A look at how Operational Process Redesign is changing how we work and is improving the hospital experience
by Cassandra Clark, Project Communications Director
With only 13 months remaining before our anticipated move-in date, Eden Medical Center is intensively planning every aspect of the transition. But moving into a new hospital doesn’t mean taking with us all of our old systems and ways of doing work. Our employees, physicians and hospital leaders are taking a whole new look at our work processes with the goal to better support the hospital’s mission and improve the way we care for patients – now and in the future.
Our Process Redesign experts do more than look at a specific task. They examine the entire process of providing a service to a person. The employees, physicians and managers performing these tasks are the experts who focus on re-designing the process as a whole in order to achieve the greatest possible benefits to the hospital and ultimately for our patients. The goal is to realize dramatic improvements by fundamentally re-thinking how the organization’s work should be done, rather than focusing on just one specific task improvement.
Leading Eden’s Process Redesign effort is Shelly Young, RN, MHA, CNOR. We sat down with Shelly to learn more about the work she’s doing at Eden.
Q. Tell us about you.
I have totally embraced Lean and Six Sigma, what we call Operational Process Redesign, because it provides a way to help groups of people from all areas of the hospital solve their own problems in a way that works for everyone.
During my years as a Registered Nurse in the operating room, people who didn’t understand my job were dictating how to care for patients without consideration of how the work was accomplished, often making the work harder. Hoping to facilitate what I thought should be “dictated,” I went back to school. Then, as a member of administration, I still found physicians or patients unhappy with the admin-driven processes. Now, as a Lean Six Sigma Black Belt, I can help develop effective, helpful solutions by coaching teams of people who do the work and know how it will fit into their existing processes.
Q. What do you want people to know about Process Redesign?
It works! It really works! Using a scientific approach to solving problems, in a way that brings together representatives from each role in a process, we come up with solutions that would not have been discovered any other way. People with different roles in the hospital sit down and solve problems together.
Q. What do you want from employees?
Participation. I want ALL employees to participate. We need employees at the table because they are the experts at their jobs. The people who do the work are very aware of the things that don’t work for them in their everyday work processes, and they often have great ideas for making it better.
Q. What’s the best lesson you have learned?
The smallest, simplest fixes can make the biggest difference. The simplest solutions will improve a process throughout the entire hospital. It doesn’t have to cost a lot of money or require big staffing changes to make a better process. We just have to organize ourselves to be more efficient to get care to patients in a healthy and safe way and, at the same time, create an ideal work environment for staff and physicians.
Q. What do you want to achieve here at Eden?
I want to help Eden employees understand how to make this difference. We care about our patients, about humanity and the future of health care. If we can create something at Eden that works for us, it can serve as a model that can work anywhere else in the country. We could change health care! It’s so simple. We don’t always have to spend millions of dollars in equipment to manage the process, we just have to listen to the people who do the work and remove everyday obstacles that keep them from getting their jobs done. Simple solutions will help us all be better prepared to move into our new, state-of-the art hospital.
I love what I do. I love making a difference for people I don’t even know. I’m excited to share this awareness that process redesign is not rocket science. Some solutions are very simple, some are huge, but most important, those solution come from a team of people who are involved in the work. It’s what sets Eden Medical Center apart and above.
Stay tuned: We’ll take a closer look at some of the Process Redesign teams in progress and follow their success over the next year.
by George Bischalaney, President & CEO
Every year on this date, May 6, we celebrate the good work of our nurses as part of National Nurses Week, a time set aside to raise awareness of the value of nursing and help educate the public about the role nurses play in meeting the health care needs of the American people.
At Eden Medical Center, we have nearly 700 registered nurses working at our Eden and San Leandro campuses. These amazing people aren’t just faces in a crowd or numbers on a chart. These are men and women who are called to a career of caring for others. In their own lives, they are mothers, fathers, daughters, sons, family caregivers, coaches. Here at Eden Medical Center, they are heroes.
My office is located on the first floor of Eden Medical Center, just across the hallway from the Intensive Care Unit waiting room. Every day I am here, I see families concerned about the well-being of their loved ones. Some are encouraged, some are grieving, some stop to talk about their experience at out hospital. And I never take for granted the fact that every person has entrusted their lives to our caregivers. I take comfort that the men and women who are caring for our patients, in any area of our hospitals, are skilled, compassionate people who want the very best for our patients and families.
So, on this day, I want to take pause and thank our nurses for all they do. Their work is never easy. It is complex, highly detailed, often exhausting, and so critical to the lives around them. They have a sense of purpose and a capacity for caring that drives them to give of themselves every day. What a remarkable calling.
Thank you, to all of our nurses, for all that you do for us.
By Bryan Daylor, Vice President, Ancillary & Support Services, Eden Medical Center
In my previous posts, I described how our “user” team approach to planning the new hospital Those of us who head up different functional areas at Eden worked in teams (consisting of managers, supervisors, staff and physicians) to determine the best way to improve the delivery of patient care in the new hospital by implementing industry best practices.
Our focus all along has been on patient safety and quality of care, efficient patient flow and effective use of skilled resources. This work has been an important opportunity to design a building that supports the process of care and enhances the experience for patients and caregivers. We were challenged with the puzzle of creating work space and flow in a new building, but in the end we feel we have achieved an excellent design for the new hospital.
While the construction teams are busy working on the visible sign of progress, we are planning for what goes inside the new building. Our teams are working with the project engineers and architects and some of the key users on what fills the space that we have so carefully designed: the structures and equipment that will be in each room of the new hospital. This space planning includes reviewing the elevations of casework, cabinets, counter tops and work surfaces to ensure that the work areas and surfaces align with work flow and support functions.
Although we have not selected the final medical equipment, we must plan for the equipment that goes into every room. We are taking inventory of the equipment needed and documenting the space allocation and utility needs (electrical, plumbing, data, cooling and ventilation) required for every piece of equipment in every room. There are more than 8,500 pieces of equipment inventoried for the new hospital that must be accounted for in the room-by-room layouts. Over the past four weeks, the team has worked together to review each floor to ensure the drawings are accurate and inclusive of the specific details required to support the equipment and functionality of the space.
The group is also researching and evaluating technological advancements in every discipline to anticipate changes and ensure that, when the new hospital opens, we will have the most up-to-date equipment for our staff and our patients.
I welcome you comments and questions.
By George Bischalaney, President & CEO
Among my mail is an envelope addressed to the CEO and marked “confidential.” It is handwritten, obviously not from a business partner or one who hopes to be. Someone has taken the time to write and make sure it gets read by me and not screened or redirected. It has my attention.
As I expected, it is a letter from an individual who wants to tell me about the care delivered to a family member. As I begin to read, there is a moment of apprehension. Will this be the grateful letter that praises the care of doctors, nurses and other staff members encountered during the stay? Or is this the letter that expresses concerns and expectations not met? Actually, I look forward to either. An individual in a position to assess our performance has taken the time to tell me about it.
I receive letters several times a week, and they are often the most instructive of a given day’s activity. Patients and their families have much to teach us about what we do and how we do it.
I am still surprised at how often it is the little things that make a difference. We put so much effort into providing the highest quality of care and avoiding mistakes that we often overlook the obvious. Those entrusted to our care need the human touch. A moment of compassion, a word of support, encouragement or just someone to listen can provide a sense of healing equal to many more clinical interactions in a patient’s mind. Letters rarely praise the well-placed IV or express gratitude for the timely administration of medication. What many patients remember are the kind words of the nurse, the cheerfulness of the dietary worker delivering the meal, or the respectful nature of the person who comes to clean the room.
There is much that we can do to improve the health care system in our country. Even as the debate continues, there is much that is working well – and it hasn’t been legislated. It is the commitment of countless individuals to go about their work with an understanding of the impact they can and do have on the people they care for. It is remembering the little things that help a patient through the day or a family member find relief in knowing that the caregivers are more than clinicians completing rounds and performing tasks. We create moments every day that will be remembered forever.
As I open the next letter, regardless of the message, I know it will help me remain connected to our purpose and be a reminder of what health care really needs.
By George Bischalaney, President & CEO, Eden Medical Center
Health care reform is on the agenda, again. The stakes are high, but our President is determined to make some significant changes. As the discussion moves from general to specifics, special interests are staking out their positions. None of the stakeholders—hospitals included—wants to feel the impact or be at a disadvantage.
Amidst the demand for cost reduction and health care coverage for all, there is and must be continued investment in care. Physicians demand it. They expect to be able to practice with state-of-the-art equipment and facilities to produce outcomes that meet national, state and local quality standards. Patients demand it. They want to know that their local hospital has the right number of well-trained staff as well as the latest diagnostic and treatment equipment, and contemporary facilities.
With this backdrop of conflicting needs, Eden Medical Center is about to begin a three-year project that will result in the replacement of the Castro Valley hospital. The project cost is estimated to be $320 million. The current 55-year-old building is anything but contemporary. With few private rooms, small operating rooms and inadequate support space for clinical services, a new hospital is very much needed.
Eden Medical Center has served the community well, but it was not designed for patient comfort and needs, more for staff needs and functionality. While our project may seem ill timed given the uncertainty of hospital reimbursement, we are required to meet California legislated standards for seismic safety in hospitals. And it truly is needed.
We’ll celebrate our long sought goal with a ground-breaking ceremony on July 1st. Then we’ll spend the next three years continuing the investment in the new buildings and equipment, while observing and hoping that decision makers do not enact legislation that essentially penalizes us for the commitment we are making. When we celebrate the grand opening and our new beginning early in 2013, it should be with the same hope and dreams as those who celebrated the first ceremony in 1954.
By Jack Alotto, President & CEO of Eden Medical Center Foundation
My name is Jack Alotto. I am the President & CEO of Eden Medical Center Foundation. I’ve been raising money for non-profit organizations for more than 20 years in health care as well as the arts and social services. At Seton Medical Center Foundation in Daly City, we raised more than $1 million and increased Seton’s employee giving campaign by 600% in my first year.
I also started the first planned giving program for the City Library of Santa Clara, California. We even created a used bookstore and café called Friends of the Library—we made great cappuccinos!
For the past two years now, I’ve been steering the ship at Eden Foundation, and we are fortunate to have a very active board with 17 members, including Lawrence Dickinson, M.D., one of the top neurosurgeons in the East Bay and our board chairman.
All the money we raise helps ensure that patients and the community we care for have the most technologically advanced, highest quality care available. We pay for medical equipment, clinical training and continuing education for our staff, plus health education seminars for our community, and health care for our uninsured residents.
I’m proud to say that in the last two years we’ve raised more than $4,000,000, while keeping our costs surprisingly low. We owe our highest admiration and heartfelt gratitude to you, our patients and members of the community for your generous donations and participation in our special events. And a special thank you to our physicians and employees who give the Foundation tremendous support.
Take a look at the prolific list of equipment and community service programs your donations paid for last year. Donor Gifts Have Gone a Long Way in 2008…
With contributions from individuals, physicians and staff, corporations and foundations, Eden Medical Center Foundation has made the following gifts to Eden Medical Center:
Tools to Enhance Patient Care
• A new CT Scanner for San Leandro Hospital provides improved diagnostic services to inpatients and outpatients
• Laerdal Airway Management Training equipment for trauma nurses to sharpen their airway management skills through realistic practice
• Two blood pressure/pulse ox/temperature monitors keep triage equipment up-to-date
• Four new trauma monitors providing state-of-the-art monitoring of trauma patients to enable health care providers to have immediate and ongoing assessment of trauma patients
• An exercise bicycle at Laurel Grove Hospital helps rehabilitation patients recover more quickly
• A golf cart for Food and Nutritional Services provides prompt service to patients and reduce the risk of injury to employees
• New IV poles and wheelchairs help nurses and department staff to provide better patient care
• A new LCD/DVD supports ongoing training for Emergency Room and trauma staff
• Bladder scanners allow the neurology/medical/surgical unit and 5th floor surgery department to perform noninvasive monitoring for postoperative patients
• A JUZO Perometer in Rehabilitation Services enhances the level of patient care provided to lymphedema patients
• X-ray imaging is performed during vascular and orthopedic surgical procedures through the use of a radiolucent surgical table
• A pediatric bronchoscope is life-saving equipment trauma surgeons use to address breathing problems of children in the trauma center, thus saving a trip to the operating room.
• Radiology techs underwent training on the best use of the Toshiba Fluoroscopy and Multi-Purpose room to facilitate better patient care.
• Free senior flu clinics were held at San Leandro Hospital and Eden Medical Center
• A Women’s Health Symposium at Eden Medical Center provided an evening of free education on the health risks women face
• Eden Medical Center hosts five cancer support groups for patients and families facing cancer, caregivers and for people mourning a loss.
• Continuing education for nurses keeps Eden’s nurses up-to-date on the latest in health care
• Students at Skyline High School, San Leandro High School and Castro Valley High School go through the anti-alcohol and drug program, Every 15 Minutes
• Social Work Services provides shelter for transients recovering from a wound
• Support for Spiritual Care volunteers working in Social Work Services department
• GE Medical Systems Bone Densitometry Screening equipment allows Eden provide free screening at health fairs and community events
• Community members and Eden employees can take part in smoking cessation programs
• Emergency First Aid Guidelines assist local school staff members in responding to emergencies until medical staff can arrive.
Besides funding projects for our two hospitals in Castro Valley and San Leandro, we have taken on raising money for Sutter Medical Center Castro Valley, the hospital that will replace Eden Medical Center.
My vision is that once the doors open, our Foundation will pay for anything the new medical center needs! We have already started our fundraising efforts; last year’s Golf Tournament, which netted more than $60,000, was the first fundraiser on behalf of the new buildings.
So here is our wish list for Sutter Medical Center Castro Valley:
The Need: $25 million
Your generous contribution could provide technological and equipment updates so doctors and nurses can provide patients at the new Sutter Medical Center Castro Valley with the best in medical care. Advancements in technology for medical tools and equipment mean patients can experience less pain and discomfort, and doctors can perform less invasive procedures. This can translate into shorter recovery times and decreased hospital stays so patients can go home sooner. We constantly strive to improve a patient’s health care experience and state-of-the-art equipment and technology helps us to meet this goal.
Intensive Care, Critical Care and Trauma Center Upgrades
The Need: $15 million
Consider making a gift to help patients in intensive care, critical care and trauma comfortably and safely recover from surgery and other medical procedures. New beds, patient monitors, bedside equipment, and state-of –the-art nurse call systems will improve a patient’s stay and help doctors and nurses better attend to the needs of each patient.
Medical and Surgical Floor Enhancements
The Need: $6 million
Philanthropic support will help us purchase beds and other patient room equipment for Labor and Delivery, the Neuroscience Center and Medical and Surgical Units.
Outpatient Surgery Enhancements
The Need: $3 million
Higher image quality and patient comfort are combined in the newest tools used by physicians and nurses. Your generous gift will enable the Outpatient Surgery Department to replace older, outdated equipment with the latest technology at the new hospital.
We have many giving programs and named gift opportunities available to our donors. If you would like more information about our work at the Foundation and how you can support the new hospital, please call me at the Foundation office at 510-889-5033, or email me.
By Cassandra Clark, Project Communications Director
Finding access to primary care services is a serious challenge for local residents who are uninsured and underinsured. Many cannot afford routine doctor visits, long-term disease management or other basic services. Often, we see patients in our emergency rooms with advanced illness because they have no access to a regular doctor. Thankfully, in our community, more people have access to low-cost and no-cost medical care because of community-based organizations that help fill the need.
The Davis Street Family Resource Center’s RotaCare Free Acute
Clinic in San Leandro and Tiburcio Vasquez Health Center in Hayward and Union City have been filling that gap by providing primary care, pediatric and dental services to local residents for many years.
So it was welcome and uplifting news when Sutter Health recently awarded $100,000 grants to each of these organizations. Sutter’s Community Clinic Access to Care Grant program is a commitment by the Sutter Health network to improve access to health care services in the communities that it serves.
When Eden Medical Center learned of the available funds through the Community Clinic Access to Care Grant program, the people of Eden immediately thought of these two clinics. Eden has worked with these two organizations for many years, and both are highly regarded clinics in the community.
The $100,000 grant to the RotaCare Clinic is now being used to upgrade equipment and expand the clinic’s hours of operation. More than 60 doctors and nurses—many of whom work at Eden Medical Center and San Leandro Hospital—volunteer one of the four evenings a week that the clinic is open. San Leandro Hospital also provides basic radiology and laboratory services to clinic patients.
Tiburcio Vasquez Health Center is using their $100,000 grant to expand primary care services to residents of unincorporated areas of Cherryland and Ashland. These areas, adjacent to the cities of Hayward and San Leandro, have virtually no medical resources and very few physician offices. The clinic can now expand to these communities and offer primary, pediatric and maternity care.
The RotaCare Clinic and Tiburcio Vasquez Health Center were among 26 medical and dental centers in Northern California that benefited from the more than $2.5 million that Sutter Health’s Community Clinic Access to Care Grant Program awarded. Often, these good works go unnoticed, and so I thought I would share the good news. As always, your questions and comments are welcome.
By Todd Peterson, Vice President of Information Technology, Eden Medical Center
My name is Todd Peterson and I’m Vice President of Information Technology at Eden Medical Center. Castro Valley has been my home for the past 26 years, and I’ve worked for Sutter Health for ten years, joining Eden 2 ½ years ago.
My team is responsible for making sure all computer systems are up and fully functioning 24/7; and while computer repair is a significant part of our business, we are responsible for implementing new technologies that are now vital to many aspects of our patients’ care.
One major project underway that will be a cornerstone of the new Sutter Medical Center Castro Valley hospital is Electronic Health Records (EHR), a project conceived when I was still at Sutter. Basically the new hospital is being designed with minimal use of paper. That’s right… no more clipboards and illegible handwriting.
The EHR will facilitate all clinical documentation and reporting; all medical disciplines will be recorded. What does this mean? Our physicians will get a full view of a patient’s care at any given time, from any location, once their patient has been admitted to the hospital. So the patient’s medical history as it relates to diagnostics, drug therapy, procedures, diet, rehabilitation and notes generated by physicians and nurses will all be available online. This also includes previous visits to any Sutter Health-owned facility or physician office.
The EHR will ultimately be integrated with biomedical technology. That means much of the clinical equipment in patient rooms—heart monitors, blood pressure cuffs, IV pumps, and even the beds themselves—will feed information directly into the patient records. With real time monitors of the patient’s vitals, a physician can be alerted if a trend in their medical condition warrants medical attention well before a critical threshold is met. So the EHR will be a documentation system and much more; it will provide clinicians with a wider view of what is happening with a patient at all times so they can quickly take action.
Patient records will also show a correlation of clinical events, a true cause and effect. For example, a physician may order medications in response to laboratory test results. Subsequent laboratory tests can then be correlated to the timing of the medication and will demonstrate the degree of effectiveness. This constant correlation gives the entire care team the information they need to deliver the best care at the right time.
The critical exchange between the doctor who is on call and the nurse on duty will also be enhanced by EHR. Without delay, a physician can access the patient’s record from home, while the nurse views the same information from a workstation in the patient’s room so rather than just rely on a verbal exchange they are both viewing the patient’s record.
One of the key benefits of EHR is patient safety. In the area of medication management, physicians will use computerized order entry to address legibility issues and alert the physician to any contra indications, such as allergies, food or other medications that the patient is on. The process of administering the drug involves the nurse scanning the barcodes on the patient’s wristband and medication bottles. The system will confirm the patient’s name, medication name, correct time, correct dose and proper route (oral, or otherwise).
We will provide full accessibility to patient data. All this information, all images, reports, etc. will be available at the patient’s bedside. Every patient room, alcoves between rooms and nurses’ station will be furnished with a computer workstation so patient records can be accessed throughout the hospital. Physicians will also have wireless devices such as PC tablets to provide the most flexibility and mobility throughout the hospital.
Down the road, our patients who see Sutter Health physicians will be able to see their own clinical results online; they’ll be able to email their doctors and arrange appointments, and more importantly, track their own history and take responsibility for their own health. We may even use EHR to work in concert with our county and state health departments to track health trends in the community.
The prospects for EHR are endless. Our patients and clinicians become real partners in the delivery of care over the long term.
Your input is very important to us. I invite you to ask me any questions about the EHR system by either commenting beneath this post (click on the title of the post, if you are on the blog’s front page, and you’ll see the comment box below), or by emailing me.
Sidney Wanetick, M.D.
My name is Sidney Wanetick. For 26 years, I was in practice as an OB-GYN in Castro Valley, and I delivered more than 3,000 babies at Eden Medical Center.
In 2008, I retired from practice to accept the position of Vice President of Medical Affairs at Eden Medical Center. Today, I serve as the administrative liaison between the medical staff and administration, helping to support our physicians as they provide high quality care to our patients now and as we look to the future of Eden.
In addition to other duties, I am actively involved in assisting our physicians in recruiting new physicians to the community.
I’m very excited about the new Sutter Health hospital that is replacing Eden. Several major benefits stand out. In particular, having all private rooms for patients will make a huge difference, bringing more services to their bedsides and giving them more quality time with their doctors.
From the physician’s standpoint, this is a much better way to take care of patients and have important conversations with family members in private, as well as offer patients the privacy and rest needed for recuperation. The nurses’ stations will have a view of every patient’s room for faster response to patient needs.
The whole atmosphere of the new hospital will feel less institutional and more supportive, soothing and restful.
Today, even though Eden has 176 beds, we are unable to utilize all of these beds. Most rooms are semi-private, with very few private rooms and even a few four-bed wards. Yet, we can’t put men and women together, and we can’t mix patients with infections in with the general patient population. So even though Eden is larger, the Sutter replacement hospital will end up with a much better capacity for utilization of services.
Moreover, we are seeing a steady decline in the number of patients admitted to the hospital for more extended periods of time. When I first started my practice we admitted twice as many patients for surgery as we do today. My patients stayed in the hospital for five days or more! Also, if patients were scheduled for surgery, they would be admitted the night before. Today patients often have surgery and are discharged the same day, or, if they are admitted, the average length of stay is much shorter.
In addition to the 130 acute care beds, we’ll have a 34-bed, multi-purpose Universal Care Unit (UCU), which also supports the shorter hospital stay. Let’s say an Emergency Room patient has been treated and needs to stay for observation, but not necessarily be admitted. He or she can rest comfortably in the UCU. Or, if a patient is recovering from same-day surgery, we could have him assigned to a UCU bed where he’ll get the attention he needs.
There will also be vast improvements in our information technology systems that just aren’t possible at Eden; our current system has reached capacity. With the new electronic medical records system, our clinical staff will have access to lab reports, x-rays, medication, etc., right at their fingertips. Recent studies have demonstrated improved outcomes and fewer errors in centers that have electronic records, and the new hospital will have innovative, secure electronic records and data systems.
I welcome your comments and questions. Please feel free to leave a comment by clicking on the title of this post (if you are on the front page of the blog), and a comment box will appear below.
By George Bischalaney, President & CEO, Eden Medical Center
This past year was another busy year for our elected representatives, passing another bevy of bills that will impact hospitals and other health care providers. In every case, I have no doubt, each bill was written with some positive motive; to provide better access to health care services, to help control or reduce costs, to protect confidentiality or a patient’s right of choice, or in some cases mandating policies or practices that are costly to implement and monitor and may have a questionable cost benefit to patients.
But will more legislative remedies to the extremely complex and already cumbersome system of health services in California actually improve the patient care experience? One has to wonder.
In most service industries, the consumer helps direct change by withholding use of a service that doesn’t meet his/her needs. This is not as easily done when someone needs medical care. Yet the consumers, our patients, speak to us through direct communication and through their responses to the surveys we send. What we need to do is listen more attentively and respond more appropriately.
At Eden Medical Center we randomly send out surveys to patients who have been hospitalized, patients who use our mental health services, patients who have surgery and leave the same day, and patients who use the Emergency Department. We ask about every aspect of their experience, from the time they are registered through their discharge from the hospital. This includes physician and nursing interactions, quality of food and housekeeping, and the staff that drew blood or took an x-ray. Patients or family members are also invited to write comments, good or bad, and tell us anything else they think we should know about our services.
Hospitals are for the most part, stops of last resort for all. People come here already laden with apprehension, uncertainty and even a certain amount of fear. They have seemingly little or no control over what is about to happen to them or their loved ones. It is our job, our responsibility, to care for them as we would members of our own family.
If more legislation is needed to encourage us or force us to care for patients as we would our own family members, then we deserve what is given us. However, if we truly listen to our patients, our customers, and respond as a service industry that needs to be attentive to the needs of its customers, the industry would be vastly improved in terms of quality care and the patient’s experience. What more is really needed?
As always, we want to hear what you have to say. Please feel free to comment or ask questions in the comment box beneath each post, including this one. We will respond as quickly as possible.