Monday, November 28, 2011

Go with your gut

To further improve the detection and response of people who are demonstrating signs of imminent clinical deterioration, we are beginning a medical center wide "Go with your gut" initiative.  Although criteria for calling the "Rapid Response Team" (RRT) is defined in medical center policy, the various criteria cannot possibly cover all situations.  We are asking front line nursing staff, physicians, patients, family members and ancillary staff to follow your gut instinct and call for help whenever you are concerned or when you feel things are not quite right.

The Rapid Response Team members hope to raise awareness of this critical safety net rescue team.  According to Rapid Response Team nurses, "The RRT brings an extra pair of hands, a new set of eyes, assist in determining the patient's monitoring needs, and most importantly, brings critical care to the bedside"
You are the most important link in our safety system. I encourage you to trust your instincts and "Go with your gut."


Wednesday, November 23, 2011

Engage with Grace

A group of bloggers have been conducting an Engage with Grace blog rally each Thanksgiving. I am posting a summary prepared by Alexandra Drane and others involved in this issue. It should be noted that I ran into this on Paul Levy's blog. I have posted about Engage with Grace before. Sadly, after watching dear friends face these very difficult conversations this last year, Engage with Grace has new meaning and importance to me.

Below is an excerpt Alaxenadra Drane's post:

Once again, this Thanksgiving we are grateful to all the people who keep this mission alive day after day: to ensure that each and every one of us understands, communicates, and has honored their end of life wishes....
...It's a mission that's driven by all the personal stories we've heard of people who've seen their loved ones suffer unnecessarily at the end of their lives.
It's driven by that ripping-off-the-band-aid feeling of relief you get when you've finally broached the subject of end of life wishes with your family, free from the burden of just not knowing what they'd want for themselves, and knowing you could advocate for these wishes if your loved one weren't able to speak up for themselves.

And it's driven by knowing that this is a conversation that needs to happen early, and often. One of the greatest gifts you can give the ones you love is making sure you're all on the same page. In the words of the amazing Atul Gawande, you only die once! Die the way you want. Make sure your loved ones get that same gift. And there is a way to engage in this topic with grace!

Here are the five questions, read them, consider them, answer them (you can securely save your answers at the Engage with Grace site), share your answers with your loved ones. It doesn't matter what your answers are, it just matters that you know them for yourself, and for your loved ones. And they for you.


We all know the power of a group that decides to assemble. In fact, we recently spent an amazing couple days with the members of the Coalition to Transform Advanced Care, or C-TAC, working together to channel so much of the extraordinary work that organizations are already doing to improve the quality of care for our country's sickest and most vulnerable.
Noted journalist Eleanor Clift gave an amazing talk, finding a way to weave humor and joy into her telling of the story she shared in this Health Affairs article. She elegantly sums up (as only she can) the reason that we have this blog rally every year:
For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they're in a crisis, which isn't the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor's office.
It's a conversation you need to have wherever and whenever you can, and the more people you can rope into it, the better! Make this conversation a part of your Thanksgiving weekend, there will be a right moment, you just might not realize how right it was until you begin the conversation.

This is a time to be inspired, informed - to tackle our challenges in real, substantive, and scalable ways. Participating in this blog rally is just one small, yet huge, way that we can each keep that fire burning in our bellies, long after the turkey dinner is gone.

Wishing you and yours a happy and healthy holiday season. Let's Engage with Grace together.
To learn more please go to post was developed by Alexandra Drane and the Engage With Grace team.

Tuesday, November 22, 2011

Giving thanks

Dear Contra Costa Colleagues and Partners,

Thanksgiving is upon us. It is a time to stop, share a meal and precious time with family and friends, and, in the midst of whatever challenges we may be facing, reflect on what is right and good in our lives. It is a time for blessings to displace our burdens.

As health care professionals, we give special thanks to those among us who cannot stop what they are doing on Thanksgiving Day -- whose commitment to our community has them assisting those in need. We also know that many are not able to celebrate due to their personal circumstances.

They will be in our thoughts, as all of you will be in mine. I could not be more thankful for the privilege of working with such a dedicated and caring community of professionals and partners. Each day you bring your skill and spirit, contributing to our mission, making us one of the finest health systems in our nation.

I am grateful for your service and wish you and all your family and friends a safe and peaceful holiday.


Saturday, November 19, 2011

Near Poor

I was not surprised to read of the new measure of poverty, "near poor," released last week by the US Census Bureau. In the NY Times these people are described as, "down but not quite out." So often overlooked and under quantified, the NY Times goes on to report, "this new count suggests they are far more numerous than previously understood."

Although the government study has not yet been released, it is suggested that the new measure may find that, "100 million people — one in three Americans — are living either in poverty or in the fretful zone just above it."

Those of us in the public sector know far too well that this story is playing out across our communities. The unrelenting nature of this recession is unique and hitting California with great force. Although the legislative analyst said a double-dip recession was not likely, it did downgrade its forecast for employment growth and housing permits. It projects California's jobless rate will remain above 10 percent through the middle of 2014 and above 8 percent through 2017. That means that although we may face another devastating round of "trigger cuts," California's safety net will be required to further step up to meet the growing need of those in need.

Friday, November 18, 2011

The Women’s Summit – Education and Health Care are Everyone’s Issue

Assemblymembers Joan Buchanan, Susan Bonilla, and Nancy Skinner hosted a Women’s Conference this week to discuss the impact of the economic downturn and the state budget crisis on services affecting women and children. I was honored to serve as one of the panelists.

The Summit was held against the backdrop of the 100th anniversary of the women’s right to vote in California. I joined panelists from the fields of education, safety and health care to address issues impacting local constituencies and encouraged the Assemblymembers to continue their strong advocacy on behalf of the safety net. Over a 200 women including local officials, leaders and residents attended the November 14th event at the Lesher Center in Walnut Creek.

I discussed the one-third increase Contra Costa Health Services has seen in people seeking health care over the past two years. People in our county are faced with difficult choices, sometimes between basic provisions for themselves and their family or health care. People who wait too long to seek service can end up sicker, experiencing personal suffering and may need more extensive – and more expensive – care. Some patients come to us in the middle of cancer or other life-saving treatment and have lost their work-based insurance. We’ve responded to the crisis by ratcheting up our already significant work to increase efficiency and access to care -- leading to multiple improvements. For instance, by implementing an automatic reminder call system for mammogram appointments, we have reduced the no-show rate from 18 percent in one health center to almost 50 percent in another. In spite of our work and improvement, the need for support is still great.

Cutting funds during this crisis is not only unwise; it will only cost us more down the road. With state revenues lower than anticipated and additional cuts looming, we must remain vocal in letting our legislators know how great the need is during these difficult times.

Even our strongest supporters – such as the three Assemblymembers representing our county in Sacramento – need to hear from us so that they can continue to fight on behalf of our patients.

Tuesday, November 8, 2011

Moving forward with Patient- and Family- Centered Care: IPFCC

What an amazing group I am working with at the Institute for Patient- and Family- Centered Care Seminar, "Hospitals and Communities Moving Forward with Patient- and Family-Centered Care."

It's a privilege to work with such a diverse group. Today we explored the power of story. I was blown away by what I heard. I'm excited to reconnect with the group tomorrow.

I want to tell Dr. Tim Rutledge, President & Chief Executive Officer of North York General Hospital in Toronto, that I am truly inspired by your team and your committment to PFCC. As faculty, I am working with twenty people from North York General Hospital! This is clear and visible committment on your part.

Also on our team are Patient and Family Advisors from Fox Chase Cancer Center, and a leader from Hospice of Cincinnati. What an extraordinary story of partnership shared by Dan about his half marathon run, in which he was joined by his doctor. You can read about it here.
Message to Jim Conway- Martha Hayward, IHI Lead, Public and Patient Engagement and I have found each other!

Sunday, November 6, 2011

PCHH Rapid Improvement Event


The Patient Centered Health Home, Rapid Improvement/Kaizen Event, will be conducted at the Pittsburg Health Center this week. The team will focus on "flow" and efficiency in the clinic. I encourage those who want to learn more about Rapid Improvement Events to join the open session from 11am to 1 pm on Monday, November 7, at the Pittsburg Health Center.

The Report Out will be held Thursday, November 10th, from 5:00- 5:30 PM at the Pittsburg Health Center.

Please support 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.