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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

Hidden St. Luke’s

Take St. Luke’s for instance. At first glance the campus looks like a collection of drab mid-twentieth century glass, concrete, and steel buildings. But sandwiched between them, almost unnoticed, there is a hidden history.

On Valencia Street, between Cesar Chavez and San Jose, is a small plaque that you could pass for years without noticing. The plaque marks the site of the original Bancroft Library. The library has since moved to UC Berkeley, where it holds one of the largest collections of manuscripts and rare books in the US.

Deep roots

Nearby is an enormous 100-year-old Moreton Bay fig tree (ficus macrophylla) that has been granted “landmark tree” status by the City (one rumor says that it was planted by Hubert Bancroft, founder of the library.) The plaque and tree both stand in front of a part of St. Luke’s that was built in 1912, including one of the most surprising parts of CPMC: the St. Luke’s chapel.

The Chapel at St. Luke's

The chapel reflects St. Luke’s roots. The hospital was founded in the early 1870’s by Dr. Thomas Brotherton, who spent several years mining for gold in the Sierra foothills before turning to medicine and the Episcopal Church, which ordained him as a priest in 1860. He started St. Luke’s because of his concern about the shortage of health care south of Market. Sound familiar?

While St. Luke’s is no longer run by the Episcopal Church, its presence can be felt throughout the hospital, nowhere more clearly than in the chapel. It’s a beautiful place, a sanctuary of quiet and calm, where patients and staff can come to pray, to think, or just to sit in silence and have a moment to themselves.

Recently the chapel was given a facelift – thanks to a generous grant from CPMC – and was restored it to its former glory. The room is dominated by a blue stained glass window with a mosaic of St. Luke, the patron saint of physicians and surgeons.

The chapel is a reminder that healing sometimes involves more than just bandaging a wound or giving a medication. There are smaller chapels at all our other campuses too, soothing spaces where you can find some peace and quiet – a precious commodity for a family going through a crisis or a staff member needing a moment to gather his or her thoughts.

Stained glass window in St. Luke's Chapel

Choir loft at St. Luke's Chapel

Ceiling at St. Luke's Chapel