Sunday, March 28, 2010

I found this months article "Turning Doctors into Leaders" by Thomas H. Lee in the April 2010, Harvard Business Review well worth the read.

Of note, Mike Rona's work at Virginia Mason is highlighted as well as the work of Intermountain Healthcare and Dr. Brent James. Mike Rona and Patti Crome will be joining us at CCRMC this week to help us continue our journey to excellence.


Wednesday, March 24, 2010

Behavioral Health Gets Lean at CCRMC


Behavioral Health Value Stream Event.

When and Where?

Monday March 29, 2010 at 11:00 AM to 1:00 PM at Contra Costa Regional Medical Center (CCRMC) in Building One, Conference Room One.

Friday April 2 at 10:00 AM to 11:00 AM at CCRMC Lobby.

Note: The introduction and report-out for each Event is video-taped and placed on CCHS-iSite.

Why are we doing this?

On March 17th CCRMC convened a multi-stakeholder group to formally introduce Lean Management to the improvement work in Behavioral Health. The group was made up of consumers, family members, advocates, law enforcement from four agencies, paramedics and the Medical Director from Emergency Medical Services, and employees.

The day began with discussion of lived experiences by all on the team. We conducted an ideas generation session with multi-voting. Many ideas were generated and rich discussion followed. Knowledge from that session will be forwarded to the mapping team.

We will continue this effort on March 29, with teams of key stakeholders in Behavioral Health to perform an exercise called value stream mapping. This mapping will examine steps in our processes and weight them in value from a patient’s perspective. We will then follow this up with a series of rapid improvement events or kaizen events (also known as kaizen blitz).

In a stand up report using an A3 format the current state will be presented. Teams will show us what they found and present a vision for the ideal future state. Taking the time to learn about our system and ways to deliver the highest quality and highest value service to individuals and their families is essential. Reflecting on our improvement work in the Congestive Heart Failure (CHF) and Surgical Care value streams (areas of work), it should be noted that much of the ideal future state presented in their stand up report has now become standard work delivered to every patient every time.

It is imperative that we learn together to fulfill our promise to provide the highest quality and highest value service to our community, making possible, health for all.

All teach, all learn.

I have been asked by some of our colleagues from other organizations if they could "come and see" what we are doing. This is not a closed session. Our doors are open to all. We welcome you and know you have much to contribute.

As we continue our journey toward the reliable delivery of care that is always safe, timely, patient-centered, effective, efficient and equitable I want to thank everyone for your genuine interest and tireless efforts.

I look forward to seeing you there.

Be well,

Tuesday, March 23, 2010

Thursday's Improvement Academy

Heading to Boston so I apologize I won't be able to make this week's Improvement Academy. I have asked Jaspreet Benepal to present the Rings of Knowledge and question sets for survey readiness. Please make every effort to attend this very important session.

The executive team is eager to learn with you and will be visiting your areas next week.

More soon...

Monday, March 22, 2010

Using new tools to drive change

I'm looking forward to the 2010 Leadership Conference at the University of California, Berkeley. Kate Fowlie and I will be speaking about the use of new media to move an organization into the future. In other words, it's a talk about blogging, tweeting and facebook!

As a wonderful bonus I will meet with the IHI Open School, University of California at Berkeley Chapter.

Sunday, March 21, 2010

Message from Congressman Miller

“Against all odds, history has been made. We promised health reform and we have delivered it.”
~Rep. George Miller (D-Martinez)
Congressman Miller is chairman of the House Education and Labor Committee. He co-authored the bill and a played a central role in the legislation over the past 13 months.

On his website: Miller points to direct benefits for our district.
“Individuals, families, small businesses, and taxpayers in my district will benefit...Never again will you be at risk of losing your insurance if you lose or change your job, children will be able to stay on their parents plans until age 26, insurance companies will no longer be allowed to deny coverage based on pre-existing conditions, and they will not be allowed to drop your coverage when you get sick.

Community health centers and hospitals in Solano and Contra Costa counties will be better able to serve their patients, and our economy will be stronger."
To read more and for a list of how the 7th district of California (that's us) will benefit please go to Congressman Miller's website.

A Rare Sunday Session. All Eyes on Congress

“We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn’t work, we will parachute in. But we are going to get health care reform passed.”
-House Speaker Nancy Pelosi
Today's schedule: U.S. House of Representatives

1:00 pm EDT
LIVE House Session and Health Care Vote

You can watch it live on C-SPAN here.

Today our President and our Congress will demonstrate that America cares more about saving lives than saving the big insurance companies. When this historic Health Care Legislation passes in the House of Representatives today, I will cry tears of joy. It won't be perfect, but it is the first step.

Source: White

Friday, March 19, 2010

So many lost

Remembering Alfred

I want to talk about my brother-in-law Alfred. No one loved a good laugh more than Alfred and no one could develop a practical joke quite like him. Al was always laughing and always playful. This is a stark contrast to his very reserved and serious older brother who is bothered and humored by very little. Most would describe him as solid - very solid.

There are three brothers, and to have them all in the same room was quite amusing. The oldest brother (my husband) is very serious, the middle brother is best described as nice or perhaps sensitive (relatively speaking), and little brother Alfred a playful joker who brightened any room he entered. They were complete opposites, bickering and debating all the time. Yet much like my three boys, they were always gravitating to each other, always together.

-From left to right; big brother, little brother, middle brother-

The truth is I have no story. I just wanted to talk about Alfred. Our family lost him to suicide nine years ago today and I want to remember him. I have nothing profound to share. It's profound enough to live through the horror of suicide as a family. I’ll admit I do wish I could remember past the way he died, to how he lived. Sometimes I can remember past it, sometimes I can't. It’s unfair that suicide seems to quiet the celebration of a loved one’s life.

Every sixteen minutes someone is lost to suicide, every seventeen minutes someone is left behind.

New Chief Medical Officer

Dear CCRMC employees and partners,

Please join me in welcoming Dr. David Goldstein to his new appointment as Cheif Medical Officer of CCRMC and Heath Centers.

Dr. Goldstein trained in our Family Practice Residency
program from 1991-1994 and has been a Staff Physician ever since. He became Chief of the Emergency Department in 2002 and is a proven leader of quality improvement and change in our organization.

Dr. Goldstein will assume his new role effective April 19.

A bumpy flight

Here's to clever minds.

Just read Jonathan Rauch's "If Air Travel Worked Like Health Care Fasten your seat belts -- it's going to be a bumpy flight." He conveys a poignant message to those of us in health care in his short skit. You can find his original article on National Journal Magazine here.

Below is a well done enactment by Mary and Peter Alton.

Thursday, March 18, 2010

Is medical education preparing physicians for the future? White Paper released this week from the Lucian Leape Institute

The Lucian Leape Institute at the National Patient Safety Foundation released a white paper this week, arguing that US medical schools fail to prepare future physicians with the skills and knowledge necessary to ensure safe delivery of patient care. The report, "Unmet Needs: Teaching Physicians to Provide Safe Care," describes the shortcomings of the current medical education system and issues an urgent call for reform.

Saturday, March 13, 2010

Thinking beyond design to design thinking

I'm posting a TED talk by Tim Brown, CEO of IDEO. His talk is about design thinking and thinking BIG. Photo source


Design begins with humans
• Understand culture and context
• Begin with people and what they need

Learn by making
• Instead of thinking about what to build, build in order to think.
• Prototypes speed up the process of innovation

From consumption to participation
• Shift from a passive relationship between user and provider to design of participatory systems.

Take design out of the hands of designers and place it into the hands of everyone
• Seek active participation of the community, of people
• What do people need? What is the question we are trying to answer?

Focus on systems
• Think BIG: Move away from the ever shrinking canvas of design which is focused on aesthetics, image and fashion, perfecting and refining what we already have (the current solutions)
• In times of change we need new ideas and new alternatives

Thursday, March 11, 2010

Dear CCRMC employees and partners,
I want you to know that the work you do has not gone unnoticed. You do make a difference to our patients, our community and our nation.
Thank you,

Below are Speaker Nancy Pelosi's remarks from a meeting with the National Association of Public Hospitals yesterday at the Capitol.
Washington, D.C. – Speaker Nancy Pelosi and Majority Whip James E. Clyburn held a photo opportunity this afternoon with representatives from the National Association of Public Hospitals and Health Systems (NAPH) following their meeting in the Capitol. Below are the Speaker’s opening remarks:

“Good afternoon. I am proud to be here with the National Association of Public Hospitals as we stand ready to pass health care for all Americans. Not only am I proud to be with them, but I also want to thank them for what they do. They make our communities and our country healthier, how they address the needs of people with no insurance as uncompensated care, which we hope to address in our legislation.

“Because of this legislation, fewer uninsured will walk through the doors of our country’s public hospitals. We will strengthen our case providing fiscal security for these hospitals so that they can be sustainable, as they see some of the poorest patients in the nation.

“In 2008, 30 percent of outpatient and 18 percent of inpatient services went to uninsured patients. Emergency room services for the uninsured cost all of us, all of us, with some estimates in size of $1,000 per year per insured [family of four].

“The mission that the hospitals have, the concern that they have for the American people, the professionalism and the innovation and vision that they have about health care for the future, is a blessing to all of us, serves our situation in our country very well. And I am very honored to be with them today."

Friday, March 5, 2010

Upcoming changes at CCRMC

This communication is intended to introduce a new improvement structure for Contra Costa Regional Medical Center (CCRMC).

What is the challenge?

With an expected increase in demand for our service, we continue to strive for ways to use our vital resources in the most efficient manner while providing quality care. Our challenge is to obtain the requisite resources to meet the needs of our community. We must reliably provide evidenced-based care to promote health in our population, and we must do so in the most cost effective manner. To achieve this, we must build capacity to continuously improve our system for the better.

It is important to recognize that more is not necessarily better. This long held philosophy of our leadership is evidenced by the formation of our System Redesign Team in 2005, whose goal was to “reduce unexplained variation” in our system. We have engaged in many improvement efforts resulting in evidence-based standardization of numerous procedures. While we face many challenges, we stand on a solid history of innovation. It is with this in mind that I share with you the upcoming planned changes at CCRMC.

What is the plan?

I believe we have most of the resources that we need to transform our system. We have a caring, skilled, and talented workforce. We have a clear mission to care for the underserved. We have the support of our governing body, the Contra Costa County Board of Supervisors. What we need is to work together as a team and rethink our delivery systems.

I am delighted to announce that Lance Mageno will be assuming the role of Chief Quality Officer (CQO) for CCRMC as of March 15, 2010. As our system of health care changes to address current and future challenges, I am confident that Lance brings to this position critical skills, vision, and leadership. Lance possesses a thorough and complete knowledge of the current principles and practices of Lean Management, Continuous Quality Improvement and extensive experience in leading innovation. Lance is well respected by his peers and by all of the members of our health care team. He is well prepared to help lead our organization into the future. I expect that Lance will work vigorously with our executive team, and with the entire health system team, in order to refine and implement our strategic plan for the future.

Why a new improvement structure?

There are many remarkable examples of excellence (far too many to list) in our organization. I am proud to be associated with each of you. The magnitude of the need for services in our community is rapidly outstripping our capacity to provide excellent and safe care. Emergency Department and Crisis Stabilization visits are up. Admissions to the hospital are up. Births are up. Patients are sicker.

We are all working faster, harder, and longer, but that is not the solution. In order to deal with the multiple pressures facing our health system, we must continue to redesign our systems of care. We need to streamline our systems so that we do not have to struggle with unexplained variation, redundancy and bureaucracy in order to care for those we serve. We need to make certain that the services we offer are the services that our patients need and want. It is time to get the impediments out of the way! That is the essence of redesign and the essence of innovation.

As part of our planned changes, we will recommit to innovation and system redesign. I have asked Dr. Mitch Applegate and Marianne Bunce-Houston to concentrate their efforts on transformation and innovation at CCRMC. Working with the Safety and Performance Improvement Department, they will lead our efforts building an Innovation Council that will help adopt, adapt, implement and spread evidence-based improvements throughout our system. Both Mitch and Marianne have significant experience leading change in our system.

We are fortunate that Dr. Stuart Forman will assume the role of the Director of Critical Care Services. Stuart has worked in critical care for 17 years and has been involved in various leadership positions in the hospital. He brings a breadth of critical care skills, as well as a strong history of leading improvement efforts including the design and implementation of the Rapid Response Team and leadership of our medication safety efforts. Stuart is well prepared to assume this new role.

These are exciting and challenging times for CCRMC and for all of health care. We can and will meet our challenges now and into the future. Please join me in welcoming these changes as we prepare for the days ahead.


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

Tuesday, March 2, 2010

Contra Costa Hospital Improves Health Care - KCBS

Contra Costa Hospital Improves Health Care - KCBS

Posted using ShareThis

CCRMC Redesign and Lean

Just returned from speaking with the Contra Costa County Board of Supervisors. As promised here is the video I shared with our Board today. Your commitment to continuous learning and improvement shines through. Strong work everyone. -Anna

Monday, March 1, 2010

So many lost, so many left behind and all preventable: Boston Overnight Walk

The 2010 Out of the Darkness Overnight Walk is June 26-27 in Boston

Please support me. Come walk with me. You can register for the walk here, or if you like, you can support me by going to my page here. Please take steps to save lives, reach out to those devastated from losing a loved one to suicide and help create an outlet to help end the silence.

I offer a story. I have posted it before. I wish I had a different story to share, but there is no other version of the story for my family. Sadly, for my family our story will always remain unchanged.
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 my husband's birthday, and 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.

With his permission, I decided last year I would give my husband a different sort of birthday gift. On the night of June 27 -28, 2009, I joined thousands of other people on a 18-mile walk overnight, out of the darkness and into the dawn in Chicago Illinois as part of the American Foundation for Suicide Prevention's, Out of the Darkness Overnight Walk. I walked for Alfred and my family.

Here is short clip from the walk this year in Chicago.

My family cannot change our story, but there are many stories not yet written. Many that can end with hope and possibility.

What will I do?

This year I will join thousands in Boston Massachusetts 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 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 support me. Come walk with me. You can register for the walk here, or if you like you can support me by going to my page here.

Please take steps to save lives.
So many lost, so many left behind and all preventable.

Some facts about suicide from the World 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 2010 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).

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