Connected Thinking Blog - NACHRI Conferences

Seize every opportunity to make a connection

To help round out an extraordinary conference, attendees heard from Dr. Carl A. Hammerschlag, chief of community psychiatry at Patch Adams' Gesundheit! Institute.

Hammerschlag has spent several decades working with Native American communities, and credits his time there with his learning how to heal. He shared a story of one of his first patient encounters as a young doctor, treating a man he later learned was a traditional medicine man for his tribe.

The man had congestive heart failure and asked him two questions: "Where did you learn to heal?" and "Do you know how to dance?" The man proceeded to ask him to dance, and to get up out of bed, respirator attached, and to demonstrate a traditional dance. Hammerschlag asked the man, "Can you teach me to dance like that?" And the man replied: "I can teach you my steps, but you have to be able to hear your own music."

Hammerschlag laments the direction society and health care have gone -- and are going. The bad news with health care reform -- no one knows what that means anymore, he says. It is very difficult for us to sustain our hearts and souls in this time; we have made unpleasant behaviors into diseases. In contrast, we need to look to prevention rather than intervention, we need to realize that in raising children, the setting of limits is a greater corrective experience than giving children everything they want; we need to look to dinner as a family and pulling televisions out of bedrooms. We need to realize that there is hope without medication.

In med school, Hammerschlag says, health was simply defined as the absence of disease, but that has nothing to do with being healthy.

If what you say and do and what you mean and how you feel aren't telling the same story, then you are not healthy. We have to come to our work with no head -- dispassionate clinical objectivity -- and no heart. Without feeling, you cannot heal. If you cannot dance, you cannot heal.

There is a tremendous fundamental difference between healing and curing. "You can be healed without being cured," he says. If you are going to connect with people, you have to be able to do so in a way that connects heart, mind and soul.

Hammerchlag shared stories of visionary people like Wilma Rudolph, a woman who overcame repeated illness to become one of the most successful Olympic athletes of all time., and Bill Irwin, the first blind man to hike all of the more than 2,100 miles of the Appalachian Trail.

Similarly, vision has nothing to do with whether or not you are sighted. Vision is about being able to see in the dark. We need to inspire people to be able to see in the dark. Do not subordinate your dreams to whether or not someone else thinks they are likely.

Hammerschlag exhorts personal relationships -- relational networks that connect within and without. We need to find places to draw from to be more ourselves. For many of the patients that will be seen in children's hospitals, there is only a sliver of time -- a small window into which we can speak into their lives, into which we can connect with them. Seize the opportunity to make a connection, no matter how brief.

Collaborating for Quality Improvement

A diverse team shared stories of lessons learned in collaborating for quality improvement. The team believes that sharing secrets is foundational and vital to improving care. Without a willingness to set aside complacency and be honest with our challenges, it is almost impossible to transform care. The goal needs to be a world where health providers and agencies collaborate to keep people healthy rather than simply treating disease.

The team brought together the VIP Network Collaborative -- 27 hospitals that were willing to share secrets, conceived around a discussion thread on the AAP-SOHM listserv. The team started with a few key ideas:

• Variation leads to waste and poor quality or value
• Evidence base for decisions is often lacking
• Institutional culture dictates care
• There exists a tension between caregiver autonomy and in individualization of care

Granular detail can be seen in the session PowerPoint, but the basic collaborative project looked at bronchiolitis - a prime target for hospital(ists), and is the #2 discharge in pediatrics, behind NICUs. The project invited any hospital that cares for children and put together a toolkit with ICD-9 codes to capture bronchiolitis in children under 2 years of age.

The data gathered looked at 24 centers and 3097 admissions in 2007 and 23 centers and 2865 admissions in 2008.

85-90% are not freestanding children's hospitlas, most are either children's hospitals within hospitals or pediatric floors in adult hospitals.

The results showed radical differences in bronchodilator utilization among institutions, along with wasted steroid utilization. A tremendous amount of treatment given (and cost associated) has zero evidence to show that it has any benefit to patients.

The team is not quite ready to discuss all the results, but have been very pleased with the initial results. The power of the VIP Network lies in creating improvement collaboratives focused on identifying places to reduce waste and improve outcomes. So far they have seen a significant reduction in overuse and misuse of protocols that lack any evidence of effectiveness. It is an example of one of many ways in which transformation in transparency and collaboration with others can revolutionize care for children.

Partnership Models Between Children's Hospitals, Pediatric Physicians and Medical Schools

In one of the final sessions of the day, a trio of experts presented a partnership model -- exemplified by a case study of Rady Children's Hospital San Diego -- for children's hospitals, pediatric physicians and medical schools to partner together, an act of wisdom and necessity in the present economic environment.

UCSD Health Sciences is a large academic medical center with 54 pediatric academically oriented physicians; Children's Specialists of San Diego is a big for-profit medical group of 160 physicians in 26 groups; Rady Children's Hospital is a 273-bed freestanding children's hospital.

A Little Background

Historically, the three groups have competed with one another -- including in recruiting new physicians (sometimes scaring them away), and the red tape for physicians and medical staff who needed to interact with the groups, especially for those physicians wanting to do research, created inefficiencies detrimental to all parties.

Over the years, there have been several failed attempts to bring the three groups together. The first success was a formal affiliation agreement signed in 2001. Affiliation included consolidation of clinical programs and faculty on the Rady Children's campus; changes to governance of Rady Children's; and financing funds flow for academic programs.

Key challenges included: cultural clases between clinical and academic faculty; competition over recruitment of clinicians; no agreement over corporate and divisional governance; and there was difficult access to the UCSD research infrastructure for outside specialists. These challenges nearly destroyed the affiliation.

Successful Collaboration

In 2008, each of these three organizations had new leaders, so in September 2008, the three organization leaders and their teams had a two day summit to look toward the future, and the group agreed to collaborate to the good of each facility and the community, and set out to find the best means to do so.

A California medical practice foundation is a nonprofit health care entity that provides ambulatory care to its patients who stay less than 24 hours. It does not employ physicians; instead, it contracts with them to provide professional services to foundation patients. The structure has other requirements, but the result has been that a lot of large medical practice foundations have developed throughout the state.

The model undertaken by the pediatric institutions in San Diego went beyond the normal medical practice foundation model, with the primary goals of improving access to patient care and improving physician improvement.

The Rady Children's medical foundation is a division of Rady Children's. It's primary responsibilities include operating all ambulatory clinics; employ or lease all non-physician ambulatory practice clinical and management staff; provide ancillary services to sites; operate clinical and financial information systems; establish and maintain a Board of Governance Committee; and to monitor utilization review, quality assurance and peer review.

The medical group, Children's Specialists of San Diego (CSSD) provides all professional, teaching, research and administrative services to Rady Children's.

UCSD offers employment to all CSSD physicians, employs all future salaried faculty, provides infrastructure for research and educational training programs, employ or leases research employees, and all UCSD salaried faculty work on behalf of CSSD to provide services to the medical foundation patients.

Immediate Benefits

Along with all the other benefits, one of the most immediately meaningful to patients is the presence of a single bill instead of many different bills, each from different institutions or groups. Physician recruitment is unified and physicians can be paid better with improved benefits. Research is far more streamlined.

Lessons Learned

• There is no one size fits all approach -- the San Diego model is one of a kind
• The reuslt for Rady Children's has been a major change in how they do business, combining private practice and academic cultures, and leading an evolution into group practice thought process
• The presence of group practice management expertise is critical
• Committment at all levels of each oganization was a requirement for success; the new leaders at the three organizations helped make success possible
• The reaction from community systems was more than expected
• The negotiation and transition were much more time consuming than anticipated
• The short timeline was an ally in many respects
• It is essential to have good advisors.

Top Poster and Impact Awards Announced

Top posters and the Impact award winners were announced at the NACHRI award luncheon. The winners are:

• Child Advocacy -- "Heads Up – Concussion Workshop"
  Amy Teddy
  Injury Prevention Manager
  C.S. Mott Children’s Hospital
  University of Michigan Health System
  Ann Arbor, MI
• Combined Category -- "Children’s Asthma Care (CAC) Core Measure – Improving Compliance"
  Steve Jensen, MD 
  Director
  General Pediatric Careline
  Miller Children’s Hospital
  Long Beach, CA
• Quality Improvement & Patient Safety -- "Patient Verification for Patient Safety"
  Patti Craig, MA, RN
  Quality and Patient Safety Improvement Manager
  Morgan Stanley Children’s Hospital of NewYork-Presbyterian
  New York, NY
• Overall Top Poster -- "Reducing Central Catheter-related Bloodstream Infection in the NICU"
  Callie Dobbins, RN, BSN
  Nurse Manager
  Gail Harris, MSN, PNP
  NNP Coordinator
  Levine Children’s Hospital
  Charlotte, NC
• Impact Award winner -- "Full Potential – Sparking a Community Conversation on Our Children’s Health"
  Donna Teach, APR
  Vice President
  Marketing and Public Relations
  Nationwide Children’s Hospital
  Columbus, OH

March Madness: Health Reform Style

 

When you launch a campaign in March comparisons to March Madness just can't be avoided.

And when NACHRI and N.A.C.H. launched the Speak Now for Kidscampaign in 2009 with just four weeks to create and implement it, it was a pretty intense and 'mad' experience! Gillian Ray, Director of Public Relations for NACHRI shared our association’s experience during this session Speak Now for Kids: Building a Public Platform for Children in Health Care Reform. 

Speak Now was developed to make the voices and needs of children heard as the health reform debate took off in Washington, DCin the Spring of 2009. With many voices being raised, and much money being spent, NACHRI and N.A.C.H. utilized the unique and viral power of the internet and social media to develop a campaign with a quick timeline and modest budget that allowed parents, health care providers and others the chance to share their views and tell their compelling stories through the internet.

With nearly a thousand stories shared, in either written or video format, Speak Now truly gathered the voices of powerful advocates for children’s health. Some of these amazing stories include Carolyn H from Indiana and Amy W from Texas.

Bev Crider, Director of Patient and Family Centered Care from Children's Hospital of Michigan, joined Gillian during this session to share the perspective of a hospital that was an active participant in the campaign. Children’s Hospital of Michigan utilized their existing network of family advocates to post stories that brought a personal face to the issues of portability of insurance, access to care, comprehensive coverage, all topics at the forefront of the health reform debate in Washington DC.

While health reform’s progress has been derailed, the Speak Now for Kids campaign is a great example of how giving individual advocates a platform can bring together powerful stories that can make a difference.

 

 

Shaping Success in This New Decade: Stewardship is Everyone's Job

Noted consultant, author and speaker Kay Sprinkel Grace shared a look back at philanthropy and financial health in the last decade, the effects of the recession, and lessons relevant for the years ahead.

The top message from the talk: stewardship is everyone's job. Every person at the hospital uses resources, and one of the streams of resources for the hospital comes for community support -- philanthropic, volunteer and word-of-mouth. Every person connected to a hospital or foundation needs to feel the weight of being a good steward of relationships as well as with resources.

Giving Trends

Fundraising is not about money; it is about relationships. If you keep focusing on relationships, you will be successful in the long term.

Though in the last decade,a trend toward larger but fewer gifts at the top were balanced by many smaller gifts acquired through viral fundraising. There has been an increasing interest among donors in their dual portfolios -- a financial portfolio and a social portfolio. To be a good steward, it is critical to emphasize to donors a high ROI on their social investments.

People will give if they are moved. Inspire people to give, and let them worry about their financial portfolios. In spite of the economy, there is abundance. Abundance is about the spirit, not the wallet.

Leadership

Our leadership and our innovation define us. We need to be viewed as a secure investment, and donor stewardship is critical. The recession has not undermined philanthropy, but it has exposed chronic problems in many organizations that have not been good stewards of their relationships. Recession has exposed things we need to be attending to, without the life raft offered by a stable economy. Complacency is the greatest enemy to organizations. 

Communication

One of the advantages of the recession has been increased communication. In times with less resources, there is a greater need to engage with one another to share ideas, information, resources, and to collaborate well and in innovative ways.

The need for increase communication comes at a time when technology has made connection more immediate than ever before. We are at a place with more opportunities and venues to connect with more people than ever before in history; our challenge is time. In a changing relational and information-driven economy, the hunger for information is insatiable. The greatest promise that technology offers is in maintaining connections and providing greater ROI as part of stewardship.

Check out Kay's PowerPoint presentation for more advice to help you be a good steward.

What are you doing at your hospital that is helping build new relationships and strengthen existing relationships? How are you a steward?

Ending the Day with an Impact

One of the last sessions of the opening day of the NACHRI 2010 Creating Connections Conference proved to be an uplifting one. Public Relations & Marketing Campaigns with Clout featured the four finalists of the Impact Award:  Ginger Ossman with Mattel Children’s Hospital; Donna Teach with Nationwide Children’s Hospital; Roya Kousari with The Children’s Institute; and Winifred King with Cook Children’s Medical Center.  It was a rare opportunity for the seasoned professionals to infuse their presentations with a healthy dose of pride.

Roya gave a brief overview of the challenge or rebranding The Children’s Institute in Pittsburgh, PA. People in the community knew of The Children’s Institute but were often confused as to what precisely it was. Is it a school? Is it a hospital? In 2007, Roya and her colleagues launched the Amazing Kids, Amazing Place campaign to rebrand the facility.

Winifred faced the daunting task of generating national media for the hospital’s neuroscience program. By her own admission, she had no national media contacts accept for a chance meeting with Deborah Roberts at a cocktail party, which by her own admission was unmemorable.

The old saying “think globally, act locally” paid off for Winnie. Starting with her local NBC affiliate, Winifred pitched them a remarkable story around patient who underwent deep brain stimulation. Once she got their attention, she went one step further and made them agree to help her pitch to the Today Show. Not only was she successful in getting the Today Show, Dateline came calling too.

Donna illustrated how public relations elevated the story behind the hospital’s data-laden, Full Potential, report. The report, which identified 10 health indicators impacting children in the Columbus-area, served as the catalyst for the hospital’s obesity prevention initiative, the FAN (Fit and Nutrition) club and has inspired statewide legislation to improve nutrition delivery in Ohio public schools.

Ginger, executive administrator for Mattel Children’s Hospital UCLA, poked fun at herself for being more concerned with the bottom line in her role with the hospital. But even a numbers person could see that the hospital’s branding campaign,The Better Way for Kids to Get Better , was a great investment in building awareness of the hospital’s recently built facility and advanced pediatric services. One specific note of pride was the involvement of actress Jamie Lee Curtis in a series of radio PSAs that continue to air on Los Angeles stations.

The Impact Award will be presented today at the NACHRI Awards Luncheon.

St. Jude Improves Compliance With Bar-coded Patient IDs

At St. Jude Childrens Research Hospital in Memphis, staff experienced that implementation of new software for widespread bar code scanning reduced compliance rates. But it was initially hard to identify the problem, except that people were not using the scanners like they were supposed to and were not asking for help.

Within the patient services department, there is a small group that helps to bring other groups together and this group worked as the infrastructure to help troubleshoot the lack of compliance with barcode scanning. Two members of the group shared their challenges and lessons learned. The problems ranged from the purely technical -- screen problems with the scanners, low batteries, stylus input problems -- to workflow issues, especially involving incorrect and expired passwords and system lag time on logins.

To start resolving issues, the team established a single point of contact for reporting issues -- a phone number available 24/7. The team sharing responsibility for calls helped direct problems to the right people, find solutions and track calls for process improvement.

A central point of contact for solutions and tracking made it possible to identify the low-hanging fruit for improved compliance. Some of the lessons learned:

• Create and train a point of contact on the unit that handles rebooting devices, checking and replacing batteries, cleaning the infrared lights on the scanning units, etc...
• Verify wireless connectivity throughout the units and make sure there are no dropped connects
• Identify and train super users to help staff on each unit
• Battery replacement is critical -- replace all unit batteries on a regular basis at shorter than the recommended intervals to avoid problems; the cost is worth the improved compliance
• Test, Test, Test

In the Spotlight: How Would You Handle It?

Don Ponturo of Mattel Children’s Hospital UCLA and Valerie Wencis of MassGeneral Hospital for Children put their colleagues in the spotlight by inviting them to share stories from the frontlines of public relations and communications. And share they did.

Valerie opened with a synopsis of her hospital’s media relations response to the Haiti earthquake in January. As soon as the hospital announced it would send teams to Haiti, media started calling for interviews and packing shots. Valerie and her team accommodated these requests after clearing them through administration, but the back and forth took time. Meanwhile the Boston Globe indicated it wanted to embed a reporter and photographer with one of her teams. Valerie helped rush this media duo through vaccinations and they deployed successfully, sending daily reports from the field. Media in Boston were looking for alternative angles and MassGeneral responded with interviews with Haitian staff members. Valerie also pushed out a tips list for parents about how to talk to your child about the earthquake. Once the teams returned, Valerie and her team created a video diary so that team members could record their experiences. This video was offered to media and posted on the hospital’s Web site. A de-brief for team members, including the Globe duo, is planned for March 30 and media are invited. Key takeaways: Disasters happen at a moment’s notice; know your responders and train them for media; equip your teams with flip cameras.

Don followed with his story about Mattel Children’s Hospital’s opening of its new hospital in 2008 which required moving critically ill children from the old facility to the new. Due to a few critical news stories about the move, the hospital was anxious: What if something goes wrong? The decision was made to control media access to the event. All media were stationed blocks from the move area and a videographer was hired to shoot the move and provide the b-roll to local stations.  The result was limited coverage in LA only. Yet Don feels the hospital missed an opportunity to be transparent and forge deeper relationships with local media and he asked his colleagues what they thought. Paula Darte of Children’s National Medical Center suggested choreography. If a hospital is not comfortable with full access then select a handful of patient families for media shadowing. Work with the families in advance and coordinate with your clinical ops team. Key takeaway: Is no news really good news? Giving up some control can be well worth it.

Barbara Mueth of Children’s Mercy shared her experience in the wake of Hurricane Katrina and why she said “no” to Oprah. After the disaster, her hospital received 24 patients and their families including nine children without parents/guardians. Media were invited to cover the transport but then the hospital “went dark” for 24 hours to allow the families time for adjustment. The time allowed Barbara’s team to identify and work with families for local media stories. But national media came calling in the form of the Oprah Winfrey Show. Oprah’s producers wanted to interview the nine children without parents and only them. No adults. The hospital had to turn down the offer, acting in the best interest of the children. Barbara explained “We want national media, but not that way." Key takeaway:  Always act in the best interest of the patients.

Following Barbara, David Perry of Seattle Children’s related the story of Ashley the Pillow Angel. In 2004 Ashley’s parents began talking with surgeons at the hospital about growth attenuation to preserve Ashley’s small size, enabling the family to take care of Ashley at home and not have to move her to a state-run center. The request challenged the hospital from three standpoints: family centered care, ethics and science. In January 2007, the day after David’s first day on the job, the hospital performed the surgery. Within 32 hours, David and his team fielded 500 media calls from 154 media agencies and did major national media interviews with Larry King, CNN, Oprah and on and on. The hospital’s decision to perform the surgery was challenged by the disability community. Because the hospital was committed to transparency, it held a joint press conference with advocates for the disabled to discuss the decision publicly. The hospital also placed a member of the disabled community on its ethics panel. Key takeaways: Transparency with bias for action; this will happen again; be prepared for the journal articles.

Next up was Debra Stevens of Phoenix Children’s.  Debra’s frontline story focused on the birth and separation of conjoined twins to a young mother. Because of the hospital’s focus on family centered care, Debra and her staff reached out to a trusted print reporter who respected the confidences of the mother and pledged to report her story with great sensitivity.  The hospital granted the reporter access to the separation surgery. All was closely coordinated with the surgery team. With the mother’s permission, the babies were placed with a foster family who could provide the level of care necessary for the babies to thrive.  The family ended up adopting the children and more media stories resulted.
Key takeaway:  Consider exclusives, open access and always do what’s right for the family.

Rounding out the interactive session was Tom Hanley from Helen DeVos Children’s Hospital related a story from the 80s, prior to cell phones, Twitter and YouTube. While serving as a PR director at a community hospital, he awoke one morning to the news that a patient had jumped from a hospital window and died on the sidewalk in front of the hospital. The suicide happened at night, after the daily paper had gone to bed. It was a non-story. But Tom carried that story to his next job at Connecticut Children’s where he asked his team: What’s the worst thing that could happen and are we ready for it? The team agreed that the worst thing that could happen would involve a child abduction. Working with a crisis communications firm, the hospital conducted a vulnerability audit via an unannounced drill. The drill revealed significant deficits in the hospital’s patient safety system including the hospital’s ability to lock down. The hospital took immediate steps to implement security measures and the PR office created protocols to bolster weaknesses in its crisis plan. Key takeaway: Conduct a vulnerability audit and address your weaknesses so that you’ll be prepared for a worst-case scenario.

Have more to add? Share your story on this blog or volunteer to participate in a similar session at next year’s Creating Connections conference.

 

FOCUS on a Fitter Future: Recommendations from a NACHRI Collaborative on Childhood Obesity

Preliminary findings from NACHRI's FOCUS on a Fitter Future were the subject of an afternoon session within the Child Advocacy track. Wendy Slussler, MD of Mattel Children's Hospital at UCLA and Megan Lipton, MA of Children's Hospital Los Angeles presented on behalf of the 15 member hospitals who participated in this 18-month effort. 

While the FOCUS Group looked at a wide range of clinical and infrastructure issues within children's hospital's weight management programs, today's talk focused in on a few of these areas: Payment/Sustainability and Hospital Environment. 

Dr. Slusser began her presentation by covering some of the complicated reasons behind the rise in childhood obesity as well as the challenges for treatment, including one of the greatest challenges - payment. The payment subgroup has developed several tools to help others advocate for improved payment for weight management programs including a power point template and fact sheet that will be available to be utilized for advocating with both public and private payers. 

Hospital Environment is another hot topic that was covered during this session. This was one of the largest subgroups in the FOCUS Group as Megan described that many "felt so strongly that we need to provide a culture of optimal health within our hospitals. We knew we really needed to 'walk the walk' "

Megan discussed recommendations for the hospital environment to improve wellness for not only patients, but also visitors and employees. One of the biggest challenges for hospitals now is in their physical environment and establishing a safe environment for an obese patient and family including physical and emotional safety. 

The hospital environment committee has compiled recommendations and examples of positive steps hospitals are taking including healthy menus, walking maps of their campus, and more. Megan concluded by sharing the belief of her subcommittee that "creating a culture of wellness makes obvious sense for our mission as well as for our hospitals' bottom line."

This hour long session really just scratched the surface of an issues that is gaining attention within our hospitals as well as on the public policy front. FOCUS on a Fitter Future plans to make all of their findings available in the coming months to NACHRI members through the website as well as to others in the medical community through a supplement to Pediatrics and presentations in multiple venues. Stay tuned for more from this dynamic group!