Saturday, December 1, 2012

On the front lines of making health reform a reality

As an integrated health system we are uniquely poised to implement health reform and it is exciting to be part of the transformation of health care in America. A recent story in the Contra Costa Times and San Jose Mercury News on our FamilyPractice Residency Program illustrates just one of the many ways we are helping make this transformation possible.

With health reform, an increased demand for just the type of doctors we train will rise dramatically. Our program, which trains residents to become multi-talented family physicians, has been recognized nationally for years. It attracts more than 700 applicants every year, eager to be considered for one of our 14 positions. Most of our residents - who come from across the country - stay in Contra Costa to practice medicine here. The success of the program is a credit to the amazing work of our doctors and staff who oversee the training of the residents.  

I’m always inspired by the dedication of our residents. The financial pressure to become a specialist is immense these days, yet our residents eagerly choose to be trained as family doctors in a safety-net health system. Why do they make that choice? As one of our residents explains in her profile on our program webpage, “I wanted to learn how to take care of patients, not just hearts or hernias or kidneys. I decided to come to Martinez for the people.”  

Her comment epitomizes who we are and what we do here. Health care delivery is more than treating an illness, injury or virus. The best health care involves ongoing relationships between patients and their providers and care team. In our system, we have many physicians– including Contra Costa Health Services Director Dr. William Walker – who have cared for the same patients for decades. 

It makes me proud to work in a patient-centered health system that is often called a model for health reform. But what makes me the most proud are the people who make our system work – they are the ones making health reform a reality.   

More very soon,


Friday, November 16, 2012

One hit at a time

Growing up, baseball was taken seriously in my home. All of us kids played on some sort of baseball team. My mother recently reminded me that we never ate dinner until the Oakland Athletics’ baseball game was over. I learned a tremendous lesson about baseball and life on what felt at the time to be the worst Fourth of July in all my young years. 

Our entire neighborhood packed up the station wagons preparing to head for the game in Oakland. I was so excited. It was a Fourth of July night game, so there would be fireworks, plus – as a special bonus – it was “bat day.” The bats were the full-size bats that came with a player’s signature on them. I could already feel the bat I was going to get in my six-year-old hands. As luck would have it, while preparing to leave, my nascent case of chickenpox was detected. While everyone waved goodbye, off to see the greatest game ever, I sat on the neighbor’s couch covered in calamine. My heart was broken into what felt like a thousand pieces.

Last Fourth of July, I was sitting in the stands at an A’s game reminiscing with my youngest son about being in the very same seats when I was his age. The line-up then consisted of players like Catfish Hunter, Joe Rudi, Bert Campaneris, Reggie Jackson, Rollie Fingers, Sal Bando, and Manny Trillo. They were a great team – I loved them because they were not made up of one or two stars, but a group of people working together to capture the win. They were a great team – a team that gave away bats!

What does this story have to do with health care? From the time I was a nurse’s aide as a teen to becoming a newly appointed Chief Executive Officer many years later, too much of my thinking was spent in pursuit of the next big thing. Like so many other health care professionals, I was enamored with the idea of a home run– even better – a grand slam. The roar of a crowd when a ball is smacked over the fence is compelling. I longed to make that one perfect hit resulting in the best care and the healthiest community; all at an affordable cost. The truth is, I still long for this. The trouble with this kind of thinking is not the goal itself. The trouble is that while many of us continue to dream of hitting one out of the park, excellence and continuous improvement generally aren’t achieved and certainly not sustained by swinging for the fences, but by a series of hits over time. Focusing on home runs is thinking too narrowly.

I don’t know how much time the health care industry spends in search of the magic bullet compared to time spent on deliberate improvement efforts, but it is my observation that we are often captivated by the idea that there is one single solution. Currently in my health system, we are humming with activity as we launch of our electronic health record (EHR). Although this technology is long overdue and will support improved processes and information flow, it is not the answer to all of our problems. As I listen to the discussions of our EHR, I wonder if we are wishing for a grand slam. Not only do I think such a thought would be wishful thinking, I think this kind of thinking is a set up for disappointment and confusion when the EHR alone fails to repair our health system. Additionally, this new capability to see will likely expose many complexities that have always existed in our system. That said, beyond the obvious and powerful ability to connect people, science and needed information, the EHR introduces a new state, new eyes and a new opportunities to understand even more about how we can improve our system - not a grand slam but an opportunity for many "at bats."

I am thrilled we are migrating toward a reformed system of health care in America. I welcome patient-centered medical/health homes; technologies that will support care and communication in ways that were once out of reach; methods to improve health care that continue spread as organizations cultivate cultures of improvement. These innovations however, are only as powerful as the team they support. Teams that are redesigning care need to include patients, family members, and our community as equal partners. Like a “game-changer,” these bold additions of patients and family members to our team are a “culture-changer.” A shift in culture away from longing for the “grand slam” to making sure everyone takes their turn at bat and every hit counts.

Every hit and every strike is an opportunity to learn and improve. This is critically important and it is our duty to provide those we serve with unobstructed access to the care they want and deserve. I also believe it is our responsibility to overcome the barriers and belief systems that prevent us from partnering with patients and family members as experts. It's time for a plate appearance from these important members of our teams.

The time for change is now. In America, the stage is set for us to change in ways that have been out of reach. We can't sit it out and wait for someone else to hit a home run. In health care, our job is for all of us to get better at getting better – one hit at a time. It isn’t one thing but everything that must change, including our belief about what is possible when we move forward together.

Recently, I found a website that allows the viewer to watch/relive baseball games hit by hit. I found the game I missed on that Fourth of July. Now, without even a scar left behind from the chicken pox, play-by-play, I watched and I imagined. I remembered the excitement I felt as a youth when I watched those games with my family. I also reflected on what I’ve learned since then. I’ve gained an appreciation once again of the value of teamwork and of getting better one hit at a time.

It was a great game. It couldn’t have been done without the entire team – so Thank you Catfish, Joe, Bert, Reggie, Rollie, Sal and Manny. I still have my bat!

More very soon,

Saturday, November 3, 2012

Improving care transitions: CCRMC RIE/Kaizen Report Out

Last week’s Kaizen report-out focused on improving our patients’ experience as they leave CCRMC and return home. In order to accomplish that goal, a dedicated Kaizen team – comprised of medical, administrative and EVS staff, a social worker and a patient representative – got together to come up with ways to reduce the lead time from when a physician issues a discharge order to when the bed is ready for the next patient in our 4B Med/Surg Unit.

Sometimes the discharge process is unnecessarily long, and that can be frustrating for our patients and our staff. And it doesn’t just affect the patient who is leaving. It means arriving patients must wait longer in the Emergency Department for their rooms to be ready.

One great improvement the team made (with the help of our patient representative) was creating a user-friendly discharge-checklist board in the patient rooms. This board provides a simple visual aid that lets patients know where they are on their journey home. It also helps staff see what patients still need before they leave – everything from whether they have medical supplies to take with them to whether they’ve received a financial consultation to whether they have a ride home. 

One focus of this Rapid Improvement Event was on improving communication between the multiple disciplines involved in discharging a patient. The team worked to create a digital version of the census board on 4B that would make it more clear to the nurses and EVS staff when a doctor has issued the discharge order and a room can be made ready for the next patient. In order to expedite the cleaning of isolated rooms, the Kaizen team put together pre-assembled “precaution bags” our EVS staff can use to clean those rooms safely. This will reduce the amount of time EVS workers spend looking around for all the precaution items they need for those isolated rooms.

Some of their tests included: 

·     Improving upon the front line staff’s Discharge Rounds board to close knowledge and communication gaps and provide a clearer picture of the patient’s journey

·     Having a financial counselor input insurance information before rounds, which has helped the rounds group better identify patient needs and any financial issues before discharge (d/c)

·     Creating standard work, a script and goal discharge order times for 4B d/c rounds to help guide residents and facilitators in presenting cases in a more efficient way

·     Developing a digital census board for the unit, which will show staff when a discharge order has been made in real-time through cclink

·     Developing a communication tool for the Charge Nurse to take notes during rounds of patients ready for discharge. They will hand off to primary nurse to close the knowledge and time gap of when the nurse knows about the discharge order so they can better prepare the patient, which was one of the biggest delays

·     Developing a patient-centered board for the room that clearly shows everyone involved in their care where they are in their discharge journey, what is still needed and any patient/family concerns

·     Developing a pre-packed bundle of supplies for cleaning Precaution Rooms since it would take EVS up to 15 minutes just to search for supplies 

By the end of the week, the RIE team reduced the baseline lead time from the discharge order written to when the patient leaves CCRMC from 120 to 99 minutes resulting in a 17% improvement. More impressively, they reduced the baseline setup time from when the bed is empty to ready for next patient admission from 60 to 34 minutes, resulting in a 43% improvement. Though the goal for the event was to cut these baseline times by 50%, they are getting closer to the mark and I’m excited to see the outcomes after more tests.  

Some of these improvements may only save a few minutes, but as our Chief Medical Officer Dr. David Goldstein put it, minutes matter and they add up. Dr. Goldstein said those are minutes a patient is spending at home instead of the hospital and time staff can spend with other patients who need assistance.  

I want to thank and congratulate all of the people who worked on improving our discharge process. There were unnecessary delays in the system and this Kaizen team is helping to eliminate them. Although the 4B unit’s revamping process is still in the early stages, we’ve already seen a significant reduction in the time it takes to discharge a patient and get a room ready for the next patient. I’m proud of all those who made this Rapid Improvement Event a success. You’ve all made an important contribution to improving our patients’ journey home and our journey to being a model health system for patient-centered care.  

More very soon,

Monday, October 22, 2012

Leaning into it: CCRMC and HC Kaizens and 5S Events Resume

I'm excited to announce that we have resumed our focused Lean efforts and specifically our Kaizen activities. We will focus our upcoming events on improving the patients experience related to transitioning out of the hospital and back the community setting.  It’s important that we construct an environment of care that supports our staff in their work. This essential step lays the groundwork for improvement.

September 28th marked the conclusion of our most recent Rapid Improvement Event. The week focused on creating this efficient and organized system for the 4A Telemetry unit using a tool called 5S. The 5 “S’s” stand for:

1) Sort: Making sure needed items are separated from unneeded items, which are removed from the workspace
2) Set in Order:  The needed items are arranged to maximize workflow
3) Shine: Workspace is clean
4) Standardize
5) Sustain, which both create a standard program of accountability to maintain the optimal and clean work environment

People often mistake 5S for a clean-up event, but building a strong foundation for the workspace will eliminate unnecessary waste such as looking for items or excess inventory.  While at the same time developing a framework for an organized work environment that supports optimal workflow, reduces confusion and redundancy and conveys respect for our employees and the work they do.

During the week, a multi-disciplinary team consisting of front line staff and a patient partner “5S’d” our 4A Telemetry Unit. They successfully identified many areas for improvement through their energy, hard work and by consulting with people working and receiving care on 4A. The aim was to create a safe, clean and optimal workspace for everyone.  The improvement achieved during the week will be sustained by use of “5 minute 5S zones” by the people who actually work on 4A.  By developing a shared responsibility for maintaining the work space every employee will feel a sense of ownership.  After the process is refined by the front line workers and sustained for 90 days, we will be spreading the improvement to our other units. I’ve posted the slides here.

West County Health Center shining example of the future

On a recent visit to our new West County Health Center, I was thrilled to see how excited staff are to be working in our state-of-the-art facility in San Pablo. They have done an incredible job or ensuring a successful move from our aging Richmond Health Center that the new center replaced.

This new health center, which opened October 9, will help us better serve West Contra Costa County residents, increasing the number of people we can serve and improving access to care.

Not only is the new health center beautiful with vibrant colors and a design reflecting our diverse community, the 53,000-square-foot, environmentally-friendly facility is significantly larger and has 58 exam rooms to help meet the demand for health care in the area.

The goal is to create a health hub in the community and this new facility will serve as a patient-centered health home to provide the right care, at the right place and at the right time. The West County Health Center offers primary and specialty care, well-baby visits, cardiology and other critical services. A $1 million contribution from John Muir Health also will help us offer expanded evening and weekend care at the center starting next year. The additional hours will provide a timely and convenient source of care to people who need to be seen the same day but don't require a trip to an emergency department, allowing us to effectively partner with nearby Doctors Medical Center.

Thank you to all who made this possible, including Congressman George Miller, Contra Costa County Supervisor John Gioia and the Board of Supervisors, the City of San Pablo, and CCHC Director Dr. William Walker. You can read a recent news story on the center here:

And a very special thank you to all of the Contra Costa County employees who made this possible and for their commitment to those we serve.

More very soon,

Tuesday, October 16, 2012

Teresa Pasquini weighs in on the importance of partnership

I'm delighted to see the CCRMC Behavioral Healthcare Partnership Chair, Teresa Pasquini, posted her experience on Safety Net Matters blog.

She shares her thoughts on how CCRMC partners with patients and family members, "We are not token advisers but, rather, equal and respected partners. With constancy of purpose, we have put our stake in the ground in our search for perfection. Our goal is to achieve zero harm and end visiting hour restrictions, seclusion and restraints, and blame and shame." Read Teresa Pasquini's full post here.

I'm grateful to Teresa for sharing her perspective and the CCRMC experience with others. Its true to the all teach, all learn philosophy in the improvement community and I look forward to hearing how other organizations engage patients and family members as the conversations continue.

More very soon.

Legacy Letters: West County Health Center Art N' The Lobby

We will be having a very special Art N' The Lobby this Wednesday 12:15pm-1pm in the downstairs lobby at our new West County Health Center.

Personal Historian Trena Cleland will be joining us to talk about her amazing project. Please join us for this special program.

Legacy Letters (also known as ethical wills and spiritual biographies) :

Reflections and Reminiscences of HIV-positive Women

A project of Trena Cleland, personal historian

2011 - 2012

Here is a brief overview of this powerful work:

Legacy Letters: Reflections and Reminiscences of HIV-positive Women

A project of Trena Cleland, personal historian

2011 - 2012

Through Alameda County’s Innovative Grants Program (funded by the so-called “millionaire’s tax” passed by voters in 2004), funds became available for innovative projects that tap the positive wisdom and experience of mental health consumers, creating ways for them to participate in their own recoveries.

In Trena Cleland’s project, several HIV-positive women in Oakland recorded their life lessons and values in lovely written documents called Legacy Letters.

Legacy Letters (also known as ethical wills and spiritual biographies) are statements of one's values, beliefs, and learnings to pass on to future generations.

Through written exercises and oral history interviews, Trena guided the participants in considering such questions as:

  • What values and principles have guided your life?
  • What important lessons have you learned?
  • What spiritual teachings and practices move you?

The responses were then edited and polished and matched with family photos to create written testimonials for the participants to share with loved ones. Creating these letters was empowering and healing for the women, and they reported an increased sense of peace, confidence, and well-being.

Trena will show samples of the Legacy Letters, provide handouts and resources, and discuss the healing benefits of life review and reminiscence.

Friday, September 14, 2012

CCRMC Health Care Workers as Creators

Please join us thisTuesday, September 18 from 4-8 p.m for the annual Healthcare Workers as Creators event at our Contra Costa Regional Medical Center in Martinez.

Come celebrate creativity with your fellow staff members with great music, visual arts, hands-on workshops, an Art Cart to create your own art, and our first PaintFest - a chance to paint a mural for the hospital. There also will be food and drinks. The event will be held in the CCRMC cafeteria courtyard, and the farmers' market will have extended hours for that day as well.

We already have many of our staff, patients and friends of CCHS signed up. If you are interested in participating or volunteering, please contact Dr. Alan Siegel via HSD lotus notes.



Thursday, September 13, 2012

Know More: National Suicide Prevention Week

During this national suicide prevention week, I would like to take a moment and share some of the work being done and the resources available in our community to prevent such tragedies. Stigma around suicide often creates a false sense that it is less prevalent than it truly is. In fact, some statistics show suicide is more than twice as common as homicide. Nationwide, it is the 10th leading cause of death. In Contra Costa County, roughly 120 people die by suicide every year.

These tragic acts don’t need to occur. Suicide is preventable and help is available. More than 90 percent of people who die by suicide have an underlying mental disorder such as depression, bipolar disorder or alcohol or substance abuse problems at the time of their death. If we each take a moment to learn about the warning signs and the available resources, we may someday save a life.

Over the years, I’ve walked Out of the Darkness Overnight to help shine a light on suicide. This issue is very personal and very important to me. Through my experience and the experiences of others, I know the difference we can make if we integrate mental health service into primary health care.

Below is a Get Ready, Get Healthy episode created by Contra Costa Health Services. It’s 30 minutes long and shares some very powerful and moving stories. At the bottom of this post, I’ve also included some resources where you can get more information about suicide and helping people through trying times.

Healthy Outlook: Spotting the Signs of Suicide -

Contra Costa Crisis Center: Call 1-800-273-8255 or visit
Trevor Project: Call 1-866-4-U-TREVOR or visit
Contra Costa Mental Health:

Monday, September 10, 2012

National Suicide Prevention Week, September 9-15

You Can Make a Difference During National Suicide Prevention Week, September 9-15

from the American Foundation of Suicide Prevention (

Many of you know that ending suicide and the suffering that accompanies suicide for all those affected is very important work to me.  Please take a moment to learn more about Suicide Prevention Week and how you can make a difference. I will post Contra Costa County specific information as well. Thank you for taking the time to learn more, end suffering and save lives.

More very soon,

National Suicide Prevention Week is taking place this week with activities all over the U.S. to bring vital awareness and attention to this national health problem. Since suicide is an issue all of us are deeply concerned about, you can be a part of the national movement to prevent suicide by:
Getting informed. Learn about suicide risk factors, warning signs and how to help someone who is in crisis. This information can help save lives.

Raising awareness. Spreading this knowledge will greatly help inform the public about suicide and the ways to prevent it. Let your friends and family know about these warning signs and suicide risk factors by sharing these links via your social media profiles. You can also post this image on your Facebook page to promote National Suicide Prevention Week.

Being involved. Join our Field Advocate Program and work with us to make suicide prevention a national priority by signing up to be an advocate in your community. Register for an Out of the Darkness Community Walk in one of 275 communities across the country. Volunteer with your local chapter -- click here to find one in your area.

Remember, help is always available and suicide can be prevented. Join us and be a part of this mission.

Keep the National Suicide Prevention Lifeline phone number handy and call 1-800-273-TALK (8255) if you or someone you know is in crisis or feeling suicidal.Facts and Figure

The latest data available from the Centers for Disease Control and Prevention indicates that 36,909 suicide deaths were reported in the U.S. in 2009. This latest rise places suicide again as the tenth leading cause of death in the U.S. Nationally, the suicide rate increased 2.4 percent over 2008 to equal approximately 12.0 suicides per 100,000 people. The rate of suicide has been increasing since 2000. This is the highest rate of suicide in fifteen years.
Suicide Rate over 16 Years
  • Every 14.2 minutes someone in the United States dies by suicide.

  • Nearly 1,000,000 people make a suicide attempt every year.

  • 90% of people who die by suicide have a diagnosable and treatable psychiatric disorder at the time of their death.

  • Most people with mental illness do not die by suicide.

  • Recent data puts yearly medical costs for suicide at nearly $100 million (2005).

  • Men are nearly 4 times more likely to die by suicide than women. Women attempt suicide 3 times as often as men. Click here to view.

  • Suicide rates are highest for people between the ages of 40 and 59. Click here to view.

  • White individuals are most likely to die by suicide, followed by Native American peoples. Click here to view.
YearNumber of Suicide DeathsPopulationRate per 100,000

Figures from the Centers for Disease Control for the year 2009.
All rates are per 100,000 population.

Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give warnings. Prevent the suicide of loved ones by learning to recognize the signs of someone at risk, taking those signs seriously and knowing how to respond to them.
Warning signs of suicide include:
  • Observable signs of serious depression:
    Unrelenting low mood
    Anxiety, psychic pain and inner tension
    Sleep problems
  • Increased alcohol and/or other drug use
  • Recent impulsiveness and taking unnecessary risks
  • Threatening suicide or expressing a strong wish to die
  • Making a plan:
    Giving away prized possessions
    Sudden or impulsive purchase of a firearm
    Obtaining other means of killing oneself such as poisons or medications
  • Unexpected rage or anger
The emotional crises that usually precede suicide are often recognizable and treatable. Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in obvious sadness, but often it is rather expressed as a loss of pleasure or withdrawal from activities that had been enjoyable. One can help prevent suicide through early recognition and treatment of depression and other psychiatric illnesses.

Saturday, September 1, 2012

We need to talk - the power of information exchange

This is the third time over the years I have posted some version of this message. Today it feels more timely than ever.

This blog was designed in an attempt to open an alternative line of communication. It was my hope that not only two way conversation may occur, but perhaps an open forum of dialogue from a diverse set of perspectives might follow.

The importance of communication cannot be underestimated. Since 1995, the most frequently identified root cause of sentinel events in the United States is faulty communication (66% of reported instances)*. In other words, the majority of serious preventable harm in US hospitals is caused by communication failures within the system.

If we review the Institute of Medicine’s six “Aims for Improvement,” we can ask ourselves what this framework communicates to us on behalf of the patients we serve:

Safe: Please don’t hurt me. Provide care for me with a health system that is safe.
Effective: Give me what I need based on the best known science.
Patient-Centered: Please respect me and all the things that make me uniquely who I am. Let me choose to be involved in my health care decisions in a way that I am comfortable.
Timely: Please don’t make me wait unnecessarily. Provide care to me at the right time.
Efficient: Please don’t waste my time or my care provider's time.
Equitable: Please give me an equal chance to be healthy. Please don’t leave me out.

The importance of communication isn't a new concept. Communication is at the root of so much of what goes right and wrong for us in all aspects of our lives. We communicate for reasons beyond mere information exchange. We communicate for survival and companionship.

Several years ago, while at a meeting for the Integrated Nurse Leadership Program, I learned about tap code , a method of communication that is commonly used by prisoners. In this case it was used by prisoners of war (POW) to communicate with each other. Letters are placed on a grid and by assigning a number to each letter; prisoners could communicate with one another by tapping on things such as a wall or pipes. It is simple in design yet very effective.

Newcomers could easily and quickly catch on. Information such as what questions interrogators were asking, to who needed help or extra food or supplies could be shared among the prisoners. POW Vice Admiral James Stockdale describes the code ,"Our tapping ceased to be just an exchange of letters and words; it became conversation. Elation, sadness, humor, sarcasm, excitement, depression -- all came through." Here is a link to a video of Stockdale speaking about the importance of the ability to communicate. In listening to him it's clear to me that this tool not only allowed for the exchange of information, but also the exchange of human spirit. He recalls that the men would communicate at any cost, "if you get caught and tortured for a while, that's just the do it anyway."

Failed communication isolates us from each other and all too often leads to misunderstanding; misunderstanding to misinformation; misinformation to complete chaos.

We continue to seek your ideas about how we can better communicate, how we can better listen. Our aim is to build an enduring system that promotes open and transparent communication. It’s not to say that we haven't done many things to promote better communication, because we have, but we know we can improve and we need to do more. Your participation will be essential. We are seeking the input of others from within our system that specialize in communication. Please join us as we seek your help to explore strategies that will strengthen our ability to connect with each other and those we here to serve.

More very soon,

Tuesday, August 28, 2012

Transforming a Health System

Transforming a health system is no easy task. This last month has been a testament to that fact as we undergo the growing pains of implementing our electronic health record (EHR). However, I remain convinced that as our planned efforts continue, our primary charge of ensuring that every person in our community has access to the right care, at the right time, in the right place is quickly becoming more than just an aspirational statement and closer to an achievable reality. In order to be ready for health reform, we have embarked on this journey to implement an EHR as many other hospitals also will do.

As with any EHR implementation, we knew it was only the beginning when we launched ccLink on July 1 and that this work would be ongoing. Because our integrated health system includes a detention health component, we have unique opportunities to ensure no one is left behind. We also have the unique hurdles of integration in a highly complex setting. Staff members have expressed concerns about how the new EHR is working in the county detention facilities. Patient safety is our highest priority and we are actively investigating and resolving any issues reported by staff. Many of the reported issues have been resolved and we are working aggressively on all staff concerns.  

We recognize the implementation process has been challenging. Ongoing technology optimization and training will continue. We also recognize that we can improve communication with staff about how concerns are being resolved and are working on this process to ensure employees have the information they need and that their feedback is received. We’ve intensified efforts in the detention facilities, sending additional technology teams in, restructuring staff to provide more support and including more frontline staff who work in the jails directly in the process to refine the system.  

I am encouraged by staff’s commitment to finding resolutions and improving how we communicate to ensure issues are addressed. An EHR is a powerful tool but it doesn’t replace staff or their knowledge. Our employees are and always have been the single most critical part of our safety system. They play a crucial role in patient safety and we need them to continue bringing forward important information. As a public agency, we understand the importance of accountability and transparency. I believe one of the greatest attributes of our health system is that we belong and answer to those we serve.

Though the road feels rough right now, we are still on track. Despite the challenges of today and the many challenges ahead as health reform becomes a reality, I remain confident that we will continue to provide high quality and compassionate care to improve the health of our whole community with special attention to those who are most vulnerable. 

More very soon,

Sunday, July 1, 2012

ccLink is Live!

We are live!

Today, we went live with ccLink! After more than a year and a half, our electronic health record (EHR) is a reality.

It was great to be there with many of our staff as we launched shortly after midnight. As I walked through the hospital and Detention Health on Saturday night and early Sunday, I felt a shared sense of excitement as we took this historic step in our ongoing journey toward improved patient safety, communication and quality. Tomorrow, our Health Centers across the county will begin their day with our new ccLink EHR live!

Though we have reached a major milestone with this state-of-the-art technology, we also know that this is only the beginning. We will continue to develop and expand ccLink, which will help us continue providing the highest quality care with the best technology.

Thank you to our staff for their incredible commitment to our patients and our mission!

More very soon,

Thursday, June 28, 2012

Health Care for All

                                                                     Photo source:

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,

Wednesday, June 20, 2012

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.

Monday, June 18, 2012

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.

Tuesday, May 29, 2012

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.

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).

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

Thursday, May 17, 2012

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....

Wednesday, May 2, 2012

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?

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.


Sunday, April 29, 2012

The Power of Purpose

Act as if what you do makes a difference. It does.  ~William James
It’s easy to understand, even predictable really, how we can get distracted by the sheer volume of projects underway in our system. What’s happening in and around our system is huge. In addition to our ccLink electronic health record implementation, we’re opening the new West County Health Center this year, expanding the Concord Health Center, continuing our improvement efforts and working on a multitude of other projects to fully realize Health Care Reform in our county.

So how do we, as an organization undergoing so much change and transformation, not lose focus and get swept away by the business of operating, updating and upgrading? I’ve felt myself being pulled into the swirl of the technological advances we’re implementing, as well as the many new exciting opportunities to improve ourselves, such as the 1115 Waiver and Delivery System Reform Incentive Payments (DSRIP) program. I want to take a moment to pause amid this organized commotion and revisit the real reason we are undertaking these monumental projects. I remind myself that these are all just tools, means to an end, to help us fulfill our purpose: to care for patients. 

There are many demands for our attention and time. Make no mistake that these efforts to improve our system are critical to realizing our mission. We are now more able than ever to provide care on a larger scale and in better ways than we ever thought possible.  But even while we are well into our ccLink implementation and other improvement and innovation, we need to keep our focus on our mission to serve.

The efforts we are making toward quality and safety improvement, patient-centered care/partnering with patients and families, and other innovations are essential. When given the opportunity to step back to scan the entire landscape of what is underway, it’s truly breathtaking to see all that we are working on. Never a week goes by that I am not asked about the innovative work you are all doing - that includes you, our patient and family partners! When I speak at events, unfailingly I am approached afterward by organizations praising your work and wanting to learn more. I think it’s because we are bold enough to try new and creative approaches with patients and family members as partners to find novel ways to do “common things uncommonly well.” What does this mean to me? It means that our system is being redesigned to provide the best and highest quality care that results in a superior care experience and an overall better health status for Contra Costans while doing so at the lowest possible cost. 

The work we do requires inspiration, and I find that remembering to refocus my attention on why I’m doing this work is crucial. Fortunately, there are many sources of inspiration right here in our own system and elsewhere. I’m currently reading “Privileged Presence: Personal Stories of Connections in Health care” by Liz Crocker and Bev Johnson. In their book, patients, family members and caregivers share their personal experiences. It’s a powerful reminder of the need for compassion and humility among those of us who work in health care. I’ve shared this book with my leadership team and the stories that many of you have shared with me and others, the resulting discussions have been reinvigorating.

If we can remain focused on our goal—to provide the best care possible for those most in need—we won’t lose track of our mission. Otherwise, the ones who will lose will be the very people we have pledged to help. Please join me in keeping a razor sharp focus on our purpose, the purpose of ccLink, DSRIP, innovation, improvement and all we do: providing the best care in the best way to those we serve.


Saturday, April 28, 2012

Education is Powerful Medicine: CCRMC Seamless Transitions Kaizen Report-Out

 The Report-Out was great. Congratulations to the team, which included providers and patients working to create seamless transitions in care. The group broke into three smaller teams that focused on important areas of opportunity to improve transitions in care. Working with front line providers and patients ideas were tested.

     Problem: Staff don’t know what education has already been given
      Prioritization Process
     Problem: No education focus or priority
     Problem: Majority of education given 10 minutes before discharge

It was great to see the human factors design embedded in the interventions. Teams focused on the development and testing of standard work. I noticed two new checklists- see the slides above. I was also pleased to see that in addition to clearly designing around the patients,  there was also a clear focus on measurement!

Many thanks to the team and to all who came out to hear the results from this weeks Kaizen.


Thursday, April 26, 2012

We're now approaching the halfway mark on our schedule of ccLink Road Shows and what a success it has been! From Richmond to Brentwood, staff have come with a great deal of interest and are eager to learn about this exciting project. As you learn about the system, we too are learning more about your needs and what ccLink will mean for your day to day activities.

Everyone had great questions and provided important feedback. If you had a question that couldn't be answered during the Road Show, it might have been answered in our latest FAQ. Didn't have time to ask your question? Submit it on iSITE or send an email to

We still have seven Road Shows to go. If you've missed the one at your worksite, check our schedule to see if you can attend one at another location. Make sure you regularly visit the ccLink page on iSITE for the latest updates and a wealth of information.

- Friday, April 27: Pittsburg Health Center
- Monday, April 30: Martinez Health Center, Building 1 Conference Room
- Monday, April 30: 7:30 a.m. and 3:30 p.m. Contra Costa Regional Medical Center
- Wednesday, May 2: 8 a.m. Juvenile Hall and 3:30 p.m. West County Detention Facility
- Thursday, May 3: 3:30 p.m. Martinez Detention Facility

More very soon.

We're heading out into the system to update staff about the implementation of ccLink, our electronic health record system (EHR).  

The updates are going well. There has been a great deal of interest and participation at the health centers. I want to thank everyone who has come to learn more about ccLink. Your questions and comments have been extremely valuable and are generating rich learning and discussion.
All the Health Center meetings will run 12:15 p.m. to 1 p.m.

Today we will be at the Concord Health Center.

More very soon.

CCRMC and HC are improving transitions in care. Kaizen Report Outs are this Friday at Richmond, Pittsburg and CCRMC.