Working Together for UMMC

Working Together for

FALL 2013

UMMC

P ublished i n c on jun c t i on w i th th e E mp l o y e e C o mm u n i c a ti o n F o r u m s a t th e Uni versi t y o f M ary la nd M ed i cal Cent er

M

Moving Forward,

any of us who work at the University of Maryland Medical Center are here because we want to help people.

Guided by Empathy

We approach our jobs knowing that at any moment, we may encounter people who are in pain or anxious about the future, as well as those who are joyful upon hearing good news.

Our C2X Employee Communication Forum theme for this fall, “Empathy Moves Us Forward,” was chosen because, in these challenging times of great change, we have to continue to move forward, and moving forward is impossible if we don’t take care of ourselves, our patients and each other. Our program for the forum and this issue of Working Together give us examples of how empathy and progress are linked in our work and our mission.

Across the country and here in Maryland, our goals in health care are to increase access, decrease cost and continuously improve the quality of the care we provide. That means staying connected to patients and to one another.

Empathy helps us to improve coordination and hand-offs between departments. It helps us support each other in our work. And most of all, it helps us to support patients and their families as they face a health crisis. Empathy is a way to walk in one another’s shoes, with all of us moving forward together.

Jeffrey A. Rivest President & Chief Executive Officer

Inside: Also see

w The 1st Annual UMMC Healing Arts Exhibit for employees and families was a huge success. See photos of the exhibit and some of the pieces throughout this issue.

5/6 Detail from Easter by John Cotterell, BSN, RN,

Detail from Little Hero by Joseph Diloy, BSN, RN

C

hanges in health care reform and the nation’s economic landscape have resulted in the kind of turbulence that makes it harder to focus on empathy. When individuals are feeling their own stress and uncertainty, it’s that much harder to think about what others are feeling.

Empathy is a tool for coping with change, to help deliver the very best care to patients and visitors, and to help support colleagues. Empathy is at the heart of Commitment to Excellence (C2X) and has always set the UMMC community apart from other academic medical centers. Throughout the region, UMMC is known as the medical center that delivers both compassionate care and technical excellence and skill.

The following initiatives are a representative sample of programs that help staff members take care of one another in order to deliver the highest quality care to patients:

1

A strategic expansion of Volunteer Services to support staff efforts to care for patients.

Volunteers are matched to areas of the hospital where they can provide the extra human touch that improves patient satisfaction and gives additional support to staff so they can focus on the skilled care patients need.

2

A new Behavioral Early Response Team (BERT) pilot project on seven units.

The BERT team responds when a nurse believes a patient’s behavior is becoming an obstacle to his or her care. The concept is to intervene early before any harm occurs. The team includes a Psychiatric Emergency Services nurse, a chaplain and a social worker from Pastoral Care Services, and a security officer.

3

A new “mock code” simulation training program to help acute care staff and the Code Blue Team develop better communication during a resuscitation effort. This training program allows an acute-care unit to go through a surprise drill that simulates an unexpected cardiac arrest of a patient. A Code Blue can be a rare event on a unit that is not an intensive care unit (ICU), so staff felt they needed more training and practice that also included the Code Blue teams, which respond from other parts of the hospital. Because feeling unprepared for an unexpected emergency is very stressful, mock codes are one way for staff to feel prepared and to keep their skills in top shape.

4

Expanding the Integrative Care Team that is available to staff as well as to patients.

The Integrative Care Team offers patients and staff a variety of services that reaffirm the importance of the relationship between practitioner and patient and focus on the whole person’s optimal health and healing, yet are based on scientific evidence.

5

The C2X Healing Arts Team from throughout the Medical Center (including some of the Integrative Care Team members). The Healing Arts Team has already hosted two events: a performance by a handbell choir, whose developmentally challenged musicians and vocalists wanted to thank the staff for caring for one of their members who died; and a large art exhibit of works by UMMC staff and their families.

To read more about each of these five initiatives, see pages 2-3.

C O M P A SSI O N Have compassion for everyone you meet,

3rd place winner in professional category

even if they don’t want it. What seems conceit, bad manners, or cynicism is always a sign of things no ears have heard, no eyes have seen.

w Taking Care of No. 1

page 4

w Models of Empathy

page 6

You do not know what wars are going on down there where the spirit meets the bone.

Miller Williams, from The Ways We Touch: Poems,

w Save

the Date • Holiday Party • Dec 18

© University of Illinois Press, 1997

em·pa·thy (noun) : the ability to understand 2

A strategic expansion of Volunteer Services to support staff efforts to care for patients

1

UMMC has embarked on an expansion of its Volunteer Services. Volunteers are matched to areas where they can provide the extra human touch that improves patient satisfaction. They also provide additional support to staff, so they can focus on the skilled care patients need.

Volunteers include students at the University of Maryland, Baltimore, especially in the School of Medicine and School of Nursing. As volunteers, they cannot provide hands-on clinical care to patients or replace staff, but they can be trained to help in a variety of ways that support clinical and non-clinical staff.

The expansion of the volunteer program includes “Yellow Jackets” — volunteers who wear bright yellow vests and help visitors, patients and staff find their way around the Medical Center. Before the additional volunteers were added this year, the wayfinding stations were staffed only at peak hours. Yellow Jacket volunteers are now stationed in busy areas and intersections — such as the rotunda elevator lobby, the Weinberg hallway, and near the cafeteria — to greet and help people who are walking by.

Volunteers at UMMC must be at least 13 years old. Anna Dziki, now 14, a freshman at Fallston High School in Harford County, started as soon as she could last summer and hopes to continue during school breaks. Anna volunteered in the Stoler Pavilion, rounding with patients to make sure they have enough to drink and to check on their other needs, and alert staff about anything that is beyond the scope of a volunteer. Many patients are just glad to have a friendly and thoughtful person checking on them.

“I was usually able to assist them, but if I couldn’t, I would be able to let hospital staff know the patient needed something,” Anna said.

“It has been just an amazing experience,” said Anna, who is considering a career in health care because of her experience volunteering. “But whether you want to go into health care or become a lawyer or whatever, it’s just an amazing experience. The people in Oncology are so caring, and it’s very inspiring.”

She is considering asking for experience volunteering in the Shock Trauma Center next, as her two older siblings have done.

Anna Dziki, 14, volunteers during her school breaks. She helps with hourly caring rounds in the Stoler Pavilion.

“Anna is a huge help as part of hourly caring rounds,” said Kerry Sobol, MBA, RN, director, patient experience and C2X. “When she or another volunteer is there, it frees up the nurses from having to meet the service needs of a full waiting room.

“In addition, volunteers serving in this capacity are the eyes and ears of the staff when they are not able to keep an eye on the patients continuously in the waiting room. These volunteers alert the staff if they see anything that doesn’t seem right with someone — including patients who have been waiting a long time, and maybe were missed in some way.”

Nancy Hicks, 50, has been volunteering at UMMC for about 30 years. While she has done many jobs over the years, she now enjoys loaning out books from the hospital’s book cart every Tuesday and Wednesday. She takes the cart around to floors, and often parks it near the Stoler Pavilion, where visitors often like to pick out something to read while they wait for a loved one to come out of surgery or to read to a patient.

Family members and friends of staff who wish to volunteer can contact Marvena Cole, volunteer services manager, at mcole1@umm.edu.

A new BEHAVIORAL EARLY RESPONSE TEAM (BERT) pilot project

2

The BERT team responds when a nurse believes a patient’s behavior is becoming an obstacle to his or her care. The concept is to intervene early before any harm occurs. The team consists of a Psychiatric Emergency Services nurse and a Security officer at least, and, if possible, a chaplain and a social worker, The approach is being piloted on seven units in the hospital.

The BERT team grew out of recommendations by two staff committees — the Patient/Public Conflict Team and the Coworker Civility Team.

The Patient/Public Conflict Team, in particular, recommended a way to provide support to the unit health care team early when they needed help with a patient whose behavior was becoming disruptive in some way. The two goals are to de-escalate the situation and to provide support to the unit staff.

The work so far has been successful, and the unit staff is learning techniques from the BERT team to apply in a variety of situations.

While nurses had always been able to call for help from a particular department, or call Security, they saw the need for a more structured and crossdisciplinary approach.

The main purpose of the team is to help the patient, even if the patient is the one putting up the obstacle. In one case, a man who was clearly too ill and injured to leave the hospital was trying to leave for fear his car would be towed. He was homeless and living in his car, which raised the stakes even higher from his perspective.

In another case, a patient in the Medical Intensive Care Unit (MICU) was resisting placement of a nasogastric (feeding) tube. Her anxiety and highly negative emotions kept her from communicating rationally, said Connie Noll, MA, BSN, RN-BC,

BERT team members Zelda Falck, MS, RN-BC, psychiatric emergency services nurse (left), and Cpl. Tim Sewell, UMMC special police officer, consult with MICU nurse Cheryl Coale, BSN, RN, CCRN, FCCS.

clinical practice and education specialist in the Department of Psychiatry.

A BERT team member was able to see that the patient had not yet acknowledged to herself how sick she was, but she did have realistic concerns about the treatment plan. The BERT team members were able to calm the patient so that she could then articulate her concerns and ultimately participate in her treatment plan.

“MOCK CODE” simulation training

3

A “code blue” is called when a patient is in cardiac and/or respiratory arrest. Mock code simulation training has started on several units in the last few months. This training program allows an acute care unit to go through a surprise drill that simulates an unexpected code-blue arrest of a patient. A code blue is a rare event on a unit that is not an intensive care unit (ICU), so staff asked for more training and practice to keep their skills fresh. The simulation training also enables the acute care units to work with the code-blue teams that respond from other parts of the hospital.

A recent simulation in the Magnetic Resonance Imaging (MRI) Suite provided the opportunity to work through unusual logistics and safety issues that are specific to that area. Due to the powerful magnet in the MRI machine, a stethoscope or oxygen tank can turn into a deadly projectile if certain safety precautions are not taken before the patient is approached by the team running the arrest code.

Staff in the MRI Suite work with the code-blue team to practice an unannounced realistic drill to resuscitate a “patient” that is actually a simulator mannequin.

and share the feelings of another The C2X HEALING ARTS TEAM of staff from throughout the Medical Center

5

Paul Jefferson (right), a patient care technician (PCT), and Janet Loehwing, BSN, RN (left), a staff nurse and educator, go over contents of the “crash cart” during a refresher course all nurses and PCTs take annually. Both Jefferson and Loehwing work in the Neurocare Unit on Gudelsky 5 West.

Expansion of INTEGRATIVE MEDICINE CARE TEAM

Including some of the Integrative Care Team members, the Healing Arts Team is the newest C2X team, formed of employees from across the Medical Center. The team has already hosted two events: a performance by a hand-bell choir, whose developmentally challenged musicians and vocalists wanted to thank the staff for caring for one of their members who died; and a large art exhibit of work produced by UMMC staff and their families.

The inaugural Healing Arts Exhibit, sponsored by the National Arts Program, drew 156 submissions from staff and their family members, some of them professional artists, from dozens of departments

3 throughout the Medical Center. The artists ranged in age from 8 to 81.

“Of the 93 artists, 57 are employees — they submitted a combined total of 93 pieces — and 36 are immediate family members of employees who submitted another 63 pieces,” said Rachel Hercenberg, the Healing Arts Team leader and a project specialist in Clinical Practice and Professional Development. “Eight of the artists are physicians, who submitted 15 pieces.”

The Healing Arts Team was formed as a way to bring together staff, physicians and students from across the Medical Center and to promote the use of art as a creative outlet for staff members.

4

The Integrative Care Team offers patients and staff a variety of services that focus on the whole person’s optimal health and healing and are based on scientific evidence.

The team now has a medical director, John Reed, MD, MDiv, clinical assistant professor of family and community medicine at the UM School of Medicine, and director of inpatient services for the Center for Integrative Medicine. Reed is also available to see staff members as patients at University Immediate Care, the medical practice on Lombard Street that provides walkin appointments for UMMC and UMB staff, faculty and students.

“By caring for the healers, it results in better care of our patients,” said Donna Audia, RN, a nurse who also is trained in Reiki. “With the higher acuity of patients as well as the limited time spent with patients, health care providers can suffer from compassion fatigue. We not only provide treatments in times of distress for staff, but resources for staff to learn how to better care for themselves.”

Audia said many of these services have been available to staff since 2006, and hundreds have been treated by the team in the last seven years.

“We do treat staff on a regular basis but not necessarily the same staff. Some come for specific times in their careers while others become so involved that they, too, learn the techniques and become champions of the team for other staff, patients and families,” Audia said.

“At first, Mondays were designated for staff treatments, but we found that we have better results going to the units and treating the staff there,” Audia said. “We honor the calls for staff treatments as an urgency, as we are a healing community for all who enter our doors — staff especially. When high-stakes surgeries take place, we have offered our services to the team prior to the surgery, during the surgery and after the surgery.”

Integrative Medicine services include Reiki, live therapeutic music in the healing garden for patients and visitors, acupressure, guided imagery, yoga breath work and expressive arts, such as drawing, painting or writing as a way of finding meaning through challenges. For more information, go to the UMMC website at www. umm.edu and type “Integrative Medicine” into the search tool.

Easter

by John Cotterell, BSN, RN Waiting for Jack

by Lynn Hamrick, BS, HT(ASCP), QIHC

1

TAKING CARE of NO. People who CarE for Others Must Remember to Take Care of Themselves

H

ealth care workers are often so focused on caring for others — including their families — that they can neglect their own health and well-being, leading to stress and burnout.

While caring for others is rewarding, it’s hard to be empathetic when our energies and emotions are spent without replenishment, said Connie Noll, MA, BSN, RN-BC, clinical practice and education specialist for the Department of Psychiatry.

It doesn’t help patients or families when a caregiver neglects his or her own health — not to mention the toll it takes on the caregiver. Whether the stress is coming from work or from family or friends, it’s important to seek balance and renewal, Noll said.

“I need to have balance and perspective in my life to be the best ‘Connie’ that I can be,” said Noll. “Sometimes our home lives are going to be taking up 95 percent of our energy; sometimes it will be work that consumes us. We need to look at why it’s out of balance, and how to achieve balance for the long term. If you can master that, you’re going to feel like you’re doing great.”

“A job in health care is very meaningful, with constant reminders of the impact health care workers have on patients and their families.”

Connie Noll, MA, BSN, RN-BC

A Wellness Toolkit

Noll also recommends pulling together what she and her colleagues call a “wellness toolkit.”

Make a list of what makes you the best ‘you’ that you can be. Start by finishing this sentence: “I feel best when I ______.”

The answer might be “get eight hours of sleep,” or “work in my garden,” or “read a good book for an hour,” or “take a 15-minute walk” or “play with my dog.” Noll recommends making an actual list of the activities that are renewing for you.

“You do these things to nourish yourself, to nourish your soul,” she said.

Sometimes that nourishment will come from work, she said. A job in health care is very meaningful, with constant reminders of the impact health care workers have on patients and their families. That’s a good thing.

In fact, one of the activities that Noll does outside of work is very close to what she does at work. Noll has volunteered with the American Red Cross since she was a teen, most of that time as part of a team that responds to disasters, including at the site of the United 93 hijacked plane crash in Pennsylvania on Sept. 11, 2001, and Hurricane Katrina.

Tools for Wellness and Work-Life Balance Wellness Wheel (or Chart) • The idea is to make a

Carebridge Work-Life Services • Carebridge

Active Challenge • UMMC offers this wellness

visual chart of different aspects of your life, then

work-life counselors have advanced degrees

challenge periodically as an incentive to staff

assess how satisfied you are with each, making

and can provide UMMC staff with free individual

to improve their health, engage in friendly team

note of the areas where you want more balance

consultation to help with finding child care, elder

competition and even earn financial rewards for

or would like to make changes. Categories can

care, college planning, personal financial plan-

improving their personal health. The program is

include, for example: spiritual, emotional, financial,

ning, and time-management/life-balance issues.

limited to staff who are members of the UMMS/

physical, intellectual, social, and professional.

Information can be found on the Intranet Human

UMMC health insurance plans, UNET and MPP. The

Several examples of a “wellness wheel” or chart

Resources page, under Financial & Work-Life,

latest challenge is called “Fit & Festive,” and runs

can be found online to help you make your own.

or call 1-800-437-0911.

Nov. 4 to Dec. 15. Registration opened Oct. 16.

The goal of this challenge is to maintain weight

Employee Assistance Program • This free, confi-

2-1-1 Maryland • This private, nonprofit partnership

and fitness and make healthy choices during the

dential counseling and referral service is available

of four health and human service agencies, includ-

holiday season. For more information, go to the

to all Medical Center employees to make access

ing United Way of Central Maryland, serves as a

Step Up to Good Health link on the home page

to counseling services as easy as possible. Trained

type of clearinghouse for information the public

of the UMMC Intranet.

mental health professionals will assist employees

can use to get help in a crisis, such as applying for

who are experiencing personal, professional or

food, clothing or housing assistance, paying for

Step Up to Good Health • If competition is not

family problems. The EAP staff provides short-term

utilities, or accessing mental health and substance

your thing, this program continues to reward staff

counseling and makes referrals to other appropri-

abuse services. Staff are available 24 hours a day.

for taking better care of themselves to reduce their

ate resources as needed. Information can be

To access them, go to www.211md.org, or call 211

health risks and better manage chronic conditions

found on the Intranet Human Resources page, un-

from most phones in Maryland.

such as diabetes, hypertension and asthma. It is

der Financial & Work-Life, or call the EAP

also open only to employees with UMMS/UMMC

at 410-328-5860.

health insurance plans, UNET and MPP. For more information, go to the Step Up to Good Health link on the home page of the UMMC Intranet.

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4

410-328-5860

www.umms-eap.org

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5

A Soothing Space for Families • The new waiting area (above) in the Shock Trauma Critical Care Tower will provide more privacy and comfort for families – a feature requested by staff who participated in the planning for the new building. A ribbon-cutting for the new building will take place Friday, Nov. 8, including a reception for employees from 4 to 7 pm in the lobby of the tower.

The University of Maryland Children’s Hospital Mosaic was created in the summer of 2012 by a diverse group of volunteers, including physicians, nurses, technical and administrative staff, patient families and friends of the Children’s Hospital in partnership with Art with a Heart. This group of nearly 200 individuals gave generously of their time to assemble the mosaic one piece at a time in the hope that its beauty would bring comfort to patients and families in the Pediatric Emergency Department.

FLu

FREE E N O Z

It isn’t necessary to actually get the flu in order to have empathy for patients who have it. People who work in hospitals should do everything they can to keep from catching this serious illness that could endanger our patients.

UMMC requires that all employees be vaccinated to protect themselves, their families and their patients from influenza viruses. New this year, an egg-free vaccine will be available in November for employees who are 49 years old or younger who are allergic to eggs.

All Medical Center employees must be vaccinated by Dec. 5 unless they provide documentation by Nov. 7 of a medical or religious reason for declining vaccination.

Those vaccinated elsewhere must provide documentation of that, also by Nov. 7.

Employee Health Services has been offering the vaccines in the Employee Health suite and in several units and offices since Oct. 1, with extended hours for staff convenience.

The flu is a serious and contagious respiratory illness caused by viruses. It can cause mild to severe illness and in some cases can lead to death. The best way to prevent the flu is with frequent hand-washing and by getting a flu vaccination each year. This is especially important for health care workers.

Visit the UMMC Flu-Free Zone website through the UMMC Intranet home page for more information, including the full schedule of vaccinations.

Employee Prescription Automated Pick-Up In response to requests from UMMC staff for a more convenient way to fill their own prescriptions, Pharmacy Services installed an automated vending machine in April and continued to adjust the service based on comments by users. Staff can enroll themselves at the machine, which is around the corner from the Weinberg Outpatient Pharmacy.

To fill a prescription, a staff person drops the prescription into the employee dropbox in the Weinberg Pharmacy. If a prescription form is dropped off by noon, the medication will be ready in the machine by 3 p.m. that day. After noon, they’ll be ready by 9 a.m. the next day. A text message can alert the employee that the prescription is in the machine and ready for pick-up.

Some upgrades have been made to the service since it first began, including: bags are available for privacy, a bin is available to recycle the plastic bags that enclose each prescription as it is dispensed, and over-the-counter drugs such as acetaminophen, ibuprofen and antacid are now available.

“That’s been especially helpful for staff who work at night, after the outpatient pharmacy is closed,” said Kathryn Vranek, PharmD, ambulatory pharmacy operations manager.

For employees who work off site, the UMMC Employee Prescription Mail Service has grown in popularity.

A cost-saving alternative to retail pharmacies, the mail service allows staff to get a 90-day supply at a lower cost and with more convenience than other mail-order and retail pharmacies. To enroll, staff can pick up an envelope at the Human Resource Services office or the Weinberg Outpatient Pharmacy, download a form from the Pharmacy Services page on the Intranet, or call 410-328-5243.

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[

6

moving forward, guided by empathy

]

our Staff shows empathy through art Little Hero byJoseph Diloy, BSN, RN

“You can never understand

The Right Words: Expressing Empathy

someone unless you understand their point of

Sometimes, especially in the sometimes-hectic environment of health care, people who want to be empathetic might still neglect or forget to express that to others. There are many examples of how tailoring the way you

view, climb in that person’s

speak to colleagues or patients and visitors can better express to them that you are sympathetic.

skin or stand and walk in that person’s shoes.”

— Spoken by the character Atticus Finch in To Kill a Mockingbird,

Examples of Empathy, Support or Cooperation

Examples that Do Not Support Empathy

How are you doing?

That’s not my job.

Let me help you with that.

They’re not doing their job.

May I help you find where you need to go?

You should know better.

Hang in there – I’m thinking about you.

Didn’t you hear what I said?

I understand.

I already told you, …..

Please.

I don’t need you telling me that.

Thank you.

by Harper Lee

Have a good day.

Support UMMC’s

United Way

Campaign Donate

New or gently used books, CDs and DVDs

Collection Box Locations:

SAVE THE DATE

HOLIDAY PARTY all employees

• Outside Patient Admitting, near front entrance • Gudelsky Entrance, next to Information Desk • Next to STC Information Desk • Paca Pratt Building, outside Human Resources

The University of Maryland Medical Center is an equal opportunity employer and proud supporter of an environment of diversity.

3-8PM

December

18

This publication is printed on recycled paper.