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.
Cassandra Clark, Project Communications Director
We recently held an Open House for employees to learn more about the new hospital construction and explore the layout of the new facility and campus. It was at this event that many staff members learned for the first time that, when the new hospital opens in 2013, the campus will be smoke free.
A smoke-free campus means that smoking will not be allowed anywhere on the hospital property, including the grounds, gardens and parking areas, by any person – including employees, physicians, volunteers, patients and visitors.
We are taking this bold step because the new hospital brings a renewed and heightened commitment to our mission to improve the health of the individuals and communities we serve. Without a doubt, smoking is the leading cause of preventable death in the United States. We believe that we have a responsibility to take a leadership role on this major health issue and promote a healthier environment.
Eden Medical Center has offered an array of smoking cessation programs for many years to help decrease tobacco use in our community. Looking ahead, we will multiply our outreach efforts and use coaching and support to address staff and visitors using tobacco on hospital grounds. Tobacco-free initiatives have the potential to improve the health of thousands, reduce health care costs, improve workplace safety and contribute to community health improvement.
Hospitals across the country are adopting smoke-free campus policies successfully by reaching out to staff, patients and visitors with effective alternatives to smoking to reduce stress. As a leader in improving health care in our community, we believe this effort is well worth undertaking.
This is just the beginning of this conversation about a smoke-free campus. We welcome suggestions from you and leading health experts on the most effective ways to reduce tobacco use and boost our outreach efforts.
“There is no safe level of exposure to secondhand smoke. Tobacco smoke is deadly.”
Dr. Richard H. Carmona,
U.S. Surgeon General Report, July 2006
Planning Is Underway for Transition to New Hospital
by George Bischalaney, President & CEO, Eden Medical Center
Although we are still nearly two years away from moving into the new hospital, teams of employees and physicians have already started planning for the transition to the new building. We call the move a “transition” rather than a move, because it’s a process that involves bringing with us good practices, good people and good programs, while entering a new era of health care. Not only will patients be treated in a new environment, but that environment and the people that provide services will do so with state-of-the-art equipment and support systems that will make care more efficient, and in surroundings that are focused on the comfort and safety for our patients and their families.
Our “transition teams” include our managers, physicians and employees from every department in the hospital. When I think of the journey ahead, I find myself thinking about the people who will make this a reality. Healthcare people work well with uncertainty, with making sense of the challenge of illness and injury and finding the right course of action that results in healing. Caregivers face this every day with patients. We are fortunate to have a great team of people who are passionate about their work and committed to making this transition the best possible experience for everyone involved.
While 2013 seems like a long time away, it is so short when you look at the level of detail involved in transitioning to a new hospital. It’s a monumental task that cannot even be described well in a simple blog post. So, we will break it down into smaller, easier to digest, pieces as time goes on. It will both informative and comforting for all to know the level of effort both necessary and desired to make sure this is done right. It will involve everything from testing equipment and systems to rehearsing the actual move of patients on that one day not too long from now. There is much to be done and we’re both excited and challenged by the task at hand.
We’ll keep you posted on our progress and look forward to your comments.
Straight Talk from the CEO
By George Bischalaney, President & CEO, Eden Medical Center
Since the early stages of planning to replace Eden Medical Center, there’s been a lingering question on people’s minds: what name will the new hospital carry? All of the initial planning and building documents have used the name Sutter Medical Center Castro Valley, and the reference has stayed with us through construction and even on this blog site.
We were well aware that many people in the community, and certainly within the Eden family itself, were disappointed at the prospect of losing the original name
The name Eden has been connected with the hospital since it opened in 1954 has come to mean so much for the thousands of people who have been treated here for illness and injury, who delighted at the birth of a child or participated in our events and classes. For the thousands of employees, physicians and volunteers here, the name Eden is as familiar as family..
So, today I am pleased to tell you that the name will continue. Eden Medical Center will be the name of the new hospital when it opens.
I share in the excitement of this conclusion, because of what it has meant and continues to mean to our community. There is a history here that cannot and will not be erased, and a legacy will be passed on to future generations to continue the excellent and compassionate care that you have come to expect.
by George Bischalaney, President & CEO, Eden Medical Center
A recent article about the new hospital construction asked readers the question, “Is the hospital too lavish, or is the new hospital just a reflection of modern times?” The reason the question was raised, from what I can gather, is because the new hospital will have all private rooms. This is a marked difference from our 1950s-era hospital that has mostly two-bed and some four-bed wards, shared bathrooms and a curtain for privacy.
When we began designing the new hospital, one of the first questions we asked ourselves was whether or not there would be all private rooms. It wasn’t a long discussion, and the answer was quickly determined to be yes.
The existing hospital, with its multi-bed rooms, is how hospitals were designed in the late 1940’s and early 1950s when Eden Hospital first opened. Sixty years later, the thinking regarding rooming of patients has evolved, just as every other aspect of hospital medical care has evolved.
There are compelling clinical reasons why hospitals across the country are converting to private rooms. Highest among these reasons is infection control. One can pick up any magazine or medical journal and read about the growth of bacterial adaptation to antibiotics over the past decade. In hospitals, there is an ever-increasing need to isolate infectious conditions that create a risk for other patients. Any such high risk patient requires a private room for better management of their illness and also for the safety of other patients and protection of hospital staff. This happens daily in our hospital, and it means that a two-bed ward then becomes a private room, decreasing the number of actual beds available for use. (See previous articles about the effects on comfort, efficiency and increased capacity.)
There are equally significant social needs for private rooms. Patients who are critically ill, injured or at the end of life often have many family and friends who want and need to visit for extended times. It is appropriate that these patients have privacy for the comfort of the family as well as for other patients and visitors.
Privacy and comfort are also compelling reasons for private rooms. Federal regulations to protect a patient’s privacy have changed how we design interiors and how we communicate with patients and other caregivers. But aside from being a regulatory requirement, privacy is a practical consideration every patient should have. This is very challenging to maintain in a room with two or more patients who are separated by nothing more than a thin curtain. In fact, across the country, the demand for private rooms isn’t driven by the perception of “luxury,” but by the need for privacy, dignity and respect.
There seems to be an outdated and misguided view that a private room is only for VIPs, those who can pay more, or those looking for luxury accommodations. There was a time when this may have been the case, but it is no longer true. At Eden, there is no added cost burden to a patient in a private room. And when the new hospital opens, there will be no fee or increased cost to any patient to be in a private room.
I can fairly assume that those who raise a concern about all private rooms have not been hospitalized themselves, or have never experienced a loved one at end of life in a patient room with one or more other patients. In talking with patients and families in the hospital, I have never been told that the single room was not preferred. It’s clear that people prefer privacy (see Washington Post article).
Our patients will benefit, and I believe they will be much happier as a result of the new hospital having all private rooms.
The Lake Chabot Road entrance to the hospital’s parking garage was closed today to accommodate work on the underground utilities. Workers began early this morning to remove the driveway and dig the trench to reach the work areas.
The access to and from Lake Chabot Road from this site will remain closed the entire month of September.
Employees, physicians and visitors may access the garage from the hospital’s main campus driveway, adjacent to the Emergency Department.
Visitors may still park in the parking lots on the hospital campus, or in the parking garage with a pedestrian bridge located on the 5th level. Proceed with caution as more traffic is now directed to the main driveway.
We have Security posted to help ease confusion and direct traffic.
Some health insurance executives claim, and some news media have recently reported, that large provider systems like Sutter Health make health care more expensive by demanding higher-than-average reimbursement from insurers. To clarify Sutter Health’s position and shed more light on Sutter’s priorities, we’re posting this recent Q&A with Sutter Health’s leadership.
What is Sutter Health’s perspective on claims that hospitals’ demands for higher reimbursement from insurers drive up the cost of health care?
Sutter Health believes its reimbursements from insurers are fair, and reflect the high-quality and readily available health care that our doctors and hospitals provide to patients. Insurers contract with us for services of their own free will. There’s plenty of competition in Northern California — from Kaiser, Catholic Healthcare West, Adventist Health, John Muir and the UC hospitals, and from many independent hospitals and physicians. Sutter Health has held annual overall average price increases for commercial health plans to single digits in the past several years. Of course we have no control over whether health plans reflect our single-digit rate increases in what they charge consumers. Recently some health plans announced premium increases in excess of 20 percent, more than double the increase in reimbursement to our providers.
The reimbursement we receive from health insurance companies help fund Sutter Health’s commitments to ensuring our communities have adequate access to physicians, as well as fund our commitments to quality, safety, convenience and free care for the poor. While we continue to focus on meeting our community commitments over the long term, the for-profit health insurance companies focus on short-term profitability goals for their stockholders. For them, that means spending less for patient care, which represents the largest part of their budgets. The U.S. Congress found that the large for-profit insurers paid on average only 74 cents per dollar of premium from individual policies to doctors, hospitals and other providers, keeping the other 26 cents for their costs of administration and profits.
Certain health insurance plans maintain web-based pricing tools for members. Some of these tools post prices that the plans pay doctors and hospitals. Why hasn’t Sutter Health participated in these tools?
We want to provide consumers with fair and reliable information that is easily understood. Although several insurance companies have begun providing what they believe to be comparable data on prices between providers, Attorneys General of multiple states have disagreed with the approaches taken. Until they work the bugs out, we prefer not to add our data to the postings. We strongly believe a patient is best served by talking with a professional who can walk them through their personal health care needs, treatment options/choices and the estimated treatment costs of those options. Staff members at our hospitals and clinics regularly work with patients to answer questions about their estimated costs, and we plan to make estimates of our costs for common procedures available on our web site as soon as we can reliably do so.
Why are health care costs increasing at such a high rate?
The government pays less than the cost of care, so any inflation in health care costs must be borne by those who actually pay a market price. Since government-sponsored patients consume about 50 percent of the care in a typical health system, the cost-shifted to everyone else is double what it would otherwise be. For example, if inflation is 4 percent, a health system’s prices have to go up 8 percent to cover the increased costs of caring for government-sponsored patients when the government keeps its payments to doctors and hospitals arbitrarily low. Improvements in technology, drugs, and seismically-safe facilities all tend to drive the cost up faster than in other industries.
Health care providers, especially those like Sutter Health that invest in their communities (rather than giving that money to shareholders), have significant financial commitments. For example, we are replacing paper records with electronic systems and replacing hospitals at a time when per-bed construction costs have more than doubled, from $1 million about a decade ago to more than $2.5 million today. The other big cost driver is the success modern medicine has had in saving lives. Health problems that were once untreatable can now be treated, so we’re seeing more and more people living with chronic conditions. We’re absolutely committed to saving and extending patients’ lives, and we all need to be mindful that the costs of chronic care continue to be part of the nation’s overall health care bill.
How will health insurance reform impact your costs and affordability goals?
Our affordability imperative becomes even more important given cuts in reimbursement under health care reform. For Sutter-affiliated physicians and hospitals, Medicare cuts will likely total an estimated $124 million each year for the next 10 years – adding up to more than $1 billion in reduced Medicare reimbursement.
The United American Nurses Union/California Nurses Association has questioned Sutter Health’s commitment to “communities of working class people” and diverse populations. What’s Sutter’s response?
Counties including Del Norte (the north state’s poorest county), Lake, Merced, Sutter, Yolo and Yuba have some of the highest poverty levels in Northern California – and Sutter Health facilities serve each of them. In many small and rural communities such as Los Banos, Tracy, Novato, Jackson, Davis, Crescent City and Lakeport, Sutter Health is the sole provider of emergency medical services. Also, Sutter Health hospitals together serve more MediCal patients in our Northern California service area than any other health care provider. Sutter Health is building or has a continuing presence in diverse urban areas as well, such as downtown Oakland, San Francisco’s Mission District, midtown Sacramento and Stockton. Ironically and unfortunately, the nurses union formally opposed Sutter Health’s plans to construct new, seismically safe hospital facilities in urban Oakland, downtown San Francisco,Santa Rosa and right here in Castro Valley.
Our hospital construction project has passed the one-year mark since the groundbreaking ceremony on July 1, 2009. The project has progressed rapidly in that time, just as work behind the scenes has progressed to plan for the programs, services and technology for the new building.
A significant effort is underway to involve the employees, volunteers, physicians and community in supporting the new hospital through philanthropy. We sat down with Jack Alotto, president of the Eden Medical Center Foundation, to find out more about their fund-raising efforts.
Philanthropy is a way for the public to invest in our new hospital. And we take that investment seriously. The Foundation represents a unique stakeholder in the new hospital. Our donors are our shareholders, so to speak, and they tell us how they want us to invest their money. We give them that right. No matter what amount they give, they tell us where they want that money to go, whether for Trauma Services or Neuroscience or any other program, service or equipment.
Philanthropy enables a broad section of community to have a partnership stake in a new facility. In other words, here is Sutter Health giving, in essence, a gift to the community by funding $320 million for its construction. And now the community can partner with Sutter Health to bring that gift to life, to direct funds programs and services that the community decides it needs. In this way, philanthropy unites Sutter Health with the community to meet the community’s health care needs. That’s an exciting thing to do.
What is the Foundation’s role in making the new hospital a reality?
We have pledged $12.8 million toward equipment and technology in the new building. All of that money is going to advance patient care. That’s our goal, and that is our board’s pledge to hospital administration.
It is very important to me that we get more and more people involved at whatever level they are comfortable, whether it’s the Eden Hospital Auxiliary recent donation of $500,000 or a $20 gift from a grateful patient. We are all a part of this effort.
Right now, the People of Eden – the leaders, the physicians, the employees – have already pledged more than $1 million. The most gratifying part of my work is meeting with employees, seeing the commitment and personal support for the care we give. Every one of Eden’s leaders has already made a gift, and I would love to see 100% commitment from the employees and physicians as well. Our employees can inspire the community to invest as well, so we will all have a say in the hospital’s future.
Where can we learn more about the Eden Medical Center Foundation?
You can visit us on the hospital Website, call us at (510) 889-5033, or we can meet with groups and individuals to explore how to become a partner in care.
by George Bischalaney,President & CEO, Eden Medical Center
Planning for the construction of the medical office building adjoining the new Eden Medical Center has started in earnest. While the hospital itself has been under construction for a year now, the medical office building project was staged to begin at a later time when, so that both buildings are complete and open at the same time in 2013.
The office building is anticipated to be four stories and provide more than 80,000 square feet of space to house physicians and some hospital staff and services. The building will be connected to the hospital at each of the four levels, providing quick access by providers and staff using the building through controlled access points. The general public will have open access from the ground level. We intentionally planned for some hospital support staff to be in the building. We want to preserve as much space in the hospital building itself for clinical space and patient needs.
Programming, or definition of specific spaces in the building, is now underway. This means defining space on each level by occupant and provider type. An important part of this planning is the space designated for the Urgent Care Center, which will be located on the ground floor of the office building and close to the future hospital Emergency Department. In addition to planning for the scope of care and space for the Urgent care Center, we need to designate the necessary support space and establish initial plans for how the center will work in conjunction with the Emergency Department when they open.
Throughout the planning process, there remains a commitment to provide the Urgent Care Center. Ideally, it will offer a faster, lower cost venue for non-emergent needs of patients. This is much needed in our community and definitely in line with national and regional health care reform principles.
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.