Stanford Health Care People - Spring/Summer 2017

STANFORD HEALTH CARE

A PUBLICATION FOR EMPLOYEES OF STANFORD HEALTH CARE

SPRING/SUMMER 2017

BUILDING FINANCIAL STRENGTH PET ASSISTED WELLNESS MAKING A DIFFERENCE

AROUND SHC President and CEO David Entwistle (left, bottom) hosted five Town Halls in May at four different SHC locations, accompanied by special guest speakers from the leadership team, including SHC Chief Operating Officer Quinn McKenna, Chief HR Officer David Jones, Chief Medical Officer Norm Rizk, MD and Interim Chief Information Officer Mike Sauk. Entwistle began and ended each Town Hall by thanking employees “for the work they do each and every day.” He also encouraged employees to send in questions they may have for SHC leadership to askadmin@stanfordhealthcare.org … The Office of Emergency Management (left, middle) deployed new resources and technologies that will improve the way emergencies are reported and announced. All employees are asked to update your contact information. Contact OEM at oem@stanfordhealthcare.org for more information … SHC participated in C-I-CARE Patient Experience Week (left, top), which is an annual event, held across the nation, to celebrate health care staff impacting patient and family experience. The event provided a focused time to celebrate accomplishments, reenergize efforts and honor the people who impact patient and family experience daily … Jeanelyn Seijo and Rouchelyn Fallorina (top, center, l to r) hold a heart-shaped stress ball at the 6th Annual HealthySteps Wellness Fair. The event is a celebration of health and well-being. This year’s theme was “Wellness Your Way”… Bike to Work Day gave employees an excuse to get out of their cars and ride to work.

Christina Hoe, Lauren Walker, Alexandria Blacker and Terry Palmer (top, right, l to r) from the Wellness Program coordinated the annual event.

from the CEO Dear Colleagues, This is a time of significant change in health care, both regionally and nationally. It is a time when the essential role of Stanford Health Care to drive innovation across the entire continuum of care and throughout the delivery system is more important than ever.

Just as we embraced the need to focus on patient experience and achieved significant results, we should now apply the same visionary focus to becoming a value-driven organization.

SHC can successfully demonstrate how to reduce costs while improving quality, keeping patients as our top priority.

No matter what your role is in the organization, this is part of your job.

Everyone at SHC can make a real difference, and our success depends on your best ideas and commitment.

Thank you for being part of these important efforts and for what you do every day to provide our patients with the best in care, safety and experience.

STANFORD HEALTH CARE PEOPLE is a publication of the internal communications department: Gary Migdol, Allison Carleton, Allyn McInerney. Photography by Paul Sakuma. Grace Hammerstrom, Mandy Erickson, Writers. Send comments to connect@stanfordhealthcare.org.

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DAVID ENTWISTLE PRESIDENT and CEO

ON THE COVER: Stanford Health Care is building financial strength through a series of employee-led projects that elevates value and improves quality and efficiencies.

BUILDING FINANCIAL STRENGTH

SHC EMPLOYEES ARE FINDING WAYS TO IMPROVE EFFICIENCIES, ELEVATE VALUE There’s a groundswell of activity occurring at every level, and in every department, across Stanford Health Care. Employees are looking deeply into how work is done and finding ways to do it more efficiently.

From simpler measures such as renegotiating Supplies’ contracts to more complex problem solving that challenges deeply entrenched practices, staff members are working to improve SHC’s financial health.

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These efforts are in response to the rising cost of delivering health care, said Stanford Health Care Chief Operating Officer Quinn McKenna. “Plus, hospitals around the country, and particularly academic medical centers like Stanford, are facing the additional pressure of being paid less for what we do.” McKenna comes to Stanford from the University of Utah Hospitals and Clinics, where he worked with President and CEO David Entwistle to elevate efficiencies, improve quality and strengthen financial performance in that system. They are bringing a similar strategy to SHC. “Our approach is not just about cutting costs, but about elevating value,” said McKenna. “To find those pockets where we may not be performing as highly as

we want in terms of quality and efficiency, and then improving upon them.”

Both leaders prescribe a four-pronged approach to improving Stanford’s financial strength.

1

Be More Intentional

There is no shortage of demand for the quality of Stanford’s providers and services, said Entwistle. But the hospital’s limited capacity mandates that Stanford be more deliberate about its program growth, said McKenna. Rather than continuing to “allow a thousand flowers to bloom,” the

EMPLOYE ES D RI V E C O S TS S AV I NGS

Clinical Laboratory Redesign Projected Savings: Over $300,000 / year

The Clinical Chemistry Laboratory processes about 8 million tests per year. Many of these require reagents to measure things like glucose, protein, sodium and potassium. Reagent and supply costs are typically the second-largest components of laboratory expenditure.

When Clinical Chemistry Co-director Raffick Bowen, PhD, MHA (left), and Chemistry Day Shift Supervisor Phil Cheng, BSc (right), looked at chemistry test volumes, they realized an opportunity to use costly reagents more judiciously. Using data from the laboratory information system and performing analyzer audit and workflow analysis, Bowen and Cheng “right-sized” the test menu on their seven chemistry analyzers to match daily volumes and reagent usage.

Less frequently ordered test reagents are now loaded on three analyzers, rather than on all seven, with no change to the quality of test results. This new process reduces reagent costs by over $300,000 per year and lowers the labor expense needed to calibrate, maintain and conduct quality control on fewer analyzers.

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Reducing Supply Costs in Patient Care Services

Optimizing Medication Protocols in Solid Organ Transplant Line

Projected Savings: $300,000

Projected Savings: $200,000

Difficulty securing durable medical equipment (DME) such as walkers had become a sore point for Patient Care Services, often holding up discharges. When Jonathan Ching started a search for a new vendor for walkers, he struck DME gold. The new company keeps an inventory of walkers onsite and assumes all liability for their cost. “Stanford now pays zero for walkers,” said Ching. The vendor also set up a stock and bill inventory of braces and orthotics, and bills patients’ insurance for all supplies dispensed.

Stanford is now only responsible for paying the amount not reimbursed by the patient’s insurance.

To make the new system operational, Ching collaborated with ED, Facilities, IT, Nursing, OR, Rehab and Supply Chain to store the additional supplies; set up workflows; and trained staff on delivering and applying the products to patients.

“By assuming some of the work, we save on all the supply cost,” he said.

Patients receiving transplants require a number of medications to prevent rejection and the development of infections. A multidisciplinary team composed of transplant physicians, pharmacists and nurses reviewed dosing protocols for a number of commonly used medications. In the liver transplant area, pharmacist Uerica Wang, PharmD, conducted a literature review of HepagamB, and compared Stanford’s use of the drug against similar transplant centers. Her findings inspired a revision of the dosing guidelines for inpatients and outpatients, which will save $125,000. Similarly, in liver transplant and heart transplant, dosing of anti-thymocyte globulin (ATG) is now based on a patient’s ideal body weight rather than actual body weight. This modification, which was based on analysis of SHC’s patient records and a literature review, is expected to save $50,000 for each program. And in the area of kidney transplants, adjusting the dosing regimen for ATG reduced length of stay by one day for highly sensitized patients.

organization is now engaging in thoughtful discussions among School of Medicine and SHC leaders to determine where and how to apply limited resources. These joint SHC and School of Medicine decisions, said McKenna, are being driven by community need. “Without this intentionality, hospital beds fill, patients are turned away, elective surgeries are canceled and financial strength is impacted.”

2

Be More Creative

Clinical redesign is another strategic focus of the new administration. Employees are being asked to rethink

Emergency Department Tackles Waste

the work they do, and to benchmark their practices against similar institutions. Many of these new clinical redesign projects are employee-inspired and employeedriven, such as optimizing the use of clinical laboratory equipment. Others are organization-driven efforts to improve length of stay and the medication formulary.

The Drug Utilization Management Guidance Team (MGT), which oversees the use of 600 medications on the physician formulary, is looking at how to reduce rising pharmaceutical expenses without negatively impacting patient care. When the team identifies a medication that is exorbitantly more expensive than an equivalent drug, or one that Stanford physicians use more frequently than their counterparts at similar

Facilities, Infrastructure & Safety Projected Savings: 42 days to 2 days

Projected Savings: $150,000 / year When Karen Stuart, RN, took a hard look at the Emergency Department’s (ED) supply budget, a few expensive line items jumped out at her. The most glaring was the cost of blood culture kits.

She worked with Supply Chain & Distribution to renegotiate the price for these kits. Then she tackled the second-biggest line item, reusable blood pressure cuffs, which were on an automatic reordering system despite their reusable design. In 2016, the ED spent $100,000 on blood pressure cuffs alone, said Stuart, who instructed the supply vendor to temporarily stop the automatic reordering system to reduce the amount of supplies in inventory. She and her team then relocated the blood pressure cuffs to a central area for better tracking in the future. Stuart’s continuous sleuthing has unearthed a number of opportunities to reduce costs, including disconnecting unused phone lines, reducing the use of oxygen saturation probes by utilizing reusable ones and eliminating the use of inhaler spacers for adult patients.

New Specialty Pharmacy in the Cancer Center Projected Revenue: $15M

Beyond the standard cleaning conducted at discharge, hospital rooms require regular maintenance and deep cleaning, a process that can take a room out of service for up to 42 days. An interdepartmental team led by Director of Facility Management Margaret Tobin conducted a pilot program in the E29 ICU, a high-use area, to reduce the turnaround time for maintaining and cleaning rooms and adjacent areas. The team took a planned approach, reviewing the standard work required from each area—cleaning, maintenance and Environmental Services—and then sequencing the work in the correct order, outlining the time it takes to complete each step and improving communication between departments to make hand-offs more swift. The critical piece, said Tobin, is being able to communicate and coordinate across departments effectively. This new approach reduced turnaround times to less than two days, a 99.5 percent improvement. The facilities team is now implementing this model throughout the hospital.

Deepak Sisodiya, PharmD, MHA, has been leading a team working to bring a Stanford-run specialty pharmacy onsite for the past two years. In August, the group’s vision becomes a reality. Stanford is opening a specialty pharmacy in the Cancer Center, replacing the Walgreens that closed in March. The new pharmacy will be a hybrid model initially focusing on providing specialty and supportive medications for the transplant and oncology populations.

“We’ve had a sizable gap for some time with our inability to provide outpatient medications,” said Sisodiya. “We simply don’t have visibility on how, if at all, our patients are using these complex medications. This will be a huge step forward towards providing meaningful information to our providers that will allow us to enhance the care of our patients.”

Sisodiya estimates that Stanford physicians write about 43,000 specialty prescriptions a year.

The new pharmacy hopes to capture 20 to 25 percent of that prescription revenue.

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patient outcomes, improve patient functioning and improve patient satisfaction,” said Tang. A newly piloted care path for pancreatic resection patients reduced average length of stay from 10.9 days to seven days.

“IT’S NOT JUST ABOUT CUTTING COSTS,” SAYS CHIEF OPERATING OFFICER QUINN MCKENNA, “BUT ABOUT ELEVATING VALUE.”

institutions, the MGT conducts an investigation. First it reviews current literature, and then compares Stanford’s prescribing patterns with those at other centers. Using this approach, the committee has successfully reduced costs for targeted drugs such as dexmedetomidine and inhaled nitric oxide, for which a lot of dollars are spent at Stanford, said committee member Stan Deresinski, MD. “We focus on rationalizing the use of these drugs so that they are only used when they provide value.”

“In many of our elective procedures, there’s good scientific evidence that if we follow a specific set of practices, we can reduce length of stay, improve patient outcomes, improve patient functioning and improve patient satisfaction.”

In a separate effort, the Length of Stay committee is looking at how to increase capacity by freeing up beds.

One strategy is to find potential inpatient populations who can be safely treated as outpatients, said Ning Tang, MD, Senior Medical Director, Clinical Effectiveness and High-Value Care. For example, new protocols for low-risk patients with chest pain or symptoms of transient ischemic attack (TIA) will have them receiving follow-up care as outpatients after their initial diagnosis and treatment in the ED. Another initiative focuses on reducing patients’ postsurgical recovery time. “In many of our elective procedures, there’s good scientific evidence that if we follow a specific set of practices, we can reduce length of stay, improve 6 / STANFORD HEALTH CARE PEOPLE

3

Be More Efficient

4

Be More Resourceful

Building on the strength of Stanford’s ongoing process improvement work, McKenna encourages employees to focus on outcomes as they simplify their jobs and increase productivity. “Pay attention to areas where the quality and outcomes are less than what you would expect from a Stanford experience,” said McKenna.

“Those are the areas ripe for improvement.”

A team in Facilities Management did just that. By re-sequencing work and coordinating hand-offs between multiple crews, the team achieved a 99 percent improvement in room maintenance turnaround times.

“As we think about cost reduction, I don’t want us to lose sight of the reality that we are better off growing,” said Entwistle. “There are tremendous opportunities on the revenue side.”

At the top of the list is documentation. Stanford has an opportunity to more accurately document the clinical complexity of the care it delivers, which will improve our ability to see more clearly where we need to focus quality improvement efforts as well as improve our overall financial performance, said McKenna. A second area for revenue growth is retaining patients within the Stanford system.

“What patients do we already have touching us in one part of our system who we are sending out of our system for other services?” asked Sri Seshadri, Vice President of the Cancer Center. A team from the Cancer Center has redesigned its processes to make medical oncology and radiation oncology appointments more accessible to surgical patients. And the Cancer Center will be capturing lost pharmaceutical revenues by opening its own specialty pharmacy this summer.

“All of these efforts are needed to restore a sustainable balance between revenues and expenses,” said Entwistle, “and to strengthen our ability to meet patients’ needs.”

Making a Difference TC Cowles is improving patient’s lives TC Cowles, RN, was so excited about starting a support program for neurology patients, he moved from St. Louis to the Bay Area before he was even offered the job at Stanford Health Care.

“I was very passionate about this project and the opportunity to develop a new program using a holistic approach,” Cowles said.

The manager of SHC’s year-old Neurosciences Supportive Care Program had been working as a charge nurse in a stroke unit back in Missouri.

He enjoyed interacting with patients but felt that they needed more than medical treatment.

“I noticed we were discharging patients back into the community without further support,” he said.

“I wanted to be more proactive.”

Soon after he was hired at SHC, however, Cowles discovered that his budget wouldn’t cover many of the services he wanted to offer. He found the money on his own—by networking, applying for grants and taking an online course so he could receive research funds.

The first offering was Dance for Parkinson’s, which was funded through a National Parkinson’s Foundation grant. Now, a year later, the supportive care program offers about 60 events a month: lectures, support group meetings for specific conditions, chair reiki, art therapy, yoga, classes on speech and Internet research, tai chi, Pilates and more.

TAI CHI IS JUST ONE OF MANY SERVICES DEVELOPED BY TC COWLES (BELOW) FOR THE NEUROSCIENCES SUPPORTIVE CARE PROGRAM.

The events are free and open to all with a neurological condition, regardless of where they receive medical care. SHC funds only 20 percent of the program offerings; the rest is covered by grants, volunteers and service organizations.

“Everything that he’s done for this program, he has found the money for,” said Cowles’ boss, Darla Watanabe, RN, director of supportive care services.

“He’s had to learn a lot. He is very passionate about making a difference.”

One of the supportive care classes is contributing to research about therapies. Cowles and Jong-Mi Lee, NP, lead advance practice provider in the neurology clinic, are conducting a study of ai chi, or water exercise, for multiple sclerosis patients. Funded by a Stanford University School of Nursing Alumnae Legacy Project Grant, the study will evaluate whether the weekly ai chi class helps patients with fatigue, pain, mental health and overall wellness.

“We would like to see if ai chi can help manage MS symptoms and be another option for complementary and alternative medicine therapy,” said Lee. “TC is instrumental in facilitating this study as well as helping patients move

through the supportive care program.”

Besides developing supportive care, Cowles meets with five to 10 patients a week to conduct a needs assessment.

He also greets patients at the classes, which meet in the Wellness Center on the ground floor of the new Neuroscience Health Center at 213 Quarry Road.

“I wake up every day excited to come to work,” Cowles said. “I see patients walk out of the classes with their heads up. It’s an honor to create innovative, specialized exercise classes and workshops for the neuroscience community.”

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FOCUS ON…

“Starting PAWS is the best thing I’ve done in my 30 years at Stanford Health Care,” said Souza, Patient Relations Manager. “It’s so heartwarming to see how the program has grown over the years, and how consistent the leadership of Cathy and Lyn has been.”

Pet Assisted Wellness at Stanford (PAWS)

“Patients and their families are facing something that is pretty stressful. This makes them smile. When we see that, it makes all the work worth it.”

There’s a small but lively team of caregivers at Stanford dedicated to relieving the stress of everyone they meet. They answer to names like Spirit, Punkie and Kona, and can be spotted at the hospital three days a week. These furry volunteers are part of one of Stanford’s most popular programs—Pet Assisted Wellness at Stanford (PAWS).

The program was begun in 1997 by Patient Representative Francie Souza.

A pet lover, Souza knew the benefits of pet therapy and was committed to starting an animal visitation program for patients and families. Her search for an appropriate program led her to Peninsula Pet Assisted Therapy Teams, and to volunteers Cathy Bones and Lyn Belingheri, who recently celebrated 20 years of bringing their dogs to work.

EMPLOYEES CAN GET UP CLOSE WITH THE DOGS IN THE PAWS PROGRAM DURING CUDDLES FOR CAREGIVERS (CENTER PHOTO). PAWS VOLUNTEERS (FAR RIGHT, L TO R): DEBBY KELLEHER, SUE MITCHELL, MARIE PENCE, BETSY GROTTE.

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PAWS started small, with Bones, Belingheri and two other volunteers bringing dogs to group therapy on the G2 psychiatric unit. “Having animals helped bring patients out of their shell,” said Souza. From there, the program blossomed, expanding to rehabilitation, patient rooms and the general waiting areas. Today, there are 25 dogs in the PAWS program, and demand for well-behaved animals is high, said Linda Velez, Director, Volunteer Resources.

The dogs become hospital celebrities.

The short walk from the parking garage to the hospital can take 20 minutes, said Bones, whose goldendoodle Punkie is a

well-known fixture around the medical campus. “There are smiles as soon as we exit the parking garage elevator,” she said.

“It’s so rewarding,” said Belingheri, who studied animal assisted therapy and the human-animal bond in college.

“Patients and their families are facing something that is pretty stressful. This makes them smile. When we see that, it makes all the work worth it.”

The benefits of pet-assisted therapy for patients are well documented— animals have been found to lower stress and heart rate and minimize pain.

And those same benefits carry over to caregivers and staff. In 2015, PAWS launched Cuddles for Caregivers, an animal visitation program exclusively for staff. On the first and third Wednesday of every month, PAWS volunteers and their dogs can be found outside of Occupational Health on the ground floor of the hospital between 11 a.m. and 1 p.m. These visits typically draw between 50 and 100 staff members, many of whom have become regulars.

“I come every time,” said Critical Care Nurse Heather Jenkins, RN. “It’s the best part of my day.”

“Look at everyone’s faces,” said Richard Giardina, RN, MPH, from Nursing Quality who stopped by to visit Spirit, Kona and Punkie. “You cannot be sad around a dog.”

FOCUS ON… Alliance Medical Group in Pinole Situated at the northern corner of the bay, Alliance Medical Group in Pinole has a unique approach to patient experience that earned the clinic Top Box Likelihood to Recommend (LTR) scores. Described by many employees as a family, the Pinole clinic, a member of University HealthCare Alliance and a partner of Stanford Health Care, has had very low turnover in the past decade.

“In fact, we have staff who have been with the practice for as many as 25 years,” said Mary Harrington, Practice Manager, Pinole and San Pablo. “The longevity of the staff is important to our overall patient experience—when patients see familiar faces, they feel like they have a partner in their wellness journey, which is our number one goal.”

Alliance Medical Group in Pinole is a multi-ethnic group of seven providers that collaborate to provide a higher level of care. The Pinole clinic offers a range of services including family medicine, internal medicine, chronic disease management, Medicare wellness visits and sleep disorder services, among others.

Chief among the reasons the Pinole clinic earned Top Box LTR scores is the supportive team atmosphere generated by the staff and providers who have worked together for years. “We work as a team, celebrating each other’s successes and encouraging each other through tough situations,” said Liz Schmidt, medical assistant. “The patients can see and feel the staff’s

EMPLOYEES AT THE ALLIANCE MEDICAL GROUP IN PINOLE DESCRIBE THE CLINIC AS FAMILY.

supportive nature when they come in.

We are a group that has gelled and has great camaraderie.”

At Pinole, the staff and providers focus on nurturing emotional connections with patients and their families. “We let the patients express how they’re feeling by listening and maintaining eye contact,” said Harrington. “We place a large emphasis on letting our patients know they’re being heard and always follow up with a phone call the next day to see how they’re doing.”

The 15 support staff at Pinole embody what it means to work as a team to advance a common goal. “Everyone plays a role in delivering care to patients—even those on the back end that aren’t face-to-face with the patient, such as IT or facilities,” said Harrington.

“While high LTR scores are a point of pride, more than that, they signal that we are achieving our goal to have all groups working together to improve the overall patient experience.”

Roxanne Castaneda, Site Supervisor, Referral Coordinator, believes that the Patient Service Representatives from the front desk and call center are the front line of patient experience: “When patients present to the office, we’re the first people they see. At Pinole, we also have a check-out desk, so we’re the last people, too. We set the tone for the visit—it is very important

PATIENT SERVICE REPRESENTATIVES JAMIE LAZARO (L) AND HILLARY WINN (R) ARE PART OF THE PINOLE TEAM THAT PUTS PATIENTS FIRST.

for my front line people to be on top of their C-I-CARE.” Integral to caring for the patient population at Pinole is also caring for the community at large outside of the clinic setting. “Blessing Bags”—care packages the Pinole staff put together replete with hygiene products—are distributed to the homeless community in the area. “We strive to give back to our community and be present in the area so that our patients are familiar with us and recognize our care,” said Harrington. “When people see that we are working outside of the clinic to make an impact on the overall health and wellness of the community, they know they are in safe, caring hands when they come to our clinic.”

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Likelihood to Recommend: Celebrating Achievements in C-I-CARE TWENTY-ONE TEAMS RECOGNIZED FOR TOP PATIENT EXPERIENCE SCORES

The focus on patient experience remains Stanford Health Care’s North Star.

“A high Likelihood to Recommend (LTR) rating is the greatest honor a patient could give us,” said Malea Schulte, Program Coordinator for Service Excellence. “It means they trust us with the care of those they love most: their family and friends.”

And so, the feedback collected by Stanford’s patient satisfaction survey vendor, Press Ganey, brings meaningful perspective on the patient and family experience. In the most recent patient experience dashboards, 21 patient care teams achieved high Likelihood to Recommend scores. These teams represented Stanford Health Care, University HealthCare Alliance and ValleyCare.

“The fact that these teams have kept service at the forefront while market factors are at play shows the dedication our organization has to creating an environment that provides patientcentered care,” said Alpa Vyas, Vice President, Patient Experience.

Teams were recognized both for incremental improvement and for sustained Top Box scores. At Blake Wilbur Lab, for example, all touchpoints— from the time someone parks, to when they pay their copay, to when they interact with a member of the lab for 10 / STANFORD HEALTH CARE PEOPLE

CLINICAL NURSE SPECIALIST STACY SERBER DURING PATIENT EXPERIENCE WEEK HONORING PATIENT UNIT C1, ONE OF SHC’S TOP LTR TEAMS.

blood work—contributed to the team’s improvement in ensuring that all patients felt welcome and cared for.

“Patient experience is the sum of every step of their care, every environment and every interaction,” said Bryanna Gallaway, Director of Service Excellence. “LTR is a data point that helps us to understand the patient’s perspective of their experience.”

The B2 Unit, as another example, was recognized for an 8.8 percent increase on their LTR Top Box scores since the beginning of the fiscal year.

“Every patient is my patient,” said Patient Care Manager Teresa Cotter about B2’s team motto.

Pauline Regner, Patient Care Manager on D3, believes her staff are drawn to rely on each other due to the unit’s high-intensity patient care. “We use staff meetings to connect and get to know each other personally, which has proved invaluable to D3,” she said. “We work together better because we know each other better, and therefore, we care for our patients better.”

“Patient satisfaction is directly correlated to provider and staff satisfaction,” said Vyas. “We have amazing team members who work tirelessly to promote patient centered care by first caring for their colleagues,” she said.

THE TOP LTR TEAMS LTR TOP BOX GOALS EXCEEDED AND SUSTAINED Alliance Medical Group—Pinole, UHA Bone Marrow Transplant Clinic CCMG—Brentwood, UHA Coordinated Care D3 Patient Care Unit Genetics Oncology Clinic Kidney Clinic Kwok Pediatrics and Internal Medicine, UHA Lymphoma Clinic

MOST IMPROVED TOP BOX SCORES Alameda Pediatrics, UHA

10% TOP BOX SCORE IMPROVEMENT Hoover Lab ITA, South Bay

5% TOP BOX SCORE IMPROVEMENT 2N Patient Care Unit, ValleyCare 2W Patient Care Unit, ValleyCare B2 Patient Care Unit Bay Valley—Pleasanton, UHA Blake Wilbur Lab C1 Patient Care Unit Mid-Peninsula Surgical, UHA OB/GYN Partners for Health, UHA Sarcoma Clinic

KUDOS January C-I-CARE Service Spotlight Award KEVIN LOW One afternoon, Kevin Low, a Social Worker Clinician, was helping to discharge a patient when the patient could not reach his wife who, was supposed to take him home. As the afternoon wore on, it was discovered that the patient’s wife had died overnight. In the wake of this tragic news, Low provided the patient with care and assistance throughout the difficult process, arranging for the patient to speak with a coroner and supporting the patient throughout the devastating emotional aftermath of this event. Thanks to Low’s efforts, the patient averted a tragic return home.

January Patient Safety Star Award CRISTINA “PINKY” WOYTOWITZ Cristina “Pinky” Woytowitz, RN, noticed some subtle behavioral changes in her patient’s condition, which could have easily been missed. Something about the changes did not sit right with Woytowitz, and she escalated her concerns to the patient’s providers and suggested some tests to rule out infection. Although those results were negative, Woytowitz continued to press, and thanks to her persistence and critical thinking, Woytowitz helped identify a complication for the patient. The medical team was then able to swiftly intervene and remedy the issue before it became more problematic.

February C-I-CARE Service Spotlight Award PHIL ARANDIA When a patient awaiting a heart transplant had to spend his 18th birthday in the hospital, RN Phil Arandia stepped up to make it a true celebration.

With the help of a few colleagues and the patient’s mother, Arandia organized a surprise party in the hospital atrium, complete with food, drinks, the gift of a PlayStation and a special personalized get-well video from the cast of The Lion King, a show the patient wanted to see but was unable to. Arandia demonstrated tremendous compassion, making the patient’s stay as comfortable and celebratory as possible over his 18th birthday.

March C-I-CARE Service Spotlight Award SHOKOH AZIZI SHC RN Shokoh Azizi went above and beyond to comfort and assist a nurse who had come to the lab for blood work. The nurse arrived in the middle of a storm and with an upset child, only to find that her paperwork had been misplaced. The nurse was clearly overwhelmed and frustrated, but Azizi quickly sprang into action, comforting the child with stickers and games and correcting the lab order with the updated information. Azizi’s efforts resulted in the nurse successfully completing her lab work, which was needed for a procedure occurring the very next morning.

April C-I-CARE Service Spotlight Award GRISSEL HERNANDEZ Nursing Professional Development Specialist Grissel Hernandez was on her way to the hospital for a meeting when she noticed a patient walking with bare feet toward Welch Road in the rain. After approaching the patient, Hernandez introduced herself and began listening to his story.

Grissel learned that he was concerned and frustrated over his prognosis. As Hernandez slowly coaxed the patient back to the hospital, she was able to make him feel heard and cared for by simply taking the time to listen to him.

The patient was overcome with gratitude for Hernandez’s act of kindness and thanked her.

April Patient Safety Star Award IAN RAVN, EVA WEINLANDER, JIMMY YAO A patient experiencing dizziness and imbalance arrived at Stanford to see Eva Weinlander, MD, who noticed the patient had stopped taking a crucial medication to prevent stroke.

She advised him to restart the medication. As he left the hospital, he began experiencing

March Patient Safety Star Award JESSICA LAU Pharmacist Jessica Lau was walking out of the satellite pharmacy office on the B3 Nursing Unit when she heard a loud cry for help coming from a patient room. She immediately rushed over to the room and found a visitor who was visibly choking.

As the first staff member to arrive on scene, Lau rapidly began performing the Heimlich maneuver to dislodge the food from the visitor’s throat, restoring her ability to breathe.

Lau not only helped save a life but demonstrated courage and care for someone in need.

facial numbness and called SHC triage RN Ian Ravn. Without hesitation, Ravn rushed to the parking lot to meet the patient along with Weinlander and Jimmy Yao, medical scribe.

Together, the three of them worked as a team to treat the patient and safely coordinate his prompt transport to the ED, where a stroke code was activated.

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OUR PATIENTS NOW

New Heart. New Life.

Stanford Hospital’s cardiologists had a problem: They weren’t likely to find a new heart for their young patient anytime soon, but the machine that kept Abraham Maga alive prevented him from moving. Without exercise, he would weaken, reducing the chance of a successful transplant.

So Richard Ha, MD, clinical assistant professor of cardiothoracic surgery, engineered a new way of attaching the machine, an extra-corporeal membrane oxygenator, or ECMO. It allowed Maga to sit up in bed, walk down the hallway—even take a few laps outside around the fountain. He grew stronger, and after three and a half months attached to the ECMO, he received a new heart.

Back home in Fresno, where he’s finishing high school, Maga said, “I didn’t think about how long it would take. I felt confident they would find a heart for me.”

Maga’s ordeal began in August 2016, just after school began. The 17-year-old was in fine health; He had even been in training to play football at Roosevelt High School in Fresno.

“Out of nowhere, my heart started beating fast when I wasn’t doing anything,” Maga said.

Over the following week, his heart deteriorated so quickly—physicians don’t know what caused it to fail—he required a transfer to Stanford Hospital.

“He was basically at death’s door,” said Joseph Woo, MD, chair of cardiothoracic surgery.

The ECMO is normally attached to a patient by running tubes through the groin or the neck, so any movement can cause the tubes to kink or detach.

Patients attached this way to an ECMO have to lie motionless, flat on their back, or risk death.

For short periods, the lack of exercise isn’t a problem. But because of Maga’s size—he’s 6-foot-1—and his blood type, the cardiothoracic surgeons knew it could be a while before a suitable heart was available.

Ha then tried something he’d never heard about but thought could work: attach the ECMO through Maga’s rib cage. “That way the tubes are more stable and less liable to infection,” Ha said.

During his stay in the ICU, Maga drew, kept up with his homework, shot baskets through a hoop attached to his hospital room wall and visited with family members. When he went out on walks, he was accompanied by his ever-present ECMO and a team of four or five clinicians.

An appropriate heart finally became available, and Woo performed the transplant surgery on Dec. 1. Maga was discharged Dec. 19.

“What we learned from Mr. Maga we applied to other patients,” Woo said. “We learned a lot about how to position the tubing, how to get patients walking with the machine, treating infections.”

All of Stanford’s cardiothoracic surgeons now know how to attach an ECMO through the rib cage. They’ve used it on a few more patients who needed, like Maga did, a high level of blood flow.

Maga said he wasn’t bored during his months in the ICU: He bonded with the nurses, who have friended him on Facebook and still tell him to do his homework.

As he wraps up high school, he’s thinking about studying architecture in college—and playing basketball, given all the practice he got in the ICU.