The Healthcare Experience

Daily perspectives of a healthcare executive in pursuit of patient safety, the premier healthcare experience, an engaged & healthy workforce and life balance.

Hey, Check out the Manatee

You know your are a newbie in Florida when...

So last night I was with a couple of friends who do live in Florida. They would like to remain unnamed...you'll understand why in a moment.

We went by the Caloosahatchee River near the Cape Coral Bridge. They pointed out an otter swimming toward us. Then quickly realized it was a manatee. I could not make it out but have been told by Dr. Amy Barash my Optometrist and friend, that glasses were not too far in my distant (no pun intended) future. Anyway, they let me know the manatee's head and eyes were showing. They said "here boy, here boy," They shared how cute and friendly manatees were with people. As it got closer I said, it looks like a coconut. I was quickly shutdown as they insisted it was not a coconut. It got closer and again I stated, it does look like a floating coconut...(long awkward pause)...I heard, "shut up...it's a coconut!"

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Good Morning CCH: How Do We Compare Nationally?

Just shared with our team:

Good morning to all CCH employees, volunteers, auxilians and physicians:

Last week, I had the opportunity to meet with the Pharmacy team. Jeff Kennedy provided great perspective as he asked about our local market share compared to our national performance. We have a strong local market share and we see a lot of patients….but, how are we performing on a national level? Some of the information we all need to review includes our associate engagement surveys and our Press Ganey and HCAHPS scores. By reviewing these reports with your managers or directors, we can prioritize what is working well and what areas we need to focus on for improvement.

With your help, Cape Coral Hospital can be the premier community hospital. There are many healthcare providers and healthcare choices in our area. We want people from Cape Coral and the surrounding communities to want to come to Cape Coral Hospital. If our community needs care, we want to be their first choice. It starts and ends with us. We need to love what we do for our patients. That's the experience our patients expect from us.

Over the past few weeks, I have had a chance to meet many of you and over the coming months I will meet many more. Beginning in September, I will be introducing In your Shoes.

This program gives me the opportunity to work right along side of you, as a member of your team, on your shift. Obviously, I will need to stay clear of performing duties where my qualifications are far from adequate, however, I will certainly help in any way possible.

Please let me know if you are interested in having me work with you and your department.

 

In Your Shoes will help me gain a better perspective and appreciation of your efforts and contributions towards our mission.

Enjoy your week.

 

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Putting the Stake in the Ground

This afternoon, our leadership team met to discuss this past month's performance.  Actually, it was my first formal meeting with the leadership team.  They had such great passion and expressed their interest in ensuring "our story" is told.

We talked about "stakes in the ground" to measure what reflected our performance as an organization.  CCCh will serve as the premier community hospital.  What does this mean? How is it measured?

So here it is at first blush...

 - CCH will be at or above the 95% percentile for associate engagement since our patient experience and care coordination starts with our associates, volunteers and physicians.

- Our patient experience scores / HCAHPS will be at or above  the 90th percentile.

- Our core measures will be at 100 percentile.

From there, the money will come and the sustainable operating margins will be met or exceeded.  Focusing on engagement, experience, safety and quallity will drive what's needed to serve as a high reliability organization.

First step...we will look at ourselves, the leadership team, to ensure we are holding each other accountable with our tactics and strategies supporting the "Stakes" listed above.

Let me know if we missed anything. Enjoy your weekend.

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Pay Me More to Provide Quality Care

As a healthcare executive, quality of care and safety are top of mind.  It's expected patients receive quality care when service is provided.  Granted, if you go to your physician for one or two issues and start to ask to review 10 issues, he/she may need to schedule a follow-up visit and yes, there would be an additional visit fee.  

At Southwest Airlines, they anticipate if you fly you will need to travel with 1-2 bags and therefore, include in the fee (aka "Bags Fly Free").  It rubs me the wriong way to have an added baggage fee instead of including in the initial plane fare.

There are times when healthcare providers ask to receive additional funding to provide improved quality care.  That's curious to me...what level of quality should be included and what level of quality merits additional pay?

I look forward to your thoughts.

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Pride Starts with Engagement

My note to our team today:

Good morning Cape Coral Hospital!

We have an amazing community of associates, physicians, volunteers and auxillians and I thank each of you for shaping the culture and patient experience each and every day.

Thank you for sharing your stories with me - please keep them coming. Here is one story I received:

"In response to what I enjoy the most at Cape Coral Hospital...it’s the people that make up Cape Coral Hospital. After 16 years at LMHS, I've concluded, the Cape is unique. People here are happier, friendly and patient oriented. I am also very pleased to work in healthcare in the community in which I live."

This is our hospital and each one of you are empowered to create the positive experience for our patients…and for each other. Patient experience starts with us and we need to continue to support each other to stay engaged and provide our patients with the best experience possible.

One way to stay energized is to focus on our own health needs. We take great care of our patients and need to do the same for ourselves. Taking just a few minutes a day can help.


On Wednesday, August 24th at 12:05, please join me, Wendy Piascik, V.P. of Patient Care Services and Dr. Sal Lacagnina, V.P. of Health and Wellness for a 10 minute indoor health walk.

We will meet in the main front lobby of Cape Coral Hospital at 12:05 p.m.


Let me know what keeps you engaged at Cape Coral Hospital. I am interested in hearing from you, so please continue to send me your ideas of how we can continue to improve our patient experience and our team's engagement.

Hope to see you all soon.

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Safety Check-In Kickoff

This morning, we started our Safety Check-in at the hospital. The purpose is to maintain situational awareness of issues affecting safety & quality of patient care and to give direction about priority and responsibility for problem resolution.  The check-in will typically last under 15 minutes and provides a great opportunity to re-enforce Safety as our #1 core value.

Let me know some of the things you do in your organization to focus on safety first.

Wendy - great job leading our Check-in kickoff this morning.

 

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Who is First for In your Shoes?

It's Friday and it was a busy few days getting to meet so many people throughout the health system.  It took me while to find a few a few areas who asked me to visit their department (Pain Clinic and Rehab).  The welcome was incredible this week.

To Cape Coral Hospital associates, volunteers and physicians...over time, I would like to do "In your shoes' where I will work in various roles for a few hours to better understand your day to day activities.  Let me know if you woud like to be first.

Enjoy your weekend.

 

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First Day on the New Job

It was such an enjoyable day with my new colleagues from CCH and LMHS.  Prior to heading to the hospital, I met Bill who started talking to me in the Fitness & Wellness Center locker room. After putting on a suit, Bill asked, "are you a doctor or a lawyer - not too many people wear suits here in Cape Coral." Then, off to the hospital I went...actually just next door.

There was a very warm reception this morning followed by a great tour by Wendy. Thank you to all the CCH and LMHS associates, physicians and volunteers for your warm welcome.

What a memorable first day.

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Lasting First Impression

We all know first impressions are lasting. Well Friday night marked my first gathering with my new Lee Memorial Health System colleagues. I certainly know protocol and was planning on wearing a tie and jacket for my first meeting. It was strongly suggested to me to skip the tie and even the jacket was unnecessary here in Florida. I forged ahead with the jacket and no tie.

Everyone started to meet indoors and then made their way outside for pre-dinner conversation. That's when my first impression became a lasting one...sweat slowly started beading on my face and it was suggested (by a few) to head into the A/C as the Florida weather takes some getting used to at first. With my suit still on (granted no tie) I stayed outdoors. It was clear that my comfort in the Florida humidity was at a low point...Larry, my new boss welcomed me and suggested I head inside and lose the jacket.  As I did, I noticed that my shirt was no longer useable as for the evening. It was drenched. Fortunately, I was staying over at the hotel and had another shirt.

The remainder of the evening was energizing as we understand the challenging times and bright future ahead. The time together certainly made a lasting first impression.

 

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Project RED: Decreasing Re-Admissions

A few weeks ago, Alicia Caramenico referenced just 5% of patients were responsible for 50% of the healthcare expenses.

This is probably not a complete surprise to a lot of people however it is a significant concern and burden on our nation's healthcare system.  So what are systems doing to help impact the cost associated with caring for patients?  One focus has been the reduction of readmissions.  According to the Agency for Research and Quality, heart disease, cancer, mantal disorders and pulmonary conditions make-up 31% of the healthcare expenses.  Cancer and heart disease for the first and second most expensive treatments on a per person basis. 

An example of how we addressed this in our organization was through participating in the AHRQ Re-Engineered Discharge (RED) Program.  The Project RED interventions redesigns the workflow process and improves patient safety by implementing specific processes and action steps to improve the discharge process and decrease hospital admissions.  The three key elements of this program include the discharge advocate, the after-hospital care plan and a follow-up phone call from the clinical pharmacist to the patient to review medications. 

Our health system focused on patients with Congestive Heart Failure (CHF).  Prior to Project RED pilot, we had 19% re-admissions for our CHF patiens. During the pilot, we dropped to zero re-admissions.  Needless to say, we rolled this out permanently. 

Too many times, organizations will try to make quick, short term changes to reduce costs.  That is just not sustainable.  Project RED reduced our costs for delivering care by improving the way we managed and delivered safe care. 

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Office Etiquette - Can I have Your Desk?

I have been gone for just a few days from my recent post at St. Joseph Medical Center. I just have to laugh at what happens when people leave.  It's unfortunate however true in many cases - and this is nationwide...  In one organization, after the departure of one of the executives, one department asked if they could use "his old office for storage."  We had to refuse - just seemed like bad karma.

In another case, the executive leaving had a very kind office neighbor.  That kind neighbor approached me prior to the person leaving and asked, "I know it is awkward, but is their any way I could move into her office when she leaves?"

And that holds true with me...the day I announced my planned departure, one of our executives asked for my credenza.  At first it was a hint like, "I really would like to get a credenza link that one.' Within 8 hours, there was a direct request for it.  And, the day of my departure, the person asked me to move my (well, no longer mine) credenza into their office. The person finally refused feeling it was poor etiquette to make me move my credenza on my last day.

You do have to laugh the things that happen in our workplace.  We work hard and things won't necessaryily get easier...you have to find the humor.  So I ask, what is the appropriate etiquette for taking over another person's office?

Enjoy your weekend.

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Morning Pep Talk

This morning started with am early morning swim with the Masters' group (a.k.a. those closer to middle age than youth).  It has been a couple of weeks since I joined the group so I moved into a slower lane - the lanes typically line up based on the slower o faster swimmers.  One could test this by having people swim over you if you are too slow.  No one enjoys moving down a lane but we know the importace of staying active...and the humility of having others swim over us!

When we were done, I heard a couple of guys discussing the Masters' swim in the locker room. Skip, a fellow swimmer, is always up[beat and encouraging no matter what your level.  He was talking to someone who swims but not in the group.  Skip asked why he doesn't join us and the other guy said that he is too competitive and if he can't be the best he won't participate.  Skip, realing that most of us has non-profesional swimming careers stated, "how's that working for you in the business world?"  I had to laugh...Skip proceeded to push further, telling the guy, "you may not always be the best, howeve it's the camaraderie we have pushing each other to be better and stay active.  In the workplace, you should expect the same.  You may not always be the smartest but certainly as a group you are much stronger." Skip looked over and gave me a smile as you could see he enjoyed weaving the swimming story into the business world.

Thanks for the early morning pep talk, Skip.

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Window of Paradise

My father, Steve Kashman, refers to the time between ending one job and starting another as the "window of paradise".  You can sleep in, relax all you want and just enjoy the time.  There are only a few times through your career where you may even get this time. Well, today is the first is my first day of "paradise" as he would say.  I have three weeks until I start my new role.  During that time, we have a family wedding and a move planned...certainly not too much rest planned.  I thought I would sleep in today until I heard from Dr. Mark who recommended a 5a wake-up for a bike and run.

My schedule stayed busy when I returned with my daughters requesting a "tackle Daddy" match where they promptly tackled me to the ground until I gave up and begged for mercy.  Sometimes, that's what the work day feels like so I appreciate the practice simulation at home.

The remainder of the day filled with errands and lots of family time (that does feel like paradise).

What would you do if you had a brief "window of paradise"?

 

 

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We're Moving...

As many of you know I have accepted a new position bringing my family closer to our extended family. Certainly, change can be exciting and bittersweet. I am joining an exceptional healthcare system. I will also miss my colleagues, friends and the communities we serve in Kansas City.

 
Yes, we are moving. And with moves, comes life out of boxes...
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Lessons on What Can be Flushed...

Never a dull moment in healthcare. This note just received (no, I was not the one who flushed these cloths)...
Lessons on What Can be Flushed...

Lessons on What Can be Flushed...
PLEASE DO NOT FLUSH THESE CLOTHS IN THE TOILET!!!!
THANK YOU

...

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Until Next Time

The past three plus years have flown by for me and my family. I have really enjoyed serving St. Joseph Medical Center and Carondelet Health. Last week, Bob Bub, our Pharmacy Manager asked what I was most proud of since my arrival. There are many things we are doing really well so it was difficult to just pick one. What stood out was our safety journey. When I arrived in May 2008, we provided great care and we provided safe care. We did not have enough people in every area talking about safety and how we can continue to make our care even safer and better. We started safety huddles, put more focus on safety in our clinical meetings, discussed at staff meetings, increased rounding, enhanced the RCA (root cause analysis) review and the list goes on.

Today, everywhere you go in the hospital, you can speak to your colleagues - associates, volunteers and physicians and they will let you know how they help contribute to safer care for our patients.

Thank you for the opportunity to serve as your Chief Executive. Over the past few years, you have made a tremendous impact on my life. Please stay in touch. Jane Hoyland will have my updated contact information. Jane shared this reflection with me and I read it at our last St. Joseph Medical Center Board meeting:

Some people come into our lives and quickly go.
Some people move our souls to dance.
They awaken us to the understanding with the passing whisper of their wisdom.
Some people make the sky more beautiful to gaze upon. They stay in our lives for a while, leave footprints on our hearts, and we are never, ever the same.


It's a small world out there and even smaller in healthcare. Our future is about collaboration as we improve the health of our patients and communities. I look forward to meeting up with you again. Until next time.

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Fun at Work...

I've heard the comments..."there should be no fun in the workplace" and "they call it job for a reason." However, since many of us spend 30%+ of our time at work and another 20-30% of our time sleeping, it is good to find those fun times at work...What's going on in your workplace to make it more enjoyable for you and your colleagues?

I was...

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Thank you Auxiliary Board Officers

It's always a celebration with our wonderful Auxiliary. Today, we enjoyed the installation of our new Auxiliary President and Board.
Chef - you and your team put a great lunch spread together..."light lunch" it was not!
Thank you to Jeri Grimes, Director and Mary Ann Nagy, Past-President, for your remarkable leadership. I appreciate the work of you...

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You Say You Want a Revolution...

You Say You Want a Revolution...
The other day we discussed "Change" during one of our leadership meetings. The more I thought about it, we all know change happens all the time. We may not like some of the change but most of us understand it is inevitable (Although I must say I still miss those aluminum foil wrapped Ho-Hos from the 70s). We just need to be clear why we want to...

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Do You See What I See?

This morning, I toured our facilities with Larry Rubin (Facilities Management), NuNu Girma (Environmental Services-EVS) and Andrew Stonestreet (EVS). They provided the tour through their eyes. It was great getting their perspective. As Andrew said, it all starts with the first impression through our "Front Doors"...and there are many:
- Our...

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