HUPdate 5 2 2014

Volume 25

Number 9

May 2, 2014

Hospital of the University of Pennsylvania

HUP’s Red Coats Make Everyone Feel Welcome Eleanor Ball, a HUP ambassador at the front desk of the Ravdin entrance, greets everyone with a smile. “Most people are scared when they come in,” she said. “When they see a smile, it makes a big difference.”

“The first impression is key,” agreed Al Black, HUP’s chief operating officer.

“We need to get that right.”

A smile is just one component of how our ambassadors or “Red Coats” make every patient’s experience a good one.

“We want to exceed the expectations of our patients and their families,” said Mona Matson, associate director of Patient and Guest Relations & Reception, who oversees the Ambassadors program.

INSIDE Heartfelt Thanks........................2 Speaking with HUP’s Leaders.......................................2 Simple Inventory Changes Make a Big Difference!........... 3 TULIP Brings Bladder Health Education Home............4 Get Your Walking Shoes Ready...............4

`` The Red Coats at HUP and the Perelman Center for Advanced Medicine help make every patient’s experience a good one.

To help ensure that all patients and visitors who enter HUP or the Perelman Center receive the same welcoming experience, the ambassadors at the four information desks and the greeters at the front entrances of both facilities recently underwent service excellence training. The three-week training program included learning the AIDET (acknowledge, introduce, duration, explanation, thank) patient communication model, as well as roll playing and shadowing sessions with Robin Arrington-Thompson, manager of Reception. For Joan Durso, who works on the upper-level atrium information desk, the training “helped to remind me why we’re here. How important we are, as the first people patients see. I think it colors the entire course of treatment.”

Durso makes a special effort to approach people “who look lost or stand there holding a piece of paper and looking around. Sometimes it’s just because I see their face and how afraid they are.”

She has become friends with many patients, especially those who come for radiation oncology treatments, which last weeks. “Some want me to come to the bell ringing at the end of their treatment,” she said. “What I do is part of the whole experience at Perelman. You can’t get that by just ‘doing the job.’ ” As a greeter for patients and families arriving at the Perelman Center, Joe Casertano said the training “reinforced what I do. I enjoy people and that’s number one for doing this job. I like to help people.” (continued page 2)

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HUP’s Red Coats Make Everyone Feel Welcome (continued from page 1)

The ambassadors also use walkie-talkies. “We can hear if someone needs assistance or is bringing a patient somewhere in the hospital. They let us know what they need,” Arrington-Thompson said. They are also the preferred method of communication with partner departments, including EVS and Patient Transport.

As part of the service excellence program, the ambassadors received new uniforms: a red coat (hence the nickname), black pants, white shirt with a red, white and blue ascot. “It’s easier to identify us. We stand out,” Durso said.

Patients and visitors have noticed the difference since the initiative began last fall. “Patients really appreciate it. We’ve received very good feedback about how helpful the staff is,” said Black. (See Heartfelt Thanks).

“Each of our staff has special skills but they all share in their desire to help people,” Matson said. “That’s the kind of people you want to welcome patients and families.”

Heartfelt

Thanks

“I brought my daughter to an appointment in your Neurology Dept. The first person we encountered was Joseph [Robinson]. He recognized that my daughter was moving slow and in pain. He offered to get a wheelchair and take her to her appointment. He also offered to return after the appt with a wheelchair and return us to the lobby and our vehicle. We declined [but] met up with him again as we waited for our vehicle. He walked my daughter out to our vehicle and saw her securely seated. How wonderful is this man! I work for a community health system and we strive to provide our patients and visitors with caring, heartfelt experience. Joseph certainly did so … and if we could clone him I would take a dozen of him!”

SPEAKING WITH HUP’S LEADERS Although HUP and the Health System continue to do well financially — better than this year’s targeted budget — we must continue to operate more efficiently in the future. “We expect more reductions in the rate of reimbursement,” Al Black, COO of the hospital, told participants in last month’s Meal with an Administrator.

She explained that the new plan has three tiers from which to choose providers:

There are several reasons for the decreasing reimbursements.

First, an increasing number of health-care services are done on an outpatient basis, which receives lower reimbursement than inpatient procedures. Also, federal rulings, such as observation status and the two-midnight rule, reclassify those who were previously inpatients as outpatients. These changes significantly reduce our reimbursement for Medicare patients.

• Out of network, which costs the most.

In addition, Medicare now bases its reimbursement on value-based purchasing. Hospitals must achieve at least the 50th percentile in a series of metrics – which include both clinical outcomes and patient satisfaction – or they lose part of their reimbursement. “We have opportunities to improve some of these scores,” Black said.

Denise Mariotti, HUP’s new chief HR officer, said that employees can help reduce expenses by using Penn Medicine providers for their health care. “We’re basically giving money away to other health systems when our employees do not utilize in-house providers.”

Starting July 1, 2014, the Health System will offer only one healthcare plan for employees. Although Aetna and Keystone plans will no longer be available to employees, “almost every physician who participated in those plans is now covered by the Penn Care PPO plan.”

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• Penn Care network, which offers the lowest out-of-pocket cost.

• In-network, which has a slightly higher cost.

Thanks to many Penn Medicine practices throughout the Delaware Valley, there is a Penn primary care physician within 10 miles of everyone’s home. Mariotti noted that a special program called the Penn Primary Care Connection will get an employee an initial appointment with a primary care doctor within 24 to 48 hours.

Employees can call 267-414-2208 to set up an appointment.

“We’re working on expanding the program to include specialists.”

In addition, Penn made a conscious decision to keep the cost for employee health-care benefits at 20 percent. The Health System pays 80 percent. “Most employers offer employees a 30/70 benefit cost,” Mariotti said. She encouraged employees to look at their total compensation statements, which show pay and benefits, including tuition and retirement.

You can view the statement at uphshrandyou.com.

Simple Inventory Changes Make a BIG DIFFERENCE! A joint PIIA (Performance Improvement in Action) project between Nursing and Materials Management has shown that simple changes can have a significant impact on the inventory management process, reducing delays in patient care and duplication of efforts.

The project, which piloted on Ravdin 9, focused on improving three key areas: communication, item descriptions, and use of space.

How Much is Used?

Currently, deciding what products are stocked on a supply cart is a “people driven process,” said Harry McCloskey, MBA, CMRP, assistant director of Materials Management. A nursing rep from a patient care unit requests that a specific supply be added or deleted from their supply cart. Decisions are not usually based on actual usage data, he said. As a result, supply cart space is wasted.

“Some products on the shelves are not needed while others are needed in a higher quantity,” said Heather Ross, BSN, RN, CCRN, manager of Nursing Products and Operations, who led the initiative with McCloskey.

If the unit ran out of a needed item, Materials Management might get multiple phone calls about it — from the unit secretary or nurse — sending different people looking for it… or sending a nurse to other units trying to find the item.

The PIIA team established a supply level of each product on Ravdin 9, based on usage data from the past three to six months. “Using data to drive decisions has provided improved supply availability and reduced wasted labor for both Nursing and Materials Management,” McCloskey said, adding that it’s also greatly improved availability.

However, if a product is not available, the distribution attendant will now place an “out of stock” card — also a part of the PIIA initiative — on the supply cart, with an “expected on unit” date and time. “Now, all shifts can clearly see that the item is not available – and the card provides steps to contact a Materials Management supervisor directly if the item is critically needed,” he said.

`` Working together to improve inventory management were (l. to r.) Francis Steenberg , Heather Ross, Dorothea Grochowski, Mia Gonzales-Dean, Ryan Lawson, Barbara Prior, Shawn Amann, and Harry McCloskey.

What’s It Called?

Supply item labels, generated by the Lawson system, contain a lot of information about the product but very little that clinicians need to identify it. This has resulted in hours of wasted time — and confusion — as the clinician tries to describe the needed item on the phone or in an email to a Materials Management employee.

The PIIA team developed new labels that use language that front-line clinical staff understands, Ross said. “The name stands out on the label and it also contains the Lawson and manufacturer numbers.”

Working together, Nursing and Materials Management also reconfigured the supply carts on the unit, grouping “like” items together. Similar to how peanut butter is next to jelly in a supermarket, some supplies should be stocked side by side — for example a syringe and a needle — but that isn’t always the case. And the team used another supermarket idea: An “aisle” sign above each supply cart lists general categories of what can be found there.

After the changes were put into place, staff members could easily grab what they needed, as opposed to looking at all the carts for a single item. “When you have 225 different supplies, the wasted minutes add up,” Ross said. “The supply room is now uncluttered. It looks neater and cleaner, and is easier to get in and out. ” Even more important: “Nurses have more time to spend at the bedside,” McCloskey said.

The initiative will be rolled out to all patient care units over the next year.

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GET YOUR WALKING SHOES READY! The Wellfocused Walk-Off — the first-ever UPHS entity vs entity steps competition — starts Monday, May 5, and anyone can participate!

Two sets of winners will be recognized at the end of the eight-week challenge: the UPHS entity with the highest average number of steps and the top five individual persons who have the highest total steps. Look for more information at your entity coming soon!

`` (L. to r.) Mary Ann DiCamillo, Diane Newman, and Rebecca Kimmel with one of the tools they use to educate women on bladder health.

TULIP Brings Bladder Health Education Home “This is the bony pelvis, the pelvic floor, the sphincter muscle in the center, a bowel that curls up inside,” said Mary Ann DiCamillo, BSN, RN, describing the anatomy of the female urinary system. This puppet exercise is one of the creative ways DiCamillo and partners Rebecca Kimmel and Diane K. Newman, DNP, teach women about urinary incontinence and how to prevent it.

An estimated 8.5 to 10 million women (as well as 1.5 to 2 million men) in the U.S. experience urinary incontinence, the involuntary loss of urine which is sufficient enough to be a problem. Seeing the need, the trio created the TULIP (Translating Unique Learning for Incontinence Prevention) Project, a five-year, NIH-supported study looking at the effectiveness of bladder health information in preventing urinary incontinence. The study, which recruited women who do not have urinary incontinence symptoms, taught them about the condition and how to prevent and manage it.

One study participant asked the leaders if they would present their insight to her 15-member women’s group. With the help of a Penn Medicine CAREs grant, Kimmel brought this presentation to the home of the group’s leader. “It was very interesting to see how the class works in someone’s living room rather than in a more formal setting,” said DiCamillo. “They were very comfortable discussing these issues and asked questions in this more relaxed atmosphere.”

“This event shows that this model is adaptable for a variety of environments,” Kimmel added.

Attendees of the CAREs-funded talk each received a copy of an extensive powerpoint presentation and bladder health CD explaining how to do helpful kegel exercises that strengthen pelvic floor muscles to prevent incontinence. “It’s about teaching women self-care methods to prevent urinary incontinence as long as possible,” Kimmel said.

The Penn team is starting a new study soon that recruits women who already have incontinence symptoms to measure how the information helps them manage their urinary health.

If interested in participating, please contact rebecca.kimmel@uphs.upenn.edu.

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TO TRACK YOUR STEPS: • Use a regular pedometer to manually enter your steps in the challenge.

• Use an electronic device such as a Fitbit, the Nike+ or the RunKeeper app . Those electronic devices automatically sync to the Healthy Rewards site and log your steps for you. ** • Sign in to the Healthy Rewards site on May 5 to join the Wellfocused Walk Off challenge and start walking!!! ** Note: To sync your device in the Healthy Rewards site, go to Settings, then click on the Apps & Devices tab and connect your device.

HUPdate EDITORIAL STAFF Sally Sapega Editor and Photographer Tara Skoglund Designer

ADMINISTRATION

Susan E. Phillips Senior Vice President, Public Affairs Holly Auer Director of Communications CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.