CCRMC and HC Strategic Planning Update

Moving Forward

The summer was a busy one with our ongoing strategic planning as we gear up for full implementation of Health Care Reform.

 

This process has brought together leadership, staff, labor, patients and partners, and we are making progress. We held our second strategic planning session at the end of August to hear back from the four design teams created following our May planning session. Those teams include the Purpose Team, whose task is to establish and communicate the purpose of the organization; the Linkage Map Team, which looked at how CCRMC and Health Centers fits into our system and the larger community; the Whole System Measures Team, which created measures that reflect a health system's overall performance in quality and value over time and is working on a dashboard to share the information; and the Voice of the Patient/Telling our Story Team whose purpose is to communicate our mission.

 

We are pulling this all together into a draft strategic plan. The next steps will be to review the plan and get feedback with an expected release of the final product by February 2014. We will be reaching out to staff, patients and family members, and our community as a whole in a variety of ways, including our website, so please stay tuned. Taking this conversation to the employees and the community will be a shared effort. Our goal is to get input from everyone and to fill in gaps that we may not see, but others will.

 

This is challenging but necessary work, and we must remain focused. Health Care Reform means new rules, and we, like other delivery systems, must evolve to adapt to this changing environment. This year has been a critical planning period, and we are taking a hard and long look at the role we play and our purpose as it relates to the community and region.  It is an exciting time with all of the improvements we are undergoing as a system and a country, as history is made with enrollment starting tomorrow in the state health insurance exchange, Covered California (see our website for helpful information). I talk about this and more in my monthly newsletter, The Update.

 

More very soon,

Anna

Update: Delivery System Reform at CCRMC and HCs Annual Report

Greeting Contra Costa Community:

I am excited to share with you our annual progress report for the Delivery System Reform Incentive Payments (DSRIP) program: http://cchealth.org/medicalcenter/culture/pdf/DSRIP-Annual-Report-2013.pdf . We recently submitted this brief overview, which provides a year-end summary of our DSRIP activities through which we are redesigning our system to expand access to care and enhance quality. We also submitted a comprehensive report  Last week, we celebrated our progress with presentations from improvement teams representing the five DSRIP categories about the amazing work they have done and continue to do. This report only captures part of the incredible amount of work we have underway. I look forward to sharing more examples with you in the coming months and year.

 

 

The DSRIP is a pay-for-performance program that is one component of California’s Section 1115 Medicaid waiver. Three years into the DSRIP program, CCRMC and HCs has met all the milestones required to date and we are seeing impressive results that are helping us transform our county’s care delivery system into one that is patient and family-centered, evidence-based and continually improving. The DSRIP has allowed us to undertake and sustain an approach to system change that involves staff at all levels of our organization, while also including patients, family members and members of our community in a more meaningful way than ever before. I am so proud of the work being done here and look forward to our continued progress.

With appreciation,

Anna

Contra Costa Regional Medical Center Welcomes You. Update on new Welcoming Policy- initial results and improvements

I wanted to provide a quick update on our CCRMC Welcoming efforts. This update covers Tuesday- Friday at noon.

We started on September 17, 2013 at 8:30pm. Our first night we welcomed 13 family members/care partners (and a pizza delivery person who brought pizza to a hungry family member). The second night we welcomed 18 family members/care partners and the third night we welcomed 15.

That totals of 46 family members/care partners that had the opportunity to participate in the care of their loved one. It also means that we at CCRMC had 46 opportunities to learn from family members and loved ones about how improve the care we deliver and how to improve our Welcoming Policy.

Each night the team learned, modified and improved the steps of the process to better support the family members/care partners. Most of the challenges faced by the testing team on the first night were related to logistics of the process - small details really matter! For example, we had some challenges with language barriers. We have modified our signs and are testing use of the health care interpreter video machines (HCIN) at check in. Timely updates are given to the Nurse Program Managers who have been present at night to support the staff and address any concerns they may have. The manager for Admission and Registration also worked on the night shift to support the staff. The security staff have been fully engaged and critical in the implementation as well. We have conducted huddles daily to support rapid improvements of our process and support the staff and our community in this exciting change.

I want to recognize and thank the staff and Patient and Family Partners for creating and implementing this important change in our hospital and health centers.

More very soon,

Anna

The patient, family, and staff responses have been very positive. I have attached some of the feedback below.

 

UNIT	OCC #	Nurses feedback	Patient/family feedback
4B -MedSurg		·        This was helpful because patient had major surgery was it supportive for mother to stay.	·        It was very helpful.
4B  -MedSurg		·        It was helpful .  Patient and family slept all night.	·        It was helpful and supportive. ·        It was helpful
4B -MedSurg	3 PARTNERS	·        Nurses were ready , had the sleep-chair ready at the bed side; ·        no challenges; ·        deputy was informed when family left	·        very pleased, one of the pt states “very comforting to open my eyes and see her here, thank you” ·        another family states “ I am just glad that I don’t have to park my car and walk all over to the ED, because the new building took the parking, I am not staying all night, but thank you for opening the front door”
4C  - Behavioral Health	0	All family left at 8pm, they were aware of the program
4A  - Telemetry			·        Appreciated seeing brother so late (0200)
4A - Telemetry	0
ICU  - Critical Care	1	No challenges	·        The family has been sleeping
IMCU  - Critical Care Step down	1	Had the sleep-chair ready; No challenges	·        New admit from ED

 

No such thing as a visitor – Contra Costa Regional Medical Center and Health Centers Welcome You 24/7

I’m excited to tell our staff and Contra Costa County residents that Contra Costa Regional Medical Center (CCRMC) is eliminating the concept of visitors in our medical center and health delivery system. On September 17^th, 2013, CCRMC will remain accessible 24 hours a day to family and loved-ones of those receiving care in the medical center.

Recognizing that family and loved-one presence supports safe and high quality care, we have worked over the last year to replace our “visitor policy” with this Welcoming Policy. Though we have carefully planned the introduction of this change, we remain open to ideas to enhance and improve our Welcoming Policy and will place it and all supporting documents on the CCRMC web page for your review, comments and suggestions for improvement.

To the team at CCRMC who work tirelessly on creating an environment that welcomes and supports family and loved-one presence always: Thank you for your efforts. Your work is inspiring. This is an important step on our journey to cultivate meaningful partnerships with people who receive care in our system and their loved ones.  I am reminded that it is not patients and their families who are "visitors" of our system - it is us who are privileged guests in the lives of those we serve. 

I also want to thank the staff in the medical center & health centers, Health Services and the Sheriff's Office for your enthusiastic reception of this planned change. You have generously shared your ideas, creativity and commitment to help make our great health system even better. 

I look forward to seeing the results of this testing period and watching this work progress.

More very soon,

Anna

To the community: Below I have attached some key text from our Welcoming Policy and Welcoming Guide. You can also find our data and PDSA tracking sheets and accompanying worksheets on our website here. Links will be added over the next few weeks as we learn more so check back in the following days as more information becomes available from our learning.

CONTRA COSTA REGIONAL MEDICAL CENTER                                                                            POLICY # xxx

CONTRA COSTA HEALTH CENTER                                                                                              September 13, 2013

PARTNERS IN CARE WELCOME POLICY

I.                    PURPOSE

The purpose of this policy is to provide guidelines that supports and welcomes 24/7 presence and participation of a family member and/or care partner in the patient’s care experience during their clinic visit, emergency room visit, and/or hospital and health center visit.  CCRMC recognizes that family members and/or care partners play an important part in the patient’s healing process. 

Family members and/or care partners, according to patient preferences, are respected as essential members of the patient’s health care team in sharing information and providing support and comfort during their health center visit, emergency room visit and/or hospital stay.   They enhance quality and safety.  They also provide pertinent information essential to the care plan.

In the unique event that family member/care partner presence would need to be limited to ensure safety or confidentiality, CCRMC employees will work with the family member and/or care partner to continue the visit as soon as possible.  Examples for when family member or care partner presence may need to be restricted include: a court order limiting or restraining contact, behavior that is a direct threat to patients, families, staff, or others in the immediate environment, or is disruptive of the functioning of the care unit.  Patient preference and patient wishes will be given priority.  Contra Costa Regional Medical Center & Health Centers  (CCRMC & HC) respects  that the partners in care are essential members who help  provide support and comfort to enhance safety and quality of care during the patient’s experience while at CCRMC & HC.

Partners in Care, as identified by the patient, provide essential information during their time in our health care system and also during the transition to home or community care. 

II.                  DEFINITIONS

A.      Partners in Care are person(s) identified by the patient who are family members and/or friends or other individuals that are present to support the patient during the course of the patient’s stay at the health care facility and may exercise the patient’s visitation rights on patient’s behalf if patient is unable to do so. The support person(s) may provide emotional and/or social support and comfort according to the patient’s preference. Such individual(s) may or may not be an individual legally responsible for making medical decisions on the patient’s behalf.

B.      Patient refers to anyone admitted to the Hospital who has an appointment at any one of our Health Centers, or is actively receiving care at any one of our facilities.

C.      Family as defined by the Institute for Patient and Family Centered Care, “family” refers to two or more persons who are related in any way – biologically, legally, or emotionally. Patients and families define their “family.” 

III.                REFERENCES

A.      CMS regulations revising the Medicare Conditions of Participation as set forth at 42 CFR      

                          § 482.13

B.       www.shipmangoodwin.com/Sample_Hospital_Patient_Visitation_Policy 

C.      Patient’s  Bill of Rights

D.      The Joint Commission RI.01.01, EP28 

IV.                POLICY

A.      All CCRMC & HC staff  as well as physicians shall not restrict, limit or otherwise deny visitation  on the basis of race, color, national origin, religion, sex, gender identity, gender expression, sexual orientation and presentation or disability. For more information refer to department specific policies.

B.      Partners in care welcomed, based on the patient’s preferences and wishes. A patient may verbally designate a partner in care to exercise the patient’s visitation rights on his or her behalf in the event the patient becomes unable to do so. Upon such designation by a patient, the legal status of the relationship between the patient and the designated partner in care shall be irrelevant. This designation of an individual as the patient’s partner in care, however, does not extend to medical decision making.

C.      All CCRMC & HC staff and physicians will work collaboratively with the patient and Partners in Care to make any adjustments or changes to maintain the health, safety, privacy, and confidentiality of all patients.  

22. AUTHORITY/RESPONSIBILITY

                This policy applies to all CCRMC & HC staff and physicians. 

VI.          PROCEDURE

A.     Share the “Partners in Care Welcoming Guide” with all patients and their partners in care.

B.     There are no specified visiting hours.  However, in the hospital, quiet time has been designated for the hours of 10 PM until 7AM every day to promote a restful healing environment for our patients.

C.     Every effort will be made to work collaboratively and respectfully with the patient and their partners in care to ensure health, safety, quality care, privacy and confidentiality for all patients.         

VII.         Attachment(s)/ Forms Used:

Partners in Care Welcoming Guide  

VIII.    Approved By:

(Clinical Practice Committee – CPC)

(Ambulatory Clinical Practice Committee – ACPC)

(Patient Care Policy and Evaluation Committee – PCP&E)

(Medical Executive Committee – MEC)                         

IX.           Created Date: 

             April 2013                                                                                                                             

 X.           Date Revised 

Partners in Care Welcoming Guide

Welcome to Contra Costa Regional Medical Center. Our purpose is to create optimal health for all through respectful relationships and high quality services. The safety and health of the people we serve is important to us. Their care requires teamwork, not only from staff, but from family and other loved ones.  Our staff is skilled in acknowledging how family members and/or Partners in Care are part of the support system and supporting collaboration.  Please feel free to talk with us about these guidelines, and any special requests that you have.  We will do our best to meet your needs, while ensuring the safety of all our patients in a restful, healing, and safe environment. 

• Our patient and family-centered approach welcomes families as vital participants in a patient’s care. Family and other Partners in Care, as defined by the patient, are welcome at the patient’s bedside 24 hours a day 7 days a week.  Our staff will work with you to ensure comfort, health, safety, quality care, privacy and confidentiality for all patients.  We are here to work with you and your loved one to support care choices, support you in learning how to manage physical challenges, and support you in connecting with others who are traveling your same path.
• There are no specified visiting hours.  However, in the hospital, quiet time has been designated for the hours of 10 PM until 7AM every day to promote a restful healing environment for our patients.
• Please ensure that all minors are accompanied at all times by an adult to ensure safety.
• Please approach the entrance of the unit to be visited, and ensure you are signed in on a log book which includes your name and the patient you are visiting for the day. Sign out at the end of your visit.
• It is helpful to maintain minimal personal belongings due to space constraints and safety.
• Public restrooms are located in a variety of convenient locations and are clearly marked.  Please note that bathrooms in rooms are to be used by patients to meet their care needs.
• CCRMC & HC Hospital main entrance is now accessible after 8pm.
• You are welcome to visit our on-site CCRMC & HC Cafeteria to purchase a healthy meal or snack.  Cafeteria is open from 6:30am until 6:30pm, Monday through Friday; and from 7:00am until 6:30pm on weekends and holidays.  Hot meals are available for purchase during the following times:

Breakfast:             6:30 – 9:30am

Lunch:                   11:30 – 1:30pm

Dinner:                   4:30 – 6:30pm

• Should you have a medication emergency or need immediate medical attention, visit the Emergency Department. Otherwise, 911 will be called.
• Respecting the privacy, comfort and rest needs of all patients is a high priority.
• To keep our patients safe, please observe all posted safety placards and directions.

Making Great Strides in Fighting Sepsis

CCRMC Making Great Strides in Fighting Sepsis 

Every year, there are many sepsis deaths as heart attacks. In fact, sepsis kills more people than breast, colon, pancreatic and prostate cancer combined. Much attention and effort has been focused on reducing sepsis in the hospital setting, and in observance of World Sepsis Day, I want to congratulate the staff at our Contra Costa Regional Medical Center for reducing the sepsis mortality rate by nearly 50%.

The credit for this accomplishment belongs to our frontline staff and our Sepsis Team, which formed in 2010 with the goal of improving severe sepsis detection and management. The multidisciplinary Sepsis Team—which includes physicians, nurses, and representatives from administration, infection control and pharmacy services—has worked tirelessly to ensure we are delivering timely care. Their work isn’t simply making a statistical difference – it’s saving lives.

 

More very soon,

Anna

5S, Just in Time (JIT), Action Period, PDSA...See what's happening in Ambulatory Care

Redesign Teams from the Health Centers left our Ambulatory Care Redesign Learning Session One (ACR:LS1) with the IHI ready for continued improvement. The Martinez Health Center Team began their action period (this is a time of testing using PDSA cycles) with a round of 5S in the storage and exams rooms of the Primary Care clinic. We have spread 5S in West County Health Center, North Richmond, Pittsburg and now Martinez.

 

What is 5S? What is Just in Time (JIT) See for yourself in the slides below which offer the 5S Week in Review. It's not a simple clean up, but a well thought out visual management system that begins with a deep understanding of the work and then reworking/designing the environment to support the work. Don't think you have an extra 1000 syringes taking up space in your office? The best way to find the answer is to "Go and See" for yourself. You may be surprised by what you find.
 

If you want to learn more or give feedback on how we can improve the process, contact the 5S team in your clinic or contact the CCRMC Blue Sky Unit/BSU (aka Lean Promotion Office).

Well done Martinez Health Center 5S Team and Team Leaders Cheryl and Amber.

More very soon,
Anna

Ambulatory Care Redesign Learning Session One

I have spent the last two days with frontline staff engaged in our Ambulatory Care Redesign project and I am energized and inspired by their efforts.   

The Ambulatory Care Redesign will improve how we deliver outpatient care by combining best practices with optimal care experiences for the best patient outcomes. Planning for this year-long effort began in early May in partnership with the Institute for Healthcare Improvement (IHI). The IHI joined staff this week as they came together for the first of our group sessions to use improvement tools and share design ideas and best practices for creating patient-centered health homes.

The five teams working on this are made up of staff from a mix of small, medium and large sites and initially includes our Pittsburg, Concord, Martinez, and West County health centers and North Richmond Center for Health. Though the work is challenging, the teams are excited and committed to transforming our system, and so am I.

Below is a slideshow of the teams at work:

I talk more about our Ambulatory Care Redesign effort and other ongoing work at our Regional Medical Center and Health Centers in the July edition of our newsletter, The Update.

More very soon,

Anna

Ambulatory Care Redesign Rapid Improvment Event (Kaizen): Referrals

 
Last week a team of four Care Coordinators, a Clinic Coordinator, a Provider, and one of our patient partners, Amanda, came together to work on our external referral process. This process starts when a provider initiates a referral for a clinical need outside of our eight health centers and ends when results have been received from the organization where the patient was seen. Referrals for services outside of our system have the potential to be highly complex with multiple hand-offs.

As an organization we are in pursuit of a patient-centered referral process that is free of defects and unneeded waits. To reach this future state the team is developing a process for tracking and coordinating all external referrals. This referral process is an integral piece of constructing our health homes in Contra Costa. The process is being tested and refined in the Martinez Health Center with a plan to spread it in the coming months. If you want to learn more please feel free to contact the Lean Promotion Office. Thanks to all who joined one of the report out presentations. For those who were unable to make it, I have included the slides above. 

More very soon, 

Anna 

Toward Health Reform: Contra Costa Health Plan selected to participate in state insurance exchange

California took an historic step toward realizing Health Care Reform today with the announcement of the 13 health plans that will participate in the state’s health benefit exchange. I am very pleased our Contra Costa Health Plan is among the plans that will be offered through Covered California.

As part of our integrated health system, Contra Costa Health Services, CCHP has a long history of serving Contra Costa County residents through its extensive county and community contracted provider networks. Our Regional Medical Center and Health Centers (CCRMC) will see some of those new patients and many also will be cared for through CCHP’s many contracted providers, community clinics and hospitals throughout the community.

Participation in the exchange provides CCHP the opportunity to continue and expand its long legacy of ensuring the community has health care coverage. CCHP was the first county-sponsored health plan in the nation to receive federal qualification and to offer Medicare. I think it's fitting that as CCHP celebrates it's 40th year in operation it continues to play an important part in advancing access to care. Today, CCHP provides coverage to 120,000 people, including county employees, small and large business groups, seniors, people with disabilities, children and low-income patients. We are proud our health plan is playing a vital role in this exciting transformation of health care in California.

CCRMC and HCs Rapid Improvement Event (Kaizen) Report-Outs tomorrow

The Update: Getting the Word Out - CCRMC and HCs Monthly News

Getting the Word Out

As someone who oversees a dynamic health organization, I’m always looking for ways to better communicate with people about what we’re doing. That’s why I’m so excited about the new Contra Costa Regional Medical Center (CCRMC) and Health Centers' newsletter, The Update. Find the most recent issue of The Update here. My goal is that this newsletter will serve as a vehicle to showcase the great work being done by our staff, and help keep our delivery system connected and up-to-date on the many ongoing projects we have underway to transform our health system in this new era.

The most recent issue of The Update highlights many exciting things going on at CCRMC & HCs including a successful effort to reduce hospital associated pressure ulcers, how the Pediatric Response Team’s prepares for pediatric emergencies, and a new program in which our Cancer Center is offering iPads to patients to use during their treatments.

If you’d like to keep up with the happening at our hospital and health centers, I encourage you to click the button below to join the mailing list for The Update.

Join The CCRMC Update Email Mailing List

More very soon,
Anna

Where Does Change Begin? Why we (you and I) must not settle.

It was only a few years ago that there were no red lines on the wall behind the beds in CCU –anyone providing patient care could only guess at what 30 degrees looked like. What was a Bundle? We couldn’t go for months without a Ventilator Associated Pneumonia (VAP). When I reflect on it now, it almost seems we planned care knowing that assisted breathing was inevitably, or at least understandably, going to be accompanied by pneumonia. It was hardly imaginable that we could go months without a VAP. Now VAPs and many other serious hospital-associated infections/complications are rare because of the innovative work of our staff. When I was initially trained as a nurse – not the formal school-based training but the ward/unit training which was something different altogether – I was taught that our 'rapid response,' commonly known as a Code Blue, was a team of highly skilled clinicians that rushed to a patient in need of respiratory or cardiac rescue/resuscitation. Today we have rapid response teams (Medical Emergency Teams, RRTs, etc.) that quickly bring additional needed assessment and care to patients when they first exhibit signs that may signal a dangerous decline in health – in most cases before a Code Blue.

Thankfully, things are changing here and everywhere. I find strength and inspiration in the stories from the bedside of those who are committed to improving health care. We are increasingly recognizing and embracing the fact that the use of improvement science does improve health and does so in dramatic and revolutionary ways. Our monthly Rapid Improvements Events are example of the ongoing improvement work in our delivery system.

As promised, here are the slides from last week’s Rapid Improvement Event (Kaizen) on the medication refill process. Many thanks to the staff from the front line and Patient and Family Partners who are working hard to improve our system for everyone. Your efforts are greatly appreciated. I also want to thank our team members who came out to support these teams. Improvement is hard work and your support is crucial.



Refusing to Settle

In spite of all the results seen here and around the world, why is it that improvement, led by front line staff, patients and family members continues to feel as though it is regarded as a "soft" or support activity? Improvement is about the work of saving lives.

We must be committed to driving defects and non-value-added activity out of what we do. I will stand with all of you, who are dedicated to serving our community and improving our system, to continue to focus on and pursue our mission.

George Halvorson in his book Health Care Will Not Reform Itself, states "the alternative to courage and focused action is a continuation and probably a worsening of the status quo." Many will agree that it takes acceptance, willingness, courage, caring and honest exchange to engage in a change effort. It also takes constancy of purpose and discipline.

There are many distractions along the path to an improved and sustainable system. The inertia of the status quo and pervasive nature of the health care industry's hierarchical culture can seem impossibly strong. Many have mastered the current state; their power, position and self-image may be derived from that mastery. Many believe that more of the same is good enough. I believe that to seek a new order, to resist the urge to 'settle,' to stand up and lead a transformation effort, is indeed the work of the courageous. It is our work. It is work we must do together. However, the first step is to change ourselves - which may be the most difficult step of all. Many will settle, taking refuge in the status quo. I will not.

What will you do?

More very soon,
Anna

Improving the Medication Refill Process through Standard Work: CCRMC Rapid Improvement Event (Kaizen) Report Outs Tomorrow

This week's Rapid Improvement Event (Kaizen) is working to streamline the process of refilling medications.  

The improvement team is testing the most effective combination of manpower, materials and machinery in the process to develop "Standard Work" to improve the medication refill process in our system. I am often asked how we can have Standard Work and continuously improve at the same time? Taiichi Ohno described Standard Work as "the most effective" approach until the standard is improved. This, he said, is done through a continuous process called kaizen or, as we refer to it, a rapid improvement using Plan-Do-Study-Act cycles that are designed and tested by front-line staff, patients and family members. I'll write more on Standard Work and its role in continuous improvement in an upcoming post.

So what is the Contra Costa team up to this week? 

 

The team is hard at work developing Standard Work for our Medication Refill Rewrite Desk. Our Rewrite Desk helps to process refill requests received from retail pharmacies. A multidisciplinary team of pharmacy staff, nurses, providers, and our patient partner, Sylvy, have come together to test ideas aimed at reducing the amount of time patients have to wait for their refills.  By developing Standard Work for our Rewrite Desk they predict they will also reduce the amount of time that our Health Home Coordinators spend working on patient requests related to medication.  One example the team is looking at is eliminating faxes between our Rewrite staff and our clinics through the optimization of our ccLink (EHR) messaging capabilities.  This is only one example of many tests being conducted this week. To learn more, keep an eye out for my post with the tests and results in the coming days. Better yet, join us for one of the Report Out presentations tomorrow!

More very soon,
Anna
 

Contra Costa Regional Medical Center and Health Centers Rapid Improvement Event Report Outs:

 

Friday April 26, 2013

West County Health Center
13601 San Pablo Ave
San Pablo, CA 94806

7:45am - 8:15am

Contra Costa Regional Medical Center Lobby
2500 Alhambra Avenue
Martinez, CA 94553

10:00am - 10:30am

Pittsburg Health Center
2311 Loveridge Road,
Pittsburg, CA 94565

12:15am - 12:45am