Take Five

You can do a lot of things in five minutes: answer a couple of emails, return a phone call, make a cup of tea, or boil an egg. You can read the Gettysburg address, aloud, twice, and still have time to spare (it took Lincoln just over two minutes, at a time when most politicians spoke for an hour or more). At CPMC we have decided to take five minutes of your time to share news about things that are important to all of us.

News huddles

We are going to start holding five-minute huddles, once a week, for everyone who works here. The huddles will take place on nursing units, in administrative offices, kitchens, and cafeterias at all our campuses. The program is designed to help all of us understand what’s happening at the medical center by sharing information about changes in policies, new programs, or just news that is relevant to how we do our jobs. Each department will add some personal touches so the information is particularly relevant to their team, such as “wins” that your department has enjoyed, or maybe a letter from a grateful patient thanking you for the work you did.

At this point you are probably asking “Don’t we already have lots of ways of reaching out to employees and letting them know what’s going on?” Yes we do, but they don’t reach everyone (not everyone has ready access to a computer for emails) and they don’t offer the chance to ask questions or make comments.

Good communications

That’s why we’re taking this new approach. By having managers and supervisors talk directly with their teams in small groups, we can ensure that everyone, regardless of where they work or what shift they are on, gets to hear the same message. By limiting the time to five minutes, we are being respectful of your time, and not take you away from the important work that you do.

Efficiency is in the eye of the beholder

I was on jury duty last month. More accurately, I sat around for most of a week at the Hall of Justice on Bryant Street waiting to be on a jury. I did not actually serve, as was true for 90% of the other potential jurors.

It was clear that the jury selection process was designed to be efficient from the perspective of the judge, the district attorney, and the defense attorney. If they thought we might need to be in or near the courtroom, we had to be there. If it turned out that they had something else to do, we waited. When they needed to ask one of us a question, the rest of us watched. Much of the time, we couldn’t even hear what was going on, because of the protective glass.  Mostly, we sat. Once, after waiting all morning, we were sent home just before lunch and told to return the next morning.

Trial and error

While I was waiting, I thought about all the ways the jury selection process could run more efficiently.  Parallel processing would have been a good start. We could have all filled out (simultaneously!) a questionnaire with most of the questions that the judge and lawyers had asked. Then they could have dismissed those of us with obvious conflicts, and then question some of us further.  That would have taken a few hours at the maximum. Instead, they used serial processing, and asked one person at a time the same few questions, while the rest of us waited.

Improving the process

Why am I telling you all of this? Because efficiency is in the eye of the beholder. From the judge’s point of view, the process had been incredibly efficient. He thanked all of us when we were finally dismissed, remarking about how smoothly everything had gone. From his perspective. From the perspective of the potential jurors, efficient was the last word we would have used.

The same “eye of the beholder” problem occurs often in healthcare.  Just like jury selection is designed for the judge and the lawyers—without much regard for the potential jurors—too much of healthcare is designed for those of us who work at a medical center, with not enough regard for our patients. Wait around in the emergency room while we find you a bed upstairs? Or sit in the pre-op “holding area” while we clean the operating room?  Sure, why not? It’s more efficient (for us) that way.

That’s why we’re using QD to take a careful look at all of our processes from the perspective of our patients. If you haven’t yet had a chance to participate in a kaizen (improvement) event, I encourage you to let your manager know that you’re interested in doing so. We need your ideas and experiences.

If you’ve only got three minutes, don’t read this: just click on the link

Hand washing is one of the simplest, yet most effective, ways to reduce infections in the hospital. A recent study from the University of North Carolina found that one out of every 20 hospital patients develops an infection they didn’t have when admitted to the hospital, and many of those infections are caused by poor hand hygiene.

At CPMC, and at every other hospital I know, there has been a concerted effort to help staff do a better job of washing their hands. But those efforts haven’t always been as successful as we’d like, and they typically focus on the front-line caregivers, like physicians and nurses.

Now we are trying something a little different. Our infection control team has teamed up with our environmental services (EVS) staff to come up with a new and creative way to keep our patients safe. They’ve put together a rap video.

(And, yes, when I tried to access this from within CPMC I got that familiar warning message; we’re working on uploading it to our intranet site.)

I’m no aficionado of rap music (my radio dial is set semi-permanently at 104.5 for KFOG), so I can’t judge this video on its merits as rap, but I can tell you that it’s awesome as an educational tool. It conveys the message about the need for good hygiene and cleaning habits in a fun, engaging and entertaining manner.

How can you not love lyrics like “The EVS keep the hospital clean/It’s infections we prevent if you know what I mean/Bacteria on equipment, devices and me/EVS removes them to keep the room germ-free?”

Hospitals often get a bad rap for not doing a better job at infection control. We’re trying to counter that with a good rap.

Let’s clap washour hands for the team that assembled the video, including….

Karen Anderson who wrote the lyrics and makes a cameo appearance in the piece

CPMC Media Services shot and edited the video

Justin Paulk is the “Rapper”

Maria Valencia is the Housekeeper

David McReynalds is Mr. C-Diff

Reynaldo Arradaza is a Spore

Markeith Anderson is a Spore

Wanda Steagall is one of the hallway dancing managers

Walter Brown is also one of the hallway dancing managers

Hands-on-Healing

For the past several years, we have understood that the phrase Beyond Medicine reflects our commitment to deliver the very best care by treating the whole person, not just the disease. But what seems obvious to us doesn’t always seem so obvious to our patients. For them the words Beyond Medicine may not always convey the commitment we bring to our job every day.

That’s why we have launched a new campaign to explain to our patients that when they come to CPMC they will get the very best health care delivered with a personal touch. We call it Hands-on-Healing. The campaign will feature the hands of caregivers as we take care of patients.

Touch comes in many forms in the hospital. We support a patient’s wrist when checking an erratic pulse; we palpate a tender abdomen; and we flex and extend an arthritic joint. We hold a fearful hand; we massage an anxious shoulder; and, yes, sometimes we touch a broken heart. Our hands lift the frail; repair the wounded; and deliver the tiny. All of these forms of hands-on healing show that we care about our patients as individuals and that we have compassion for their problems.

Over the next few months you are going to see and hear Hands-on-Healing ads in newspapers and magazines, on buses and billboards, and on radio and TV. They are a way of reaching beyond our hospital walls to connect with our communities and let them know who we are and what we do.

Medical technology helps us care for patients in ways that would have been unimaginable even a few years ago. But the basic elements of the best health care remain the same: the skill, experience, and compassion of caregivers, delivered in a personal, hands-on way.

To sleep, perchance to dream

I admit it: I’m a big fan of a good night’s sleep. Not only does sleep feel good, it’s also important for our health. That message was driven home recently with the publication of a research paper in the Journal of the American Medical Association. The study showed that sleep apnea, a condition in which someone stops breathing temporarily while asleep, can increase the risk of dementia and other cognitive problems. The main factor leading to diminished cognition was oxygen deprivation, also called hypoxia. Women who had frequent episodes of low oxygen, or who spent a large portion of their sleep time in a state of hypoxia, were more likely to develop cognitive impairment.

Home grown research

The study was done by Katie Stone, PhD, of the CPMC Research Institute – along with her colleagues at UCSF and the Brigham & Women’s Hospital in Boston. Their findings are important because they show the serious consequences that can occur if we don’t sleep well. While this particular study was only done in older women, Katie and her colleagues say there is no reason to think the findings don’t also apply to older men, and possibly also to younger women and men.

The findings are important too for another reason. They are a reminder that we have a robust research institute and a long history of doing great scientific work here at CPMC. That history dates back to the early 1900’s. When researcher Harold Farber arrived at what is now the Pacific Campus he was led to “a dusty, abandoned hallway on the fourth floor of the old School building.” His first purchases were a hammer, saw, and some wood and nails so he could build a cabinet, shelves and a work space.

Scientific advances

Since then, scientists working at CPMC have made important advances in research on HIV/AIDS, cancer, heart disease, diabetes, osteoporosis, arthritis, hepatitis, microsurgery, organ rejection, premature birth, stroke and other serious health problems.

I have a particular soft spot for research. Before becoming CEO, I served for 9 years as the Scientific Director of the CPMC Research Institute. Now, under the guidance of Dr. Michael Rowbotham, CPMCRI has more than 60 principal investigators who are working on everything from new ways of measuring breast cancer risk to the potential cancer-fighting properties of marijuana.

You can learn more about CPMCRI at http://www.cpmc.org/professionals/research/, where you can sign up for our annual Bay Area Clinical Research Symposium which will take place on Friday, November 4^th at the Hotel Kabuki.

 

 

The best of the best

Some awards are announced with a fanfare of trumpets and a blaze of publicity honoring the winners. US News & World Report chose a very different approach in announcing its 2011 list of Top Doctors. It simply published them, very quietly, online. Regardless of the method, the fact that more than 200 CPMC and Sutter Pacific Medical Foundation physicians are on the list is reason enough to celebrate.

Our list is too long to print here, but it starts with Dr. Michael Abel, a colon and rectal surgeon, and ends 205 physicians later with Dr. Katherine (Branch) Young, a plastic surgeon. In between, the list reflects the diversity of talent, skill and expertise at all four of our campuses.

The idea behind the list is simple: to help consumers find the doctors who can best address their needs. To do that they surveyed experts in each field and asked them who they would go and see if they, or a loved one, needed help. The result is a list of physicians who are regarded by their peers as the best at what they do.

If you’d like to see the full list, it’s on the US News & World Report site.

The list includes physicians who are regarded as in the top 1% in the nation—and we have 17 of those, from Lesley Anderson (an orthopedist) to Lory Wiviott (an infectious disease specialist).

Congratulations to all of our fine physicians.

Time for a Pop Quiz

Take a look at these two lists of 20 sets of names and numbers. What do you think they are and what do they have in common?

Hint #1: The lists are related to CPMC. Hint #2: If you think you know the answer, make sure you can explain numbers 11 and 13 on the second list.

LEE	351	1.20%
WONG	321	1.10%
CHEN	281	0.96%
LI	254	0.87%
HUANG	231	0.79%
CHAN	169	0.58%
WU	165	0.56%
YU	161	0.55%
LIU	156	0.53%
KIM	155	0.53%
NG	117	0.40%
LIN	111	0.38%
LAM	107	0.37%
TAN	88	0.30%
LAU	87	0.30%
NGUYEN	86	0.29%
ZHANG	84	0.29%
LIANG	83	0.28%
TRAN	79	0.27%
WANG	77	0.26%
MA	75	0.26%
SMITH	75	0.26%
CHANG	72	0.25%
LEUNG	66	0.23%
LU	65	0.22%
JONES	64	0.22%
LOPEZ 40 0.77% GONZALEZ 37 0.71% HERNANDEZ 37 0.71% GARCIA 35 0.67% MARTINEZ 35 0.67% RODRIGUEZ 34 0.65% RAMIREZ 33 0.63% GOMEZ 24 0.46% CRUZ 20 0.38% PEREZ 20 0.38% JONES 19 0.37% SANCHEZ 18 0.35% SMITH 18 0.35% CAMPOS 15 0.29% REYES 15 0.29% ALVAREZ 14 0.27% GUZMAN 14 0.27% FLORES 13 0.25% GUTIERREZ 13 0.25% DIAZ 12 0.23%

WARNING: Don’t read on if you’re still working on the answer.

I’ll get back to the names in a minute, but first I wanted to talk about one of my main frustrations since becoming CEO of CPMC: the misperception that we are somehow an elitist hospital, one that serves only a small,  select patient population. This myth is usually spread by folks opposed to our rebuilding plans, but that doesn’t make it any less painful when I hear it. Some even accuse us of being insensitive to the needs of the “community” – conveniently, a term left undefined. Again, the implication is that we focus on one group of patients and ignore everyone else, especially those who are non-white or poor.

What’s in a name

As I’m about to reveal, nothing could be further from the truth. Which brings us back to the two lists at the top of this blog. Have you figured them out yet?

The first list is the most common surnames for children born at our California Campus during a recent 5-year period (along with the numbers and percent of births). The second list is the most common surnames for babies born at our St. Luke’s Campus during the same time. We don’t actually track the ethnicity of our babies, but it’s pretty clear that all of the top 20 names at the Cal campus are Asian (though Lee, as some readers of this blog have pointed out is also, of course, a common English name), and that 18 of the top 20 names at St. Luke’s are Latino.

These names aren’t my opinion about who’s born here, or a wish list for City leaders. These are the actual names of actual babies: the facts, just the facts.  These babies are the reality of what we do at CPMC. They, and their parents and families, are the community we serve, 24/7/365 (366 next year!).

A walk through the halls of our hospitals reveals the full diversity of San Francisco, in the patients we serve and in the staff caring for them.

Serving the community

I find the misperception about us especially frustrating because of my belief that what makes San Francisco special is our success—to a greater extent than any other city I know—at building a community that defines itself by the City we live and work in, not our ethnic, religious, racial, political, economic, or cultural identities. Our City works best when we all remember that. It works less well, and sometimes not at all, when people try to separate us.

So the next time someone implies that our doors are not open to all, show them these lists of names. Perhaps doing so will open their eyes about who we really are.

Heroes in our midst

The grand ballroom in a San Francisco hotel isn’t where one might expect to find inspiration for healthcare, but recently I attended the 2011 Healthcare Heroes Awards at the San Francisco Palace Hotel and found it a truly inspiring event.

The awards are given out by the San Francisco Business Times, whose goal was to “recognize excellence, promote innovation, contribute to the enhancement of the value and quality of health care, and recognize unsung heroes who enrich the lives of those they serve.” (You can read about all the honorees in the July 29 edition of the Business Times)

Healthcare Hero Bernie Brown

One of those unsung heroes hails from our Davies Campus: Bernard Brown, of our Food & Nutrition Services team. With a simple kitchen tool and some fresh ingredients, Bernie–usually known as “the milkshake guy”–makes patients feel better, and, we hope, heal faster. He uses his background in nutrition to create custom-tailored milkshakes and smoothies for patients whose appetites have been affected by their underlying disease or treatment. Bernie’s shakes are created with nutrition in mind (his wife Pam, by the way, is a dietitian at our PAC Campus–the two met at CPMC 15 years ago) and served with a smile and a kind word. Bernie is living proof that you don’t need to have a medical or nursing degree to make a difference in the lives of patients and their loved ones.

Another of the honorees does have a nursing degree. But it’s what she does on top of being an excellent nurse that earned Laura Euphrat

Healthcare hero Laura Euphrat, and a fan

accolades. Laura, who has been with CPMC for more than two decades, works as a pediatric nurse at our California Campus. She is also co-founder and president of Little Wishes, a non-profit that grants the modest wishes of seriously ill inpatients. Unlike other wish-granting programs, Little Wishes isn’t just for kids with life-threatening illnesses. Young patients with chronic illnesses that require frequent extended hospital stays also have their wishes granted. None of the wishes cost more than $150, and all wish-granting takes place within the hospital. Laura and a team of volunteers, many of them staff from Cal, like Little Wishes co-founder and vice president Joanne Davantes collect donations, buy and wrap the gifts, and deliver them each week. The Little Wishes concept caught on, and the program has expanded to Sutter Medical Center, Sacramento as well as to Sacred Heart Children’s Hospital in Spokane. We’re all proud of the passion that Laura and her team bring to Little Wishes and to CPMC. (You can also donate to Little Wishes, which is a 501(c)(3) non-profit.)

Passion is also what drives Dr. Stewart Cooperin the battle against liver diseases. Dr.

The heroic Dr. Stewart Cooper

Cooper, a Sutter Pacific Medical Foundation physician who heads our division of hepatology and hepatology research, was named the winner in the Research & Development category. His Liver Immunology Laboratory is at the forefront of research into the hepatitis B and C viruses, which can severely damage the liver. These viruses infect approximately 700 million people worldwide and result in millions of deaths annually. Outside the lab, he also leads CPMC’s efforts in the Citywide campaign to eradicate hepatitis B from San Francisco’s Asian communities. Hep B infects one in 10 Asians, compared to about one in 1,000 in the general population. Through the San Francisco Hep B Free program, thousands of people receive free screening and vaccination against the virus. Many who are diagnosed also receive treatment through CPMC’s community benefit program.

Dr. Steve Lockhart who worked previously at CPMC in many roles (as an anesthesiologist, as Medical Director of Surgical Services, and as Chief Administrative Officer of our St. Luke’s campus), and is now the Chief Medical Officer of Sutter East Bay, was honored for his work in the Haiti relief effort.

Congratulations to all the honorees. They are a reminder of why CPMC is such an amazing place to work.

Rallying Support

The only thing better than a good rally to boost your spirits, is, well, two rallies. Which is what happened in the last few weeks. There was a rally at our St. Luke’s Campus (led by the Medical Executive Committee there) and another at San Francisco City Hall  (led by the Alliance for Jobs and Sustainable Growth).

Save St. Luke's Rally

Both rallies were important for CPMC, in different ways. The rally at St. Luke’s showed that physicians at the hospital support our plans to build a new, full-service, acute care facility there. Their voices sent a powerful message to City Hall that the people of the Mission and surrounding communities need a new hospital and that, after decades of uncertainty, our plans represent the best hope for the future of St. Luke’s.

The rally at City Hall brought together hundreds of carpenters, plumbers, electricians and others in the buildings trades who are hungry for the 1500 construction jobs our RebuildCPMC project will create. It brought out young

CPMC staff at St. Luke's rally

people from the Bayview and Tenderloin who have a chance for a career in healthcare because of our project. It brought out our community health partners who talked about how CPMC helps them do their work, and how important it is for all of us to have new hospitals. It brought out patients who told the crowd that without CPMC they might not be alive. And it brought out our own staff, nurses, managers and physicians.

Constructive support for CPMC

One of the speakers reminded everyone that they were the community we hear so much about. Another, an unemployed construction worker, told people “I live here, I vote here, I shop here—I ought to be able to work here.” Hard to argue with that logic.

It was an encouraging sight, all the more so because City Hall has seen more than a few, much smaller, protests by our opponents calling for our plans to be rejected, or demanding we pay more than $2 billion to the City for the right to build our hospitals.

The rising chorus of voices from those two rallies send a powerful message that the people of San Francisco are behind

Rally at City Hall

our plans and want them to be approved. It looks like the politicians in City Hall are listening.

Always look for the fine print

A few weeks ago I blogged about our new ad campaign for RebuildCPMC.  You can access the ads here.

Part of the campaign uses medical images (like a pill bottle) to convey our message.  One of those ads is entitled “A Formula for World-Class Care for San Francisco’s Next Generation,” with a picture of a baby bottle.  Today, I received an email from a concerned employee, worrying that we were sending the wrong message by encouraging the use of infant formula. We shared those concerns, so we were careful to make sure that the bottle was labeled (right there at the bottom!) as “Breast Milk.”

Just so you don’t worry in case you had seen the ad but missed the “fine print.” Enjoy the Holiday.