Chicken Noodle Soup – A Patient’s Story

We talk lot about the importance of focusing on our mission of “providing high quality, compassionate patient-centered healthcare”. A different way to describe our mission is to keep our patients as our true north. This week I learned of one employee, Yvonne Cameron in our rehabilitation unit, who exemplified our mission in a big way.


Yvonne Cameron and her Director, John Miller

A patients had a hemorrhagic stroke and was with us for a long stay to recover. Our Johnston-Willis campus is one of only two hospitals in Virginia certified as a comprehensive stroke center. One of the service commitments we make to our patients is to have nursing leadership visit them every day. The goal is to ensure that everything is going well and to address any opportunities to better serve the patient. This particular patient shared the most memorable part of his stay was the day that he was craving chicken noodle soup. You can imagine being cooped up in a hospital and just wanting something as ordinary as chicken soup. Yvonne Cameron, a nurse tech, called the dietary department and ordered chicken noodle soup for him. When his soup arrived, he was somewhat disappointed as it was not exactly seasoned the way he would expect. He ate it anyway, however it was clearly not meeting his expectations that day. Yvonne saw the look of disappointment on his face and went home after working all day and made him homemade chicken noodle soup. The next day she surprised him with her mother’s special recipe. This patient described the compassion Yvonne showed as something he will always remember. This act of kindness isn’t something we could have ever asked for or scripted. It is something that just came from the heart. Yvonne shared “I used my mother’s recipe for the chicken noodle soup which she always made with lots of love. That’s just what we do on the rehab unit.”

So this week I tip my hat to Yvonne for Creating a Wow – a memorable experience when it was needed most. Great job!

Introducing The Snack Shack

SnackShack3Running a 24 hour operation like a hospital has plenty of challenges. One of those includes serving and connecting to the individuals who work through the evening and nights.

Throughout my time here, one of the most frequently received suggestions from night shift employees is to have more available food options between midnight and breakfast, when our cafeteria and food courts are normally closed. To address these concerns, and demonstrate how important your Voice is to us, we are piloting something new and exciting at Chippenham Hospital – The Snack Shack.

SnackShack2The Snack Shack is a “mini-market” that will be stocked with delicious fresh sandwiches, salads, and a variety of both healthy and indulgent snacks. It will have many beverage options, as well as standard “convenience” fare. The Snack Shack has an automated payment function via kiosk that allows you to pay with a credit card or to create an account using cash, and replenish that account as necessary. Our vending partners will be on site through the end of the week to assist with orientation and initial account setup.

SnackShack1The Snack Shack will certainly help meet the needs of our overnight team members, but will also be open 24/7 for any employee who would like to take advantage of its offerings. It is located on the 4th floor of the Levinson building just off the Levinson Lobby elevators. The area will have badge access security, and all staff members will be able to swipe in for access.

The Snack Shack is a great example of your Voice having a direct impact in making CJW a great place to work and care for patients. We hope that you will come check out The Snack Shack soon, and let us know your feedback as we assess bringing this idea to the Johnston-Willis Campus.

Dr. Buxton & the Future of Behavioral Health Services

Dr. Buxton

Dr. Buxton

This week, I sat down with Dr. Martin Buxton, chief of psychiatry and medical director of child & adolescent program at Chippenham Hospital’s Tucker Pavilion. The Pavilion is our 137 bed psychiatric hospital embedded within the Chippenham campus serving inpatient and outpatient patients as young 5 years old all the way through geriatrics adult services. Dr. Buxton and his psychiatric partners at Insight Physicians have been instrumental in leading the clinical services in the area of behavioral health in the Richmond market.

Tim: How long have you been at Chippenham Hospital’s Tucker Pavilion?

Dr. Buxton: I have worked at Chippenham for 20 years and been a child psychiatrist for almost 40. I came to Chippenham because they had an adolescent (13-17 years old) inpatient program and they wanted to expand it to child (5-12 years old).

Tim: Recently, there has been concern raised around behavioral health services both regionally and nationally. What is driving that change?

Dr. Buxton: The spotlight has been both positive and negative. Today, there is greater awareness of mental health wellness. Unfortunately, we often hear sound bites of both the problems and the answers and they don’t tell the whole truth of the story. With that being said, the number of high acuity complex cases has increased. I think in the past mental health issues were more hidden and not as broadly discussed or treated.

Tim: There has been a lot of public discussion about the increased use of psychiatric medication in both children and adults. Some people believe psychiatrist are pushing medications and not getting at the root of the issue. What is your take on the issue?

Dr. Buxton: The scientific evidence supports the increased use of medication in the population. Today we have better medications available than before. However, we still don’t have the quality of medications we need. The efficacy is very good but the significant side effects and tolerability still remains a challenge. On a positive note, we are able to use dual agent drugs that can impact multiple neurotransmitters. In effect this allows us the capability of dealing with multiple parts of the brain at one time with one medicine. There is some truth to the perception about the frequency of prescription writing in the field. However, part of what drives that perception is there are more non-physician therapist so the practicality of the need in the community has forced psychiatrist to write prescriptions and not to focus only on therapy.

Tim: Tucker Pavilion recently opened a state-of-the-art $5M Child and Adolescent unit and are about to open an intensive outpatient facility to serve children with acute mental health needs. Why was this important?

Dr. Buxton: We know there is an unmet need for children to stabilize acute psychiatric emergencies. By expanding the beds and constructing it in a way to meet the varied needs of the population we are able to have a greater impact in a setting that supports the latest evidence based treatment.

Tim: Your son Dr. David Buxton is joining your group, Insight Physicians, as a child and adolescent doctor in September. Tell me about that.

Dr. Buxton: It is more complex than I thought it would be. I am not just his father, I am a colleague. I always envisioned him becoming a physician and psychiatrist but I didn’t know he would join me. It expands our personal relationship and allows us come to understand each other better. At the same time, we have to see each other as colleagues and not father and son, it is an adjustment and needs to be no different from any other psychiatrist on staff.

Tim: We often talk about partnerships as being the key to the success. What your take on the CJW-Insight Physician partnership?

Dr. Buxton: It is a win-win. We are devoted to providing inpatient and outpatient psychiatric care and HCA is a system that has recognized the need for behavioral health outreach. Our goals are aligned. The open and collaborative dialogue has allowed us to improve together.

Tim: What keeps you up at night?

Dr. Buxton: Challenging patients keep me up many nights. I think about what I need to do to help specific patients get better. I often question whether I have run out of options. I feel like there are high expectations of my skills and abilities in the community and that can be a lot to live up to. I do better when people have never heard of me without expectations. I put additional pressure on myself to help when I hear from families that I am the last resort.

Tim: What is the biggest misconception about psychiatry?

Dr. Buxton: People often have a lack of understanding about behavioral health. Mental wellness isn’t usually a simple black or white issue but rather somewhere on a spectrum. What makes people healthier is understanding their particular challenges and customizing the care. Patient can’t operate under the notion that they don’t have any mental health issues. The reality is everyone has some degree of mental health challenges. The question is how incapacitated are they and how much do they want to expand themselves. There has historically been a lot of prejudice against mental health patients because people assume they aren’t affected. The opportunity for us is to gently educate the public that being healthy is like walking up a down escalator. If you don’t work at it you will continue to drift downward towards poor mental health.

Tim: I have been in your office and there is no couch to lie down on. Is that only in the movies?

Dr. Buxton: (laughs) I was psychoanalytically trained early in my career. At the time they used a couch. I have a small sofa in my office and sometimes patient arrive and wonder if they should lie down. I have to tell them we aren’t doing that kind of therapy. That is one helpful technique but it isn’t for everyone.

Tim: What is your vision and hope for Tucker in 10 years?

Dr. Buxton: To be the premier mental health site in Virginia and beyond. We have an extraordinary opportunity that is unmatched. With our recent expansion into outpatient care at Tucker we can do more than ever. There are very few sites with our current abilities and our future potential. I have had the opportunity to practice at nationally recognized elite psychiatric centers like Yale, University of Michigan, Medical College of Ohio, and NJ Medical School and have never seen as such a caring, competent staff with an eagerness to learn and stay updated and to try new innovative treatments.

Shark Week!

The-Great-White-Shark-000044158484_LargeI have an obsessed fascination with Shark Week on the Discovery Channel every year. My family knows that during this week I try to align family schedules to allow us to watch this marathon as much as possible. It is hard to believe that so many intriguing television shows can be created around one topic. I admit it makes me timid to go in the ocean, especially when you hear about the unusual flurry of attacks this year in North Carolina. I still don’t buy into the comment the expert always makes that sharks aren’t interested in humans. They insist it is a case of mistaken identity and that they would rather have a high fat seal. My take is that I enjoy eating a small Cornish game hen as much as I do a large plump turkey so why would a shark respond differently?

An aerial view of Chippenham Hospital

An aerial view of Chippenham Hospital

Johnston-Willis Hospital's emergency room entrance

Johnston-Willis Hospital’s emergency room entrance

The most interesting aspect to this year’s media stories has been the first responders and hospitals that cared for these patients in the emergency situation. While I understand that a shark attack is very rare, emergency care and trauma is not. This year we increased our Trauma levels at both Chippenham and Johnston-Willis Hospitals to best serve our community.  We forget how amazing emergency providers are who are on the ambulances and helicopters and in our ERs. Our hospitals have made great strides over the years to grow with the needs of our community. A few weeks ago I announced our construction of a new Emergency Room called Swift Creek ER on Hull Street in Midlothian. The clinical care done in our facilities is continually impressive. It could not be done without the talent of the entire care team.  We have seen 3,000 more patients in the first 6 months of 2015 compared to the same time period last year. That takes us to 69,000 patients in our ERs in the first 6 months. During that same period we experienced close to 1,000 more ambulance drop offs – a 9% increase. The CJW team has a lot be proud of in the care of these patients. Drs. Scott Hickey and Kevin Norieka, our medical directors, do an exceptional job ensuring the highest quality of care at our facilitators. Thank you to the whole team for helping make us a premier medical center.

2015 Employee Satisfaction Results

During the month of May, we conducted our annual employee engagement survey at Chippenham & Johnston-Willis Hospitals (CJW). 2,727 (87%) of our employees took the survey. I appreciate the high participation rate as it gives us an accurate and well-rounded picture for employees’ perception about CJW as a place to work. Our vision and goal is to be the employer of choice for healthcare in the Richmond Metropolitan area. We recognize we can only achieve this through continually listening to your feedback and making changes where appropriate to positively impact both the work environment and our patients’ well-being

There is much more work to be done, however the 2015 results showed improvement from the 2014 survey. We specifically focused efforts in three priority areas developed from last year’s survey results. Those targeted goals included:

  1. Improve employees’ ability to share their voice
  2. Improve senior leadership’s availability and approachability
  3. Improve employees’ perception of appropriateness of staffing and workload

Below are the CJW aggregate results from the survey. Each director has their respective departments results. Our expectation is that over July and August these are openly shared with all staff. The most important piece is that leaders work collaboratively with their department’s staff to prioritize their focus areas and build meaningful action steps to improve the work environment.


We will continue to utilize a number of different avenues to gather your feedback including, but not limited to, CEO town hall meetings, senior leadership departmental rounds, staff meetings, huddles, employee focus groups, the blog, and the “Ask Tim” link on the intranet.

I appreciate your participation in the survey and look forward to working collaboratively to make CJW an exceptional place to work.

Taking Stock after the Tragedy in South Carolina

This week headlines were focused on the devastating massacre in Charleston, SC. Nine innocent people were killed at the hands of young psychotic man named Dylann Storm Roof. My heart goes out to those families and the community that will forever be impacted by his senseless act. There was, understandably, no shortage of media coverage on the tragedy. What stood out most in the stories from the major networks and newspapers were the ones that shared the victims’ individual stories. There are powerful teaching moments to be gleaned from the fallen victims who made a substantial impact both within their close knit families and the broader Emanuel African Methodist Episcopal Church. What resonates with me is the pervasive message of resilience and determination from the community to not only reflect and understand, but also, perhaps most importantly, to heal and move forward. It was a great reminder of the importance of surrounding ourselves with loved ones who we share deep personal connections through the best and the worst of times. It ultimately comes back to a focus on building and maintaining a strong culture.

I have the great honor and opportunity to see how a strong culture directly impacts patients in need every day at Chippenham & Johnston-Willis Hospitals (CJW). Most hospitals across the country have skilled clinicians and support teams that care for their patients, but not every hospital has a strong culture that binds the associates together in a meaningful way to deal with the most adverse situations. I am convinced that competent clinical skills are not enough without a strong and vibrant culture. The positive impact on our patients and their families is born from a supportive and healing culture of 3,000+ employees finding common bonds and a shared purpose for helping patients during their crisis.

In recent months we have been talking about our six core beliefs of simplify and focusing on what matters, living excellence every day, shattering silos to do what needs to be done, creating wow so patients remember us, owning the challenges until they are surmounted, and deciding what needs to be done and not waiting for permission. I am proud to see how CJW’s culture, which is created and owned by our employees, exemplifies those core values. The events this week in Charleston are another reminder that putting family first is a critical imperative for us all. Most of us think not only of our blood relatives as family, but also our work family, who we often spend more waking hours with each day. It is our culture that enables patients to heal when it is possible or pass with respect and dignity when it is not.

Thank you for what you do to make CJW a special place in our community.

Expanding Emergency Services: Swift Creek ER

214023 Hancock Village 3 214023 Hancock Village 1 214023 Hancock Village 2This week we finalized the purchase of land on Hull Street/Rt. 360 for our new Freestanding Emergency Room to be named Swift Creek ER. We intend to immediately start construction on the 11 bed state-of-the-art facility in the next few weeks. The location is directly in front of Hobby Lobby (outside Rt. 288) where the Swift Creek reservoir crosses Hull Street. The 10,000 square foot center will include a traditional Adult ER, a dedicated Pediatric ER with separate entrance and waiting, state of the art CT scanner, behavioral health capabilities, and tele-medicine linkage to Chippenham & Johnston-Willis Hospitals (CJW). We expect the center to open shortly after the New Year in 2016. This location is important as it sits in the middle of one of the fastest growing areas of the greater Richmond metropolitan region. This service means that emergency care, when minutes often make a difference to clinical outcomes, will be closer to home. These patients can rest assured that, should they need hospital admissions, they can be immediately linked into one of our two campuses at CJW. Swift Creek ER will always be staffed by board-certified emergency medicine providers 24 hours a day, every day of the year.