Thursday, February 17, 2011

Thursday February 17: CCRMC and HC Town Hall Today at Noon


There has never been a more exciting time to work in health care, nor a more challenging one. We are on the precipice of national health care reform while forced to work with a state and local budget that challenges us to find new ways to meet our mission; to care for and improve the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems.

It is with this in mind that I invite you to a Town Hall meeting at CCRMC in Building One, Conference Room One at 12:00 noon tomorrow, Thursday February 17. I will open phone lines to all Health Centers across the county using the Noon-Conference dial-in numbers.

I plan to provide updates and time for discussion on the following:
• Proposed budget submission

CMS "bridge to reform," delivery system reform incentive pool (DSRIP)

• Contra Costa County Board of Supervisors ordered Sustainability Study of Contra Costa County Regional Medical Center (Hospital) and Health Centers (Clinics), which is currently under way
Please join me for this important discussion.

More very soon,

Wednesday, February 9, 2011

Doing Common Things Uncommonly more time

Why do we do common things uncommonly well? I've been asked several times recently about the origins of the statement I so often use "doing common things uncommonly well." I have done a brief post about this in the past and decided to post it again for those who are interested.

Without actually asking George Degnan we can’t be sure what may have inspired his association of Contra Costa County Hospital with his prophetic and simple statement:

“We do common things uncommonly well”

George Degnan, M.D., Chief Surgery, Founding Residency Director, County Health Director, Contra Costa County: 1950 – 1980.

Here is an excerpt from a interview conducted by Caroline Crawford, University of California Berkeley (1997) with Henrik L. Blum M.D., M.P.H., champion of public health, social justice and considered to be one of the true fathers of health planning. He served as health officer of the Contra Costa County Health Department from 1950 to 1966.

Not only do I find these interviews fascinating, I find it reveals a great deal about today to read these historical recounts.

Crawford: Did the two of you (Degnan and Blum)reinforce each other in the community?

Blum: "In a sense, yes. Yes. I mean, we were constantly friendly enemies or friendly competitors, or something. I remember when the Easter Seal Society came around and wanted us to do something. They were going to put on a big campaign, and the campaign was to state that our county health department had the best crippled children's service in the state. Well, it probably did, but that's nothing to put into a campaign which is going to tell my board that their health department is the
best in the world therefore it won't deserve any significant new funding. I mean, one just can't say stupid things like that.

George was at the meeting. It was in my office, I remember, he was this big handsome guy, and he was listening to these ladies who were driving me nuts. They just could not be talked out of it. I said, "Look here, it's our county, and you're coming from San Francisco and are telling me how to play ball here. We'll get you whatever you want, because we want the same things, but don't come out with this kind of propaganda, like it's the best program in the world. It's insane." They just couldn't hear me. So I got up and walked out, slammed my own door, and left. George, they tell me afterwards, turned to look at these people and he hadn't said a thing all this time and he said, "Well, I think that settles that, doesn't it, ladies?" He was a good ball player, a good card player, a good poker player, and it worked. They came around and did what we wanted. It all worked out very well our way without our telling the world we had the best health department. If you do something like that, you're crazy."

I am drawn to this story when I look at the address plaque of Merrithew Memorial Hospital that hangs on my wall. It underscores the perverse incentive/disincentive-based-system we call American Health Care. American Health Care, like all systems, is designed to get the results it gets; needless pain and suffering, needless death, unwanted waits, helplessness, waste and health care inequity. This design rewards settling for less than the best and reinforces perceptions that county/government owned and operated medical centers are a place of "last resort." This design supports a prevailing cautionary note that whispers (or screams, depending on the day), "Don't tell the world you are great. If you do you something like that you are crazy."

I recognize and am truly grateful that we stand on the shoulders of these great and visionary leaders. I also believe that it no longer serves us to downplay what our system can and does do for our community. A "last resort" is not what I see when I look at our publicly owned and operated health system. I see an integrated health system based on primary care and prevention. I see a dedicated team comprised of employees and members of our community working together, drawing on science and the energy and creativity of each other to continuously improve our great health system. I see a place of hope. I see a place where no one is left out.

I see a place where we do common things uncommonly well.

Anna M. Roth RN, MS, MPH, Chief Executive Officer, Contra Costa Regional Medical Center

Below are some potential sources our Residency Director, Dr Jeremy Fish sent (not clear who said it first as they lived amongst each other) that Dr Degnan may have drawn on.

“Learn to do common things uncommonly well; we must always keep in mind that anything that helps fill the dinner pail is valuable.”
George Washington Carver quotes (American. Started his life as a slave and ended it as horticulturist, Chemist and Educator, 1864-1943)

The secret of success is to do the common things uncommonly well.
- John D. Rockefeller 1839- 1937 , Founder Shell Oil

Doing common things uncommonly well.
Orison Swett Marden 1850-1924, American author and founder of Success magazine.

As Jeremy points out, it is interesting and noteworthy that these three men’s lives overlapped.

Thanks for sharing Jeremy.

Friday, February 4, 2011

Perinatal Kaizen Report Out

Thank you for joining me at the Perinatal Kaizen Report Out this morning in the CCRMC lobby. This was the second of six monthly Kaizen/Rapid Improvement Events targeted to improve processes throughout the perinatal experience in the medical center and health centers.In "Healthy People 2020" released in December of 2010, the U.S. Department of Health and Human Services released the new 10-year goals for our nation's health - and supporting breast-feeding is prominent among them. By 2020, the goals call for increasing the percentage of Baby Friendly Hospitals to 8%. Contra Costa Health Services is committed to providing quality patient-centered care.

As a review, in October 2010 a team of physicians, nurses and social workers from the medical center, health centers, Healthy Start and public health performed approximately 50 patient observations and time studies of the patient experience from the prenatal visits, through delivery and ending with the first post partum visit. From these observations, the team created a current state map of what our patients experience during their care across the entire care experience. The current state was critically evaluated to determine a vision of our future state. Attached below is an A3 which describes the plan for improvement over the next year.This week representatives of the Post Partum Inpatient Care Experience, which includes patient partners, are working together to develop and test improvement strategies for the inpatient Post Partum Patient Experience, including medication safety, education, and tubal ligations.

I will post a summary of the report in the next few days so you can learn more about the work of your colleagues and our patient and family partners as they draw on science and the energy and creativity of each other to continuously improve our health system.