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As a community-based hospital we take very seriously our responsibility to reach out beyond the medical center and out into each neighborhood.
Community is one of the six Pillars that we use to measure our performance (Quality, People, Service, Finance, and Growth are the others). So how did we do in 2009?
Community
It’s all-too-easy to forget that we have been an essential part of the fabric of San Francisco for more than 150 years.
We deliver more than half of all the babies born in the city; provide emergency care to more than 75,000 patients a year in our four emergency rooms; and perform surgery on almost 30,000 people a year, including more than 400 who receive transplants. It’s not even possible to imagine health care in San Francisco without us.
Once again, some will point out that we lag behind several other San Francisco hospitals in the amount of charity care that we provided. (For those who don’t know, charity care is defined as free care provided to uninsured patients who can’t afford to pay for it. At CPMC, anyone whose family income is less than four times the Federal poverty level is eligible for charity care.)
But this shortfall in charity care is misleading, because it fails to recognize the enormous financial commitment we have made to support, revitalize, and rebuild our St. Luke’s Campus. Over the previous five years, and during the next five years, we will spend about $500 million at St. Luke’s—an amount that dwarfs the charity care at other hospitals in the city. And the amounts of non-reimbursed care that we and every other hospital provide to patients with governmental insurance (especially MediCal) dwarfs the amount of actual charity care provided.
The hidden secret about American health care is that commercial health insurance (the kind that you and I have because we work here) subsidizes the costs of caring for patients with government insurance and the uninsured. If it weren’t for this simple fact, most hospitals in the U.S would have to close their doors—and we are no exception.
Plus we supported over 30 community-based organizations, including North East Medical Services, the St. Anthony Foundation, and the Latina Breast Cancer Agency, through sponsorships, grants, health screenings, and other activities.
We participated in eight health fairs that helped screen patients for high blood pressure, high cholesterol levels, and hepatitis infection.
Our major commitment to the community, of course, is our plan to rebuild two new hospitals in the City (at Cathedral Hill and St. Luke’s), along with the hospital renovations at Davies and new medical office buildings.
I’m pleased to tell you that these plans for rebuilding our facilities received unanimous support from San Francisco Health Commission. We are now working with the Planning Commission as it reviews our proposals . If you haven’t already done so, please visit www.rebuildcpmc.org. Your active support for these projects will be critical as they move forward.
WB
We are in the middle of an ambitious plan to dramatically reshape not just CPMC, but to help create a city-wide system of care.
We are planning on building two, new, state-of-the-art hospitals to serve the people of San Francisco, and those plans will hopefully get the green light from the San Francisco Planning Commission and the Board of Supervisors in 2010.
But as growth is one of the six Pillars that we use to measure our performance (the others are Quality, People, Service, Finance, and Community) it’s appropriate to look back and see how we did in 2009 with our Growth pillar
Growth
The main events growth-wise this year have taken place at the Davies Campus, with neurosciences and rehabilitation medicine at center stage. If you haven’t already seen the new Terrain Park there—where patients in our rehabilitation unit can learn how to maneuver in a real-world setting—be sure to stop in for a visit.
When Davies joined CPMC 13 years ago (note to self: remember to make sure that the “old” Davies Medical Center website is taken down!), we could not have anticipated the transformations that would take place there—not the least of which is the dramatic changes that have occurred in the treatment of HIV/AIDS, which seem like nothing less than a medical miracle to me.
In a relatively short period of time, AIDS has gone from a disease that was killing our friends, relatives, neighbors, and colleagues to one that we can usually control with medications, much like diabetes. For that I am truly grateful.
We also started a new relationship with the Brown & Toland Medical Group, to which many of our doctors belong. This will help us to plan better for health care reforms that require more integration between inpatient and outpatient care.
The Pediatrics Emergency Department at the California Campus, which opened in 2008, has been hugely successful with patients and their families. Staff seems to like working there—or at least that’s what I heard from them when I visited.
And, of course, we’ve been working hard at regionalization, as the new Sutter West Bay region develops its management structure.
As always, I’m interested in hearing from you. If you’d like to leave a response, or ask a question, just post a comment below.
WB
2009 was a difficult year financially for a lot of people, and CPMC didn’t escape unscathed. We have six Pillars that we use to help us measure our performance throughout the year, Finance is one of them (Quality, People, Service, Growth, and Community are the others) so how did we do in 2009?
Finance
Like everyone else in the country, we knew that 2009 was going to be a difficult year economically. We had to do some early belt-tightening. At the time, none of us was sure whether it would work. Indeed, the most common question I was asked at the “Meet the new CEO” events late last spring was “Are more layoffs on the way?” My answer was that I did not think so, unless the economy worsened substantially.
We are all fortunate that the overall U.S. economy held relatively steady for the rest of the year, and I join you in hoping that the worst is over.
The difficult decisions we made early in the year enabled us to reach our budgetary targets for 2009. Thus we will be able to fulfill our promise to our patients to provide them with the very best care, without having to make further reductions in staffing as we start 2010. And we can stand behind our commitment to rebuild our facilities in the near future.
As always, I’m interested in hearing from you. If you’d like to leave a response, or ask a question, just post a comment below.
WB
Health care is many things to many people, but increasingly we need to see it as a service industry. If we don’t give our patients and their families the best service – not just in terms of medical care but personal care as well -we won’t survive.
At CPMC we use six Pillars to measure our performance; those are Quality, People, Service, Finance, Growth, and Community. So how did we do with our Service pillar?
Service.
We continue to struggle to provide every patient with compassionate respectful care. I recognize how difficult this can be, particularly in our older facilities in which two patients must share a single room.
Here’s my suggestion: make a personal connection with every patient you interact with, even if it’s just a warm smile and a nod of hello. This is not just good for patients, but it will also make your own job more enjoyable.
If you spend more than a few minutes with a patient, find out something about him or her, or even tell them something about yourself that you think they might want to hear.
Our patients—and their families—have incredible stories. Sharing those stories will enrich your experience of caring for them. This is not hard to do. Ask simple questions, like finding out where someone lives, how long their family has been in California, or what they do (or did) for a living.
All of these help bring patients to life, and remind us why we chose a 24/7/365 career—presumably not for the hours or the glamorous lifestyle, but for the chance to make a difference in the lives of our patients.
As always, I’m interested in hearing from you. If you’d like to leave a response, or ask a question, just post a comment below.
WB
2009 was a tough year for a lot of people and many businesses, and health care was not immune to those challenges. Fortunately at CPMC we have a number of terrific assets, the most important of which is the people who work here.
At CPMC we use six Pillars to measure our performance; those are Quality, People, Service, Finance, Growth, and Community. So how did we do with our People pillar?
PEOPLE
We started out 2009 on a high note. We had the best results ever on the Sutter-wide EOW survey: the 80th percentile, meaning that our employees were in the upper 20% of all health care employees in terms of overall job satisfaction. We had substantial improvement is most categories, as did almost every other Sutter facility, perhaps because many of our employees appreciated the experience of working at CPMC more this year due to the downturn in the national economy.
Unions
As some of you know, we are out-of-contract with both SEIU-UHW and CNA. We would much prefer having long-term collective bargaining agreements with both of these unions; the uncertainty is not particularly helpful either for us or for our employees. We have been negotiating with both SEIU-UHW and CNA for a long time, with some progress.
I’d like to see us come to agreements soon, but I don’t want to mislead anyone into thinking that we can agree to contracts that we cannot afford or manage simply to get an agreement. The economy has still not recovered; there is much uncertainty about what is going to happen in health care (I’ll be blogging about this in a few weeks); the costs of employee benefits (particularly health insurance) continue to go up; and we need to be responsible employers.
As a health care organization, we have two special obligations: first, to make sure that our employees have good health insurance, and second, to avoid making commitments to our employees that will make health care less affordable for everyone else.
I’m sure all of you have had the experience of speaking with someone who can no longer afford health insurance, and I believe that we need to set an example rather that exacerbating what is already a very difficult problem.
Looking Ahead
We’re very pleased that we graduated the final class of nurses in a four-year partnership with City College of San Francisco supported by the Betty Irene Moore Strategic Partnership Grant. If you’re one of the 85 new nurses we’ve added to the profession, welcome to CPMC.
If you haven’t already, I hope you soon get to meet Mark Kimbell, the new President of the CPMC Foundation, who succeeded Jerry Mapp, now in emeritus status.
Of course, this is the year that Martin Brotman MD moved from CPMC to become the Regional Executive Officer of Sutter West Bay, and that many members of our team took on additional responsibilities for the West Bay region.
And our long-time Executive Vice President and Administrator, Jack Bailey, retired on January 1. We send him and his wife Marsha our very best wishes, and deep gratitude for his many contributions to CPMC.
As always, I’m interested in hearing from you. If you’d like to leave a response, or ask a question, just post a comment below.
WB
I want to begin this blog by thanking everyone at CPMC for all the work you do every day to care for our patients. It’s all-too-easy to forget that what we do—no matter how small it may seem at the moment—matters a great deal. Whether or not you touch patients directly, your work at CPMC helps to make sure that our patients receive state-of-the-art, compassionate care 24 hours a day, 365 days a year.
I hope all of you take the throughout the year to look in the mirror with the pride that comes from spending your career making a difference in other people’s lives.
So what happened at CPMC in 2009, and what are our plans for 2010? Over the next few days I will attempt to summarize what we did and where we are going by using the six Pillars that we use to measure ourselves by: Quality, People, Service, Finance, Growth, and Community. Let’s start by looking at Quality.
Quality
We ended 2009 on a high note, being informed that we were the recipient of a Leapfrog Top Hospital Award. Only 42 other hospitals in the entire country received this recognition. Even more remarkably, we are one of only three medical centers to have been chosen as a Top Hospital every year since the inception of the award in 2006 (the other two are Virginia Mason in Seattle and the University of Maryland, Baltimore).
For those who don’t know, Leapfrog represents a group of organizations concerned about hospital quality and safety. They took this name from the concept of encouraging hospitals to leapfrog one another in pursuing tougher standards (www.leapfroggroup.org). We also received recognition from the American Heart Association for our programs in caring for patients with myocardial infarction and stroke.
We did not do as well at meeting the Sutter system-wide quality targets this year. Though the St. Luke’s Campus met these goals (we call this being “green” on the Sutter dashboard) for most of the year, the other campuses struggled, particularly with making sure that we provide smoking cessation counseling to patients and that we clarify what medications patients are supposed to take after going home.
We also didn’t meet the goal for in-hospital mortality—we think because we need to do a better job making sure that we list and code patients’ pre-existing medical conditions more thoroughly.
We still have too many “Argh” moments—that’s what I call the times when I learn about an adverse event at one of our campuses and say to myself “Argh, this shouldn’t have happened at CPMC.”
I know that things can go wrong in hospitals and that even the most experienced people can make mistakes. Our responsibility is to make it hard for those mistakes to happen by making it easy to prevent them, and then to detect and correct them if they do occur.
That means all of us—and especially those of us in management—need a whole new set of skills, which is why we are going “back to school” during 2010.
We are going to learn the same skills that manufacturers like Toyota have used to build safer and better cars, and that health care systems like Virginia Mason have adapted for medical centers.
We are going to call this the QD (Quality Delivery) System, and I will write more about this in the coming months. QD refers to systems that apply to every patient, every day (qd stands for quaque die, which is Latin for “every day”).
Everyone will be expected to participate—to identify safer, better, more efficient, higher quality, less wasteful ways of taking care of our patients. That way we can spend more time helping patients and their families, talking with them, and explaining what’s going on, and less time running around like headless poultry.
We are not looking for high-tech solutions. We are looking for frilly toothpicks—you know, the kind with the colored cellophane twists at one end. Not only do they look pretty, they’re actually safety devices, so you can see the toothpicks in your sandwich before you accidentally include one with a bite of food.
As always, I’m interested in hearing from you. If you’d like to leave a response, or ask a question, just post a comment below.
WB
