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Archive for the ‘Quality improvement’ Category

I’ve learned from watching our nurses over the years that nursing is a profession where a significant amount of personal effort is given in terms of skill, dedication, time, emotions, education, and care.

But seldom are nurses recognized for their important work.

There is one great form of recognition, though. Each year the nursing profession in Colorado honors its own by presenting the Nightingale Award for Excellence in Human Caring to the six top registered nurses in the state.

Florence Nightingale, circa 1858.

The award was founded in 1985 by the University of Colorado to recognize registered nurses whose performances echo the quality and dedication of Florence Nightingale. The award, now presented by the Colorado Nurses Association, is designed to honor nurses who demonstrate the uppermost levels of leadership, advocacy and innovation.

Florence Nightingale was the daughter of a wealthy British family who entered the nursing field in 1845. She did this despite her family’s strong objections.

Today, we can gaze back and say we’re fortunate to have had such a hardy, giving person, with such a pioneering spirit, in the medical field. She helped put the nursing profession on track to become what it is today. Thanks to her efforts and insights, hospital sanitation methods were reformed and greatly improved.

Poudre Valley Health System registered nurses have been well-represented at the winners’ podium for the statewide Nightingale Award. We also have had many finalists represented on the statewide level.

Our nurses who received the statewide honor in previous years were Jo zumBrunnen, Maureen Fields, Laura Lambird, Nancy Mershon, and Susan Markley Miller.

Their work assignments range from being a nursing director (Jo) and operating room nurse (Laura) to an oncology nurse (Maureen), gastronenterology nurse (Nancy) and cardiac specialist nurse (Susan).

Nightingale honorees are selected by a thorough grassroots process.

Nominations are developed by the colleagues, patients and family or friends of nurses. Nominations are sent to one of the appropriate six regional nurse organizations throughout the state. The nominations consist of essays about the nurse and letters of recommendation, and are reviewed on the regional level.

Each region hosts an awards ceremony where regional winners are nominated to compete for the six statewide awards. Our regional ceremony is held by the Centennial Area Health Education Center, which covers 10 counties in northeastern Colorado. The CAHEC also recognizes licensed practical nurses who are nominated through a similar process. However, LPNs don’t compete in the statewide Nightingale competition.

The CAHEC ceremony will be March 9 in Loveland, while the statewide ceremony will be May 19 in Denver.

This year we have 10 registered nurses nominated in the regional competition for becoming a finalist for the Nightingale honor. Here’s information on each:

  • Tamara Bockman, charge nurse in the Medical Center of the Rockies cardiac unit, was nominated for her team work, caring and ability to motivate others.
  • Mona Brower, an emergency room nurse at Poudre Valley Hospital, was recognized by colleagues for the way she provides comfort, compassion and stability for her patients.
  • Jennifer Ellis, who works in the PVH resource pool, was nominated for her outstanding care of patients and their families. (A note of explanation: When a nurse works in the resource pool, that means she or he may work in a variety of nursing departments during various shifts rather than being assigned to only one department.)
  • Another resource pool nurse, Tonya Gilmore, is known for the kindness and compassion that she demonstrates to MCR patients.
  • A PVH operating room nurse, Barbara Hardes, is a nurse educator who diligently pursues excellence not only in patient care but also in helping colleagues improve their skills.
  • Sue Larsen has held many patient-care positions during her 36 years in the profession. Recently, she has been a clinical quality specialist for our women and family services and is a strong advocate of quality care.
  • Another long-time nurse, Cheryl Milner, works in PVH’s surgical services and is highly respected for her grace and commitment to patients and improving health care.
  • Alene Nitzky, a PVH outpatient oncology nurse, is known for her passion for writing and giving presentations on health topics, particularly cancer, for the public. Alene also runs ultramarathons (100+ miles) to raise funds for our campaign to build a regional cancer center.
  • Susan Webster, a nurse in our health system for 24 years, has been a leader in improving emergency services for the survivors of sexual assault. Susan championed an effort to start the Sexual Assault Nurse Examiner program within PVHS.
  • Karen Wikholm, an extremely talented nurse who works in general surgery for Poudre Valley Medical Group.

Each nurse is known for specific personal qualities and professional commitments. But that is only part of the story. Each is highly educated. Each has had extreme success in caring for patients.

And each is the type of nurse who provides the high-quality care, compassion, dedication, advocacy, and innovation that any person with a healthcare need would want.

I wish each of the nine nurses the best of luck in the Nightingale competition. Each one is a Florence Nightingale in her own right!

Rulon

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One of the greatest opportunities of being the president and CEO of Poudre Valley Health System is that I often receive the most sincere thank-you cards you can imagine.

I know that George Hayes, FACHE, president and CEO of the Medical Center of the Rockies, and Kevin Unger, FACHE, president and CEO of Poudre Valley Hospital, both receive a huge number as well.

However, George and the staff at MCR received one recently that was truly unique.

This is a YouTube video thank you from Don Koralewski and his family to thank the physicians, nurses and staff at MCR for their great care.

Honestly…how cool is this?

Make sure you watch until the end…the kids are adorable!

Thank you to the staff members who took care of Don and his family. I know all of our patients throughout the health system receive this same level of care. This makes me so proud!

Thanks all…and thanks for taking the time to send this, Don!

Rulon

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After long and hard consideration last year, PVHS made the decision to require mandatory flu vaccinations for PVHS employees. 

There was as much discussion on the topic as any that I have posted on my blog.  Many sincere, well-meaning people disagreed with the decision, and I appreciate the candor and willingness of employees who disagree to openly share their opinions.

With the flu season rapidly approaching, I was intrigued to see this communication from the American Hospital Association: AHA Endorses Patient Safety Policies Requiring Influenza Vaccination of Health Care Workers.

While this policy statement by the AHA confirms the decision made by PVHS well ahead of the rest of the industry, I know the topic remains a concern for many.

The PVHS policy in 2011-2012 will not change from last year. 

However, I do believe that it is important to note what others in the industry are doing, and to point out that, whether you agree or disagree, our only intent in creating this policy is to improve patient safety.

Rulon

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Recently I was at a meeting and learned what the staff members at our new Caribou office (home to the Poudre Valley Health System Center for Performance Excellence, the best Baldrige consultants in the country!) … were doing for lunch.  Very cool.

Salad Garden at Caribou Office

They have a garden growing outside of the office.  At lunch or when they need a snack, they have the ready fixings for a healthy alternative.  Thanks to the folks at that office for taking a lead in making a difference in their health!

Salad table for the picking! :)

 
So next time you think of a healthy alternative for lunch take a tip from the people at Caribou…and grow your own.  What a good idea! Great job!
 
Rulon

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In moving forward to implement healthcare reform, the federal government has passed significant policy changes to impact how the industry will work in the future.  Central to this is the provision of “accountable care.” 

Whether or not you agree with the new legislation, it is hard to argue against the concept of “accountable care.” 

Generally, the term means that healthcare providers will need to find better ways in the future to integrate the care provided by hospitals, physicians, rehabilitation hospitals, pharmacies and every different type of healthcare provider. 

In the past, the different parts of the industry have not communicated and shared data as well as we could have. Working together to keep people healthy–as opposed to just fixing them when they are sick–is a good thing, and a positive outcome of the push for healthcare reform.

However, there is reason to believe that, as the process goes forward, governmental mandates will be given by many who don’t understand the industry and have only a limited background, if any, in actually making health care work. 

As a result, the process of providing accountable care has been translated as organizations offering care through so-called “Accountable Care Organizations.” 

But, by defining and creating ACOs,  the government has created a system so complex and so far removed from how health care is actually provided that a step backward is taken in the process. 

A few weeks ago the details of how ACOs would be organized was published, this to the general shock of those in the industry.  This feeling can be seen in a letter written on behalf of the organizations used to test the concept of ACOs. 

The summary of the program, as described in this letter, represents my thoughts better than I could have said it myself.  The letter signers represent some of the most high-quality organizations across the country, and their concerns should be a focal point of creating the process in the future.

I’ve linked to their letter here so you will be able to read it. 

I am hopeful the government will listen and avoid creating yet one more bureacratic nightmare in American healthcare.  Such an increase in complexity will result in higher costs and reduced access, just as has happened every other time the industry has had to increase complexity and regulation.

Rulon

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Health care is changing, both in what our patients expect and how other organizations, including the federal government, expect us to provide care.

Poudre Valley Health System’s mission is to provide world-class health care, so we’re always looking at how to best do that. As a Malcolm Baldrige National Quality Award recipient, we’ve also demonstrated our commitment to continual improvement.

PVHS leadership recently spent two days at its spring retreat learning new ways we can improve our organization and, in turn, the care we provide our patients and community.

It’s no small task. In the last two years PVHS has grown significantly, adding a thousand new employees and strengthening our partnerships with numerous doctors and medical clinics in northern Colorado. The result is the largest locally-owned network of care in the region and the ability to serve our patients and community in ways we couldn’t just a few years ago.

That growth has also resulted in opportunities for improvement, which was the topic of the leadership retreat and is what we’re focusing on going forward. Here are some areas we discussed: 

  • How can we improve the experience for every patient
  • How can we make our standard as the Best Place to Work in Healthcare even better?
  • Why do we do things a certain way, and how do we do them better?

These are some of the questions we’ll keep asking. As always, if you have ideas for improvements we can make, please share them here.

Rulon

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Several years ago we asked our customers what they expected most when they came to a PVHS facility.  They told us three things:

  1. Quality service
  2. Prompt service
  3. Friendly service

With this information we gave our Customer Service Steering Committee the charge to come up with a way to make this memorable for our employees.  So, in a moment a brilliance, the committee devised three penguins to represent the service our customers expected.  And, they named the penguins so as to remind us the areas of service required by our customers.  The names are:

  • Tip Top (quality)
  • Flash (prompt service)
  • Amigo (friendly service)
Tip Top, Flash and Amigo

Tip Top, Flash and Amigo, PVHS Customer Services icons!

Today, in order to recognize units which excel in providing customer service, they become a “Penguin Partner” and receive the statue of the penguins to recognize their outstanding effort.

MCR OR Customer Service Champions

No telling what they will do to the penguins after they receive them.

Holiday Cheer Penguins in PVH ER

Some departments even take their penguins on vacation!

MCR Cardiac Unit taking their penguins bowling and to the beach!

Congratulations to all the departments who work so hard to make customer service a top priority, and making PVHS such a fun place to work.

Rulon

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I wanted to point out some recent standards developed by The Joint Commission which give organizations the opportunity to incrementally improve their flu vaccination rate until they meet the highest standards of participation. The Joint Commission is an independent, nonprofit organization that accredits and certifies more than 18,000 healthcare organizations and programs in the U.S.

Among the proposed requirements are those for vaccine programs ambulatory care facilities, such as clinics,  and flu vaccine programs at hospitals.

Last year, 95.4 percent of PVHS staff received the flu vaccination. As I’ve written before, that bodes well for the safety of our patients, which in health care is our top priority.

I honestly believe that the people in our organization who opposed flu vaccination last year did so because they are good, honorable, reasonable people who disagreed with our decision. I also don’t think that there were any who were simply trying to make things more difficult. It is reasonable to assume, however, that we are heading to a point were one day soon, all healthcare workers in the United States will be required to have flu vaccinations if they want to stay in health care.

Rulon

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In an article several years ago, the New England Journal of Medicine pointed out that quality outcomes in health care are directly related to the number of procedures done. So, as you might guess, a hospital which does 1,000 procedures has higher quality outcomes (generally) than a hospital which only does 100 of those same procedures per year.

Given that background, I thought you might find some recently published data from the Colorado Hospital Association meaningful. The CHA is an industry leader in gathering and publishing utilization data such as this. I predict that the industry will come to them in the near future to learn how to do this stuff.

Recently CHA published data (through third quarter 2010) about various volume rates at different Colorado hospitals. I thought you might find some of this information interesting. Here is a list of the three heart-related volume measures they published:

Heart Surgery:

HOSPITAL Number of Surgeries
EXEMPLA-ST. JOSEPHS 255
MEMORIAL-COLO SPRINGS 241
THE CHILDRENS HOSP 204
MED CTR OF THE ROCKIES 197
CENTURA-PENROSE HOSPITAL 190
UNIV OF COLO 173
CENTURA-ST. ANTHONY CEN 131
CENTURA-PORTER 127
ST. MARY-GRAND JUNCTION 114
MED CTR OF AURORA-SOUTH 106
PARKVIEW EPISCOPAL 101
SWEDISH MED CTR 97
EXEMPLA-LUTHERAN MED CTR 96
BOULDER COMMUNITY 84
NORTH COLO MED CTR 82
P/SL 68
SKY RIDGE MEDICAL CENTER 47
LONGMONT UNITED 37
ROSE MEDICAL CTR 22
TOTAL 2372

As you can see, Medical Center of the Rockies is the third-busiest heart surgery hospital for adult heart surgery in the state. That would explain a lot about why MCR outcomes are so good as well.

“Cardiac procedures: (Sometimes when a physician does a cardiac catheterization they just look around to see what they can find. These diagnostic procedures are most often done as an outpatient and include diagnostic catheterizations to look for blockage in a heart artery and heart valve and rhythm evaluations. Pacemaker battery changes are also done as an outpatient. Interventional procedures are more invasive and usually involve a hospital stay. This includes things like stents, new pacemaker, and internal defibrillators.)

The data listed below reflects the total number of cases performed in MCR’s Cardiac Cath Lab during the first nine months of 2010 at MCR.

The same method was used to pull comparative data from the Colorado Hospital Association database.”

HOSPITAL OP cases IP cases Total cases
MED CTR OF THE ROCKIES 956 814 1770
MEMORIAL-COLO SPRINGS 531 1196 1727
EXEMPLA-ST. JOSEPHS 763 674 1437
CENTURA-ST. ANTHONY CEN 816 496 1312
MED CTR OF AURORA-SOUTH 508 755 1263
SWEDISH MED CTR 578 474 1052
EXEMPLA-LUTHERAN MED CTR 542 483 1025

Because there are so many hospitals in the state which do interventions, I only listed those who had done more than a thousand interventions through the first nine months of 2010. As you can see, Medical Center of the Rockies has done more cardiac interventions than any other facility in the state, which speaks volumes (no pun intended) about the quality and the trust a patient can have in the facility.

Finally, I thought I would list the electrophysiology cases done at Colorado hospitals through nine months in 2010. Here is the list for 2010 (first nine months):

HOSPITAL OP cases IP cases Total cases
UNIV OF COLO 127 150 277
MED CTR OF AURORA-SOUTH 142 85 227
EXEMPLA-ST. JOSEPHS 130 45 175
MED CTR OF THE ROCKIES 95 66 161
SWEDISH MED CTR 128 24 152
CENTURA-ST. ANTHONY CEN 107 15 122
MEMORIAL-COLO SPRINGS 49 58 107
EXEMPLA-LUTHERAN MED CTR 59 17 76
CENTURA-PENROSE HOSPITAL 2 74 76
THE CHILDRENS HOSP 71 4 75
NORTH COLO MED CTR 35 25 60
ST. MARY-GRAND JUNCTION 41 12 53
DENVER HEALTH MED CTR 20 21 41
BOULDER COMMUNITY 1 21 22
P/SL 11 2 13
PARKVIEW EPISCOPAL 6 7 13
CENTURA-PORTER 4 8 12
CENTURA-ST. MARY CORWIN 0 3 3
ROSE MEDICAL CTR 2 0 2

As healthcare reform makes a bigger and bigger impact, these kinds of data will be more and more available. Programs which can’t do enough procedures to ensure quality and keep costs down will simply no longer be authorized. The prudent patient will make sure to go to the programs which have the most experience, and where it is right to expect they will get better outcomes.

Rulon

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If you haven’t taken my advice from yesterday and gone to the Poudre Valley Health System Quality Festival, you’re missing out on seeing first-hand the numerous ways PVHS staff and physicians are working everyday to improve patient care.

It wraps up at Medical Center of the Rockies in Loveland today at 3 p.m., but you still have a chance to visit the festival at Poudre Valley Hospital in Fort Collins on Thursday and Friday:

  • Thursday, April 7: Poudre Valley Hospital (map) Cafe A, Fort Collins, 7 a.m. to 7 p.m.
  • Friday, April 8: Poudre Valley Hospital (map) Cafe A, Fort Collins, 7 a.m. to 3 p.m.

In the meantime, check out a photo gallery of the event so far.

Rulon

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