connect John Muir Health
Fall 2015
We do amazing things together
What Is an HRO? And why are these trainers so pleased that John Muir Health is becoming one? Leadership Corner President and CAO Mike Thomas, up front and personal Share Your co-workers are changing kids’ lives— and their own Inside Story The future of digital health is here
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Perspectives
The Road to High Reliability Being here for our patients, which means providing the safest and best possible care and experience, is at the core of Vision 2022. Consistent with that vision, we are undergoing an important culture change, one that is making a significant difference in the lives of our patients, physicians, staff and volunteers. Our focus on high reliability is truly in service to our patients and tapping into why we are all drawn to working in health care—the opportunity to truly make a difference, every day. High reliability allows us to take our already great health care organization and make it extraordinary. As you will read in this issue, the case for high reliability is compelling. Error Prevention for Reliability and Safety Training gives all of us the opportunity to understand the science behind Irving Pike, M.D. high reliability and error prevention, see Chief Medical how effective it has been in other Officer C o - C h a i r, high-risk industries, such as nucleHigh-Reliability ar power and the airline industry, Program and learn how it can be applied to health care. One of the most rewarding aspects of being trainers is when we hear a participant remark, “Thank you for this class—this is really needed in our department.” Physicians and staff who have participated in the program so far have begun to see the value of high-reliability practices. Whether it’s asking clarifying questions or avoiding assumptions or stopping, thinking, acting and reviewing, or voicing a concern, we’re all empowered to speak up for the safety of our patients and each other. Lisa Foust These error-prevention Senior Vice President, Human Resources techniques make sense; they’re “Join us and your easy to do; and they’re naturally C o - C h a i r, H i g h Reliability Program part of our brand promise of liscolleagues in tening, explaining and working being ‘Committed together as a team. Most importantly, they allow us to support each other to Always!’— and deliver the safe care and excepdoing the right tional experience that our patients expect and deserve. thing, each and Join us and your colleagues in every time.” being “Committed to Always!”— doing the right thing, each and every time.
J o h n M u i r H e a l t h | johnmuirhealth.com
Let’s All Talk— and Listen Give your feedback, speak your mind, talk up, chime in: However you put it, your contributions are needed and appreciated. JMH Connect can only be as good as all of our ideas and suggestions. To make your connection, email internal.commu nications@johnmuirhealth.com or call (925) 947-5384.
JMH connect Published by the Corporate Communications Department. Send us an email at internal.communications@ johnmuirhealth.com. John Muir Health 1400 Treat Blvd. Walnut Creek, CA 94597 Produced by DCP.
O n t h e cov e r : Sue Gorgen, B.S.N., R.N.-B.C., and Gilbert Fuentes, B.S.N., R.N., C.M.S.R.N. Cover photo by Matt Edge.
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Who We Are
Why Do You Love Your Work? “For me, the 1,600-plus volunteers make JMH a great place to work. Sid Kotz, a volunteer in PASE, has made this a great workplace for me since my first day on the job … with his wonderful sense of humor, balanced outlook and deep concern for others.” —S t a c y A p p e l
Volunteer coordinator, John Muir Medical Center, Walnut Creek, and Outpatient Center, Walnut Creek (pictured with volunteer Sid Kotz)
“I chose to work for John Muir Health after I met the most amazing nurses who changed my life forever with the way they cared for our family and my husband … when he was diagnosed with leukemia in 2010. Watching them in action, I realized how dedicated, caring and compassionate they were with their patients. I had just started my career in the medical field, and they helped me realize that if I was going to be in this field, then this is the type of medical professional I wanted to be.” —D e s i r e e S a l m o n
Medical assistant, 2305 Camino Ramon #120, San Ramon
Years of Service @JMH Medical/Allied Staff
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A view of your co-workers’ length of tenure at John Muir Health
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“The fact that John Muir Health listens, not just to their patients but also to their employees—that’s why I love working here.” —T i p T i l t o n
ITS informatics analyst, 1400 Treat Blvd., Walnut Creek
“Family members of our patients are often stressed as much as, if not more than, the patient. Family is very important in my culture, which helps me be extrasupportive with those family members who need it.” —Zo h a i b R a s h i d
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J M H C o n n e c t | Fall 2015
Unit supervisor, Post-Surgical Unit, John Muir Medical Center, Walnut Creek
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Leadership Corner
Q&A: Mike Thomas P r e sid e n t a n d c h ie f a d m ini st ra tive of f ice r, J o h n M u ir M e d ic a l Ce n te r, Co n co r d , sin ce 20 0 9 What have you found to be most satisfying about your job at John Muir Health? I have a passion for the mission of health care. I’m really proud to work with an organization that’s been entrusted with the responsibility to maintain a critically important community asset—not just now, but for generations to come. I believe in our mission, and that’s what inspires me to stay in health care. Maintaining our culture of excellence is an important part of Vision 2022. How important is the current HRO (high-reliability organization) initiative in keeping us at the top of our game in safeguarding patients? There’s no question that our health care environment is becoming more complex and dynamic and putting us constantly under difficult working conditions. Therefore, adopting new tools, like those we’re learning about as part of our focus on high reliability, is vitally important. We need to continually improve communications to improve our ability to deliver safe and high-quality care, which our patients expect from us.
usually find me rounding on the floors, which happens to be the favorite part of my job. I view my job as being an enabler, to help make things happen, so it’s very important to me that I interact with physicians and staff in their natural work environment. Only then can I really fully appreciate the challenges they face and the pressures they’re under. I’m also a bit of an adrenaline junkie—I like the hustle and bustle in the emergency department. I stay well out of the way there. My contributions on the floor are filling patients’ ice buckets or delivering newspapers! I purposely have a very visible presence on the campus. Patients and family members are generally surprised and appreciative wherever I meet them, whether it’s in the lobby or patient rooms or the ED.
What’s an average Mike Thomas workday look like? My days are long, and they tend to be filled with meetings on a whole variety of topics from clinical issues to human resources issues to strategic issues to financial issues. Whenever I have gaps in my schedule, though, you’ll
How do you balance your work and family life? Both my wife and I work, and we have three children. One way we ensure balance is to schedule time together as a family. I’m a strong believer in family vacations so we can recharge the batteries and reconnect in meaningful ways.
Outside interests: Hiking, backpacking, fly-fishing, mountain biking. I’m also a huge fan of soccer. I played center midfielder at Claremont McKenna College and am in their Hall of Fame. Surprising fact about you: I have a backyard aviary at my home, filled with finches and canaries I raise. Fact you want JMH employees to know: Come up and say hello to me. I’m very approachable. I take my work and what we do here at JMH far more seriously than I take myself.
J o h n M u i r H e a l t h | johnmuirhealth.com
High Fives
Mending Hearts Overseas
Top: Maroo Balabagno; bottom: Susan Kell
J o h n M uir H e alt h p hysicia n s , n u r s e s a n d e m p loye e s t rave le d to I n dia o n t h e ir own tim e , at t h e ir own exp e n s e to p e r f o rm lif e s aving ca r diova s cula r s u r ge r y
Top: Former employee Beth Yared, R.N., CVICU; Susan Kell, R.N., CVICU; and Erin Cardiasmenos, physical therapist, take a break from surgery. Bottom: The surgical team performs a post-op echocardiogram to ascertain ventricular wall motion in a patient who became unstable after surgery. She ended up doing great—FYI! Dr. Ramesh Veeragandham is pictured at the center of the photo, hand on chin.
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A contingent of 17 of our medical professionals showed a lot of heart— and endurance—when they journeyed more than 8,000 miles in January to perform 16 open-heart surgeries and one vascular surgery in five and a half days. “We went to Vijayawada to make a difference in the lives of patients, but more importantly, to interact with the local surgeons so they will be able to do what we have done in many more patients,” says Dr. Ramesh Veeragandham, co-director of cardiovascular services at John Muir Health and coordinator of the cardiac surgical mission to southeastern India. The John Muir Health volunteers worked alongside staff at the 1,000-bed NRI Hospital, a charity facility co-founded more than a decade ago by Veeragandham and about 30 other physicians, demonstrating complicated procedures and operating on patients who otherwise might not have survived the typically long wait for surgery. One patient had an aortic dissection, a severe condition that occurs when the large “It was a totally blood vessel branching out from the heart is torn. “Typically, they would not have done voluntary thing surgery on him because the risks are too coming out of great,” says Susan Kell, R.N., cardiovascular ICU nurse at John Muir Medical Center, their heart. I Concord. “Dr. Veeragandham and his team would say they were able to take the patient into surgery, and it was a huge learning experience.” put 200 percent The mission was also a valuable learning opportunity for our physicians and staff. of their effort “What the clinicians in India are able to do into the mission, with the amount of resources they have is incredible,” says Kell, who has participated each and every in several medical missions abroad. “One of one of them.” the biggest things I get out of it is learning what actually can be accomplished. I come —D r. R a m e s h back a much stronger nurse.” Ve e r a g a n d h a m “It ‘opens up’ many people to see co-director, hundreds of people waiting for medical cardiovascular services, treatment and it makes us more grateful for John Muir Health everything we have,” adds Veeragandham. “Also, it made everyone proud to be part of an organization that can do things like this.” Veeragandham says he hopes the success of this mission will inspire others to participate in future missions. “The camaraderie is incredible,” says Kell. “When I come back to my job, I have a different kind of relationship with the people I work with and that’s quite lovely.”
Know another JMH all-star who deserves a High Five in Connect? Email the info today to internal.communications@johnmuirhealth.com.
J M H C o n n e c t | Fall 2015
The ABCs of Being an HRO Slug
Learn how John Muir Health is becoming a â&#x20AC;&#x153;high-reliability organizationâ&#x20AC;? and enhancing the ways we all can prevent errors and safeguard our patients and each other Matt Edge
J o h n M u i r H e a l t h | johnmuirhealth.com
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Inside Story
S DOUBLE DUTY: When they’re not engaged in error-prevention training, Sue Gorgen and Gilbert Fuentes have busy clinical positions at John Muir Health. Gorgen is a clinical nurse educator at John Muir Medical Center, Concord. Fuentes is an orthopedics unit supervisor at John Muir Medical Center, Walnut Creek.
ue Gorgen, B.S.N., R.N.B.C., and Gilbert Fuentes, B.S.N., R.N., C.M.S.R.N., couldn’t be more proud or enthusiastic about taking breaks from their regular hospital duties to be part of a unique team of trainers working to improve patient and employee safety and the overall patient experience. Little wonder: Among those joining them as trainers are some of the health system’s top leaders—including Dr. Irving Pike, chief medical officer; Lisa Foust, senior vice president of human resources; and even Cal Knight, president and CEO. In different pairings of clinical veterans with nonclinical peers, this blue-ribbon crew is teaching error-prevention strategies. The strategies are so important, in fact, that everyone—physicians, nurses, pharmacists, social workers, maintenance workers, administrators, volunteers, every JMH employee—is expected to undergo a training session on key concepts and be personally involved in implementation. It’s all about becoming an HRO —a high-reliability organization in safety and patient experience— and John Muir Health is totally committed to and invested in the transformation. “I promise my Error Prevention for Reliability and Safety class that they’re going to walk away knowing something that’s going to make a huge difference,” says Fuentes. “This program is unlike anything John Muir Health has ever rolled out. We’re not going to be the same after going through this process.”
Error Prevention for Reliability and Safety The series of trainings began this summer, starting with physicians and employees at the Walnut Creek and Concord medical centers. One of the key challenges facing trainers is how to convey to the diverse ranks of our health system what’s at stake and how every physician and employee can take steps that minimize the possibility for major safety mishaps. Gorgen explains to attendees, for instance, that “when serious safety events happen, there typically are about eight different points of contact with the affected patient beforehand”—conceivably, that’s eight different opportunities to avoid the problem. Fuentes reports these statistics to his “students”: In 1999, an analysis by the Institute of Medicine found that 98,000 preventable deaths were occurring each year in U.S. hospitals. A 2013 study estimated the annual number of preventable deaths had risen to as many as 440,000. “The key word is ‘preventable,’ ” he says. “We give people the tools and techniques to use with every patient, every time.” Toward that end, class sessions emphasize simple yet powerful low-risk behaviors that reduce the probability that an error will reach a patient. One of the key behaviors employees learn to use is “asking a clarifying question,” says Lisa Foust, speaking as a trainer. “There are circumstances throughout a typical day in health care, where a caregiver might not be entirely clear about a plan of care—maybe it’s just a gut feeling or something
J M H C o n n e c t | Fall 2015
doesn’t fit well with what he or she knows from experience,” says Foust. “Asking a clarifying question is about not proceeding in the face of uncertainty.” Research supports the approach, she explains: “In health care settings, making an error is two and a half times less likely when someone stops to ask one or two clarifying questions instead of blindly forging ahead.” “In a high-reliability organization,” Foust adds, “there is a uniform, very widespread, hard-wired understanding, from the very bottom of the organization to the top and everywhere in between, that low-risk behaviors are important, expected, supported, appreciated and followed by everyone as a matter of habit.”
“We’re not doing this because we have a poor safety record but because we want to be the best organization we can be.” —Dr. Irving Pike, chief medical officer, JMH
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LEARNING From Other HROs The error-prevention curriculum was developed in consultation with Healthcare Performance Improvement (HPI), a Virginia-based firm that has advised more than 700 U.S. hospitals—large and small— on safety best practices. “Interestingly, much that we, and other hospitals, are learning from HPI is derived from time-tested practices from other industries that operate under hazardous conditions all the time—such as the nuclear power industry, airlines and the military,” says Pike, who, before coming to JMH, worked at a hospital that was one of HPI’s early adopters. Those industries have adopted the same practices John Muir Health is putting in place, dramatically reducing the probability of error and rates of serious safety events, he points out. “The U.S. Navy, for example, has had 50 years of operating nuclear submarines without a serious safety event.”
Inside Story
Replicating such successes is the order of the day, says Pike. “In the same way that set procedures are followed on the deck of a Navy carrier or an airplane cockpit, we will follow proven protocols—preparing patients the same way for surgical or other procedures, for example, or following a standardized reporting process during shift changes.”
Our Changing Culture Signs that we are becoming a high-reliability organization are already apparent. One example is a practice known in HROs as “safety huddles,” which are being implemented throughout the health system, Pike explains. “At both John Muir Medical Center campuses and the Behavioral Health Center, every division and department gathers in one place for 15 minutes or so to report on any safety events that have occurred over the previous 24 hours and warn against any potential safety events that could occur in the next 24 hours. It’s amazing how quickly health and
safety problems can get resolved.” Huddles also take place in nonclinical settings, such as in Administrative Services at 1400 and 1450 Treat and 5003 Commercial Circle, where participants might discuss safety concerns for employees among other issues. Work is also underway with the Physician Network to determine how best to implement HRO tools and tactics. While the ultimate aim is having zero serious safety events, adds Pike, the daily mission is changing our culture—which requires an unending pursuit of a superior patient experience and optimal safety. Foust describes the quest this way: “We know John Muir Health is exceptional in patient safety, but we’re taking it to a higher level. I fully expect a time here, in the not too distant future, when it’ll be hard for us to remember when we worked without these tools. Lowrisk behaviors and error prevention soon will be part of our vocabulary—a common language we all understand and always apply.”
FIND OUT More Visit the JMH Intranet to find info on tools for preventing errors, safety success stories, good catches and more.
Sue Gorgen says one nurse with 35 years’ experience described her error-prevention class as “the best I’ve ever taken.” Gilbert Fuentes emphasizes that “every single employee has the responsibility and permission to put safety first and speak up.”
J o h n M u i r H e a l t h | johnmuirhealth.com
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Inside Story
Left to right: Therapists Kimberly Zibelman, Erin Arnold, Alejandra Bengtsson, Valerie Spiteri and Jamie Lutat, with Rob Walters, director of Inpatient Rehab Services, at the new center’s Open House.
Rehab 2.0
Clockwise from top: Mike McEuen, Matt Edge (2)
O u r n e w i n p a t i e n t r e h a b i l i t a t i o n c e n t e r a t t h e Wa l n u t C r e e k medical center boasts more space and new technologies— a win-win for patients and staff
Our occupational, physical and speech therapists take a collaborative approach to helping patients regain strength and functionality following significant neurological and musculoskeletal injuries. In October, our team began seeing patients at a new inpatient rehabilitation center, which is three times the size of the current facility and features an expansive open floor plan that’s sure to enhance teamwork. “We talked to our team, looked at how we currently work and took that information to build something that was friendly to both patients and clinicians,” says Robert Walters, M.P.T., M.B.A., director of inpatient rehabilitation services at John Muir Health. The new center will also offer cutting-edge technologies that Walters says will leverage the advanced training of many clinicians. Using the Bioness Vector, a robotic balance system featuring a harness hooked up to a track on the ceiling, we can encourage patients to explore their limits without worrying about falling. “As a physical therapist, that’s an exciting piece of technology because it allows our patients to relearn things in a safe way for them and for our clinicians,” says Walters. Our speech therapists and patients who require a quieter, less stimulating environment will have access to private treatment rooms. Thanks to new kitchen, bedroom, bathroom and car setups, occupational therapists can simulate challenges patients might face in their daily lives. “We have the space to do great work,” Walters observes. “We’re providing new opportunities and better experiences for our patients.”
Sara Gamble , M . S . P.T. , physical therapist , John Muir Medical Center, Walnut Creek:
“The new center will be excellent for patients because they will get a sense that they’re not alone in recovering. It will enhance our creativity, too, because we’ll be able to see what others are doing and have a big, safe space to challenge patients to get better.”
J M H C o n n e c t | Fall 2015
Allison Stephens, O.T. R . /L . , C . B .I. S . , occupational therapist , John Muir Medical Center, Walnut Creek:
“As therapists, we were involved in requesting some of the new equipment, including the Dynavision, which is this cool device that helps patients with visualmotor retraining and neuro retraining. We’ll really be able to personalize our therapy sessions with more choices.”
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Inside Story
Call, Click or Come In N ew o n lin e to o l s i n c r e a s e a cce ss to p rim a r y c a r e a n d o u r e nga g e m e n t wit h pa tie n t s
searches online for “local doctors” or “primary care Walnut Creek,” ZocDoc is one of the sites (along with ours) that shows up in the top of the search engine’s results. Casting a wider net enables us to attract more patients. “Regardless of which channel that appointment comes from,” says Castro, “our staff will manage the incoming information by looking at just one thing, which is their Epic scheduling system.” With eVisits, patients can seek advice from John Muir Health physicians about minor health issues without going to a clinic or even making an appointment. Patients simply log in to MyJohnMuirHealth and fill out a detailed questionnaire. Within an hour (between 8 a.m. and 8 p.m.), a John Muir Health primary care physician will respond with advice ranging from home remedies to prescription medications (which patients
can pick up at the pharmacy of their choice) to making an online appointment or seeking more immediate care at one of our facilities. The service was piloted by health system employees and their families and is now available to patients through MyJohnMuirHealth. “This system is well put together with many medical protocols and accepted practices at work in the background,” says Dr. Maureen Stevenson, vice president and chief operating officer of ambulatory services at John Muir Medical Group. “We get a thorough picture of the problem, so physicians feel comfortable giving advice, plus we can link it into patients’ medical records and see if there are other things we should be considering in terms of care.”
J o h n M u i r H e a l t h | johnmuirhealth.com
Clockwise from top left: Gonzalo Castro, David Hoffman and Dr. Maureen Stevenson. “We’re adding efficiencies so doctors have more bandwidth to do what they’re here to do—to be healers,” says Castro. Matt Edge
This fall, John Muir Health is ramping up online services with the launch of Online Scheduling and eVisits. “This is a major part of our overall strategy to expand access and make it easier for new patients to come to John Muir Health and for existing patients to get their needs taken care of,” says David Hoffman, director of product engineering for eBusiness. “Some people would like to do everything from their home.” With Online Scheduling, new and existing patients can book appointments with the click of a button through a number of channels at any time. Today, existing patients can schedule appointments through MyJohnMuirHealth. Soon, new patients will also be able to book appointments through the “Find A Doctor” feature on our website and through our new partner, ZocDoc, another online scheduling tool. These efforts are part of a novel and ambitious digital health initiative to attract new patients and continue to grow, one that will help our physicians fill up their practices more rapidly and make us a more attractive health partner in the community. “This is truly an innovative approach and provides a unique advantage over our competitors,” says Gonzalo Castro, director of product management for eBusiness. “Our partnership with organizations like ZocDoc reflects the fact that many consumers are seeking health advice online.” For example, when a patient
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Share
Bridging Gaps Between Cultures Community nurse program positively impacts schools in need
“I‘m managing my conditions; they’re not managing me.”
Joy to the World
Matt Edge
A n e m p l o y e e ’s q u e s t t o i m p r o v e h e r h e a l t h c a n i n s p i r e u s a l l
What Joy Rossyion has achieved on her road to a healthy lifestyle is nothing short of amazing. She has given up cigarettes (that first landmark came in 2011); changed her eating habits; gets regular exercise—even purchased her own treadmill; lost weight—down to 135 pounds from nearly 300—and currently wears her dream size 4; and lowered her blood pressure. “Everything about me has changed,” says Rossyion, a financial counselor in the ED at John Muir Medical Center, Walnut Creek. “I found a way, a healthy way to feel good about myself. My physician, Dr. Chin (JMMC, WC), and the HealthMatters program for John Muir Health employees were the most instrumental part of my transformation.” Rossyion is especially sold on the Healthy Living component of the HealthMatters program: six-week modules, available online, that teach a particular aspect of self-care and wellness—heart health, eating healthy, etc. The best experience since she began her wellness journey? “The love I’ve received from family, friends and co-workers. My co-workers are my best allies. They constantly encourage me.” FYI: Health Promotion Services aims to help all JMH employees achieve their own health improvement goals. To get started on your own journey to good health, call (925) 947-4496.
Esperanza Loera, R.N., works in a job that’s all too rare nowadays. She is a community nurse in the Pittsburg school district—a position that’s funded by John Muir Health and primarily serves low-income students, most of whom are Spanish speakers. Another community nurse, Catherin Crofton, R.N., provides services in the Mt. Diablo school district. “I know I’m helping people in my community who wouldn’t get what they need otherwise,“ says Esperanza, who is bilingual, raised in Brentwood by Mexican parents who didn’t speak English. “I remember being in a family that didn’t know where to go or call for health care. There were six of us. My mom did the best she could, but her resources were so minimal. I go above and beyond each time with my students and their families because I know my mom would have liked being helped that way.” On any given school day, Esperanza helps kids manage diabetes, gives medications to asthmatics, makes sure vaccinations are up to date and more. “I fill the gap between the parents and the schools,” she says. “This is not just a job for me. People trust me, look to me for answers, and I am able to help them— thanks to John Muir Health.”
J M H C o n n e c t | Fall 2015
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