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

‘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

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

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

It is the season when we begin to look back on the year. It is a time of thanksgiving (big T and small t) – so I am not just speaking of turkey and cranberries! I personally have so much to be thankful for. I truly have many blessings in my life, both personal and professional.

It has been 3 months now since my mom passed away. The kindness that I have received from many of you has me simply overwhelmed. I received so many texts and words of caring, support, and sympathy, hugs, prayers, beautiful flowers, and personally selected gifts, and for these I will forever be grateful. I was awed to see those who took the time out of their busy schedule to drive two hours to a small town in Wisconsin (and back!). You are amazing; you touched my heart and brought me to tears. My team kept working and told me not to worry, and not to return until I had time to grieve. Your thoughtfulness at a time when our hospital has been the busiest ever, is so impressive. Words are never enough, but I am truly thankful for you!

I am as well thankful for the doctors who saw that the end was near and took the time to sit with us and talk with us about Mom’s wishes, the acute care nurses who made her last days comfortable, especially Megan (a.k.a., “my ice cream nurse”), the nursing assistants who gently moved her and kept her clean and beautiful, the dieticians who patiently tried to find things that she could eat and that would give her a bit of pleasure, the housekeepers who kept her room clean so that she would not suffer from an infection, and whose kind smile brought a smile to Mom’s face, the palliative care ARNP who arranged for us to take Mom home and spent what seemed like an eternity with us until we were able to accomplish this, the hospice nurses who asked many questions so that they knew her, connected with her and us, then lovingly spoke to her when it wasn’t clear that she could hear us and have called me twice since Mom died just to ask “how are you doing,” and of course, the hospice bath aid, who made Mom laugh on her first day home, and methodically  and skillfully bathed her to keep her clean and carefully massaged her skin with lotion just as if Mom were her own mother. I am thankful for the great medical care, but most of all, I am thankful for the compassion and caring they showed my mom and my family.

This care occurred at another hospital, but I could say these same words, bring on these same emotions, and find these same caring behaviors performed within our hospital each and every day. For this, I am thankful for you.

Here a few of the many examples about our own UI Health Care family:

• (Patient) called with multiple compliments for her Ortho Trauma doctor, Dr. Michael C. Willey. She states he saved her leg from amputation. He treated her like a person, not a number. She can’t say enough good things about him. She said she has never been high-fived by a doctor before! He is thoughtful and caring and she thinks the world of him.
• My mother spent three days at 5th floor SNICU. We had two of the most wonderful male nurses, Rob and Austin, who were so professional and caring. Thank you so much. We will forever be grateful. The family of (Patient).
• Dr. Callaghan has performed 2 successful hip replacements for me. One of the items that is stressed post-surgical is to contact the doctor about any cuts or infections; which could result in complications at the surgical site. Late afternoon 9/29, I was stung by a hornet near my right knee which is the same side that hip replacement surgery was performed on 6/14/2016 . . . the sting sight turned yellow and red inflammation spread approx. 3-4 inches in from the sting sight. On Monday morning 10/3, I called into the orthopedic department and spoke with Dr. Callaghan’s scheduler Lori Yoder. Lori advised she would speak with Dr. Callaghan’s nurse, Deb. Deb returned my call and inquired if I had a smart phone to send a picture . . . within 15 minutes after receiving my picture, she returned another call advising that Dr. Callaghan wanted to check the condition as soon as I could get to the hospital. Dr. Callaghan examined the sting sight and for fluid and/or swelling in the knee joint. He had a prescription for Cephalexin 500 mg capsules sent to my pharmacy. He advised me to call him if my condition did not improve. After taking the medicine that afternoon and evening, the inflammation and yellow at the sting sight noticeably improved. I’m a soon to be 69 year old male, whose quality of life had been significantly diminished as a result of osteoarthritis in my hips. Dr. Callaghan has given me back mobility without pain, and his follow-thru is extraordinary, when patients communicate concerns about potential infections, which if unattended might result in reconstructive surgery. Dr. Callaghan has an incredible patient load, so his scheduler Lori and nurse Deb are his gate keepers/screeners. Lori is a great people person who keeps the patients informed and she works with us to accommodate our needs. Deb is a wonderful person and her having me utilize my smart phone to assist Dr. Callaghan with determining when I should see him, is great teamwork. And as for Dr. Callaghan, I am fortunate to be the patient of an outstanding surgeon. Thank you to team Callaghan.
• Her bedside manner is better than any doctor I have ever encountered. Shalina Shaik is a very intelligent doctor. UI Hospitals and Clinics, UI Health Care are very blessed to have such a great mind working with them.
• Michael Phillips joined the BTC [Burn Treatment Center] one month ago, but we are already seeing the difference he is making in the unit! He has an effervescent positive personality, and his smile is contagious throughout the unit. This quality is definitely appreciated by the staff, but it also really helps improve the mood of the patients in the unit. It is wonderful to have someone so empathetic and cheerful talking to our patients when they need it the most, and we are very lucky Michael chose to volunteer in the BTC.
• What an outstanding provider Dr. Prashant Khullar is, and he is a huge asset to University of Iowa Hospitals and Clinics. My dad was brought by ambulance on May 25th from Dubuque, Iowa, and he was a very sick man. Dr. Khullar met our family in the emergency room since he was Dad’s provider while he was an inpatient at the University. Even though my dad doesn’t remember anything during his stay here, our family does and we cannot thank him enough for the care he provided to our dad, the knowledge he had with his case, and the concern he had while Dad was sick and also to be available to answer all of the questions from my family when we needed answers of what was going on with our dad. The care he provided from the moment we met him until Dad’s follow up appointment was always the same—it showed he truly cares about his patients. Dr. Khullar has the best bedside manners I have ever seen in a provider and a caring heart for his patients and that makes him one of the best providers I have ever met. Keep providing excellent care it will always be noticed.
• We came into UIHC on Tuesday @ 6 am, 7/5/16 for our 31-year-old son, brain stem brain tumor surgery with Dr. Menezes (4th time at ages 10, 11, 21, and now 31). After being checked in by the regular RN who was also very nice, Lynn Fitzpatrick came in to go over and explain the anesthesia part. Her calm and caring manner was very much appreciated as she explained everything to both (patient) and us (his parents) and asked if we had any questions. By the time the time came for her to take (patient) for his surgery, we felt we could completely trust this woman and that (patient) was in the best hands possible, and he was! We also appreciated her stopping in the ICU later to see him, and she was delighted as we were with his alertness and abilities (high fiving everyone, etc.) virtually immediately after arriving at ICU. Lynn’s calmness, caring attitude, and professionalism helped allay our anxiety at a very stressful time.

And I could go on and on and on….

I have learned a lot on the “other side of the patient experience.” In the future, I WILL:

•  Always try to connect with my patient.
• Always try to put a smile on my face (even when I don’t feel like it).
• Always try to ask “is there anything else I can do for you?”
• Always remember that there is a person behind the medical record number (and strive to give that person the care I wished for and got for my mom).
• Always remember those who have gone that “extra inch” for me and my family and pay it forward.
• Always try to make the patient see the team I work with and how valuable each of them are.
• Never deny my patients, if that is their wish, the opportunity to be cared for by people in the wonderful program called Hospice

As we bring in 2017, WILL YOU . . . consider a commitment to connect with every patient everyday, . . . take every opportunity to lessen their suffering, and . . . focus on our purpose of caring and not be distracted by the hustle and bustle of our every day tasks?

I wish you all a wonderful holiday season and a Happy New Year! I am truly thankful for all you do for our patients, their families, and our staff.

—Theresa Brennan, MD, Chief Medical Officer

I remember several years ago, sitting at my mom’s kitchen table with her. It was the day after Thanksgiving. I was a young medical resident then, and frankly probably didn’t know very much. Mom had had a mole removed from her back, and while we were sitting there talking, she received a phone call about the results of the biopsy. I distinctly remember her picking up a pen and writing on a yellow pad of paper. As she wrote m-e-l-a-, I felt like I couldn’t breathe. I remember somehow being able to shout in a terrified voice, “It’s a melanoma?” She finished the call and confirmed that they told her that indeed the “mole” was a melanoma and the margins were positive. My mom has no medical training, so to her, positive margins was of no great significance. For me, though, the one thing that I did know was that this would likely be very bad. Even today, I feel a lump in my throat when I think about that moment; all I could think was whether my mom would be around for the next Thanksgiving. Fortunately for my mom, her melanoma was identified very early and with a large excisional biopsy her cancer was completely removed. Back then, though, that was not the case for most people who were diagnosed with melanoma.

As you may have read in a recent VPMA Voice, our Holden Comprehensive Cancer Center was rated by Becker’s Hospital Review is a “Great Oncology Program”. We are on their May 2016 list of one hundred hospitals and health systems with Great Oncology Programs. We should congratulate our colleagues and be very proud that we can offer such great care to patients with cancer.  It is therefore fitting that this blog is about how we treat our cancer patients.

Medical advances in the diagnosis and treatment of many disease states are occurring every day. Usually, these advances are slow to have significant impact on our patients. In the linked column below, written by our own Drs. George Weiner and Mo Milhem, you will see how cancer therapy really has gone through a period of disruptive innovation. What we remember from our training about the therapies and outcomes of patients with cancer is changing so rapidly. As we care for patients, we must make decisions based on their comorbidities; we must determine the best course of therapy based on the whole person. Understanding their comorbidities is very important for us to make the best recommendations to our patients. For example, how I approach aggressive versus conservative care, or even palliative care, for a patient with a cardiovascular event may be altered by my perception of their comorbidities, particularly the prognosis from their cancer. For this reason, I must make sure that I have the accurate information needed to give the best recommendation to my patient.

As you will read in the following column, Drs. Weiner and Milhem are encouraging us to more actively engage our oncologists, so that we know exactly what the treatment plan and the prognosis is for our patients. Our preconceived notions, based on remote education or experience, particularly for those of us they do not care for cancer patients every day, may not be in line with the reality of what options exist today. It is only through talking with our oncology partners that we will better understand the treatment that is available for the patient we are caring for, and be able to understand his/her prognosis. It is only then that we can present to the patient and their family the best options for their overall care.

Read Dr. Weiner and Dr. Milhem’s blog post: Disruptive Innovation in Cancer Medicine – See Cancer Differently

Whether you are the primary provider, the nurse, the social worker, the learner, the dietician, the pharmacist, or anyone who interacts with our patients, we need to make certain that when we speak to them, we have all the information, and that it is correct. It is frightening for them to hear differing opinions from members of their health care team. This fear and anxiety results in suffering for the patient and their family. Our patients deserve for us to speak with a common voice when it comes to their treatment plan. For this reason, we must treat each patient individually and make certain that we have all the information, the information is correct, and that the entire team is on the same page. In the future, before making assumptions about my patient, I will pick up the phone.

—Theresa Brennan, MD, Chief Medical Officer

In my previous blog, I shared a story about a dying physician and how he gave his best to “that patient” on his last day in the operating room. Since then I have received two letters that I want to share with you today. These letters illustrate the importance of each of you and the role you play here at UI health Care. The first is from a member of our own UI Health Care family. The words are so true and I appreciate the ability to share them with you.

My Story-

I am not a physician, a nurse, a medical assistant, a perfusionist or any one of our staff who provide care directly to our patients every day.  So I struggled a bit with Teri’s column in the last Quest… about giving each individual patient the best of me every day… I don’t have patients. There is a reason Teri is a care provider and I’m not… my job is (different).  My job is to explain …  sometimes this is easy, and sometimes it can be downright difficult 🙂   I chose a different path, I’m better with (what I do in my role), I’m better at interacting with staff.  I realized very early that I’m not wired to provide patient care.

 So how does her column relate to me?  What is it I do every day that impacts this patient or that patient?  What does the person processing claims do every day for this patient or that patient?  For many of us our world is two degrees removed from the face of each patient, how can we feel that same connection?  Well… by golly… for those of us in the hospital, we make that connection in the hall when we help someone find their way… we make the connection when we smile or play peekaboo with the child in the elevator… we make a difference when we prepare a meal for that patient on a special diet… we make a difference when we fix the ventilation so that the air flow is safe… or when we put a finger to our lips when we hear staff speaking to loud about a patient.  For the non-patient care staff in off-site locations, you make a difference to that patient or this patient when you program an easy way for a clinician to sign on to the computer… you make a difference when you ensure that we have contracts with payers so we can get paid and keep the lights on… you make a difference when you transcribe the report to go out to the referring physician. 

I know I’ve not captured all the ways each and every one of us makes a difference for this patient or that patient… but each of us in our own way helps those care providers on the front line… they represent our faces, too.  So next time Teri is entrusted with the life of her patient… in the background… we all share in her wonderful privilege to treat that one patient and thank him or her for choosing us.

Shortly after receiving the first letter, I received the following letter from a patient. The patient has given me permission to share this with you. This is a patient who spent a lot of time in our hospital, interacting with many front line staff and faculty. This is a patient who understood that it takes a team to run a great hospital.

To the Staff on the Sixth Floor RC,

Thank you to the nurses who gave me intelligent care, hope when I was losing mine, humor, straight talk, good explanations about medications, answered my questions without judgment, and advocated for me when I was too sick to do so. I do not think people really appreciate the stamina and knowledge it takes to be a professional RN.

Thank you to the nursing assistants for helping me when I was too unsteady, who often anticipated what I might need, their encouragement, humor, and making me laugh while helping me heal.

Thank you to the housekeepers who helped keep me safe, a very important part of the healthcare team, by keeping everything so clean. Thank you for being efficient, polite, and talking very briefly with me about books, kids, your hobbies, etc. while you continued to work. It gave me a boost to focus on something else besides my illness.

Thank you to the clerks who gave information to my friends/visitors, which helped them to feel comfortable in the hospital.

Thanks to the social workers who guided me through the paperwork and supported my decisions.

Thank you to the people behind the scenes; pharmacists, computer folks, plumbers, electricians, other maintenance people, food service, the people who took my food requests and the volunteers in the patient library.

Thank you to the sneaker brigade, all those doctors in training, for choosing your profession despite the costs, long hours, and many years of study.

Thanks to all the doctors who explained things thoroughly, answered my questions, listened to my concerns, and educated me about my illness and options for treatment. My priority with doctors is intelligence with good diagnostic skills. During my hospitalization I got that, plus respectfulness and good humor.

During my three hospitalizations despite my pain, teariness, fighting my fears, push of speech from the medication, and all my questions and concerns, I came to understand that this experienced, intelligent, and caring staff would take very good care of me.

I am so grateful to have received such wonderful, professional, intelligent care from a great team of people who despite long hours and many patients, provided better care than I could have hoped to receive. This was accomplished with respect, good humor, and kindness.

I wish there was a special word to express how I think and feel about all of you but until that word is invented please accept my heartfelt thank you.

I was amazed that this patient realized the importance of so many aspects of our team! What a wonderful feeling I had reading it! I hope that you did as well.

Both of these letters show that no matter your occupation, or your duty, as a member of our team, you are important and you have an enormous power each and every day. The power you possess is the ability to make a difference in the life of a patient, a family member, or a member of our staff. The knowledge that you have made that difference becomes a personal reward; this is the true value you bring to our patients, their families, our staff, and our community. We need this positive reinforcement to continue to endure the challenges we face each day. This is what keeps us going that “extra inch” and it is what keeps us engaged in our UI Health Care team. It is what drives us to continuously improve by being our “best” every day. It is what makes me do what I do and it makes me grateful to be a part of this team.

I hear frequently about the greatness of our staff. I suspect that each of you do not hear as frequently as you should about the great work you do. I am grateful for each and every one of you as a part of our team and I hope that you recognize how important you are in creating “Our Stories” for our patients, their families, and our staff.

And tomorrow….with these stories in mind, I challenge each of us to find your meaning, your inspiration. “How can I make a difference for my co-workers, our patients, and families today?”

Thank you for all your hard work! Every day you create “Our Stories”!

—Theresa Brennan, MD, Chief Medical Officer

I have had, for several months, this vision of sharing stories with you and so today I begin. These true stories are meant to remind each of us that the reason we are here is for that one patient. No matter what your role, the good you do ultimately has an impact on a single person. You see, every patient we care for is that “one patient.”

In July, 2011, I took a job as a hospital administrator. It would be a big change. I told my family, friends, and colleagues that as Chief Medical Officer I could help many patients. When I look at patient satisfaction data, core measures outcomes, and CLABSI rates, I think of these patients. As I made the change to CMO, I had it all wrong. I would not have the opportunity to help “the many patients,” but a set of individual persons who need to be cared for as individuals. I have known since I was 11 years old, that I would became a physician, but I had no idea what a blessing it would be to be given a patient’s trust, to know the intimate details of their lives, and be allowed to care for each of them. I love to care for my patients, to have the opportunity to make a difference for that one individual person in front of me. So, it is not “the many patients” I think about on Thursdays when I go to clinic. At the end of the day I think about “this patient” or “that patient.” Each of them has a unique face and name, a family, a struggle, and a story. No two are alike. I think of each of them as the individual persons they are and so often this makes me smile as they are such a rewarding part of my life. So, as I look at any good our administrative team has helped to create over the last four years, I must realize that it is not the “many patients” that have benefitted, but it is individual persons who have the misfortune to be ill, have each trusted us with their life, and therefore must now be called our patient.

The story, “My Last Day as a Surgeon,” published in The New Yorker, is an excerpt from a book written by a dying physician. As you read it you will be struck by the courage of this physician. What I hope you will also see is the impact of his illness on the way he performed his job on his last day in the OR. You will see how this “elderly man whose spine had degenerated” unknowingly got the best of Dr. Paul Kalanithi that day. As I sit here finishing my clinic notes, I wonder if each of my patients got the best of me today. . . .

My Last Day as a Surgeon – The New Yorker

I will continue to send stories but my goal for this blog is they will be our stories. They will come from you and the great things that you and your team do every day. They will highlight the immense impact that each and every one of us can have on one life. They will show the great things that happen here each and every day.

My “New Year’s wish” to you is that somewhere in these stories you will be as inspired as I am by those in our UI Health Care family who give the best of themselves . . . for that one person.

Please send me your stories so we can cherish and learn from the many great things happening everyday here!

—Theresa Brennan, MD, Chief Medical Officer