OR "face lift"

My thanks to Barb Bestor, Operating Room Manager, and to the OR staff who worked on what Barb calls “a wonderful face-lift.” The crew of 16 was at Community General on Saturday to help clean, move, re-organize, re-stock and completely re-vamp the sterile storage areas.

The result? Hallways are clear and clean, clutter has been reduced. It looks good and, as Barbara tells me, it helps assure safe practices.

In the photo, from left to right are Julie Vecchio and Karen Stuber, both RNs, along with surgical technicians Megan Barnes-DeRusha, Jennifer Soury, Karen Smith, and Beth Foster.

Thanks to all who helped!

State grant to start health information exchange

Yesterday Governor David Patterson announced the award of $105 million to 19 health information exchange (HIE) projects across New York State. This includes an award for the HIE being planned for Onondaga County. The local grant will be announced Monday (March 31) at a press conference in which I will participate.

The project in Onondaga County[1] will join with one in Broome County to develop an electronic information exchange in Central New York that will make available patients’ radiology, laboratory, and prescription data among physician offices, laboratories, pharmacies and hospital emergency departments. A study showed that such an HIE has the potential to reduce medical errors, to reduce unnecessary tests, and to improve care delivery in Central New York.

A recent article in the Harvard Business Review (HBR)[2] called such regional health information organizations (or RHIOs) “a promising new type of health care organization,” but asked “can these new entities…survive?” A handful of RHIOs are currently working in the US, and there are “some 100 or 200 more in development.” A number of such organizations are starting in New York, thanks to seed money provided by state government under its HEAL[3] grant program.

RHIOs are important because, despite all the computers used in health care, patient health information systems do not talk with one another. The RHIO that is planned for Central New York would allow patient data, including test results and prescription information, to be available through the Internet among hospitals and medical offices.

If there are big advantages to RHIOs, there are also big obstacles, as I have discussed. RHIOs need large capital investments to get started. They require cooperation among hospitals, labs, doctors, public agencies. They must have systems for assuring confidentiality, and they must overcome the lack of industry-wide technical standards.[4]

The local sponsor[5] of the RHIO is working on a business plan that will use the savings generated by the exchange to fund its ongoing operating costs through health insurance companies. That means the health insurance companies, hospitals, and doctors business will all have to agree on the business plan and will all have to forge agreements with the RHIO to make it a reality.

Yesterday’s HEAL grant awards is a promising start for this project. But it is a beginning, not the end.

Those of us who provide health care – and those who pay for it – will have a lot more work to do to make such a health information exchange a reality. And now is the time to start.


[1] The Onondaga County project is sponsored by the Health Advancement Collaborative of Central New York, of which I am the Secretary.
[2] Adler-Milstein, Julie and Jha, Ashish, “Fledgling Firms Offer Hope on Health Costs,” Harvard Business Review, March 2008, pp. 26-28
[3] Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY)
[4] Adler-Milstein and Jha.
[5] Health Advancement Collaborative of Central New York.

Their words say it all

At Community General Hospital we’re working on plans to convert the former nursing home facility into a new acute care medical-surgical facility, thanks to a multi-million grant from New York State that is being made available to implement the decisions of the Berger Commission. This has us focused on the future and the many decisions that are necessary to update our hospital services.

This month I had occasion to meet with the former managers of our 50-bed nursing home facility, which closed on January 11, 2008. Along with the staff, these managers and clinical leaders worked hard to assure that the residents and families were respected during the difficult closure process. As they did so, the staff and managers faced transitions of their own as they sought positions within Community or elsewhere.

Despite their personal concerns, they did a great job with those entrusted to their care, as evidenced by the outpouring of appreciative words from the residents and family members that I have accumulated in my top drawer these past several months.

Their words say it all:

▪ “Thank you for acts of kindness and concern for me on this difficult time…”

▪ “Thank you for all you did to care for my mom…I am forever grateful.”

▪ “You are all missed and thought of with great affection…”

▪ “You… took excellent care of our mother….The sixth floor at CGH has the best care and staff…”

▪ “Due to the Berger Commission … we unfortunately had to find a new home for [our mother]….Although the move went well, we feel she missed the comforts and friends she had grown to enjoy the past three years…”

▪ “My heartfelt thanks to east and west for the loving care which was always the best…”

▪ “I thank you for always making [our mother] comfortable and being there for her no matter what her mood or condition. I know if she could talk she would say thank you with all her heart and a wink!”

▪ “Your dedication, hard work, and sensitivity in sometimes difficult circumstances have been an inspiration to our family…”

MASH camp

This week 19 middle school students finished up MASH Camp at Community General Hospital. They learned CPR, got to put casts on one another’s arms, and saw what it’s like to operate operating room equipment (see the photo, at left).

MASH stands for the Medical Academy of Science and Health, and Community runs this special program for junior high school students each year during February break week. I got a chance to visit with the future nurses, doctors, pharmacists, technicians and therapists as they ate lunch.

I talked about how Community got started, and I showed them a brick from the old General Hospital of Greater Syracuse. (That’s where the “general” comes from in Community General Hospital). I talked about the role of government in health care, and I showed them a flag that flew over the nation’s capital, a gift from Congressman Jim Walsh.

Health careers offer youngsters a great future with many options – but they need a good education. That’s one of the messages of MASH Camp: stay in school and do well in math and science.

The other message? Ten or 15 years from now, knock on Community’s door when you’re looking for a great place to work!

To see the MASH campers, check out Mike Price’s spot from this week’s WSYR-TV newscast (click on “Good News: Hospital Mash Camp 2.20.08”).

A moment in the life story of a mother and a family

My thanks to Drs. Howard Weinstein and Maria Banda for their op-ed piece this week in the Syracuse Post-Standard about the quiet advantages of Community General Hospital’s Jim & DeDe Walsh Family Birth Center.

The article, headlined These patients not lost in numbers, responded to a story about two weeks ago. That story, Population boom, reported on the number of patients discharged from local hospitals last year.

It was gratifying to see the article by Drs. Weinstein and Banda talking about the advantages of Community’s maternity service, advantages that are not usually available at community hospitals.

Dr. Weinstein is the Chair of the Department of Obstetrics and Gynecology at Community, and Dr. Banda is an experienced house officer, one of the obstetricians who assist private doctors with C-Sections, surgeries, and the care of maternity patients at any time of day or night.

Their op-ed piece mentioned the on-site house officers. These are experienced physicians, not doctors-in-training, who are available around-the-clock for Community's maternity patients.

They also talked about 24-hour on-site neonatology coverage for every single birth, backed up by neonatologists, plus the caring, patient-sensitive nursing staff that gets high marks from patients and doctors.

Community’s maternity service typically ranks in the top quartile of all area hospitals in the annual review by the Regional Perinatal Center. And our C-Section rate is the lowest among Syracuse hospitals.

Community’s investments in maternity services date from the very start. Our very first patient on January 1, 1963 was a maternity patient!

Over the years there have been many additional investments, including recently. Some have been highly visible, such as the award-winning Walsh Family Birth Center. Others, less so, such as the reconfiguration of obstetrical house officers last year. In each case, the investments were made to assure high quality, patient-centered care for mother and baby.

Every birth is an important, a personal moment in the life story of a mother and a family. Each birth represents a personal commitment to excellence by Community’s experienced and caring staff.

As Drs. Weinstein and Banda said: “The beauty of a smaller practice is that no one patient is lost in a multitude of numbers…”

An eye opener

“What an eye opener,” said an employee this week after attending the annual meeting of the Employee Community Service Fund. His e-mail said, “I think CGH employees really don’t know what’s going on with the employee fund.”

What’s going on is the good, quiet work of CGH people.

For more than a decade, the Employee Fund has helped members of the CGH family who experience unexpected financial hardship. The help can go to any member of the hospital family, employees, retirees, or active volunteers. The hardships involve emergencies, tragedies, and difficult situations – a house fire, the death of a loved one, or financial problems following a divorce or illness.

Such situations are varied, and each is handled privately, one-on-one, by a member of the 14-person panel that governs the Employee Fund.

When I mentioned the employee’s e-mail to panel-member Maureen Blackmer, she said that it’s not easy to talk about the work of the Fund because each situation requires confidentiality. “Some situations are heartbreaking,” she said. “Until you hear about them, you don’t appreciate the need. It’s so important for the Fund to help.”

Last year the Employee Fund helped two-thirds of all who applied for assistance. In all, 22 applicants received emergency assistance totaling $18,466.

In addition the Fund helped the United Way of Central New York, which received $28,450, thanks to the generosity of employees and others.

The donations helped 31 specific United Way agencies, including AIDS Community Resources, the Girl Scouts and Boy Scouts, Canine Helpers for the Handicapped, Dunbar Center, Hope for the Bereaved, Hospice, Syracuse Jewish Family Service, Catholic Charities, the Rescue Mission, and Vera House.

What was the source of such generosity? There were 500 donors to last fall's Employee Fund campaign, and the average gift was $91.51. To each of the employees, retirees, and volunteers who made a donation, thank you.

Thank you to Nancy Thompson for her work as Chairperson of the Employee Fund. And thanks also to all members of the Fund: Maureen Blackmer, Kristin Dombroske, Tracy Fenner (secretary), Donna King, Melissa Martin, Debby Michaels, Gillian Ottman, Ken Redmore, Phil Sherwood (treasurer), George Slavinski, Nancy Towne (vice chairperson), Jean Waldron, and John Zacharek.

Collegiality

When David Halleran, MD, was elected president of the Community General Hospital medical staff last month, he carried a dictionary with him to the podium. He opened to the definition of “collegiality” and reminded his colleagues how important it is to maintain respect for one another and to work toward common purposes.

Dr. Halleran, who is a colon rectal surgeon, said that "collegiality" is the theme of his term of office, and he encouraged his colleagues to recall why they chose careers in medicine. He reminded them how satisfying it can be to collaborate with others on patient care. “It’s still a great profession,” he said, “when you are caring for the patient.”

The stresses and strains affecting doctors were recently the subject of a New York Times article, called “The Falling-Down Professions,” which said, among other things:

▪ About 60 percent of doctors reportedly have considered leaving the medical profession.
▪ Nearly 70 percent of doctors know a physician who has already left medicine.
▪ Applications to medical schools are down about nine percent from 1997.
▪ Physician incomes have lagged behind those of other professions.

As the Times reported, “Complaints about managed care crimping doctors’ income and authority over medical decisions are nothing new, but the problems are only getting worse…” It quoted a doctor's complaint: “What irritates me the most is the use of the term ‘provider.’ We (physicians) didn’t go to provider school.”

If physicians have become “providers,” patients have also become “consumers.” The imagery may be inexact, but the commercialization of the medical care process is clearly a factor in the changing doctor-doctor relationships, the changing doctor-patient relationships, and (as I can attest) the changing doctor-hospital relationships.

This week I again heard Dr. Halleran speak about collegiality, this time at a meeting of the Quality Committee of the Board. He said that collegiality involves more than “being cordial.” Collegiality facilitates more effective communications among physicians regarding patients and their care. It’s also facilitates physicians and nurses working effectively to improve patient safety and to assure that patients get the right care at the right time.

Professional collegiality, or the stresses and strains to which it is subject, is an issue bigger than our corner of the world. But I’m very happy to have Dr. Halleran calling us to order – and getting us to work on it.

Life lessons

Congratulations to seven-year olds John, Joseph and Madison Riccardi, and to their older brother Tom Riccardi, who started it all.

Playing as a team, the second graders placed eighth in their division at a national chess tournament in Houston, TX in December. A sophomore at Marcellus High School, Tom has six national U.S. Chess Federation titles to his credit.

All are the children of Dr. Tim and Sue Riccardi, and I remember those kids as toddlers. I haven’t seen them in years, but I’ve followed their chess careers in the Post-Standard, including yesterday’s story and photos (click on Photos of the Day: 01.30.08).

It's a great human interest story, their winning ways, and it's a story of family togetherness. There was an item of particular interest in yesterday's report – how the players learn from their mistakes. According to Sue,

Chess has given the triplets a lot of self-confidence, and it's taught them critical thinking. It's also taught John how to lose…[H]e's seen he can learn from (losses).

The family uses dinner time to consider games that have been lost, using a display chessboard on which Tim recreates the sequence of moves. "It's fun to figure out what moves I should have made," Joe is quoted as saying. "It helps me a lot." What a life lesson!

Dr. Tim Riccardi is the Chair of Ophthalmology at Community General Hospital.

Congratulations to Bill and Lew Allyn, who were honored in the January 2008 issue of Repertoire Magazine, a publication for medical product distributors. The Allyns were the third generation of leadership at Welch Allyn, a company noted for quality products and community service.

The magazine publisher notes that Bill and Lew Allyn

were great stewards of their family business who consistently did things the right way for the right reasons…. They kept the company in upstate New York, even though it is not a business-friendly state in terms of taxation, energy costs and regulation. They were extremely generous with their time and resources, giving and continue to give, to a large number of local and national causes. And through all of it, they maintained a family culture that embraced everyone who worked for the company, including the distributors who sold the company’s products.

Bill, who was a long time member of the Board of Directors of Community General Hospital, continues to be interested in hospital affairs. Since his retirement, Community has been served by two excellent Welch Allyn executives: past Board member Louise McDonald, Executive Vice President & President, International, and current member Kevin Cahill, Executive Vice President & Chief Financial Officer.

The magazine’s honor is a well-deserved tribute to the Allyn brothers and to the quality-focused, community-minded company they served so well.

Smoke and fire

Smoke in the corridor – visibility was, maybe, 25 yards. There were patients in there!

That is my memory from perhaps 15 years ago when an elevator motor fire caused smoke on a patient floor. It was a brief episode, readily addressed by Community General Hospital's Fire Brigade. No one was hurt. No one had to be moved.

But I still remember the momentary panic in my stomach as I saw smoke in the corridor.

Yesterday Community had two fire alarms, one right after the other. The first was a fire drill about 10:30 a.m. The second alarm, coming just minutes later, was triggered when someone, smelling an odor, pulled the fire box. Coming after one another, the alarms caused uncertainty – just as there would be in a real emergency.

It’s because of the potential for confusion and uncertainty that Community has procedures for all to follow during an alarm. One of the first procedures is to close all doors and stay where you are. When I was new to the hospital, that rule seemed counterintuitive to me – shouldn’t we open the doors and get out?

No.

Hospitals are constructed in compartments that can withstand a fire for a matter of hours. That means, if it was the real thing, the fire itself could be contained in a single area, allowing time to get patients (and ourselves) to safety in an orderly way.

But if the integrity of a compartment is broken, fire or smoke can spread, dangerously shortening the time and ability we have to get patients out of harm’s way. That is why following procedures during a fire alarm is so important.

Yesterday, one of the fire alarm monitors told me she was distressed to find an employee, and later, a visitor trying to walk down a corridor during the alarm, despite the monitor’s request to please stay put. That is dangerous. People traffic has to stop during a fire alarm. The air system shuts down. Doors have to remain closed. The integrity of compartments must be maintained.

That is the reason we have drills – to practice how to behave in a real emergency, as if from habit. A drill has to be treated as the real thing, every single time, because our behavior during a fire alarm is the best protection we have for patients, for coworkers, and for ourselves.