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.

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.