Sunday, December 26, 2010

Workforce Safety and Vitality: Request for your input


Workforce safety is a growing concerns facing health care systems across the nation. The need for a safe environment for all is paramount. For an environment to be safe, we must listen and respond to those who have their feet on the floor -- the employees.

I am seeking your ideas and feedback to design and build the necessary structure for continuous improvement of your work environment. I am proposing a dedicated Center for Workforce Safety and Vitality. The Center would develop a transparent and accountable process to support and amplify the voice of employees and meet their identified needs. For the Center to be truly employee-focused, I need your help

Below, or in your email, you will find a draft of a proposal for the Center. Please consider this document as a draft only as I am eager for your feedback. Please send your suggestions to Tess O'Riva, either by email at teresa.o' or transmittal to my office directly by 1/10/2011.

As we look to a new year and new opportunities to improve, I welcome your prompt feedback and creative thinking.

With respect,

Center for Workforce Safety Proposal for Employee Review

Friday, December 24, 2010


“A line has been drawn in our lives and there is no going back to the time before the line – we can only move forward or stay stuck.” Dr. Joel Fay
Each of us is charged with making meaning out of the events that happen to us. Our experiences greatly influence our subsequent actions for a lifetime. On October 25, 2010, the unthinkable happened. On of our own was assaulted during the course of her work and succumbed to her injuries. During the debriefing which occurred in the days following, Dr. Joel Fay reminded us all – “A line has been drawn in our lives and there is no going back to the time before the line – we can only move forward or stay stuck.”

I have watched as we try in each of our own ways to make sense of this senseless act. Deputies and health staff have established an even deeper respect and team spirit. The deputies are now defined as part of the treatment team. We have examined our joint practices to begin re engineering how the work flow moves through the detention facility. Deputies and health staff sat together in Critical Incident debriefings. There is a difference in the way we treat one another.

Although in very early stages, we are in conversation about how to design a safer workspace for all staff. The Sheriff’s Office and Contra Costa Health Services have forged a stronger and more united bond not only to ensure there is safety and respect, but to reestablish where the two departments have common goals. We have begun discussions with the labor representatives and Risk Management to provide feedback in our process as we move along. In the next year, we will be developing a Center for Workforce Safety and Vitality. Still in the design and feedback stage, this is an essential step to new and redesigned patient care while ensuring that our system is a safe and rewarding place to work.
“I now know Cynthia through your stories.”Jim Conway
Jim Conway joined us for some of those conversations. He came to assist us in problem-solving and to provide his expertise on ways we could continue to provide safe and excellent service without compromising quality of care. As the detention staff and others met with him over the course of two days, he was struck by the deep respect they had for each other and their work. Evident was a committment to move forward in a meaningful way creating an enduring legacy to honor Cynthia and all who are committed to our mission. Before he left he thanked the detention nurses commenting “I now know Cynthia through your stories.”

There was outpouring of concern by the inmates. That such a grievous act could be performed by a fellow inmate was unacceptable. They, too, mourned her loss. They rallied together to contribute to the fund set up in her memory and created a work of art that will hold a prominent place at Martinez Detention Facility.

It was moments such as these, and many others, that spirit and strength of our great system shined through.

During this time of the year, my heart extends to Cynthia’s family who are without her. I can not imagine their loss. They are in the hearts and minds of many people. We will not forget Cynthia, nor will we forget you. Like her, you have chosen to offer your skill and spirit in service to our community and I am honored and privileged to stand with you as we welcome a New Year and new opportunity.


Wednesday, December 22, 2010

System Redesign

I have been asked several times to post this again and have been waiting for today to do so. Remembering my Dad on his birthday…

On June 9, 2005 the first annual Hospital Redesign Summit was held in San Diego. How much more perfect could this get, since I was charged with helping lead System Redesign? Like everyone else, I wasn't quite sure what that meant. I arrived late that night to San Diego after a very full week of long hours in the hospital dealing with what seemed to be an expanding list of issues. My week was not consumed by the halls of Contra Costa but spent in other hospitals sitting at the bedside of my father who had fallen quite ill. After what seemed to be weeks of sleepless nights, my father was transferred to a large tertiary medical center. It was a welcome reprieve as the drips and lines seemed to be increasing with each day. With him safely tucked in at one of the finest centers in the world, I could now get on a plane to learn more about “Redesign.” To be honest, I was tired and needed a break.

My day started off with a video from Sorrel King, mother of Josie. To this day I will never forget her words, the words of a mother who lost her child to a chain of errors and system failures.
~Josie King Story~
She challenged hospitals to think about having a team that was available to bring care quickly to people who were deteriorating before they went into a cardiac or respiratory arrest. She called it a medical emergency team or rapid response team.

I went from session to session and could not escape the realization that our system was broken. It wasn’t about the hospital, but rather the whole system of health. I also found others who were trying to learn ways to improve their systems through ‘redesign.’ I came home energized and full of ideas about improvement methods and reliability, and concepts like ‘spread.’ I also came home to find my father sicker than when I had left.

The days following the Summit were filled with ideas scribbled on paper while sitting at my father’s bedside. I tried to keep up as the teams rounded on him. It seemed so odd that after all the time I had spent in a hospital, I hadn't a clue how it all worked. I couldn't figure out who was in charge of which part of his body. I couldn't keep up with his deteriorating health and growing amount of health care intervention. It was truly a mess but in just a few more days he was discharged to my home for what would surely be a very long but full recovery. It was four days later I had come back to work for a meeting about the digital diagnostic imaging system (PACS) when the call came in about my Dad. It wasn't good news…

As I drove home that night from the mortuary I wondered. Did he experience any harm due to error? He took high-risk medication, what if it was the insulin? Was it a postoperative complication or infection? Was it sepsis? I wondered what might have happened if there were some mechanism like the rapid response team that Sorrell King had described. I wondered about the people we serve.

When I returned to work, the System Redesign Team approached the most senior leadership and the Performance Improvement Committee with a request to endorse and actively participate in the IHI 100k Lives Campaign. In the months to follow, leaders all over the system stepped forward. Tools and how-to-guides were brought to life by teams that had already been working in many aspects of the 100k Lives Campaign interventions. We heard stories of steady improvements that began to take the form of breakthrough improvement. The energy was palpable.

As I read through the email responses to my ‘small test’ in communication and was stopped in the halls this last week, I realized that many people are wondering, "What ever happened to System Redesign?" It's a reasonable question, and it points to how redesign elements have been integrated into the current system. System Redesign was never occurring in a conference room but rather in improvement teams on your unit. 'System Redesign' wasn't a committee making sweeping changes and impersonal decisions that shaped the experience of the individuals we serve: you were, one decision at a time, one experience at a time, one patient at a time. The team located tools from experts to share with you. Tools that others across the nation had found, if used reliably, made it easier to do the right thing for your patients.

So where is System Redesign now? System Redesign has been diffused into structures such as Safety and Performance Improvement and the teams you are on in your local work areas. Some of you call it the IHI work. Some of you may know it as the work we have done on Lean. Others still may not call it anything specific, but it is the output of the team efforts you are all engaged in across our great health system. Redesign can be found everywhere. I found a number of people who said you didn't need more resources but you need to find different ways to do the right thing, a viewpoint supported by Steve Spear in the New York Times (More for more? Spear, S.), where he notes that in health care, more is not necessarily better. Not necessarily more, but better, that is redesign.

Recently, I was on the fourth floor and a rapid response was called. I watched as the team delivered what appeared to be a seamless response that resulted in a rapid transition to critical care. I thought of his family. A few days later, I learned that the man had been discharged home. I thought of my Dad.

Friday, December 17, 2010

Perinatal Kaizen 1 Report Out

The most recent Kaizen was aimed at eliminating the gap that exists for mothers and babies who are delivered by cesarean section. The goal was to ensure at least 15 minutes of skin-to-skin time for mothers and babies in the first 60 minutes of life. The average time for mothers who delivered vaginally was less than 15 minutes to skin-to-skin, as opposed to mothers who delivered via cesarean who on average waited more than 3 hours for 15 minutes or more of skin-to-skin with their child. Increased skin to skin has been shown to reduce hemorrhaging and anxiety, increase the likelihood of breastfeeding, increase the maternal-child bond (we learned that fathers feel more bonded as well), and reduce pain.
In other words, the team focused on much more than health care, they focused on HEALTH!
I found it interesting and refreshing that teams spent an entire week trying to get "us" (health care delivery) out of the maternal-child experience and instead support health, which we we have learned is best accomplished not by us, but by us supporting the mother and child.

I will be posting a video on the most recent work and what patients are saying very soon.

Monday, December 13, 2010

WIHI on The Patient Activist

The Patient Activist
Thursday, December 16, 2010, 2:00 PM – 3:00 PM Eastern Time

Bill Thatcher, Executive Director, Cautious Patient Foundation

Barbara Balik, RN, EdD, Senior Faculty, Institute for Healthcare Improvement

Tricia Pil, MD, Medical Writer, University Health Sciences Project Coordinator, Patient Activist

Charles Maclean, PhD, Founder, PhilanthropyNow

When you think of a patient activist, what sort of individual comes to mind? Someone who has been harmed by health care or who has a loved one who’s experienced an error? Someone who’s filed a lawsuit against a hospital? Someone who’s angry and still waiting for answers... and an apology? If these are your impressions, OR your experiences, OR the experiences of someone you know, they are indeed features of what’s motivating a new “army” of individuals and groups to insist on a far safer and more patient-centered health care system – both in the US and internationally.

What may be less well understood is how sophisticated this loose network of “fellow travelers” has become. Many groups now work directly with health care organizations, especially hospitals, on the redesign of care, on shared decision making, and on far more reliable ways of communicating vital information to patients and families. The mushrooming of patient advisory councils is also another sign of active engagement with providers and administrators on what’s working, what’s not, and how to improve.

Some 50 patient activist leaders travelled to IHI’s National Forum in Orlando, Florida, to share experiences and to consider ways to combine forces to be that much more effective. Come find out what happened at this first-ever summit by tuning into WIHI on December 16 and hearing from Bill Thatcher, Barbara Balik, Tricia Pil, and Charles Maclean. Each has a story to share and a role to play, as do you, to make health care safer and more effective. WIHI host Madge Kaplan invites you to come learn and add to the ideas and the blueprint for change.

To enroll, please click here.

About WIHI
WIHI is an exciting "talk show" program from IHI, connecting you to the cutting edge of health care improvement. It’s free, it’s timely, and it’s designed to help dedicated legions of health care improvers worldwide keep up with some of the freshest and most robust thinking and strategies for improving patient care. A 60-minute program is offered live every other week, or you can listen to recordings of the broadcast later at your convenience. WIHI is your opportunity to meet up with colleagues who want to improve patient care and shape a true health reform agenda.

Saturday, December 11, 2010

Take-aways from Maureen Bisognano's Keynote at IHI's 22nd Annual Forum

"Together, our destination is the Triple Aim. It won’t be easy. It’ll take courage, new leadership skills, new care models, new business models, a commitment to equity, and new assumptions:

• Health care systems can be sustained with modest annual cost increases; and
• There is enough capacity in the systems to provide equitable, high-quality care to all; and
• Solutions to national problems will be designed and implemented at the local level"
Maureen Bisognano, President and CEO, Institute for Health Care Improvement

With ease and grace that I have come to associate with Maureen and her leadership, she called on us to listen. Listen to those we serve, listen to the workforce and listen to ourselves. The theme of this years forum was to 'Take Care.' I was honored to join my colleagues and fellow IHI Fellows in learning and collaboration. I love the forum because you are truly surrounded by amazing people who are actually changing the world for the better.

I was particularly excited about the patient and family delegates who joined the conference this year and the focus and challenge to us all to look to the single greatest untapped resource in health care, patients and families. They included a morning devoted to bringing together over 50 Patient Activists and Partners in Quality and Safety. The aim was to bring together activists to tell the healthcare system (us) how it (we) must change to lower cost, reduce waste, and improve their care without harm, and not mince words doing so. Many hospital chiefs say they are now preparing to put patients on their boards and executive teams.

Just imagine the possibilities....I think I like where this is going!

CCRMC and HC Perinatal Value Stream Mapping- blog post from NAPH

Here is a post from Lindsey Marshall at NAPH, who recently joined us at CCRMC to learn more about our improvement efforts.

"During the week of October 25, I had the opportunity to visit Contra Costa Health Services in Martinez, CA, to observe a week-long “Kaizen” quality improvement event focusing on perinatal care. The Kaizen method, derived from Japanese management concepts, means change (“Kai”) to become good (“Zen”).[1] Above all, the Kaizen method focuses on helping employees learn to spot and eliminate waste in business processes.[2] Over the past year, Contra Costa has adopted the Kaizen method to support them in improving key service lines, including psychiatric care programs and perinatal care. While attending this event, I learned how Contra Costa is using Kaizen to identify waste and strategies for improvement in perinatal care. I also came away with observations about the value of this type of work for safety net hospitals...." Continue reading the entire post on the NAPH blog Safety Net Matters.

Friday, December 3, 2010

Joint Commission Survey

Contra Costa Regional Medical Center and Health Centers: Caring for and improving "the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems."

I am pleased to share with you that The Joint Commission completed their week-long survey of the hospital and health centers. The findings are remarkably positive and the surveyors noted many times that your commitment to quality and safety was extraordinary.

I want to thank all of you and our community partners for your commitment to our mission. The strength of our system is grounded in the shared vision of the Contra Costa County residents, leadership, dedicated and skilled staff, and our governing board, the Contra Costa County Board of Supervisors.

Please take a moment to accept my sincere praise and gratitude. I am proud to work with you all as we continue our journey of continuous improvement to safe, effective, patient-centered, timely, efficient, and equitable care for all.

Today we celebrate, tomorrow we accelerate.