Health Care for All

                                                                     Photo source: politic365.com

Health Care for All

I’m guessing I was not the only one who was moved this morning when the Supreme Court ruled in favor of the people instead of politics (actually, I know I wasn’t!). I'm grateful that our nation has taken another step toward no longer tolerating the suffering and inequities brought on by a broken health care system.

I have spent my entire career working in the safety net, serving people who are either uninsured or underinsured and have witnessed with frustration how we’ve failed as a nation to care adequately for those most in need. But today’s court decision brings us ever closer to a nation where everyone has access to the health care they need and deserve.

Though today is a time for celebration, there is as much work and challenge ahead as there is opportunity. The court’s decision could allow states the choice to participate in the Affordable Care Act’s (ACA) expansion of Medicaid coverage. The ability to “opt out” of Medicaid expansion could leave many of our nation’s most vulnerable people without access to health care. It’s important to recognize where we are in this movement toward a reformed health care system. Washington has once again stepped forward and preserved the possibility of a nation where the promise of health is equally distributed. Now it’s our turn to renew our efforts to improve the patient experience of care (including quality and satisfaction); improve the health of the populations; and reduce the cost of health care. 

We have already taken many important steps in health reform. We are expanding health coverage through our Contra Costa Health Plan. We have improvement efforts under way across our delivery system. Together, in partnership with those we serve, we provide quality care to all people in Contra Costa County with special attention to those who are most vulnerable to health problems. We continue to meet our responsibility to engage as active members of America’s Health Care Safety Net and as participants in the nation’s movement toward reformed health care.

It's true that we have many challenges before us. Yet I don't see the imperative to reform our health system as a burden, but rather a privilege. It's the commitment to service, and the skill and spirit I encounter every day working on the Contra Costa team that has convinced me beyond any doubt that no matter what lies ahead, health care for all is within our reach.

More very soon,
Anna

What Summer Vacation? Remembering to Breathe and Flash Mobs

We couldn’t be in a more stressful environment than right now. That is the sentiment being expressed all around me. We’re less than two weeks away from “go live” of our electronic health record, ccLink, opening of our new West County Health Center this summer, expanding the Concord Health Center, developing the patient-centered health-home model and continuing ongoing improvement efforts as we help make health reform a reality (see my April 29 post). Any one of these alone would be enough to stretch us to capacity!

The Contra Costa team continues to model effective and simple ways to harness the winds of change and drive forward. Exercise and healthy eating are within everyone’s reach. You can start small by replacing an elevator ride with the stairs or taking a stroll to the Farmers Market at the CCRMC campus every Tuesday to browse the fresh food choices. In the coming weeks, I will introduce our planned efforts promote movement and physical activity in our county.

Perhaps an even more simple way to promote well-being and something you don’t have to go anywhere for is remembering to just breathe. Our employee’s creativity never ceases to amaze me (it’s one of the reasons I love working here). Karen Lloyd, one of our Rehab Therapy Services managers, provided a short demonstration last week to our leadership team focusing on mindfulness and breathing to reduce stress and help increase focus. After less than a minute of closing my eyes and concentrating on my breathing, my stress level plummeted as did our collective blood pressure I imagine. This small practice is based on Jon Kabat-Zinn’s Mindfulness Based Stress Reduction (MBSR) – an evidence-based process piloted at the University of Massachusetts Medical School to promote stress reduction for medical professionals and patients. This exercise is a regular feature of the Wellness Groups offered within our system in the Integrated Health Services program led by Dr. Karen Burt and Dr. Joyce Tang. It has been shown to reduce stress, depression and anxiety and even improve performance. I’ve heard rumor that mini mindfulness Flash Mobs (yes, I said Flash Mobs!) are springing up throughout the system, so keep an eye out for the opportunity to just breathe.

For those who may not be familiar with the term "Flash Mob," I leave you with a short video of one of the most frequently viewed Flash Mobs on the web. Enjoy...

More very soon.
Anna

Breaking Eggs (or not?): NAPH Fellows Visit Contra Costa Regional Medical Center

CCRMC had the honor today of hosting the this year’s National Association of Public Hospital and Health Systems (NAPH), fellows. It was exciting to meet leaders from across the country embarking on a journey I took myself just a few years ago. The visit was part of the fellows learning session which coincides with the NAPH annual conference, which starts Wednesday in San Francisco.

Our Health Services Director Dr. William Walker and I had the privilege to share our organization's story and to talk about some of the accomplishments here at Contra Costa Regional Medical Center and Health Centers. We started the day in our Redwood Grove and then the fellows were given a tour of our hospital in areas that have been the focus of some of our improvement efforts.

Patient and Family Member Partners shared their stories and our staff shared lessons we have learned in the application of the Model for Improvement and Lean management. Our guests had a chance to participate in interactive exercises designed to illustrate how Lean and rapid improvement works. I was struck by the creativity of the different groups when designing. One of my favorite parts of the day was watching the imaginative design concepts that teams came up with to protect an egg from breaking when dropped several feet from a ladder!

It was reinvigorating to spend time with the NAPH fellows. Today was yet another reminder of how truly important and essential the improvement work you are all doing is. I look forward to presenting on patient and family involvement this Thursday at the NAPH conference and am excited to hear what other systems are tackling so stay tuned.

More very soon.
Anna

Every 40 seconds someone in the world dies by suicide. Every 41 seconds someone is left behind.

Every 40 seconds someone in the world dies by suicide. Every 41 seconds someone is left behind.

What am I doing?

On June 9, 2012 I will join thousands in San Francisco, CA who are taking steps to save lives. The goal of this journey, which will begin at dusk and finish at dawn, is to raise funds for suicide prevention. I will help end the silence and erase the stigma surrounding suicide and its causes, encourage those suffering from mental illness to seek treatment, and show support for the families and friends of the over 30,000 Americans who die by suicide each year. Suicide is the third leading cause of death among teens and young adults and the second leading cause of death for college students.

What can you do?

Please help end the silence. You can register for the walk here, or if you like you can support us by visiting our team webpage.

Please help save lives, reach out to those devastated from losing a loved one to suicide and help create an outlet to help end the silence.

So many lost, so many left behind and all preventable.
~Anna

Source
More facts about suicide from theWorld Health Organization (WHO)

•In the year 2000, approximately one million people died from suicide: a "global" mortality rate of 16 per 100,000, or one death every 40 seconds.
-It's 2012 now! How many have been lost? Read the next line--too many

•In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide.

•Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020.

•Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries.

•Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex socio-cultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (e.g. loss of a loved one, employment, honor).
- WHO

Unfortunately the list goes on. To learn more you can visit the AFSP website here.

Quality is Goodness

I attended a wonderful talk today by the former Administrator of the Centers for Medicare and Medicaid Services, Dr. Don Berwick.

Here are just a few take aways.

"Waste threatens health care as a human right."
This has great meaning for me and probably confirms what many of you likely already know about me. Yes, I believe all people have a right to health and health care. Our health system should leave no one out.

"Quality is Goodness"
Taking on the broad use of the term quality, Dr. Berwick drew boundaries around the term and poignantly described meaningful quality as goodness.

What do we need to do? This is the 2.6 trillion dollar question isn't it? Here is a list to help guide us.
1. Put patients first
2. Protect the disadvantaged
3. Start at scale –move fast – go "all in"
4. Return the money
5. Act locally

"The mission is perfection."
Yes, he said perfection. This means we must take aim at zero and 100%.  

"To transform we need a transition in self-image and sense of purpose. We must accept our ethical duty to learn from and redesign our system to prevent harm."

The Ethics of Improvement

1. Professionals have a duty to help improve the systems in which they work.
2. Leaders have a duty to make 1. Logistical, feasible and supported.
3. No excuses for inaction on 1 and 2 are acceptable.
4. The duty to improve encompasses safety, efficiency, patient-centeredness, timeliness, effectiveness, and equity requires continual reduction of waste. The IOM six dimensions quality of are dimensions of goodness
5. Those who educate professionals have the duty to prepare them for improvement work.

Don's dream:

That we will embrace improvement as our duty to accomplish great and ever greater good.

I was honored to join the panel today and am grateful to California Hospital Association and John Muir Health for such a rich day of learning and collaboration.

A good day....

Anna

A note from the CCRMC and HC Transitions Kaizen Team

Using the Model for Improvement Everyday: CCRMC Improvement Academy Thursday, May 2 2012

It is important now more than ever to make sure everyone understands that improvement is in their hands. All staff should be able to recognize and use the Plan-Do-Study-Act (PDSA) cycle in this critical time of change. What better time to make things better for our patients and staff?

Objectives:

After this presentation, learner’s shall be able to:

• Understand all elements of the PDSA cycle
• Articulate the reasons why it is used to guide PI efforts
• Understand how the PDSA cycle is utilized  in a clinical setting
• Apply the PDSA cycle in their own improvement work

We will have time for Q&A to talk more about how the Model for Improvement (MFI) is applicable to your everyday work. 

Please join us.

Anna