Friday, August 24, 2007

"No secrets"

In an editorial today, the Post-Standard calls for more discussion about the grant application that Community General Hospital and Onondaga County submitted to the Department of Health to comply with the decision of the state’s Berger Commission. In the newspaper’s opinion:
Onondaga County residents have a compelling right and need to know exactly what is being proposed and exactly how much it will cost.

I discussed the application several weeks ago in a posting. See the newspaper’s website for the full text of its “No Secrets” editorial.

Saturday, August 18, 2007

A remarkable profession

I met this week with the staff of Three West, a nursing unit that includes both telemetry (heart) and oncology (cancer) patients. These meetings were make-up sessions because the busy 3W nurses did not have time to attend my last ’round-the-clock employee meetings.

3W is a busy place with nurses caring for patients in space that, despite various improvements over the years, maintains the same basic configuration as when the hospital opened. Patient room sizes are unchanged, but over the years we’ve added more medical equipment, and visiting is no longer limited to a few hours a day. We pack more electronic equipment into today’s care environment. The nursing station is a center of biotelemetry displays. Caregivers use electronic health information systems[1] in charting areas that are undersized. As we move to CPOE[2] next year, the need for more equipment will only increase.

The 3W census is high, and the work demanding. So what did I hear from staff when we met during morning and afternoon shift changes? They suggested ways to better meet the needs of patients. They talked about more special patient chairs, about bed replacements, and about the better use of space in patient rooms. They told me about the importance of patient safety, and they suggested ways we might improve customer service.

These are nurses you read about –professionals with demanding jobs in the complex world of acute care hospitals. They wear sensible footwear and scrub tops. They spend remarkably long hours on their feet. They meet exacting standards every day. They deal with complex medical problems and with difficult family situations. Yet, they have smiles for patients and encouragement for families.

The whole nation knows about the nursing shortage, and these nurses experience it firsthand. There are openings on 3W, and recruitment is underway. In the meantime, nurses work overtime, and the hospital fills gaps with per diem and agency nurses.

There’s an open house planned for job applicants[3], and some 3W staff members plan to participate so prospective employees get a chance to meet the people with whom they would work. The professionalism and collegiality of nurses are the best recruitment tools we have.

The day before I met with 3W staff, I received a letter from the son of a patient who died recently on that nursing unit. Here’s part of what he said:

…I want you to know how much we appreciate the care and compassion that the staff provided to my father. It was reassuring to our family to know that he was well cared for and valued in his final days.
“Well cared for and valued.” Who could wish more for one’s parent during a difficult hospitalization?

It’s a remarkable profession, nursing, and it’s a remarkable group of individuals who choose to practice their profession in the demanding world of an acute care hospital.

[1] In 2006 the hospital installed Sunrise Clinical Manager (SCM), a product of Eclipsys® Corporation, that provides immediate, secure access to patients' health information and improves the quality and efficiency of care. SCM features a state-of-the-art workflow engine, embedded evidence-based content, and sophisticated clinical documentation capabilities. For more on SCM at Community General, see the Eclipsys news release.
[2] CPOE means “computerized physicians order entry,” and Community General will be implementing CPOE in 2007. Studies indicate that the structured orders of CPOE systems can significantly reduce the potential for serious medication errors.
[3] There's a job fair, Monday, August 20, on 3W from 11 am - 2 pm and from 4 - 6 pm.

Tuesday, August 14, 2007

Today's news about the Berger Commission

The Post-Standard blog reported today about our application last month (with Onondaga County) for state funds to implement the decisions of the Berger Commission. I previously wrote about the two scenarios we submitted as part of the grant application.

Saturday, August 11, 2007

Of quality & board oversight

I recently made a presentation to the hospital’s quality committee that displayed 293 quality and safety measures tracked by Community General Hospital. It was a confusing, hard-to-understand picture of the ongoing surveillance we perform.

A few months ago I sat at a table with hospital CEOs from across the state as we struggled to get our arms around the number of quality measures each of us tracks. How, we asked ourselves, can we use such data more effectively to improve performance at our hospitals?

“We are at our limit in making sense of so many indicators,” said one CEO. Another observed, “We can’t go in a thousand directions. We have to focus on a limited set of meaningful measures.” “We’re struggling too,” added a third.

What is included in our 293 data measures? Data we report to the federal and state governments about heart disease, pneumonia, and infection control. Data we examine internally, including medication problems, falls, and near-misses. Measures we report to insurers in compliance with pay-for-performance contracts. And measures reported about us by outside organizations, such as HealthGrades®, the Niagara Health Quality Coalition, or Thomson Healthcare (formerly Solucient).

A recent article in the Journal of Patient Safety the performance of some 200 hospitals and concluded that “better quality outcomes were associated with hospitals at which the board spends more than 25% of their time on quality issues.” The Institute for Healthcare Improvement (IHI) recently recommended that “[b]oards in all hospitals…[should] spend at least 25% of their meeting time on quality and safety issues.”

A few years back, Community General’s board agenda was rearranged so that reports on quality come before reports on finances. But how much time does the board actually devote to quality issues? I reviewed last year’s board minutes and estimated the time spent on quality issues was about 30%. That was higher than I had thought. But does it mean we are working on the right things? Are we doing enough? I asked such questions of members of the board’s quality committee – and they think we can improve.

Serving on a hospital board is quite a responsibility. As a director, you have the overall responsibility for hospital performance. Section 405.2 of the New York State hospital code holds the governing body responsible for quality performance and for process improvement. The board exercises its responsibility, of course, by hiring management, by assuring proper policies are in place, and by overseeing the hospital’s performance.

In New York, most hospital boards are composed of volunteer representatives who devote their time (and often donate money too) to assure their community has excellent hospital care and services. What education and information do they need to provide quality oversight?

Chaired by board member Dr. David Tyler, the quality committee has held two meetings on this subject, and it will make recommendations to the full board later this year. Management is working with the committee in developing its recommendations. As part of the process, some members of VHA Empire State[1] generously shared with us their own board-level quality reports, and we have learned from them. We will probably borrow ideas from some of these boards, but our work is very much organization-specific. Where should Community General focus its attention in order to make more progress in areas that will best serve patients?

This week Community General was honored for having “one of the fastest and most consistent rates of improvement in the nation” by Thomson Healthcare. It’s reassuring that our improvement has been better-than-average in recent years as we set the stage for the next series of safety and quality initiatives.

[1] Community General Hospital is a member of VHA Empire State is part of VHA, Inc., a health care provider alliance of more than 2,400 not-for-profit health care organizations.

Thursday, August 9, 2007

Trial in New Orleans

Yesterday’s USA Today featured a story about the owners of St. Rita’s Nursing Home in New Orleans, LA, whose criminal trial starts next week. The owners are charged with 35 counts of negligent homicide and 24 counts of cruelty to the infirm for the deaths and suffering of residents who were not evacuated before Hurricane Katrina.

The case against the nursing home owners is being prosecuted by the state’s attorney general, who sought – and recently failed to get – an indictment of a physician who was accused of murdering patients at a New Orleans hospital in the terrible aftermath of Katrina. I recently wrote about this case.

Wrote USA Today about the nursing home:
For all the misery Katrina unleashed and all the missteps and bad decisions surrounding it, the [owners of the nursing home] are the only two people to face trial for them. Were they arrogantly responsible….or are they scapegoats…?

Monday, August 6, 2007

Among the best

I was delighted to learn over the weekend that Community General Hospital was named one of the Thomson 100 Top Hospital Performance Improvement Leaders. The honor recognizes Community as having “one of the fastest and most consistent rates of improvement in the nation.”

The honor was reported today in Modern Healthcare.

The “Thomson 100 Top Hospitals” awards were formerly known by the name “Solucient 100 Top Hospitals.” Solucient was acquired by the Thomson Corporation in October 2006.

Thomson identifies performance improvement leaders by a multi-year trending methodology that uses the Medicare Provider Analysis and Review (MedPAR) data base, the Centers for Medicare and Medicaid Services (CMS) Standard Analytical File (SAF) outpatient data set, and the Medicare Cost Report. Each hospital is classified according to its size and teaching status, and each is ranked by performance measures that include patient outcomes, patient safety, efficiency, financial stability, and service growth.

Community General’s overall ranking, as compared with our peers, was at the 98th percentile.

I learned today that another Syracuse hospital received the honor – Crouse Hospital. Congratulations to Dr. Paul Kronenberg and his staff (and my former colleagues) at Crouse. That both of us received the honor is especially significant because Community and Crouse were part of the Health Alliance of CNY from 1999 to 2003…an affiliation that did not work.

During the Health Alliance period, both hospitals suffered significant financial losses, and Crouse filed for Chapter 11 protection from its creditors in 2001, ultimately emerging from bankruptcy a couple years later. Community left the Health Alliance in 2003, and each hospital has since remained independent. As evidenced by the performance improvement awards, we have each made progress notable enough to be recognized nationally.

The credit for Community General’s success goes to all members of the CGH family – especially, our managers and employees, our medical staff, and the members of our board. Thanks also to the auxilians, volunteers, and donors who assist the important work of our hospital.

It is hard work, what we do each day and each year, caring for patients. It is nice to know that objective measures show we have made a difference, and that the pace of our improvement is among the best in the nation.

Congratulations, all.

Saturday, August 4, 2007

The flowers of summer

When the Central New York leaders planned Community General Hospital in 1957, they sought a location away from downtown in a place of “therapeutic green.” That concept sounds remarkably contemporary.

The planners suggested three “green” sites as possible locations for the hospital: Tecumseh Golf Course, Sunnycrest Park, and the Onondaga Hill site of the County Sanitarium (now, the Van Duyn Home and Hospital). The Onondaga Hill site included 42 acres of land that had been reforested in the 1930s under the Civilian Conservation Corps. (The CCC put to work young men from unemployed families during the Great Depression of the 1930’s.)

As we know, Onondaga Hill was selected and CGH opened here on January 1, 1963. The hospital has been known for this distinctive green and wooded campus ever since, thanks to the community planners. A circle of trees is the hospital’s logo.

If the campus is characterized by its trees, it is also known for its summer flowers.

And for this beauty we owe thanks, not to the community planners, but to Community General’s volunteers.

We are fortunate to have more than 300 women and men who volunteer their time and talent, helping in many ways to make us “more than medicine.” Among their helpful activities are the flower beds volunteers maintain in the park outside the hospital’s several entrances.

Vince and June Lawrence have been a big part of this beautification project for years. The photo of Vince and June, with their flowers, was taken yesterday. When not working in the gardens (as they did on a very hot Wednesday this week), you can find them helping elsewhere (such as assisting patients and visitors at the main desk on Friday). Other members of the flower team include Dottie DeSimone, Caroline Newell, Julie Newell, John Ronan, Bill Thorp and Carolyn Topalian.

Thanks to all who help make Community General Hospital, not only a place of therapeutic green, but a place of beauty.