Everyone Can Help Someone

Donna Sollenberger, EVP & CEO, UTMB Health SystemAs you may recall from previous Friday Flash Reports, I am the oldest of three children. When I reflect on my childhood growing up in Springfield, Illinois, I have many memories of my mother. She was, by any measure, a very busy woman—she had three kids, worked part-time, and took care of most of the “homemaking” responsibilities that were common in the 1950’s, like cleaning the house, doing laundry, getting kids to and from school and after school activities, and cooking three meals a day. To me, this was nothing short of amazing.

One day, she was particularly harried, trying to set the table and get dinner ready. My dad, who the three kids called “Stormin’ Norman” when he was out of ear shot, saw me in the dining room and told me to go into the kitchen and help my mother get dinner ready. Being the rebellious first child, I did not like to be told what to do, so I nonchalantly told my dad that helping mom with dinner was “not my job”.

This statement…was a mistake.

Stormin’ Norman took me firmly by the shoulders, made me look straight into his eyes, and he said, “When you see someone who needs help, you help them. That is always your job.”

I could feel my response to him building up inside me, but I decided it would not be in my best interest to talk back, so I went into the kitchen to help my mom. As I started to set the table without her asking me, tears ran down her face. I asked her what was wrong. She told me that she was just really tired and appreciated my help.

That wasn’t the most memorable moment of my life, and it was not particularly dramatic, but that experience became a defining moment in my life. Seeing my mom react so appreciatively to my efforts to help her out made me realize that I needed to be more in tune with what others were feeling so that I could do my part to help out.  I remember as I responded to my mom, “It’s no problem,” my dad’s eyes locked with mine.

I never told my mother that my gesture was really less than magnanimous and Dad had basically forced me into helping, but he never told on me either. Until she passed away in 2010, she always thought I was actually a better person at that point in my life than I really was. It was a great lesson to learn at a relatively young age, and ever since, I have always tried to take time to try to help others when I see the need.

A story that recently took place at the UTMB Health Multispecialty Center in League City illustrates that helping others out in times of great need comes naturally to Patient Services Specialists Vanessa Romero and Donna Papa. One evening, as they were leaving work a little later than usual, they were approached by some of the landscape workers. Two of the men were carrying their unconscious co-worker.

Vanessa and Donna immediately went into action—they called 911 and stayed with the men until the paramedics arrived. They knew that there still was a physician, Dr. Kevin Merkley, in the clinic, who was able to get the automated external defibrillator (AED) ready for the paramedics (an AED is a portable device that checks the heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm). Throughout the experience, Vanessa was able to speak to the workers in Spanish and served as a translator between them and the paramedics.

The actions of Vanessa and Donna exemplify our Best Care motto, “Every patient, every time,” because no matter what, we should always be ready to treat those who come to us for care with the same respect and compassion as we would like to be treated, and as we would also want the most cherished of our loved ones to be treated.

Our opportunities to help those in need from day to day may not always be as dramatic as Vanessa and Donna’s story, but each and every one of us has a chance daily to be a light in someone’s world and to help them out. You might be on the team who helps make sure our phones work so patients can reach our hospitals and clinics, and through your work, you play a role in Best Care (I’d like to extend a special thank you to the Information Services team who helped out with a phone problem at the Angleton Danbury Campus earlier this week!). You might help ensure supplies are quickly unpacked and delivered to our inpatient units, and you play a role in Best Care. Or, you may simply help someone find their way to their destination—and YOU play a role in Best Care.

There are things we all can do each and every day, both big and small, that impact the experience of care at UTMB Health. Thank you, Vanessa and Donna, for modeling the way for Best Care!

Donna Papa and Vanessa Romero

Donna Papa and Vanessa Romero

Never get tired of doing little things for others…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThere is a saying, “Never get tired of doing little things for others. Sometimes those little things occupy the biggest part of their heart.”

This week, I would like to share a story about a couple of teams at UTMB who went above and beyond to deliver Best Care to one our patients. This story was submitted by Dennis Santa Ana, patient care facilitator in the Cardiothoracic Surgery/Vascular Surgery Unit. It was originally published in this month’s issue of Nursing News, but I thought it was such a wonderful and touching example of how two departments worked together as a team to make a special wish come true for one of our patients, I wanted to share it with you all in today’s Friday Flash Report.

During the latter part of May, a 46-year-old female was admitted to the Intermediate Specialty Care Unit in Jennie Sealy Hospital with a diagnosis of end-stage heart failure. She was placed on the highest priority waiting list for a heart transplant. However, this meant that she would need to remain hospitalized until a suitable heart donor was found.

During a casual conversation with her nurses, she mentioned the upcoming wedding of her son. She said she would love to attend the wedding, but she had dismissed the idea because of her current condition. Her nurses toyed with the idea that maybe they could have another wedding in the hospital chapel so she could be there, but planning it seemed extremely complicated.

However, the nurses in the unit were persistent about finding a solution. They had a meeting with their nurse manager, Dell Roach, and came up with a plan. In collaboration with the Information Services Department, they were able to stream the wedding live using an app so the patient could view the wedding on the big projection screen in the 9th Floor Jennie Sealy Hospital Conference Room.

The patient was so excited to hear the news. On the day of the wedding, she put on an elegant dress and two of her friends came to watch the wedding with her. Dell Roach and her staff brought food and refreshments, including a wedding cake. She was so thrilled to see the whole event unfold on the big screen.

I must admit, I had tears in my eyes by the time I finished reading this story. I think, as we focus on Best Care over the next year, sharing stories like this one demonstrates that no matter what your role—whether you deliver direct patient care or work in support of those who do—everyone at UTMB contributes to Best Care. Even if you work from behind the scenes or in areas such as Revenue Cycle Operations, the Access Center, or Business Operations & Facilities, you help create an exceptional care experience for our patients and their families.

These two teams were able to give a mother and her family the chance to share a very important life moment—and that is priceless.

Thank you for everything you do to deliver Best Care at UTMB Health!

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Achieving Uncommon Success through Teamwork

Donna Sollenberger, EVP & CEO, UTMB Health SystemA couple of things happened this week that (once again) made me realize what an incredible group of people we have working at UTMB. It also made me realize that when we work together as a team, we truly are able to work wonders.

On Wednesday afternoon, UTMB received a phone call notifying us that a number of patients were being transported to our trauma center, all of whom were in critical condition after having suffered a chemical exposure. Our team in the Emergency Department (ED) did an incredible job supporting these patients (and many others) that day. Their work was nothing short of extraordinary, both in effort and in outcome.

Yesterday, I saw Christine Wade, director of Patient Care Services and assistant chief nursing officer of the ED. I thanked her for the great work that her team had done the day before. Without hesitating, she told me how incredibly proud she was of each and every person who works in her department. However, she said what struck her most about this incident was how everyone at UTMB had joined together to work wonders in a time of crisis.

The minute the team received the call, Christine said they immediately sprang into action. ED Manager Pam Cruz took control of operations and EMS Coordinator Chad Connally managed the arrival and decontamination process of the patients. Meanwhile, ED Techs Donnie Walker and Preston Huff donned full decontamination gear to assist with the arrival and care of the patients in outside temperatures of well over 95 degrees.

Christine told me about the many other teams who came to the aid of the ED staff. With one quick call, Respiratory Therapy was on site and ready to respond. With another call, the Blocker Burn Unit (BBU) staff, physicians and fellows were working seamlessly, side-by-side with Trauma Surgeon Dr. Carlos Jimenez and the other clinicians and members of the ED patient care team. Meanwhile, the pharmacy had ensured the needed emergency medications were delivered within minutes.

Then, just after the first patients, more arrived who had also suffered the same chemical exposure. In the midst of this, another serious trauma arrived. The team did not miss a beat; they remained calm and well-organized, and rushed the trauma patient to the operating room.

Josette Armendariz-Batiste, director Patient Care Services and assistant chief nursing officer for the Adult Medical/Surgical Intensive Care Units, quickly obtained assistance from the ICUs to help care for all of the incoming critical patients. At the same time, Mike Mastrangelo, UTMB’s institutional preparedness program director, and his team were also on deck to help Clinical Operations Administrator Jennifer Casso coordinate resources, help the Patient Placement Center team find available beds, and assist the ED faculty in managing the flow of regular patients.

Christine told me that Jason Sheaffer, nurse manager of the BBU, worked late into the evening checking on patients across the multiple units. She said there were countless other staff members who also selflessly worked extra hours to ensure that the patients had everything they needed. Throughout it all, everyone maintained a positive can-do attitude. The ED never stopped seeing regular patients and did not go on diversion. She credited ED Charge Nurse Darrin Radzinski with helping keep everything running smoothly during the course of these events.

It was clear to me that in this time of crisis, UTMB physicians, nurses and staff had a singular focus—to provide the best care and comfort to patients in their greatest time of need. How humbling it was to hear the stories of this incredible work!

One might think this would be the ending of my report this week, but I must tell you, my amazement did not end with this story! That’s because while I visited with Christine, we were both in attendance at the annual Good Samaritan Foundation’s Nursing Excellence Awards, a luncheon held each year in the fall to honor outstanding nurses from hospitals throughout the greater Houston area. Much like the Olympics, the awardees are given gold, silver and bronze medals for their outstanding contributions to nursing.

As with past years, UTMB Health had many nominees and many, many awards. In fact, 27 UTMB nurses were awarded bronze medals. Two of only six gold medal recipients were also from UTMB—Odette Comeau, from the Health System, was recognized for excellence in Clinical Education and Dr. Carolyn Phillips, from the School of Nursing, was recognized for excellence in Nursing Education (Faculty). Both Odette and Carolyn had videos that were shown during the ceremony in which colleagues told of the outstanding work and contributions each has made to the field of nursing. It was a moving tribute to two outstanding nurses!

The events of the past two days reminded me that the greatest successes are rarely achieved by individuals alone; rather, they are achieved by teams of people who are all committed to a common cause and to making an impact that will last for years to come. It also reminded me of the importance of preparation on an individual level so that we can give our very best and contribute to the success of our team as a whole.

Uncommon situations require uncommonly prepared and talented people to be successful. At UTMB Health, you all have demonstrated this excellence time and time again, and this was certainly demonstrated on Wednesday. Just as you have done in the past, when called to action, you rose to the challenge. Thank you to everyone who has contributed to the care of these patients and all of our patients, each and every day.

There is a saying, “Individually we are one drop, but together we are an ocean.”  When we focus individually on being well-prepared while working collectively as a well-orchestrated team, we truly do “work together to work wonders.”

'Teamwork is the secret that make common people achieve uncommon result.

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Happy Labor Day!

Donna Sollenberger, EVP & CEO, UTMB Health SystemThis weekend, we celebrate Labor Day, which always falls on the first Monday of September. For those who are headed back to school or who have already hit the books, this weekend marks the end of summer, although the first day of fall is officially September 22. For many individuals at UTMB, this is a welcome holiday because it means they will enjoy an extra day off. For others, especially those who provide patient care or support those who do, it will be another day of exceptional and compassionate service as they remain on board in our hospitals, urgent care clinics and emergency rooms to ensure UTMB patients receive the Best Care. I’d like to especially thank you all for your service on this day.

Labor Day was established as a tribute to the contributions of employees across the U.S. to the strength, prosperity, and well-being of our country. At UTMB Health, we could not provide the best possible patient experience without the talent and expertise of all of our employees and physicians, working together to work wonders. So in honor of everything you personally do for our patients, their loved ones and your colleagues, I’d like to thank you for your service.

Whatever your role, from the moment you put on your UTMB badge, you are part of the patient experience at this organization. I’d like to share a letter recently received from a patient’s loved one that illustrates the impact you make on people’s lives each and every day. Even if you weren’t directly involved in this specific patient’s care, I’d like you to think about how you played a role in this couple’s experience at UTMB—whether you realized it or not:

“On Monday morning, May 2, my wife and I were returning to Galveston on a cruise ship when she was discovered unconscious for unknown reasons. Once docked, paramedics came to the ship’s infirmary and transported my wife to the UTMB Emergency Room facility. She was discharged the following Friday after spending several days in ICU while UTMB physicians and staff cared for her.

I wish to say “Thank You!” to the UTMB team. I was extremely impressed with both the quality of care and the compassionate disposition of the UTMB staff. During my wife’s most difficult medical procedures in the ICU, we received a level of treatment that FAR EXCEEDED any prior experience. I was greatly relieved to know my wife was in such capable and experienced hands.

In my opinion, the entire UTMB team went above and beyond at every opportunity and greatly eased my wife’s suffering during a very difficult situation. She made several remarks to me during her stay about how much she appreciated the professionalism in the staff and how she felt that her caregivers really considered her comfort and well-being. They took the time to explain to us what procedures were planned and the results of tests that had been conducted. They answered all of our questions and took the time to make sure my wife understood what was happening.

As a husband, I want to thank you and your entire team for all that was done to help in my wife’s recovery. I cannot convey how much it meant to me to know she was getting the best possible care provided by a staff who gave so much of themselves to their patients. Most importantly, we left Galveston much better than we had arrived as a result of the tremendous care we received at UTMB. Please extend to the team our grateful appreciation for their hard work and dedication.”

The gentleman who wrote this letter described an excellent patient experience at UTMB. While this is just one couple’s story, there are many other narratives we may not always hear about, although they happen every single day—someone who warmly greeted another person who, in that moment, really needed to see a friendly face, or someone who provided an anxious, concerned visitor with directions from the parking garage to the correct hospital entrance—the smallest gestures of kindness can make an impact.

I am pleased to share with you that our most recent patient satisfaction survey results reflect that our patient’s experiences are consistently good. In fact, for the month of July, 85.4 percent of patients from our Galveston campus hospitals gave UTMB the highest overall rating, according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. (Patients are asked to rate their experience on a scale of 0 to 10, where “0” means “worst hospital possible” and “10” means “best hospital possible”.)

The survey, which is administered by Press-Ganey, showed that for this rating, we performed better than 93 percent of 1,985 hospitals. Compared to other hospitals in our bed group (300-449 beds), only one percent of hospitals performed better than UTMB! Meanwhile, when compared to our academic medical center peers within this group, only five percent outperformed UTMB. This is outstanding!

Everyone at UTMB Health impacts the patient experience, and everything we do while we wear our badge represents our commitment to our patients, visitors and colleagues:

  • When you provide the right care to the right patient at the right time, you impact the patient experience.
  • When you help someone find their way or simply listen to their story, you impact the patient experience.
  • When you help a patient schedule the appointment they need when they need it, or when you help provide great customer service, you impact the patient experience.
  • When you document patient care or translate clinical documentation into codes that accurately reflect the patient care delivered, you impact the patient experience.
  • When you deliver or maintains materials, supplies or equipment to the individuals who deliver patient care, you impact the patient experience.
  • When you help ensure our facilities are operational and running efficiently, you impact the patient experience.
  • When your role is to find the right candidate for a certain job, you welcome them aboard, or provide training or educational opportunities, you ultimately impact the patient experience.
  • When you support information systems like the Epic electronic medical record, you impact the patient experience.
  • When you help transport test specimens to the laboratory or ensure the right medications are delivered to the right patient at the right time, you impact the patient experience.
  • When you serve a patient a delicious meal or you help keep our campuses beautiful, you positively impact the patient experience.
  • When you educate our future medical professionals or make medical discoveries through important research, you impact the patient experience.
  • When you quickly respond to and fix parking equipment to minimize delays in exiting our hospitals, you impact the patient experience.
  • When you promptly order and install way-finding and parking signage to reduce patient and visitor confusion regarding where they need to go to get to a clinic or pick up a discharged patient, you affect the patient experience.

From a patient’s first impression to their last impression of UTMB Health, you are all a part of the patient experience, and you all help deliver the Best Care to our patients. Thank you for everything you do at UTMB Health, and enjoy a safe and happy Labor Day!

If it doesn’t challenge you, it doesn’t change you.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI read online that viewership of the 2016 Rio Olympics is down. That was news to me, since I have been glued to the television during all of the swimming, diving and gymnastics events. I don’t read the spoiler alerts on the news and in social media, because I want to watch each event with nervous anticipation and hopefulness. I love to be surprised by the results!

As you know, swimming is a favorite sport of mine – more so lately because my grandson, Jack, participates in the sport. In my last two Friday Flash reports, I told the story of his most recent meet, as I watched him swim in adversity and finish his first race with his goggles lodged between his nose and mouth; then, I had a chance to see him finish in fifth place for his 100-meter backstroke event. He had told me all about his strategy to improve his time, and in his last race, the 200-meter freestyle, I learned even more about Jack as he once again put his strategy to work—he shaved a full 15 seconds off his personal best time and finished in fourth place!

Last week, I used Jack’s story to talk about our own strategy for success when it comes to Best Care. Our vision is to not only deliver the safest care to every patient, every time, but we are also challenging ourselves to rank among the top 20 academic medical centers for quality and patient safety*. This week, something happened to reassure me that we can and will meet this very aggressive goal.

As a participant in the Medicaid program, which provides medical coverage for more than 4 million low-income Texans, UTMB takes part in its pay-for-performance program. Simply put, the program has two basic elements upon which we are rated: potentially preventable readmissions (PPR) and potentially preventable complications (PPC).

The penalties are not insignificant. When the program began three years ago, UTMB had $3.5 million of its Medicaid payments withheld due to unplanned readmissions and complications. We were astonished. But, as we looked into the data, it became clear that a good deal of the reimbursements were withheld not because of the quality of the care provided, but rather because our documentation and coding was not sufficient; therefore, it did not accurately reflect the degree of our patients’ illnesses or the specificity of their complications. In response, we set out on a mission to improve our documentation and coding, as well as to review every unplanned readmission.

The results the following year were incredible—instead of the $3.5 million figure being withheld, we had reduced the amount to a $2.5 million—all from readmissions. Following this significant improvement, we planned to further reduce this amount in FY16 by at least another million by sustaining our gains in reducing readmissions and focusing on preventing complications.

Because our Medicaid population is heavily represented by mothers and children, we talked to the department leaders, we rolled up our sleeves and reviewed OB charts with identified complications, brought in experts in the 3M PPR and PPC algorithms, and shared findings and recommendations with faculty and residents, informing them of the implications for their ongoing documentation.  As a result of that work, a physician leader reviewed each case forwarded by hospital coders. The physician then communicated clarifications to the individuals involved in that patient’s care and medical record, and provided any overall messaging that would be useful in guiding the entire department.

While documentation and coding were certainly high contributors to the outcomes, there were also some process changes that helped us turn the information into actions that improved our overall care. The team engaged partners in Information Services to make changes in the Epic EMR infrastructure that would better facilitate the identification of the complexity and co-morbidity of OB patients, and to guide the assignment of observation status as appropriate (thereby avoiding an inpatient readmission).

The result? This week, we received our report from Medicaid outlining our results for the 2015 performance period, which go into effect September 1, 2016. We had zero deductions for unplanned readmissions and zero deductions for unplanned complications of care. That’s right—we exceeded our plan, and we did not incur ANY of the potential $2.5 million penalty!

This outcome reinforced several things for me:

  • We need a plan that we follow without exception.
  • We need people to be engaged in this effort to help us identify problem areas, develop solutions to those problem areas, and be willing to assist in teaching and educating our providers and staff to help us achieve our goal.
  • We can achieve lofty, seemingly impossible goals, if we have a plan, execute it and stay singularly focused on achieving it.

While I would like to think that the large amount we retained will help our budget next year, we also learned that some of our funding from other various sources will be reduced more than we had anticipated. So while the latter is disheartening, it is another reason why we are so focused on Best Care—safer care is not only better for our patients, but it costs less, too.

If we remain focused on meeting the performance benchmarks for academic medical centers, increase our efficiency, reduce variation in care, and improve our quality, everyone wins. We lower our costs, see greater reimbursement, and most importantly, our patients get the best possible care—this is our ultimate goal.

We have a tremendous opportunity to showcase our talent and expertise through this endeavor. Thank you all for everything you are doing to help UTMB Health achieve Best Care for all of its patients!

*As measured by the Vizient Quality & Accountability Study.

Commit to Excellence

Donna Sollenberger, EVP & CEO, UTMB Health SystemLast week, I shared a story about my grandson, Jack, who recently competed in a swim meet. During one of his races, he swam four laps with his goggles between his nose and his mouth after they were dislodged upon diving into the pool. Despite this obstacle, Jack finished the race. I thought this story was a great example of the importance of staying the course to achieve our goals, despite the obstacles we may encounter along our way.

After this race, Jack had a little bit of time for lunch before he swam in his next two events. As the time approached for the 100-meter backstroke, he sat down next to me. Instead of asking him if he was nervous, I asked about his goal for his heat. He told me that he wanted to improve his time and finish in the top eight, which would earn him a ribbon.

“So, you have a plan?” I asked.

“Yes,” he said. (He is a boy of few words – or maybe it is just that he is 10!)

“How did you get that plan?” I asked. (Jack thinks his Nana asks a lot of questions, but I tell him I had many years of practice when his mom was young!)

“I worked with my coach.” He said. “She had me practice my dive into the water and my turns. My coach and I talked about what I needed to do to improve my stroke, and we talked about my plan for swimming the race.”

Then he told me about how he would try to get a good entry into the water, move under the water as long as he could, swim hard the first lap, pace himself, and then give it all he had toward the finish.

“Do you feel it is a good plan, one that will work for you?” I asked.

Jack nodded.

“Then go do it, Jack, because I know you can.”

As he dove into the water a few minutes later, I held my breath, hoping that his plan would pay off and he would meet his goal. A few minutes later, Jack had finished in the top five!

I thought about what Jack had done – how he had prepared for and swam his race. I realized how similar this is to what we are doing in the next twelve months to achieve our Best Care goal:

  • We have selected the races that will help us rank among the best. In other words, we have identified several areas of focus in quality and safety – mortality, readmissions, length of stay and patient safety – that will help us improve the most and place us among the best academic medical centers in the country, as measure by Vizient’s Quality & Accountability Study. We also know we must maintain our success in patient-centeredness and equity, as well as remain focused on clinical documentation improvements and enhancing the Epic EMR to be successful.
  • We have set challenging but achievable targets. Working together, Health System leadership, the Provost & Dean of the School of Medicine, and the Clinical Chairs identified measurable goals that we believe we can achieve within the coming year—as long as we work together and maintain our commitment, dedication and focus. Learn more about these measures on the Best Care website.
  • We will coach ourselves so we always know how well we are performing and where we need to increase our focus to improve. Teams across the Health System have created reports that can be accessed on the Process Improvement Dashboard to help us track our progress. Clinical Chairs and unit leaders can access these reports, identify areas for improvement on an ongoing basis, and help lead their teams to success.
  • We believe we can do it! Above all, we believe we can be the BEST, because know at UTMB Health, we have the talent and expertise – and most of all, we have the passion – to deliver a safe, reliable care environment and an excellent patient experience to every patient, every time.

“Desire is the key to motivation, but it is determination and commitment to an unrelenting pursuit of your goal – a commitment to excellence – that will enable you to attain the success you seek.”

—Mario Andretti

Just Keep Swimming: Facing Adversity and Finishing

Donna Sollenberger, EVP & CEO, UTMB Health SystemSeveral weeks ago, my grandson, Jack, swam in a large meet in the Houston area. Jack has been a swimmer for almost two years, and he swims in the 10-year-old category. This particular meet was very illuminating to me, because what happened to Jack told me something about his character.

This particular Saturday, Jack was scheduled for three events: the 100-meter freestyle, 100-meter backstroke and 200-meter freestyle. His first event, the 100-meter freestyle, should have been his best. However, as he dove into the pool for his heat, his goggles were not on tightly enough and they ended up just below his nose with his mouth partially covered by them.

I could tell from where I sat that he was upset and struggling. The same thing happened to another swimmer in the heat. Jack swam four laps in the 25-meter pool and finished in 14th place out of 53 swimmers. The other swimmer whose goggles had also slipped pulled himself out of the pool after the first lap, and in a fit of defeat, threw his goggles into the practice pool.

When Jack got out of the pool, he was also very upset. This was his best event, and he knew if the goggles had stayed in place, he would have placed in the top eight in this event—practice after practice, that had been his goal. Now, he did hadn’t even placed in the event.

A little later, as we were waiting for Jack’s next event, I talked to him about his experience and told him he should be proud of what he accomplished. While the other swimmer had given up, Jack finished his race despite the obstacle in his way.

What happened to Jack caused me to think about how many times we have to keep going despite adversity so that we can finish, and at times, finish strong. This is true in the workplace, in our personal lives, and it’s true for our patients and their loved ones. Every day, we each have a choice as to how we will meet our challenges. We have a choice as to whether or not we are willing to overcome the barriers that get in our way, or if we will give up, even despite all of the hard work we have put in so far.

When it comes to Best Care, we have set the bar high, and we have some tall orders ahead of us when we consider we have to simultaneously improve in mortality, readmissions, length of stay and patient safety events. At times, it may be tempting to throw in our goggles after one bad race, but that doesn’t mean giving up is the right thing to do—for ourselves or our patients. We make a choice each day to keep swimming and finish the race!

  • We may face adversity when it comes to helping a patient with multiple illnesses get well enough for discharge.
  • It may be a challenge to help patients who will require some level of care outside of the hospital setting; however, they may not have the resources to acquire that care.
  • It may be a challenge to help some patients learn about healthy lifestyle choices or to help them find the resources they need to avoid readmission.
  • We may do everything in our power to create a plan of care that meets all of a patient’s needs, but they may have trouble following their care plan or will simply not comply.
  • Not all patients and families begin at the same starting line—even though there may be a patient whose length of stay extends beyond what we hoped, we know we must stay the course until that patient is well enough to go home, because it’s the right thing to do.
  • We will face challenges on our own teams at times—perhaps there will be disagreement among team members or lapses in communication.

It is said that when beginning a journey, start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible. Whatever challenges may come, we must stay focused and remember to break these large areas of focus—readmissions, mortality, length of stay, and patient safety events—into effective and manageable tasks, like using the 8 Ps, working together during progression of care rounds, and improving our use of the medical record. All of these seemingly smaller efforts will begin to align and will get us to our goal more quickly than waiting for one big opportunity to come along.

Remember: Determination, patience and courage are the only things needed to improve any situation! Whatever our obstacles to Best Care may be, let’s continue to work together, focus on our goals, and finish our race strong!

You can’t serve from an empty vessel.

Donna Sollenberger, EVP & CEO, UTMB Health SystemLast week, we explored the importance of working together effectively on our teams and addressing challenges in a positive way, particularly as we embark on our journey towards achieving Best Care at UTMB. In my post, I mentioned the importance of stress management, because when we operate under stress, we may not always be able to contribute to our teams in a positive way, or we may create a situation where our environment could potentially become unsafe. Over time, stress can even begin to affect our health.

This reminded me of a talk I have given in the past to different groups of caregivers and leaders about the importance of self-care. I was often asked during these discussions about how I managed to effectively juggle family and career—how did I manage to “have it all”?

That question always made me laugh, because I am not sure anyone ever “has it all”.  What we do have is the outcome of the choices we have made in life that best suited us, our family, and our career. The outcome largely depends on how we set our priorities, and there really is no single answer for how we should go about doing this. We make the best decisions we can based on the knowledge we have at the time. In fact, I believe we have to approach most problems and solutions on a case-by-case basis, because our priorities can shift with time and depend on where we are in our current stage of life.

From a personal perspective, I realize managing stress isn’t always easy to do, especially when one has a great deal of dedication to those for whom they care and for the work they do. Over the years, however, I’ve learned that I must carve out time in my schedule for myself to ensure I can continue putting my best foot forward.

When I have led my talk on self-care, a visual aid I often used was a Mrs. Butterworth’s syrup bottle, which I washed out and filled with rice. I would begin by talking about the many important priorities and obligations we have in our lives, and how in the process of putting so much of oneself into fulfilling these tasks and into caring for others, little things begin to drop off our radar when it comes to our own well-being. These little things can add up to have a significant impact.

As I continued the talk, I would shake a little rice out of Mrs. Butterworth as I went through the tasks of a “typical” day in the life of a career person with a family. Each time the responsibilities of the job or family required “action” on the part of Mrs. Butterworth, I would shake out a little rice.  I did this over and over in the talk until we got to the end of the “typical” day.  At this point, I shook and shook the bottle, but nothing came out—Mrs. Butterworth had expended all that she had by the end of the day with nothing left for herself to replenish or recharge.

I think that this is probably true of many of us. We love and are committed to what we do at work and the role we have within our family. However, after a busy day, we often forget to make time for ourselves and we have depleted our “reserves” over time. As a result, we can overlook important details, become forgetful or less productive, or feel irritable and incredibly stressed.

As we work together in a positive manner and navigate the challenges we encounter along the road to achieving Best Care, it is important to remember that in addition to being positive with others and maintaining a focused and optimistic outlook, we also need to take care of ourselves. No one can go on endlessly doing for others without also recharging their own batteries. There are some simple things we can do each day to help re-energize ourselves:

  • Outside of work, take time to look at your daily activities and determine which ones help you feel your best. Add these activities to your calendar. If you plan them, you are more likely to actually have time for them.
  • Check-in with yourself regularly to see if your routine needs to be changed. Sometimes we forget to ask ourselves the most obvious questions, like “Am I tired?” or “Am I happy?”
  • Go for quality not quantity. Even though you may like watching TV, and can spend several hours doing that, aren’t there other things that would be better for you?
  • It can be okay to say “no”. If you’re taking on so many commitments that you’re left feeling exhausted, it’s time to start prioritizing. Whether you decline an invitation permanently or simply take a rain check, saying “no” is sometimes exactly what your body needs.
  • Take a break. If you’re passionate about your job, you might feel reluctant to take a vacation. However, if you don’t take breaks, not only are you not taking care of yourself properly, but you may eventually end up undermining your performance. Working more does not mean you will maximize productivity. In fact, just the opposite is true.
  • In addition to feeling like you don’t have time for a vacation, having a hectic life can also give you a sense that you need to let your hobbies slide. Consider setting aside an hour a week that is only ever to be used for those activites.
  • People with busy lives can often forget just how valuable self-reflection can be. If you don’t spend time thinking about how you’re feeling about what you’re doing each day, you risk losing touch with what you really want from life (and reduce the chances you’ll feel grateful for all the good things in life). If you have 15 minutes of free time a day, then you have time to keep a journal. Reflecting on what happened in your day and how you’re feeling can help you understand you get a better sense of your needs.
  • Stay focused on the present moment. Practice mindfulness and use basic breathing exercises to get your mind into the right zone for creative visualization. Spend time listening to your favorite music, keep up with hobbies that help you feel fully in tune with your body (such as yoga, walking, swimming or cycling).
  • Finally, never underestimate the benefits of laughter! It releases a flood of feel-good endorphins that boost your mood and help you to relax. So, surround yourself with family and friends that make you laugh!

A challenge only becomes an obstacle when you bow to it.

Donna Sollenberger, EVP & CEO, UTMB Health SystemThis week, I was reminded of a time in the past when I worked on a leadership team that did not function as well as it could have. We were a diverse group of people from many different backgrounds with a wide array of professional expertise. Individually, we were all really good at what we did, and we all accomplished a lot within the departments we directed. As a leadership team, we even had a pretty clear idea of what our individual responsibilities were; however, we did not work well together to accomplish our shared goal.

We all knew what we were working toward, but we became frustrated when we did not progress quickly enough to the end result. So, we each started doing our own thing, according to our own leadership styles. Pretty soon, everyone was confused because there was so much duplicative work. No one seemed to know what the other was doing, and as a consequence, teams across the organization didn’t know what they needed to do to contribute to the goal or who was supposed to be doing what. I knew in my heart that the employees’ frustration was justified. So, I made a decision—I could allow this lack of coordination to continue, or I could try reshaping the team so that we worked together more effectively. I decided to do the latter.

As the team worked hard to come to an agreement, we conducted an exercise that involved completing a questionnaire to help identify our preferred working styles. It also honed in on how we each responded to stress in the workplace. Many of you have probably taken similar questionnaires, and you were categorized as a combination of letters or a certain color, like yellow, blue, green or red, which defined how you normally acted, as well as how you acted under stress. For example, if you were categorized as yellow, it meant you were generally process driven—a sequential thinker. If you were categorized as blue, it meant you were a “people person” who generally tried to understand everyone’s point of view and tried to get people to work together. Green meant you were a planner and strategist who was easily bored with details. If you were red, you were a detail-oriented person.

When our team shared their predominant color for our normal work mode, we had a great blend of the colors—something all teams should have. We had a people person, a planner, the process-oriented person, and detail-oriented team members. But what happened when we were under stress was really interesting. We were all in the red category. This meant that under stress, we all approached our work from the same point of view, and we didn’t have the important input from the sequential thinkers, the planners or the outgoing people with strong communication skills.

To really emphasize to our group how the organization was affected when this happened, I put tape on the floor so that we had four clear quadrants. I then asked everyone to stand in their respective color quadrant, exactly as the survey tool had placed us in “normal mode”. The closer someone was to the center, the more they reflected traits from multiple quadrants; the further away one was, the more strongly they reflected a single working style.

Under normal circumstances, we were all pretty well distribute across the colors. But when I asked everyone to occupy their stress quadrant in the exact placement the survey depicted, the result explained everything—we were all deep into the red, trying to occupy each other’s space. No wonder the employees said they were confused! In stress mode, our leadership team each tried to take charge, and to the organization, this seemed as if no one was in charge.

Why do I tell you think story? If we are going to achieve Best Care, we need everyone in the organization to contribute their unique talents and working styles to the team. Whether you are mostly a planner, a people person, a strategist or an operational process person, we need all of you contributing to reaching Best Care by August 31, 2017.

So what can you do?

  • Make sure that you understand your primary role on the team – whether you are on a patient care team or an operational team. Your position description provides guidance on your job, but what is your role on the care team? If you are not sure, your manager or leader should help you better understand your role and the contribution you can make to Best Care.
  • If you are a manager or leader, your job is to have clarity about how your area can most effectively contribute to Best Care, and then make sure that everyone knows they are on the team and what their role should be.

It is so important that we try to stay in our “normal” mode at work, because if we are operating under stress, we may not be able to contribute to our teams in a positive way, or we may create a situation where our environment could potentially become unsafe. Dr. Gary Grody defined stress this way: “Stress is defined as an inability, or the perception that you are unable, to take control of your life. If you feel in control, even if you’re not but you perceive you are, you won’t feel the stress.”

We all have high hopes for what UTMB Health can achieve over the next year as we work toward our goal of Best Care. We are already beginning to emerge as a leading academic medical center in many ways—we have experienced unprecedented growth and are performing better than most in many areas. Now, to deliver the Best Care to every patients, every time, we must remain focused on what we want to happen as an organization.

We will be rapidly moving toward our goal, so let’s remember to continue working together steadily as a team toward the goal, even in the face of challenges or frustration. Zig Ziglar says, “When obstacles arise, you change your direction to reach your goal; you do not change your decision to get there.” We must identify the areas in which we can make a change and come up with creative solutions to move the needle. We have an opportunity to become a model healthcare organization, and teamwork, focus and effective communication will be critical to improving the health and well being of all we serve!

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Accountability is the glue that ties commitment to the result.

Donna Sollenberger, EVP & CEO, UTMB Health SystemOn Wednesday, I had the pleasure of speaking at a Lunch & Learn for Health System leadership about the importance of accountability for both individuals and members of leadership. I am sharing it today via the Health System Intranet for you to review. Whether you are a manager, director or individual staff member, there are worthwhile reminders in the presentation for all of us.

After the presentation, I began thinking about how important the principle of accountability will be to achieving our goal of Best Care this year. You will recall that Best Care is an initiative we are implementing in response to University of Texas System Chancellor William McRaven’s challenge that UTMB rank in the top 20 of academic medical centers by August 31, 2017 (as measured by the Vizient* Quality & Accountability Study).

In Stephen Covey’s book “The 4 Disciplines of Execution,” he contrasts an organization that thinks conventionally with one that thinks in terms of both individual and collective accountability. In the organization with conventional thinking, team accountability is always top down: “We meet with the boss periodically and s/he lets us know how we’re doing and what we should focus on next.” In the organization used for contrast, the individuals on the team collectively share accountability for achieving goals and results: “We make commitments and then we’re accountable to the boss; but more importantly, we are accountable to each other for following through.”

A culture of accountability is crucial to achieving goals, particularly when the storms of change and multiple priorities are whirling around us. Often in these types of environments, teams end up breaking apart because individuals decide to go off on their own to “just get it done”. The goal becomes increasingly difficult to achieve if, within the whirlwind, we are also trying to change the behaviors of a lot of people.

With this in mind, I started thinking about how much we have going on right now. We are really going to need to buckle down, prioritize our work, and maintain a steadfast focus on achieving Best Care, especially because reaching this goal will require changing the behaviors of many people and teams. Failure to achieve Best Care is not an option, because it is the right thing to do for our patients!

everstThe work that we must do to deliver on our promise of Best Care reminds me of the book, “Into Thin Air,” which tells the story of two teams of climbers who attempted to get to the summit of Mount Everest. The first team included the author of the book, Jon Krakauer. He wrote about the numerous adversities his team encountered as they tried to reach the summit. As blizzards, high winds and altitude sickness began to affect the team, certain members decided to split off on their own in an attempt to get to the top. Although each climber had the same goal, by setting out on their own, they abandoned the team and discarded discipline and accountability to each other. The results were disastrous as the weather conditions proved too much for eight of the climbers who ultimately lost their lives.

The second team of climbers included a blind climber, Erik Weihenmayer. If the group succeeded, Erik would become the first blind person to reach the top of Mt. Everest. The biggest difference between this group and first is that at the end of each day, they huddled together in what they called a “tent meeting” to talk about what they had accomplished and what they had learned. The team used the meetings to review their strategy, make needed adjustments in their approach to the climb, and define each member’s role. They also decided who on the team would go ahead to clear the path and secure the ropes so that Erik could climb.

Erik characterized the teamwork this way: “Our team stuck together and took care of each other, which gave me the courage to finish.” The result? On May 25, 2001, the team reached their goal, and Erik Weihenmayer became the first blind person to stand on the summit of Mt. Everest.

There are so many lessons to be learned from this story, but here are some of the critical ones that we will need to implement to ensure we achieve Best Care:

  • Form teams that have specific goals for achieving Best Care.
  • Make certain that the team has their specific goal, target and deadline assigned and understood.
  • Encourage the team to engage in developing the plan to achieve the goal.
  • Make sure that everyone on the team understands their role, including the role of the leader.
  • Hold each other accountable for making contributions to the team. Speak up in a kind and understanding way to help a team member who is not fulfilling their role on the team—encourage them, but also be firm about the fact that everyone on the team has to do their part in order to deliver Best Care to every patient, every time.
  • Meet regularly and make adjustments along the way.
  • Celebrate milestones and congratulate individuals who demonstrate exceptional effort along the way.
  • Most importantly, ensure that the patient and their loved ones are at the center of all decisions. This is not about “us” or “me”. It is about doing what is best and right for the patient.

Accountability is critical to any organization’s success. Even if we have all the goals, priorities and metrics set, without accountable leaders, teams and individuals, we cannot achieve our goal. If we commit to these actions, on August 31, 2017, we will have achieved our goal of Best Care.

*Vizient was formerly known as UHC.

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