Perception is Reality

Last weekend, I had the chance to go to the Georgia Aquarium in Atlanta with my cousin and her grandson. I have always loved going to the aquarium. The vibrant colors in nature, like the intense yellow of the angel fish, amaze me. I enjoy watching the sea otters as they play together and swim through the water. My favorite habitat at the aquarium, though, is that of the penguins. I always laugh at their silly waddle and the way they flop forward onto their belly and then slide right into the water—they’re comical on land, but such fast and graceful swimmers.

11-15-14 seeing thingsAs I watched my cousin’s grandson, Cole, observe these sea animals for the first time, I felt almost like it was my first visit. I watched him as he scrutinized each creature’s movements; he laughed as the otters swirled and glided through the water, and he eagerly pointed out a whale shark as it passed over us in the glass tunnel. I have no doubt there will be many more visits in his future!

Watching Cole carefully examine each creature and point out every detail about them made me realize something—as we become more familiar with our surroundings and activities, we often miss the small details. We end up taking what is in front of us for granted, because it becomes a common experience to us.

This is an actual phenomenon, which psychologists refer to as “habituation”. Simply put, it is a decrease in response to something after repeated presentations—the more often we see something, the less we notice it.

This made me think about health care settings, and the fact that as caregivers and employees, we eventually become accustomed to our patient care environments. We become so used to seeing the same setting every day, we may hardly notice when something is out of place, something has collected a little dust, or that a new, unsightly blemish has appeared on a wall, a piece of equipment or furniture.

Because providers and staff are busy focused on patient care, these small details might be easily overlooked; however, patients are looking. I know from my own experience as a patient, when I’m waiting in an exam room, I usually have enough time to give it a thorough inspection. Small details and first impressions have the potential to create a powerful set of assumptions. If patients see something askew or neglected, it may plant seeds of doubt in their minds about quality of care. As an inpatient, one has even more time to examine the details of a room. If something is not working or doesn’t look clean, it may signal to the patient that we don’t care, which is certainly not the case.

Perception is reality to our patients and their families. That’s why as providers and employees we have to practice seeing every aspect of our interaction with patients from their perspective—it’s more important than most of us think.

In fact, a number of studies link a range of aspects of the physical environment to patient safety, patient and family stress and healing, improved overall health care quality and cost, and even staff stress and effectiveness. The physical environment shapes every patient experience and all health care delivery, including those episodes of care that result in patient harm, according to the Agency for Healthcare Research and Quality (AHRQ). According to the NIH, various studies conducted at ambulatory care centers also show the physical environment has been associated with favorable patient outcomes.

The lists of physical features in care environments that are associated with positive patient experiences can be quite comprehensive, but some of the principle demands are an environment that:

  • Promotes safe behavior by patients, staff and visitors – for example plentiful, visible hand washing and hand disinfection stations.
  • Prevents accidents – for example ensuring spills are promptly cleaned up to prevent slips and falls.
  • Encourages patients and staff to feel reassured – through adequate interior and exterior lighting, visibility of security personnel, and, in the case of inpatient care, secure storage for personal items such as glasses, keys and money.
  • Reduces stress, anxiety and aggression – through the provision of pleasant, comfortable waiting spaces, feedback and communication on waiting times and priorities, attention to ambient temperature, light and noise, etc.

These aspects can be further supported by robust monitoring and reporting, demonstrating a Culture of Trust, and having a sense of personal responsibility and willingness to admit safety concerns and report mistakes, should they occur.

On a regular basis, take an unbiased look at your patient care or service environment. Try seeing it from the patient’s perspective. What would be your first impression of the waiting area? Does furniture or equipment need repair? Is it dirty or scuffed? What does the front desk look like? Is there excessive or old signage? Are patients and family members warmly greeted on arrival? What do the exam rooms and/or inpatient rooms look like? Are ceiling tiles damaged? Is the work area cluttered? Is paint peeling or scuffed?

These are just some examples of things of which we should remain aware. I believe we do a wonderful job at UTMB of providing an excellent care environment, but we should always be vigilant. We need everyone’s help!

  • Report facilities issues that need maintenance; if the problem does not get fixed or you don’t have a response within a week, escalate it to your supervisor
  • Keep clutter out of the hallways
  • Assure all supplies are not expired and that they’re properly stored
  • Check for expired supplies and medications
  • Ensure refrigerator temperature monitoring, proper food labeling, and cleanliness
  • Make sure linens are covered
  • Eliminate dirty, cluttered work areas

It’s very easy to quickly resolve issues that impact patient care by dialing one number: 2-4040. Requests may also be made with each area’s designated Zone Mechanic. Calls will be routed to the UTMB Service Response Center, which has expanded its service to act as the single point of contact for all clinical support services in the following areas: Environmental Service, Pest Control, Food and Nutrition, Clinical Equipment, Nursing Unit Support, Maintenance, Utilities, and In-house Construction.

More information on these topics can also be found on UTMB’s internal web site, The Joint Commission: http://intranet.utmb.edu/qhs/TheJointCommission/default.asp

Thank you for the part you play in keeping UTMB hospitals and clinics beautiful and safe for our patients and our staff!

Safety Doesn’t Happen by Accident

Donna Sollenberger, EVP & CEO, UTMB Health SystemGrowing up, I was somewhat of a rebel. My mother and father were often frustrated with me, because I didn’t want to follow their rules. I couldn’t understand why they got so upset about things like missing curfew, driving outside of town, and having a summer job. I was even more perplexed when they told me they established all of these rules to keep me safe. Really? I thought that sounded a lot like an excuse and not a reason!

But as I became an adult and had children of my own, I experienced what many of us have – I started sounding a lot like my parents when I started creating and enforcing “the rules”. When my kids pushed back, I cringed a little as I heard my own voice echo the words of my mom and dad: “These rules are meant to help you. They’re meant to keep you safe!”

I had to admit, my parents were right—it’s easy to think you’re safe from harm in your own backyard. It’s easy to underestimate that something harmful might happen to us  because the odds seem so small. We sometimes take our safety for granted, not realizing the potential hazards that can be present in our everyday activities. We feel a little overconfident at times, perhaps because we’ve done something so many times before, or we’ve become a little complacent and discount the risks—we think we’re being “safe enough”. However, taking risks and acting hastily are often the very elements that create an environment conducive for an error or accident to occur.

The same is true of safety cultures, and the longer I have worked in health care, the more I have come to appreciate the rules that are in place to keep employees and patients safe. We often emphasize the importance of safety in health care with the patient at the forefront, but the safety of our staff is equally important.

It’s easy to go through the motions of something as common as patient handling, drawing blood, or administering intravenous medications, but these are also some of the most common ways both health care workers and patients can be potentially harmed. Therefore, safety interventions, such as proper hand hygiene and safe lifting techniques, protect not only our patients, but our staff as well. This is why it’s important to practice these safety measures the same way, every time.

A perfect example of a safety intervention in place at UTMB is the barcode medication administration system we recently implemented. This is the system where the nurse scans his or her employee badge, scans the patient’s wrist band, and then scans the medication. Then, the system confirms for the nurse that they have the right patient, the right medication, the right dosage and it’s the right time for administration. Using this system is critical to assuring that we keep the patient as safe as possible. When we follow this process exactly, we almost completely rule out the possibility of a medication error, and that keeps the patient safe!

In areas where we do invasive procedures on patients, rules are in place to assure we are doing the correct procedure. If the procedure is a surgery, for example, the nurse asks the patient to confirm his/her name and birthdate to make sure it is the right patient. Then, the nurse or physician confirms with the patient the procedure they are about to undergo, and they mark the patient’s body on the correct side and specific location where the procedure will be performed. This process is repeated again once the patient is in the procedure room, when the physician calls a “time out”. Here, the physician again confirms the patient’s name and birthdate, the procedure to be performed, and the location. Then, anyone present may speak up to express concerns they have about any aspect of the procedure. These processes are in place to keep the patient safe and to assure that the staff proceed as planned.

If we watch other people on our team for “state to error” risk patterns, every time we see one, it will automatically make us think more about what we are doing. And if what we see is sensational enough, we’ll do more than think about it—we’ll actually react to it. This will not only protect our patients from harm, but we’ll also protect one another.

At UTMB, we work to do everything we can to create a safe and highly-reliable environment for our patients and employees. It is crucial all of our staff remain alert and work together as a team at all times to recognize and avoid potentially unsafe conditions and activities for the safety of all. Remember:

  • Everyone has a part to play in creating a safe and reliable care environment.
  • Slow down. Be methodical and mindful.
  • Support effective safety measures and demonstrate accountability at every step.
  • Report mistakes and system flaws — it is safe and valued.
  • Recognize individuals who act with safety in mind.
  • Speak up when you see something that feels unsafe, if you feel concerned, uncomfortable, or think the team should stop and reevaluate a situation.

Although health care settings are varied and present both common and unique safety issues, interventions to improve safety for patients also improve safety for employees. After all, safety doesn’t happen by accident!

“For safety is not a gadget but a state of mind.”  ~Eleanor Everet 

Recognizing Team Accomplishments, Sharing a Vision

Donna Sollenberger, EVP & CEO, UTMB Health SystemThis week, I came across a posting of monthly clinic stats for the PCP Pediatrics Clinic developed by Practice Manager Ashley Dusek. The creative style she used to help inform her team of the most recent numbers for completed patient appointments really stood out to me. She did much more than simply reveal the data—she helped her team understand why the work they did during the month of February mattered to the 1,421 patients they served.

The post began, “Total Number of Completed Appointments 1,421. Why do I care you ask?” The communication continued:

“Because of you…1,421 patients were reassured their vitals were stable and that their lab work, which you drew, would be processed in a timely manner.

Because of you…1,421 patients were able to receive specialty care, immunizations, or just a simple reassurance by having their medical questions answered.

Because of you…1,421 patients were examined and given the right medications to make it all better!

Because of you…8,943 patient phone calls were answered. They were able to make appointments, ask questions, get test results, get prescription refills and know that we were there to answer and help with whatever they needed.

If you got to the end of this and you still believe you are too small to make a difference, Try sleeping with a mosquito!”

Ashley acknowledged the work her team had accomplished and also recognized that their efforts had positively impacted the patients’ experiences.

When I speak with individuals across the institution, whether their role is in direct patient care or they work behind the scenes, it is clear to me that as an organization, we believe we are ultimately here to serve our patients and their families. We find the greatest satisfaction in our roles when we know that we have provided good service to them and that we have truly made a difference.

Several months ago, when Sharon Johnson, a senior radiation therapist at UTMB, was asked how she felt she impacted the patient experience, her response wasn’t made in reference to the tasks she performs daily to deliver patient therapy alone. Instead, she answered, “I just try to be who they need me to be at that moment. Sometimes it’s a shoulder to cry on, sometimes they need a sister or a mother figure, sometimes it’s just a friend to hold their hand. I give a little piece of myself to the patients and I gain so much in return.”

While we all do what we do at UTMB because we receive the intrinsic reward of helping our patients and families, it also feels good to receive direct feedback that affirms we have made a difference. When our patients are satisfied, we feel satisfied with our performance. However, it can sometimes seem that we more frequently receive feedback about the areas in which we have yet to improve, and perhaps less frequently that our names are called out in a moving patient testimonial that so eloquently describes the true impact that we have made.

That is why, as team leaders, we must be supportive of the work our teams do. It is not always just about celebrating the major milestones; it is also about celebrating the small successes we have made along the way. When we feel good about what we do, we also develop a desire to continue that success—we have a sense of pride and ownership. Therefore, even when we do identify areas needing improvement, we must take care that we are constructive in our approach to both delivering and receiving the message. We want to emphasize fixing our processes, not assigning blame—that is a Culture of Trust.

Much of the work we do in health care today takes place under an umbrella of a changing health care environment. While this change is sometimes difficult, many of the best components of these changes are embedded in improving the quality and efficiency of care as well as the experience of the patient. It will take teamwork to be successful, and this means we are all involved, at all levels of the organization. This is a positive process! It’s important that we share information, celebrate accomplishments and provide timely, consistent and authentic feedback. Our focus of discussion is on how we can build on strengths and past positive experiences. We must do more than identify what is already working well; we need to identify what else can be done to enhance this work.

Tom Morris, author of If Aristotle Ran General Motors: The New Soul of Business, explains that while the pace of change may be at an all-time high, the challenge of change has always been with us. Change is the condition for positive, creative growth. At UTMB, we must stand firm in our values of compassion, integrity, respect, diversity and lifelong learning. We share in the vision of the road ahead, and we will work together to achieve it. We are here to work together to work wonders for our patients and their families!

If you would like to recognize an accomplishment or creative solution, please share with it us! Email us at health.system@utmb.edu

New Year’s Resolutions

Donna Sollenberger, EVP & CEO, UTMB Health SystemEach New Year presents new opportunities—opportunities to learn new things, to focus on what we hope to achieve in the future and to treat one another and ourselves better. As we bring one year to a close and embark on a new stage in our journey, it is important for each of us at UTMB Health to reflect on the changes we want (or need) to make, set our sights on what we’d like to achieve in the next 12 months and resolve to follow through on those changes.

On an individual level, we can choose what we want for ourselves in the New Year; on an organizational level, we share in many of our goals, and we are guided by core values that help to define our culture. As an academic medical center, faculty members, health care providers, staff and students all share in the responsibility of caring for our patients and improving health in the communities we serve. Sharing a common vision keeps everyone moving forward. Teamwork and collaboration are the very basis for the great accomplishments that we will achieve.

If we resolve to place the patient at the center of everything we do and to abide by our core values in all of our endeavors, we will meet with success in not only achieving our goals, but ultimately by providing the best care for our patients and their families. We’ll also go a long way toward creating a safe and positive work environment for everyone at UTMB.

So let us begin 2014 by reaffirming the values which serve as the cornerstone of UTMB’s reputation as a leading academic health center and an institution deserving of the trust that our patients and their families place in us:

We demonstrate compassion for all. The letters I receive daily from our patients reflect that compassion is alive and well at UTMB. Caring for others is why we are here! In 2014, may we always maintain an awareness of others and consider what life may be like after walking a mile in their shoes. Many of you may have seen the video “What if you could read their thoughts?” in which Cleveland Clinic explores what empathy really means and explores how our interactions with others would change if we knew what they were feeling and thinking. In a hospital, empathy underpins human relationships, and I encourage you to view the video if you haven’t already.

We always act with integrity. Everyone plays a part in creating a safe and reliable care environment. Each of us holds ourselves accountable and each of us expects one another to do the same. As the saying goes, “Character is who you are in the dark.”  When no one’s looking, we are the ones to whom we answer. Having integrity means we believe in what we do and why we do it, and essentially, we trust one another to do the right thing. Moreover, our patients and their families trust us do the right thing. They trust us to be honest, qualified, knowledgeable and to not only have one another’s best interests at heart, but to especially have at heart what is in their best interest.

We show respect to everyone we meet. It is widely acknowledged that there are different kinds of respect. Respect can be defined simply as a behavior or it can be defined as an attitude or feeling. However, respect is always directed toward, paid to, felt about, or shown for another person. We can show respect to others by valuing and appreciating them as unique individuals and when in the work environment, also treating them as esteemed colleagues. We show respect by listening and engaging during discussions and meetings. We value the thoughts and opinions of others, even when we may think or feel differently. Finally, we regard one another not merely as a means to serve a purpose, but as valuable human beings. Therefore, we should all work in partnership with one another because we are all here at UTMB, in whatever our role, to serve a single purpose: to provide the best service and safest possible care for our patient and their families.

We embrace diversity to best serve a global community. The concept of diversity encompasses acceptance and respect. It means understanding that each individual is unique and recognizing our individual differences, including dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies. It is the exploration of these differences in a safe, positive, and nurturing environment. It is about understanding each other the best we can and moving forward in our encounters with respect of those differences, including how we communicate, educate and provide patient care. We should embrace and celebrate the rich dimensions of diversity contained within each individual.

We promote excellence and innovation through lifelong learning.  Through innovation and by exploring new solutions, we not only gain knowledge, but we are also then able to contribute to the greater body of knowledge. Lifelong learning makes us successful, no matter what our definition of success may be. We grow as a person through learning and when one masters a subject through continuous learning, it brings satisfaction. Lifelong learning enables us to be confident, competent, and knowledgeable; it increases productivity and makes us better leaders.

I’ve said it before, but I am proud to be part of an organization like UTMB and to work alongside each of you. Everyone is doing a truly remarkable job, both by helping one another and going the extra mile to serve our patients and families. So this year, let’s embrace the values of compassion, integrity diversity, respect and lifelong learning and embark on the beginning of a very successful 2014!

Be sure to share the great achievements you and your teams accomplish along the way!

The Greatest Accomplishments are Achieved Through Teamwork

Donna Sollenberger, EVP & CEO, UTMB Health SystemIn the world of health care today, it’s hard to go anywhere without hearing about the necessity of teamwork or that the greatest accomplishments are achieved when people work in teams. Teamwork requires constant attention, communication, inclusion and collaboration.

One of my favorite sports is basketball, and one of the all-time greats and holder of six NBA championship rings, Michael Jordan, once said the said the following: “Talent wins games, but teamwork and intelligence win championships.”

Think about it. We have so many talented and intelligent people who work at UTMB, but Jordan’s sentiment about teamwork is the essential ingredient for ultimate success. At UTMB, we have to work together to benefit the health and care of patients. Just before the holidays, I took some time to review everything that we had collectively achieved over the past year, and not only was it clear to me that we are all passionate about being the best possible place for patients to receive care, but I was amazed by all that we had accomplished as a result of this teamwork!

We began 2013 by breaking ground on the Victory Lakes expansion, an exciting project that will allow UTMB to provide more services and convenience to our patients in the Bay Area while also offering a more integrated system of care. Meanwhile, we built mock-up rooms of the new Jennie Sealy Hospital to allow staff and community members a chance to provide feedback; we made modifications based on that input and then conducted patient simulation drills to ensure the design would be as refined as possible for our patients, their families and our patient care teams.

We made a collective commitment to engage our patients and their families in every stage of their care by placing them at the center of their care team. We also went live with utmbConnect, which enabled us to offer our patients the convenience of a single electronic medical record and a combined bill for all of their encounters at UTMB. And speaking of the utmbConnect project, UTMB recently received news that we were rated an “A+” top-tier performer by Epic—what an outstanding achievement! We could not have been as successful without a tremendous amount of teamwork across all areas of the institution.

In 2013, it seemed as though awards came in one after another. We became first hospital in Texas to receive American Health Association’s Get with the Guidelines®-Resuscitation Silver Quality Achievement Award and became one of four centers Texas and one of 44 in the U.S. to be designated as an AAGL Center of Excellence Distinction for Minimally Invasive Gynecology. We also received certification from the American Association of Cardiovascular and Pulmonary Rehabilitation, and these are only a few examples of recognitions—don’t forget the SICU’s recent Gold-level Beacon Award from the American Association of Critical-Care Nurses and Family Medicine’s recognition as an NCQA Level-3 Patient Centered Medical Home. This was quite a year for UTMB!

We also developed great partnerships, such as the shared pilot program between the UTMB Emergency Department and Galveston EMS that reduces the time it takes to get a stroke patient to a CT scan after reaching the ER entrance from 20 minutes to 2 minutes—this is valuable time saved for a stroke patient, who may lose 10 percent of salvageable brain function for every 15 minutes they go untreated.

I could fill an entire book with all the great accomplishments over the past year, and I assure you, these are but a handful of the highlights. I am excited to share all that we will accomplish through teamwork in 2014. If you have stories that you would like to share, please send them to me at health.system@utmb.edu

Thank you for your teamwork. I am proud to work with each of you and to be part of the UTMB team!

Making a Pound of Honey

Donna Sollenberger, EVP & CEO, UTMB Health SystemI have always been fascinated by honeybees. I often observed the bees as a child, and although I’d occasionally get too close for their comfort and was stung, I was still very intrigued by how synchronized they were in their work and how each bee seemed to have a certain role.

During a honeybee’s short lifetime, which lasts about two months, it will visit millions of flowers and travel a distance equivalent to twice around the earth, while only producing one-twelfth of a teaspoon of honey. Thus, it requires anywhere from 20,000 to 60,000 bees to make a single pound of honey. From the queen bee to each and every worker bee, the entire hive must work together in their roles to achieve their life’s purpose of making honey.

This past week, I thought of the bees and the magnitude of their collaborative effort when I heard about two outstanding recognitions achieved at UTMB—these accomplishments could not have been possible without a tremendous amount of teamwork!

News of the first recognition came last Friday, when David Marshall, our chief nursing and patient care services officer, sent out an announcement that UTMB’s Surgical Intensive Care Unit (SICU) was awarded the American Association of Critical Care Nurses (ACCN) Beacon Award.

The Beacon Award recognizes individual units that distinguish themselves by improving all aspects of patient care. It also signifies that UTMB patients who are admitted to our SICU experience better outcomes and are more satisfied with their overall experience.

For our nurses, this award means that generally, there is a positive and supportive work environment with a greater degree of teamwork and collaboration between all caregivers, higher employee morale and lower turnover rates. What an outstanding accomplishment that exemplifies the phrase “win-win” for both our patients and the staff of the SICU!

In addition, earlier this week, Dr. Barbara Thompson, professor and chair of the Department of Family Medicine, received the news that all three of our Family Medicine practice sites (Island West, Island East and Dickinson) were awarded Level 3 Patient-Centered Medical Home (PCMH) status, the highest level recognized by National Committee for Quality Assurance (NCQA). Only a little more than half of NCQA-recognized practices have achieved the Level 3 status.

This recognition acknowledges an undertaking that began in the fall of 2011 to prepare our clinics to operate under a special model of patient care that is designed to strengthen the relationship between the patient and their care team. Each patient has an ongoing relationship with their care team, which consists of their physician, a medical assistant, nurses, patient care technicians and other clinical and administrative staff, at a single location. The team takes collective responsibility for the patient’s care, providing for his/her health care needs and arranging for appropriate care with other qualified clinicians. The medical home is intended to result in more personalized, coordinated, effective and efficient care. This is the epitome of teamwork, and having this recognition positions UTMB well for the future of health care reform!

Each of us works on a team that in some way, shape or form impacts our patients, and we all have an important role to play in assuring that our patients receive the best possible care. Our individual contributions to the team on which we work are critical to achieving UTMB’s vision of “working together to work wonders as we define the future of health care and strive to be the best in all endeavors.”

Thank you for your individual contributions to the team. Your work truly does make a difference in patients’ lives!

Aiming for the Top in Quality and Accountability

Donna Sollenberger, EVP & CEO, UTMB Health SystemSeveral weeks ago, I attended the annual University HealthSystem Consortium’s (UHC) Quality Forum. As I reviewed UTMB’s performance in the latest Quality and Accountability Study, I felt proud of how far we have come in terms of quality improvement. Yet, I also realized just how far we still must go to make sure our patients are always receiving the best possible care.

Reading the report, I thought of how the emphasis on quality in health care has increased in the last decade, and that it will continue to be emphasized as patients have more responsibility for the cost of their care—they will expect the best outcome at the best price, which equates to the best value.

My thoughts took me back to 2009, a time that is memorable to me for many reasons. Not only had I just arrived at UTMB Health that fall, but I had also received the UHC Quality and Accountability results for UTMB for the first time. The report typically includes approximately 110 academic medical centers that submit data on areas such as patient satisfaction, hospital acquired conditions (infections), mortality rates (deaths that are not expected), and cost. The centers are then ranked based on their performance using a five-star system, with five stars being the best. That year, we were only a two-star hospital, ranking in the bottom quartile of the list of reporting hospitals.

This year, I was pleased with the news that we are now solidly a three-star hospital and performing at the median of the reporting hospitals. We did very well in the measures of mortality (27 out of 112 reporting), equity of care (we ranked first of all the reporting hospitals), and patient-centeredness, which includes our performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures.

The more challenging news, however, is that our performance in several other areas needs improvement. In the category of effectiveness, which includes data for all-cause 30-day readmissions and core measures, we ranked 76 out of 112. For safety, which includes measures on postoperative hemorrhage and hematoma, we ranked 53 out of 112. In efficiency, we ranked only 94 out of 112. The latter means that we have a long way to go in managing our inpatient length of stay, as well as our cost of care for certain services.

While we have done an excellent job in many areas, my goal is that UTMB Health continues to improve its performance in this important study. During the conference, I sat next to a friend whose hospital has been in the Top 10 of the Quality and Accountability Study for four years in a row. I firmly believe UTMB can also achieve this if we continue working hard to improve. This means we must always place the best interest of our patients as our top priority. We can achieve this by focusing on patient satisfaction, patient safety, and the effectiveness and efficiency of patient care delivery.

Here are a few things to consider as each and every one of us work to improve our patients’ experiences while at UTMB Health:

  • Are we communicating with and meeting the needs of our patients?
  • Are we creating an environment where patients have the best opportunity to have the best possible outcome?
  • Do we have the correct and necessary supplies we need for patient care? Are any supplies expired?
  • Are patient rooms available in a timely manner? Are they thoroughly cleaned so that the patient’s risk of infection is minimized?
  • Are our physicians and residents working closely with care management to assure that the patient’s length of stay does not exceed what would be expected for that condition?
  • Are all health care employees effectively and efficiently using the resources required to deliver patient care in a manner that helps ensure the cost of care does not exceed what would be expected for a patient with a particular diagnosis?
  • Are our systems and processes streamlined to minimize cost and increase effectiveness?
  • Are we washing our hands or using gel each time we enter and leave a patient’s room?
  • Are our physicians sitting down at eye level to the patient each time they enter a patient or exam room?

I know we can continue to excel in this study by focusing on these measures—we have come so far already! Thank you for everything you do to make a difference in the quality and safety of patient care at UTMB Health. I look forward to working with each of you as we continue our journey to be the safest and highest quality hospital for our all of our patients.

 

A Visit to CMC Clinics, Infirmaries and Pharmacy

Last week, I had the privilege of visiting our Correctional Managed Care (CMC) clinics and infirmaries at the Walls Unit and Estelle Unit,  as well as our CMC pharmacy in Huntsville.  The people I met and the work that they do is nothing short of amazing!

What makes their work so outstanding?

Dr. John Beason, Regional Dental Director, CMC with Donna Sollenberger, EVP & CEO Health SystemDr. John Beason, Regional Dental Director, CMC with Donna Sollenberger, EVP & CEO Health System

Dr. John Beason with Donna Sollenberger

First, they are passionate about everything they do. At the Walls Unit, Regional Dental Director, CMC, Dr. John Beason, gave us a tour of the dental facility in a small but extremely well-organized and clean clinic.  It was clear that each person there was very proud of the work they and their colleagues do, and their enthusiasm for their work was palpable.

Special thanks to Nurse Manager, Beth Pipkin, for organizing the tour of the infirmary and historic section of the Walls Unit, led by Sergeant John Heil. The Walls Unit is the oldest prison in the state, established in 1848 and was once home to the Texas Prison Rodeo, which ended in 1986.

Secondly, they pride themselves in their delivery of cost effective care. Each person I spoke with in every area I toured could tell me how their work has contributed to the ability of UTMB’s CMC operation to achieve a per member per day cost of just a little over $9 per day.  To put that into perspective, the cost in California for offender care is $48 per day!

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Dr. Stephanie Zepeda with Donna Sollenberger

Dr. Stephanie Zepeda, Director of Pharmacy Services, CMC, showed me around the 20,000 square foot pharmacy facility which operates as a mail order business with next day delivery.  Stephanie could hardly fit all the information about the pharmacy into the tour, which is understandable when one considers that the team provides services to approximately 156,000 patients  at 125 facilities statewide, with customers including the Texas Department of Criminal Justice and Texas Juvenile Justice Department.

Stephanie showed me how they saved over $10 million per year by having a very effective and compliant recycling program for returned pharmaceuticals. Their automation, most of which was custom built, enables the pharmacy to dispense nearly 4.5 million prescriptions each year, approximately 375,000 each month, and over 18,000 a day with an average prescription cost of only $8.53.

Donna Sollenberger, EVP & CEO, with Misty Hawking, Radiology Technician

Donna Sollenberger with Misty Hawkins

At the Estelle Unit, I met Radiology Technician, Misty Hawkins, who later told me that she loves working at UTMB so much that she hopes to retire from the organization!

Finally, the quality of the care was outstanding! At the Estelle Unit, Dr. Dave Khurana, Medical Director of Nephrology and Dialysis for CMC, showed me around the unit, which currently has the largest dialysis census for a single hemodialysis clinic in the State of Texas at a capacity of 222. The quality of what they do is nothing short of amazing. They are now able to download dialysis information into the EMR in real-time, which has been a huge satisfier for the medical team. In addition, their use of an AV fistula, which is considered the best long-term vascular access for hemodialysis (compared to central venous catheters), consistently meets and/or exceeds both state and national performance by nearly 12% according to standards identified by the National Kidney Foundation and KDOQI guidelines. In fact, their quality is so outstanding that they skew the data in each survey in which they are included!

Dr. Dave Khurana, Dialysis Patient Care Techs Bradley Bowns and Sheila Jones, and Donna Sollenberger

Dr. Dave Khurana with Dialysis Patient Care Technicians, Bradley Bowns and Sheila Jones, and Donna Sollenberger

What struck me most about this tour is the tremendous variety in each person’s role at UTMB and how our contributions allow our organization to meet its mission and achieve its vision. I am fortunate to see the UTMB values — compassion, integrity, respect, diversity and lifelong learning — alive and well through the work that you do each and every day!

Stay tuned for more detailed stories about the tour complete with lots of photos about my visit in upcoming issues of Friday Focus.

 

Patient-Centered Communication Affects Satisfaction, Quality & Patient Safety

Donna Sollenberger, EVP & CEO, UTMB Health SystemLast week’s Friday Flash Report focused on patient satisfaction, its importance, and how each of us, whatever our role at UTMB, can help to ensure that our patients have the best possible care and experience at UTMB Health.

An important component of patient satisfaction is communication. That’s why surveys such as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) and CG-CAHPS (Clinician & Group) ask patients how well they felt doctors and nurses communicated with them during their visit. That information is then used as an indicator of the patient’s overall satisfaction with their experience. However, there is a much more important reason that patient-centered communication matters – it can affect the safety and quality of the patient’s care.

Every health care interaction depends on effective communication, from making an appointment and registering for a visit to describing symptoms, discussing risks and benefits of treatments, and understanding care instructions.

Whatever our role at UTMB, as we go through our daily routines, many of the terms we use and tasks we perform tend to become second nature, ingrained in our minds to the point that sometimes we can forget how our environment may be perceived by someone who is not familiar with our system. This is something of which we should try to be aware when communicating with our patients.

Factors such as language barriers, disabilities or health care literacy can also contribute to how a patient perceives their experience. These factors, if overlooked, can potentially compromise a patient’s health, particularly when they do not clearly understand their diagnosis or care instructions. A patient who has a hearing impairment or difficulty seeing, reading or writing may not always announce their limitations, because they may be embarrassed or too impaired to mention it at the time. However, these factors could adversely affect their care if they are unable to read the names of their medications and/or the correct dosages, etc.

Communication breakdowns, whether between care providers or between care providers and their patients, is the primary root cause of the nearly 3,000 sentinel events—unexpected deaths and catastrophic injuries—that have been reported to The Joint Commission.

That’s why we must all be committed to patient-centered communications, as leaders, managers and front line staff:

  • When speaking with our patients, even when we are busy, we should always remember that it is important to make eye contact and listen to their questions and concerns.
  • We must err on the side of caution and clearly communicate using simple language (this applies to written materials as well).
  • Encourage patients to repeat the care-related information you have explained to them to make sure that they understand what you told them.
  • When applicable, limit information to two or three important points per clinic visit.
  • Use drawings, models or devices to demonstrate points and always encourage patients to ask questions.
  • Patients should always receive an After Visit Summary (AVS), with information about all of their medications, diagnoses, test results and plans for follow-up care, as well as physician and clinic contact information.

Simply striving for patient-centered communication can make a big difference in the health and wellness of our patients! Please remember that there are also services available to assist you, such as UTMB’s Patient Services & Language Assistance programs.

What are you doing to improve communication with patients? What techniques are you using that have improved communication?  I would love to hear from you this week about what you and your colleagues are doing to improve communication with our patients. Please send these examples to me at health.system@utmb.edu, and I will share your examples in future issues of Friday Flash Report.

Next week’s topic: MyChart