Initial Recipients of the CPMC QD Frilly Toothpick Award

Last week, as part of our Quality Delivery (QD) System, we presented CPMC’s first Frilly Toothpick Awards to four sets of recipients. The award honors contributions that improve quality, safety, or flow at CPMC.  It’s named for those cute but useful toothpicks with the cellophane frills that are placed in sandwich halves (or quarters). Frilly toothpicks have two functions: one, to hold the sandwich pieces together, and two, to warn you that there’s a sharp piece of wood in the bread, so you don’t accidentally bite through and puncture your palate. Plus they make an ordinary toothpick a bit more attractive. Simple but effective.

Frilly Toothpicks

Ben Gover, from Materials Management, received an award for his plan for rerouting delivery trucks from the Sutter West Bay distribution center to save mileage and fuel. He’s already been honored by CPMC’s Green Team, so this is kind of like winning both a Golden Globe award and an Oscar. (I’m using “kind of” pretty loosely, Ben.)

Janet Leung, Jann Jeung, and Bonnie Jacobsen-Lee of the Transplant Clinic  devised a simple flag system placed on the door jamb of the patient rooms in the clinic that indicate at a glance whether the patient is an room ready to see a doctor or a medical assistant. That way, the staff can tell what’s needed without having to walk down the hall, knock on the door, see who’s in there, etc.

Tom Peitz of the Pacific Emergency Department was recognized for his blue card scamper solution. ED staff could never find the blue patient cards they need to stamp papers and slips. Tom attached a little plastic doo-dad to the back of the patient clipboard, so the card was always nearby.

Finally, Bud Schawl of Support Services and Allan Pont (VPMA) were honored for developing the “phone for a ride” system for the Clay Street hill on the Pacific campus. Phones at the bottom and top of the hill can be used to notify security to send a CPMC golf cart for patients who can’t make it up (or down) the hill to get to their doctor’s office.

Congratulations to our winners. If you’ve got other ideas, let me know; the next round of awards is coming soon !

Could The World Cup Help Us Reach Other Goals

Like many of you, I’ve spent a good deal of time the past few weeks watching the World Cup.  I caved in and got a DVR so I could record the games to watch in the evenings, warning people all day long not to tell me the scores.  I had a few favorite players (Michael Bradley, the U.S. coach’s son; Diego Forlán of Uruguay).  And I enjoyed listening to the ESPN announcers, whose pithy phrases and exotic accents made the usual sports commentary seem loud and pointless.

Soccer and Americans

Americans, of course, are notorious for our relative lack of interest in soccer.  We moan about the flopping, the lack of scoring, the shirt- and shorts-pulling, and the apparent witlessness of having a single referee try to see the entire pitch while sprinting.  Perhaps most of all, we’re not fans of ambiguity. We like fair play, instant replay, and lots and lots of scoring. We like games where the better team wins most of the time, and sometimes by a lot. Those 1-0 games are OK every now and then (especially if Lincecum is pitching), but not as regular fare.

What has any of this got to do with health care? That’s a good question.  As I see it, there are a bunch of traditional differences between the U.S. and the rest of the (developed) world.

Characteristic	Rest of world	U.S.
Favorite sport	Soccer	Not soccer
Health care	Universal	Trying (finally)
Politics	Multi-party	Two-party
Measurements	Metric	Yards and pounds

Signs of change

But the gap is closing.  Lots of us watched the World Cup; we’re making progress in health care; and every now and then a third political party gains some traction. Can meters, kilograms, and degrees Celsius be far away?  (For the record, I’m 1.82, 79.4, and 37.)

Whooping Cough, Not Cranes

The State of California recently announced that we were officially in the midst of an epidemic of pertussis, better-known as whooping cough. More than 900 cases have been reported, and since the disease is often missed, many more have probably gone undiagnosed.

Pertussis is preventable, by getting and staying immunized. Not only do you need to receive the vaccine as a child, but you need periodic boosters (with your tetanus booster) to maintain your immunity. The disease itself is treatable with antibiotics, if it’s recognized early.

For an enlightening—albeit graphic description—see my colleague Dr. Jan Gurley’s blog on the subject.

And, yes, like the cranes, patients with the disease do sometimes whoop.

Chain, Chain, Chain

Most of us realize that there is a national shortage of organ donors. Right now, there are nearly 70,000 people in the U.S. on waiting lists for kidney transplants, 4000 of whom will die each year while waiting.

Usually, of course, people agree in advance to become organ donors as their last act if they die of an accident or  illness that leaves their heart, liver, kidneys, corneas, or other organs intact. Note: If you’re not already an organ-donor it’s easy to become one, just go here.

Kidneys are different

But it turns out that kidney transplants are different from heart and liver transplants in one important respect. We have two kidneys, and most of us can get along fine with just one. And some people on the kidney waiting list are lucky enough to have a relative or friend who is willing to donate his or her “extra” kidney directly to them—a so-called living-related donor. I have a friend who gave one to his dad, for example. But the donor’s kidney has to be a good match for the recipient, and that doesn’t always happen.

Here’s where the chain comes in. Sometimes, the volunteer donor’s kidney would be a good match for someone else—a complete stranger—on the waiting list.  And if that stranger also has someone who is willing to donate a kidney but isn’t a good direct match, then his or her kidney can be used for yet another patient. And so on, down the chain.

If this sounds like an urban myth, it isn’t. (By the way, next time you hear a rumor that does sound mythic, check out www.snopes.com; the rumor has probably been around for years.)

Starting the chain

What happened recently is that a San Franciscan named Maggie Ervin donated a kidney, altruistically, which started a chain that helped at least three patients on the kidney transplant waiting list (two here and one at Cornell) and could help a couple more if they can find matches for the Cornell recipient’s would-be donor.

Thanks to software (called Matchmaker) developed by David Jacobs, a CPMC kidney transplant patient, we can now create complex swaps where patient A’s donor gives to patient B, patient B’s donor gives to patient C, and patient C’s donor gives to A. These swaps are becoming increasingly common, thanks to a lot of work done by Dr. Steve Katznelson and his team in pioneering the approach.

In this case the chain was begun by Maggie. Amazingly, she who didn’t know anyone else in need but just wanted to do something to help. All the surgeries went well for the donors and recipients. So well that Maggie left CPMC just two days after her surgery!

Donating a kidney to a complete stranger is a true act of loving kindness. Hats off to Maggie Ervin.

To hear Maggie talk about why she decided to donate a kidney just click here

Difficult Job Dealing With Difficult Patients

Today I was rounding with one of our nurse managers.  Our first stop was a unit that has been treating a difficult patient—someone who has challenged our ability to provide care.

Staff told me how they have attempted to meet the patient’s needs, only to be rebuffed and even worse. They were aware that satisfying this patient was like boiling the ocean or walking to the moon. That didn’t mean they had stopped trying to do so, but it did mean that they were discouraged, frustrated, and sometimes just plain scared.  I was impressed by our staff’s openness in talking about the situation and the ways that they supported each other.

Pushing your button

Dealing with difficult patients is one of the great challenges of health care. It’s one for which we are not well prepared.  After all, in our personal lives, we try to avoid people who “push our buttons” or at least minimize our interactions with them.  But when someone becomes a patient at CPMC, we have a responsibility to care for them—avoidance is not an option.

Some  advice

Most of us receive very little training in this area. I was lucky. When I was a medical resident in the primary care clinic at San Francisco General Hospital, I had a preceptor who was a psychiatrist. He was there to help us address patients’ psychological issues, as well as our own limitations in caring for difficult patients. I learned a few lessons: to pay attention to my buttons so they’d be harder to push (easier said than done, believe me); to be aware of patients trying to split the health care team (“You’re really nice, but that Dr. So-and-so is a jerk”); and to ask for help when I was in over my head, rather than just toughing it out.

Hospitals are often places of last resort for those who have fallen through the cracks in our society. Most of the time, patients are deeply grateful that we’re here. But not always.

Patients With Patience

Most of the senior leaders at CPMC round every week in an area of the medical center.  It’s part of our “Adopt a Unit” program which is a way to ensure we don’t get stuck in our offices and lose sight of our purpose here, to ensure that our patients get the best care possible.  The rounds are a chance for us to hear directly from staff and patients about how things are going. My adopted area is the Intensive Care Unit (ICU)  at the Pacific campus, where I round most Wednesday afternoons with Sam Rad, the manager.

It will come as no surprise that the patients in the ICU are extremely ill, with life-threatening conditions or recovering from substantial surgical procedures. One group in particular stands out.  I think of them as the “patients with patience.” They are in the ICU with end-stage liver disease, waiting to get liver transplants. And there is nothing they can do to rush that process along, since it depends on factors out of their control.

I ask the patients if there’s anything we could do differently to improve their care. The patients with patience—or their family members—usually say “Not really. The people here are wonderful.” Then they add, “OK, maybe a new liver.”  They know it’s a bittersweet request, because getting a new liver requires an organ donor, someone who is willing to make a gift without ever knowing whether it will be received. So they wait patiently, and hopefully, and appreciatively.

Sometimes I get to see a patient patient after their wait has ended. Then they’re impatient to go home.

Farewell to Cynthia Chiarappa

In English, we usually pronounce the letters ch as “chuh,” as in cheese and chocolate.

In French, they say “shuh,” like champagne.

In German, it’s a guttural “hkuh,” like Bach.

 But in Italian, they say “kuh,” like zucchini. So for many years, I used to gently correct people that Cynthia’s last name was pronounced with a kuh. “It’s Chiarappa: like Chianti.” (Cynthia herself, of course, was too polite to say anything. My hypothesis for why her name is often mispronounced has to do with those silly Chia pets——but that’s another story.)

Of course we say kuh in English, too, for words like chord, chorus, chameleon, and Christmas; plus a whole bunch of scientific and medical words, like chemistry, cholera, cholesterol, and chiropractor.

Still, in English, the most important kuh word is one that describes Cynthia perfectly: character.

So my new phrase is: “Chiarappa: like character.” Which she manifests in both senses of the word, with her unique style and panache, and she is a person of worth. Cynthia has been the heart and soul of CPMC, leading our efforts in communication and marketing, where she has been an advocate for listening, truth-telling, and open communication.  Along with being a good friend and colleague to many of us.

She will be leaving us to take on a new position in marketing and communication at Oakland Children’s Hospital and Research Center, where we wish her success. But I do need to warn her that at a place called Children’s Hospital, they will mispronounce her name as Chee-arappa all too easily.

Scrutiny

Scrutiny. It’s an interesting word: from the Latin scrutari (to search), referring to the actions of people who picked through scruta (trash) looking for the good stuff. Thus the word originally meant separating what is valuable from the scraps.

The word is now usually used for the opposite process: looking for what’s wrong or valueless.  Which may explain why few of us enjoy scrutiny, as we are undergoing this week while a team from The Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO) scrutinizes us to ensure that our policies, procedures, and practices are in order. This is an unannounced visit, in keeping with their new policies.

We’ve got an excellent group of surveyors and they take their responsibilities seriously. Not only are they pointing out what we are not doing right, they’re also suggesting ways we can get better. And when they think that our processes are working, they say so.

It’s too soon to know the final results of the survey. We know some of our warts (see the April 6^th blog) and have instituted plans to fix them. When we get our report from The Joint Commission, I’ll let you know.

In the meanwhile, please remember that scrutiny, including self-scrutiny, is essential if we are to improve.

WB

Honoring Our Colleagues

Judy Li

I don’t usually like to brag about the people who work here, but I’m going to make an exception for three women—Judy Li, Dionne Miller, and Toni Brayer—who were just named to the San Francisco Business Times list of the “Most Influential Women in Bay Area Business” for 2010.

It’s quite a coup to have three women from CPMC make the list. (OK, Toni, the Chief Medical Officer for Sutter West Bay, does not technically work at CPMC, but she was our Chief of Staff and we’ve got a link to her really excellent blog.

Dionne Miller

The list features women who have moved through the ranks of their organizations into leadership positions. The honorees were selected from corporate, non-profit, and government organizations, for their leadership and guidance, paving the way for other talented women.

Toni Brayer

There are many other women in leadership positions at CPMC, including three of our other CAOs (Mary Lanier, Bernadette Smith, and Hamila Kownacki), several other VPs (including Diana Karner, Linda Isaacs, and Wanda Roane), and TNTC (too numerous to count) directors, managers, and supervisors. We’re proud of them too.

Thank You, Nurses!

We love our nurses! And since this is National Nurses Week (May 6-12), now’s the perfect time to say so. (For those who are curious why the week starts on a Thursday, it’s so it can end on May 12th, which is Florence Nightingale’s birthday!)

Florence Nightingale

CPMC employs about 2,000 nurses. Without these caring souls, we could not provide the high quality of health care nor and compassion and empathy that we are known for.

The 2010 theme for the week is Caring Today for a Healthier Tomorrow. This is particularly fitting here at CPMC, as we work to build new facilities at St. Luke’s and at Van Ness & Geary. Our nursing staff has been critical in the process of planning for these new facilities, contributing their knowledge and expertise to the development of logical floor plans with efficient placement of rooms, equipment, and supplies. We want to encourage all of you to send us your suggestions on what you would like to see in the new facilities that can improve patient care and make your work experience better. We also welcome suggestions for making a smooth transition when we finally move in.

We all lead busy lives, but I hope everyone will join me in taking the time to stop and thank all our nurses. Without them, CPMC wouldn’t be what it is today.