Caller-Outer of the Month Award #9

Our Board of Directors awarded this month's caller-outer award to Tinea Simpson, Practice Representative in our GI department.

GI staffers on Tinea's floors are practicing a “Leaner” way to conduct their day to day business thanks to her call-out, and the resulting reorganization that came from her work with Resource Nurses Mary Ellen Johnson and Christine Hunt.

As you may know, there is a patient packet for every procedure that happens in a hospital. For the past several years BIDMC volunteers have assembled these packets covering the entire demand of our GI unit – over 100 procedures a day.

As medical practices are revised and forms become obsolete or go unused, the end result can be a tremendous waste of paper and money. These three women evaluated the situation, decided what forms were necessary and what were not, and with the help of Volunteer Services, took action to correct the packets and reduce the use of hundreds of forms.

They created a path of action to include creating new sample packets for volunteers to follow and purging forms that were no longer warranted. Congratulations to Tinea for demonstrating the concept that each person should feel encouraged and empowered to recognize and go about seeking solutions to inefficiency and waste that he or she sees in the workplace.

Translation Service

A friend sent me this training page that appears to be from the SEIU. The link to the website from which it was obtained is disabled. Maybe someone from the union can point us to the document's new location. Maybe not. It was entitled, "For internal use only -- Not for distribution."

Veterans Day Thanks

An idea we have adopted for Veterans Day. Have you considered a similar thing for your hospital?

To: BIDMC Community

From: Paul Levy, President and CEO

Eric Buehrens, Chief Operating Officer and Executive Vice President

Subject: Veterans’ Day Thanks

BIDMC pays tribute to those who serve our country through military service.

It is our privilege to say, “Thank You,” to the many employees who are among the 24 million living American veterans – as well as the numerous staff and family members who are on active duty now. We appreciate their service and honor them for their sacrifices.

Tomorrow, Veterans Day (Wednesday Nov. 11, 2009) employee veterans and United States Armed Forces active duty personnel will receive a free meal (breakfast, lunch or dinner) in the east or west campus cafeterias. Just present your BIDMC ID badge and let the cashier know you are a veteran or active duty personnel member.

Also, if you would like to have a prayer offered for any veteran or active duty member of the military, please send the name and details you wish to include to either the Pastoral Care mailbox (select Pastoral Care from the dropdown menu in the “To” field of the e-mail) or directly to Rev. Julia Dunbar, Director, Pastoral Care and Education, at [email excluded here].

Next month: Helping The Borum

Thanks to those of you who visited my auction site to support the Bowdoin Street Health Center, whether you chose to bid or not. Next month's auction, starting December 1, will benefit the Sidney Borum Jr. Health Center.

I have already received some great auction items, including many that are just right for holiday gifts -- whether you live here in Boston or anywhere in the world. Visit the auction before you go to the mall!

Located at 130 Boylston St, across from the Boston Common, the Sidney Borum Jr. Health Center opened in 1994 to serve the health care needs of homeless youth and young adults, many of whom engage in unsafe sex with adults in exchange for money, food or a place to sleep.

The Borum provides primary medical care as well as mental health and substance abuse counseling, HIV counseling, testing and risk reduction reinforcement, as well as other clinical and social services. Its primary focus is on young people who have been unable to gain acceptance in more traditional health care settings for a variety of reasons, including homelessness and involvement in street life and the sex industry.

Through the online auction on this blog, The Borum seeks support for its linen service and grooming/hygiene products that help patients live with the dignity they deserve.

Please donate items at any time and stay tuned here for the latest auction details.

Bourbon, neat

OK, I have to admit that not all of the time in Lexington, Kentucky (see below) was spent on health care issues, unless we consider bourbon a therapeutic substance. I had a little time to visit the Bourbon Trail with some friends, and we toured the Four Roses distillery. Here is a picture of our tour guide offering samples and a video of the fermenting mash.

With the Wildcats

I just attended a session run by the University of Kentucky's Program for Quality, Safety & Patient Rights in the Center for Enterprise Quality and Safety. The director of the program is Dr. Joe Conigliaro, who related stories of meeting Bostonians during his matriculation at Harvard Medical School. "How's your brother/cousin?" he would be asked, even though he was not related to Tony.

But that's not the main point of this post. UK, in cooperation with the Lexington Veterans Administration, has a keen interest in patient safety. My role in the morning plenary session was to lay out legal, ethical, and practical implications of disclosing adverse events. Participants then attended concurrent sessions, one on transparency and disclosure evaluation through incident reporting, and the other on historical perspectives on transparency and disclosure.

My last event of the day was a panel discussion on these topics with: Dr. Steven Kraman, Vice Chairman of Internal Medicine at UK College of Medicine and Margaret Pisacano, Director of Risk Management (seen above). Unfortunately, I had to leave before hearing from State Representative Tom Burch, who I am sure gave an insightful perspective from the public policy point of view.

It is so satisfying to be with advocates and practitioners of patient quality and safety and to learn from one another's experiences. Wait, did I tell you they have a blog, too! It is hosted by Ann Smith, chief administrative officer at UK Albert B. Chandler Hospital, and jointly written with some of her colleagues. Please check it out and submit comments.

Tempus fugit

Just 15 more hours left to bid on great items and services at my auction to benefit Bowdoin Street Health Center.

Hybrid Vigor, or Heterosis to you

I am extremely fond of many of our staff, but Dr. Rafael Campo is near the top of my list. He is an excellent physician . . . and poet . . . but also head our Office of Multicultural Affairs. He has written a credo for this office, and I wanted to share part of it with you. I cannot think of a better way to explain the importance of diversity and inclusiveness in a hospital setting. I also love the way he stretches the use of a term from another field, "hybrid vigor," as a metaphor for what we hope to accomplish. See what you think.

The Office of Multicultural Affairs . . . is an embodiment of BIDMC’s belief that the best possible medical community is one in which the maximum diversity and inclusiveness is found. We believe that the best research and medical care occurs in a context where differences are highly valued; that "hybrid vigor" is not just relevant but fundamental to the structure and optimal functioning of human groups. We do not advocate a sublimation of our differences, however. Our inherent tendency to cluster into our group identities is also essential to the preservation and nurturing of each of our unique cultures. Multiculturalism is the search for an appreciation of the richness gained by the co-existence and mutual respect of our differences, as well as an acknowledgment and embrace of our similarities. We feel that these values are essential to the development of outstanding physicians and the delivery of extraordinary patient care.

Monique exclusively for you

The last time Monique Doyle Spencer gave a talk at a corporate retreat, the CEO reported that it was the single most motivational event in all of his years with the company. She has donated her time for a session for your company or civic organization to my online auction to benefit Bowdoin Street Health Center.

Here's some background:

Spencer believes in humor as a powerful force in restoring the human spirit under any conditions. She is a three-time cancer survivor who has used laughter to reach wide audiences, to teach people how to survive and even thrive under challenges. Whether the audience has been women in prison, business groups, firefighters, cancer patients or grieving spouses, Spencer’s unique approach has inspired countless people to find their personal courage and restore joy in their lives.

Spencer is a contributing columnist to the Boston Globe. Her Globe columns also appear on NYTimes.com and in the International Herald Tribune. She is author of The Courage Muscle: A Chicken’s Guide to Living With Breast Cancer; and How Can I Help? Everyday Ways to Help Your Loved Ones Live with Cancer. Her third book, The Real Life Body Book, will be available in March, 2010.

Rational choice?

I'm trained as an economist, and I understand the theory of comparative advantage, but I still have not figured out how the world's economic system makes it possible for this bottle of water to find its way from Fiji to Boston, a distance of about 8000 miles. It is not just the water, it is the plastic bottle, which is either manufactured somewhere and imported to Fiji, or the raw ingredients of which have to be imported to Fiji and made into a bottle there. Then, the bottle and the water both have to be shipped around the world to this market.

But what I really don't understand is why anyone would buy this water. (I acquired this bottle at a hotel in Boston, where I was attending a conference. Do they really think that we make choices about hotels based on which bottled water is served?)

A 24-pack of the Fiji 500 ml bottle weighs 27 pounds and costs $38.00 on this website. That's 12 liters for $38.00, or over $3 per liter.

A comparable pack of San Pelligrino from Italy costs $26.00, or a little over $2 per liter.

Poland Spring water from Maine costs $7.49 per pack, or less than $1 per liter.

Tap water in Boston costs $6.oo per 1000 gallons, which is roughly 3780 liters, for a price of .16 cent per liter.

Another part of economics is the theory of rational choice, which basically says that people consider the costs and benefits of their actions before making purchases or taking other economic steps.

Right.

Tired?

Direct Tire offers a service package (including oil and filter change, tire rotation, and more at any of its locations (Watertown, Norwood, Peabody and Natick) in my online auction to benefit Bowdoin Street Health Center.

Sleepy, too? Maybe you have guests coming to town? Don't forget to bid on an overnight at the Courtyard by Marriott in Cambridge.

Spreading the word to CEOs on transparency

The VHA Foundation is a 501(c)(3) that aims to improve individual and community health by promoting and diffusing new, effective models of health care. It has a program called the Health Care Safety Network for hospital CEOs to help them accelerate their patient safety leadership skills in an environment where they can learn from their peers and national safety experts.

I had a pleasant visit last week from Dr. Peggy Naas, vice president and leader of Physician Strategies for VHA. She was in my office to tape a session about BIDMC's efforts to improve the safety and quality of patient care, with a particular emphasis on our view of the importance of transparency as a management tool in this journey. This video will be shared with the CEOs in the Health Care Safety Network.

I hope our experience proves useful to my colleagues and that it will make them feel more comfortable in sharing their clinical outcomes and process improvement successes and failures with others.

Sweet tooth?

Cookies, gelato and more at my auction to benefit Bowdoin Street Health Center, courtesy of Dancing Bear Baking Company and Giovanna Gelato.

Great dance

A new auction item has just come in, a dance performance by the Trey McIntyre Project at the ICA theatre on Friday, November 20. It is courtesy of World Music/CRASHarts and is available here at my auction to benefit Bowdoin Street Health Center.

Cooley-Dickinson vanquishes VAP

About a year ago, I wrote about the great progress made by Cooley-Dickinson Hospital in Northhampton, MA with regard to eliminating ventilator associated pneumonia. I now hear from Daniel J. Barrieau, RRT, CPFT, Director of Respiratory Care Service, that "we are now counting our time between incidences of Ventilator Associated Pneumonia in YEARS instead of days. This week we passed the 2 year mark and took a moment to celebrate the milestone. Here is a pic of the cake. . ."

Congratulations!

Zip-a-Dee-Doo-Dah

Find custom made jewelry made from zippers! Really. Courtesy of ZipBling's owner and designer, Louise Loewenstein. Check out my auction to benefit Bowdoin Street Health Center.

Working with a family advisory council

The concept of patient and family advisory boards to hospitals is gaining currency. The idea is to integrate the perspective of patients and families into decisions about clinical practices, space, priorities, and the like. We have had a Family Advisory Board for our Neonatal Intensive Care Unit (NICU) for some time. Here is its mission statement:

The mission of the BIDMC NICU Advisory Board is to touch the lives of each NICU family in a positive and lasting way. Our goal is to complement the NICU's outstanding clinical care and embrace the hospital's commitment to Family-Centered Care with programs and initiatives that acknowledge and support the family in a time of crisis, and to extend the relationship between the family and hospital well beyond discharge. The NICU Advisory Board will support this mission through representative feedback on existing and future programs, facility and policy enhancement, staff/family relations, development and fundraising, and other issues related to the needs of NICU families.

If you are going to create an advisory body like this, you need to share key information with them. I am showing here a few slides of a presentation delivered yesterday by Dr. DeWayne Pursley, chief of service. Among other things, the presentations contained a full exposition of progress on the metrics by which the NICU judges its success with regard to family interactions, along with a statement of initiatives in the various dimensions of care. This kind of transparency leads to a greater sense of involvement, and it also prompts discussions that often lead to good ideas.

In a post below, I wrote about some recent success in our adult ICUs. That success was dependent on involvement by a similar patient and family advisory council. Our experience with the NICU council helped us design the adult council, but it also gave the medical staff some confidence that the effort involved in creating and meeting with the council would be worth the effort. Clinicians and hospital administrators are often skeptical on this point. Let's hope that such skepticism gradually erodes as the good work of these councils becomes more widely known.

Feeling the need to wine?

A limited edition, new California wine from Je Suis is available at my auction to benefit Bowdoin Street Health Center.

Help for migraines

Here's a short and excellent discussion about migraine headaches on the FOX25 Morning News with Dr. Carolyn Bernstein, a headache expert with BIDMC's Arnold Pain Management Center. She is the author of The Migraine Brain: Your Breakthrough Guide to Fewer Headaches and Better Health.

Need inspiration?

Planning a meeting for your company or civic club? Hire one of three great inspirational and informative speakers at my auction to benefit Bowdoin Street Health Center. Look under "Unique Experiences."