Wednesday, March 28, 2012

From here to there - seamless care, seamless transitions

This week's Kaizen team is evaluating the experience of a person in Emergency Department from the time they are admitted to the hospital until their first clinic appointment after being discharged.

 The 15-member team is looking at the process from a patient perspective to guide future improvement opportunities. Specifically, the team is recording the time it takes to move through various stages of care. This process is called Value Stream Mapping and is an integral part of all our improvement efforts. This afternoon, the team transcribed its nearly 100 observation recordings onto a map that depicts the most reoccurring steps. By the end of tomorrow, the team will develop a Transitional Care Charter that will guide future rapid improvement/Kaizen events. Finally, a future state map will be developed to paint a picture of what we feel the process should look like within a year.

Transitions in Care, Kaizen Report-Outs will occur on Friday, March 30 as follows:

7:45-8:15 AM Richmond Health Center
10-10:30 AM CCRMC Hospital Lobby
12:15-12:45 PM Pittsburg Health Center

Please join me and support the work of your colleagues and our patient and family partners as they draw on science and the energy and creativity of each other to continuously improve our health system.

I look forward to seeing you there.

NAPH highlights Innovation at CCRMC and the Health Centers

CCRMC and the Health Centers’ innovative work has been highlighted by the National Association of Public Hospitals and Health Systems on the NAPH website and in its newsletter. Our Perinatal Unit’s award-winning program to reduce repeat Cesarean sections, "Vaginal Birth after Cesarean (VBAC) Improvement Project," was featured along with the CCRMC Change Agent Fellowship program.

See the NAPH website for the stories:

VBAC story:

You all are deserving of this recognition. Yet again, I am in awe of all you are accomplishing and am inspired by your commitment to innovation and improving the care we provide. I am so proud of our team and our system. I hope you are too.


Sunday, March 25, 2012

Department of Family Medicine Retreat and 97 Days and Counting for ccLink

I was so pleased to have been asked to attend our Department of Family Medicine’s retreat today at our Regional Medical Center. It was exciting to see such a great turnout and an excellent opportunity to hear directly from front-line providers.

With the incredible amount of change and transformation underway in our system, it was a chance to connect and share information in an informal setting. We all know Health Care Reform isn’t happening in Washington, D.C. – it’s happening right here in Contra Costa. We together are literally “the boots on the ground” making it a reality. We’re working hard to make sure we have the tools and infrastructure in place to support Health Care Reform, including the growth of primary care. 

In this morning's meeting we talked about some of those tools and infrastructure: Patient-Centered Health Homes, the implementation of our electronic health record, ccLInk, and other efforts to make our transformation work possible. I was joined by our Health Services Director Dr. William Walker, Chief Medical Officer Dr. David Goldstein, Medical Staff President Dr. Ori Tzvieli, Chief Nursing Officer Jaspreet Benepal, Director of Detention, ED and Ambulatory Nursing Anthony Longoria, and ccLink Transition Leader Dr. Troy Kaji.

People had great questions and the retreat highlighted the need for regular communication. I heard you loud and clear that you want more information and will be working with department leadership on how best to do this. This is a challenge for CCRMC and Health Centers and also for a large integrated system like ours (Dr. Walker talks about this in his upcoming April message in the Director’s Report).  Along with other members of our leadership team, I will continue to work to keep you updated via emails, flyers, screensavers and other ways.

Click on image to see full size
Our ccLink implementation is picking up speed as we rapidly approach our go-live date of July 1. This Wednesday, we’ll conduct our 90-Day readiness assessment with Epic, which means we’ll assess how we are progressing. You also can find news on the EHR implementation in our new ccLink Update newsletter (posted here) which is being distributed electronically and in hard copy, as well as on iSITE. 

Please let me know if you have ideas on how to best get information out. You can send me your ideas directly or via our Communications Officer, Kate Fowlie at or 925-313-6268.

I hope to be able to participate in more staff retreats. Dr. Nancy Palmer, Jose Yasul and the other members of the Department of Family Medicine Leadership Group did an excellent job organizing the event.

There are so many activities underway that some may seem unrelated, but they all are linked and critical to ensuring our Health Care Reform work is successful. We know there are a lot of questions, excitement and anxiety. This is only natural considering what we are striving to accomplish- the transformation of our health system to provide the Right Care, at the Right Place, at the Right Time.

I’ve heard Dr. Walker describe this as the most exciting time in his nearly 38 years with Contra Costa Health Services. I agree. This is an incredible time to be in health care and I am truly honored to be part of a health delivery system that is so uniquely positioned to implement such revolutionary change is how we provide care. Thanks again to Dr. Nancy Palmer and the Department of Family Medicine for inviting me to join you this morning.

More very soon.


Monday, March 19, 2012

TAKE STEPS TO END SUICIDE NOW: WALK WITH ME --- AFSP 2012 Out of the Darkness Overnight Walk in San Francisco

With my husband on his birthday...

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 today’s date, 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.

A few years ago I decided I would give my husband a different kind of gift for his birthday and joined thousands of other people on a 20-mile walk into the dawn as part of the American Foundation for Suicide Prevention's, Out of the Darkness Overnight Walk. This year on June 9th in San Francisco we will walk Out of the Darkness together. We invite you to join us to end the silence and stigma that so often accompanies suicide.

Together Aaron and I end our silence. We have formed a team called 'Common Things' and we will walk for Alfred and our family. If you like, we will walk for you too.

Click here to join team Common Things ,our 2012 Out of the Darkness, San Francisco Overnight Walk Team.
The goal of this journey, which will begin at dusk and finish at dawn, is to raise funds and awareness for suicide prevention. We would like to 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 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.

To support our team please go to our team webpage.

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

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

Aaron and Anna Roth

Sunday, March 11, 2012

Patients, Family, Public and Community - Jim Conway on the journey and the destination

It's no secret that I am inspired by Jim Conway. In "Informing the journey, not changing the destination," Conway explores recent publications about engaging patients, family members and our community in improving our health systems. He sorts through a variety of perspectives and provides an elegant summary.  I think you'll find it well worth the read and hope our partners will share their thoughts about this as well. 

More soon.

Saturday, March 10, 2012

Message from the Kaizen Team

Dear Colleagues and Partners,

Please find the "postcard" below from the recent Kaizen team addressed to all of you. The team would like you to know about the Kaizen week and related efforts.  I hope you will provide feedback and suggestions for improvement. Click on the images below and they will appear in full size.


Saturday, March 3, 2012

Health and Housing, Children and more: Building the bridge between the health centers and public health

Thanks to everyone who came to the report outs yesterday. I was so pleased to see such a diverse cross section of our system and of our community. This week's Kaizen team consisted of providers from as fCCRMC, HC and Public Health as well as two patient partners. The team focused on building a bridge between public health nursing and family practice clinics. Although family practice serves up two thirds of pediatric patients in CCHS we found we are not reliably referring pediatric referrals from family practice to public health nursing. Public Health provides case management and home visits to children in need of further support. Public Health Nursing is also key in delivery of services to those who are experiencing homelessness, another vulnerable group who we often treat in the health centers. Too often these groups fall through the cracks between the health centers and their homes or shelters.  This directed the scope and four target metrics for the week:
  1. Decrease the defect rate of missed pediatric appropriate referrals from 50% to 0%;
  2.  Decrease the defect rate of overall inappropriate referrals to public health nursing (PHN) from 25% to 0%
  3.  Increase the % of screening for homelessness from 0% to 100% and
  4.  Increase homeless referrals from Primary Care to Public Health from 0% to 10%.
The multidisciplinary Kaizen team tested multiple trials: creating a trigger mechanism to identify homeless patients at the time of their visit, closing the fragmented communication loop between provider, care coordinator and public health nurse to improve continuity of care for patients and improving staff education on the role of a public health nurse and referral criteria for pediatric and
homeless patients.

 The screening form assesses for homeless populations that come to our clinic sites, which may include patients who may be using our county shelter, but who are not followed due to the public health nurse not knowing about their medical needs.  The form also includes a list of other things that the patient may need help with that they can check off. 
The education team did a cross-training trial which involved having a resident physician, LVN, patient, care coordinator go out to the Concord Shelter to simulate the PHN's referral process to learn more about the PHN role through a first-hand experience.
The standard work will be rigorously implemented over the next 30 days in Martinez Health Center and will spread to the rest of the clinics to ensure successful metrics, sustainability and overall improved healthcare outcomes for patients. The public health nurse will also attend family practice staff meetings and be incorporated into new staff orientation for nurses.
I did have a chance to speak to those who attended about my visits to Congress this week and the importance of the work you are all doing. Threats and concerns about health care reform continue to loom. Local demonstration of the use of improvement and innovation are key in supporting federal policy. Our discussion that centered on supporting delivery system reform had two key themes: Integration and Innovation. I was proud to present the work we are doing in these areas and more. I encourage you to watch the video of my report on iSite.
More very soon.

Thursday, March 1, 2012

Kaizen Report Out Tomorrow, Friday March 2

Join me at the Kaizen Report Out in your region.

Please come to hear about the work the team is doing to strengthen the link between our health centers and public health nursing to provide a seamless care experience to those we serve.