When our sixth floor will close

This afternoon hospital managers met with residents (and then with staff) of the sixth floor, 50-bed skilled nursing unit at Community General Hospital. A representative of the Department of Health was present. They announced what everyone wanted to know (and dreaded to hear) – a closure date for the sixth floor.

CGH’s skilled nursing floor will close on January 15, 2008, conforming to the requirement of the Berger Commission.

On September 28, New York State announced its decision to allocate grant funds to close CGH’s sixth floor. It was part of an overall agreement negotiated by Community General Hospital and Onondaga County to comply with the Commission’s requirement for affiliation and downsizing. Understandably, the decision to fund the closing created uncertainty among residents and staff. It made the closure suddenly real.

As a result, some residents and some staff members began to make decisions about leaving the sixth floor, not wanting to wait for the planning process to unfold. Sixth floor occupancy has declined from a census of 48 (September 28) to 41 (today)…and this trend will continue.

As staff departs, more temporary personnel will be required, increasing variability and potentially affecting quality. As residents transfer, a lower census generates financial losses. Neither trend is tenable for an extended period of time. For these reasons, after management consulted with the State Department of Health, I made the decision to announce a specific closing date. This ends the period of uncertainty, it avoids a more protracted period of declining occupancy, and it allows residents and staff to start making their plans.

Consistent with state regulations, there will be a 30-day closing period, starting December 15. We announced this today so residents and staff have advance notice to start planning for the transition period.

Is the holiday season a good time to do this? No.

A compliance plan was required by the state by the end of September (thus, its funding announcement of September 28). It also requires an executed agreement between CGH and the County by December 31. Such time frames and the associated announcements affected both residents and staff, making the holiday impact inevitable.

Last Friday I wrote about the Thanksgiving quilt, a patchwork of thoughts, reflections, and aspirations being generated by members of the CGH family for display during Thanksgiving week. I share with you one of the thoughts just submitted:

I am thankful for the capable and compassionate staff who have taken care of my [parent] on the sixth floor….We will miss them when we are forced to move [my parent]. (Original emphasis.)

I sincerely regret the disruption, the upset, and the sadness occasioned by the closure of our skilled nursing unit.

Life in the blogosphere

Last June 30, I converted the weekly CGH family letter into the More than Medicine blog. [1] For a number of months the content of the family letters continued to reflect the content of the blog, but gradually the blog postings have begun to diverge from the letters.

The blog now includes items that do not make it into my letters. These may be some quick thoughts, they may be references to contemporary events (such as the legal prosecution of health care people following Hurricane Katrina), or they may be comments on news articles (such as the Berger Commission or hospital infection risk) or references to other blogs that comment on More than Medicine.

A comparison of the last week’s activity – letter versus blog – shows I wrote two letters (one on flu, the other on the blogosphere) compared with eight postings on this blog (ranging from "medical arrogance" or "all fish swim in the same water").

The content of the blog and the letters are related – but they are hardly identical. This is interesting, and it is not what I expected. I expected the blog to be little more than an electronic version of the letter. As it turns out, the nature of blogging encourages shorter, more frequent, and more topical entries.

Blogging also invites more interaction. I’ve had 19 comments on blog postings since June – hardly an overwhelming number, but more frequent feedback than I had with the letters alone. And not all comments are from CGH employees. Some are from readers, known and unknown, in the blogosphere.

Unlike the family letter, anyone can subscribe to the blog. The blog also allows me to track the number of times people look at it each week. After Paul Levy, the hospital CEO who authors Running a Hospital, linked a past entry from More than Medicine to his blog last Tuesday, I had 128 “hits,” a new high for me.

Another blog advantage: each posting is accompanied by “key words” so you (and I) can look up every time I’ve discussed a topic, such as “Berger Commission” or “mortality rates.”

I am, of course, continuing my weekly letters at Community General Hospital, as I have since writing the first one on October 19, 2002 (about three weeks after the Board of Directors asked me to serve as CEO). But the letters are not the same as the more frequent, more interactive communications through the blog.

When I started blogging, I thought I was merely expanding the letter content with an new means of electronic distribution – what I actually did was to learn an entirely different communications tool.

Don’t hesitate to write and tell me what you think!

[1] You will notice a number of blog postings with dates earlier than June 30, 2007. That is because, as I have occasion to refer to past family letters, I covert them to blog postings with their original dates. This process gradually populates More than Medicine with the content of past letters and allows me to link similar topics.

The Thanksgiving quilt

A year ago I wrote about “the Thanksgiving quilt” that was compiled by Peter McGinn[1], who was the CEO of United Health Services (UHS) in Binghamton. It was patchwork of thoughts, reflections, and aspirations reflecting the spirit of the UHS workforce.

With thanks to Peter and his colleagues at UHS, we at CGH borrowed his quilt idea this year. Yesterday posters went up, showing how the Thanksgiving quilt will look and offering instructions on how to participate. The Thanksgiving quilt is also displayed on all CGH computer splash screens.

Through November 12, members of the CGH family may drop handwritten messages into boxes that are located next to the poster displays[2]. Or simply send a brief e-mail message to ThanksgivingQuilt@cgh.org.

Feel free to share thoughts about family, friends, and work. Share something that makes you smile, warms your heart, or helps you meet the challenges of life.

Your messages will fill the squares of CGH’s Thanksgiving quilt during Thanksgiving week.

[1] Matt Salanger is the current President and CEO of UHS.

After his retirement from UHS last year, Peter McGinn, PhD, founded Leadership Impact “to help leaders and organizations excel by bringing out the best in people and aligning their talents with the goals of the organization.”

[2] In CGH's main lobby, in the Diagnostic Center and outside the cafeteria.

If you read nothing else...

Today’s Post-Standard reports that more than 200 Central New Yorkers probably died as a result of hospital acquired infections in 2004. The number comes from Excellus BlueCross BlueSheild, which made the estimate “based on data from the federal Centers for Disease Control and Prevention and other sources.”

I have previously posted comments about hospitals and infections, including Community General Hospital’s own infection rates and recent efforts to improve hand hygiene compliance. See: All fish swim in the same water, Weird glowing substances, A tale of two cities.

If you read nothing else, A tipping point deserves your attention. It contains the obituary of a Canadian gentleman who died as the result of a hospital-acquired infection. Please read it all the way through.

All fish swim in the same water

Before I began the blog, I wrote weekly messages as short letters to the employees, physicians, volunteers, and auxilians of Community General Hospital – to all the members of the CGH family. Hand washing, infection control, and standard precautions have been consistent themes. Here are excepts of past letters that have not been posted as blog entries.

From “All fish swim in the same water,” March 5, 2005
“If you saw a co-worker or someone from another department fail to wash hands, what do you do? Be embarrassed for them? Bite your tongue and say nothing? I suggest that you say something, such as: ‘Excuse me, did you forget to wash your hands? You must have a lot on your mind – just trying to help.’

“The fact is, hand washing is often done privately. Most of the time there is no one to remind us, just a sign (on the wall)…and that little voice in our heads that tells us to do the right thing. All of us who work in health care share the responsibility for keeping our patients and our co-workers safe. That responsibility starts with hand washing….

“In the aquarium all fish swim in the same water. In our world, we breathe the same air and touch the same surfaces. We touch our patients. Hand washing is not something to take for granted.”

From “Why the obsession about hand washing?,” March 19, 2005
“Nationally, statistics show hospital personnel comply with hand washing requirements only 54% of the time. That is shocking. At CGH our compliance last year averaged 90%. That is almost twice the national rate, but it is not good enough. Even a single instance of noncompliance could put an employee or a patient at risk of infection.”

From “A culture of safety,” July 3, 2005
“Last month the State Legislature passed a bill that will require hospitals to report publicly infection rates for surgical wound infections and for bloodstream infections related to central lines in ICU patients…..

“This particular bill received a lot of attention statewide and across the nation, thanks to publicity generated by the Committee to Reduce Infection Deaths (‘RID’), a non-profit organization that has worked to require the public reporting of hospital infection rates. I wrote to RID earlier this year in support of its efforts…”

From “Not Halloween masks,” October 29, 2005
“As you can see, [hand hygiene] compliance in October is 95%. That sounds great, but consider this as you look around the cafeteria. Of the 99 other people there, who are the five who, on average, fail to wash their hands? When it comes to infection control, we cannot be satisfied with 95% – 100% has to be the goal.”

That's Mitchell Brodey, MD, Hospital Epidemiologist, in the photo, above. Actually, it's a photo of the life-size cutout of Dr. Brodey that makes its way around the hospital to remind everyone at CGH about the importance of hand washing. Dr. Brodey's doppelganger has been "on duty" since September, a companion to the life-size cutout of Sue Chamberlain, RN, CGH's Infection Control Program Director, who has "patrolling" the halls and departments since July.

Compelling hospital stories

Please check out Running a Hospital, the notable blog from Paul Levy, President & CEO of Beth Israel Deaconess Medical Center in Boston. Paul is the pioneer of hospital CEO bloggers, notable for the insights, the candor, and the sheer abundance of his entries.

Yesterday he hosted a "Grand Rounds" posting that linked commentaries on experiences at hospitals that changed someone’s behavior or beliefs. Many compelling stories there.

Diamonds & Denim

Last Friday evening the Community General Foundation held its annual, informal gala at the OnCenter in Syracuse with the theme “Diamonds & Denim.” The nearly 600 in attendance contributed some $189,000 to the fundraiser.

In his opening remarks Gala Committee Co-chair Mark Re, Vice President & General Manager of Gallinger RealtyUSA, said:

The “denim” is a symbol of people who roll up their sleeves and work to make a difference. The “diamonds” symbolize people who sparkle with accomplishment.

Honors were awarded for special accomplishments to the medical profession, to the community, and to Community General Hospital. The photo shows, from left, Mark Re, Dr. Drew Merritt (one of those honored ), and me.

The proceeds from Diamonds & Denim will help CGH upgrade its medical technology, including:

▪ New high-definition video equipment to improve the ability of surgeons to peer inside the body as they operate with miniature surgical tools that reduce injury and speed patient recovery;

▪ An upgraded, multi-slice CT (computerized tomography) scanner that brings faster and new imaging tests to our patients; and

▪ A state-of-the-art computerized physician order entry (CPOE) system using patient safety features available at only about ten percent of the nation’s hospitals.

The multislice CT is already in use. The high-definition video will be in place before year-end, and physicians will begin to use the new CPOE system in 2008.

We do not take for granted the support of donors to the Foundation. Thank you for your support, which directly benefits the patients of Community General Hospital.

My special thanks to Steve Johnson, Chair of the Foundation; to Gala Committee Co-chairs, Mark Re and Kim Dynka; to the Auxiliary for organizing the charity auction – and to all the volunteers who made it a fun night!

Medical arrogance

My thanks to Dr. Paul Kronenberg, President and CEO of Crouse Hospital, for his op-ed piece on “medical arrogance” in today’s Post-Standard. Dr. Kronenberg writes:

Hospitals are run by people, and people make mistakes. We don't always listen as well as we should. And yes, we sometimes fail to live up to the expectations of our patients and their family members.

Effective communications between caregivers and patients (and among the caregivers themselves) are not just a matter of politeness. Poor communications raise the risk that something is misunderstood, that something is missed – this can foster medical errors.

Dr. Kronenberg is right to emphasize the importance of caregiver communications. For more on this, see these past postings – Stop me if I say something you don’t understand, The importance of listening, and Whatever became of bedside manner?

The flu, "a patient safety issue"

A few days ago Dr. Richard Daines, the New York State Commissioner of Health, sent a “Dear Colleague” letter to health care providers across the state.

In it he emphasized the importance of flu shots for health care workers, saying it is "a patient safety issue":

Unvaccinated HCP (health care personnel) have been implicated in the spread of influenza and outbreaks in every type of health care setting. In fact, the failure to adequately immunize HCP is a patient safety issue in all health care facilities, including home care and ambulatory care settings. Low vaccination rates among HCP are associated with an increased number of outbreaks, poor patient outcomes, and increased employee absenteeism. Despite this, HCP vaccination rates remain low.

I recently wrote about the flu vaccination clinic for employees.

In addition to the clinic, Sue Chamberlain, Infection Control Program Director, will bring the vaccination cart to work sites throughout CGH during the week of November 4 – this will make it even easier for employees to receive the vaccine.

CGH will also hold a flu clinic for employees’ family members on Saturday, November 17. This exercise will help test out hospital’s organization for the prompt dispensing of shots, as may be needed in an emergency situation.

There are many reasons to get the flu vaccine: to protect ourselves, to protect our families, and to protect our patients.

That flu bug

A couple years ago Sue Chamberlain, CGH’s Infection Control Program Director, accompanied by a cart full of supplies, appeared at my office door.

“Did you get your flu shot?” she asked, knowing the answer. Then she admonished me: “You have to set an example.” So I signed the consent, rolled up my sleeve, and had the shot.

I have been, uh, setting an example ever since.

This fall Sue is again leading the charge to inoculate the maximum number of hospital staff, and this time she’s enlisted the help of Dan Cameron, graphic designer.

Dan created his own version of the flu bug, as displayed on posters around the hospital and on computer splash screens. He's even included that flu bug in the hospital’s logo. Gone is the disc fir trees, symbolic of our beautiful campus. That disc in the logo has been replaced by a flu bug in surrender!

The next time flu shots will be offered for CGH employees: 6:30 - 10:00 a.m., November 2, in the Employee Health Office.