Saturday, June 18, 2016

Father's Day

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

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

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

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

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

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

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

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

Happy Father's Day,
Anna

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

Thursday, January 1, 2015

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

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

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

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

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

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

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

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

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

Anna

Wednesday, September 24, 2014

Suffering In Silence: Why We Should Talk About Suicide

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

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

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

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

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

Help end the silence and erase the stigma surrounding suicide and its causes. Encourage those suffering from mental illness to seek treatment. Show support to the families and friends of the 36,000 Americans who die by suicide each year. Suicide is the third leading cause of death among teens and young adults and the second leading cause of death for college students. Every 40 seconds someone dies by suicide in the world.

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

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

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

Anna

Wednesday, September 17, 2014

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

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

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

Anna

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

Wednesday, July 2, 2014

We Are Indeed Better Together

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

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

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


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

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

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

Simply being open 24/7 isn’t enough. There is a difference between a 24/7 visitation policy and a welcoming policy. We as hospitals need to be truly welcoming places where families and loved ones are recognized and included as essential to patient care. It’s also not up to us to define family- patients have that right and we are proud to also be recognized as a "Leader in LGBT Healthcare Equality" by the Human Rights Campaign Foundation. http://cchealth.org/press-releases/2013/0711-CCRMC-Honored-for-Service-to-LGBT-Community.php

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


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

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

More very soon,
Anna


Wednesday, June 25, 2014

CCRMC Safety System Kaizen 3

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

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

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

Here are the slides from the report out:


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

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

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

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

More very soon,
Anna
 

Wednesday, May 28, 2014

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


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

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

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

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

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

Friday, January 10, 2014

The Latest News From CCRMC and Health Centers


Greetings,
 
I wanted to share with you the latest issue of our newsletter, The Update. In it, we highlight some of our achievements from 2013 such as the expansion of our award-winning Telephone Consultation Clinic, the introduction of our CCRMC Welcoming Policy, and the opening of our innovative Concord Health Center 2 (CHC2), which integrates behavioral and physical health care. You can see a video of CHC2’s opening celebration here .

We also feature some new things going on at CCRMC & HCs including our new evening dental clinics and the pilot for myccLink, our new online portal that lets our patients message their doctors, request prescription refills and see most lab results. We will be rolling out myccLink to all our patients later this year, so stayed tuned.

More very soon,

Anna

Wednesday, January 1, 2014

Change is here. All that is possible lies before us.

Change is here. All that is possible lies before us.

Greetings friends and colleagues,

Today is not only the start of the new year, but also the dawn in a long-awaited era of affordable health coverage and care for families across America.  Today, amidst hard economic times when there are many around us who are struggling to make ends meet, at long last, much needed help is on the way. Today we move forward as a nation on the basis of our shared ideals.  

As our community’s health system, we will continue to ensure the smooth implementation of health reform (Affordable Care Act) . Our goal is to provide care for our patients that is of the highest quality, coordinated and integrated, that will allow for earlier intervention, fewer avoidable emergency department visits and hospital stays and, ultimately, a healthier population while containing costs across our system and our community.  

Contra Costa Regional Medical Center and Health Centers (CCRMC & HC) will continue to expand access to health care and enhance quality through our Delivery System Reform program, also known as DSRIP. The improvements we are implementing as part of this plan are seen as key concepts of health reform. This critical effort builds on the extensive and innovative work that is well underway at CCRMC & HC and contributes to important knowledge for our country.  Our investment in innovative care models and technology, along with the many improvement efforts underway, have helped us become more able than ever to provide care on a larger scale, doing so in better ways than we ever thought possible.   

In the coming weeks, we will be seeking input for the CCRMC and HC's five year strategic plan. This plan will incorporate your feedback with recommendations from the 2010 Sustainability Study and the DSRIP.  There is still more work to be done, but we should not forget how much we have accomplished this past year. We have made great strides in safety and quality, and we have increased access to health care for our community.  

I want to give special thanks to those among us who serve our community on holidays, after hours and on weekends – those whose commitment to our mission has them assisting those in need. I could not be more thankful for the privilege of working with such a dedicated and caring community of professionals and partners. Your commitment and partnership are making a difference every day in our community.  

Please accept my sincere best wishes to you and your families for a happy, healthy and prosperous new year.

Together, let us welcome a new year. Together, let us welcome those who have long waited for the opportunity to access health care. Together, let us move forward.
 
Anna

Friday, December 6, 2013

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

Tuesday, November 19, 2013

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

Sunday, September 22, 2013

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

 

Monday, September 16, 2013

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 17th, 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
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.  
  1. 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.