Donna Sollenberger and the Health System Leadership Team
Wish you a Safe and Happy Independence Day!
I was in the process of writing this week’s Friday Flash Report when I received news of an incident that really underscored the importance of always being prepared to spring to action in support of our patients and patient care environments.
During the process of renovating an area on the fifth floor of the John Sealy Annex, a chilled water line broke and caused water to leak through to several areas in the building. Fortunately, UTMB’s Environmental Services and Environment of Care/Utilities Management teams immediately came to the rescue and were able to address and resolve the issue. This is just one example of why always being prepared for unexpected events is so important, and I’d like to give kudos to these teams for their diligence and quick response!
The incident seemed like a perfect introduction to the fact that, although it seems like only yesterday that The Joint Commission (TJC) visited the UTMB campus, nearly 19 months have passed since our last accreditation survey (November 2012), and we are once again in the accreditation survey window.
The unannounced Joint Commission Accreditation survey, which occurs every 18-36 months, is a validation of our organization’s continuous improvement efforts. More importantly, because the accreditation is a nationwide seal of approval that indicates UTMB meets high performance standards, this is a great opportunity to reinvigorate our current efforts to ensure we are providing the safest possible care for our patients, families and one another.
TJC accreditation can be earned by many types of health care organizations, including hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services. The survey process is data-driven, patient-centered and focused on evaluating actual care processes. Surveyors use the tracer methodology by selecting a patient and following the path the patient has taken throughout their hospital stay, observing practices, documentation and the environment, as well as interviewing staff and patients. Surveyors will ask questions about the care each patient received and the steps taken to ensure that it was safe and of high quality.
Areas of focus for the surveyors include both patient-related and organizational functions. Please take a moment to review the brief outline below and be sure to work with your supervisors and colleagues to assure action items in your area are addressed. Our success will require the cooperation and support of every provider and staff member, as well as on everyone’s familiarity with TJC requirements in their particular area!
The Joint Commission can arrive any time during our survey timeframe. The survey will last five days and your supervisor will keep you informed of survey progress. At the end of the on-site survey, the surveyors will present UTMB with a preliminary report that identifies if there were any standards that were scored as partial or non-compliant, also known as Requirements for Improvement (RFIs).
It is important to note that UTMB’s performance during the survey is made public and available on the Internet. Our competitors, affiliates, referring physicians and – most importantly – our patients and their families will be able to read the details of our performance. However, I prefer to have full confidence in our teams and I believe we will be fully prepared for the survey, because we all share the belief that every UTMB employee at every level is very much responsible for upholding our mission and providing excellent patient care!
For more information on Joint Commission Accreditation preparedness in your area, please visit http://intranet.utmb.edu/qhs/TheJointCommission or contact Janet DuBois, Associate Director of Accreditation. In addition to accreditation participation requirements, the following areas will be considered during The Joint Commission Patient-Centered Accreditation Process:
The patient-focused section includes chapters on Infection Control, Medication Management, Provision of Care, and Rights and Responsibilities.
This section of the CAMH includes chapters on Environment of Care, Emergency Management, Human Resources, Information Management, Leadership, Life Safety, Medical Staff, Nursing, Performance Improvement, and Record of Care.
NATIONAL PATIENT SAFETY GOALS
Identify Patients Correctly
Use at least two ways to identify patients. For example, use the patient’s name and medical record number. This is done to ensure that each patient gets the correct medicine and treatment. It also confirms that the correct patient gets the correct blood when they get a blood transfusion.
Improve Staff Communications
Improve the effectiveness of communication among caregivers (“read back”, timely report of critical values, hand-off communication).
Use Medications Safely
Label all medications before procedures. Reduce the possibility of harm for patients on anticoagulation therapy. Maintain and communicate accurate patient medication information (Medication Reconciliation).
Use Alarms Safely
Make improvements to ensure that alarms on medical equipment are heard and responded to on time.
Be vigilant about hand-washing protocol. Use the “proven guidelines” to prevent infection (difficult to treat infections, blood from central lines, after surgery and urinary tract infections caused by catheters).
Identify Patient Safety Risks
Learn which patients are most likely to try and commit self-harm.
Prevent Mistakes in Surgery
Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body. Mark the correct place on the patient’s body where the surgery is to be done. Pause before the surgery to make sure that a mistake is not being made. (Take a “time out”).
I was fortunate to grow up in a home where my mother always emphasized the importance of showing respect to others. She taught my siblings and me that we should be kind and polite to every person we encountered. When she thought that my sister, brother or I were getting a little too arrogant, her favorite phrase was, “Do not get above your raising.” Looking back, this is one of the great life lessons I have learned, especially as I have taken on leadership roles. I learned to appreciate the work of everyone – each person’s contribution is needed to assure that we can provide great care to our patients. I am grateful for a wonderful mother who modeled the way for being courteous, kind and polite in all her interactions.
The word “respect” is often used in our day-to-day conversations, because it encompasses a wide range of actions that show we value and have concern for others. At UTMB, one of our core values is respect. Having respect for someone could mean that we admire them because of their abilities, qualities or achievements; but more importantly, when we demonstrate respect to others, it is because we value their feelings, wishes and rights; we recognize that they are a human being, and we care about how we treat them. Just as with our core value of integrity, when we respect others, we do the right thing by them because we know it is what should be done.
I recently read a story about a business student who did well on her final exam—until she came to the last question: “What is the name of the person who cleans your dorm?” She stared at it in disbelief. How could she be expected to know the answer to that? What did this have to do with her business degree? Finally, she asked the professor if the question really counted toward their final grade. “Of course it does!” he replied. “Most of you dream about becoming the president and CEO of a successful company. But success is a team effort. A good leader takes nothing for granted and recognizes the contributions made by everyone on the team.”
When we recognize the strengths and importance of individuals on our team, people feel valued. When we respect one another, we encourage each other to leverage those strengths. In turn, everyone on the team will naturally want to do their best. In this way, we learn from one another and are then collectively able to achieve what an individual alone could not. This is especially important because we all ultimately work together to serve a single purpose at UTMB: to provide the best service and safest possible care for all of our patient and their families.
Let’s consider for a moment what happens when a team or an organization does not embrace respect. Lack of respect immediately impedes the team’s ability to achieve success. After all, when people believe their managers and colleagues don’t really care, how likely are they to give their best? How often will they feel encouraged to be innovative or to collaborate? We can use the word “respect” each and every day, but if we don’t behave in ways that demonstrate respect, it makes it difficult for others to trust us.
When we treat others with respect, we treat them as we would like to be treated. But respect is also a two-way street—we have to give it to receive it. Just as with any other value we hold in high regard, this may require daily reflection about how well we have demonstrated it. After all, we are all works in progress! Just as acting with integrity inspires others to do the same, treating others with respect encourages others to act in kind ways. By recognizing that both integrity and respect are at the foundation of a Culture of Trust and by working each day to demonstrate them, we take the most important step toward truly achieving it.
We can incorporate simple gestures into our daily routine to show our colleagues, patients and families we value and respect them:
As we show respect for all, we will be living another of UTMB’s important values.
This is the end of the first week of Hurricane Season, and I’ve been keeping a closer eye on my fuel gauge. I’ve also started taking additional precautions to prepare for the possibility of tropical weather in our area. The more I add to my emergency kit, the more I wonder why is it only during Hurricane Season that I make these preparations? After all, anyone who has watched the news or has lived in the Houston-Galveston region for any period of time can affirm that weather-related and other adverse events can be unpredictable, and that we should always be prepared in case of an emergency.
Many at UTMB have experienced adverse situations, with Hurricane Ike in September 2008 being one of the most prominently remembered. During these times, many of you were asked to stay onboard to help ensure that our patients would continue receiving the important care they needed, to help protect our facilities and to ensure our operations continued. Fortunately, these circumstances are rare; however, we realize that while we are busy caring for our patients first, it can be stressful because of the concerns we also have for our homes, loved ones, dependents and pets. Likewise, our friends and family will be concerned about our well-being during an emergency, and we should be sure we have communication systems in place to let them know we’re okay.
While UTMB Health is no stranger to storms, there are many additional emergency situations for which we should also be prepared. For example, the 1947 Texas City Disaster is a part of UTMB’s history and an important reminder that technological and accidental hazards are a possibility. There are also situations like pandemic outbreaks that, although seemingly less likely to occur than a weather-related event, would be a mistake to dismiss. Being prepared and ready to adapt to changing circumstances is important—having an emergency preparedness plan in place before something happens is crucial.
Where to begin? Websites like www.ready.gov and www.utmb.edu/emergency_plan can help guide you in making your preparations and offer a number of checklists to get you started. One of the first steps in emergency preparedness is to have a basic disaster supply kit that includes water, non-perishable food for people and pets, batteries, a weather radio, flashlight, first aid kit, sanitation and hygiene items, matches and other tools. Other important items you’ll want to be sure you have on-hand include all necessary medications you and your family require—it’s important to have enough available in case you cannot get them immediately refilled; having a list of all your medications is also important if you need to visit a health care professional outside of your health care network. As a UTMB patient, signing up for MyChart is an easy way to ensure you have access to this and other personal health care information for yourself and your dependents. If you haven’t already done so, now is a good time to sign up for MyChart!
The next step is to develop a communication plan with your family. Emergencies can happen at any time. Does your family know how to get in touch with one another? It may be that as employees, we are asked to stay for an extended time at UTMB, and we may be away for hours or even days. Or, we may not be at work or home at the time of an emergency. Lines of communication could be temporarily down or unavailable due to call volumes. It’s important to have a family discussion to determine how you will contact one another, where you will go in case of emergency, and to make arrangements for the care of dependents and pets.
For these reasons and others, it is also important to complete the Employee Acknowledgement Form and be familiar with the Business Continuity Plan for your UTMB unit or department. Understand how the plan is activated and by whom. Be aware of your role at UTMB before, during and after emergency. Please keep in mind that if you are currently classified as a non-essential employee, you could potentially be designated as an essential employee during an emergency. For complete details about staffing during adverse conditions, review IHOP Policy 3.1.1. In addition, “Shelter in Place/Ride Out Team” information can be found on UTMB’s HR page.
Finally, it’s important to stay informed. There are important differences among potential emergencies that should impact the decisions you make and the actions you take. Hazardous events and serious weather conditions may come with very little warning. A useful source of information on weather updates for the Houston-Galveston area is www.weather.gov. You can also find important general updates on iUTMB, through UTMB Alerts, via UTMB’s Facebook page and your UTMB email account.
I hope we will remain safe throughout the Hurricane Season and throughout the years to come, but when it comes to emergency situations, it’s better to have a plan—when an emergency occurs, the time to prepare has passed!
In each Friday Flash Report, I like to share my thoughts with you on UTMB’s special events, stories that I find inspiring, or important initiatives currently underway in the UTMB Health System. This week, I’d like to invite YOU to take a turn by sharing your thoughts and questions with me—are there any topics you’d like me to comment on? Do you have any questions about initiatives going on at UTMB? Would you like to recognize someone for a job well done?
In fact, a great example I recently received came to me by email from an individual who wanted to share the innovative idea her colleague had to improve care delivery in the UTMB Cardiac Catheterization Lab (often called the “Cath Lab”).
The UTMB Cath Lab is one of very few labs in the nation that do more than 30 percent of its cardiac catheterizations using the radial artery approach. In short, it is a minimally invasive procedure in which small tubes (catheters) are inserted into the circulatory system under X-ray guidance. The procedure reveals information about blood flow and pressures within the heart to determine if there are obstructions within the blood vessels feeding the heart muscle (coronary arteries). The catheters necessary for cardiac catheterization can be inserted either into the femoral artery (in the groin) or into the radial artery (in the wrist).
Because the radial artery is much smaller and located closer to the skin surface, the risk of internal bleeding is eliminated and any external bleeding can be easily compressed. After the catheter is removed from the radial artery, a compression device is placed around the wrist to apply pressure on the artery. In general, patients find radial catheterization more comfortable than femoral catheterization because they do not have to remain immobile for some time after the procedure. This is a particular advantage for patients with back problems.
Nicole Wooden, a nurse in the lab, saw a need to help better secure the left arm when doing radial artery access catheterizations; however, there was nothing available in the market that could be effectively used. Nicole went home with an innovative idea and developed it into a safe and effective device, called the “Gilani”, named after Dr. Syed Gilani, assistant professor, Division of Cardiology, to facilitate the procedure! This is just one example of innovation at UTMB, and we’ll have more information and an interview with Nicole in next week’s Health System Friday Focus Newsletter.
There are incredible people working wonders every day at UTMB, and there are countless ways to put your good ideas into action! Not only would the Health System Executive Leadership and I like to know about the exciting projects you’re working on, we also want to know what you’d like more information on, too, to help ensure we can continue our journey down The Road Ahead working together, as a team.
To submit a topic you’d like a member of the Health System Executive Team or me to write about, you can either comment on this post, below, or send us an email via the Health System Q&A website (which offers an option to send comments and questions anonymously). We’d love to hear from you!
In addition to sharing your ideas with members of the Health System Executive Leadership and me, The Innovation Challenge 2014 is also in progress at UTMB. Visit the IDEAxCHANGE website, where ideas can be posted and discussed by any member of the UTMB community throughout the state. If you’re a manager or supervisor, please also encourage your teams to take part in Innovation Challenge!
“Creativity is thinking up new things. Innovation is doing new things.”
“Believe you can, and you’re halfway there.”
Last week we celebrated Nurses Week at UTMB, and I had the great opportunity to “Walk a Mile” in the shoes of Bill Morey, RN in the Acute Care for the Elderly (ACE) Unit. As we talked, our conversation touched on the new barcode medication administration program that will begin on Tuesday, May 13, 2014 at UTMB. After our conversation, I thought it would be a good idea to tell everyone at UTMB about this exciting development and why we are doing it.
Why are we implementing barcode medication administration?
The primary reason we are implementing barcode medication administration at UTMB is to increase safety for our patients. The barcode medication administration system is an important step toward achieving the Health System’s goal to become known nationally and globally as a value-driven leader in health care delivery by achieving and sustaining superior performance in clinical outcomes, quality and patient safety, a goal that also supports UTMB’s institutional strategy as outlined in “Road Ahead”.
Is there evidence that supports the use of bedside barcode medication administration to improve patient safety?
In 1999, the Institute of Medicine (IOM) issued a call to action for hospitals, titled To Err Is Human, to improve the processes used in delivering health care in the United States and to reduce the number of deaths from preventable medical errors in our hospitals. One of the most avoidable errors, and an IOM recommended strategy for error reduction, was to implement safety systems, such as barcode medication administration, to improve patient safety in our hospitals. The use of barcoding to support medication administration has been demonstrated in a number of studies over the years to reduce errors by as much as 50 percent.
How often do medication errors happen?
Medication errors in hospitals are common and often lead to patient harm. In fact, one study showed that out of every 100 patient admissions, 6.5 adverse events are related to medication use; more than one-fourth of these events were due to errors and were therefore preventable. About one-third occurred at the time the medication was ordered, another third occurred at the time the medication was given to the patient, and the remaining third occurred during the transcription and/or dispensing stages.
What is the goal of the project?
Simply put, we want to protect our patients and assure their safety while they are in our care. The goal of barcode administration is to make sure that patients are receiving the correct medications in the correct doses at the correct times by electronically validating and documenting medications. The information recorded through the use of the barcodes allows for the comparison of the medication that is being administered with what was ordered for the patient.
How does barcode medication administration support provider order entry?
UTMB Health began medication safety improvement efforts in 1994 with the implementation of provider order entry in our Invision system. In 2005, we transitioned to the order entry components of Epic, and at that time we also began to use their pharmacy system and the electronic medication administration record. At this point, the provider’s order directly drove both the dispensing of medications and the documentation of their administration. The implementation of barcode technology to support the administration process will be the last step in closing the medication delivery loop by extending the same system containing the provider’s original order to serve as a safety net at the point of care. It reduces the risk of error through transcribing the order into the pharmacy system. The barcode medication administration program at UTMB will initially cover more than 80 percent of all medications dispensed.
Although this technology will not, nor is it intended to, eliminate medication errors entirely, and cannot replace the diligence and critical thinking of the nurse, it is simply a safer way for UTMB to provide high quality care for our patients in environments that have frequent distractions and elevated levels of stress. Barcode medication administration is another way that UTMB Health is working together to work wonders!
In Central Illinois, where I grew up, snow and frozen lakes are the norm. Almost as soon as my brother, sister and I could walk, we were given ice skates. Family videos, now on DVD, capture us all spending weekends together, ice skating in Springfield and Paris, a city about two hours away. To this day, my favorite video is of my younger sister, Jan, who was two years old at the time. My brother and I watched as my mother guided her around the ice, clapping enthusiastically as Jan glided on her own just for a brief moment before falling down.
As my brother grew older, he continued his passion for the ice by playing ice hockey. I remember sitting in the bleachers with my family weekend after weekend, cheering Dave and his teammates on to victory. My own passion for the ice played out much more vicariously, as I hung up my skates to cheer for my brother and to watch the 1960 Olympic Games on television as Carol Heiss won the gold medal in women’s figure skating for the U.S.
My love of the ice and the Olympics has stayed with me through the years, and in 2004, I met Casey FitzRandolph, a US speed skater from Wisconsin who won Olympic gold in 2002, setting a record for the 500m race. His record still stands today. As he and I became friends, I learned the powerful and motivating story about his journey to become a gold medalist.
On Friday, May 16 at noon, we will culminate Health System Week with a special presentation by Casey in the Levin Hall Main Auditorium, where he will share his inspiring message of family support, determination and perseverance despite many of the odds that were stacked against him. His talk will also be streamed online so that those who are unable to attend in person can hear his history-making story.
As you listen to Casey, you might be surprised by how similar his story is to UTMB’s own story of transformation following Hurricane Ike. The contributions made by each UTMB employee, faculty member and nurse to our recovery from the storm and to making this organization the wonderful place it is for our patients and families are equally motivational and also tell a story of courage and determination—you all are record setting champions!
And speaking of champions, at Casey’s talk we will honor and recognize the many teams and individuals at UTMB who earned recognition this past year for UTMB—many of them are gold, silver and bronze award winners, too!
I hope you will enjoy next week’s Health System Week activities that celebrate and recognize YOU for the incredible work you do each and every day on behalf of UTMB! Casey’s talk is open to the public, so if you have friends, neighbors and/or family who would like to hear Casey’s message, please invite them to attend. For more details on his upcoming presentation, please click here.
I have always been a competitive person. When faced with a challenge, my adrenaline starts pumping, and I work very hard to exceed the goal or win the competition at hand. My younger brother has always joked that everyone should step aside when I am focused on accomplishing something. I always tell him that as we grew up, I had an opportunity to hone my leadership skills on him and my younger sister. Every time, he replies that I was just bossy! I am pretty sure we will never resolve this lively debate!
Everyone responds to challenges differently. At times, some may not feel up to the task of the challenge and instead of taking it on, try to blend in. Meanwhile, others will not only take on the challenge, but greatly exceed it. The latter is exactly what happened in April with the UTMB Health Revenue Cycle Operations Team.
At the end of March, Suman Smith, vice president for Revenue Cycle Operations, and I put forward a challenge to the 325 members of the revenue cycle team: if they met the cash goals for both Physician Billing and Hospital Billing plus collected an additional $5 million in cash, they could wear flip-flops and work-appropriate shorts or capris (with the exception of individuals who might be seen by patients and visitors). In turn, I would come to Shearn Moody Plaza for a day in May and work alongside them in my capris and flip-flops.
As I monitored the progress of the daily cash reports, it became clear that I would soon be dusting off my flip-flops. The results the team achieved were simply stunning. As of April 30 at 11:59 p.m., the team had collected $8.7 million more than the April goal! At midnight that evening, I got up, found my flip- flops, put them on my kitchen counter and took the photo below, sending it to Suman Smith to share with the staff. Flip-flops it is for me on May 30 and I could not be happier about it!
In many revenue cycle circles, the mantra is “cash is king”. Why is this cash so important? The funds generated by the Faculty Group Practice and the Health System are what enable UTMB to hire the people we need to do the many important jobs at UTMB; it directly supports our threefold mission of education, research and patient care; and it contributes to our ability to build the new state-of-the-art facilities we must have in order to fulfill each mission area.
In short, the work that the Revenue Cycle Operations team does is critical. We can see all the patients we want and bill all we can, but without the people of the revenue cycle team to do medical coding, send out bills and collect payments due, we would not be able to continue our business and meet our mission.
This recent accomplishment of the revenue cycle team is an example of how we can truly make a difference at UTMB through teamwork and by working together to work wonders! Please take a moment to congratulate them the next time you see them!
When I was younger, I was a very active person. In high school and as a young adult, I played competitive volleyball, fast pitch softball and racquetball, and I ran or walked almost every day for exercise. But as time passed, my life became much busier—I got married and had children, I worked full time, and before I knew it, my exercise habits had become secondary to those everyday demands.
Every year, I vow to myself that I will do better; I will develop the important habit of exercise, because I know that it reduces stress and is good for overall physical and mental health. I always start out strong, but then I slowly taper off as work and family responsibilities once again take precedence.
This week, I saw an announcement on iUTMB for the 2014 UT System Physical Activity Challenge. I decided to sign up. From May 1 through June 12, I have committed to walk 50,000 steps each week. I am excited because this will not only improve my health, but I also have an opportunity to challenge each of you who have the same struggles I do with making a commitment to exercising consistently.
One of the benefits to signing up is that I get a free pedometer to measure my daily steps. The site also provides a short instructional video on how to log my activity and get credit for it. I completed a health assessment so that my activity could be credited to UTMB in the UT System Health Challenge. At the end of the six weeks, the UT institution with the highest per capita logged activity will be awarded this year’s “Traveling Trophy”. I am a pretty competitive person, so wouldn’t it be great if all of you joined me in this physical activity challenge and UTMB won the trophy?
However, with or without the trophy, I am doing this because the real winner will be my family and me, because hopefully, I will have developed a habit that keeps me healthy and active. Isn’t that the best trophy?
So, I am asking you to join me. Are you interested? Visit http://www.livingwell.utsystem.edu/challenge14.htm and sign up. If you feel comfortable doing so, please let me know how you’re doing with the program. Also, if your department decides to participate as a team, or you have fun ideas to get motivated or involved in the program, please share! Then, let’s all get started moving!
I recently had the opportunity to spend a day learning firsthand about the important work being done at the Texas Department of Criminal Justice Beauford H. Jester III and IV Units in Richmond on March 28. I was joined by Dr. Mark Kirschbaum, chief quality, safety and clinical information officer, Dr. Owen Murray, vice president, Offender Care Services, Beverly Echols, administrative director, mental health services, Stephen Smock, associate vice president, Outpatient Offender Care Services, and Gary Eubank, associate chief nursing officer, Offender Care Services, on each leg of the tour.
It was a pleasure meeting the UTMB Offender Care Services team members and learning about their roles on the units. Everyone we met along the way was proud of the work they do, and there was a tremendous sense of team spirit. The quality of care delivered to their patients is nothing short of outstanding, and it goes without saying that these individuals do it all in a unique care environment.
UTMB values are alive and well at the two Jester Units we visited, and I wanted to take a moment to recognize these outstanding teams by sharing some photos* from our tour; most importantly, I would like to thank them for their hospitality and for making a difference—excellent patient care cannot take place without compassionate, skilled individuals working together as a team!
Look for more photos in the upcoming issue of the Health System Friday Focus newsletter.
The first leg of the tour began at Jester IV Unit (est. 1993), a 550-bed inpatient mental health unit. Dr. Philip Farley, chief psychiatrist and clinical director, and Andrey Vasiljev, business manager for inpatient operations, warmly welcomed us to the unit and gave us a detailed tour of the facility. We were also joined by Donald Hlavinka, mental health manager, Stephen Rogers, cluster nurse manager, Senior Warden Alphonso James, and Major Leroy Bailey. Among the many services offered at the unit are ambulatory medical, dental and inpatient mental health services and inpatient medical care 24 hours a day, seven days a week.
The second half of the day, our group had the opportunity to tour the Jester III Unit (est. 1982), where ambulatory medical, dental, and mental health services are also offered around the clock, seven days a week. The unit offers rehabilitation services, including brace and limb care, wound care, occupational therapy and physical therapy and has 132 wheelchair accommodating cells along with a 12-bed assisted living infirmary. Digital medical services, electronic specialty clinics and chronic disease care are also offered. Senior Practice Manager Susan Dostal and Cluster Nurse Manager Marisol Genin guided us throughout the facility and introduced us to their team members. These individuals truly work wonders for their patients!
*select individuals requested to be identified only by last name