Develop a passion for learning. If you do, you will never cease to grow.

Donna Sollenberger, EVP & CEO, UTMB Health SystemSix years ago this month, my father-in-law, Talmage, passed away at the age of 95. As I think about Tal, I am always reminded of his love for learning and innovation. As a young soldier in World War II, he worked with a small group of men who perfected radar tracking systems for submarines. After the war ended and he had completed two master’s degrees in electrical engineering and physics, Tal and his new bride, Barbara, moved to Cape Canaveral, Florida where he began working with some of his Army colleagues to develop radar tracking systems for the space program. Eventually, he moved to California with his young family to become head of research and development for a company one of his Army buddies had started.

At age 50, he thought he had retired when he and his family moved back to Barbara’s childhood home in Illinois so that she could become chair of the English department at a new community college. Once they arrived, however, they discovered the college needed an instructor in electronics. Once again, Tal was pressed into action, this time to teach.

I met Tal after he had retired from teaching. But retirement for Tal did not mean sitting around and watching TV. He was a voracious reader of anything about mathematics (his undergraduate degree), physics or engineering. He read about three to five books a week and was well-known to the library staff in Auburn, Illinois and eventually Madison, Wisconsin. When he started growing a little more forgetful, he used a small notebook to write down the names of the book titles and authors he had already read so that he could reference it when he was picking out new books at the library—he wanted to make sure he was choosing something he had not already read!

One of the most memorable moments I had with Tal was during one of his visits to California where we lived. At the time, Tal was 83. One morning he walked into the family room, and I noticed a large hardback book in his hand. I asked him what he was reading.

His eyes lit up when he said, “I am reading a mathematics book.”

“What do they write about in a mathematics book?” I asked.

“Oh, it is a fascinating topic,” he replied with a large smile. “It describes how the property of numbers change as they approach infinity.”

That conversation was typical of Tal. He loved reading and learning all his life. He loved innovation, taking something familiar and seeing if he could improve on it. I miss his enthusiasm for learning and his quest to understand more about his love of math and science.

To me, Tal is a wonderful example of the love of innovation and education we should all embrace as we move forward into the future as an academic health sciences university and academic medical center. Right now, our industry is filled with uncertainty and change. And while it is challenging to balance all of the change with the practical reality of taking exceptional care of patients, I hope we can do so with enthusiasm and  positive outlook Tal had.

As I travel and meet with other colleagues throughout the country, I am always struck by how much better UTMB seems to be doing as an organization than others in terms of innovative programs. We have already implemented a number of programs that many are still struggling to get off the ground. For example, others are looking to us for guidance when it comes to achieving Magnet™ recognition by the American Nurses Credentialing Center (ANCC). They want to know about how we have been working to integrate a small community hospital into our system for the past several years. They want to learn about how we are leading the way as anchor for Medicaid 1115 Waiver Region 2, the 16-county area in which we have implemented more than 30 innovative Delivery System Reform Incentive Payment (DSRIP) projects. They also want to know more about our MakerHealth™ Space, the first such makerspace in the country where health care providers, staff, students and faculty gather to create innovative solutions to patient care.

When I have conversations with staff, particularly in patient care areas, people often say they were drawn to UTMB or remain here because, in their own words, they love that they can learn something new every day. Many of you have told me that you love being part of teams that are delivering new and leading-edge, life-saving care to patients. You’ve told me that you love working at UTMB because no day is ever the same, and that you like how quickly your shifts go by.

While all of our values are important, I believe lifelong learning and our innovative spirit are what really distinguish UTMB from our peers. I know and appreciate that some of you feel weary from the pace and magnitude of change we are experiencing—I confess that I, too, feel that way at times. But what keeps me going is seeing each of you do all you can to provide Best Care to patients while still making time to continue learning, whether it is through formal education, reading about the latest initiatives at UTMB, by taking advantage of educational and training opportunities offered, or through simply working together in teams and on councils to learn from each other. I am inspired by the work you all do each and every day, and you all inspire me to continue my own professional growth as I try each day to be a better leader and do my own part to improve the health of our patients.

Thank you all for living the UTMB values each day!

“Develop a passion for learning. If you do, you will never cease to grow.” —Anthony J. D’Angelo

The power of focus – keep your eyes on the prize

Donna Sollenberger, EVP & CEO, UTMB Health SystemJimmy Johnson is an American football broadcaster and former player, coach and executive. His coaching career was incredible. He was the first and one of only three football coaches to lead teams to both a major college football championship and a Super Bowl. He is also one of only six men in NFL history to coach consecutive Super Bowl winners (for inquiring minds, the others included Vince Lombardi, Don Shula, Chuck Noll, Mike Shanahan, and Bill Belichick).

In Johnson’s first year as coach of the Dallas Cowboys (1989), the team had a terrible season. Johnson, however, did not take long to develop the Cowboys into a championship-quality team. Once, before a game they needed to win to keep their season alive, he told the Cowboys a motivational story:

“I told them that if I laid a two-by four plank across the room, everybody there would walk across it and not fall, because our focus would be that we were going to walk that two-by-four. But if I put that same two-by-four plank 10 stories high between two buildings, only a few would make it, because the focus would be on failing. Focus is everything. The team that is more focused today is the team that will win this game.”

Johnson told his team not to be distracted by the crowd, the media, or the possibility of losing, but to focus on each play of the game itself, just as if it were a good practice session. The Cowboys won the game, 52-17.

Last week in my post, I talked about how, when we began the Best Care initiative, many people expressed to me that our goals for Best Care were too far of a stretch and it would be a highly unlikely feat. Yet, after I reviewed the second-quarter results of Best Care, I feel as confident as ever that if we maintain our focus, we will be successful. So far, we have really improved in almost all areas. It is true, we slipped slightly in our 30-day readmissions goal at the close of the second quarter, but our six-month overall performance still meets the goal. We just need a lot of focus in this area as we head into the third quarter. We also saw a spike in our second major safety measure, the Central Line-Associated Blood Stream Infection (CLABSI) Standardized Infection Ratio (SRI). While the reasons for this spike are partially due to surveillance definitions that affect all measured organizations, we have implemented improvement processes where appropriate, and we expect to improve in the next quarter for this goal, also.

Overall, when I look at our performance for the first two quarters, I see we are trending in the right direction. This made me think about how “overnight success” is a myth. Success is a journey that sometimes comes with setbacks and adversity. Most successful people throughout history dedicated years to learning and perfecting their craft, during which they experienced disappointment, reinvention and, finally, success. Most experienced periods of trial and error. The one thing successful people (and organizations) have in common is that they know in order to accomplish their goals and to be successful, staying focused is critical.

I think when you’re working as hard on something as we have been toward Best Care, when there is any area in which one’s performance isn’t quite as good as one had hoped, there is a naturally tendency to get stuck on the negative and think about all of the losses for the day. But, it is important to also count all of one’s wins and find all of the good that took place. We should be very proud of the progress we have made.

Best Care is a journey, and we are learning as we go. It takes time to make some of the improvements we need. For example, common causes for readmissions nationally involve medications—sometimes patients are on high-risk medications like anticoagulants (blood thinners) or are on a high number of medications (polypharmacy). We will now have a pharmacist on board who will be dedicated to helping us with these issues so our patients are not readmitted. We also will continue looking for ways to find resources for our patients once they are discharged from the hospital. And, we will continue working on our processes to assure our patients have follow-up clinic appointments once they are discharged from the hospital.

I shared a parable once several years ago that tells of three stone cutters who were asked what they were doing. The first replied, “I am making a living.” The second kept on chiseling while he said, “I am doing the best job of stone-cutting in the entire country.” The third one looked up with a visionary gleam in his eyes and said, “I am building a cathedral.”

Are we all truly focused on Best Care—our cathedral of sorts?

Working on Best Care is our long-range goal. It will require focus, determination and exceptional teamwork. There will be times when we may feel like quitting, but that is absolutely the time we need to strengthen our resolve and remember why we started this work—for our patients to receive Best Care, every time and in every interaction.

We are halfway through the fiscal year, and we have made tremendous progress. If we stay focused on doing what’s right for our patients, I am confident we will achieve our goals by the end of August. Thank you for everything you are doing to assure that we achieve Best Care!

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When you can’t see the forest for the trees…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThe evening before Valentine’s Day, my son, Brad, and his wife, Maureen, went out for a nice dinner at a small bistro in Coronado, California, which is a beautiful resort town near their home. As they were looking over the menu, Brad noticed flames suddenly flickering over the top of his menu. He put down his menu and looked across the table at Maureen, who was studying the bottom of her menu so carefully, she didn’t notice the top was dangling above the candle on the table and had caught on fire.

“Maureen, your menu!” Brad alerted her. She looked up, screamed and dropped her menu on the table, which then caught the table cloth on fire. The couples at nearby tables immediately grabbed their glasses of water to toss on the fire and extinguish the flames. Needless to say, I’m sure this was a Valentine’s Day Brad and Maureen will never forget!

Aside from sounding like a scene from a romantic comedy, this scenario made me think about how sometimes, we become so focused on something we are doing that we miss detecting something that’s rather obvious or unexpected (like your menu being on fire). Or, at other times, we can become so distracted by a single task or detail, we fail to look at the situation as a whole.

When it comes to being focused on a task, we commonly mean thinking about one thing while filtering out distractions. So, it makes sense that if you give your full attention to one task at a time rather than trying to do several things at once, you’ll have higher quality results. But in reality, we have all learned to function well while multitasking. In fact, we can even become overwhelmed at times by information, a load of projects, or technology to be used. Trying to focus on too many things at once can easily open the door to mistakes. As the Nobel Prize-winning economist Herbert Simon wrote, “Information consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention.”

There are a couple of big ways not being focused, whether on our environment or on a task at hand, can have an impact—like on Best Care, for example.

Here’s a possible scenario. Two boxes of medications are packaged very similarly. While trying to perform more than one task, like answering the phone, I might accidentally grab the wrong box, expecting that I have the correct one. After all, it’s a medicine I administer almost every day! That could be a costly mistake for my patient! Fortunately, we have a bar code medication administration system which, when used properly, can catch my error.

Here’s another example. I am having a pretty good day, but very busy. I am walking down the main corridor of Jennie Sealy Hospital and checking an email on my phone. While I am trying to also watch where I walk, I fail to notice the expression on the face of a distraught family member who is trying to find the intensive care unit to visit their loved one. Or, I may even simply pass someone who is lost and trying to get to their clinic appointment on time. Let’s put down our phones and focus on our surroundings when we are traveling throughout our campuses and health system complex. No matter what our role, we all have a job to do in assisting visitors and patients who may be lost or confused trying to navigate our large system of facilities. Some of you have asked me how you can help achieve Best Care. This is one way you can do that.

To err is human—we all are capable of missing details. That’s why realizing we are susceptible to filtering out incoming information in our environment is important. Because we work in a fast-paced, demanding environment, we must practice awareness and remain vigilant about the safety and quality of the care and service we deliver.

Here’s another perspective on our Best Care focus. There are different ways of thinking about Best Care—there are the simple things we can all do each and every day that contribute to a positive patient experience, some examples of which I described above. But there is also the technical side of the coin, where we are collecting different forms of data to understand and track our performance in delivering care. We collect information on the cost of care, and we also use clinical documentation to reflect how ill our patients were and to record the processes of care we used to treat them. Together, this information determines our ranking for certain quality measures, like mortality or efficiency. So, it is possible to be so focused on moving the needle—improving Best Care—that we could lose sight of the fact that the ultimate goal of it all is to always do the right thing for our patients. Best Care means we are honoring patient-centeredness and delivering on outcomes that matter to patients and their loved ones!

In closing, I’d like to share a short video. Please watch it and follow these instructions: In the video, there are two teams of three persons each, one dressed in black and the other in white, revolved around each other and passed basketballs to their teammates. Count the number of times the ball is passed among the players in white.

This was a study conducted in 1999 by psychologists Daniel Simons and Christopher Chabris. They discovered that consistently, about 50% of their study participants failed to notice the gorilla. Whether or not the individuals saw the gorilla was not an individual difference trait. And interestingly, those who did see the gorilla could not believe that others actually failed to see it!

It just goes to show the importance of “avoiding distractions, paying attention to what others might notice, remembering that looking is not the same as seeing, and realizing just because your eyes are open, it doesn’t mean you’re seeing something!”*

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*Mike Lyles, Quality Engineering Program Manager

Today, I will learn something new.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI am left-handed—at pretty much everything. I write left-handed, and when I played softball, I pitched left-handed. The only thing I really can do with my right hand is iron, and that is because my right-handed mom always left the ironing board set up in the utility room the way she liked it, ready to turn on. (I was too lazy as a kid to unplug the iron, collapse the ironing board, turn it around and set it up again, so that is how I learned to iron.)

When I was in elementary school, we were taught to write in cursive. Our lessons began in fifth grade, and by sixth grade, we were to use cursive exclusively. I wrote as most left-handers do: my left hand bent at the wrist, pen on the paper, dragging my hand across the ink, often smudging it across the page. At least, that’s how I wrote until Miss Bell became my sixth-grade teacher…

I remember the first time we were practicing cursive in the classroom. Miss Bell walked toward my desk, watched me write and then said, “You will not pass handwriting in my class unless you learn to write so it appears you are right-handed.” She then proceeded to show me how to do that, which involved turning my paper the opposite way and then writing without bending my hand at the wrist. I was mortified as all of the kids in class watched me. I was struggling. It felt so foreign to try to write that way.

I spent the better part of three months working and working on doing something differently than I had learned to do it for an entire year. I have to admit, it was really challenging. However, once I got the hang of it, cursive writing became easier and easier. Over the years, I have had people tell me that my writing looks as if I am right-handed, and most people who have seen my handwriting are surprised that I am left-handed.

I recall this part of my life now because the other day, my husband took a note I had written down to the front desk at the condominium building where we live. He came back amused that the two ladies at the front desk had asked him if he wrote the note. He told them that he did not; his wife had written it. One of the ladies asked him if I had ever won any awards for hand-writing! Now, I was laughing!!

The memory of trying to change something I had done for months, which had now become habit, made me think of the changes we are having to make to achieve Best Care. At first, we heard the goal and thought it really wouldn’t be possible. However, we also know that failure is not an option. We even have the University of Texas System Chancellor urging us on, and most importantly, we have patients who depend on us to give them the Best Care, every encounter, every time. So, some of us have to change the way that we have approached patient care, sometimes for years.

But change we must. So we begin by trying a new approach, one that we believe will get us the results that we were not getting before. For example, the way physicians document in the medical record the care they have given to a patient and the way they describe the patient’s illness can be the difference between being rated as a very high-quality or lower-quality academic medical center. Many physicians are having to learn to document differently than they have for years. It is hard to make the change, yet it is necessary so that we are recognized appropriately for the work we are doing.

In other instances, people who were trained step-by-step on how to document in the Epic medical record (because following that particular process helps ensure we are adhering to the recommended processes of care and that we are capturing all of the information we need) are then sometimes told once they are on the unit, “Oh, there is a easier way. Just do it like this.” And before you know it, the trained behavior is left behind because “there is an easier way.” Unfortunately, the easy way may actually make things more complicated for others who have to use the record further down the line. We may make the change to make our own work easier, but as a consequence, we unintentionally make work harder for someone else.

Can you think of a time when someone changed how they did their work, and that made your job harder? That is why, as we change our system and learn new ways of doing things, we need to do our part according to the way the process was designed. If the process needs improvement, let’s work on that together. Changing just our part may actually make it unsafe for the patient somewhere else down the line.

So, just like I practiced and practiced my handwriting until what I was doing became a habit, we must practice the changes we need to make in order to help us achieve Best Care. Whether you work on the loading dock, run blood tests in the lab, or develop work-flows to be implemented in the electronic medical record, let’s all work together, make sure we understand our role in the process, understand why we do something the way we do, and how our work impacts others. It is then that we have the greatest opportunity to achieve Best Care.

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They will never forget how you made them feel.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI remember one year growing up in Springfield, Illinois, my uncle developed a chronic illness which, I believed and was wholeheartedly convinced, required a specialist. I attempted to persuade him to see a physician who specialized in his chronic condition. It would be easy, I told him, because I could arrange the appointment. However, my uncle declined. He wanted to stay with his current physician.

Not one to let things lie, I probed more closely. Why would he prefer to stay with his current physician and decline seeing the doctor that specialized in the chronic condition? His response interested me. He said that his current physician delivered a great quality of care for him. Why would he change now? So, I continued my probe.

How did my uncle know that his physician delivered great quality of care? His multi-faceted answer was even more insightful. It seems my uncle assessed the quality of care he received from his doctor in a way that most non-clinical people do, even today—they base it on the quality of their experience. To my uncle, a quality patient experience was about the following:

  • My doctor and his staff know me, so I can always get through when I contact them and get my questions answered or my needs met.
  • They always call me back within the day.
  • They are close to my home, so it is easy for me to drive there.
  • If I am sick, they always work me in that day.
  • Parking is easy and free.
  • My doctor’s office is new and pretty.
  • My doctor always has time to listen to me.

For a health care professional, it might seem odd that there is nothing in the above assessment regarding the training and experience of the physician, the access to other physicians for consultation, the way in which the chronic condition is managed so that it is under control—even in remission. There is nothing in his preferences about access to the best equipment, use of evidence-based guidelines in the patient’s treatment, or about the outcomes of other patients. My uncle’s entire assessment of the quality of his care was based solely on the experience he had as a patient visiting his physician. And yet, my uncle believed the quality of his care was outstanding.

Over the years, I have come to learn that the value of the patient experience cannot be underestimated. As a provider, we can do everything well in terms of the patient care delivered and the care interventions we make, but if the patient does not feel that they were treated with compassion and respect, or if they do not feel that we were responsive to their needs, or if they have trouble getting access to an appointment time that was convenient or timely for them, or if they felt they were not being listened to because the physician and/or staff never made eye contact with them or the conversation was rushed, the patient will not perceive that she or he is getting the quality of care s/he deserves. In short, the patient experience is crucial to the patient feeling as if they are receiving quality care.

In the past months, we have been focused on Best Care, which means we are upholding our unwavering commitment to deliver the right care, at the right time, in the right way, for the right person – and achieve the best possible results – for every patient, every time. One of the components of Best Care is patient-centered care, which means “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Institute of Medicine, 2001).

Every employee at UTMB in some way impacts how well we perform in the areas mentioned above—whether that contribution is direct or indirect in terms of the patient. It is true, sometimes in a large organization like UTMB, an individual who doesn’t directly “touch” a patient might not immediately realize how what one does truly helps or impacts the patient. If you feel that way, just think of a line of people passing buckets of water from one to the other from a source of water to be poured into a large water tank. An individual in the beginning or middle of the line may not be able to see the end result (i.e., the water being thrown into and filling the water tank), but the contribution of the individual is indispensable to the final outcome.*

Every interaction a patient has with our system influences their experience!

At UTMB, we are dedicated to providing an exceptional experience with excellent outcomes to all patients, no matter who they are, what their background is, what age they are, what their gender, race or ethnicity is, or how much insurance coverage or ability to pay they may have—this is equity of care, another focus of Best Care.

So, what can each person at UTMB can do to contribute to the patient experience? The following are just a few easy things we can all do, but there are ultimately countless actions we can take, and I encourage you to think about how you make a difference in your own important role:

  • Always warmly greet and assist patients and visitors—and one another.
  • Treat all patients and visitors with respect.
  • Be aware when someone looks lost or confused and offer to help them to their destination or point them to someone who can assist.
  • Assure equipment, supplies and medications are available for all patients at all times.
  • Conduct timely equipment inspections.
  • Provide language interpreters and interpreters for the hearing impaired; you can receive certification to assist in this endeavor through language services.
  • Attend training to increase ability to care for diverse groups of patients.
  • Work in teams and as a team.
  • If your personal finances permit, contribute to programs like the UTMB Good Neighbor program.

There is a quote attributed to Maya Angelou (and a few others) that says, “They may forget what you said—but they will never forget how you made them feel.” This can certainly be applied to the patient experience—whether you deliver patient care, respond to the patient’s concerns, ensure supplies and lab samples are delivered, help patients access our system, help them find the resources they need, or you create a warm, welcoming environment, you all contribute to the feeling of being well cared for at UTMB Health. I appreciate everything you do to create an excellent patient experience and to contribute to Best Care.


*Concept adapted from Grant Bright, Former Project Lead, IBM

**In addition to patient-centeredness and equity of care, the remaining areas of focus for Best Care include effectiveness of care, efficiency, patient safety and mortality, as measured by the Vizient Quality & Accountability Study.

Compassion is a verb.

Donna Sollenberger, EVP & CEO, UTMB Health SystemOne year during the holidays in Wisconsin, I realized I had forgotten to get a greeting card to give to my father-in-law on Christmas morning, which my family celebrates. So my son, Blake, and I went to the local drugstore to find one.

While we were in the greeting card aisle, I noticed another lady who was also looking for a card. She reached the cashier just before we did. Standing in line behind her, we overheard her conversation with the cashier.

“That’ll be $5.99,” he said.

“Oh, I think it is only $1.99,” she replied.

The cashier double-checked the price. “No, it’s $5.99,” he said.

“But it was on the $1.99 rack. It’s for my daughter,” she replied.

The cashier then said, “No ma’am, I’m sorry. It must have been misplaced on the rack. It doesn’t matter where it was, it’s $5.99.”

Clearly disappointed, the woman exited the line to replace the card on the rack. My heart truly went out to her. After I had completed my transaction, my son and I waited outside of the store. I just had this feeling that I needed to do something to help, because I could tell she couldn’t afford the card. When she came outside, we handed her a twenty dollar bill.

“Please, go buy the card you wanted for your daughter. Get her a small gift.”

I don’t know if I can really describe my emotions at that moment, as the lady’s eyes welled up with tears. I just knew I had to do something to help this person in need.

I remembered this experience because we are in the midst of the holiday season, but I wondered if there was something special we could all do for someone else—and not only during the holidays. Every day is a day for practicing kindness, compassion and generosity. We have opportunities daily to help our patients and visitors—and it doesn’t have to cost a cent.

Recently, Laura Amos, a patient care technician in the Galveston Recovery Room, stopped to help a patient who was walking with her IV pole in a main corridor of Jennie Sealy Hospital. The patient looked as if she was about to pass out. Laura noticed this immediately and asked the patient if she was okay. When the patient replied that she felt weak and dizzy, Laura stayed with the patient while another employee got a wheel chair. Then, Laura assisted the patient into the chair and helped take her to transportation, who escorted her to her room.

We can always offer something of ourselves to someone else at any time, whether it is our talent or a skill, a little moral support, or a word of kindness. After all, “Generosity does not come from wealth. Wealth comes from the flowers of kindness and love,” says physician and author, Dr. Debasish Mridha.

Laura not only demonstrated compassion for this person, but by being observant and proactively interacting with this patient, she also helped prevent a potential injury to the patient if she had fallen. This is a wonderful example of Best Care, and a wonderful example of how, by simply being aware of those around us in our hospitals and clinics, we have a real invitation to brighten someone’s day.

“The best part of life is not just surviving, but thriving with passion and compassion and humor and style and generosity and kindness.” ~ Maya Angelou

Your silence gives consent. (Plato)

Donna Sollenberger, EVP & CEO, UTMB Health SystemMy passion for history began in middle school. In fact, much of my elective reading has always been about important historical events or the lives of famous people. Most of all, I really enjoy reading about the lives of presidents. Given the fact that I grew up in Springfield, Illinois, it probably would not surprise you to find out that I love to read about Abraham Lincoln. As a child, I grew up visiting Lincoln’s home and tomb, the Old State Capitol where the Lincoln/Douglas debates were held, and New Salem where a young Abraham Lincoln studied law by candlelight. Perhaps it also is not surprising that I love to read about President John F. Kennedy. When President Kennedy was shot, I was in middle school. That day was a defining moment in my youth. Even now, I read as much as I can about these two presidents.

Traveling a couple of weeks ago, I had forgotten my book. (I have a Kindle, but I still love to turn pages!) In the airport, I saw a paperback book called “Killing Kennedy: The End of Camelot”, written by Bill O’Reilly. I decided I would buy it, and I read it on the plane. To me, the best part of the book was about John F. Kennedy’s time in the Oval Office. In particular, I was fascinated by the account of the Cuban Missile Crisis and the Bay of Pigs.

In April of 1961, President Kennedy had made the decision to authorize the invasion of Cuba. First, however, he wanted to hear from his top advisors to determine if this was the best course of action. At the time, his Secretary of State was Dean Rusk, an Oxford-educated Rhodes Scholar who had served as a chief of war plans during World War II. He was experienced in organizing covert missions similar to this.

Dean Rusk had not been President Kennedy’s first choice as Secretary of State, and Secretary Rusk knew that. Consequently, he was not confident of his relationship with the new President. In a time when the President truly needed his advice, Secretary Rusk felt he should remain silent, despite the fact that he had shared with others that this operation was misguided and that it had a “snowball’s chance in hell” of succeeding.

Secretary Rusk was not the President’s biggest problem. His largest problem was that not one of his advisors was willing to give him their advice, because it was contrary to what the President wanted at that time. As a result, Kennedy gave the go-ahead on April 14, 1961 to proceed with the invasion. Almost immediately, the invasion was a disaster. Fidel Castro, who had recently overthrown Cuba’s American-backed president, had learned about the attack in advance from informants; meanwhile, the operation of attack did not go as planned. As a result, the Bay of Pigs invasion failed, and after less than a day of fighting, 110 men on the American side were killed and nearly 1,200 were taken prisoner.

This story resonated with me because perhaps the outcome of all of this could have been avoided if the people surrounding the President had been willing to speak up. But when they did not, many people paid the price for that decision.

Sally Hogshead, an author and professional speaker, once stated, “You will not make a difference by being quiet. You will make a difference by being heard.”

As a leader, I want people to challenge my thinking. It may not change my decision, but good decisions are made when all perspectives are heard. This does not mean the leader will always change his or her mind, but it does mean that all voices have been heard and considered.

Best Care requires that we speak up when we see something that can or may result in patient harm, and it requires that the person receiving the message listen carefully to what is being said. At UTMB Health, we are dedicated to serving others and improving the patient and family experience. We achieve this through demonstrating respect for our patients, their loved ones and our colleagues. When we respectfully offer constructive feedback, we do so with the intent to offer information that calls attention to a problem or prevents a potential problem. The objective is to have a conversation that leads to the best solution or course of action. Whether you are the individual receiving the feedback or the person delivering the message, maintaining a spirit of mutual respect and learning is of paramount importance.

As the person speaking up, we need to remember the following:

  • Whenever possible, convey your positive intent by choosing a good time to talk, when the other person can listen and respond thoughtfully. In instances when you are caring for patients, you may have to speak up at that moment in order to avoid patient harm.
  • Let the person know that you respect his or her position/role, and that is why you are willing to share this feedback. It is always best to discuss concerns directly with the other individual—avoid communicating through a third party. Take care with your words—focus on the behavior or action that needs improvement, not on the person. It is helpful to link the behavior or action to patient safety or other important business needs.
  • Maintain an objective tone. Listen objectively, as well.
  • Try to keep your message brief and concise. When possible, consider picking out one or two significant consequences of the action and discussing them.
  • Be sure to include specific descriptions as part of the conversation. Facts generally point toward a solution.
  • Leave the responsibility for action with the other person. If there is still the possibility for patient harm and the appropriate action is not taken, escalate the concern immediately.
  • Always thank the other person for their time, and ask them to reflect on the message, if that is possible.

As the person receiving the message, we need to make sure that we:

  • Focus on the content of the message, not on the person.
  • Realize and be appreciative that someone is making sure every action taken is being done in the best interest of our patients.
  • Listen calmly and attentively. Try not to plan a response while the other person is speaking (we are not really listening when we are busy thinking of how we will respond).
  • Listen with an open mind and acknowledge the other person’s concerns.
  • Ask questions to confirm your understanding.
  • Try not to take offense—instead, welcome suggestions.
  • Maintain an awareness of your feelings, but also try to suspend judgment or reaction until you have had time to consider the suggestions that were offered. Truly consider what is being said.
  • Respond respectfully, and thank the other person for expressing their thoughts or concerns.

The story of Secretary Rusk and President Kennedy is a great reminder of why every member of the team must be willing to speak up and be heard. It is only when we do this that we will achieve Best Care!

“If we remain silent, we are guilty of complicity.” – Albert Einstein

One person can make a difference, and everyone should try.

Donna Sollenberger, EVP & CEO, UTMB Health SystemBefore I share the patient letter I recently received, I wanted to begin with a story. Written by Loren Eiseley, I thought it was a great example of how each of you, through your everyday service and care of our patients and their loved ones, make a big difference. Although you may not always immediately see or hear about how the work you did impacted someone else’s life, your efforts often carry a significance far greater to others than you may realize.

“Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out “Good morning! May I ask what it is that you are doing?”

The young man paused, looked up, and replied “Throwing starfish into the ocean.”

“I must ask, then, why are you throwing starfish into the ocean?” asked the somewhat startled wise man.

To this, the young man replied, “The sun is up and the tide is going out. If I don’t throw them in, they’ll die.”

Upon hearing this, the wise man commented, “But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can’t possibly make a difference!”

At this, the young man bent down, picked up yet another starfish, and threw it into the ocean. As it met the water, he said, “It made a difference for that one.”

Each day, when you do something special for a single patient, for all of our patients as a whole, or even in support of a colleague, it matters. The letter that follows, which was written by a patient’s wife, provides a powerful example of how one of our employees, Care Manager Mary Jacinto, made this sort of tremendous difference in a family’s life.

As you know, a key strategy of UTMB’s Best Care initiative is to manage our patients’ care, not only while they are in the hospital, but also after they are discharged. For many patients, this is to help prevent readmission (for example, the care manager may follow up to make sure the patient is taking their prescribed medications); for others, the goal is to help patients transition to another level of care or to help them find the resources they need to continue their care plan once they’re home. This letter tells the story of how, through Mary’s actions, she helped save a patient’s life:

“We want you to know how Mary Jacinto helped save my husband’s life. Back in September 2015, Michael [patient’s name is used with permission] got sick and was admitted to UTMB Galveston. Michael had cirrhosis with ascites, an enlarged spleen, an aortic aneurysm, hepatitis C and chronic obstructive pulmonary disease (COPD). After Michael was discharged, this is where Mary came into our lives as Michael’s Care Management Nurse.

We didn’t have insurance and little money. Mary got Michael lined up with the Freeport Clinic, so he could get the medical attention he needed. He wasn’t getting better and needed further medical attention. Mary used her resources and got Michael set up as a casebook study at UTMB.

In May 2016, we found out Michael had liver cancer and without a transplant, he only had a year to live. We still did not have insurance. I had tried several times to get insurance and wasn’t successful. Mary took the time to sit with me, and we did a conference call with the Health Market Place. We got insurance, effective June 1, 2016.

Then, Mary got Michael set up with the Liver Transplant Clinic. On August 8, 2016, Michael got a liver transplant at UTMB Galveston. He is doing fine and is very thankful to be alive. Because of Mary’s persistence, perseverance and caring ways, Michael is alive today! She is a very special person! We call her our angel! We want Mary to get the recognition she deserves.”

This is just one example, but this sort of amazing care takes place every day at UTMB. I can go on and on with examples of how individuals and teams across UTMB contribute to Best Care. In fact, just the other day, after a power outage in League City, individuals from Clinical Equipment Services, Nursing Services and many other areas discovered and preempted a potential patient safety issue with back-up batteries and emergency power. They then immediately took action to resolve the problem in a single evening. Some of the individuals who helped weren’t even on schedule that night, or they came in early the next morning to ensure everything had been addressed. To me, this sort of teamwork is outstanding and it proves that often, it is not one person or one action that makes the difference; it is the collective efforts of many who are working together toward a common goal.

As we continue the Best Care initiative and receive feedback from groups across the organization, leadership has learned that many people still aren’t sure how they impact Best Care. Although Best Care is largely focused on some areas for improvement that are difficult to impact for those who do not deliver direct patient care, I want to emphasize that each of you plays a very important role to the overall Best Care initiative. When it comes to helping patients navigate the health care system, ensuring they have a positive experience, or making sure needed supplies are delivered and facilities are operational, through your collective service, you make an impact.

Never doubt that one person’s efforts can make a difference. It did for Michael and will for so many others.


November 11 is Veteran’s Day.

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Success is the sum of small efforts…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThe famous artist Michelangelo once received a visit from a friend as he worked diligently on a sculpture. After a brief chat, the friend left but returned later to find Michelangelo working on the same statue. Thinking the statue was nearly completed on his last visit and seeing no visible change, he exclaimed, “You haven’t been working all this time on that same statue, have you?”

“Indeed I have,” the sculptor replied. “I’ve been retouching the facial features, refining the leg muscles, polishing the torso; I’ve softened the presentation of some areas and enhanced the eye’s expression.”

“But all those things are insignificant,” responded the visitor. “They are mere trifles.”

“That may be,” replied Michelangelo, “but trifles make perfection, and perfection is no trifle.”

Even today, painter, sculptor, architect and poet Michelangelo is still widely regarded as the most famous artist of the Italian Renaissance. Among his works are the “David” and “Pieta” statues and the Sistine Chapel frescoes. His work demonstrated a blend of psychological insight, physical realism and intensity never before seen.

The moral of the story? People and organizations who pay attention to the “little things” produce excellence in larger matters. As American entrepreneur, businessman and founder of the Marriott Corporation J. Willard Marriot said, “It’s the little things that make the big things possible. Only close attention to the fine details of any operation makes the operation first class.”

UTMB’s Best Care initiative is composed of many “moving parts”. There are a number of focused efforts in each area in which we are working to make significant improvements: reducing our observed mortality rate, improving effectiveness (doing or using the right things to achieve the desired patient outcome and best experience of care) and increasing efficiency (doing or using the right things to achieve the desired patient outcome and best experience of care). There is a tremendous amount of work in progress, and I am truly excited about the collaboration and teamwork taking place to make Best Care a reality.

Many of you are a part of the teams conducting this focused work, but everyone in every role at UTMB Health contributes to making our organization the best place to receive care and to have an excellent patient experience. I know you are all dedicated to this endeavor and have a desire to stay informed of our progress and the projects underway. That’s why this week, I would like to give you an update on some of the work that is taking place, as well as the work that will be conducted in the time to come.

Reducing UTMB’s Mortality Rate

At UTMB, all patient deaths are reviewed within 48 hours of the event, as generated in the Epic electronic medical record (EMR). Each death is then classified based on how likely the patient’s death was to occur—some patient’s illnesses are severe and they were expected to pass away, while other patients who passed away were not expected to. This is why detailed and specific clinical documentation is important when it comes to predicting mortality, because it illustrates how sick our patients are and it helps identify any additional illnesses or complications that may make care delivery more complicated. To aid in this documentation effort, an enhancement known as a “smart phrase” will be made in the EMR is forthcoming.

Another way we have improved our mortality rate—and more importantly, improved end-of-life situations for patients and their families—is to consult with patients and their families when the patient is expected to pass about moving into hospice care. This helps give them a choice about how to spend their last days and honors the patients’ preferences. So far, we have been able to transition 14 patients into comfortable end-of-life care. These efforts will continue and remain ongoing in the future.

Diagnosing, Treating and Preventing Sepsis

Sepsis is a leading cause of mortality. It is a bloodstream infection that results in tissue damage and organ failure. Sometimes patients arrive in the hospital with sepsis; at other times, they can develop it after a surgery (if this occurs, it is considered a patient safety event).

Recent work to improve our performance in this measure has focused largely on placing a workflow in the electronic medical record (EMR) to help providers follow the evidence-based care recommended for testing and treatment of sepsis. A report has also been developed to help monitor all patients with sepsis on their problem list—this helps ensure that if sepsis is initially documented as “suspected” or “probable”, it is eventually also documented as “confirmed” or “ruled out” and the final diagnosis is clearly documented.

Clinical documentation guidelines for the diagnosis, documentation and coding of sepsis and septic shock have now been posted to the Best Care website, and clinical documentation specialists and inpatient coders continue working closely with physicians on this area for improvement.

Clinical Documentation Improvement

After physicians document the care they provide in the medical record, it is later translated into codes which are used not only to determine the cost of care and reimbursements, but to help illustrate how sick patients are and to track disease trends. The documentation/coding process is fairly technical and detailed, but one important factor is to identify not only the primary diagnosis, but also identify and document any complications or co-morbidities (aka, secondary, co-existing illnesses). It is also important to note whether or not the secondary illness was considered “major” (meaning it required more resources to treat and was at the highest level of severity) or “simple” (meaning the condition resulted in some increased resources, but at a much lower rate).

When ICD-10 was implemented in October 2015, it changed how some conditions and procedures were classified. That is one reason why specificity of clinical documentation was strongly emphasized. However, it was predicted that on a national level, some services that are considered “procedural-heavy”, like general surgery, general medicine and cardiac services would be more susceptible to the impact of this shift than other areas of care.

At UTMB, clinical documentation improvement is focused in all services, but project teams are also particularly focused on Cardiology. To help providers make the best possible diagnosis choices, Department Chair Dr. Ken Fujise has requested that a template be developed for use in the EMR, and this work is in progress.

Effectiveness and Efficiency

Building on work already accomplished, Orthopaedics continues work to reduce patient length of stay and preventable 30-day readmissions through revised order sets (order sets are standardized lists of orders for specific diagnoses that help physicians follow evidence-based guidelines for care), conducting risk assessment for patients (that is, understanding what might put a patient at risk for readmission), and improved patient education and physical therapy training. Sometimes, a patient may need advanced care after a surgery, such as a knee replacement, but their condition isn’t serious enough to actually be admitted. By placing them in observation instead, which is a less expensive care environment, a 30-day readmission can be avoided.

Other areas of focus that are helping to improve the data for our readmission rate overall is ensuring that elective surgeries are clearly distinguished from non-elective surgeries and that inpatient procedures are accurately coded as planned or unplanned.

Last but not least, throughout the inpatient arena, patient care teams continue conducting progression of care rounds and using the “8 Ps” (an assessment of preventable risk factors for readmission). Teams also continue conducting and documenting “Teach Back”, which helps ensure that patients understand their condition and how to care for themselves at home. Care managers remain focused on following up with patients after they are discharged to ensure they are following their plan of care. Particular attention is being given to caring for hospital-dependent patients.

“Success is the sum of small efforts – repeated day in and day out.”

As you can see, there is a lot of work going on! Although I mentioned a couple of weeks ago that we slipped in our rankings in the most recent Vizient Quality & Accountability Study, all of the amazing work I described above was not included in the data submitted for that study’s time period. Therefore, I am confident that if we continue these efforts and maintain a steadfast focus on Best Care, including maintaining our performance in patient-centeredness and equity of care, we will be successful in our endeavor to become a top 20 academic medical center in the next study.

Thank you all for your diligence and hard work! And remember, it’s the things we work hard for that have the greatest worth. We have a tremendous opportunity to prove that UTMB Health is the best place to receive patient care!

Quote attributed to Robert Collier

Remember Why You Started

Donna Sollenberger, EVP & CEO, UTMB Health SystemHave you ever worked really hard to improve at something, only to find that after dedicating a lot of time and attention to it, you did not get better? Or worse yet, that you didn’t even do as well as when you started? Did you give up, or did you make adjustments and work even harder?

When I was in my early 20’s, I decided I would take up golfing. Many of my friends played, and I thought it would be a good skill to have, especially if I were going into business. Everyone in business plays golf, right?

The first thing I set out to do was purchase a set of golf clubs. I am left-handed, so borrowing clubs was out of the question, and no one I knew had left-handed clubs that I could borrow. I had even tried playing a round of golf using right-handed clubs, but wow, was that a mistake! I didn’t even get through three holes before I realized it simply wasn’t going to work.

So, I set out in search of some left-handed golf clubs. I had been saving up for a new car, but I decided since my car was running fine, I would use the money to buy my clubs instead. I would love to say that they helped my performance, but they did not.

Despite family members who tried to teach me and despite the lessons I paid for with more of my car savings, nothing helped. In my entire life, I have played nine holes of golf twice. I am sure it was entertaining to those accompanying me—I would miss the ball and hit the grass with the club, knocking up a chunk of earth, or I would swing repeatedly at the air while trying to tee off. Then, it would take me about 10 strokes just to get to the green. While I was a pretty good putter, it did not make up for the rest of my performance.

Ultimately, I decided that golf was not my game; so, I invested my time in playing other sports I was good at like volleyball, softball and bowling. (I ended up being pretty good at bowling!) However, I have often wondered how good I could have become at golfing if giving up hadn’t been an option. I guess I will never know…

This experience made me think about Best Care. Last week, we received our results from Vizient for the quality and safety data we submitted in parts of 2015 and 2016. While we are still generally in the top 20 for equity and patient-centeredness, and we are almost at the top 20 for patient-safety, we have fallen in our overall ranks for mortality, efficiency, and effectiveness. As a result, our overall score fell from being 58th to 76th out of a little more than 100 academic medical centers. While we are still in the three-star category, our results within that range slipped.

What happened? There are several things to point out:

  • The 12 months of data we submitted did not include most of the last four months of effort we have given to the Best Care initiative. This means that some of the great progress we have made so far was not captured in this set of data. This was particularly evident in the category of mortality; for example, we know we have made considerable progress by converting patients who were expected to pass away to hospice care at the right time.
  • As we had already anticipated, several items were also added to the survey this year which affected the scores. For example, length of stay (LOS) was previously calculated according to the date of inpatient admission and the date of discharge. Now, patients who are being observed but are later officially admitted are also included in this count, and the time they spent in observation is included in their length of stay, thus increasing UTMB’s overall length of stay performance.
  • We have identified issues that are creating the need to keep patients in observation, such as limited availability of some weekend services in the hospital (other than what is needed for emergency services). The Health System has started working with affected departments to help improve patient access for those services on a routine basis.
  • It should be noted that several services have improved their performance by reducing their length of stay, as well as the direct cost of care for the patient. So, there was some positive news in the latest results.

We will be looking very closely at the data this week and developing the additional action plans we need to meet our Best Care goals, but we need everyone to stay focused on what we need to do in our individual roles—and most importantly as part of our teams—in order to be successful.

They say, “When you think about quitting, remember why you started.” Unlike my decision to give up on golfing, quitting Best Care is not an option for us. We have to double down on our efforts—we owe it to our patients and their families and we owe it to ourselves to show the world that the care and service delivered at UTMB is the very best. When the Vizient Quality & Accountability Study comes out next fall, and we are in the top 20, our efforts to “Be the Best” will not end. Maintaining that position will be as challenging as achieving it. It is hard work to always deliver Best Care, but it is also highly rewarding.

I am convinced with the many good people we have working together on Best Care, that we will achieve our goals. Thank you for all of your contributions to and work on behalf of our patients to assure that they receive Best Care – every patient, every time.

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