Responses to our new goals

As promised below, I am sharing some of the responses I received from members of the staff and also outside observers after we announced our new goals for patient satisfaction and quality and safety. As you will see, there is a variety of opinion on the issue. This is not expected. I am going to divide them up by doctors, nurses and other staff, and outside folks who read the story or editorial in the newspaper or heard a radio interview.

I am not including my replies to these emails. You can offer your own replies in the comments!

Doctors

#1 -- How does BIDMC plan to determine if harm prevention measures are actually causing unintended harm? This isn't an idle question - we have bypassed much of the usual science of medicine when invoking quality improvement. We assume that if we force providers to don gloves and gowns before examining patients in an ICU that they will still go into the rooms just as much. We assume that the pass-off errors caused by resident work-hour changes won't exceed the benefits from reduced fatigue errors. We assume that the benefit of infections prevented by forms and checklists with central venous catheters makes up for the occasional delay in acute resuscitation. We assume that the benefits of medication reconciliation in the outpatient world will exceed the harm done by the loss of precious minutes spent actually talking with patients (my department can't even provide projected numbers on how long it should take the average MD to type in an average med list for our patients.) These are all measurable questions. Perhaps we assume too much? Auerbach's editorial on the question in the NEJM should have been a clarion call for us to redouble our efforts to evaluate change before declaring it beneficial.
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#2 -- I am delighted to hear from your email of the Hospitals' re-affirmation to emphasizing patient satisfaction.
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#3 -- (A) Makes me proud. I think that this is in part an ethics issue: there are few moral responsibilities we have as serious and widely acknowledged as the Hipprocratic admonition to “Do No Harm.”

(B) At our monthly Ethics Rounds (held in every ICU and 15-20 units total) we should consider moving from asking about “any cases of adverse events in the past month that you think weren’t disclosed/reported properly?” to “any cases in the past month where a patient was harmed by something we did that was preventable?”

(C) We could also encourage our individual Ethics Liaisons (designated by the chiefs of more than 50 clinical and administrative units) to think about ways they can help foster a culture in which we take moral responsibility for not harming patients, and constructive “preventive ethics” efforts not to do so in the future.

We have found our many Ethics Rounds a useful tool in the past for exploring in a BIDMC-wide way the views or experiences of front-line clinical staff about ethical aspects of issues such as a possible VIP unit. Our Ethics Liaisons Program is already proving it has great potential for engaging a large group of individuals across multiple departments.
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#4 -- (Reply comment from another doctor:) RE "C", I would emphasize even more strongly that the moral responsibility is to learn as much as possible from every episode of harm in order to prevent that harm from recurring. We need to remain clear that competent and well intentioned providers may find themselves part of an event in which there is harm, and foster the culture where people see these as learning opportunities to prevent future harm.
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#5 -- This is good, and it is clear that goal number one can be published because it only provides a measuring stick (new for BIDMC) for something we have already been doing. But goal number two: How does the hospital elegantly air this goal without the fear of being criticized for not having been doing this all along? Perhaps a better wording would be to emulate the wording of the first goal and say that we will establish new measures to ensure that our preventive measures work, so that we can fix them if they don't.
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#6 -- I really liked your very thoughtful and important words on public radio this morning.
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# 7 -- I am concerned about the wording of the second goal- there is a problem when you set an unobtainable goal, only to publicly show that you couldn't achieve it. Here is the unobtainable goal:

"BIDMC will eliminate all preventable harm by January 1, 2012."

This cannot be done, because it is stated in absolute terms. Eliminating "all preventable harm" is a noble ideal, but it is unrealistic given the complexity of delivering health care by multiple layers of teams and individuals. The best that any hospital can do is to develop mechanisms to reduce preventable harm, not to guarantee that all harm will be prevented. Any preventable harm, even if it was humanly impossible to foresee it, and even if no other hospital could prevent it, will be held against us as a failure to achieve what we promised.

I suggest that this second goal be revised as follows:

BIDMC will continue to create an environment that reduces preventable harm to the fullest extent possible. To this end, by January 1, 2012 we will be recognized as a national leader in the field of patient safety. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.

This is also a noble goal, but it has the merit of being achievable....
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#8 -- This is great, and the report in yesterday’s Globe has a lot of people elsewhere talking about it, and very favorably. May I suggest that the next step, given your interest and ability to be well ahead of the curve, would be – where the specific data permits such granularity – to know and report whether results were similar or different segmented by race, ethnicity, age group and gender. It would be fabulous to be able to say, with respect to various indices of care, that there was no difference at BIDMC when examined by race, ethnicity, gender and age group.

Nurses and other staff

#1 -- I treasure my place here and I imagine it will be a very long time before I will look elsewhere. I love this safety and quality initiative and I even love the naming exercise for the "thing"!!! Thanks for being who you are- it makes it possible for us to be who we are as well.
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#2 -- Thank you for taking the lead in making and returning BIDMC a wonderful place for patients. I hope to contribute to the attainment of this goal as a clinical nurse.
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#3 -- I am a nurse working at [a specified floor], and was just wondering if this meeting was in response to latest news that medical insurance will not be reimbursing hospitals for preventable occurrences (aside from the obvious that we care and value patient safety and prove that we are one if not the BEST hospital in Boston)?
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#4 -- Take the leaps...set the goals...Count Me In!
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#5 -- These are goals we can certainly reach. Over the last two years, we've made great strides creating performance measures in the Department of Medicine's divisions. After many meetings with our colleagues and data collection, it feels good to see the improvements based on our results.
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#6 -- You have my support...please let me know what I can do to attain the goals you have set.
This is an awesome hospital....and I'd like to help make the patient experience even better.
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#7 -- Although the initiatives you are describing relate to patient care, I believe that all subjects in research studies are patients as well. Please do not hesitate to contact me if I can lend my support and experience to any committees under development or in any way you see fit.
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#8 -- WOW!
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#9 -- These initiatives are terrific. I appreciate them both as an employee but more importantly, I appreciate it as a patient. Should I, or my family, be so sick that we need to be hospitalized, I want to feel confident, when we are most vulnerable, that we will be cared for safely. While we have not ever been hospitalized, we have utilized the outpatient services and have run up against some significant gaps in quality care. I've raised those issues with the appropriate managers and in both cases they responded quickly and appropriately. We have a way to go at all levels. You can count on me to help work toward these goals.
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#10 -- I appreciate your and the Board's "raising the bar" at BIDMC and BID-Needham. I am looking forward to doing my part.

I want to make sure you're aware of something I saw at the FDA website. I imagine you are aware of it but since it appears to be right in line with the announced aspirations and "The Thing" I felt I should take a chance at being redundant. The title of the FDA program is "AHRQ Releases Toolkits to Help Providers and Patients Implement Safer HealthCare Practices" and here is the link.
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#11 -- A thought about patient feedback: The several times I have been hospitalized, the efforts of staff to go beyond courtesy to make me feel taken care of and cared about have always stayed with me more than anything else about a hospital stay. And of course, apathy, lassitude or grumpiness has made an equally strong impression on me. There were times when I felt mistreated by “bad apples” (not at BIDMC). At the time, I wished I had had the opportunity to give feedback to the hospital. However, in the weakened state of illness, patients do not have the physical or mental energy to seek recourse on their own. If patients were given feedback cards (as often happens in restaurants) when they are admitted (not on leaving, when the memory is less accurate), this would help in more ways than one: the patient would feel he/she had recourse, and would thus leave feeling the hospital cared, even if the “bad apple” didn’t appear to, and 2) if they know patients have this forum, bad apples are likely to take more care how they treat patients.

Question regarding the phrase in your email: “We will measure ourselves based on national benchmarks”: I was just wondering if national benchmarks include a measure of staff satisfaction, since patient satisfaction depends daily on the way they are treated.

Outside folks

#1 -- I can say that after my experiences @ BI & my husband's experiences at an unnamed hospital, you are well ahead in the process & examples.
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#2 -- Bravo!
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#3 -- Bravo! I will follow with great interest.
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#4 -- Reading today's Globe, I was once again struck by how very proud I am to be associated with Beth Israel Deaconess Medical Center. Not only do I appreciate your forward thinking but am amazed at your goal to not only be first, but to do right.

Congratulations. This is a great day.
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#5 -- Congratulations to both of you and your Boards for this outstanding initiative.
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#6 -- Hearty congratulations and a bold and positive step!
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#7 -- First rate and I am sure will be supported by all of us.

One issue to think about over time. You can make the hospital experience great and are doing that. However, with the advent of out patient care and day surgery, much of the experience takes place in the doctor's office. Some are not so great at continuing the great feeling one gets at the hospital.

As a lawyer I represent many banks. I am acutely aware that how I treat the bank's customer in documenting the transaction reflects back at the bank.

I hope you can (or can continue to) foster that feeling in your doctors.

Regards and with continuing admiration for what you are doing.
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#8 -- Congratulations on your quality goals. Nice to see someone put a stake in the ground and focus on what this business is really about.
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#9 -- Impressive move by you and your board. That's the way to push the envelope. Let's hope others take up the challenge as well.
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#10 -- Great Globe Editorial today! I’m so proud to now be a BI patient!
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#11 -- Good luck with the initiative. It’s a big undertaking.
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#12 -- I am really delighted that you have chosen to meet this head on. Obtaining accurate data and putting the CARE back into healthcare will continue to keep us in the forefront both in Boston and nationally.
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#13 -- I can’t tell you how excited I am by your commitment to avoid all preventable harm to patients. It is simply the right thing to do. In a similar vein, I first learned of Ascension Health’s commitment to “no preventable deaths by 2008” in the fall of 2004. I have known Dr. Sandy Tolchin for many years and have had the opportunity to learn of his efforts, initially at Borgess Health Alliance in Kalamazoo and now as VP Clinical Excellence in collaboration with David Prior and others at Ascension Health. When I last spoke with him in the late fall, he said, “We have now demonstrated that flawless care is achievable.”

What's in a PCAC?

Following on our theme below, I am presenting a bit more on our governance of hospital safety and quality to provide background to others in the field who might be interested. A friend asked me how our Patient Care Assessment and Quality Committee (PCAC) is constituted and what its charter is. Here it is in its entirety. The key points are that its job is related to the overall institutional goals established by the Board of Directors (the ones mentioned below), as well as statutory responsibilities. Also, that membership by the lay leadership (entitled "Medical Center Governance" below) always exceeds that of internal management and clinical leadership. Note, too, the inclusion of the Vice President of Education to ensure that quality and safety programs are integrated into the educational programs for both medical students and residents -- very important in an academic medical center.

This is a hard-working committee for the volunteer leadership, meeting monthly and dealing with difficult and challenging issues. We have great appreciation for those people, who devote hours well beyond the committee meetings in staying informed and thinking about the most important topics on the Board's agenda.

BIDMC Committee Charter
Patient Care Assessment and Quality Committee (PCAC)

Reports To: BIDMC Board of Directors

Mission:
The mission of the Patient Care Assessment and Quality Committee (PCAC) is to support the aspirations for clinical quality and safety for BIDMC as set forth by the Board of Directors, and make appropriate recommendations for improvement. The PCAC shall also serve the role of Medical Peer Review Committee as defined under the statutes of the Commonwealth of Massachusetts.

Charge and Scope:
Monitor the occurrence of harm to BIDMC patients, with a focus on response and corrective action when harm occurs.
Select and monitor priority metrics that evaluate clinical quality and safety processes and outcomes achieved within BIDMC.
Recommend to the Board of Directors, at least annually, priority initiatives for improving quality and safety of care at BIDMC, and monitor the extent to which approved priority initiatives are satisfactorily executed.
Ensure that BIDMC remains alert to current best practices for quality and safety, at BIDMC and other entities (in health care as well as other settings), and recommends appropriate adoption. This shall include ensuring that best practices within BIDMC itself are spread and implemented throughout the organization.
Approve annually the Qualified Patient Care Assessment Program.
Ensure that all regulatory reporting mandates for clinical performance, including the filing of major incident reports to the Commonwealth, are met.
Ensure that members of the Committee have the appropriate knowledge and training necessary to carry out the mission of the committee.

Committee Chair:
Member of BIDMC Governance, Appointed by Chair of Board of Directors

Members:
Chair (Member of Medical Center Governance)
Vice Chair (Member of Medical Center Governance)
Chair, Board of Directors, ex officio
CEO, ex officio
President, faculty practice, ex officio
Chair, Medical Executive Committee, ex officio
Chair, Deptartment of Surgery, ex officio
Chair, Department of Medicine, ex officio
Chair, Academic Department (Rotating 1 year appointment, appointed by the Chair of the Medical Executive Committee)
Vice President, Education, ex officio
11-24 Members (Members of Medical Center Governance)

Staff:
Chief Operating Officer
Senior Vice President, Clinical Operations
Senior Vice President, Health Care Quality
Patient Care Assessment Coordinator

Meeting Schedule:
Monthly (except no August meeting)

Source material on quality, safety, and patient satisfaction

As a follow-up to the post below on the quality, safety, and patient satisfaction goals established by the BIDMC and BID~Needham Boards, I thought some of you might be interested in reading the material that led to the votes. It is a bit long, but descriptive of the issues that were considered. For some of you, this might be more than you want to know. For others, it might provide primary source information that could be valuable for your own institutions. My hope is that more hospitals will find themselves moving in this direction, and if the accompanying memo helps in your own consideration, please feel free to use it. (In the memo below, the LEAD program refers to a partnership between our hospitals and Blue Cross Blue Shield of MA, under which auspices the Board training program was held.)

In my next posting, I plan to give you a sense of the internal feedback that I have received since making this announcement.

To: BIDMC Board of Directors and PCAC Members
BID-Needham Board of Trustees and PCAC Members

From: Lois E. Silverman, Chair, BIDMC Board of Directors
Seth Medalie, Chair, BID-Needham Board of Trustees
Robert Melzer, Chair, BIDMC PCAC
Paula Ivey Henry, Vice Chair, BIDMC PCAC
Christoph Hoffmann, Chair, BID-Needham PCAC
Paul F. Levy, CEO, BIDMC
Jeffrey H. Liebman, CEO, BID-Needham
Ken Sands, MD, Senior Vice President, Healthcare Quality
Stan Lewis, MD, Senior Vice President, Network Development
Dianne Anderson, Senior Vice President, Clinical Operations

Re: LEAD Board Program Follow-up

Date: November 30, 2007

Dear Board Members,

Following our immensely engaging LEAD retreat last month, a group of us got together to draft a proposal on quality and safety goals for both hospitals for your formal consideration.

It was clear from the retreat discussions that there should be two ambitious overarching goals for both institutions: One for the quality and safety of care and another for patient satisfaction.

The group agreed that the Board’s role is to set an expectation for organizational performance for these two areas. Management is then expected to devise programs for achieving these goals, and to determine the metrics against which performance will be measured. We anticipate that the structure of the Board meetings will change to include systematic reviews of the programs related to these goals on a quarterly basis.

On the patient satisfaction front, we propose the following goal:

BIDMC and BID-Needham will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to “willingness to recommend.” For this goal, BID-Needham will measure itself against national peer group hospitals and BIDMC against a national dataset of all hospitals.
A top 2% goal means that effectively nine out of every ten patients rate the hospital in the top tier category on national surveys for willingness to recommend. BIDMC is presently performing in the top 10-15% range, on average. BID-Needham is in the top 30%. This goal represents a steep climb in performance for both institutions.

Formulating a goal for quality and safety proved more challenging, as there is a broad spectrum of definitions for harm and error, and consequently a broad range of implications for goal setting. First, there is a distinction between preventable and non-preventable harm. The latter type occurs when a patient is harmed as a result of a cause that could not have been predicted or prevented, such as the administration of a drug resulting in an adverse reaction that a patient’s history would not have indicated. Preventable harm, on the other hand, occurs when there is a failure on the part of either an individual or a system to render ideal care, such as when the administration of an incorrect dose or medication results in an adverse outcome causing actual injury to the patient.

It should further be noted that there is a distinction between harm and error, and that not all errors result in harm to the patient. For example, an incorrect dose of a particular drug administered to a patient might not affect the patient. The Institute for Healthcare Improvement (IHI) reports that only 10 to 20% of errors are ever reported, and of those, 90 to 95% cause no harm to patients. While much can be learned from all errors, many (including IHI) recommend that institutional governance focus on those causing actual harm. The theory is that by discussing openly those events actually experienced by patients, a hospital begins to foster a culture of safety that shifts from individual blame for errors to comprehensive system design and therefore lasting improvement in safety.

The first step in identifying harm is to develop a clear definition. Our small group reviewed several definitions of harm, ranging from IHI’s very comprehensive definition of all harm, including preventable and non-preventable harm, to the Ascension Healthcare System’s quality goal of no preventable harm. We felt that we needed to focus our resources where we can have the greatest impact, on eliminating preventable harm. At the same time, we wanted to maintain an organizational awareness of all harm, including non-preventable adverse events, and to seek to reduce our overall incidence of harm. The goal that we propose for quality and safety, therefore, is:

BIDMC and BID-Needham will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
To determine and clarify how we would actually measure harm, we propose a modification of the categorization developed by the National Coordinating Council for Medication Error and Reporting and Prevention, known as the “NCC-MERP” Framework, to consist of the following categories of evidence of harm:

- Required hospitalization or extended hospitalization
- Permanent harm or disease progression
- Patient death

We feel that focusing on these categories will give us the greatest opportunity to achieve a meaningful and sustainable reduction in harm, while making the best use of our resources. The occurrence of harm that falls into any one of these categories would qualify for individual case review. In addition, while the boards of our institutions will focus on “preventable harm,” we also expect our respective PCAC committees to develop systems for periodic assessment and reporting on the occurrences of harm that are not within the categories listed above.

It is important for the Boards and the respective organizations to understand that these goals represent a far-reaching aspiration for our hospitals and for the level of care that we seek to provide. We must acknowledge that getting there will be a three to four year journey that will require further strengthening of our culture of safety and transparency. It will mean further bolstering our efforts to create an environment where caregivers feel safe discussing the occurrence of harm.

We discussed and propose the following timeline: At the December Board meetings, each Board will discuss and vote on these proposed goals and the attached resolution. Management would then be charged with outlining specific programs with measurable milestones to achieve these goals. In January, staff will be asked to present to their respective PCAC committee a timetable for these programs for the following year, along with a trajectory of performance towards the end goals. Upon review and approval by the respective PCAC committee, the action plans and milestones will be brought to the Board at its first subsequent meeting. A quarterly review of progress towards these goals would then become a regular element of each institution’s Board and PCAC meetings. In addition, the Compensation Committee of each hospital will be charged with building these quality and safety goals into the annual incentive plans for senior management.

We welcome your feedback and questions on these proposed goals, and look forward to our discussions at the December Board meetings.

Aspirations for BIDMC and BID~Needham

Here is an email I sent last night to the staff of BIDMC and our community hospital, BID~Needham. Thanks to CEO Cleve Killingsworth and others at Blue Cross Blue Shield of MA for being our partners in the Board training and providing other assistance and encouragement that helped lead to this step: Please see Jeff Krasner's story and an editorial in today's Boston Globe. Special thanks to Jim Conway at the Institute for Healthcare Improvement for his wise counsel and for conducting a significant segment of our Boards' training, and to three unnamed patients who addressed the Boards and powerfully made these issues tangible. Finally, after the text of this email, please read the statement we received on this matter from State Senator Richard T. Moore (Senate Chair of the Joint Committee on Health Care Financing).

Dear BIDMC,
There are some things that we do that are meant to transform our hospital, to set us on a path to very high standards that, at first blush, appear so audacious as to be unachievable. But if you never take the leap and set out the goals, you never know what you really can achieve.

Today, we announce such goals, in the hope that they will set the stage for such a transformation.

Several weeks ago, the Board of Directors of BIDMC and the Board of Trustees of BID~Needham met and had serious discussions about what their hopes were for our two hospitals. As the representatives of the community who have fiduciary responsibility for our two non-profit organizations, they decided on a pair of goals that represent their aspirations for us. Of course, the clinical and administrative leadership of the hospital were deeply involved in these discussions as well and provided the technical support for the decisions that were made.

The Boards decided that two overarching types of goals were important. The first relates to patient satisfaction. The second relates to safety and quality of care. Here is the vote that was taken by the BIDMC Board (and a virtually identical one was taken by the BID~Needham Board):

WHEREAS, the Board of Directors, Patient Care Assessment and Quality Committee ("PCAC"), and Patient Care Services Committee ("PCS Committee") of Beth Israel Deaconess Medical Center ("BIDMC") have determined that it is in the best interest of BIDMC to set ambitious and overarching goals related to healthcare quality and patient safety, and patient satisfaction.

NOW THEREFORE BE IT RESOLVED AS FOLLOWS:
To approve the following goals for BIDMC related to healthcare quality and patient safety, and patient satisfaction:

BIDMC will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to "willingness to recommend." For this goal, BIDMC will measure itself against a national dataset of all hospitals.

BIDMC will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.

That Management will develop and implement action plans and programs to achieve these goals, to be reviewed and approved by the PCAC Committee, PCS Committee, and the Board, and will report to the Board, PCAC, and PCS Committee on at least a quarterly basis using defined metrics against which performance will be measured.

Daunting, eh? You bet. Here's more. We will be publicizing our progress towards these goals on our external website for the world to see. In other words, we will be holding ourselves accountable to the public for our actions and deeds. Our steps towards transparency have just been notched up a level.

These Board votes certainly do not mean that we are not already doing a good job now. Our Boards have immense respect and affection for all of the staff who work in our hospitals. They know you take really good care of patients and provide a warm and caring environment for patients and families. But the votes mean that our Board members who represent the community want us to do even better, out of a sense of public service and also out of a sense of pride that we can do better.

Over the last several months, we have seen a hint of what is possible. Our efforts at infection control on the floors and in the ICUs are but a few examples. Meanwhile, too, we have made process and customer service improvements in a number of clinics. We have saved lives, reduced adverse events, improved customer satisfaction, and made life a bit less hectic for some of our staff. (You know from previous emails that I am working hard to make even more improvements on that latter point.)

We have come a long way. Six years ago, both of our hospitals were close to being sold or shuttered. Four years ago, we had passed through a turn-around and proved our ability to survive. These past two years, we have shown that we are vibrant members of the Boston and Harvard medical communities. Now, we rise to the largest challenge yet -- setting standards for patient satisfaction and reduction of harm that are truly world class.

Stay tuned as we roll this out and decide on the yearly priorities and work plans that will eventually lead to reaching these audacious goals. In the meantime, as always, please keep in touch with your ideas, suggestions, and criticisms.

Sincerely,
Paul

Here is Senator Moore's statement:

“BI-Deaconess deserves to be strongly commended for taking this challenging, bold step to improve health quality and transparency. By including a small community hospital (BID-Needham) as well as a major academic medical center, BI-Deaconess becomes a true champion of health care quality and patient safety. Their leadership in promoting transparency is unprecedented in the Commonwealth, and is fully consistent with the principles behind legislative initiatives such as Senate Bill No. 1277/House Bill No. 2226, An Act Improving Consumer Healthcare Quality. They obviously understand the meaning of 'First, Do No Harm.' They get it right!”

Thank you, Senator!

An idea for US News and World Report

Here is an open suggestion for Avery Comarow, the editor of the annual US News and World Report ranking "America's Best Hospitals." Why not add to your algorithm extra points for those hospitals that voluntarily publish clinical indicators of the degree to which they harm patients? I am not talking about the usual hodgepodge of outdated CMS data, which are available anyway. I am talking about substantive clinical metrics, like central line infections, ventilator associated pneumonia, and the like. Or the ultimate, the hospital standardized mortality rate calculated by the Institute for Healthcare Improvement.

I can already hear the arguments against this. Who is going to validate the numbers? Which definition of central line infections should be used? How would you compare from hospital to hospital?

Please, put all that aside. Let's just accept as a premise that hospitals that choose to post these numbers do so not for comparative or competitive purposes, but rather to hold themselves accountable to the public for their efforts in quality and safety improvement. Shouldn't that be worth something in the US News listing?

A fallback, if you don't want to change your algorithm. Just create a special box listing the hospitals that post these kinds of results, along with their url, so people from hospitals around the world can check in and make their own judgments about the usefulness of this approach.

Avery, you have become a force in this field. As noted on your blog, your perspective uniquely qualifies you to observe and comment on the efforts by hospitals and other health care providers to improve care and patient safety. Why not use that influence to push the industry along to greater heights by giving space to those who risk holding themselves accountable in this manner?

Safety in the NICU

Mark Graban at Lean Blog asked the following question as a comment to a posting below. It is interesting and important enough to repeat here for a larger audience -- and particularly for people at other hospitals who might find the answers of value. I am sure the BIDMC people mentioned would be very happy to provide further information to people from other hospitals. (Also, I have to admit to a little pride in that our folks, who already thought they had a very good plan on this matter, went further to adopt additional safeguards for these very tiny babies.)

"Do you have thoughts to share on the preventable heparin error involving Dennis Quaid's twins in L.A.? What steps is BIDMC taking to proactively prevent that same error from occurring in your hospital?"

After consulting with our people, I posted this initial response, with the help of Greg Dumas, one of our pharmacists:

I asked our folks about the heparin question you raised. Here is part of the response from one of our pharmacists. As you can see, the staff is still working on other ideas.

"Please see the steps below that we put in place prior to the tragic September 2006 incident at Methodist Hospital in Indianapolis.

"1) Heparin Flush Syringes 10 unit/mL are stocked in the NICU Automated Dispensing Machine(ADM). These syringes are stored separately from adult heparin products in an area designated for "Neonate Use Only".

"2) All medications that are filled in the NICU ADM are checked by a pharmacist prior to delivery.

"3) All heparin containing intravenous fluids are prepared by the pharmacy.

"Additionally, the pharmacy does not stock the Baxter heparin products , which were involved in both the Indianapolis and the LA incidents.

"After the most recent heparin incident at Cedar Sinai, our Clinical Pharmacy Coordinator Medication Safety, we decided to evaluate utilizing the bar code technology as an added safety measure. The NICU/Pharmacy Committee will review this at this Tuesday's meeting.

"Providing medications safely and effectively for our NICU population is of utmost importance to our pharmacy."

And, a bit more explanation:

"The Methodist Hospital NICU stocked heparin flush 10 unit/mL in 1 mL vial. The pharmacy technician mistakenly delivered heparin 10,000 unit/mL vials which are used for SC injections for DVT prophylaxis(there are also 20,000 unit/ml vials). This is what caused the 1000 x overdose. The news stories do not say that a pharmacist checked the vials before they before they were delivered. We require all medications be checked by a pharmacist.

"I am comfortable that this could not happen here. We purchase pre-made 3 mL heparin flush 10 unit/mL in 12 mL syringes. These syringes are blue and stored in a special section of the pharmacy designated for NICU only. The adult heparin flush syringes are 100 unit/mL and in a yellow syringe. These are stored with the main inventory far away from NICU stock."In July, we began stocking the NICU with premix heparin IV solutions. This enabled us to remove the heparin 1000 unit/mL 10 mL vial that had been stocked for nurses to prepare initial IV bags for UAC and UVC lines. The RN would add 500 units to the 1 liter bag of fluid.

"We removed the heparin 1000 unit/mL vial in July and the only heparin in Omnicell now is the heparin flush syringe. This was a safety quality initiative that the NICU/Pharmacy committee had started a couple of years ago and finally implemented it this July."

I just received a followup from Susan Young, clinical nurse specialist, in our NICU:

"The NICU/Pharmacy committee met today; pharmacists Karen Smethers and Steve Maynard joined us to look at other safety measures we could use in the NICU to prevent mis-dosing heparin. The NICU has only one concentration of heparin stored in Omnicell - the 10 unit/mL syringe. This syringe has a blue label. There is another syringe available through Pharmacy that is 100 units/mL. It has a yellow label.

"Omnicell has the ability to read barcodes. We decided to use this feature for heparin to provide a double check for the system. Pharmacy technicians load the heparin syringes into Omnicell. When they do this, they will barcode the heparin syringes. This will provide some safety, but will not ensure that all syringes are of the correct concentration because only one syringe can be scanned when filling the Omnicell bin. (To scan each syringe would require the technician to close the draw after each individually scanned syringe and re-enter Omnicell.)

"The second part of the safety will require the NICU nurse to scan the syringe when removing it. This will ensure that she has removed a syringe with the correct heparin concentration, in the chance that a syringe was incorrectly loaded in a batch. These added steps provide some added layers of safety.

"The NICU is moving ahead with implementation of POE. This will also help to prevent errors and overrides when we have a quicker way of sending order sets for medications to the Pharmacy. Admission of infants to the NICU is one time when we remove medications prior to them being overseen by Pharmacy. Umbilical lines require heparin, vitamin K and erythromycin are administered quickly. POE will help with this process. One system issue that interferes with a more rapid process is that infant medical record numbers are generated after an infant is born. The committee will be examining whether it is possible to start that process earlier so that medications that are needed immediately after birth would be ordered and authorized by Pharmacy, in some cases even prior to the birth of the infant. Working with Admitting is key to this part of the plan, and one that is recommended by Karen Smethers as a way to provide more Pharmacy oversight."

Responses to Thanksgiving email

As promised, I want to keep you up to date on responses to the staff email included in the post below. The email certainly struck a chord, and the replies give you a sense of the range of feelings within our hospital. This is the one that sticks with me the most and gets to the heart of what I would like to change: This facility provides great pay and benefits. Fulfillment, though, is something that I seek elsewhere. What a shame that we cause anyone to feel that way!

Remember, these were not anonymous replies, and I am fortunate that people here are so forthright with me. These are mostly unexpurgated and presented in the order I received them, so you get the vicarious pleasure of reading both the good and the bad. And yes, you can laugh (or groan) with me at the humor!

I am guessing that people in other hospitals will see common themes -- or would, if they asked the questions.
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Hi Paul,

You're SO right about the fetching!!!

Three things come to mind:

1. On rounds, I spend at least twice as much time looking for patient charts as I do with the patients. This is due to simple lack of consideration by my colleagues who feel they are too important to spend their time putting the chart back when they're done with it---some consciousness-raising here would be great!

2. We had a semi-similar program here in the 80's called "Prepare 21" as in "prepare for the 21st century." (But I'm sure you already knew that. . .) People were very skeptical about the program until they received their first "incentive" check which distributed the cost savings the hospital realized during that quarter from implementing the suggestions made, then suddenly the whole staff was on board and knocking themselves out for new ideas. (It would have warmed your heart if you had been here then.)

3. In the movie "Mean Girls" (a classic) the girls tried to introduce a "cool new word" into the vernacular; that word was "fetch" (as in, "your new sweater looks really fetch.") Maybe the inspiration for the new program's name could come from there???

All the best for a great Thanksgiving (the best holiday of the year, since it is the all-American, non-sectarian, no-gift-giving-pressure holiday devoted to family, eating, and football.)
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What a wonderful email Paul !!

I am proud to be a part of BID.
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I think it should be named The 3rd Hand...since every nurse wishes she/he had an extra hand and also, tends to multi-task beyond the call of duty.
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Hello Paul,
It might be a "fun" idea to have a contest on picking the program name.
My program name would be "let’s have fun getting it done".
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Paul—
I loved this communication. I’m ready to get involved!
Hope your Thanksgiving is also wonderful…
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Hello Mr. Levy,
Hospitals typically make use of an antiquated hierarchical form of management. This is true for the BIDMC, and we keep using a playbook which relies on scolding and belittling the staff. And yet we continue to call upon outside consultants to speak with the staff, while year after year the existing management teams treat input from the front lines with contempt.

Why can’t our current management staff learn from their own teams? Is it a feather in our cap to point out that we are hiring—paying for—outside consultants to find out how we can improve? Can we not "capture value" and get "lean" with our current leaders? Whenever I have an opportunity to answer survey questions, I always respond, "Please talk to your staff."
I’m convinced that this could work.

I don’t mean to have a disrespectful tone. This facility provides great pay and benefits. Fulfillment, though, is something that I seek elsewhere. How many former managers in our midst want nothing to do with leadership positions? Your concern and good wishes for Thanksgiving—and for the general improvement of the professional development of the staff are genuine and appreciated. Thank you.
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Truth is, we also spend tragic amounts of time documenting instead of being in contact with patients. Even more than fetching.
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Hi
I love this idea.

When I am rounding, I spend a lot of wasted time looking for and "fetching" charts that were not put back on the rack after someone used them. This shows lack of respect for whomever they think will put them away (reminds me of my teenager…)
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Thank you. Happy Holiday to you and to your loved ones as well. My suggestion for the title is "Let us make it work, TOGETHER".
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Dear Mr. Levy,
What a wonderful way to start my day. My motto has always been in my 30+ (ahem) years that "This is not just a paycheck". I truly believe if this program is successful, that employees will take pride in their work and feel "valued" and that they are not here to simply put in their time and then go to the bank for survival. The increased self esteem will also be such an added perk.
I hope you have a safe and happy holiday as well.
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Mr. Levy,
I normally don't write back on these sorts of things, but this one has caught my attention. I personally can answer no to two of your questions. Many employees in my position feel like the extra's we do go unnoticed but if we make an error it is immediately noticed. Each day I come to work and think about the person on the other side of my counter (the patient). I treat each patient as if he/she was my mother or father. I try to instill in others that patients come here because they are usually sick. This is especially true in my division (thoracic surgery). The last thing any patient or family member needs to hear is "I don't know" or feel as though they are bothering us. I love what I do for work and I would relish the thought they our supervisors would notice a job well done. Telling someone they have done a good job goes a long way and brings a smile to the employee. Feeling good about your job is an important part of doing a good job. Thank you for taking on a project to make each employee feel as thought he/she is a valued employee. My suggestions for a name for your upcoming program are: Feel good at work and I matter.

Happy Thanksgiving.
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Hi Paul,
This is very, very exciting news. Your idea is wonderful. I have one suggestion that you might find of value. It may be helpful to create a hotline, either a phone or email based response venue that allows employees to report stuck ideas.

The one thing that is very discouraging is when people work hard on finding solutions only to have them get "lost" in the system. One of the major stumbling blocks in a large institution like this is that what one person does can and often does affect others in different departments. So when a change is proposed, it has to go through a committee. It is important that feedback be given to those who worked on a solution, especially if it is discovered that one aspect of the problem is made worse by the proposed solution. They should be encouraged to work with the department to find an acceptable solution.

In order for employees to feel empowered, they need to have a voice in finding out what is happening to their proposal.

I really appreciate your leadership. We are truly lucky to have you as our team captain.
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Dear Paul,

Happy Thanksgiving to you and your family also. I want to compliment you on the wonderful vision you have at just about everything you do and say and plan, I truly appreciate all your efforts.

Yes, you caught my attention and in my opinion you are right on target. I think BIDMC does a superb job generally but I believe there is always room for improvement. The thought that keeps coming to my mind about what to call the 'program' is to look at it from the perspective of why these "work-arounds" can be so prevalent. I think it is because of how we all choose at times to 'overlook' things. Such as "oh well that was the last 'whatever', I don't have time to tell somebody my patient needs me now, I am sure someone else will order more", etc. I think a good name for the program might be DO. Which I believe would stand for Don't Overlook. If just a few more people chose to not overlook something we could be even better than we already are to our patients and fellow staff.

Thanks for caring so much.
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Good day Mr Levy,

You should name the programs (DRKN) it identify the three questions. D is for dignity, R is for respect, K is for knowledge, and finally N is for notice.
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Hi Paul
I find this idea intriguing, I have a suggestion with a little humor attached:
S uggestions
M aking "SMILE"
I nstitutional
L ife
E asy

Enjoy the Holiday
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Good Morning Mr. Levy,
This message may be one of hundreds that you receive this morning alone; I just wanted to drop a quick note to thank you for your timely message. This is an issue that I have been bringing in to work recently. It's nice to know that it is being discussed and that more is to come.
I wish you and your family a wonderful Thanksgiving.
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What comes to mind-
Smart Care
Working Smart
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HOW ABOUT "FETCHING R-E-S-P-E-C-T"------I think ARETHA FRANKLIN would respect this choice!!!!!!!
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A suggested name for this program: RESPECT = Representing Evaluating Specialties Provides Excellent Consistency Throughout

Happy Holiday!
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Hi Paul,
This is VERY exciting! I work in the OD group. I've spent a lot of time with the Nursing groups for the survey work......one of their big complaints is this "fetching" you describe. They're tired and frustrated.

I look forward to learning more about this critical initiative!

Happy Thanksgiving to you and your family. Drive safely.
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Good Morning,
Happy Thanksgiving to you and your family!
One suggestion for a program name – "Streamline to Success"
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What a great idea….When I worked as an Operations Coordinator for Nursing it was a daily challenge.

Maybe we could call it "finding Nemo".
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I love my job....always have.....you might make it more fun?...bring it on
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Good morning Mr. Levy
I know you are very busy and I appreciate your time.

I have been wanting to email you for a bit now.............I came to BIDMC in September as a new Med-Surg CNS for the East Campus. When you spoke to my orientation group you said "if you find something wrong or can't figure out why we do something, tell me soon........for in a very short time you will get used to this way and you won't be of any use to me."

Well, there were a few things here and there but nothing dramatic that you probably weren't already aware of. I have been involved with the LEAN project and that certainly has had an impact on changing work habits, etc.

So why am I writing? Well, two reasons...............
First, I want you to know how genuinely privileged I feel to work here at BIDMC. I have never felt so welcomed or respected. I chose to come here (yes, I had several other offers) and have never regretted that decision. My days are long and challenging but I couldn't work for or with better people.

This Thanksgiving, I have much to be grateful for.

Second, I'd like to be part of the Value Capture project in any way you deem appropriate. I have been trying to find a way to bring the FISH philosophy here to BIDMC http://www.fishphilosophy.com/ It is a simple concept really and incorporates much of what is part of the Value Capture culture....... It is based on the way business is conducted at the Seattle Fish Market.......honestly, I couldn't make this up!

A. Make their day...............what can you do to make your positive energy contagious?
B. Be there..........being fully present in the moment to all of our customers, internal and external. How are you"being" on the job?
C. Play...........is there a way to bring fun into an otherwise serious situation?
D. Choose your attitude.............you can wake up everyday and 'select' your attitude. Hey, everyday you wake up is a good day as it sure beats the alternative!
....all of this may seem simplistic and obvious, however it has true value and is worth considering.

Thank you for your time and attention. I wish you and your family the very best this holiday season.
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Here is my idea.
BID Real MC Time! Or just BIDMC Real Time!
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PROJECT NO MORE BOONDOGGLE
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Hello:
I've been an employee at BIDMC since 1981 and I've seen quite a few changes. We used to have a program called "Prepare 21" where employees submitted ideas and were rewarded with ones that worked and made a positive difference. Art School, perhaps teaching was my first career choice, but soon after marriage and a child, I came to then named "Beth Israel Hospital" and it was one of the best decisions I've made. I continue to enjoy my work today.
I now working in Ambulatory Education & Systems supporting our Ambulatory clinics and working hard to make things work for the practices (and I do teach)! I love taking a creative/out of the box approach to things! Here is my "creative" suggestion:
The BID-HIGH Plan or The BIDMC-HIGH Plan or simply
"BID-HIGH"
"Bidding to Better, Caring to Win"
Thank you for your hard work to better this Institution.
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Paul,
A suggestion below:
"Revolutionize Your Job!"
Free your work flow from cumbersome processes and unnecessary paperwork to get to the heart of patient care and support.
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For the new program's title:
"Because it's right" or It's only right""We're only human" or "Do the Right Thing" or"WHat I learned in kindergarten""It doesn't take much"or"It never hurts to be kind".
Corny, I know, but, I look forward to the program.
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Mr. Levy- Happy Thanksgiving to you and your family. Name for the new program--- "Our Work is Fun!!!"--
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Dear Paul,
What a refreshing email! It really hits home. There are countless work-arounds every day that we take care of patients. As a nursing supervisor on the evening shift, I get paged for many most basic, mundane things all the time. Interestingly enough, items that should already be at the point of care are prime contenders! Well, the other night I had this dream: I was paged to bring, get this, a bag of composted manure. Yes, you read that right. I woke up and laughed out loud! So, my "fetching" went from the ridiculous to the sublime! At least they didn't want a bag of lime, which is VERY heavy and could have resulted in a work related injury. I applaud your new idea and I hope it can be very successful.

Happy Thanksgiving to you and yours.
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Thank you! Happy thanksgiving to you and your family as well- This project/training tool sounds like exactly what BI needs! I would call it ‘project moral’ for employee moral because that is the underlying heart of BI.
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Sounds like a great idea to me and I'd love to be involved.
Love your blog - have never posted, but always read!
Happy Thanksgiving!
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I wanted to write back with a thought. It is clear that like most - or more realistically all - medical center employees, I do a lot of fetching & rework. Certainly some of this is related to inefficient processes, and I agree it's a terrific idea to try to improve these processes.
But another problem is that there is not enough support to enable me to do as much physician work as I'd like to do. I spend a lot of time doing work that a non-physician could do. As you well know, lots of support positions were cut during the hospital's very difficult financial times, and many have never been added back. We manage with fewer personnel, but it means many of us are doing work that really would be more appropriately done by others, and all of us are working significantly harder than we have been in the past.

I had brought this point up at a forum you attended a year or so ago, and you had replied that these concerns were valid, but that medical center's operating surplus was not such that adding staff was realistic.

Working smarter is a good thing, but having enough people to do the job is just as important.
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Good day Mr. Levy,

I am writing back as you suggested with my idea. My Suggestion for a Name:

The HIGH5PROGRAM
(I would have done the text using text art, but I did not have the option on my workstation).

Happy holidays to you and your loved ones.
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Good morning,
The program sounds looong overdue. How about:
"SAS" -SaveAStep (ie get "sassy" about saving time)
Have a great Thanksgiving,
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Suggested program name "If I had my way, we would ……..".
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Hi Mr Levy,
This maybe a start to a name- (driven) program & it stands for d-dignity, r-respect, I- I did it, v- value, e-encounter, n-noticed.
Happy Thanksgiving
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Hello Mr. Levy,
How about the program name of "Innovations"!
Just a thought….This will be a great collaboration and I look forward to it.
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Submitted for your consideration are a few names for the new program BIDMC will begin working on over the next several months:

The Quality Time Initiative
The Get There Program
The Work Around Initiative
The Gotta Go Initiative
The Short Visit Initiative
The Short Stay Initiative
The Focus Program
The Focus Factor
The Prime Directive
The Prime Time Directive
The Can Do Initiative
The Ready for Prime Time Directive

Thank you for taking time to read this communication. I hope the Holiday is a safe and pleasant one for you and your family.
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I don't have an idea for a name - it all sounds exciting - just wanted to wish you and your
family a Happy Thanksgiving.
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Healing the healers.
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Hello Paul,
I am very happy to see that you’ve decided to take on this monumentous challenge. I can’t think of a better way for all of us to focus on improving the quality of service to our patients.

My suggestion is to name this the "Mirror Image" Program because every time that I have a chance to improve patient care or go out of my way to help anyone, I always consider it a chance to treat that person as if it were myself or a family member. My mirror image encounter. At least this works for me and I am always happy to regard myself as the kind of employee that I would want my Mother to meet, for example, if she had to visit BI as a patient.

Thanks for listening!
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One of my college professors once told our class that "Efficiency" is "doing things right" and "Effectiveness" is "doing the right things". This sounds like what this program is trying to achieve so maybe a good name could be "Achieving Efficiency and Effectiveness at BIDMC" or something like that? I’m not crazy about that exact name though… I think it’d be better if the name told people straight out that we’re trying to improve our ability to "do things right" and "do the right things".
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Dear Paul,
Sounds fantastic….I look forward to implementing some of the strategies for home too!
For a title how about "BIDMC - Working from the Inside Out" or "BIDMC - Turning it Inside Out!"
That was the first thing that came to mind. I’m sure it will be very clever! Thanks.
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Putting air in the Cadillacs tires
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A few ideas for names:
Operation Short cut
Operation direct access
Operation Direct path
Operation Straight line
Happy thanksgiving!
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"Slam Dunk"
I’m not aware if there is a more efficient process in sports; among leaders, the objective is achieved more than 98% of the time. It can be done with a flourish, but in most cases it is direct and decisive (and has the same value).
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Dear Paul,
Here is a suggestion for a name: Project Butterfly Effect.
It is not that funny, but it is both, inspirational and scientific.
From Wikipedia: …" The flapping wing [of the butterfly] represents a small change in the initial condition of the system, which causes a chain of events leading to large-scale phenomena. Had the butterfly not flapped its wings, the trajectory of the system might have been vastly different."
Happy holidays!
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Paul,
I'm glad to hear that we are working on this area that we are in desperate need of repairing. I have often found that we get so caught up in the bureaucracy that we often miss the goal, the patient. I work in the Ultrasound department and I have often heard people say that they were hired to do ultrasounds not office work, which translates into less time for quality patient care. I'm not saying that my co-workers do not strive to offer the best care possible, however, it is exhausting sometimes keeping up with everything else that is required of us.
Thank you, for your constant care and supervision of our facility.

P.S
Operation Recovery
Group Care
Caring Group
Fetching Care
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How about "STRAIGHT LINE' .....A more direct way to deliver care without all the obstacles!
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Good morning Paul,
This popped into my head as I popped the turkey in the oven and myself into the shower:
"Heart Work." It speaks to the staff's work ethic, dedication, compassion, commitment to quality, and, of course, and caring.
BTW, I've been a patient rep here for five years and elsewhere for another five.
I would very much like to team up with you when this program launches. You could use someone who can accurately portray the patients' points of view as you make this place even safer and smarter.
Let's talk (turkey?)!
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Dear Paul, The overall idea is excellent, to treat everybody with respect regardless of rank and appreciate others work, but I am not sure how that will cut down all the bureaucratic rules and double work which is forced upon us today. However, in view of the time of launch of this program and its content I think it should be called: "Don’t be a turkey"-program or for short: "No – turkey" program. With best wishes for a happy Thanksgiving
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I want to propose the following as a possible name for the new program.
Solutions
Over time
Lead to
Valued
Employees.

Identify
The solution.
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Mr. Levy,
Thank-you for the opportunity to contribute to this very important effort. As a new employee here at BIDMC, I am very impressed with the collegiality of the staff and the openness to new ideas. My suggestion for naming this program is: The Patient FIRST Initiative.
The letters in FIRST each represent a characteristic needed to accomplish the goals outlined in your commentary.
Focus
Integrity
Recognition
Solutions
Trust
This name also emphasizes and reinforces our commitment to the patient. Every minute of every day should be spent with the patient in mind even when we are not directly involved in patient care. This requires each of us to re-evaluate how we go about our daily work, how we interact with and treat each other as individuals, and what changes we can make to provide the best possible care to our patients.
Thanks again for the opportunity to share my thoughts. It is very refreshing to be asked by the President and CEO of a major teaching hospital for your contributions. I am quite sure that I made the correct choice in coming to BIDMC.
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Hello,

what a lovely email!
I look forward to the fruits of this labor.

Now that I am in a non-patient-care role, I do spend a fair amount of time fetching, but more than that I spend time wondering--wondering what my role is, wondering if the person tasked w/ initiating a meeting will get around to it, wondering what the deadline is--basically, wondering how we are going to work together in a team.

In a front-line clinical situation, roles are clearer, more similar to a sports situation, or an industrial process.

The murkiness is draining.

So, I would be infavor of a slogan that captured the clarity of how teams work together.

Since I don't know a lot about sports, I don't have anything clever to offer, but basically something that captures
1. leadership recognizes that it is tasked w/ helping everyone know their role/position and play their best in that position
2. everyone has their own honor at stake for playing their best in their assigned role.

What do coaches say to people to propel them forward in these ways?

I would love to hear more of that coming from my colleagues' lips!
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Dear Paul F. Levy,
I loved your email. Dare I hope that things might turn around for the caregivers here? You have turned this place around on so many levels but here in the OR on the west campus we continue to suffer and struggle to provide high quality care. Not a day goes by that I don’t consider leaving because of system inadequacies. I won’t waste this email detailing our woes but instead look forward.
Based on your description of us fetching…. I think you might call it the Fido Project. It’s fun, it’s light, it’s non- bureaucratic. Your project can be used to transform "fetching" from a verb to an adjective. I have more ideas but right now I have to run to get something.
Thanks for reading,
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One less step
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Hello Paul,

Well you hit the nail on the head about antiquated systems, etc and also with the 3 questions which allow greatness to be possible. Value Capture is good. It can work here.
I returned to the Deaconess (BIDMC) after working here 25 years ago. I have been caught crying in the bathroom (which shouldn't happen at age 49) both frustrated and disappointed. I thought I was coming back to major league, and I have, except that systems you mentioned are far worse than I had expected for a hospital of such caliber. Even my superiors admit to the chaos. One said to me, "You will learn to function in this dysfunctional environment" - How sad and telling is that!! I want to like my job.

Fetch is a verb which should only apply to a dogs actions, so I will propose your program to be called "No Fetch"
I doubt it'll go over but it is unbureaucratic! How 'fetching' is that!!
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how about Absolute Fabulosity? :)
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Paul Levy,
Thanks for daring to take the steps that have led this institution to firm footing.

Of the past you underscore:
1. Big institutions, like most hospitals, are based on old patterns and systems.
2. Other fields have progressed in terms of process improvement, but medicine is woefully behind.
3. Personal commitment, hard work, and good will, have allowed patients to get extraordinary care, due to "work-arounds" (despite the suboptimal effectiveness of systems).

Goal: Engage the whole medical center in strategic planning.
We seek, the next steps, to advance the process. How to begin to solve the "underlying work process problems."
It's time for us to get "HIP" to the improvements which will drive this organization to superior continued growth. This name ("HIP") is a mix of bureaucracy and modernism, with a flair that grabs attention. In fact that is also the point of the whole new "not-a-program"--to as much as reasonable advance old bureaucratic positions/patterns to more adaptive ones, but accomplish it with a vigor and flair that is exciting, even trend-setting.

It's time to get "HIP" to the New Directions at BIDMC--You tell us how!! You show the way!!

How to improve HEALTH at BIDMC?
Get HIP--(Join BIDMCs' H.E.A.L.T.H. Improvement Program)

Hospital Efficiency And Long Term Healthcare Improvement Program. H.E.A.L.T.H. Improvement Program

Nice because it ties in older concept of Hospital Efficiency Index (HEI), but emphasizes push towards new directions in medicine towards "health," not more classical/currently accepted "management of illness." Such "management" is institutionally embodied in rigid adherence to "work-arounds" that ought to have long been supplanted by systems adjustments. "Management" has its accepted share of the activity at any time, but dramatic advances in treatment (and institutional effectiveness and patient care) will multiply, when a thoughtful process has been engaged about how we can all get "HIP."

Help us get "HIP." Join BIDMCs' HEALTH Improvement Program.
"Setting the trends (viz. synonym for 'hip') for a Healthy Future." Beth Israel Deaconess Medical Center.

Issue 1: Working together to be a trendsetter. (Regardless of role or rank, I have real knowledge to share with and about My BIDMC--and WE care, listen and respond to every concern).
Visual 1: You or someone else who embodies the institution (like the Apple vs. PC commercials) could dress in a stuffy way (clearly not your usual style), and act as if they are trying to learn a new dance step.

In the distance an employee who had been cleaning the floor or some other work (holding a mop, or a pipette, or a phlebotomy tray, RN pausing as they put something into the tube system, MD looking over while typing a note into computer) could be shaking their head and laughing, while rubbing their head in amusement.

Another shot could have them sitting next to you working through an issue they identified (showing you/us how to be/do "HIP.")

Help us get "HIP." Join BIDMCs' HEALTH Improvement Program.
"Setting the trends for a Healthy Future." Beth Israel Deaconess Medical Center.


Issue 2: "Pain" of doing the "training and (learning) new approaches to our work." "Learning!--When's the test?"
Despite the "it will be fun" argument--I'm sure it strikes fear into seasoned staff, nurse and physician alike, and probably even some administrators. "Once again another new procedure, process, system, and an additional layer of paperwork, I have to learn!?" "Fun!--yeah, hearing you loud and clear boss."
(Learning this set of knowledge, tools and support will enhance my ability to contribute to and enjoy My BIDMC and my private/personal endeavors).

Visual 2: Grouchy caricature of employee reading the "Get HIP" announcement, reads the line, "It will be fun." Retorts, "Fun!--yeah, hearing you loud and clear boss. Another set of papers to fill out." (The really jovial medicine attending who works on IT integration, though not so grouchy, could swing this well also.)

In the background or in another frame, the room where the training is going on, can have Club lights and music and people doing the electric slide, while a few are off on the side learning how to do it.

[Learning the electric slide. It's a 'fun' experience, that most people found at least a little difficult--to have to tolerate the learning process. But after doing so, most have enjoyed years of real fun after just a little time adjusting and learning. To bring this right home, the picture could be 'staged' in the cafeteria, as if the cafeteria were going to be the room used to do the "training." All the chairs tables could be stacked to the side, DJ in place and employees (or actors dressed as such), could dance around for the shot and others act the part of learning the new steps. You've got to be in the shot--nice if a few department heads (RN, SW, Cafeteria, Medicine, Surgery, Psychiatry, etc), could swing over for some of the shots also].

Tag line-- Can you do the Macarena?

Get "HIP." Join BIDMCs' HEALTH Improvement Program.
"Setting the trends for a Healthy Future." Beth Israel Deaconess Medical Center.

Visual 2A Another Visual or another part of Visual 2, could have people doing limbo dancing, where each person's effort is recognized or "Soul Train" Line Dancing where the whole line watches one person do improvised/interpretative dance. (This could emphasize the notion that many people are pausing to recognize and appreciate each person's contribution).


Issue 3: The Fetch-It/Re-Write Paradox
Visual 3: Harried RN/staff/MD, can be seen in a blurred shot running back and forth for papers/medicines/labs/supplies etc. Or frustratingly copying information from one format to another--yet another time, for billing purposes/or whatever reason.

First screen is all that's needed. With tag- "Don't you think it's time to get HIP?" Join BIDMCs' Health Imp . . .

A second screen, could show person with a light bulb coming on above/in their head.

Third screen, Slick (well-groomed, etc) follow-up shot of same person, with- Are you HIP? button, clipped on to their white coat--no longer harried, but now dancing fluidly (or contentedly proceeding) through their work, in half the time with improved accuracy (improved patient care).

Get "HIP." Join BIDMCs' HEALTH Improvement Program.
"Setting the trends for a Healthy Future." Beth Israel Deaconess Medical Center.


Question: Do patient's also have the opportunity to get "HIP?" Could be a way to enhance participation in patient survey's of Quality of Care/Treatment Experience.
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Bless you for finally doing something about this!!!! I became an x-ray tech because I never wanted a desk job, but now.....it's just as you said.
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Thanks.
Any chance the project could start in the west campus O.R.? There is so much $$$ waste in staff turnover (requiring expensive temporary staff, overtime shifts, etc). Have you ever seen the list of experienced OR staff who have left here (because of frustrations with the systems)? It’s as long as your arm. Most staff didn’t WANT to leave, they just felt they couldn’t tolerate the dysfunction any more. I know that because I have worked here for 20 years and watched my friends leave one by one.
It CAN be fixed. But it requires that someone important care.
Thanks for reading.
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As institutions like ours are particularly enamored with acronyms, my suggestion is:
Redefining Efficiency - Valuing and Managing Proficiency (RE-VAMP)
Thanks
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Hello Mr. Levy,
Despite having a militant connotation, I suggest "Mission Ready Program". The program has the concept of what occurs in the military before personnel are allowed to go into the field of combat; that is to have all elements of the process by which we deliver our services functioning at the highest level prior to execution. If we think holistically about the challenges we face, it is much like a battle that we must overcome, or better yet a war. We win our little battles with our workarounds, but the war deals with the underlying problem that seeks and needs resolution. Second, the concept of the hospital’s mission statement is evoked. Again in the military it is known by all what the organization stands for and what guides the organization based on the mission statement. Illuminating the idea of the mission statement brings focus of values and pride to the people of the organization. For us to face the challenges that you have laid out, it is a fitting concept.
Thank you for your consideration.
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Dear Paul,
Hope your holidays were wonderful. This new initiative sounds just wonderful and so much in the BIDMC philosophy and spirit. So, in my spare time between patients here are some names. Don’t know if there is a deadline for naming the program and others may come to me if you want more!


Old Problems: New Solutions
Old Problems/Fresh Ideas
Show Us The Way!
Try It, You’ll Like It!
Solution Central
Staff Strategies
2008: In with the New
Not the same old, same old
Anatomy of the Workplace
Better Idea Design Makes Cents
Better Ideas Deliver More Care
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Service Improvement or P.I.G (Process Improvement Group(s))
;)