HOUSE STAFF ORIENTATION 2011

1. HOUSE STAFF ORIENTATION 2011

2. Thank you for choosing to bring your skills to our organization.

3. WFUBMC Strategic Plan WFUBMC WFUBMC VISION To be recognized as the highest quality AMC with balanced excellence VISION To be recognized as the highest quality AMC with balanced excellence VISION To be recognized as the highest quality AMC with balanced excellence MISSION Improve the health of our region, state and nation MISSION Improve the health of our region, state and nation MISSION Improve the health of our region, state and nation VALUES VALUES VALUES ClinicalGoals and Strategies ClinicalGoals and Strategies AcademicGoals and Strategies AcademicGoals and Strategies Financial Goals Financial Goals

4. Our Values EXCELLENCE demonstrate the highest standards of patient-centered care, education, research and operational effectiveness COMPASSION respond to the physical, emotional, spiritual and intellectual needs of all SERVICE cultivate selfless contribution for the greater good INTEGRITY demonstrate fairness, honesty, sincerity & accountability DIVERSITY honor individuality and protect the dignity of all COLLEGIALITY foster mutual respect, facilitate professional growth and mentorship, reward teamwork and collaboration INNOVATION promote creativity to enhance discovery and the application of knowledge

5. Our Purpose • TOINSPIRE an integrated, high performing, care-giving organization with a common culture, shared values and aligned goals that: • Provides patients and families the highest quality care possible • Provides employees a positive work environment • Supports continuous improvement

6. Whole Systems Measures • Safe • Rate of Adverse Events • Incidence of Non-fatal Occupational Injuries or Illnesses • Timely • Days to 3rd Available Appointment • Equitable • Equity (Stratification Core Measures) • Effective • Standardized Mortality Ratio • Unadjusted Mortality • Hospital Readmission Rates • Reliability of Core Measures • Patient-Centered • Patient Overall Satisfaction

7. Whole Systems Measures Scorecard

8. Mortality The Mortality Index uses a complex algorithm to compute a denominator for expected deaths in a variety of conditions.

9. Creating a Service Excellence Culture

10. A Culture of Care

12. “I Care” 12

13. A Service Excellence Culture • Promotes our values: excellence, compassion, service, integrity, diversity, collegiality, innovation • Links our values and behaviors: connection, courtesy, anticipation, problem-solving, individual accountability • Encourages personal fulfillment • Achieves the kind of care you would want for yourself and your family

14. Service Excellence introduce yourself and your role c connect and communicate what you are going to do a ask and anticipate patient needs, questions, or concerns r respond topatient questions or requests promptly e explain what will come next and hand-off courteously

15. A Foundation for Care Compassionate relationships lead to: • Healing for our patients • Positive interaction with families and visitors • Teamwork among co-workers • A renewed sense of purpose They connect us with what it means to CARE in health care.

16. “I Care” Goals • Exceed customer expectations • Achieve Press Ganey patient satisfaction levels at or above the 95th percentile across all parts of WFBH

17. Service Excellence in Action • “I actually felt like (the doctor) cared about my son. Most ER docs and physicians at my local hospital are just there to do their job and don’t care about the patient as a person.” • “My doctor was friendly and seemed genuinely concerned for my health and well-being.” • “The doctor helped put all the pieces to the puzzle together, listened to me and made me feel like a part of my son’s team.” • “I chose this hospital because the doctors and staff at the other hospital I went to before are cold and aloof. Very different experience here – much better!” • “He never rushed. He took time to answer all my questions.”

18. Service Excellence introduce yourself and your role • knockand pause before entering room • smile • make eye contact • speak clearly • ask and address the patient by theirpreferred name • acknowledge others in room/introduce your team members and their role

19. Service Excellence • take time to hear the patient • explain what you are there to do and why • if family members or visitors are present, explain your role • describe what the patient should expect • ask permission prior to touch c connect and communicate what you are going to do

20. Service Excellence a ask and anticipate patient needs, questions, or concerns • ask if there are any questions • observe reactions that might show need for more information • anticipate needs based on information you have (diagnoses, condition, preferences), such as call light, TV remote, bed operation, location of waiting rooms, food, bathrooms • identify other concerns that are important to the patient

21. Service Excellence • acknowledge questions and respond • promptly explain what you will do to get the answers you do not have • follow-up with patient to make sure questions have been answered and understood • ask if the patient’s needs have been met and follow up as necessary r respond topatient questions or requests promptly

22. Service Excellence • provide plan for what should happen next • when possible let the patient know when to expect you to return and who will care for him/her now • explain what to do if you are needed sooner • thank the patient for the opportunity to care for him/her e explain what will come next and hand-off courteously

23. Service Excellence Remember:careService Excellence • is the cornerstone for achieving excellence • is vital to patient healing • creates a culture of care

24. Poor Customer Service • “My father and his children felt like a number among many numbers, and our questions were answered robotically as if quoting a text book. No human element.” • “I became very upset when one of the doctors on the team stood outside my door and talked so loud (about my condition) I could hear him in the room with the door closed. I was crying about what happened to my privacy, and he talked so loud that others heard.” • “The hospital physician was very rude, and always contradicted what my attending physician told me to do.” • “The physician did not care about my feelings. I was very upset with the way they handled my situation. They did not care about my after care.”

25. Service Excellence BecauseI care… • our patients and families feel safer and more valued, • my colleagues find more gratification in their work, • I feel personally more fulfilled.

26. CMO/CNO CO-MANAGEMENT TEAMS

27. WHAT IS A CO-MANAGEMENT TEAM? Clinical Leadership of each of our inpatient units • charged with driving the execution of our Strategic plan and its goals by leading all faculty and staff working in the patient care areas.  • which are a central foundation in our journey to top decile performance across all aspects of our clinical endeavor.  • will focus upon a set of metrics aligned with our strategic goals • are empowered and expected to lead significant change in all areas not already at top decile performance.  • are charged with identifying problems and solutions at the individual patient care area levels.

28. TEAMS • Currently we have 50 co-management inpatient teams • Each leadership team consists of: • Unit Manager • Medical Director • Director • Executive Medical Director

29. PERFORMANCE METRICS AND GOALS PATIENT SATISFACTION: • Understanding patient perceptions helps our organization focus its improvement efforts, deliver excellent clinical care, develop loyal customers and improve its bottom line. • Goal: Target Press Ganey rankings at top decile against our region in both in and outpatient settings in 3 years • Short-term: Choose beginning metric targets reasonable to yearly achievement • Press Ganey: Enterprise • No Lowest quartile scores by end CY10 • All above the median by end CY11 • Top decile Overall Press Ganey Scores by end of CY12

30. PERFORMANCE METRICS AND GOALS LENGTH OF STAY • Length of stay is important to the patient’s experience and the efficiency of our services. We need to use our inpatient beds efficiently to ensure a shorter length of stay for our patients, thereby, improving patient satisfaction while providing efficient and effective care for our patients. • METRIC: Unit based index. Targeted reduction in excess days and LOS Index • Goal: Aggressive UHC benchmark

31. HIGH FREQUENCY INJURIES SOURCES • 1. Adverse drug events (ADEs, ADRs) • post-operative deep wound infections • urinary tract infections (UTI) • lower respiratory infections (pneumonia or bronchitis) • bacteremias and septicemias • 2. Iatrogenic infections • 3. Pressure injuries • 4. Mechanical device failures • 5. Complications of central and peripheral venous lines • 6. Deep venous thrombosis (DVT) / pulmonary embolism (PE) • 7. Strength, agility and cognition (injuries and restraints) • 8. Blood product transfusion • 9. Patient transitions

32. PERFORMANCE METRICS AND GOALS TIMELY COMPLETION OF THE DISCHARGE DOCUMENTATION • It is important to our patients’ continued care that information about their hospitalization is transferred to the next provider in a timely manner at discharge. Transfer of information through the electronic discharge form is important in preventing readmissions, medication errors, complications, etc. Timely completion of the electronic discharge form expedites more accurate coding of the patient’s inpatient care. • METRIC: Fully implement the E-Red Border form for 100% of discharges and 100% authentication at time of discharge. • Goal: Those below 50% compliance, need to reach 50%. Those at or above 50% need to reach 100% compliance.

33. PERFORMANCE METRICS AND GOALS PRESSURE ULCERS • According to CMS, 257,412 preventable pressure ulcers were reported as secondary diagnoses in hospitals in 2007. It is important for us to recognize if a patient is admitted with a pressure ulcer but also very important that we recognize the signs for hospital acquired pressure ulcers so we can prevent them from occurring. METRIC: The goal is to be at or below the benchmarks. Unit based numbers and targets. • Goal: These goals are by Unit Type with the unit specific goals to be at or below the benchmark. The benchmarks are the mean for like units (critical care, med-surg, etc) in hospitals with 500 or more beds.   

34. PERFORMANCE METRICS AND GOALS FALLS • Preventing falls among patients in an acute healthcare setting requires a multifaceted approach, and the recognition, evaluation and prevention of patient falls are significant challenges for all who seek to provide a safe environment in any healthcare setting. Preventing falls serves to maintain a shorter length of stay, maintain patient satisfaction, improve the cost per discharge, etc. • METRIC: The goal is to be at or below the benchmarks. Unit based numbers and targets • Goal: These goals are by Unit Type with the unit specific goals  to be at or below the benchmark. The benchmarks are the mean for like units (critical care, med-surg, etc) in hospitals with 500 or more beds.   

35. PERFORMANCE METRICS AND GOALS FOR CRITICAL CARE UNITS ONLY • Individual units will look to improve their rates to the next best percentile over the course of the year. • Reduction in BSI • Goals for FY11 ≤ NHSN 50th percentile (adult units/PICU) • Goals for FY12 ≤ NHSN 25th percentile (adult units/PICU) • Reduction in VAP • Goals for FY11 ≤ NHSN 50th percentile (adult and pediatric units), VAP Index ≥ 95% • Goals for FY12 ≤ NHSN 25th percentile (adult and pediatric units), VAP Index ≥ 95%

36. WHAT ARE ‘HUDDLES’ • The idea of using quick huddles, as opposed to the standard one-hour meeting, arose from a need to speed up the work of improvement teams. Huddles enable teams to have frequent but short briefings so that they can stay informed, review work, make plans, and move ahead rapidly. • Huddles have a number of benefits: • They allow fuller participation of front-line staff and bedside caregivers, who often find it impossible to get away for the conventional hour-long improvement team meetings. • They keep momentum going, as teams are able to meet more frequently. • They enable action cycles to proceed rapidly.

37. DAILY HUDDLES • Huddles are team events for problem solving and updating the plan. Anyone can call for a huddle to • deal with new issues, added complexities, unusual circumstances, or any need to adapt the earlier plan. • Huddles occur frequently throughout the healthcare system and many times throughout the day. Huddles • provide an opportunity to update/clarify the plan through common language, recognition and removal of • assumptions, and reallocation of resources. • Plan for the day • Plan for the stay

38. HAND HYGIENE

39. 91% 86% Combined 89%!

40. Hand Hygiene Data February 1, 2011 – June 10, 2011

41. Hand Hygiene DataFebruary 1, 2011 – June 10, 2011 Compliance for all 18,617 observations February 1 – June 10 = 83%. (up from 77% on April 1st)

42. Hand Hygiene Data February 1, 2011 – June 10, 2011

43. Hand Hygiene Data by Discipline May 2011 versus April 2011

44. HEALTH SYSTEMS GOVERNANCE

45. CEO Dr. McConnell President and COO Dr. Sibert Health Systems Management Council Chair – Dr. McConnell Practice Council Chair – Elected Executive Committee Chair – Dr. McConnell Quality Council Chair – Dr. Sibert Medical Executive Committee Chair – Dr. Howerton Risk Management Chair – Dr. Howerton

46. RISK MANAGEMENT

47. Claims • The Claims section of Risk and Insurance Management handles all employee, patient and visitor claims of injury, malpractice and compensation. • Among others, please contact us with concerns regarding: • Auto or Property Loss (file a report with Security)Malpractice and General Liability InsurancePatient, Employee or Visitor OccurrencesWorkers' Compensation (ADA, FMLA, Transitional Duty) Patient/Attorney Contacts

48. Occurrence Reporting • Occurrence Reporting   Employees are required to report ALL incidents of property damage, occupationally related illness, or injury to patients, personnel, and visitors to their supervisor using the Occurrence Reporting methods available below. The Medical Center aims for a blameless culture so that employees feel comfortable reporting occurrences without fear of punishment or retaliation. Click on the buttons below to complete the occurrence reporting process: •   As a general rule, if you need to report patient and visitor occurrences, you can always call Risk Management at 3-2320 or the Emergency Communications Center at 6-3305.

49. Documentation in Medical RecordsQuick Tips for Documentation • Documentation should demonstrate that appropriate care has been provided and the standard of care was met. In the event of a lawsuit, the medical record may form basis for the plaintiff's case or the nurse's, physician's, or facility's defense. Strong, proper documentation is an effective defense • . Never Document in the Medical Record • Risk Management notified • Occurrence Report completed • Blame • Speculation • Never obliterate an entry with white out or other means • Always Document in the Medical Record • Patient event, adverse outcome • Instances of patient non-compliance • Date and Time every entry • Write legibly, including your name • Clinically significant information without evidence of emoting

50. How should I document unusual occurrences and legal information in the Medical Records? • Document medical complications, mishaps, or unusual occurrences in the records.Use terms that reasonably reflect what happened and do not misrepresent the facts.Omit from the records all risk prevention activity.Omit from the records actions which have legal implications but have no value to patient care.Legal threats and complaints about the quality of care may be briefly documented in the patient records in a judgmentally neutral manner.   • Example During a minor bedside surgical procedure, substantial bleeding was encountered. The problem was controlled, but the patient lost a large amount of blood, became hypotensive, and required administration of 4 units of whole blood. How would you document this event?   "Substantial blood loss. Hypotensive. Given 4 units whole blood."