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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Security and the Healthy Work Environment

At Chippenham & Johnston-Willis Hospitals, we are committed to providing a safe and secure environment to all members of the hospital community. The primary goal is to improve personal safety and security for anyone in our buildings through training, cameras, panic buttons, and access control to the facilities.

During the recent employee satisfaction survey, we asked questions about security to help us guide future steps to make our employees, patients, and visitors feel safe on our campuses. We are reviewing your feedback and making plans to address areas you identified. I want to share with you some important security upgrades that have been implemented in our two facilities in the recent months.

Emergency Phones

We installed emergency phones at both hospitals. At Chippenham Hospital, new emergency phone boxes can be found in the parking lots and deck. These visible “blue light” stations ring directly to the hospital switchboard as soon as someone pushes the emergency button. The blue light activates and a Security Officer is dispatched directly to the location by the switchboard operator. Johnston-Willis Hospital has added red emergency phones at the main entrance, loading dock, Thomas John’s Cancer Hospital front entrance, Surgery Center entrance, and Atrium entrance. 16 additional panic buttons were also added to the duress alarm system at Chippenham.

Video Surveillance Cameras:

The ability for Security Officers to view and retrieve camera information has also been greatly enhanced by adding a new digital Closed Circuit TV (CCTV) system. Digital CCTV allows for faster retrieval of information should a situation occur. Additional cameras were also added to bring the total numbers of recorded cameras to over 260 throughout the hospitals.

Card Access Panels:

We are in the process of implementing card access panels to replace keypad locks in many areas of the hospitals. These card access locks have been installed at Chippenham Hospital in Post-Partum, NICU, Pediatrics, and Labor and Delivery and are in process of being installed at Tucker, the Operating Rooms, ICU areas, the Emergency Department, and additional exterior doors.

Infant Security:

Security enhancements were added for the littlest ones we care for at Chippenham and Johnston-Willis Hospitals. A new state of the art Infant Abduction Prevention System was installed at both facilities to keep our babies safe.

Police:

We currently have round-the-clock police officers at both campuses. With the addition of the Tucker Crisis Triage Center in 2013, an additional employed police officer was added from 2 PM until Midnight, 7 days a week at Chippenham.

New security equipment will enhance the healthy work environment at Chippenham & Johnston-Willis Hospitals. But the most important part of any security program involves people much more than equipment. We can’t continue to improve the safety and security of our work environment without partnering with every employee at Chippenham & Johnston-Willis. Please report any security related events, including close calls, as soon as you can so they may be investigated. Together, we can continue to improve the safety and security of our hospital and provide a healthy work environment for everyone.

If you have additional ideas for security enhancements, please contact Mike Beshada at (804) 323-8754 or by email at mike.beshada@hcahealthcare.com.

Your Feedback Matters

Throughout May, 90% of our employees responded to the 2014 annual employee engagement/satisfaction survey. The confidential survey focused on 7 key areas: Leadership, Staffing, Voice, Rewards, Culture, Quality, and Outcomes.

Each department leader has the results of their respective departments and will be sharing those at staff meetings. This will allow you to see exactly your department perception in each of the care areas. We have asked department leadership fully engage staff collaboratively to develop action plans to improve the work experience at Chippenham and Johnston Willis Hospitals.

Today I want to share the high level hospital-wide results. While there were improvements in six of the seven major categories, there is still a lot of work to be done to take CJW to the next level and consistently exceed the expectations of our associates. While overall engagement improved 2% from last year’s survey, the results also showed opportunities for improvement regarding perception of senior leadership’s availability and approachability.  We are in the process of developing specific actions plans to improve in these two areas. Once these plans are finalized, I will be sending a letter to your home outlining the specific steps being taken to improve our workplace.

Based on your feedback here is the high level summary of employee perceptions of the top strengths and opportunities.

Top Strengths

People in my work group demonstrate the skills needed to meet patient/customer expectations.

My work gives me a feeling of personal accomplishment.

My supervisor shows a sincere interest in me as a person, not just as an employee.

Top Opportunities

We have enough people in my work group to handle the workload.

I believe actions were taken as a result of the last employee survey.

I am satisfied with the amount of voice I have in the decisions that affect my work.

 Below you will see the results of the top 5 drivers of engagement which compare 2013 to 2014.

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Our goal is to be the hospital employer of choice in Richmond by providing an environment that supports our mission of high quality, patient-centered healthcare. I look forward to sharing more details of the survey results along with our plans to continually learn and improve. I appreciate your willingness to participate in continued open dialogue with the leadership team regarding your satisfaction with employment at CJW. I am confident that this will help us find meaningful and lasting solutions to support a great culture in our organization.

Field of Dreams

You can’t watch the news without seeing another grim story on the declining healthy eating habits in our country. It is a crisis in every sector of our culture regardless of age, socioeconomic background, ethnicity, gender, and geographic location. So a year ago we decided to take active steps to make a difference. Chippenham Hospital partnered with Greg Riggs (more affectionately known as Farmer Greg), a local farmer who provides a mobile market to our hospital every Friday, 11:00AM to 5:00PM, near the cafeteria. The market sells everything that is seasonally available. Farmer Greg prides himself on selling fruits and vegetables from the field to his customers within 48 hours of being picked. He grows much of the product at his farm called Field of Dreams and also coordinates with other local growers for additional product.

Farmer Greg working in his farm, Field of Dreams

Farmer Greg working in his farm, Field of Dreams

I sat down with him to better understand what motivated him to start this business. He shared that he believes if people have a local source of good healthy food, they will lose weight and be less sick. Statistics also show that if companies can promote good nutrition, not only will the employee benefit, but so will the company through reduction of health insurance claims and a drop in absenteeism. Six years ago the Center for Disease Control (CDC) came out with a report that said for the first time ever younger generations will live shorter lives than their parents based on the lack of healthy lifestyles which have caused a spike in diabetes, obesity, and other poor nutrition driven illnesses.

At the time, Farmer Greg worked at Microsoft as a systems integration network provider but he felt a calling to do something about this crisis. He called the CDC to learn what he could do to impact change in our community. They told him about a program called Farm to School which had the goal of not only feeding school-age children better, fresher food but also teaching them the importance of a healthy diet.

Farmer Greg began his farm on a 3 acre lot and produced over 2,000 plants including tomatoes, peppers, cantaloupes, and watermelons among many other items. He then sold them to the Henrico County schools and provided educational talks about farming, fruits, and vegetables to elementary kids. Farmer Greg went on to open a series of 5 day camps called CHEF (Culinary Health Exercise and Farming) for ages 6-14. This summer he has over 150 kids learning about gardening and healthy living. He built a 150’ X 50’ garden for the camp which includes actively growing plants for harvesting and empty space for planting new seeds and seedlings. He teaches how to creatively use every day trash to create a vegetable garden such as a discarded tire, the shelf of a bureau, or an old pot. At the camp they also learn to pick their own food, cook it with one of many recipes they study through the week, and then cap off the week with a formal luncheon prepared for their parents. He shared with me that there is an “Ah ha” moment for many of the young kids where they learn the importance of farm-to-table. He is proud that 60% of the campers come back the next year and he knows when he teaches these important lessons, the kids will put pressure on their parents to grow some of their own food.

Because of his success, the CDC asked him to speak to a breakout session on the Farm to School program which was originally created by the USDA and Department of Agriculture to get more local fresh foods in the schools.

In 2013, Farmer Greg built an herb garden next to Chippenham Hospital’s Cafeteria which helps supply fresh herbs to the kitchen including oregano, dill, parsley, cilantro, and thyme. He is excited about the farmer’s market at Chippenham and knows that his loyal core of hospital employee customers miss him when he is not there because they appreciate the variety, especially in the summer.

Farmer Greg & Peg Peebles at the Chippenham Farmer's Market

Farmer Greg & Peg Peebles at the Chippenham Farmer’s Market

To learn more about Farmer Greg’s Field of Dreams Farm, you can visit his website http://www.fodfarm.com . But, for now, please be sure to show your support for his product by visiting him any Friday near the Chippenham cafeteria.

What ideas do you have for expanding our health lifestyle options at CJW?

Top 10 Most Interesting Facts about the 4th of July

Lately, I have been writing the blog about some serious topics. I thought I would take a break and share the most interesting facts I found about the 4th of July holiday. So through the magic and convenience of the internet, here is what I found most fascinating:

1. America didn’t declare its independence on the Fourth of July1

Perhaps the greatest misconception of this holiday lies in the name and its equally iconic date. The true “Independence Day” depends on your definition of when such an official declaration was made. It’s widely believed that America’s first Continental Congress declared their independence from the British monarchy on July 4th, 1776. However, the official vote actually took place two days before and the “Declaration” was published in the newspapers on July 4th. Which leads us to #2 on the list.

2. John Adams thought ‘the Second of July’ would become Independence Day1

John Adams, a Founding Father and future president, wrote to his wife, Abigail, about the events that led to the nation’s founding. In one, he famously predicted, “The Second Day of July 1776, will be the most memorable Epocha, in the History of America.”

3. The Declaration of Independence wasn’t fully signed on the Fourth of July1

Declaration of Independence, John Trumbull

Declaration of Independence by John Trumbull

Another misconception is that when the vote was made official, everyone signed it at that time – a moment that’s often portrayed in popular paintings. However, it took an entire month to get all 56 delegates together to put their “John Hancock” on the document. In fact, the only person to sign the document on July 4th was also its first signer: John Hancock.

 

4. Three successive presidents died on the Fourth of July1, 2

US Presidents, and Founding Fathers, Thomas Jefferson and John Adams passed away on July 4th. The even more amazing coincidence is that both died on the same day in the same year of 1826 by a difference of five hours with Jefferson passing first at age 82 and Adams at age 90. Our fifth president, James Monroe, died a few years later on the Fourth in 1831.

30th President, Calvin Coolidge

30th President, Calvin Coolidge

5. Calvin Coolidge was born on the Fourth of July2

Calvin Coolidge, the 30th president, was born in 1872 on the Fourth of July in Plymouth Notch, Vermont. Malia Obama, our current president’s eldest, was also born on July 4, 1998.

6. The Fourth of July was originally celebrated with a lot of greenery instead of red, white and blue1

Fourth of July celebrations these days are filled with fireworks, clothes and ornaments covered in red, white and blue. Such colors weren’t widely available for decoration in the shadow of the nation’s birth, especially in the heat of battle during the Revolutionary War. The first few Independence Day celebrations used greenery as decorations instead. They also fired artillery used in battles following the completion of the war for the Fourth of July, but the practice waned as cannons fell apart and were slowly replaced with fireworks.

7. The USA isn’t the only country to celebrate our independence2

Even though the Fourth of July is America’s birthday, we’re not the only ones who celebrate it. Denmark began celebrating our Independence Day in 1912 after thousands of Danes immigrated to the USA. Thousands of Danish Americans and U.S. military personnel stationed in Europe celebrate Independence Day at the annual outdoor festival in Rebild, Denmark. The Danish tourism office bills it as the largest Fourth of July celebration outside the United States.

8. A country gained its independence from the US on the Fourth of July3

In 1946, on July 4th, the Philippines gained their full independence from the United States through the Treaty of Manila. However, they celebrate their Independence Day on June 12th which is when they gained independence from Spain in 1898.

9. The song ‘God Bless America’ stayed in Irving Berlin’s rejection pile for 20 years1

Irving Berlin was drafted into the military in the early 1900s and helped to draft a musical comedy for his fellow troops in which he composed the song for its final number — a tune inspired by a phrase his Russian mother would often utter after escaping to America from underneath the iron fist of the bloody Russian empire. However, the composer didn’t think it would fit in the show and kept it in his file for 20 years until singer Kate Smith wanted a patriotic song to sing on the radio as war broke out across Europe. The song became one of the most requested patriotic ditties almost overnight and a staple in American songbooks.

The flag of the United States of America

The flag of the United States of America

10. The modern flag was designed by a high school student as part of a class project1

High school student Robert G. Heft of Lancaster, Ohio was assigned to create a new “national banner” for America that would recognize the statehood of Alaska and Hawaii. Heft simply added two extra stars to the flag to give it an even 50 and stitched his own design. His teacher only gave him a “B-minus” for his effort, so he sent his project to President Dwight D. Eisenhower for consideration and a change of grade. Eisenhower chose his design personally and the new flag was officially adopted in 1960. His teacher changed his grade to an “A”.

I hope you all have some time to spend time with your family and friends at some point this holiday weekend. Be safe.

 

Read more interesting facts about the Fourth of July:

110 Things You Didn’t Know About the Fourth of July | http://thefw.com/things-about-fourth-of-july/

2 Nine Things You Never Knew About the Fourth of July | http://abcnews.go.com/Politics/OTUS/things-fourth-july/story?id=16707033#.T_R-JBxYizB

3 http://en.wikipedia.org/wiki/Independence_Day_(Philippines)

Anthem, Bon Secours, & HCA

If you are a reader of the newspaper in Richmond or are associated with the healthcare field, you have likely heard about the very public contract dispute between Anthem Blue Cross/Blue Shield and the Bon Secours Health System. Negotiations between health insurance companies and hospitals are usual and customary to establish payment rates. However, in my career I have not seen such a public breakdown in negotiations as is occurring now in our community. It strikes me as an important issue to give my perspective.

The Richmond Times-Dispatch and others have reported that Bon Secours is terminating their Anthem contract effective November 7, 2014. Bon Secours’s leadership communicated this termination to all of the physicians that practice in their hospitals. This includes many doctors that also work at HCA hospitals in Richmond. The net impact of the termination is that Anthem patients will not be covered as “in network” if they seek care in one of Bon Secours’s four Richmond-based hospitals, their ancillary services, or their associated employed physicians. This has very significant financial implications and out-of-pocket costs to these patients.

The dialogue that has come to light has brought to question appropriateness and comparability of Bon Secours’s billing practices and payment rates. Through this negotiation, it appears that Bon Secours’s contracted rates are some of the most expensive in Virginia for outpatient services. At the same time their facilities have some of the highest average profit margins in the region. It is important to note that Bon Secours’s leadership suggests that by not getting rate increases from Anthem their financial future and their ability to provide care to those who need it most will be threatened. According to Virginia Health Information 2013 Industry Report, HCA’s Chippenham & Johnston-Willis Hospitals (CJW) and Henrico Doctors’ Hospitals each provide more charity care than Bon Secours’s largest facility, St. Mary’s Hospital.  In addition, HCA Virginia’s hospitals are the only for-profit or tax paying entities in Richmond which, in CJW’s case, means over $14 million was paid to the region and state last year.

HCA Virginia is proud to have a long-standing, strong, and stable relationship with Anthem and their patient base. We are confident and committed to providing uninterrupted coverage for the patients impacted by Bon Secours’s termination of their Anthem contract in our facilities. HCA Virginia takes pride in being the largest provider of health care services in the Richmond region serving more inpatients than any other health system. We can, and will, do more to serve all the needs of our community.

Part of the frustration communicated by Bon Secours’s leadership is that in 2013 it was announced that HCA Virginia would be the preferred provider for the Anthem patient covered under the Health Care exchange otherwise known as the Affordable Care Act (or “Obamacare”). This is notable because it is strong evidence of appropriate cost and high quality outcomes in our facilities. Our hospitals are committed to working with Anthem in finding ways to improve quality, lower cost, and provide value to patients and physicians. We score very highly on Anthem’s quality program called QHIP which evaluates hospitals based on patient safety, health outcomes, and patient satisfaction.

I encourage you to stay informed on this important issue and, most importantly, ask that Anthem patients give us the opportunity to show you what we mean when we say, “Our Patients. Our Priority.” We look forward to the opportunity to serve the healthcare needs of our community whenever that care is needed.

Unexpected Tragedy

Richard and his son, Little Rich

All of our jobs are, in one way or another, about preserving life. Often the work focuses on healing the sick. Unfortunately, there are times where the focus changes to preserving the dignity for those whose illness cannot be overcome. These occasions usually allow us time to plan for the loss. This week we weren’t given the luxury of time to plan for the passing of one of our own.

Richard Knowles was a 28 year old young man with a bright future. He worked in our Information Technology department since 2011 as a Service Desk Analyst. Most recently, he was also actively working towards his Master Degree in Information Systems with a goal of graduating in spring of 2015. He unquestionably had the promise of a great career with HCA. Unfortunately, Richard suddenly passed away this weekend while playing flag football with friends. His death is one of those occurrences that you would never expect as, by all public indications, he had a long life ahead of him.

Richard was also the primary caregiver to an 8 month old boy affectionately known as “Little Rich,” who carries on his name as the third generation. He took great pride in his role as a father.

Richard’s boss Jared Mabry shared it best when he wrote, “For those that hadn’t had the opportunity to meet him, Rich had an infectious smile and air of positivity that impacted every person he came in contact with. Rich’s positive nature and passion for life were an inspiration to all who knew him. Rich was a fierce friend, a devoted father, a trusted colleague, and above all else, Rich was a fantastic human being. “

His passing affects so many on our team and in our community. The grief felt brings up the uncomfortable discussion of how to cope with such tragedy.  We all know stress is a part of living but times like this call for extra support. As an HCA employee, we have resources to help with any crisis through our Employee Assistance Program (EAP). EAP can be contacted by calling 800-434-5100.

These programs are designed to assess the crisis, educate on techniques for dealing with the event, provide short term counseling and referrals where needed, and establish long-term support plans. I encourage you to take advantage of these services for tragedies like Richard’s passing or other crises you experience in life. No one who is exposed to sudden loss is untouched and we all cope and grieve in our own way. Please know that, as both colleagues and friends, our teams are here to support you in every way possible.

Richard’s passing is a great loss to our Chippenham & Johnston-Willis Hospital family. We will be holding a special memorial service at Chippenham at 2:30Pm today (June 12). Please feel free to share your memories or thoughts about Richard here as replies to the blog.