What we are thankful for

The Thanksgiving Quilts are on display at Community General Hospital, representing thoughts from members of the hospital family. There were some 90 submissions. To do them justice, we created three quilt graphics. To read the comments on each quilt, move the cursor over the picture and click. The quilts are on rotating display on the first and ground floors, allowing everyone to share the tender, thoughtful, and appreciative comments of friends and colleagues. Thank you, all, who submitted thoughts at Thanksgiving time.

Here is what I am thankful for this week:

• All who make our patients feel welcome, safe, and respected by thoughtful actions and by kindness in their voices.

• All who demonstrate leadership through their knowledge and expertise, through their example, hard work, and willingness to help with new ideas and new projects.

• All who show up on time every day, who pay attention to the details of everyday work, and who do their jobs to the best of their abilities.

• All who wash their hands consistently, who follow the “red rules” of patient safety, who assure safe practices.

• All who make new employees feel welcome, who teach proper procedure and who encourage employees to feel a part of the CGH family.

• All who celebrate birthdays, take up collections, offer congratulations at coworkers' weddings and graduations, and who are ready to help when there is an accident, an illness, or a death in someone's family.

• All who volunteer their time, who donate their money, who share their stories, and who make time for others.

• All who say hello with a ready smile, who hold open doors, who are courteous, and who pick up after themselves (and others).

• All who return to school, continue their studies, and demonstrate progress within their jobs, their professions, and their careers.

• All who respect our doctors by showing professionalism, responsiveness, and teamwork.

• All who forego gossip and comments that can be hurtful, unkind, or thoughtless.

• All the patients who entrust to us their safety and wellbeing.

• All the physicians who have confidence in our care for their patients.

• All with good hearts, who see when another feels awkwardness or worry or pain – and who make an effort to help.

• Our board of directors and board advisers who give their time, their expertise, and their personal funds solely for the purpose of making Community General Hospital a better place.

• For the opportunity to work hard, to solve problems, and to be of assistance to colleagues every day.

Happy Thanksgiving, everyone.

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.

Our survey by the Joint Commission

Yesterday the Joint Commission re-accredited Community General Hospital for a full three-year term.

The preliminary award of accreditation was announced at the summation conference for senior management, following a three-day unannounced site visit that involved four surveyors. The re-accreditation is subject to review and finalization by the Joint Commission over the next week.

The review was detailed, and the surveyors identified a number of areas for CGH to make improvements – some of these are requirements for improvement (RFIs) for which we have 45 days to make changes that are acceptable to the Joint Commission. Other changes, called supplemental recommendations, are intended to improve CGH performance even further.

CGH received nine RFIs. Improvements are required in the provision of care, namely better documentation involving pain management and conscious sedation. We need to do better in two national patient safety goals: better medication labeling in the operating room and better measurement of the time frames involving critical test value reporting. Other RFIs involve a change in the Medical Staff’s policy on awarding temporary privileges to physicians in emergency situations and improvement in the signing of verbal orders by physicians. The remaining requirements involve the routine testing of the emergency generator and repairs and safety improvements in the physical plant.

We take the Joint Commission’s RFIs seriously, as we do the supplemental recommendations. We have already begun to make the changes needed.

The surveyors followed a “tracer” methodology. They identified patients at random, reviewed their charts, and traced the progress of their care. They interviewed the patients, spoke with their caregivers, and examined documentation and policies specific to the individual patient and the caregivers. The surveyors visited many areas of the hospital, including off-site departments. Noteworthy were comments they made about CGH employees: “bright,” “very knowledgeable,” “willing to listen,” and “not afraid to explain.” They also challenged us to be more consistent in our processes with comments such as “mandatory,” “not acceptable,” and “inconsistent” to describe areas where we need to improve.

I sincerely appreciate the attention and respect afforded the surveyors by the CGH family, but most of all I thank employees and managers for the preparation, competence, and professionalism they bring to patient care every day.

The surveyors noted with interest our preparations for computerized physician order entry (CPOE), which will be rolled out at CGH next year. They said the introduction of CPOE, electronic medical records and other information technology in the coming years should help improve our processes, further lower the risk of error, and avoid some of the documentation issues that were encountered.

I thank members of the Board of Directors and Medical Staff who participated in the Joint Commission leadership conference: Steve Infanti and Chet Amond, current and past Board chairs; as well as Drs. David Halleran, Thomas Hartzheim, Andrew Merritt, and Howard Weinstein, representing Medical Staff leadership. I appreciate the assistance of Mary Kinneman, interim Chief Nursing Officer, who helped the Nursing Division and the management team improve standards compliance and survey readiness. Dr. Fred Goldberg, new in his role as Chief Medical Officer, was helpful in this survey. Thanks also to Brendan McGrath, interim Vice President – Operations.

I especially acknowledge the staff of the Quality Department, which helps the entire hospital monitor and maintain compliance with our policies and with the Joint Commission standards, particularly Sally Ramsden, Director of Quality and Education, and Wendy Tarby, Director of Performance Improvement.

Last month CGH was honored as one of the Thomson Top 100 Performance Improvement Leaders among the nation’s hospitals. This demonstrated our progress in recent years in reducing mortality, improving patient safety, improving length of stay performance, as well as other measures. Maintaining Joint Commission accreditation is further evidence that Community General Hospital provides quality and safe care for our patients – and that we are committed to making ongoing improvements.

Thank you all, and congratulations.

To the nursing shortage, add doctors

Most people are familiar with the nursing shortage. But there’s another health care story that deserves our attention – the growing shortage of doctors.

Retiring doctors often are unable to find replacements for themselves, especially when they are in solo practice. Sobering facts: 28% of New York’s doctors are in solo practice, and 34% of the state’s doctors are over age 55[1], meaning their retirement is in the foreseeable future.

Why do retiring doctors have a hard time finding younger physicians to replace them?

For one thing, finding a replacement doctor costs money (advertising, travel, and recruitment firm, not to mention the new doctor’s salary). Many practices operate on tight margins, and money spent on recruitment has to come directly out of the budget for staff salaries, including the doctor’s own.

New doctors often come into practice burdened with high debt from their medical schooling. They need a decent income quickly, and they cannot afford to wait, gradually building their patient base over several years as in the “good old days.”

Another concern, physicians need coverage. New physicians need to join a coverage group immediately – that is, a set of doctors who agree to cover the new doctor’s patients on a scheduled basis after office hours and on weekends. Every physician needs such coverage, and those who fail to get it cannot practice indefinitely with self-coverage. No one can work (or be on call) 24 hours a day, seven days a week.

Some parts of the country – those with booming economies or year-round pleasant weather – have advantages when recruiting doctors, just as they do when recruiting engineers or other professionals. Although Central New York's rolling hills, clear lakes, and four seasons are beautiful, its slow-growth economy does not add to its charm.

“At a time when the aging baby boomer population finds itself in need of more medical services,” reported the New York Times recently, “fewer young doctors want to work in many of the distressed cities and towns throughout New York State.”

Add to these complications, a doctor supply problem. In a recent Post-Standard op-ed article, Dr. David Smith, President of SUNY Upstate Medical University, wrote that “too many of the doctors now in training are not choosing the most needed specialties. Primary care physicians, general surgeons, and obstetricians are in high demand.”

And, according to the Wall Street Journal,

[p]rimary-care doctors, including internists, family physicians, and pediatricians are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005….The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

Why are fewer doctors going into primary care? Money. The median income of primary care doctors is about 45% below that of specialists, according to the Journal. Remember, doctors have to pay off those medical school loans, which can amount to hundreds of thousands of dollars.

Last year's report by the Center for Health Workforce Studies shows the supply of primary care doctors in Central New York at 64.4 per 100,000 population. That compares with 76.0 per 100,000, the median ratio among all regions of the state. The report also shows that CNY’s physician supply lags other regions in such specialties as pediatricians, neurologists, infectious disease, psychiatry, and others. Although CNY has 2.7 endocrinologists per 100,000 population (which is slightly better than the 2.2 median for all state regions), a recent story reported that several endocrinologists are leaving Syracuse.

If the nursing shortage is a major problem, the doctor shortage is not far behind.


[1] Armstrong DP and Forte GJ. Annual New York Physician Workforce Profile, 2006 Edition. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany. December 2006.

The power of the initials "RN"

I want to share the following message I received from a registered nurse:

I just finished reading your letter[1] and felt compelled to write. My mother…has also been ill and entering her third week in hospital care. She had an MI[2] three weeks ago. Since then my sister and I have learned a lot. But for myself, as a medical professional and an RN, the lessons have been invaluable and worth passing on.

I learned the power of the initials "RN" that I have taken for granted for 25 years.

I learned it is important to proudly say, “I am the RN taking care of you today, and if you have any concerns or questions, I am the person you can come to today.”

This statement is a simple one, but could have saved so much time and confusion. I never knew who was who. I asked questions over and over to the wrong people, mixed with painful emotions, and the lack of slack of sleep and energy did nothing but build anxiety.

It would have been so simple to have known at the beginning of each day...who could answer our questions or at least steer us in the right direction.

We learned many other things along the way, but this I felt was the most simple and a good one to pass on to my colleagues….

We grow as professionals when we see our world through the eyes of patients and family members.

The writer gave me permission to print her letter without her name. I thank her for her personal and important message.


[1] On January 27 I wrote: “Two of my relatives were hospitalized in the last two months, and their experiences reminded me how different is the hospital world that a patient experiences from the hospital world we see every day as caregivers. What is obvious or routine to caregivers may be invisible or incomprehensible to patients. They don’t understand our language. They don’t share our mental map that readily understands the relationships among attending and consulting doctors, charge nurses and discharge planners, therapists, and service staff.” (See “Stop me if I say something you don’t understand,” January 27, 2007.)

[2] "MI" is myocardial infarction, a heart attack.