Pushing Herself for a Reason: Deedee Karanian, CRNA, Pushes for a Cure for Crohn’s and Ulcerative Colitis

Many people find it difficult to exercise with any regularity. I have no doubt exercise is the most common New Year’s resolution many of us make. However, imagine if you exercised for a serious and great cause. Could you see yourself committing months and months of training only to culminate in a 12+ hours Ironman Triathlon which includes a full 26.2 mile marathon, a 2.4 mile swim, and 116 mile bike ride? Few people can compete in this extreme sport, but I have every confidence that Deedee Karanian, one of our Certified Nurse Anesthetist (CRNA), will be successful on Sept 27, 2015. I also know that with the help of family, friends, and many others, each of us can make a difference for this worthy cause.

Deedee will be competing in the Ironman Triathlon in Chattanooga, Tennessee with Team Challenge. She chose it as a vehicle to raise money and awareness for the Crohn’s and Colitis Foundation of America (CCFA) for research and to find a cure. These diseases are autoimmune diseases that can affect patients in devastating ways. Today there is no cure. This cause is near and dear to her as one of her close family members is impacted by the disease which can be physically and mentally debilitating as well as financially challenging for patients and their families. Today over 1.6 million people have irritable bowel disease. According to the Foundation; “Crohn’s disease belongs to a group of conditions known as Inflammatory Bowel Diseases (IBD). Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. Crohn’s most commonly affects the end of the small bowel and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Ulcerative colitis is limited to the colon, also called the large intestine. Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon. Ulcerative colitis is the result of an abnormal response by your body’s immune system. Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations.”

Deedee Karanian

Deedee Karanian

Deedee shared that in her role as a Certified Nurse Anesthetist in the operating room she has seen firsthand how well these patients are cared for at Chippenham & Johnston-Willis Hospitals by the team of surgeons, specialist, anesthesia providers, and operating room staff. These patients suffer from inflammation and pain from their disease and the hospital care teams’ goal is to give the patients control of their life by reducing pain and minimizing the symptoms and exacerbation that often flare up. The Crohn’s and Colitis Foundation is not just looking to find a way to treat these patients, but more importantly, ways to cure them. Significant advances have been made in recent years. Through her work and her personal life she knows the importance of raising funds and advocate for these patients to give them a stronger voice for research.

Last year, Team Challenge (nationally based) had the largest number of charity racers for any Ironman event and rose over $1.33M from 200 racers. From these funds, $0.82 of every dollar goes straight to research and education. The great news is that the Federal government matches each dollar with eight dollars of funding through the National Institute for Health. This exceptional match is done because of the highly promising and successful research done to-date and the sheer number of people suffering across the country.

The latest research is heavily focused on the genetics initiative. They have already found five genetic pathways so they can further isolate and treat the cause and not just the symptoms. These efforts have brought us new medication options and one has already been shown to be safe in humans.

IMG_0067Deedee has launched her fund raising campaign and needs all the help she can get to exceed her goal of $5,000. A little bit goes such a long way. To make an online donation click: http://online.ccfa.org/goto/dkaranian. She has worked at CJW for over 15 years and lives in Powhatan, VA with her husband, John Karanian, a family law attorney with Barnes & Diehl, and their 2 sons, Zack (11) and William (10). This will be her first Triathlon, however it builds off her successful completion of four marathons (NY, Shamrock, Richmond, and Big Sur), and three ½ marathons. She left me with a final thought, “Less than 1% of the population will finish an Ironman; however on race day I will race for 1.6 million people! That is a great feeling!”

If you would like to learn more how you can get involved in the Crohn’s and Colitis Foundation of America you can go to www.ccfa.org.

The Powerful Impact of Hospitalists

A large percentage of our inpatients are cared for by hospitalists (Internal Medicine physicians exclusively focused on caring for patients in the hospital setting). This job is incredibly difficult and challenging considering the medical complexity of patients’ illnesses and the large number of patients who chose our hospitals. Apollo MD, a national hospitalist and ER physician company, runs our program at Chippenham and Johnston-Willis Hospitals (CJW). This team includes over 40 physicians led by Drs. Mike Perini and Brian Hanrahan. We are fortunate to have such a strong group of physicians in our four walls 24 hours a day. I asked Dr. Perini to sit down and share his observations with me.

Dr. Michael Perini

Dr. Michael Perini

Tim: When did you first start at CJW and why did you choose this specialty?

Dr. Perini: I have been here since 2001 and found that I prefer acutely ill patients. I enjoy working closely with physician specialty consultants, nursing, and ancillary staff. In my role, I am able to have an impact on the way hospital patient care works.

Tim: How has the implementation of hospitalists into inpatient care improved medicine?

Dr. Perini: Early on people that became hospitalists were doing it simply because most primary care physicians no longer wanted to come to the hospital. However, over the past 20 years, the rapid pace of change in areas like standardization for care protocols, expansion of drug treatments, and high utilization of cutting edge technology has created the need for more specialized care for inpatient hospital medicine. Today’s physicians do much more then write a patient progress note. They are very focused not just on quality but also efficiency and transition care (getting them back into the outpatient or skilled nursing setting). Today the hospitalists’ quality agenda includes working on improving areas such as mortality outcomes on specific diseases like sepsis. The full care continuum (inpatient and back to outpatient) was not traditionally managed from the inpatient setting as it is today. We have evolved to be more adept at getting people through the continuum of care.

Tim: What is your view of Chippenham & Johnston-Willis Hospitals?

Dr. Perini: They are terrific hospitals. I view CJW as critical care hospitals serving complex patients. The broader medical staff is very seasoned and experienced. Our hospitalist program carries a census of 190-200 on the Chippenham campus alone, which is about 75% of the patients on the acute care side. That is a testament to the quality of the doctors. I am proud of the service that CJW provides Central Virginia.

Tim: What do you see as a top priority for hospitals today?

Dr. Perini: Patient safety is clearly the priority. There is such a degree of complexity going on with any given patient. They are in the hospital for a much shorter period of time than ever before. So our focus is on ways to improve the delivery of care. We now use a checklist to make us more methodical so that we can deliver care efficiently and timely. Consequently, we can better help patients. Our success depends on consistent, strong communication with physicians and hospital staff.

Tim: What is different about this group of hospitalists and the patients they see?

Dr. Perini: The high volume of patients and the intense complexity of their needs require us to be closely aligned with all the medical staff specialties. Our initiatives are targeted on being more efficient than a typical community hospital. We are proud of our strong outcomes on quality metrics. However, we continue to look for additional ways to improve. The hospitalist team at CJW is willing to try new strategies for making patient care better and I believe the broader medical staff has grown to appreciate them. I would personally feel very comfortable with any of these doctors caring for me or my family.

If you work at CJW or have experienced care with the hospitalists in our facilities, I’d like to hear your feedback as a reply to the blog.

Lucky to Have a Hero

We deliver almost 3,000 babies a year at Chippenham & Johnston-Willis Hospitals. If you have been on one of our Mother Babies units – you know that they are very well appointed with not only the latest technology but the highest level clinical skills available. Of course delivering in the unit is predicated on actually getting to the unit. That did not occur with one expectant mom in late January.

Sylvester "Sly" Brooks

Sylvester “Sly” Brooks

Sylvester (Sly) Brooks has worked on the night shift in housekeeping as a Floor Technician at Chippenham Hospital for nine years. He is one of the critical members of our team that makes our hospital literally shine. One night in January, he was buffing the floors in the Chippenham ER waiting room, a busy place that treats close to 100,000 patients a year. He and the other visitors in the waiting room heard a commotion coming from the parking deck. Someone was screaming, “help, help!” Sly ran outside to see what was happening only to find two people in a car – one of whom was a pregnant woman in great pain. There was no time to get anyone else. According to Sly, “the baby was halfway out.” Sly stepped up and helped out when he was needed most. He quickly reacted and put his hand under the baby’s head and placed a blanket under the baby. Within minutes the baby was delivered. Soon thereafter nurses and other providers came outside and rushed the mom and baby into the Emergency Room. The baby and mom did great.

I asked him to tell me what it was like to have such an extraordinary experience. He said, “I was very nervous. I had no idea that was going to happen. My instincts kicked in to do the best I could to do. The only reason I went was to help any way I could. When my first daughter was being born I fainted watching her be delivered. I didn’t watch my other 3 kids be born because I was afraid of doing that again. So at the moment I saw a stranger’s baby delivering I was very nervous and wanted to hold it together. I was just thinking about the mother and the baby.”

I asked him how this experience ranked to others in his life (assuming this would be at the top). He said it was the second most spectacular. Of course I had to follow up and learn what topped his list as #1. It turns out he has been a hero before. One day three years ago he jumped out of his car on Midlothian Turnpike because he saw a SUV with two young children and no adult pulling straight back onto the road from a convenience store parking lot. A 6 year old was at the wheel. Apparently, the children had been left in the car and were able to switch the car into gear, causing it to move backward on the busy road. Sly saw the boy screaming out the window so he quickly moved his car to block the moving car, jumped out, ran to the driver’s side, and pushed the car into park as it went across the median strip.

This week, I brought Sly to the CJW Board of Trustees’ meeting to be recognized for his heroic acts. His final words during out interview were, “I do whatever I need to do to make the company better. I am all about teamwork. Anything I can do – I am there.” So if you see Sly working the night shift buffing floors, please stop him and thank him for stepping up when he was needed most.

Defining our Cultural Beliefs

I know we all agree that creating and sustaining positive, strong workplace culture is directly tied to our success, both caring for patients and as employees. I am a strong believer that our culture isn’t taught, but rather is something that permeates across the organization regardless of our individual role. It hits at the core values of all of the people who work day-in and day-out in our organization.

Cultural Pyramid

Cultural Pyramid

With that in mind, we recently spent time clarifying and articulating the values and beliefs of our teams at Chippenham & Johnston-Willis Hospitals (CJW). The culture has clearly been built over the 40+ years of our history. It also lives in the 3,000+ associates in our facilities today. Great cultures embrace their core beliefs and allow for an environment where we hold each other accountable for living up to those values. The beliefs aren’t something for posting on a wall and talking about one time. They live in the work done every day – all day. As you see people live these values, I ask that you find ways to recognize them because they make us an extraordinary place. It is why patients choose us and it is why an employee would choose to work here when there are so many options in healthcare.

Here is what came to light as key imperatives for CJW’s culture. They are written in the first person because it is something that we ask from ourselves if we are to be successful serving others.

  1. Create Wow – I create extraordinary experiences for everyone, every time
  2. I Decide – I am trusted to be a decision maker and my voice matters
  3. Own It - I take accountability to be the solution
  4. Shatter Silos – I contribute to a team bigger than my department
  5. Simplify & Focus – I prioritize what matters most to deliver our key results
  6. Live Excellence – I bring my best and encourage others to shine

I would really like to hear examples from you on how you have seen one of our team members exemplifying one of these core beliefs. Please share your feedback either as a reply to this blog and more importantly in daily workday recognition moments with those that inspire you.

Strengthening Culture and Preparing for Tomorrow.

Chippenham & Johnston-Willis just finished two record months of patient volume in December 2014 and January 2015. Volume growth is one of the best signs that more and more patients and physicians are choosing our hospitals to receive care when they need it most. December saw a record Emergency Room visit total with close to 13,000 in the month – the most in our history. That equates to over 400 visits a day. Admissions also saw new highs with over 3,000 admissions in both December and January. We recognize this 10%-15% spike in volume causes significant challenges in staffing and we sincerely appreciate all the many associates who helped by picking up extra shifts to care for our patients. Prior to the volume increase we had initiated an aggressive and focused effort to expand our nursing recruitment which yielded over 150 nurses in the last 3 months. We know it takes time to on-board new staff to our culture and systems, but there is light at the end of the tunnel. In the meantime we are looking at several ways to solve the short-term staffing challenges by expediting our hiring process, developing creative staffing solutions with our own staff, and utilizing agency/contract staff when needed. In the long-term, we also realize the importance of building and maintaining a culture that not only attracts great talent but also retains great talent. I am always amazed by the long tenure of so many of our staff.

As a leadership team, we have the opportunity to do better – not only to meet the healthcare challenges of today but also to prepare ourselves for the challenges yet to come. Nationally, the number one concern on most hospital employee satisfaction surveys is proper staffing and workload. Our goal is to ensure that none of our shifts go unfilled. Moreover, we want to ensure success in staffing the high peaks in census as well as we do the average volume days. I encourage you to continue to share your ideas with us as we focus on reducing employee turnover while successfully recruiting new team members for our ever growing organization.

We have CEO town hall meetings starting tomorrow through the first week of March at both Chippenham & Johnston-Willis Hospitals. I hope you can join us to hear about both our long-term vision and also our short-term action steps to serve both our employees and our patients.

A Level II Trauma Designation to Better Take Care of You

On Monday, Chippenham Hospital received our official notice that we are now a Level II HELO_01Trauma Center as designated by the State Health Commissioner from the Commonwealth of Virginia Department of Health. This makes Chippenham Hospital the only Level II trauma center serving central Virginia.

There are over 2.2 million lives served by the Old Dominion EMS Area, of which our HELO_03
HELO_06
community is a part. Did you know trauma is the 5th leading cause of death for all ages and the leading cause of death for people under 44? Last year alone, Chippenham Hospital’s Emergency Department saw over 97,000 patients, 30,000 of them children (0-18) – more than anybody else in South Central Virginia. That’s why it’s so critical to ensure our region has the necessary trauma resources.

Chippenham’s Level II designation is an essential step towards ensuring our patients get the help they need as quickly as possible during the Golden Hour of trauma. This Golden Hour is the first 60 minutes after an initial injury and can often mean the DCIM100MEDIAdifference between life and death for trauma victims. With few exceptions, we can now care for all trauma patients at Chippenham Hospital. With our newly opened second helipad, renovated trauma bays, and clinical specialists added to our medical staff, we demonstrate our commitment to providing the best care for these patients during this critical time – and any time – during their continuum of care.

I would be remiss if I didn’t thank all of the partners that supported us on our quest to achieve our Level II trauma center designation. EMS, police, fire & rescue, community leaders, medical staff (in particular Dr. Raymond Makhoul and Dr. Scott Hickey who continue to lead our trauma teams), emergency department employees, Nancy Malhotra and our Trauma Services team, and so many more were pivotal to our success. Thank you for your ongoing support.

Setting the Stage for 2015

It is the beginning of a new year and, as always, there are lots of lists out there suggesting what we could do to better our lives. Most of them sound great when you read them but are often hard to apply to everyday life with any consistency. If you are like me, you are pretty good about it for a month or two but then slip into old habits and comfort zones. With that in mind, I was recently forwarded an interesting article by Paul C. Brunson from www.paulcbrunson.com titled 20 Successful Habits I Learned Working for Two Billionaires. Reading his list of habits struck a chord with me, so I thought I would share a few that have applicability to both the the work we do at Chippenham & Johnston-Willis Hospitals and in life. Paul’s perspective comes from working with billionaires Oprah Winfrey and Enver Yucel. Here are some of his tips with a few added comments which are largely self-explanatory but if practiced well would benefit us all:

  • Invest in yourself: It is critical to keep growing
  • Be curious…about everything: This curiosity will lead you to solve many problem
  •  Surround yourself with “better” people: Who you chose for your inner circle says a lot about you and keeps you both grounded and stretches you to do more
  • Never eat alone
  • Take responsibility for your losses
  • Take no days off completely
  • Focus on experiences vs. material possessions
  • Take enormous risks
  • Don’t go at it alone:Success isn’t a solo act.
  • Recognize the value of simple ideas
  • Be patiently impatient
  • Be gritty
  • Connect with people outside your community
  • Over-communicate your message
  • Learn to laugh at yourself
  • Be great at one thing, first

What ideas resonate with you for 2015?