Thursday, May 21, 2009

The Thin Blue Line: Heroes Among Us

Remembering Paul

“Courage is not the absence of fear, but rather the judgement that something else is more important than fear.” -Ambrose Redmoon

I'll place the 2009 Video up when it's released by the
National Law Enforcement Memorial Fund

On May 13, 2009 the names of 387 law enforcement officers killed in the line of duty were read aloud and formally dedicated on the National Law Enforcement Officers Memorial in Washington, DC.

Wednesday, May 13, 2009

Knitting the Sweater While Wearing it...reflections from Miles Kramer

I couldn't leave this buried in the comments.

In response to Julie Kelley's post. Miles Kramer said...

I hardly find it a surprise that a break from the "Safety Net" spent in the one place where folks who fall through the chasms in the net are sure to end up was a reinvigorating experience for a safety net warrior. Not only do people count on us to provide safety net health care to all those in need, but the realities of our failures, waiting lists, treatment delays, service line stratification's and payment silos become quite clear at the back door of the jail on a Thursday or Friday night around 10:00 pm.

Correctional health has been, and ought to continue to be a significant part of our mission as a safety net institution. The clinical complexities and the microcosm of social inequities in health care and social service access are readily apparent in the correctional setting.

From women incarcerated for participation in the interstate commerce of drugs and sex to the mentally ill, too sick to ask for help, too stigmatized to be deserving of help until they become the very crazed murderer society has long ago decided they are destined to become. You'll see it all in jails.

I'm very proud that you went to "my gemba," and spent time in service of not only the under-served, but the comfortably ignored.

It will forever offend me that we send out advanced life support emergency services (sometimes even helicopters!) for the most acute medical events and the S.W.A.T. team for the most acute psychiatric events.

You did good in the jail! You now know that America already has a great model of single payer healthcare for all; all 2.2 million Americans incarcerated today. That's more folks behind bars with constitutionally guaranteed health care than the populations of North and South Dakota, Vermont, Alaska and Montana combined!!!

The follow-up to the "New Asylums," Aired earlier this month, it's called "The Released." On a day you're feeling strong, give it a watch . . . suffice it to say that being freed from prison for most is just a temporary decent into the impossibility of accessing the American Mental Health System . . . just long enough to return to the waiting arms and warm embrace and their state's department of corrections. Lather, rinse . . . repeat.

So for now, those of us in jail will continue to look up to the safety net above us with admiration for all they do along with a deep longing that they'd do more before patients come to our hotel, some to die, some to struggle, most to leave and come back again and again.

We'll Leave the Light on For Ya . . . .


Tuesday, May 12, 2009

Knitting The Sweater While Wearing It

~Posted by Juliette Kelley~

Sometime in late 2007 I burned out. I can’t recall the exact moment but my best guess is that the culmination of my career charring flare was during the holidays in late December. My job had become so far disconnected from patients and the system of care that I knew I could no longer be effective for the patients, staff, or myself. So, I went to jail – literally.

Literature shows that the most important part of job satisfaction is the knowledge that the employee makes a difference. That’s not to say that equitable pay and working conditions are unimportant. But what gets most people out of bed in the morning is knowing they are part of a structure that makes the world a better place. I had not been feeling connected. Furthermore, as a member of the hospital’s burgeoning System Redesign Team I became exhausted by my inability to fathom how our system of care could ever be retooled and redesigned, given the local, state and national priorities.

I was fortunate enough to engage in a clinical hiatus as a Mental Health Clinician in the Martinez Detention Facility, or as most of us know it – the county jail. It turned out to be the perfect place for me to become reacquainted with the purpose of public systems and my career within them. Several years ago, the PBS series "Frontline" featured one of their programs on "The New Asylums" pointing out that jails provide most of mental health care in the country. In addition, unlike most of the nation, in jail, health care is a right. But far too often this access is frequently too little, too late.

What I learned from my time as a jail therapist is that regardless of the desire for redesigning, retooling, blowing up and rearranging our system of care, our patients often have nowhere else to see a doctor and get treatment. Rather than creating a false dichotomy of redesigns or provide good care, the job of the clinician is to knit the sweater while wearing it. In other words, make change happen and let clinical practice guide the changes. There are plenty of things wrong with public systems, but we must continue to provide necessary services while collecting data, looking at best practice, building teams, asking patients what they want.

I am returning to hospital administration at the end of the month and I will continue to work in the jail on a limited basis to ground myself in clinical practice. With a breath of fresh air and perspective, I will see you all very soon. I can hardly wait to show you my new sweater.

Wednesday, May 6, 2009

AHRQ releases the 2008 National Healthcare Quality and Disparities Reports

AHRQ. May 6th, 2009
2008 National Healthcare Quality & Disparities Reports
For the sixth year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. The reports present, in chart form, the latest available findings on quality of and access to health care.

The National Healthcare Quality Report tracks the health care system through quality measures, such as the percentage of heart attack patients who received recommended care when they reached the hospital or the percentage of children who received recommended vaccinations. The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as children and older adults.

So are we "Crossing the Quality Chasm?"

Some highlights from the reports:

• Healthcare is suboptimal and continues to improve at a slow pace.

• Reporting of hospital quality is leading improvement but safety is lagging.

• Health care quality measurement is evolving, but much work remains.

• Disparities persist in health care quality and access.

• Magnitude and patterns are different within subpopulations.

• Some disparities exist across multiple priority populations.

Although we are seeing some gains in improvement, we are challenged to sustain our gains and accelerate our efforts. The reports draw on lessons learned from other sectors about improvement.

Some common themes presented:

Constancy of purpose is essential
There is no quick fix, we must remain disciplined in our approach with continued vigilance

• We must form Partnerships
Simultaneous efforts are required by multiple stakeholders

• Measurement is vital to improvement
Focus on quality, focus on results

To learn more the reports can be found here:

National Healthcare Quality Report 2008

National Healthcare Disparities Report 2008

Monday, May 4, 2009

All Staff Message from the Director

The following is an all staff message sent today by William B. Walker, M.D., Director and Health Officer, Contra Costa Health Services.

As we begin a new week, I want to share some information related to the H1N1 influenza outbreak. (We are no longer referring to it as swine influenza at the request of the federal government.)

As of today, we do not have a major increase in the number of probable cases (there are now eight.) There will no doubt be more. There are now five schools closed and there may be more closures as more test results come back, based on evolving guidelines from the State and the Centers for Disease Control and Prevention. Symptoms for most cases in the United States have been relatively mild, and preliminary work in analyzing the virus itself shows it lacks the components that made the 1918 virus so deadly. (Updated information is on our website at including a list of the closed schools.)

Last Friday, our initial shipment of Tamiflu – the antiviral for treating the disease – arrived from the federal Strategic National Stockpile. Adequate amounts have been distributed to all our local hospitals to be used by medical staff according to guidelines we are providing.

While I am cautiously optimistic about the disease not becoming unmanageable, there have been influenza outbreaks in the past where a relatively mild wave has been followed by a much more severe one, so it is too soon to relax our vigilance. And school closures certainly cause considerable problems for children, parents and other caretakers so we want to proceed with investigation of the problem in this area very cautiously and in consultation with the school community.

We are continuing to monitor the number of new cases, and in the days and weeks ahead we should know more about the virus and the outbreak. Meanwhile, continue to be vigilant about hand washing and other methods of preventing the spread of the disease. Please stay home if you are sick. People have asked about the use of masks. In general, they are not effective except for health care workers working directly with patients with influenza symptoms. It is not necessary or effective for others to use masks.

As we move into our second full week of the emergency, one thing I feel very positive about is the progress we’ve made internally and with our partners in responding. CCHS staff has been outstanding in their professional and efficient actions. Public Health (assisted by others) has staffed our Department Operations Center, preparing comprehensive plans for our response, making home visits to test suspected cases, working with schools, providers and partners to get out accurate information, shifting through avalanches of information to cull out critical directives and coordinating with our regional counterparts. Our Public Health Lab is in high gear testing samples to comply with CDC’s request that local health
departments step up surveillance.

Contra Costa Regional Medical Center has been holding twice-daily briefings with their managers to share updates on the latest directives and deploy staff appropriately. The Emergency Department has expanded its space to serve residents who are concerned about the influenza outbreak. Our Health Centers are working to identify patients with symptoms and conduct appropriate tests. Our Health Plan Advice Nurse Unit has fielded hundreds of calls from concerned patients and community members and is working with their pharmacy local provider networks. Emergency Medical Services continues to survey local hospitals to monitor emergency room activity and emerging trends. Information Systems converted our internal Incident Response Information System to a web-based application available 24/7 so
our Emergency Management Team can monitor our ongoing response from anywhere.

Fed by all of those working on the response, our Community Education and Information Unit is continually posting information on our website, blast faxing alerts to our partners and using social media like Twitter to get out our messages. Amazing as it is, in the Google search process, our website is number 20 worldwide for the search “flu pandemic” and number 11 worldwide for "gripe pandemica.”

It has been an impressive example of how an integrated health department can work together.

William B. Walker, M.D., Director and Health Officer
Contra Costa Health Services

Social Media and Us

The world is changing. Are we keeping up?

See how we're using social media at Contra Costa Health Services by clicking here.

I found this link to Hospital Crisis Communications and Social Media and on Marc Miyashiro's blog The Bridge. It's on social media and it's use at Innovis Health in Fargo, North Dakota. I think you'll find the post interesting. It gives us all something to think about when we think about communicating. I have been following CDC, and CCHS on Twitter this weekend. The quick brief updates are easy to follow. There may be something to this?

Saturday, May 2, 2009

Update from Dr. Walker

Twitter Instant Update [subscribe]

"H1N1 media briefing today at 3:30pm." about an hour ago

We are continuing our daily briefings at CCRMC in Building One, Conference Room One at 9AM on Saturday and Sunday and 9AM and 4PM daily on weekdays.

For updates on H1N1 virus and Contra Costa County please go to the Contra Costa Health Services website.