What are your intentions for 2015?

Can you believe it? The New Year is officially here and we are nearly through January already! If you’re like most people, you started off the New Year with a resolution – a promise to change a behavior or add a behavior in the New Year.

You’ve had about 3 full weeks to work on your New Year’s resolution. So, how’s it going so far? Have you stuck to your plan, or did you become distracted? 

Don’t feel discouraged. Instead, look at your resolution in a different way. Trish West-Low (PT – Toms River) once told me that we shouldn’t be thinking about resolutions which could be easily abandoned, but instead focus on intentions because if we get derailed, we can always refocus and reassert our intention.

Now, that’s really something isn’t it? An intention does not seem to carry the same weight if you end up not following through with your resolution.

Intentions are best set when they are within reach—something you can see and touch; something you can create an action plan for. 

Perhaps your intention for the New Year is to become healthier. To help you set your intention, you should think of a personal memory of when you felt your best and focus on getting back to that feeling. In order to get there, you need to have a plan. It’s not going to happen overnight, but as long as you are moving in the right direction and focusing on the route it takes to get there, your intention can be fulfilled.

Many of you have already heard about my morning routine. For the last 14 years at 4:30 a.m. Monday through Friday I have met my now 85-year-old father at the home I grew up in. We chat about 15 to 20 minutes, just to catch up, and then in separate cars we head to the gym to get our sweat on!

The gym opens at 5 a.m., and the group that is dedicated enough to work out that early is not very large – maybe around 20 people or so. Many people make a New Year’s resolution that focuses on health and fitness—losing a certain amount of weight, focusing on moving more and eating better, or what have you. So, we’ve seen our small group of morning gym go-ers really increase.

And yet, year after year, after just a few short weeks we see that number start to decrease again.  

Now, I’m not one of those regulars at the gym who complain about the “resolution starters” who start coming just because it’s a new year. Instead, I commend them! After all, everyone has to start somewhere.

If each of the new faces I see at the gym set an intention on January 1 instead of stating a resolution, they’d look at their goal in a different way. They’d plan what they need to do in order to reach that goal and be successful.

So this year, the intention I am working towards is to be a better person than I was yesterday. Some days it is harder to measure, but I am purposefully working every day on this effort.

Our intentions at Children’s Specialized Hospital are articulated in our vision to create a world where every child has a chance to reach their intentions – their best self. We know we are a big part of helping them take that first step, say their first word, or connect in a way you could only dream about.

That is what we do each and every day. We are working towards that vision – one step at a time.

What vision are you stepping into to? What do you wish for in this New Year, and how will you get there? I would love to hear what your intentions are for 2015! 

Skipping the line with the new tablet registration

In a perfect world, our patients and families wouldn’t have any wait time before their appointment. After receiving some feedback from patients and families, as well as observation from staff, about the registration process—we knew we had to figure out a solution to a very long registration process.

Drumroll please…

On December 15, 2014 our Mountainside outpatient center rolled out a new tablet registration process! And so far, the feedback has been terrific!

Here’s how it works—a patient comes in to register for their first appointment, we need to scan them in or double check their documentation before “clearing” them. We would work with this patient to clear all of their documentation before moving on to the next patient family – who is probably here for their weekly therapy visit.

So, if the next patient in line has already had their paperwork checked and is considered a “clean registration,” they’d still need to wait until we complete the registration for the first patient.

You can see the issue here.

This new tablet registration streamlines the whole process and decreases wait time. Now, each patient will receive a card that will allow them to check themselves in at the self-service kiosk. How cool is that?!

Let me explain.

Greeters wait in the lobby in Mountainside for patients to arrive. The greeter can see the patient’s appointment time as well as if there is any documentation that they need copies of or signatures for.

Each patient gets a card like the one below. This card allows them to breeze through the registration process with just a swipe! If there is any missing documentation, the system will alert the family (if using the self-service registration) or the employee that something needs to be completed.

The bonus? They get two cards – so if there are two caretakers who swap appointments they won’t need to worry about sharing a card – and the card can be used at any of our locations.

This new registration process is incredibly beneficial on many levels.

First, by allowing patients whose documents are up to date move quicker through the registration process, their wait time is decreased significantly, allowing for an improved patient experience. In addition, because each “clean registration” receives a card, families are able to check themselves in for their appointment and avoid waiting in line!

As any project that we begin, we need to ensure that the end goal is aligned with our corporate goals. As an organization, we have set a growth goal of opening 1-2 sites each year. With the addition of this tablet registration process, we decrease wait time but also increase the amount of patients we are able to see. With more patients, we are able to look into more sites!

And lastly, consistency is key! The tablet registration will help to streamline the registration process and create more consistency at all of our sites. Since the goal is to have a “clean registration” for each patient, the documentation process will be much smoother on the back-end as well. For example, Finance will be able to collect the necessary information for insurance claims, since each greeter will be ensuring all documentation is updated and in the system before the patient proceeds.

This project was a huge undertaking, and took a cross-departmental team of motivated folks to complete. I have to give major kudos to Darlene Carr, Jana Prokop, Carrie Snyder, Lindsey Marabella, Nicole Assante, Tamisha Bourne, Jessica Hall, Donna Provenzano, Chuck Chianese, Linda Waddell, Haig Minassian, and Taaliba Warden for working through weekly 2-hour meetings, and testing. Kudos to Patient Access, Strategic Improvement, and IT for all of their hard work in making sure the table registration went off without a hitch.

And lastly, cheers to the Registration Staff at Mountainside for being our pilot site to launch the table registration. They have been continuing to provide input to the team on modifications, and helped us to get into a better situation to launch this system to our other sites.

By Spring we hope to implement tablet registration in two other sites – Newark & Hamilton – with a goal of using the system in at least 85 percent of our sites by the end of 2015. 

The journey is never easy

Last year, one of our former inpatient and CogRe graduates spoke at the Foundation Gala. As I listened to Matt Peltz share his journey of recovering from his traumatic brain injury, he referenced how different his life is after the injury.

He didn’t talk about how  much he missed out on or how hard he had to work, but how the injury opened up a new calling for him to care for others the way that he was cared for by each of you.

Matt is now working with adults at Bancroft – leading nonprofit provider of specialized services for individuals with autism, brain injuries, and other intellectual or developmental disabilities – in the traumatic brain injury program. He talked about how "wild" it is that he is now coaching and helping people face the same challenges he has  and the empathy he has knowing exactly what they are going through.

There is something extremely powerful for a patient and their family to see this young man – who has now completed his undergraduate in Psychology from Penn State and his graduate degree in Social Work from Rutgers – helping others the way clinicians helped him.

In creating the Family Faculty positions almost 10 years ago, it was our hope that we would be able to provide this type of “in your shoes” support to families, and they certainly have. The Family Faculty members partner with Children’s Specialized staff and parents to navigate the journey of recovery and disability for their children.

Many of you have probably heard Nancy Panarese's story about her anger when her grandson was diagnosed with cerebral palsy and how that manifested itself in her behavior with staff. She couldn't control the diagnosis but she so wanted someway to make it better. And in retrospect, she had to work through this process to get to personal acceptance.

During a recent visit in on the patient floor in New Brunswick, a parent had just had a major melt down. The staff was upset and I could sense the feeling of helplessness at not being able to address this parent’s concern. The reality is that this mom was devastated by her son's injury and her frustration just bubbled out. Staff did a great job of diffusing the situation and getting things back to normal, but it was definitely a tough day for all. 

Today I think back to Matt. The journey isn't always a straight road or the even road that we wanted to be on. But once on that road, we are trying to give our families and you, the support we can to help people through that journey. Both the clinical skills and tools, and the supports like Family Faculty to help us walk with people on their journey.

Some days are easier than others.

Matt’s journey has taken him five years. Now I see a strong young man, who has dedicated his life to helping others. The gift of compassion you all have given Matt, Nancy, and every parent or patient going through probably the toughest time in their lives, is just as important as the physical recovery.

Thank you for your continued efforts each and every day to help our children and their families on their journey that brought them to Children's Specialized Hospital.

I have heard from many of you that you are struggling with our changes in focusing on trying to serve more kids. We are focused on this because families have told us that they are really struggling with the limited availability for appointments. 

You have said to me "I don't like all the pressure on productivity or I wish it could go back to the way it was." Children's Specialized Hospital has the word Children first for a reason.  

We are here to serve and care for the children. That is why we all work so hard—to improve the lives of the children who need our care.

One of the changes we are going through in health care is that in large measure, the health care industry as a whole asks patients to work around what is good for the clinicians.  

An example is why would we ever need to take a child who is not critically ill to the emergency department if the parent was unsure that emergent care was needed?   Wouldn’t it be easier to virtually see a physician on call via Skype or FaceTime? Then the parent and doctor could decide together whether the child would be needed to move from the home? We haven’t adapted enough in health care.

My point in linking these examples is that this all is part of our own journey. In the period of change we are going through you may feel frustrated and you may find it difficult to see what the end game is. I truly believe the organization that partners with families to find ways to deliver care in a way that has positive outcomes and empowers families will be the organization that has a different place in the landscape.

So what is my point? Just like with Matt Peltz, his brain injury has created tremendous opportunities. Through this time of change and pressure, there will be opportunities that we can't clearly see today but we know that if we continue to stay focused on increasing access and responding to our patients’ needs, we will get there and be stronger than we ever could have imagined.

So does this resonate with you? Can you see the pathway? 

The small things

Emily Dickinson once said, “If you take care of the small things, the big things take care of themselves.” Today’s Employee Recognition story is a prime example of taking care of one teeny, tiny, but important thing.

An elderly caregiver of one of our patients left their child’s appointment with multiple scripts and a stack of papers in his hands. He asked Lorraine Landisi (Front Desk Coordinator, Mountainside) if she would make him a copy of everything before he left. He looked very tired as he was wrapping up some last minute things before heading home.

Without hesitation, Lorraine went to make the copies, a task that only took her a couple of minutes to complete. When she came back to the counter to give the man his copies, he thanked her not once but several times. He continued to thank her while he organized his papers at her desk!  

Lorraine’s simple gesture of making this man’s evening a little easier made a huge impact on him. She told him, “It was no trouble – it was a simple thing to do.” But he replied, “Small things count.”

What Lorraine did not know was the man had a few more errands to run that night before heading home to relax, and having those copies would make it easier for him to do what he needed to get done that evening.

Small things count. 

It’s as simple as that. Sometimes it’s not about the big favors or the big moments. Sometimes we [and, yes, we all do this at times because we are all human] wonder if what we do really matters—whether it’s here at work or at home.

We never know when small acts of kindness serve to touch other peoples’ lives in an impactful way. Sometimes we are not – but should be – aware how profoundly we can extend ourselves and make a difference in the lives that touch us in the smallest of ways.

Just something to think about. Thank you so much Lorraine for truly going above and beyond.

Have you had an experience like this? When someone has done something small for you that impacted you in a big way? Please share!

Reaching for success with Operation: Excellence

Operation: Excellence. 

It is the management method we use to drive our efforts to meet our strategic goals laid out in our strategic plan. 

Think of it as a road map that helps us to chart our course throughout the year. Each location on the map is a goal we want to reach, and the route that we need to take to get to that location are the action steps we will take to meet that goal.

We have four categories that make up Operation: Excellence that help us strategize on how to reach our goals: 

Engagement: Have the best team that actively collaborates for the care of the child.

Finance: Help the child focus on their goals more than how to pay for their care.”  

Growth: Give the child access to state of the art models of care.”   

Quality: Treat the child like a member of the family and help them reach their full potential.”  

How we work towards meeting our goals

Each pillar has their own team of employees that focus on ensuring we meet our quarterly goals in that category. The team is responsible for developing a 90-day action plan to track our progress and make recommendations on how we can meet our goals. 

The Operation: Excellence group meets at the end of each quarter to regroup and review our progress. Each pillar team presents the information from their category, if we have met our goal for that quarter or not, and informs the group as a whole if there are any changes that should be made. 

Operation: Excellence is part of the way we hold each other accountable and ensure we all understand how all of the work we do each day is involved in reaching our long-term goals of increasing the number of children we serve, achieving our quality report card objectives, continuing our financial success, and reducing the wait time to see developmental pediatricians to name a few.   

Keeping you in the loop

Right now, we use the twice-yearly employee meetings to update everyone on our goals and the progress to meet them.  In addition, we post monthly updates on the Intranet under Statistics. Take a look if you have a few minutes.

The Strategic Improvement Department, in collaboration with the Engagement Team, is working on a new Intranet that will be interactive for all employees to keep apprised of the status of the goals and action plans. It’s going to be a great way to keep everyone updated on a regular basis, as well as enable you to provide immediate feedback directly to the Pillar teams. We are super excited about this HUGE improvement to our internal communication – more on that later.

Do you have ideas or questions?  

Feel free to ask your Senior Leader or anyone director or manager if you have any questions! 

The down-low on scribes

Have you heard that we use scribes with our physicians and advanced practice nurses?

What is a scribe?

A scribe is a person who literally helps the healthcare provider (physician/advanced practice nurse [APN]) by taking notes in the patient’s electronic medical record (EMR), to allow the clinician to focus on the child/patient and family. 

We use a company called ScribeAmerica. The company is present in over 600 locations across the country with 22 million patient encounters in 2014 alone.

In early 2014, we started with the company as a trial – to see if their service was something that would work with our model. It didn’t take long for us to see how their service helped enhance productivity and allow the physician to refocus their attention to the patient. Now, we have 7 scribes across our Mountainside, Hamilton, and Toms River sites and we anticipate growing that number in the future.

For me the biggest thing about using a scribe is the complaint from doctors that the insurance company demands for documentation have taken them away from what they love the most – treating the kids. Dr. Elvira Downs and APN Louise Walpin have both experienced first hand the benefits of using scribes. I asked them to share a little bit about their experience. 

“With the advent of EMRs and the need to document in real-time, having a scribe has allowed me to focus my full attention on my patient and their family while having the encounter completed at the time of the visit. There is no struggle to enter the information (which can be difficult, as I am a 2 finger typist) so I can listen attentively, follow up on concerns and am not distracted during the visit. The visit is more relaxed and the patient has a better experience.”- Dr Elvira Downs – Section Chief-Psychiatry, Hamilton

 “From the initial encounter, I appreciated the fact that I’m no longer tied to my computer.  I can once again make eye contact with my clients and communicate via both verbal and nonverbal communication.  This makes delivering quality care so much easier.” 
- Louise Walpin – Advanced Practice Nurse, Hamilton

As a result of this innovation we are ahead of last year in the number of kids that have been seen by physicians/advanced practice nurses and we have reduced the time it takes to have the reports completed. This is a bit of technology that Dr. Chris Haines brought to our team.

Is there a new technology or improvement you think we should investigate to either help us see more children or take work off your plate that isn’t fully using your expertise?

Building Brave People

Some of the best ideas or articles I get come from many of you who share things that you read that speak to you. The article “Culture of Change: Creating a Culture That Breeds Bravery” came from Missy Morrow McCulley (Education Administrator, Strategic Improvement/New Brunswick). The article is a quick read; I’d love to hear if it speaks to you, and why.

I have two big takeaways from the article.

1. During times of rapid change, our anxiety goes up and the willingness to “Lean In” or take risks goes down. 

Now this makes perfect sense because when you feel like the world is spiraling, you aren’t going to want to do more things to make it spiral any faster.

Last week Horizon Health announced a new program for their insurance customers—24 hours a day, 7 days a week they will have access to speak to a physician. Unfortunately, you can’t pick the physician you want to speak with, but someone will be available 24/7 to answer questions.

Think about the type of disruption this could cause. When a parent wants to know which doctor to go to for their child’s issues, they can just call a phone number and the doctor on the other line could have the Horizon book in front of them that may tell them who has the best quality scores or would cost the person the least amount; in essence driving the decisions that families will make.

This one tool could be a huge disruptive force.

We could spend our time worrying about this, fighting it, or believing that we don’t have to worry because our relationships with our existing patients will trump any other doctor on the other end of the phone. Or we could see this as an opportunity to educate those physicians on the unique needs of our kids and figure out how to be an integral link to what they are doing.

Now it may not be probable that we will get to do this, but it is possible.

The article shared that possible is the stretch. It is the dream that could be a harebrained idea, but in doing so, we learn and put ourselves out there. We can’t accomplish that by playing it safe.

2. You gain strength and influence when you give up your power and understand that if you think it is important; there is nothing beneath you.

I recently had this conversation with Jagdar Tamesar (Environmental Services/New Brunswick). I am forever picking up garbage off the floor – not just in the hospital, but everywhere. In Macy’s, the parking deck – it doesn’t matter – I bend down and pick it up to throw it out.

The reason I do it at Children’s Specialized is because trash on the floor is a poor reflection on us. It shows people that we don’t care enough to attend to the little things and if we can’t get the little things right, what we will do when confronted with something as important as caring for their child?

So, I pick up the paper. After all, it is everyone’s job to pitch in and I can’t hold myself above that or anything else that I am capable of doing.

So those were my two big takeaways. What are yours?