Saturday, June 18, 2016

Father's Day

I have been asked to share the story I told of the last Father's Day my dad and I shared and the precious gift a nurse gave us. It's posted below.

Anyone who’s heard me speak about the CCRMC System Redesign has heard me speak of my father. In my blog entry on his birthday, I disclosed how disorienting the experience of being a ‘daughter at the bedside’ was for me.
“I tried to keep up as the teams rounded on him. I began to realize 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 seemed in just a few short weeks my father went from being a strong independent man who always knew best, to a person reduced to a diagnosis, a set of complicated and ever-changing presentations. He became a man who was dependent on a system of care surrounding him that didn’t seem to truly grasp how far away he was from himself. After knowing him my entire life, experts began to redefine him in terms I would have never considered using to describe my father: the Acute Renal Failure (I even heard them say ARF); the pancreatitis in 12; confused, demented and elderly. Sometimes (I believe in an attempt to reassure us) we were told “for his age this is common.” It was anything but common. It was absolutely unique for him and for us as a family.

I remember my dad’s last Father’s Day. He was in the hospital and I gave him a collection of CDs. It was an audio collection of mystery radio. When I was a young girl, my mother went to law school at night. My dad and I would drive 30 minutes to the school and sit in the car waiting for my mother to get out of class. We would listen to Radio Mystery Theater with E.G. Marshall. It was an attempt at radio show revival during the 70's. During the show, we would try to guess who committed the dastardly act. I would "rest my eyes" in the last 15 minutes but I would pretend I was awake the whole time and my dad always played along. The show would end about 15 minutes before my mother actually came out. My dad and I would explain our rationale for choosing the suspect and almost always our conversations would wander.

We traveled very little, we were a big camping and hiking family. I always wanted to see the great cities of the world, so my dad would tell me a story about a place he had gone when he was in the military. He would recall little details which didn’t often reveal very much about the place of interest, but revealed a tremendous amount about his experience of being there. He would describe how warm or cool the wind was, the smell in the air, colors people were wearing, what the food tasted like, and the feel of the ground under his feet. His stories were always my favorite part of the day. If ever I asked for him to tell me about a place he had been, he would always, without fail, deliver. He was a great storyteller.

If the truth be told the radio show CD's were probably more for me than him, ibut as always, he played along. I placed the CD in the portable stereo I had brought from home. I think he quite liked the idea, but didn’t really listen, because I don’t think he felt well enough. He drifted in and out of sleep. His nurse peeked in the room and motioned to me she would come back. She softly shut the door and at that moment every monitor, hall conversation, ringing telephone and supply cart rolling by faded into the distance. It was as if we were sitting in the dark parking lot in our family car, me and my dad and Radio Mystery Theater, just as I remembered. When the show was over my dad opened his eyes and said “I knew who did it the whole time.” He smirked because we both knew he had no clue, he was fast asleep. He asked me how school was going and I told him all about Parnassus Campus (one of my favorite places). I shared little details about Millbury Union, the beautiful fog that seemed to linger all day, and the great library. He said he remembered the library well, calling it “the crossroads of the world.” He complained that no one goes anymore and soon young people will not understand the silence of the great rooms of knowledge and the smell of old books. The nurse came and went and my dad drifted off to sleep. I did too, I was exhausted.

While walking through the medical center I reflected on Don Berwick’s plenary speech at the 2009 International Forum on Quality and Safety in Health Care in Berlin. He said that he believes we would all be better off "if professionals (us) would behave with patients and families not as their hosts in our care system, but as guests in their lives.”

We can count how many patients are in our hospital, but how many lives are we really touching? So many people make up our experience of living: people whom we can delight just by slowing down from our hurried pace and taking a moment to listen to them with an aim to understand what they are telling us; people whom we can disappoint, because too often we assume we know what is right and we define them relying on our experience as a professional, rather than on their experience as a unique and vibrant individual with stories and experiences that far exceed anything we will have the privilege of knowing.

I thought about the nurse who shut the door for my dad, a gift from her to us. No more monitors, no more call lights, no more ringing telephones, just me and my dad and Radio Mystery Theater, just as I remembered. She took the time. She gave us respite from the unsettling experience of being in a hospital. She gave us a moment of peace and quiet on our last Father’s Day. On that night, that nurse not only cared for my father, she touched my life too.

Happy Father's Day,

This story also appears in Privileged Presence: Personal Stories of Connections in Health Care. 2nd Edition. Crocker, L. & Johnson, B. 2015.

Thursday, January 1, 2015

Welcoming the New Year: Building on a solid foundation in 2015

Every January 1, I look forward to sending a New Year message to all of you who make up our team here at CCRMC, Health Centers and Detention Health. It’s an exciting time as we welcome a new year and all that it will bring. I want to give special thanks to those among us who serve our community on holidays, after hours and on weekends – those whose commitment to our mission has them assisting those in need.

This past year we strengthened our foundation with our patient, family, and community partnerships, we saw the continued development and optimization of our electronic health record as well as improvement work throughout the health care delivery system, and we collaborated with other Contra Costa Health Services divisions. In the coming weeks, we will release our 2015-2020 Strategic Plan that builds on these accomplishments and reflects our commitment to compassionate, high quality care, partnerships and new ways of thinking about health in our community.

Our focus will continue to be on delivering the highest quality care to all and expanding our patient and family partnerships. We are still seeing the far-reaching and overwhelmingly positive effects of the replacement of our Visitors Policy with a Welcoming Policy. This cultural shift reflects our shared belief that hospitals should be places where families and loved-ones are welcomed, recognized and included as essential to partners in health care.

2015 is the fifth year of our Delivery System Reform Incentive Payments (DSRIP) program to expand access to care and enhance quality. This vital program has provided essential support of the redesign of our health delivery system to meet the needs of our community. The work that you have been doing has set a course toward health for all. This is the promise of health reform and your efforts are making a difference.

Our ongoing partnership with the Behavioral Health division to integrate physical and behavioral health care continues to improve how we provide patient-centered care that treats the whole person. We are set to expand this integration with additional services launching at our Miller Wellness Center this month and the new Antioch Health Center planned to open later this year. Integration efforts like these support our efforts to improve access to care and how we provide that care. 

In our West County Health Center, we have implemented the Health Leads program, which helps to address critical issues facing our patients such as food, shelter and housing to support health in the broadest sense of the word. We will continue to build on partnerships within our Health Services Department and beyond, as we did with Public Health and Emergency Medical Services during our extensive Ebola Virus Disease preparedness efforts. Being part of an integrated health system allows us to better care for, respond to and protect our community.

As we welcome the year with the ambitious goal of creating optimal health for all, we move forward together—patients and their families with staff, community groups with CCRMC, health plans with doctors, and countless other essential allies. In every situation, sustainability, efficiency, and the delivery of value requires that individuals and groups unite. The bold promise of health reform can only be achieved by fundamentally transforming how we work, recognizing that an interdependent approach is essential to make the best use of our collective skills, knowledge, and experience. I, for one, am happy that this year brings a new opportunity to work with all of you.

My sincere best wishes to you in the year to come.


Wednesday, September 24, 2014

Suffering In Silence: Why We Should Talk About Suicide

I can remember it so clearly. It was just a few hours before the clock struck twelve and it would be my husband’s birthday. He loves presents, but always makes it difficult for me to get the right thing. He acts as if his birthday doesn’t matter to him, but I do think he likes a bit of a fuss.

The message on my phone wasn't very clear. There was a great deal of background noise. I could hardly hear him say, “Call me now, it’s an emergency!” I tried calling several times, but he wasn’t answering. Finally, I called my father-in-law and I could have never predicted what would come next. His voice was different; it was slow and soft as he calmly explained to me that my husband’s brother had just killed himself. He was 26 years old. It was incomprehensible. I couldn't make sense of it. Even after years of working in mental health, I could not even begin to grasp what I was hearing.

There isn’t a day that goes by that I don’t think of him. He and my husband were best friends. Al was always there. He did everything with us. I remember he would come out on the boat with us. He never got out on the ski or wake board. He never drove either. He just liked to come along for the ride. He liked to spend time with his brother. The feeling was mutual. They were very close. Where you found one, you would very likely find the other.

It only takes a momentary glance to see the sadness in my husband’s eyes. I have come to know this silent sorrow all too well, because it dwells in our family. I have experienced other family members dying. I have talked about my father's death, which had a profound effect on me but this is different; there is a silence that accompanies suicide. The silence is deafening. Each December we are quiet, our conversation subdued, as his birthday passes and the holidays come and go. Then there is there is the day Alfred ended his life - the eve of my husband’s birthday. Even though we rarely speak of the night he killed himself, we are all thinking about it. I don’t really know how to say it other than directly. I miss Alfred. I really miss him. There is so much silence. I wish we could talk about him more.

A few years ago I decided I would give my husband a different kind of gift for his birthday and joined thousands of people in Chicago on a 20-mile walk into the dawn as part of the American Foundation for Suicide Prevention's, Out of the Darkness Overnight Walk. Two years later, when he was ready, my husband joined my on the journey Overnight in San Francisco and we walked Out of the Darkness together. Since then, we spend each day combating the silence and stigma that too often accompanies suicide.

Help end the silence and erase the stigma surrounding suicide and its causes. Encourage those suffering from mental illness to seek treatment. Show support to the families and friends of the 36,000 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. Every 40 seconds someone dies by suicide in the world.

Please approach those suffering with compassion and remember that “many people who are experiencing suicidal thoughts don’t want to die; they want the pain to go away.” Take the warning signs seriously. You can find them on the Contra Costa Health Services website here. I encourage you to reach out and offer support to families who are devastated from losing a loved one. They will be grateful to know you are there. You can make a difference by ending the silence.

You can find more information on the Contra Costa Health Crisis Service page. Or in other communities you can check your local crisis resources or the resource page here at the American Foundation for Suicide Prevention.

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


Wednesday, September 17, 2014

CCRMC and HC Rapid Improvement in the Health Homes: Kaizen Report Out

Over the last year we have been actively redesigning our ambulatory health system, pushing ourselves to build a stronger patient-centered, team-based system of care.  Last week a multidisciplinary team came together to work on optimizing the roles of each member of our health home teams.  The improvement team set out to better define the connections between team members in pursuit of meeting patient’s needs in a more timely manner.  The team was supported in their work by one of our patient partners, Nancy, who directly participated to help design and carry out the tests of change throughout the week. 
The Kaizen team focused their energy on two roles; the Care Coordinator and the Health Home Coordinator.  Our Care Coordinators assist patients with system navigation and specialty referral management, among other tasks.  While our Health Home Coordinators have a nursing clinical background that supports patients with health education and chronic disease management.  The team felt that by improving the connections and clarity between the two roles teamwork could be improved.  Over the course of the week the team defined processes for reporting laboratory results, reception and processing of any incoming patient calls, and initiation of durable medical equipment (DME) requests.  One example of the improvement work, involved utilization of online tools that staff will now use to streamline DME processing.  This new process was able to reduce initial processing cycle times by 20%.  The team will continue to monitor the changes over the next three months, with a continued emphasis on adjusting and learning from their experiments. I have included the slides from the report out above.

Two overarching themes that continue to rise to the top are centering all we do on meeting the patients expressed needs and creation of standard, predictable roles so we can work seamlessly as a team to meet our patients needs. I hope you take the time to review the visibility boards in your work areas which display our current work and progress towards our goals.
More very soon,


Many thanks to Miles Kotchevar and the Health Home Kaizen team for your contributions to this post. Keep an eye out for the Kaizen Team Postcard!

Wednesday, July 2, 2014

We Are Indeed Better Together

I am once again humbled and in awe of what we as “public hospitals” do.

Contra Costa Regional Medical Center (CCRMC) is a county hospital, and we hear repeatedly from those we serve that they are surprised by the excellent and compassionate care they receive here.

This myth that public hospitals are places of last resort has once again been debunked, this time by the Better Together campaign, which was launched Tuesday by the Institute for Patient- and Family-Centered Care (IPFCC). We are honored to be one of only 12 hospitals recognized nationwide by IPFCC for supporting families as partners in care by eliminating restrictive visiting hours.           

IPFCC’s campaign calls on all hospitals to welcome families 24 hours a day and to transform their approach to care so that patients’ families and loved ones are included in care and decision-making, based on patient preferences.
We implemented a “welcoming” policy nine months ago, eliminating restrictive visiting policies and the concept of "visitors" at CCRMC. One experience that contributed to CCRMC’s decision to change was when a young boy wasn’t allowed to be in our ICU with his grandfather, who had raised him, because it was after visiting hours. The grandfather passed away and the two lost the chance to say goodbye.

That incident really hit home for me and our entire staff. We knew we could do better. Our old policies treated family members like visitors, until we realized that we are the visitors in people’s lives, not the other way around. This was a huge cultural shift, and one that the staff here was courageous enough, bold enough and caring enough to undertake.

Since then, we’ve had more than 5,000 people come after hours to be with their loved ones. Tracking the data is an important part of assessing success and we’re gathering input and feedback from staff and patients and their families. See my previous blog post here for more information.

Simply being open 24/7 isn’t enough. There is a difference between a 24/7 visitation policy and a welcoming policy. We as hospitals need to be truly welcoming places where families and loved ones are recognized and included as essential to patient care. It’s also not up to us to define family- patients have that right and we are proud to also be recognized as a "Leader in LGBT Healthcare Equality" by the Human Rights Campaign Foundation.

We know family and loved-one presence supports safe and high quality care. You can read more about this on the IPFCC website:
It’s been a wonderful experience working on the Better Together campaign with IPFCC and their President and CEO Beverley Johnson. They’ve produced some fabulous videos found here that highlight CCRMC staff, patients and partners.  It’s an excellent tribute to all the staff – here at CCRMC and Health Centers, Contra Costa Health Services, and the Sheriff's Office - who made possible this shift in culture to reflect our commitment to working with patients and family partners to provide the care that those we serve want and deserve.

To make this work, it was important to sit down with staff and listen to their concerns about changing visiting policies. We brought together everyone who was involved, from doctors, nurses, security personnel, receptionists and other staff to patients and their families and loved ones, to lead the effort.

While our policy welcomes families 24/7, that doesn’t mean there aren’t boundaries. We always consider safety and our patients’ preferences in every situation, but now having a family member or loved one by the bedside is the norm. It’s part of our culture of excellence. And if that’s what “public” means, we wear that badge proudly.

More very soon,

Wednesday, June 25, 2014

CCRMC Safety System Kaizen 3

I wanted to share a quick update that went out via CCRMC postcard from the Kaizen team.

Contra Costa Regional Medical Center Kaizen Safety Stream June 17-20, 2014

This was the third of five scheduled events dedicated to addressing our safety system as it relates to the Root Cause Analysis process. When a serious safety event occurs at the medical center or health centers, our organization uses a standard process called a "Root Cause Analysis" (RCA) to understand the system failures. Those failures are addressed by interviewing the staff involved and detailing a timeline of events. At the completion of the Root cause Analysis convening, the participants devise actions items to complete to prevent similar events from occurring in the future.

Here are the slides from the report out:

The two previous Rapid Improvement Events (RIE) focused on: 1) the immediate response to a serious safety event, and 2) preparation for the RCA meeting. This third event focused on the RCA meeting. The goal was to achieve a more consistent approach to the meeting structure and to standardize the roles of those facilitating the meeting. These goals were to be accomplished through standard work creation and development of action plan criteria.

In three days, the team identified problems, opportunities for improvement and simulated the changed process:
RCA Meeting Agenda: Adjusted agenda to ensure sufficient time is allotted to event analysis and action plans
Action Plan Tracking and Criteria: To track action item completion a spreadsheet was revised to better capture the details of progress and to identify the lead person responsible for each item. A shared electronic version will be investigated in the next RIE. A guide was also created to facilitate action plan creation.Roles Clarified: Standard work was developed for the RCA roles of facilitator, scribe, and timekeeper
RCA Meeting Follow-up Plan: To help expedite action item completion the team created a work flow for follow-up meetings and communication for a small sub-team of Department Heads, Nurse Program Managers, Quality Managers, and the Patient Safety Officer

Interviews with staff and leaders provided great insight into the current state and provided excellent ideas to further investigate. There will need to be a heavy emphasis on teaching the standard work to ensure the next RIE can pick up easily from where the last team left off.

The next RIE is scheduled for August 26-29, 2014 and will be dedicated to “Implementation, Closure and Communication of Lessons Learned. All standard work is located on “Standard Work Library” under Hospital & Health Centers.

More very soon,

Wednesday, May 28, 2014

4612 Welcome moments - Zero complaints -- Contra Costa Regional Medical Center Welcome 24/7---Update

Nine months ago, Contra Costa Regional Medical Center made it a priority to respect family members/care partners as a valuable part of the patient’s care team by transforming our then "Visitor Policy" to what is now know as our Welcoming Policy. We recognized the great benefits a patient receives while having loved-ones by their side during care transitions, moments of decision-making, and to provide overall comfort.

As with any new practice implementation - areas for improvement were identified and quick fixes that employees, patients and loved ones suggested were trialed. Our staff took the initiative and worked admirably to ensure safety and well-being was never compromised. Together these ideas and changes in practice have helped to support family and loved-one presence during hospital stays at Contra Costa Regional Medical Center (CCRMC). 

4612 Welcome moments - Zero complaints
I am excited to share a recent data  that shows just how many family members/care partners have taken advantage of our new Welcoming Policy. The chart below shows the amount of family members/care partners that have passed through the CCRMC main entrance or Emergency Department after normal business hours, 8:00 PM - 7:00 AM.
Here the same data by unit.
For those who may be interested in our policies and data collection tools, we have updated those on our Welcoming page on our public website.  

For staff who want to follow along with the data, please check "By the Number's" on iSite for the current data.

Many thanks to everyone for supporting family and loved-one presence. This important step supports safety and healing.
More very soon,