2014 Management Conference
YNHH managers kick off fiscal year 2014
YNHH managers reflected on the hospital's 2013 performance and looked ahead to plans for 2014 at the Omni Hotel on October 1, the first day of the new fiscal year.
October 1 marked the beginning of a new fiscal year and nearly 700 YNHH managers gathered at the Omni Hotel to look back on the highlights of fiscal year 2013 and look ahead to the challenges, hopes and expectations for the upcoming year. Joining them were leaders from the medical staff and Yale School of Medicine.
"This is a great opportunity to get everyone together in the same room and look at the year that just passed and the year ahead," said Richard D'Aquila, YNHH president and COO. "We had a lot to celebrate this year, despite some big challenges. Midway through the year we were thrown some serious curveballs; 2013 was a year of grace and focus for YNHH."
Managers enjoyed the 2013 Year in Review video which showed activities and accomplishments. The video showcased highlights of the year related to service to the community, clinical achievements, new leadership, expansion of the hospital and growth of the health system, as well as employer of choice and provider of choice milestones, dealing with the Joint Commission extension survey, Hurricane Sandy in October, a historic blizzard in February, and state and federal cutbacks.
"Our performance was nothing short of amazing," said CEO Marna P. Borgstrom. "Yale-New Haven Hospital saw continuous growth and we achieved record performance in every dimension — including ending the year with a 4.2 percent operating margin, a little above our goal of 3 percent — despite the state and federal cutbacks." She added, "Everyone should be very proud of how they rallied in support of great patient care and, at the same time, stayed focused on our value work (better quality, lower costs), without which we never would have produced this impressive performance."
Keynote address on quality and safety by Dr. Richard Shannon
Richard D'Aquila and Marna Borgstrom thanked keynote speaker Dr. Richard Shannon from the University of Pennsylvania Health System after his talk about patient safety and quality of care.
Richard P. Shannon, MD, chairman of Medicine at the University of Pennsylvania Health System, spoke about "Pursuing Excellence: Quality and Safety as the New Currency." He stressed the importance of organizational values and said that values are characteristic of highly reliable organizations. Values in reliable organizations can drive out harm — adverse events, hospital-acquired infections, preventable falls, medical errors — all of which cause added expense, extended hospitalizations and patient deaths.
In his remarks, Dr. Shannon was hard-hitting, at times critical, but genuinely optimistic about U.S. hospitals being able to make great strides in driving harm and waste out of the system. Dr. Shannon described the six levers of waste as harm to patients, overtreatment, defects in care transitions, excess administrative costs and fraud and abuse.
"There are 1,800 quality metrics available today. We are awash in meaningless data and preoccupied with process. We often confuse efforts with success," he said. "What we need is habitual excellence, not episodic excellence."
He called the "consistent elimination of harm and waste" an unassailable goal. It will also result in a hugely positive financial savings as a by-product — reducing the associated healthcare costs that come with adverse events, prolonged hospitalization, avoidable readmissions and, worst of all, patient deaths.
"The good news," said Dr. Shannon, "is that doing the right thing is doing the economically good thing."
Care delivery: Safety and quality at YNHH
10 areas of focus for safety
and quality in 2014 are:
1. Hand hygiene
2. Patient identification
3. Care transitions
4. Catheter-associated bloodstream infections
6. Healthy skin (pressure ulcers)
7. Catheter-associated urinary tract infections
8. Prevention and management of disruptive behavior
9. Use of restraints
10. Surgical site infections
Thomas Balcezak, MD, senior vice president, Safety and Quality, and Daniel Barchi, senior vice president for Information Technology, teamed up to talk about patient care.
"What do patients want?" asked Dr. Balcezak. "It's pretty simple. They want to be healed, they want freedom from injury in the hospital, and they want us to listen to them and include them." Dr. Balcezak believes YNHH is well on its way to giving patients what they want and, in essence, becoming a highly reliable organization. "We have made great strides in continual YNHH regulatory preparedness — which is mostly about safety and quality." He cited YNHH's adverse event tracking and root cause analysis processes in place, as well as the Great Catch program and daily morning safety reports on both campuses. Two new programs for FY14 will include senior operations group rounding on patients and new management and frontline staff training.
"We deliver high-quality, safe patient care," he said. "But our aim is to continue to get better — to aim for zero events of patient harm.
"Our current performance plus our continuous improvement is how we will make the hospital safe for every patient, every time," said Dr. Balcezak. "We strive to be a high reliability organization."
Daniel Barchi, who gave an update on the YNHHS Epic project, stressed that "Epic has been a great tool in bringing us together to help secure and measure the quality and safety of care throughout the system."
Epic provides one master patient database, common order sets and common workflows and has brought four pharmaceutical formularies down to one. It has helped standardize clinical processes, offers computer physician order entry, bedside barcoding and record training. Barchi added that the MyChart feature in Epic is also a great way for patients to take a more active role in their own health — enabling them to be more aware and involved in the safety and quality of their own care.
First and foremost: The Patient Experience
Cynthia Sparer, executive director of YNHCH, and Peter Schulam, MD, chief of Urology, discussed the question, "What do patients and families want?" and shared the vision for Patient Experience at YNHH. To illustrate the vision, they shared videos featuring patients with both positive and negative experiences at YNHH. One featured Kenyatta Clark, a systems associate in the Development Office, and the other featured Michelle Gray and her son Zachary. Gray is a member of the Children's Hospital Family Advisory Council.
Sparer said that the improvements in overall YNHH patient satisfaction scores have been dramatic — going from the 39th percentile in 2008 to 80th percentile in 2012, but noted a dip in scores in 2013, due at least in part to the implementation of Epic and the efforts around integration of the Saint Raphael Campus. "But," she added, "the bar is now higher because every other hospital is getting better and 2014 is an important year to redouble our Patient Experience efforts."
Patient Experience goals for 2014 include an increased focus on the voices of patients and families, a focus on creating a healing environment, a more consistent structure for Patient Experience forums and more physician engagement. Dr. Schulam challenged every manager and every physician leader to find ways to improve the patient experience in their areas — which would translate into higher Press Ganey and HCAHPS patient satisfaction scores.
Clinical program growth with a spotlight on the new musculoskeletal center
YNHH President Richard D'Aquila.
Our vision for integration has always been and still is "One hospital, two campuses, one vision," said President Richard D'Aquila. The initial goal was to balance the inpatient load between both campuses, implement Epic and renovate units and grow volume on the Saint Raphael Campus.
"When our hospitals came together, we made a promise that the Saint Raphael Campus would become something special as we reconfigured both campuses," said D'Aquila. "Now that we are in year two of integration, the clinical service planning is getting more specific and the hospital will be undergoing a lot of change over the next 12 to 24 months."
Major medical/surgical services, emergency care, heart and vascular, neurosciences, cancer care and behavioral health will remain in place on both campuses. High-acuity services will remain at York Street; and there will be more of a focus on specialty services at SRC, such as the musculoskeletal center, low-risk/high-amenity obstetrics, comprehensive geriatric services and several specialized and unique programs.
During Phase I — in early 2014 — elective and orthopedic spine patients will begin to move to a new unit on the Saint Raphael Campus. This will be followed by the Acute Care for the Elderly Unit and other specialized programs. Details of other unit moves and transitions will be finalized once the major services for musculoskeletal, acute Geriatrics and low-risk Obstetrics are solidified on the Saint Raphael Campus.
A number of other enhancements to clinical support services, such as the operating rooms, would occur in tandem with other inpatient unit moves. Also discussed were enhancements to post-acute care services, such as the Grimes Center. The Grimes Center, which D'Aquila called "one of the jewels of the health system," has undergone renovation to better meet the needs of rehabilitation and post-surgery orthopedic patients.
In addition to these clinical investments and moves on the inpatient campuses, during 2014, YNHH expects to continue to grow and reconfigure its ambulatory settings in New Haven and eastern Connecticut "As we look to truly managing the health care of our populations, outpatient settings and primary care sites become increasingly important. They are no longer an afterthought to inpatient services as they were in the past."
D'Aquila and Abe Lopman, senior vice president, Operations, discussed plans for the new musculoskeletal center at the Saint Raphael Campus, with the goal of making the patient experience there similar to the successful team approach at Smilow. To view the musculoskeletal center video, go to the ynhh channel on the YNHH intranet. It's in the patient stories category.
YNHH Inpatient Clinical Services Vi sion Left to right, Rebecca Ciaburri, performance manager in YNHCH Quality and Safety; Cynthia Sparer; and Lucy Lano, RN, assistant patient service manager, Pediatric Transplant Unit, enjoyed a break at the conference.
Strategy for the future
In closing, Borgstrom reflected on the success of the past year and discussed YNHHS's corporate strategy. "We are a very significant health system in the United States, and Yale-New Haven Hospital is the anchor of the health system. But, the successes of the past are no guarantee of success in the future."
She cited the new vision of the health system: "YNHHS enhances the lives of those we serve by providing access to integrated, high-value, patient-centered care in collaboration with others who share our values."
"This is a very important change, as health care moves from volume to value. We cannot be all things to all people, but to provide access to comprehensive services, it is important that we partner with others who share our values," she said.
YNHHS has three corporate strategies to support this vision:
- Continuing to grow and build scale, including clinical service breadth and depth;
- Continuing efforts to enhance value (enhance quality/reduce cost); and
- Enhancing alignment with physicians.
Added D'Aquila, "As we look at the year ahead, I know we will be successful if we continue our focus on four key areas: care delivery, the patient experience, employee engagement and clinical growth. We are one team with a single destination."
From the left, Yollanda London, associate director of business development; Jeannette Hodge, director of Patient Relations, Volunteer and Guest Services; three members of YNHH Patient Family Advisory councils, Kenyatta Clark, Dick Metz and Mary Ellen Pappas; and Sue Kamm, manager of Patient and Family Centered Services, gathered for a group photo.
From the left, Terrance Mallory, manager, Environmental Services, talked with Environmental Services supervisors Mark Midgette and Darrell Wright during a conference break.
Left to right, Rebecca Ciaburri, performance manager in YNHCH Quality and Safety; Cynthia Sparer; and Lucy Lano, RN, assistant patient service manager, Pediatric Transplant Unit, enjoyed a break at the conference.
Peter Herbert (left), MD, YNHH chief of staff, and Robert Alpern, MD, dean of Yale School of Medicine, both spoke at the annual management conference.
Exchanging ideas after the conference were (l-r): John Tarutis, Grimes Center executive director; Kevin Walsh, vice president, Development; Ena Williams, RN, vice president, Patient Services; Abe Lopman; and Thomas Lynch, MD, physician-in-chief, Smilow Cancer Hospital.
Kevin Myatt, senior vice president, Human Resources, said that ongoing leadership development will guide YNHH on the journey to a high reliability organization.
Michael Holmes (left), senior vice president and chief integration officer, chatted with Allen Hsiao, MD, YNHH chief medical information officer.
From left, Bertie Chuong, RN, Ambulatory Surgery nursing director; Susan Maxwell, RN, Women's Services nursing director; Katie Donohue, RN, patient service manager, Maternity; Bob Hills, manager of Compensation; Diane Vorio, RN, vice president, Patient Services; and Francine LoRusso, RN, Heart and Vascular nursing director.