Barbara Stannard, Her Personal Journey Fighting Breast Cancer

You can’t watch NFL football this month without noticing the bright pink shoes in honor of breast cancer awareness month. Most of us have someone in our own family or immediate group of friends who has been challenged with this disease. Thankfully, early detection is better than ever with enhanced diagnosis and treatment. A recent technological advancement is the new state-of-the-art Tomosynthesis 3D imaging which is a notable upgrade to traditional digital, 2D mammography. This technology is able to assess dense breast tissue and identify potential abnormalities better than ever before. HCA’s Johnston-Willis and Henrico Doctors’ Hospital are the first and only hospitals in Richmond metropolitan area to have this technology.

This week I wanted to make breast cancer more personal so I asked for an employee who would be willing to share their personal story. RN Barbara Standard’s name quickly came to light not only for her personal fight against breast cancer, but also because of her role as our Chippenham & Johnston-Willis Breast Cancer Nurse Navigator. She has been in this role for 6 years and been an oncology nurse for over 30 with HCA. As the Navigator, Barbara reaches out to women who have initial abnormal findings in their mammogram to ensure they get linked into additional screening and treatment when necessary. The fact is about 30% of mammograms come back abnormal. Thankfully, only 15-20% of those are actually positive for breast cancer.

Barbara Standard

Barbara Standard, RN

In Barbara’s case she was having her routine mammogram on her birthday in 2011. The results came back abnormal and they asked her to come in to have additional imaging views. Dr. Jackie Hogg, radiologist, was intimately involved in the case and coordinated with Dr. Ruth Felson, breast surgeon, to make the final diagnosis of invasive ductile cancer – one of the most common forms of breast cancer. Barbara eventually had six surgeries, including a lumpectomy and mastectomy, in addition to radiation and chemotherapy for a year. Barbara shared with me that as an employee she always knew what a good place Johnston-Willis (JW) Hospital was for care. But after becoming a patient she soon came to realize that it was a really a great place when you are a patient too.

She said, “Once you become a cancer patient it is humbling because what you thought you knew about cancer was really not that much. It was very enlightening and gave me a different perspective. Coming to an advanced breast cancer center like JW was really important.  It puts in place all the right people and the latest technology in one place and walks the patient though all the important steps of getting diagnosed and treated. I was always someone who would schedule my life way in advance. I now know that each day is a blessing. Every day that I get up and put my feet on the floor is a good day. It helped me prioritize my life.”

She emphasized the advice we hear so often but sometimes fail to follow: “Do your mammogram every year and be sure to conduct breast self-exams routinely as recommended by American Cancer Society”. Today, every abnormal mammogram patient gets a personal call from Barbara to talk about next steps. In the past, patients would receive a letter (sometimes on weekends) and be left to figure out what to do next. Thankfully, they now always have Barbara to call.

Barbara emphasizes the importance and power of a strong support network. Through her experience, she came to realize that the employees and doctors at Johnston-Willis were like family. She believes in the importance of getting involved in support groups, like the ones held by Robin Yoder at Johnston-Willis every Wednesday. The first group is for newly diagnosed patients and the second is for long term support.

I asked Barbara what the biggest misconception is about breast cancer and she said, “People think when they hear ‘cancer’ that it’s a death sentence. Once they realize how many survivors there are they get hope. They often think they won’t be able to work but the fact is a lot of people will be able to work through much of the treatment.”

If you want to call Barbara for advice she is willing to help at 804-267-6243. I am pleased to report that today, she is healthy and doing great. If you are a woman over 40 years old, I encourage you to make sure you get your annual mammogram as that is the best way to stay informed about your personal health.

If you would like to share your breast cancer story or experience, please feel free to do so as a reply to the blog.

Imagine a Heart Attack Overseas

Imagine being an experienced, Virginia-based, ICU nurse and finding yourself overseas with a sudden, life-threatening medical crisis. This is exactly what happened to DeWitt Wert. Dewitt has worked for HCA for almost 2 decades, most recently in our Medical/ Surgical ICU at Chippenham Hospital. Prior to his trip, he was overall healthy with no known cardiac issues. That was about to change.

Min & Dewitt in Guangzhou, China

Min & Dewitt in Guangzhou, China

DeWitt and his wife, Min Zhang, an Echo tech at Chippenham, have been married for 6 years. They decided they would make the 23-hour journey to her homeland in Guangzhou, China. This would be his first time meeting his in-laws. After several days of enjoying the culture and sites, Dewitt noticed he was having some discomfort which he thought was related to a previous history of mild esophageal spasms. It turns out these symptoms can mimic some of the classic signs of a heart attack. He thought the discomfort might have been related to all of the touring and enjoying foods he was not accustomed to eating.

Towards the end of the trip, the symptoms became more pronounced after a day with sudden weather changes where the temperature went from 60 to 90 degrees. He took the elevator up to 15th floor and realized he was very hot and felt nauseated. After trying to get the AC on he started getting dizzy and more exhausted. Something wasn’t right. DeWitt assumed he was dehydrated and suffering from heat exhaustion. His wife wanted him to go see a doctor but he delayed. By morning he hadn’t improved and, after taking his blood pressure and heart rate, he realized he needed to go to a public hospital ER. Imagine how scary it would be to go to a hospital in a different country with a significant language barrier. One of the first things the hospital asked DeWitt for was cash before they would treat him. His bill would end up being over $13,000. He shared that during his stay they wouldn’t even give him a bed pan until he paid for it first. He also had to sign a legal waiver to remove his ability to sue them if things didn’t go well. They gave him a choice of signing the document or taking an aspirin and going home.

They proceeded to take blood samples and an EKG; their initial impression was that he was fine so they didn’t do the whole set of cardiac enzymes. Time passed and they eventually did more tests and started to suspect a Myocardial Infarction (heart attack). Ultimately they would find that he had a 100% blockage in his right coronary artery. Evidence shows that treating a heart attack within 90 minutes is key to survival. Dewitt knew this as an ICU nurse and realized that it had been much longer than that. In fact, he didn’t go into the cath lab for close to 9 hours. He had to make a final decision to pay for the Chinese catheter or pay 10x more for the USA manufactured catheter (he opted for the latter). As Dewitt was wheeled into the get the cardiac cath, which is inserted through the arm, and the balloon pump, which is inserted through the groin, he came to understand that they don’t use any anesthetic for the procedure. In the United States, you are put under an IV-conscious sedation so you don’t feel discomfort and don’t remember the experience. Communication about medication and treatment continued to be a big issue as his Chinese wife only spoke Mandarin not Cantonese, the predominate language at the hospital.

In describing his experience to me DeWitt shared, “At one point I thought I was dying in the hospital prior to getting any treatment. I had a tremendous sense of doom. My wife was praying in my ear. I am not particularly religious but something changed. She told me she didn’t want me to go. I knew I felt a deep and profound love for her. Something changed and I suddenly found peace. I can’t explain it. It felt really good and I knew I was okay with moving on no matter what the outcome. I wanted my wife to come back to tell my unit at Chippenham Hospital just how much they meant to me. It changed me. I am more focused on my kids, my family and now when I am in the unit I take a little extra time to think about what I am saying to be respectful of feelings more so than I ever was before. ”

He is quick to acknowledge that while their care model is very different, they saved his life. They enabled him to come back and continue being a great nurse at our hospital. We are lucky to have him.

Bringing Awareness to Pediatric Cancer

Kathleen Yancey, RN, has been a nurse for almost 20 years with half of her career in Chippenham Hospital’s ER. She is a great nurse with a compassionate heart and we are fortunate to have her on our team. In addition to decades of service to patients and co-workers, Kathleen has also been an extraordinary advocate for pediatric cancer. This passion stems from the heartbreaking reality of losing her teenage son, Justin, to Acute Myleoid Luekemia (AML) after a difficult and courageous four month battle.

Justin & his mom, Kathleen

In 2010, Kathleen was on her way to a family vacation with Justin and his older brother. Justin began spiking a high fever during the trip which led Kathleen to take him to an ER in Georgia. The doctors’ concluded that it was virus and he would be ok so they released him. Time always matters in these situations. Unfortunately, his fever was not brought under control and he was later admitted to another facility where he was properly diagnosed with Leukemia within 5 days. Research shows that the survival rate for patients with AML is about 40%. It is a rare leukemia and generally a secondary cancer, meaning most people have already had another kind of cancer and are generally adults. At the time, VCU’s Massey Cancer Center said they had only treated a few other cases.

Kathleen shared that Justin was known for being a fun kid with a loving and giving disposition. He would walk in a room and relate as well to the infant as the elderly.  He was everyone’s friend. During his short life, he was clearly a difference maker.

Kathleen Yancey

Kathleen Yancey

As part of Kathleen’s quest for pediatric awareness, she orchestrated a Whipping Childhood Cancer Challenge at Chippenham & Johnston-Willis Hospitals. For the challenge, you take a video of yourself talking about the pediatric cause, challenging 7 of your friends to give $7 to a pediatric cancer charity, and taking a pie to the face. The Chippenham Challenge was recently spotlighted on the local news (http://wtvr.com/2014/09/21/whipping-childhood-cancer-challenge/)

Jon Burkett, CBS6, interview Kathleen

Jon Burkett, CBS6, interviews Kathleen

Got Her

After the #WhippingChildhoodCancer Challenge

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#WhippingChildhoodCancer

I asked Kathleen what her inspiration was for this particular event and she said, “You hear a lot about other cancers, but not enough about pediatric cancers. We don’t have the same voice so it becomes the parent’s role to campaign for their kids. You see pink ribbons on everything. You don’t see the other color ribbons. Orange is leukemia and gold is pediatric cancers. I wasn’t seeing enough awareness campaigns here in Richmond, VA. The statistics are disheartening – 46 children are diagnosed every day and 7 children die of childhood cancers every day.”Chippenham & Johnston-Willis Hospitals’ fund raising supported a not-for-profit called Dragon Master www.dragonmaterfoundation.org which is focused on setting up a database to collect genomic data (the DNA sequencing of cancer) and correlating it to clinical data from patients. Their hope is that by doing this, researchers can focus on a cure. The organization was started by Amanda and Richard Haddock in Kansas in memory of their son, David Pierson, who passed away from pediatric brain cancer. He was told he would live 8 months; he ended up living 20 months. Kathleen commented that the extra time was an amazing gift for his parents.

It was difficult for Kathleen to share her story with others but she is so passionate about the cause and feels fortunate to have had 16 years with Justin.

She told me, “I have always been supported emotionally by the Chippenham Hospital team. It is hard to come here every day, in the place where my son passed away. The ER employees came together as a loving family. They were there for us from diagnosis through treatment. Even after he passed, they were so supportive and understanding. Kelly Grindstaff, my ER director, has also been amazing. The team at Johnston-Willis was helping us to organize a bone marrow transplant which unfortunately was not able to happen because of his rapid decline. Pediatric cancer awareness needs to come to the forefront. I hope that no other parent has to experience it. My dream is to find the cure. Progress is being made every day.”

If you would like to share anything on the topic of Pediatric Cancer, please feel free to share here on the blog as a reply.

Top 5 Life Lessons I Wish I Knew When I Was Young.

I often ask my young kids what they want to be when they grow up. Afterwards, I have a slight sense of guilt because it feels like I am trying to rush them through their childhood – but that isn’t really what spurs the question. What is on my mind is the old adage, with maturity comes clarity, and I wish I had some of that knowledge in my formative years. The truth is I was one of those kids who had some ideas about possible careers and life goals but very little idea how to get there. I am pretty sure my guidance counselors never encouraged me to think of actions I could take to be more purposeful in the direction I was headed.

Thinking about this lead me to wonder – if I could give my boyhood self any advice, based on all I have learned through the years, what would I say? Had I approached school, career, and life decisions with this knowledge I might have made a bigger impact. Some decisions might have led me in different career directions but I suspect many would have just made me a more well-rounded adult (I wish I had taken 6 years of Spanish classes seriously).

So here is the advice I would give my younger self.

  1. You don’t know it all so listen first and talk last. It isn’t hard to have a strong opinion. That doesn’t make it the best one. Force yourself to let others share their perspective first. This will allow you to see their side of the situation and better formulate your opinion. People will appreciate that you listened and they will respect your opinion more.
  2. Building a few strong, meaningful relationships is more important than building a voluminous network. Today, I see people trying to maximize the number of connections on social sites like Facebook and LinkedIn instead of fostering relationships with a handful of people who they can really trust and collaborate with in meaningful way. Casually knowing a lot of influential people won’t benefit you nearly as much as these deeply meaningful relationships will.
  3. What others think of you matters but it matters less than what you think about yourself. Like many people, I am my harshest critic. Figuring out what you can control and what you can’t is critical. Learn from your mistakes while also having a thick skin. Lots of people have an opinion on how you could be better. Your attitude and approach has a compounding effect on your success in life and in work.
  4. Change is always hard so how you approach it matters. It is incredibly difficult to change the real flaws of our character or the imperfections of our life. No matter how much I envy people who are laidback, Type-B individuals, I will never be one of them. Focus on modifying your actions and adapting in a reasonable and measurable way. Lasting change will happen when the improvement is a habit (e.g. it takes 28 days of action to make exercise and healthy eating a routine).
  5. Reach out of the box and be bold. Just because someone achieved success one way doesn’t make it the only way. The most innovative, successful people in history had a lifelong commitment to trying something new despite what all the naysayers said. Take chances on going after the tough jobs and assignments because, if you don’t, someone else will and you will find yourself right where you were.

What is the advice you wish you knew when you were 18?

Ethics Drives Everything

If you are a Virginian, you likely felt disheartened by the conviction of former Governor Bob McDonnell and his wife on twenty counts of corruption. Hearing the sordid details of their poor decision making and selfish acts was reminiscent of trials and sentences of the past in areas like Chicago and New Orleans. Thankfully, this was the first, and hopefully last, high level egregious case in our state’s history. If there is any light to this dark period, I am optimistic that it will lead to stricter laws and greater compliance to commonsense rules of business.

As a company, HCA and Chippenham & Johnston-Willis Hospitals have made a significant long-term investment and commitment to building a sustainable culture rooted in strong ethics. The ethics and compliance program is designed to offer a number of avenues both onsite and telephonically to give employees the opportunity to share their concerns. Betsy Blair serves as CJW’s ethics and compliance officer supported by Brian Lundblad as the assistant ethics and compliance officer. A toll free number is also available to express your concerns (800-455-1916). Our broader leadership team and human resources are always available to listen, research, and respond to issues that come to light. Our hospitals utilize an ethics and compliance committee to oversee our program and ensure its effectiveness. If you aren’t sure whether something you are seeing or hearing is at the highest ethical benchmark, please bring it to someone’s attention. For all of us the safest thing to do in our business is to never operate in a gray area.  Our company has also required all employees take an annual code of conduct training module on Health Stream. This course gets refreshed each year and offers real life examples of navigating difficult situations.

It was a hard lesson for the former Governor to learn in such a public fashion but hopefully our elected officials will take meaningful action and limit the temptation of others to abuse the power and influence of their roles.

Senior Leadership’s Response to Employee Feedback

In May we conducted our annual employee satisfaction survey which had over 90% participation. We appreciate the feedback and value the chance to respond to the opportunities highlighted. There have been many steps taken to ensure that we are meeting the organizations needs both today and tomorrow. I want to highlight a few of those steps as outlined by the specific areas rated in the survey. Brandon Haushalter and I will be sharing more detail at the town hall meetings next month.

Surveyed Area: Senior leadership is available and approachable:

Senior leadership is increasing the frequency of rounds at both campuses including evening and weekend shifts. The purpose of rounds will be very much on hearing directly from employees about ways that we can best support them in their job. We will continue to see patients but we want to ensure that we are hearing your feedback directly. We are also setting up job shadowing by senior leaders throughout the hospital where we will spend quality time working with you to understand what your jobs are like day-to-day. In addition we will continue to hold monthly staff focus groups which allow a more casual conversation over breakfast or lunch. These focus groups are a randomly chosen group of people each month, however, if you would like to be included in one of these, please let either HR or administration know and we will get you on the schedule.

Surveyed Area: I believe actions were taken as a result of the last survey

All leadership, including administration and Department Directors, will set aside focused time in daily huddles and monthly staff meetings to talk about actions to address the top priorities your department identified in the survey. Each department’s issues are unique and we want to be sure that leaders are customizing their dialogue around those priority issues first. This will also be a checkpoint to ensure the action plan developed is in fact improving the problem identified. Please be sure to share your opinion. We will talk about broader hospital-wide issues in CEO town halls and other forums. In addition to the in-person discussions, we will maximize the use of the “Feedback Fridays” weekly e-newsletters to share updates on the steps being taken across CJW. Department leaders are also sharing with their colleagues best practices for improving the work environment each month at the leadership meetings. Our hope is that this education will spark impactful ideas throughout the organization.

Surveyed Area: Our Facility has a vision for the future that is inspiring

We will be broadening the CEO town hall as we know it is often hard to leave your department to hear one of the scheduled meetings. Brandon Haushalter or I are prepared to do an abbreviated version of the town hall in your department. Directors have been asked to invite us if this would be beneficial to your area. Please communicate to your leader if you would like to have this done. It is also a great way to share your feedback.

 

Thank you for all that you do to make Chippenham & Johnston-Willis Hospitals a great place to work and receive care. I welcome your feedback directly if you have other ideas of how senior leadership can best serve you.

What is Quality?

(This is a guest blog from the Chief Medical Officer of Chippenham & Johnston-Willis Hospitals, Dr. Michael Menen.)

There is a lot of talk about quality metrics, pay for performance, value-based care, and penalties for poor outcomes. Hospitals have been using a variety of strategies to improve quality for decades. In this regard, it’s useful to ask a basic question. What is quality? Well, it depends! It depends because many different factors make up quality, and many different perspectives.

Quality in healthcare may include, for example, the safe use of prescription drugs, the training of healthcare professionals, effective medical information technology, good processes, and top-notch medical technology. Quality may also include nice surroundings, efficient registration, good patient transport, and clean rooms.

We measure quality indicators like compliance rates, complications, and adherence to protocols, all of which are important in helping us improve patient care and safety. But at the same time, there are very important aspects of quality that cannot currently be quantified. For example, we have no yardsticks for technical expertise, critical thinking, fund of knowledge, good judgment, compassion, curiosity, or relentless determination to do best by each patient.

Quality also depends on your point of view. To an insurance company, low lengths of stay may indicate quality. A clinic manager likes providers who get patients seen more quickly and efficiently. Risk managers want no unnecessary testing, but also no missed diagnoses. Patients should get health care without delay, treatment without harm, and only the medical tests necessary for diagnoses.

Because there are so many competing quality interests and perspectives, the different elements of quality are sometimes difficult to reconcile In other words, if you want fewer missed cancers on chest X-ray, there will be more negative CAT scans for questioned findings on chest X-ray. Newer medications and technologies, often desired for their great promise curing disease, have shorter track records and may be more risky.

In many industries, enhancing quality is an effective strategy for improving financial performance. Companies that invest in quality can eliminate waste, gain market share, or command a higher price. Experts in quality improvement generally believe that improving quality in health care – despite the costliness of some approaches – will similarly result in improved financial as well as patient outcomes. In the current health care system, investments in quality – while producing net economic benefit for society – do not routinely translate into improved financial performance. The absence of evidence that health systems, providers, and others who invest in quality improvement will see a return on investment within a reasonable time frame is widely acknowledged to be one of the most important obstacles to improving health care.

The challenge – quality improvement lies in making stakeholders aware of the financial benefits of good care. The successful creation of an economic motivation to improve quality will most likely depend on the ability of theses stakeholders to come together, motivated not by short-term economics, but by a long-term commitment to an improved health care system. Making health care function will likely require ending business as usual, and will most likely include:

  • Expanding public access to performance data for different providers
  • Educating the public about what is included in excellent care
  • Better aligning the financial incentives of the system with improved patient outcomes
  • Decreasing the fragmentation of the health care system
  • Promoting a shared sense of public stewardship

Continued investment and attention to quality should be our greatest priority, as we strive to provide the best health care possible.

What does quality mean to you? Leave a reply for me here.

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