Unfortunately, COVID-19 is now another one of “Our Stories.” It is in our community and I would venture that each of you has now have someone you know who has been infected. When this occurs, and when we see community transmission of infections locally, it becomes very personal. This leads each of us to begin to think about and worry about many things. For you, the issues are magnified as you are health care workers.

This blog has been devoted to “Our Stories” from the beginning and for most of them they are very positive. COVID-19 is not a positive story, but I think there are things we can do make it into one.

I would offer three things:

1. First, all those working within UI Health Care are not new to facing great and complex challenges. It was recently said that we are made for this and I agree.  No matter what happens, we will FIGHT this and we will ultimately win the battle.  We can only do this, though, by standing together.
2. Second, our community has been amazing in joining us in this battle. Be grateful for the entire UI Health Care team and our community. Show your gratitude with the WE STAND TOGETHER campaign.
3. Finally, focus on what we can control, and focus on the positive. I am disappointed by all the negative that we see today. Be empowered, and focus on the positive.

Together, we’ll get through this.

March 8 to 14 has been designated as Patient Safety Awareness Week. The Institute of Medicine’s report, To Err is Human, has been transformational for patient safety. The report brought to light that many errors in health care result from a culture and system that is fragmented and that improving health care requires a team approach. Several major points in the report are that errors are common and costly, systems-related problems cause errors, errors can be prevented, and safety can be improved. Twenty years later, the Patient Safety movement has produced learnings that demonstrate significant improvement in the care patients receive, and conversely that many opportunities remain.

Health care organizations are in a constant state of stress due to high patient volumes, complex, sicker patients and staff shortages. UI Hospitals & Clinics is not protected from these challenges. Daily we prioritize and re-prioritize throughput issues, discuss barriers to discharge, navigate the impact of behavioral health on patient and staff safety, accommodate medication shortages, and at this point in time, strategically plan how we will respond to an impending pandemic related to coronavirus.

Who we are as an organization and how we responsibly engage in the work of patient safety could not be more important. In the past five years much work has been accomplished to implement and operationalize a quality and safety structure that has reduced fragmentation and emphasized alignment of quality and safety work across the organization. This alignment creates greater critical mass and collective voice around quality and safety priorities, and in turn establishes health care as team sport, allowing us to continue to improve the care we provide patients.

In addition, senior leadership continues to invest in tools and programs that will influence UI Hospitals & Clinics’ ability to achieve and sustain excellence in care delivery free of preventable harm. On March 9, we will launch a new incident reporting system, Riskonnect. The new system is intuitive with a user-friendly platform, provides improved detail in event reporting and analytics, and system availability of Root Cause Analysis (RCA), peer review, and claims modules providing one protected location for all event review information. This past week, training was provided on how to communicate and disclose information to patients and families that have experienced a harm event. In the near future, we will make a decision on a Just Culture consultant who will partner with us over the next couple of years to establish systems of strong accountability for safe practices in which healthcare is delivered.

As we approach Patient Safety Awareness Week, take the opportunity to reflect on the many ways in which we contribute to the provision of safe, high quality patient care. I invite you to participate in the activities that have been planned here at UI Hopsitals & Clinics. And last but not least, I encourage you to take the opportunity to thank the members of your team, those you work closely with each and every day, to ensure we make a difference in the lives of those we care for!

Beth A. Hanna, BSN, RN, MA
Director, Quality Improvement Program

Our national history shows that in 1621, the Colonists and their Native American allies, the Wampanoag, shared a harvest feast.  This is thought to be one of the first thanksgiving celebrations in the United States.  This tradition continued, on and off, until 1863 when Abraham Lincoln proclaimed the fourth Thursday of November to be a national holiday—Thanksgiving.

These original “feasts” were really a celebration of life based on a successful harvest during times of significant hardship.  They celebrated their crops and they celebrated their families and friends.  This holiday is referred to by some as a day to celebrate with happy gratitude.  Many of us are blessed to be able to have this time of celebration with our family and friends.  Although we celebrate today, for many of us as a day of excess, the original Americans celebrated their ability to survive.

As your chief medical officer, a physician, and a patient, there is much for me to reflect on with happy gratitude.  We have a fantastic team who takes excellent care of our patients each and every day, and does it through unconditional support of each other.  Though there are times when we stumble, as the need arises the team with UI Health Care can always be counted on to rise to the occasion and bring forth our best.  I would be living in fantasyland if I did not also recognize the many hardships that we face each and every day.  Though our struggles are different than those first Americans, the effort required to overcome them are just as great.

I write to you today to express my sincerest gratitude for what you do each and every day for our patients, their families, and all who work at UI Health Care.  Although we all, I may be the worst, tend to look toward tomorrow and how we can be better, now is an excellent time for us to look back and celebrate.  I recently received an unsolicited note from a patient:

“… whomever is responsible for the amazing turnaround that appears to have occurred in patient services at UIHC should be commended and recognized. I have a considerable history at UIHC …. and have experienced the best care I could imagine. However, the services surrounding the direct care, as you know, have not always been great.

“Things have obviously changed for me and, I assume, others. For example, I walked into the digestive disorders clinic one afternoon bleeding from a polyp removal.  The staff said Dr, Gerke would be a minute. Dr. Gerke, completing a procedure  on another patient, met with me and indicated that though it didn’t appear to be an emergency he couldn’t be sure.  I could either go to the emergency room, stay the night and get prepped for a colonoscopy the next morning or, surprisingly, go back with his team and have the procedure, unsedated, NOW.   I chose the ‘NOW.’ I left an hour later, repaired, impressed, and laughing about the experience and pain.  There is no place in the world I could have gotten that kind of care.

“Though not as dramatic my recent experiences with your other clinics have also improved my perceptions of UHIC patient care and services. I hope your success continues. “

“Whomever is responsible”, is you!  And this is only the start.  Did you know that in fiscal year 19, we:

*The following numbers are rough estimates

• Provided around 2,593,606 million meals
• Volunteered over 110,000 hours
• Cared for over 55,000 ETC patients (with over 740 being transported via AirCare)
• Preformed over 34,000 surgical procedures
• Provided over 315,000 radiographic exams and treatments
• Filled over 2.2 million pharmacy orders
• Provided around 5.5 million laboratory tests
• Trained over 1800 students in Health Education
• Provided over 220,000 social service consultations
• Privileged 258 new providers, modified 120 current providers, and reaffirmed 762 providers
• Submitted 15,811 PSNs
• Submitted 218 NIH grants
• Published 2,797 research pieces

And since January 1, 2019, we have:

• Cared for over 27,755 inpatients
• Delivered over 2,111 babies
• Saw and cared for around 890,000 patients in clinics
• Helped over 325 colleagues COPE with a challenging work-related experience

And we have successfully undergone 4 accreditation visits from the Joint Commission including our massive triennial survey.

All of this while improving our surgical site infection rates, our central line blood stream rates, our medication errors, our hospital acquired pressure ulcers, and our patient satisfaction metrics in nearly every category and achieving an all time high on our nurse and doctor communication HCAHPS.   And there is some much more to this amazing story….

This is Our Story and it makes me proud and filled with happy gratitude.   Take a moment to step back and be grateful to yourself and to quote one of our quality leaders, “Go (continue to) Be Great”!!

—Theresa Brennan, MD, Chief Medical Officer

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

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!

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

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 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

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