Our Stories: Making Difference through Documentation

Accurate clinical documentation is essential to patient care. The medical record allows us to have asynchronous communication among the many team members and with our referring physicians. Telling the patient’s story, accurately, in the medical record allows for the highest quality and safest care for our patients. Documentation also lends to appropriate risk assessment of our patients. This is a critical way to assess our quality of care. Finally, clinical documentation leads to medical coding which results in overall payment for inpatient admissions. For all of these reasons, it is our duty as health care professionals to make sure that our documentation is accurate and complete. I have asked Deanna Brennan, director of Clinical Documentation Improvement to lead this month’s blog and discuss accurate and complete documentation. 

As we move into the month of May, I am excited to have the opportunity to share our program with you and answer your questions regarding how clinical documentation impacts our organization and why it’s such an important piece of your daily work. As the director of our Clinical Documentation Improvement department for the past three years, I have had the opportunity to hear the daily frustrations that many of you have regarding documentation requirements, queries, and coding nuances. One of the most common questions I hear from providers is, “What difference does it make?” To answer that question, your documentation has the potential to make a tremendous difference in accurately reporting the complexity and acuity of the patients you care for. In turn, this data is used to show the excellent care that we give, and that University of Iowa Hospitals & Clinics is a high-quality organization that cares for highly complex patients with excellent patient outcomes. 

Clinical Documentation Improvement programs are an integral part of health care facilities across the nation, facilitating high level accuracy of documentation and coding. These programs are made up of clinical documentation specialists that partner with providers and coding teams to impact documentation quality, patient outcomes, and accuracy of data analytics. UI Hospitals & Clinics implemented the Clinical Documentation program in 2004, with the assistance of eight “DRG nurses” who reviewed charts and assigned a documentation related grouper (DRG) that reflected the patients’ care needs, acuity of illness and expected length of stay.  As focus on documentation and coding increases, the UI Hospitals & Clinics program has evolved to take on new projects, challenges, and improved engagement strategies to help our organization achieve its mission. 

Through its daily efforts, the Clinical Documentation Improvement (CDI) team works with providers to ensure medical records contain a complete and accurate picture of the patient’s level of care, severity of illness, and risk of mortality, while also supporting necessary resource utilization. The CDI nurses help to ensure that the record supports accurate capture of documentation codes, statistical data, quality metrics, and reimbursement. This is accomplished through ongoing education and collaboration among the CDI nurses and various specialty teams.

The department works as a liaison service for multiple areas of the hospital, using data analytics to identify areas of opportunity for improved documentation. CDI uses a teamwork mentality to partner with services, provide education, and identify areas of focus to improve documentation accuracy. The department provides regular feedback to providers regarding individual patient records, takes part in chart review discussions, and provides resources for documentation improvement.

Our department is comprised of 16 clinical documentation specialty nurses and a quality oversight specialist. The team’s primary purpose is concurrent review of medical records to improve accuracy, clarity, and specificity of provider documentation. They bridge the gap between providers and hospital coders by clarifying at-risk documentation prior to claim submission. They collaborate extensively with physicians, coding staff, and other patient caregivers to improve accuracy and completeness of acute inpatient documentation. They must adhere to ethical and professional business practices as governed by the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA).

Clinical Documentation Improvement is a specialized field that utilizes highly experienced nurses with a diverse clinical background, requiring them to acquire proficient coding skills and knowledge. CDI nurses must have the ability and willingness to seek out changes in healthcare reform and coding regulations, then incorporate those changes into their practice. These nurses must possess a high level of organization and computer skills, comprehensive medical knowledge, and utilize effective communication. These capabilities help them to identify gaps in the clinical documentation.

The CDI department at UI Hospitals & Clinics is an excellent resource for providers wishing to increase their knowledge of documentation requirements and improve accuracy and completeness of medical records. In the past year, CDI has partnered with a variety of specialty services, such as the Heart and Vascular Center and neurosurgery, to help identify opportunities for documentation improvement for accuracy and completeness. CDI continues to look for opportunities to educate, collaborate, and improve clinical documentation throughout our organization. If you or your team wish for increased engagement from the CDI program or if you wish to learn more about documentation improvement and engage in educational opportunities, please contact our program with information below.

Thank you for the excellent care you give to our patients and for your attention to the impact that your medical record documentation has on our organization.

Deanna Brennan, RN, BSN, CCDS
Clinical Documentation Improvement manager/director

Contact:
Clinical Documentation Improvement
Pager #5496 or
CDI-RN@uiowa.edu

Manager/director: Deanna Brennan, deanna-brennan@uiowa.edu
Quality oversight specialist: Jaime Sherman, Jaime-sherman@uiowa.edu

Our Stories: A Quality Improvement Journey at UI Hospitals & Clinics

I am pleased to have Beth Hanna, director of our Quality Improvement Program, as our guest author for the CMO blog this month. As we all are aware, quality revolves around our patients. High quality care with elimination of preventable harm is what we must strive for every day, and we do! Please take some time to read Beth’s very well done blog, and as usual, please contact us with comments.  

National Patient Safety Week was celebrated March 10–16, 2019. University of Iowa Health Care will celebrate Patient Safety Week April 29 to May 3 in partnership with the Quality Improvement Program, Department of Nursing, and the Office of the Patient Experience. Twenty years have passed since the Institute of Medicine, renamed the National Academy of Medicine in 2015, published To Err is Human: Building a Safer Health System. The report garnered the attention of many because it estimated that as many as 98,000 hospitalized patients in the United States die each year as a result of patient safety failures. Subsequent articles have suggested the number may be much higher. Regardless, this report heightened the nation’s awareness of the risk to those hospitalized and the urgency to further understand and mitigate risk moving forward.

Make no mistake, achieving patient safety is a journey—a journey constantly challenged by the complex, dynamic environment in which patient care is delivered. It’s a continuous search for ways to improve the quality and safety of care in a time of overcrowded emergency departments, hospital census at capacity, and ever-more complex and sicker patients. In an effort to leverage quality, safety, and performance improvement practices to mitigate risk in one area, risk may be created in another.

So how do hospitals persevere in such challenging times? As part of UI Health Care’s effort to eliminate harm to patients in every setting, the leadership of our organization has invested in and supported a number of strategic initiatives over the past few years to influence our ability to achieve safety for all. In 2016 a quality and safety structure was implemented consisting of five domains: Surgical Procedural, Adult Inpatient, Children and Women’s, Ambulatory, and Shared Services. Associate chief quality officers and nursing leaders are responsible for the organization of quality and safety committee structures within each domain. In March 2016, the Quality and Safety Oversight Subcommittee held its inaugural meeting. The subcommittee is comprised of 44 members who meet the first Monday of every month. At this same time, a new provider role, physician value officer, was incorporated into the hospital quality and safety structure.  And most recently, in January 2019, Clinical Quality, Safety, and Performance Improvement (CQSPI), Operations Excellence (OE), and Nursing Quality staff have formally integrated into one program, the Quality Improvement Program. Lastly, effective March 18, 2019, we re-launched the Quality Improvement Database, creating a central repository of institutional performance improvement initiatives.

As we establish and operationalize a more integrated and aligned quality and safety structure, we are positioned to more efficiently and effectively mobilize each and every one of us to address the risks that we face—to be the system that provides high quality, patient-centered care free of all preventable harm. Our greatest resource is all of you, who get up each and every day to provide the best possible care to patients who entrust their lives to us. The dedication, commitment, and work ethic of our staff, our team, is second to none.

As we approach the next fiscal year, the goals of the organization are being set. The goals are ambitious and necessary to continue advancing the cause of quality and safety. We look forward to partnering with all of you as we continue on our journey. As mentioned at the beginning of this blog, UI Health Care will celebrate Patient Safety Week April 29 to May 3. Take time to participate in the activities!

Thanks for making a difference!

Our Stories: Employee Suggestions

My sincere apologies for the gap between blogs. This winter has been very busy for our institution as well as our community. One project that has kept my team occupied was the development and implementation of Blind Spots. Through several meetings and discussions, I have noticed a theme from faculty and staff.

“We want to be heard.” And, “How do we go about getting (whatever the issue) solved?”

Historically, emails, phone calls, and even hallway conversations would be heard by senior leaders with concerns or issues. As a team, it was impossible to collate these and therefore no way to prioritize. Some issues have been addressed, and unfortunately many were not. We did not have an effective way of tracking these concerns or doing timely follow up. So we went to the drawing board. What if we had a “suggestion box” of some sort? A place where faculty and staff could share concerns or issues and someone from leadership would be assigned to review them. A “suggestion box” that could track themes and encourage faculty and staff to share their possible solutions.

The research I’ve read all said suggestion boxes are bad ideas. They can be ineffective and fail to produce engagement. Some of the reasons included: lack of follow up, only implementing a small number of ideas, no way to share improvements, hard for people to submit ideas, and no way to check out who is participating and who isn’t. Really, these were all the reasons why I wanted one in the first place. We took this idea to HCIS. From there, they created an electronic ticketing system. It is easy to use, and something we could pull data out of.

Next, we needed a name. A name that would explain what the system was designed for. My team, with great help from MarCom, did a thorough evaluation of a lot of ideas: rock-in-your-shoe, be the change, wouldn’t it be nice, good to great ideas, etc. Then, “Blind Spots,” an area where a person’s view is obstructed, was discussed and this is what we decided on. These would be things that may be out of view for leadership for one reason or another. In even the best managed organization, there will be blind spots. Perfect.

Anyone within UI Health Care can enter a Blind Spots report, and those reports get assigned to senior leaders. Those assigned then review the reports and decide the best way to address them. To simplify, we chose three main categories for closing a ticket:

  1. Closed: complete/getting taken care of.
  2. Closed: parking lot/great idea, but cannot be completed at this time due to some constraint.
  3. Closed: unable to achieve. These are the ones that are not possible (e.g., move the football stadium to get more parking!).

We went live in mid-December. The goal is to be able to assist when local efforts have failed. When marketing Blind Spots, we encouraged faculty and staff to use this reporting system as an additional resource if more help is needed, or if it is unclear who can help. We will direct the Blind Spot to the appropriate leader. Please remember to add your possible solution. We want to hear your thoughts!

So how are we doing? I am happy to share that as of 3/5/19 we have two open tickets and 47 closed.

  • 31/47 were completed/getting taken care of. Examples: adding better signage to ramps, changing the coffee line order, adding Visa/MasterCard accepted sign, fixing an error in provider enrollment, or fixing the heat in a particular area.
  • 8/47 were unable to achieve. Examples: one administrative structure for UI Health Care, University of Iowa, College of Nursing, and Athletics; or replacing Bread Garden with Java House.
  • 8/47 are in the parking lot. Examples: Ergonomics room for testing out equipment or fixing/cleaning up the skywalks.
  • All 49 tickets were addressed and assigned on average within 2 weeks.
  • The 47 closed tickets were closed within an average of 28 days.
  • 22 different leaders have been assigned tickets.

After reviewing the tickets, there have been no overwhelming themes for areas or departments with issues. However, there are lessons that can be learned from what has been gathered thus far. A large number of the tickets have to do with improper communication and education amongst teams. I challenge all of you to work on improving communication in your area. Share staffing changes, equipment purchases, and future upgrades. Educate co-workers on how to report EVS and maintenance issues, ethical concerns, or system problems. Ask questions! If you are wondering something, chances are there is someone else wondering the same thing. Lastly, do not just be a problem spotter, be a problem solver. We are counting on you!

I want to thank all that have entered or resolved a Blind Spot so far! With better communication and better teamwork, Blind Spots is just one more way we are striving for excellence at UI Hospitals & Clinics every day. To submit a report, click on the Incident Reporting link found on: The Point, under Top Links, or on The Loop, Employee Info page, under Tools.

 

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Improving Communication

‘The art of communication is the language of leadership’ -James Humes

Communication: a simple word that is anything but simple. It is the basis of everything we do. We communicate with our coworkers, team members, patients’ families, and patients continuously. In fact, most of us spend 70 to 80 percent of our waking hours in some form of communication. (Lee, Dick & Hatesohl, Delmar. 2018). Without effective communication, a message can turn into error, misunderstanding, frustration, or even disaster.  Excellent communication, on the other hand, is the foundation for great teams.

At UI Health Care, we have multiple ways to communicate: meetings, landlines, Voalte One (hospital hand-held devices), Voalte Me (app for your personal cell phone), email, pagers, Spok Mobile app, and Smart Web. Though having multiple ways to communicate can be convenient, it can present a unique set of challenges: incompatible platforms, dropped calls, undelivered messages, dead batteries, full inboxes, and frankly, just too many messages. This is why it is critical to ensure that your device(s) are on, batteries are charged, and when you are not available, designate another team member to return messages in a timely fashion.  Also, be sure to choose your preferred method of communication in your Smart Web profile          (Smart Web User Guide: Device Management, page 2).

‘The single biggest problem in communication is the illusion that it has taken place.’             – George Bernard Shaw

Excellent communication is vital to fostering a culture of safety.  The Patient Safety Net entries with an underlying issue of communication are entered daily, and the Clinical Quality, Safety and Performance Improvement Office evaluates each PSN report. Occasionally, a root cause analysis, or RCA, is necessary to determine how and why events occur. This process aids in the identification and implementation of systems-based improvements. Since July 2017, 85 percent of RCAs completed had communication issues as a contributing factor. Those errors may be as simple as a misunderstanding of what was said or not closing the communication loop fully. It is no wonder we ask our patients how well our providers explained things and listened, how nurses kept them informed and educated, and how well teams worked together. It is also why we ask you, our staff, how you feel team members do with communication. As a leader, it is part of my job to help teams communicate more effectively and understand where the gaps may lie.

There are several beneficial tools and strategies to help with team communication.  TeamSTEPPS has been rolled out in many areas throughout UIHC.  With this program and tools such as SBAR, (Situation, Background, Assessment, and Recommendation), we can more create consistencies of what each of us can expect when we communicate.  Read back and verify/Check-Back uses closed-loop communication, or repeating what was said, to ensure that the information conveyed by the sender is understood by the receiver. And I PASS THE BATON is just one example of a handoff tool designed to enhance information exchange during shift change or transitions of care.

(AHRQ Pub. No. 14-0001-2, Revised December 2013)

A more recent tool developed by a large workgroup at UI Hospitals and Clinics is clinical messaging templates built within Smart Web and Voalte. With these templates, the sender enters all required information into the message so the receiver can act on a request or simply be well informed of a patient’s status. Use of these templates should help decrease the number of pages to providers as well as improve the overall communication among clinical teams. By standardizing the messages, there are clear expectations of what must be included in each message sent and a timeframe expectancy on the action requested. STAT: Need at Bedside should be an immediate response.  Any Routine messages should be acted upon within 10 minutes.  And any Urgent messages should be addressed more quickly or within less than 10 minutes, but truly rare occurrences. If they do occur, the sender may page again sooner due to urgency, as actions requested may directly affect patient care. The sender should escalate to a senior resident or attending when there have been two messaging attempts with no response.

 ‘Communication and communication strategy is not just a part of the game- it is the game.’ – Oscar Munoz

Given the importance of communication in the development of our safety culture, I have decided to add a section highlighting communication and ways to enhance it in Quest, our monthly newsletter. This section will cover updates in communication platforms in addition to sharing stories about communication, both successes and areas that need improvement. I want to share best practices and any learning opportunities with you.

As always, I encourage you to share any story you may have with my office, and I challenge you to continue to improve communication in your area. Hopefully, you find some of the tools and strategies mentioned helpful.

If you would personally like to learn more about improving communication, I strongly encourage you to attend an Effective Communication course offered by the University of Iowa’s Learning and Development Office. Sign up through “My Training” in Employee Self Service.

‘Communication is a skill that you can learn. It’s like riding a bicycle or typing.  If you’re willing to work at it, you can rapidly improve the quality of every part of your life.’                  – Brian Tracy

In an effort to promote optimal communication I want to be sure that you know that I thank you for all your hard work and dedication to our patients and families, and to our team!

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Perception or Reality?

Perception or reality?

The saying goes that if the truth is not visible, then “perception becomes reality.” As a leader in a large academic center, I am always focused on how we are perceived. Our patients choose us, trust us, and continue to rely on us based on their own perception of our quality. While we publish metrics about infection rates, mortality rates, and how satisfied our previous patients have been, each of our patients brings to us a preconception of what he or she believes to be quality. This, I believe, is because quality is truly in the eye of the beholder.

A patient undergoing cardiac surgery expects to go through the procedure without a complication (a wound infection, a heart attack or stroke, a need for longer hospitalization, etc.). This same patient, though, when asked about quality may measure quality based on how fast they can get back to golf or work, or whether the health care team treated them with respect and kindness.

I believe our patients want to trust in us and know that we will provide them with high quality of care, free from preventable harm, in a compassionate way. They want us to heal them, keep them safe, and know them for their values and their choices and ultimately deliver our care to them with empathy and compassion. For each patient, the “metrics” for this are varied. This is the basis of the quality conundrum.

I am writing this blog because I believe that, due to these many complexities about what the quality reality is, our patients will rely on their perceptions. I am deeply disturbed by two recent events.

First, in recent conversations, I have asked many of you if you have seen the new TV show about the life of a trainee in a large medical center, perhaps not unlike ours. The show portrays so many negative, and some horrific, events as routine occurrences. The health care workers, specifically physicians and nurses, lack accountability, self-control, honesty, and integrity. The leaders are without ethics and rules, and they value dollars over patients. I am concerned that this sensationalized portrayal of individuals—from leadership, to physicians, to nurses, to support staff—will be seen by patients and families as reality. I believe it has the potential to harm the trust our patient have with their physicians and their care teams. You may say, “It’s just TV.” Yes, I know, but I also worry that the advent of “reality” TV causes perceptions to blur, and fiction may be perceived as reality. Especially as those fictitious shows seek to  promulgate and cash in on the urban legends of health care.

This brings me to the second recent event that has been in the media: the trial of Dr. Larry Nasser. When a physician steps away from the duties and responsibilities entrusted to them by the patient, and performs actions that are unethical, the profession, and thus each of us, is injured. When a physician  uses his powers to exploit and assault young persons, it makes the average person wonder about our profession as a whole. This sort of behavior is so far from the norm that I as a physician and human being cannot comprehend how one can become so lost.

What can each of us do about this? We must never allow our colleagues, patients, and their families to worry that our integrity and good will is in jeopardy. We must see each patient as an individual who has stories and worries and who suffers—not as a diagnosis, a room number, or an object.

Each of us came to health care in order to care for people. These examples, one contrived and one real, put a stain on our profession, and we must not allow that to happen. We can counteract erroneous perceptions by showing our patients, their families, and our colleagues that we always have our eyes on the prize – the health, well-being, and safety of the most important part of our team – our patients. We do this by being an integrated team, focused on quality and safety, and by communicating with each other and to our patients in a clear and compassionate way. We do this by holding ourselves and each other accountable to achieve our goals and to live our values. We do this by being transparent about where we are doing well and where we have opportunity. Most importantly, we must look at each opportunity to improve our patient care and perception of us, in order that we make that perception consistent with our reality.

We have exceptional people within UI Health Care who work each and every day to create our stories of human dignity, success, and kindness.

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Looking Back and Advancing Forward

Welcome to 2018!

The New Year is always an opportunity for growth, renewal, and a time to look back on the passing year.  Those who know me well know that this is my favorite time of year. It is such a wondrous time, but is routinely both stressful and joyous. I greatly value the memories created when spending time with my family and friends. This brings me joy and recharges my spirit. I hope that you were able to do the same. For me, it is these moments and memories that provide the much needed fuel to help combat the stress of working in an ever-changing, fast-paced, and often taxing environment that is health care today. This season brings an opportunity for reflection and really brings home to me, why I have chosen health care as my path.

Recently I’ve been thinking about all of the things we have accomplished in 2017. Often the larger picture can get blurred in our day-to-day work. We are all constantly trying to be better, but rarely do we actively review what accomplishments have occurred. When I start listing the projects and improvements, I’m overwhelmed by what our efforts have been able to achieve. You are what makes working at UIHC really special. Every single person at this institution brings a unique and unquantifiable perspective and skillset to work every day. A colleague reminded me of this just yesterday when he sent me the New York Times op-ed by Tom Brokaw from December 31, 2017, entitled “You Can Find the Entire World Inside Your Hospital.” In it Mr. Brokaw notes, “What I’ve learned is that American health care is a universe of scientific genius and selfless compassion populated by what seems to be the most diverse population in the country.” Your individual capacity for teamwork and caring make our unique organization a truly great place to be, day in and day out.

In order for us to celebrate all the amazing work that has been happening here this past year, I’ve gathered just a few of our institutional stats to share. Note, this list is by no means, and it is not meant to be, all encompassing. The actual connections built, patients healed, families heard, and students inspired are what we are truly proud of.

In 2017, we . . .

*The following numbers are rough estimates
  • Completed and opened the new University of Iowa Stead Family Children’s Hospital
  • Cared for over 31,000 inpatients
  • Delivered over 2,200 babies
  • Provided around 3 million meals
  • Volunteered over 120,000 hours
  • Triaged and cared for around 55,000 ETC visitors (with over 800 being transported via AirCare)
  • Provided around 350,000 radiographic exams and treatments
  • Saw and cared for over 900,000 patients in clinics
  • Filled over 1.5 million pharmacy orders
  • Provided around 6 million laboratory tests
  • Trained over 4,000 students in Health Education
  • Provided over 200,000 social service consultations
  • Performed over 26,000 instances of service recovery
  • Submitted over 15,000 PSNs
  • The valet team parked over 77,000 vehicles
  • Positively changed an unquantifiable number of lives

Together we are greater than the sum of our parts, and we have accomplished so much. This new year is guaranteed to bring more incredible accomplishments. It will surely bring challenges and is likely to bring hardships as well. We must remember to celebrate our achievements and recover quickly from difficulties. This is the true definition of resilience.

For 2018, I challenge you to find out what it is that recharges you and take the time to embrace it. This will allow us to push forward together and accomplish so much as a team. I am proud to be your colleague and I want to thank you for all you do each and every day to make this such a great place. I wish you a wonderful 2018, filled with good health, happiness, and success!

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Know me, heal me, keep me safe.

Our patients want this, expect this, and value us when we do this. Here are just a few of their comments:

  • “I cannot complain about the nurses or doctors. I felt safe, was scared, and they listened, they cared.”
  • “I have always felt that I have a whole team on my side. These people are caring, polite, respectful, and professional. I feel safe and cared for.”
  • “The team of doctors in charge of my care, tests, etc. were awesome. I felt safe, secure, and knew they were doing everything they could to help me get better—I was very sick.”
  • “Holly and Courtney on Labor and Delivery were absolutely wonderful. They tended to every need, were so encouraging, and made me feel safe and empowered.”
  • “Wonderful physician. I have complete confidence. The anesthetist was fun and put me at ease and his nurse was just as easy going, made me feel very safe.”
  • “The best care ever, felt safe.”
  • “Considering the circumstances, everyone was kind and respectful, we felt safe, and our questions were answered promptly and with compassion.”
  • “The teams of doctors, nurses, transporters, Housekeeping, PT, RT ALL made my family and I feel safe, cared for, and thought of. Everyone cares for the person not just the illness. Most of my time in the hospital was spent in RSCU. They are all top notch! My family and I are grateful for the care I received!”

Strong communication = strong patient safety

Quality, safety, and a positive patient experience go hand-in-hand. We focus every day, with every patient, on improving the patient experience by treating our patients as individual persons and on communicating effectively with them. This communication allows the patient to trust that we will heal them. This is what we do. We provide patient centered, high quality care. When there is opportunity to improve, we take it. We have a culture of continuous improvement. We, each of us, focus on being our best for our patients.

In the last year, we have done many things to improve the experience of our patients with the roll-out of Compassionate Connected Care (C3) training on 7JC, 4JP, 3RC, CVICU, and most recently on 6RC and in the Emergency Department. We are seeing results and are proud of the hard work being done here and on other units. We have had nine Physician/Provider Communication workshops (training about 80 physicians and APPs) focused on relationship centered communication tools. These have been well received with 75 percent of respondents stating they would recommend to a colleague, and so we are now finalizing a plan to train our physicians to facilitate these workshops and thus offer it to more providers.

Most of the time, safety is just a given. It is what we expect as caregivers, and what the patient expects. We have protocols and policies to guide us in providing safe care. Safety is obtained through having consistency of practice and common expectations. We use check lists, order sets, and good habits (i.e., hand hygiene) to maintain safety. Our systems, though, are essential for maintaining safety. Our systems must be designed to make us successful. We know through our Patient Safety Net (PSN) reports that the vast majority of safety events are a result of a breakdown in communication and thus a faltering of our systems. We receive about 60 PSNs per day. These are reviewed daily by the CQSPI staff and addressed through different mechanisms by severity/harm/harm potential. Local leaders review all on their units, and senior leaders receive a daily safety brief with those that may have broader institutional impact. In every field, safety must be a focus and health care is no exception. Our patients trust that we will keep them safe and we recognize that the basis of safety must always be communication.

Upcoming event: Patient Experience and Patient Safety

On October 18, at 6 p.m. in the East Room (Elevator F, Level 8), we will have a speaker from the American Association of Communication in Healthcare coming to discuss: Patient Experience and Patient Safety: A Discussion on How Integrated These Priorities Really Are. This will be a discussion about the positive association between the patient experience and safety. Effective communication results in an optimal patient experience. Patients tell us that when we communicate effectively, they not only have higher satisfaction, but they trust that we will keep them safe. Their perception is that our communication results in a safer environment. It is clear from published studies that communication positively impacts patient satisfaction and that increased patient satisfaction correlates with increased safety. Please join us for this important discussion.

Safety culture survey

Communication and safety are the basis of our recent survey. We want and need to hear your voice. This communication, the sharing our experiences and perceptions help us to improve our systems. This results in a safer environment for our patients and a more satisfying place to work. Without your input, we make assumptions and in a complex health care environment, we must base decisions on reality, on data. The survey took me just under 7 minutes, including addition of comments. I encourage you to make your voice heard. We are listening!!!

I am hopeful that when you read the comments above (just a few of the many positive comments we receive each and every day from our patients), that you feel a sense of pride in the job you do, and in the team you work with. These are our stories and I am proud to be a part of this team.

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Embracing Training Opportunities

Day in and day out we come to work with the very best of intentions, but often busy schedules and growing piles of responsibilities overshadow those good intentions. It may not take long to find that you’re showing up to work with your head down, perhaps doing your best just to make it through the day and check off as many of the “boxes” as humanly possible. The ability to care for others should give us great personal rewards, but this task driven mentality can take the reward out of what we do.

Recently our hospital has started offering some new training opportunities to help faculty and staff work and communicate more effectively and efficiently with our patients, their families, and each other. The goal of these trainings is to learn ways to do our work in a more thoughtful and engaging way, a way in which our patients feel that they are the center of our focus. This engagement allows us to create deeper connections with patients and co-workers all while saving time and cutting down on our own stress.

I had the opportunity to attend the C3 (Compassionate, Connected Care) training. As the title suggests, the training is geared toward intentional, thoughtful, and “present in the moment” communication. Taking the time to listen, acknowledge, and empathize with those around us helps build a positive rapport. For our patients it can also mitigate unnecessary suffering. On the outside this concept can sound strenuous, but the content provided in this training was simple, user-friendly, and evidence based. Small changes in how you position yourself in relation to those around you (heart to heart), and how you phrase questions showing empathy and compassion, can completely change the course of an interaction. I find myself using the tips and gestures at both work and home. At their core the concepts are not rocket science but have made a huge impact on my day to day interactions nonetheless.

“Having this tool leads to better patient care and driven purpose with each units team staff.”

This summer a pilot workshop provided by the American Academy on Communication in Healthcare (AACH), has been offered to a number of our providers. The objective of the workshop is to build better relationships with our patients while communicating more effectively using specific tools and techniques. I will be the first to admit that taking a day out of my already busy schedule for another training was concerning. I felt like I generally make a connection with my patients. But, if I am to ask others to go do this, I felt that I must as well. I’ve been a physician for 25 years and thought it would not be possible to teach this “old dog new tricks.” Of course, they proved me wrong. Just by incorporating a few of the communication tools in clinic, I felt my day went much smoother, and my patients felt heard. And you can imagine just how thrilled I was to receive this feedback from one of our orthopedic surgeons, who also recently attended this training:

“Thanks Teri for setting this awesome workshop up. My clinics today went like a miracle using the strategies I got from the workshop. Residents gave me comments on how well, and how quickly, I built patient rapport. It was obviously a worthwhile full day. A patient who had earlier gotten into an altercation with an outside provider was smiling and laughing with us. In addition I got done with clinic a full hour earlier than usual.” —Phinit Phisitkul, MD

I am very hopeful that others will at least have some of the impact that Dr. Phisitkul had!

In addition to workshops on communication, Dr. Hightower and her team are offering Epic Thrive training. These training sessions are focused on tips and tricks to using our EMR more proficiently. The feedback from these has been great:

“Wish I had learned this years ago.”

“These skills should be taught to each and every provider. It could make the difference between burnout, depressions, or having a manageable job.”

I know you are very busy, and I want to tell you again, that I greatly appreciate your daily hard work to make this a high quality, safe hospital where our patients get care delivered by thoughtful compassionate people every day. Change can be daunting, but if done with intention it can bring about positive effects in our day to day lives. Change and continuous improvement can improve the quality of care we provide to our patients and the quality of life we experience at work and home. I truly believe that our patients deserve the best quality we have to offer—care we would wish for our loved ones—and our team, you and I, deserve a vibrant, effective, satisfying work place.

You’ll notice a new look to the Quest newsletter. Our aim has always been to reach as many people as possible and communicate the importance of and any current updates with regards to safety, quality, and the patient experience. Everyone in UI Health Care can have an impact on these issues. We’re making more changes to Quest to keep the content relevant and make it quick and easy to read, so you can get on with your day. You can help us by submitting your questions, concerns, and your stories to cmo@uiowa.edu, and letting us know what is meaningful and helpful to your day and work, and what great things are happening within UI Health Care.

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Through the Eyes of our Volunteers

It was over a year ago now I shared my first story in this blog, and my goal remains the same: to provide a forum to share our stories, to highlight the immense impact that each and every one of us can have on one life, and to show the great things that happen here each and every day. One great thing here at UI Hospitals and Clinics is our Volunteer program. It is an extraordinary program that has stood the test of time, and those who make up this wonderful program continue to make a difference every day.

I have asked Jean Reed, Director of Volunteer Services, to give her thoughts on how our amazing volunteer program has impacted our institution, each and every day:

Last week was National Volunteer Week, an annual celebration observed in many countries to promote and show appreciation for volunteerism and volunteering. You do not need to spend a great deal of time at our hospital to see the tremendous impact our amazing volunteer team has on the patient experience here.

In any given year, over 1,400 individuals choose to volunteer their time with us. They attend orientations and trainings, have TB tests, immunizations and health screenings, pass criminal background checks, take competency quizzes, provide letters of recommendation and sign confidentiality statements – all for the privilege of servings alongside us… without pay. There are about 1,400 different reasons people make this choice every year, the motivations are as varied as the volunteers themselves. But the thread that connects them, and hopefully every one of us, is the opportunity to make a difference. No matter what your role, the good you do ultimately has an impact on a single person, and nowhere is that more simply seen than in the reflections of our volunteers:

“Today was really great. I got to speak with a patient for almost 2 hours about her family and all of the great recipes she makes. When her family came in, one of her daughters stopped me later and said that I made the patient’s day. I love being able to make such an impact on these patients’ lives.”

“Today I had a patient’s dad come find me after his daughter was done with her appointment to thank me for being a volunteer. It made me feel like I was making a difference!

“Today was busy, and I took lots of patients out. One patient’s family was so thankful that they even gave me a hug! It’s so nice that a small act can mean so much to people.”

We thank our volunteers for choosing to spend their time here, but we also thank our staff and faculty for welcoming them onto the care team. At our academic medical center, our volunteers appreciate the teaching mindset they encounter in service here:

“There are times that I have doubts about becoming a nurse. But every time I volunteer in the ASC, those doubts fade away because of the amazing nurses who I get to work with! #Careergoals”

“Today was a great shift. I got to talk with a lady who was lonely and get to know her while also letting her know me. I overheard the patient’s family members all talking about how awesome every nurse has been toward the patient. What a great group of nurses to be mentored and surrounded by. I hope one day that’s said about me!”

“Today was great! I was reminded again why I love this unit—someone was undergoing respiratory distress, the room was packed with doctors and nurses—it is so great to see them working so well together!

Could there be greater confirmation of the rewarding nature of this environment than the 120,000 hours our volunteers choose to contribute here in service to our mission every single year? That these team members contribute the equivalent of nearly 60 full-time positions is the big volunteer picture. But it is the personal stories that remind each of us that the reason we are here is for that one patient:

“I forgot how much the little things mean to the kids and families. Even just sanitizing wall toys reassures parents about their child’s care here. One mother thanked me for cleaning the wall toys and it made me realize how important it is to keep the unit clean. Small things matter!”

“I told a patient that I was an engineering student only to find out that the patient was an engineer themselves! They were very excited to be able to talk to me about something we were both passionate about. It was a great moment of forming a connection with a patient.”

“A young patient, not much younger than I, needed escort. While I was taking him out we had a fantastic conversation about school, life, and our plans. When we got to his car his mom looked at me in the eyes and said, ‘I haven’t heard him carry a conversation like that ever!’ I was very pleased to know we could share that conversation.”

“I had a great time today because the unit was so busy! I discharged three patients and visited with almost every patient on the floor, and they were all so nice and sweet. One woman had been waiting for her ride for a long time, so I wheeled her around the third floor to see all the paintings and outside the unit, so she could have a change of scenery. She was so appreciative, and it made my day!”

“The coolest thing about this unit is that I get to have real conversations with the patients. I spent a lot of time with a woman still grieving a loss. She thanked me for listening and said I was the first person she was willing to talk about it to in a long while. I’m thankful I’m able to be a part of this unit and get to have these experiences.”

“My most meaningful experience this month was getting to help a patient eat his lunch. He really did not want to eat anymore, and he kept telling me stories so he wouldn’t have to. I learned a lot about his life as a farmer, but also convinced him to eat a little too. It was a win-win!

“A patient was being discharged and I got to wheel her down with her family as they were leaving. This has been the highlight of my volunteering thus far, because I knew it was the happiest day that family has seen in a while. They were so excited to be going home together and could not stop smiling, and I was so glad I got to be a part of their day. It had me smiling all day!”

Seeing the impact of the care provided, through the eyes of our volunteers, inspires me! It should make each of us appreciate the wonderful privilege that we are all given each and every day. I’m inspired not only by these stories, but by the volunteers in our UI Health Care family who give the best of themselves each and every day—for that one person.   If you have the opportunity to spend time with them, they will fill your tank! They are the happiest people on earth, and I believe that this stems from the unconditional personal giving that they do every day. The volunteers on our team make it a better place for our staff, our patients, and our families of course, and their enthusiasm for our mission makes me grateful to be a part of this team, too.

Thank you volunteers, staff, faculty, and students alike for all you do to create “Our Stories”! Please take a moment to thank a volunteer today!!

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Spring has Sprung

How are you? This is a simple question that we get asked probably every day, maybe multiple times per day. There are number of potential answers, but recently I have noticed that a significant number of people respond with “busy,” “tired,” “drained,” or “stressed.”

Stress, in and of itself, is not necessarily bad, but too much stress can result in physical and emotional symptoms and ultimately to health problems. Stress can result from things that we perceive as negative or as positive. Illness, death of a friend or loved one, divorce, loss of job, and financial difficulties can clearly result in an increase in stress in one’s life. We sometimes forget that those positive and wonderful things like marriage, the birth of a child, buying a new home, graduating a child, or even opening a brand-new spectacular children’s hospital can cause stress. I have commonly said that when life is stressful at work I can handle it, and when life is stressful at home I can handle it. It is when life is stressful at both, that I find myself struggling. We sometimes forget that the people we are working with have struggles outside of their day-to-day job. Taking a moment to recognize the good work of a coworker colleague can have positive benefits for both of you.

We have had many discussions about how busy we are today. Our census has been high for so long that now we believe that this is probably our new normal. We have had The Joint Commission in to visit which has resulted in the need to change some of her practices. And though extremely exciting and wonderful, the planning for and opening of the UI Stead Family Children’s Hospital was stressful as well. These are all things that can happen when you have a great hospital, when they happen together in time, it can create a stressful environment.

Last week we had a taste of spring, and after a long (though relatively mild for Iowa) winter, spring is in sight. Spring is a new beginning, so it so appropriate that at this time of the year we do what we can to leave the stress behind and look to the future by being resilient. Resilience is not about how strong we are but is about how we see and react to challenges, setbacks, and stressors. We need to take action to control stress and not allow it to control us. There are a number of things we can do to make this so. First and foremost, we need to recognize the triggers of stress in our lives and address them head-on. As we work hard every day, it is very important that we take time to rest. This restful time can be spent doing things we enjoy alone or with family and friends, and reflecting on all the good things that we have. Perhaps you have plans for spring break. Use this time, whether you are traveling or not, to refocus and refresh. Having a positive attitude and seeing things (even with they appear to be negative) in a positive light can impact how we successfully deal with stress. Use this positive attitude to deal with the things that we cannot change but also to focus our efforts on embracing things that we can. Concentrating on all of the good things that you do here each and every day, can help to fill your tank when you are feeling drained. The physical effects of poor diet, lack of exercise, and poor sleep, will compound the effects of stress. Eat a healthy diet and engage in regular physical activity to counteract the stress. Most Americans do not get the necessary sleep to allow our brain and bodies to recover. Taking the time to get adequate sleep will reap benefits by allowing us to be more productive when awake.

Sometimes we may need more to counteract the effects of stress. Having someone who will listen to you and help you to positively face the stress in your life can be very productive. I don’t know what I would do without those who are my friends, my confidants, and sometimes my conscious. There are many programs to help promote wellness and counteract stress available here at the University of Iowa, including but not limited to mindfulness training and the Employee Assistance Program. Use the people around you and the resources available to you to get back on track.

Spring is just around the corner. It is a great time to renew and refresh. Take care of yourselves and have a wonderful spring!!

—Theresa Brennan, MD, Chief Medical Officer