. It has taken a village to keep her alive and get her all of the medical attention she needed to go home. It has been amazing to get to this point. Every person who has cared for her and negotiated with this family deserves credit for her being able to go home, but it was Maura Hines who has worked day in and day out at this point in the process, to convince her family she will thrive at home. Just like Vice President Biden needed to be the person at the person to broker the final deal, you some times need someone else to bring the ball over the line for the score.

Katie Marsala and Bobbi Jo Pansier have been working non stop since Hurricane Sandy to help and support their colleagues and friends. They have opened their homes, organized drives, done everything they could think of just so they could make sure people knew that they were not alone and as importantly that they are loved.

Think about the power of one; the power of trust. Never forget the importance of the little things we do are the building blocks that create trust over time. Perhaps you have a mentor; a special patient experience; a colleague that really has made a difference in your life or the lives of our patients.

I would appreciate if you wanted to share your stories about the power of one that you have seen or have impacted your life.

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.