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BayCare Hospitals Offer New Service for Deaf Community 1 CHE Innovation Center: Creating a Competitive Advantage 2 St. Peter's Merger Update Rebuilding Haiti: Seven Months Later

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Program for Excellence in Ministry Provides Executives with Tools to Lead Benefits of Rapid Process Improvement Across the System 10 Minutes with ... Michael McCoy, M.D.

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HORIZONS

CATHOLIC HEALTH EAST

Summer 2010

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ccording to the Centers for Disease Control and Prevention, more than 37 million American adults are affected with a hearing loss. In southern Florida, the Tampa Bay Deaf and Hearing Connection reports that more than 165,000 deaf and hard of hearing individuals reside in the Tampa area. These conditions can lead to a frustrating hospital patient experience when attempting to communicate with caregivers and family members. Often times, interpreters are not immediately available to assist with communications, which can interrupt care, especially in the emergency room.

New Service for Deaf Community

BayCare Hospitals Offer

"We would call a sign language interpreting company and the company would send a live interpreter to the bedside of the requesting patient. Many times this delayed our non-emergent, urgent care, while we waited for the interpreter," said Sharon Benson, R.N., B.S.N., COHN-s, director, patient services, St. Anthony's Hospital, who was previously nurse manager of St. Joseph's Hospital emergency department. "Also I saw the inefficiency of having the interpreter sit at the bedside for hours while the patient slept. Together with Tina Long [director,

Jane Durbak, administrative assistant, St. Joseph's Women's Hospital (in black top) sets up a demonstration of the video ASL technology for colleagues (from left) Beth Fontana, R.N., mother/baby; Jaime Ruhe, R.N., high-risk OB; and Shuneeka Milton, R.N., women's services.

patient care services at St. Joseph's Hospital] and through web investigation, I became familiar with a new way to provide sign language interpreters, via the Internet using a video link." Today, in order to facilitate communication with these individuals, St. Joseph's Hospitals and South Florida Baptist

Hospital are now offering American Sign Language (ASL) via Video Remote Interpretation (VRI) through NexTalk®, a telecommunications company based in Utah. According to Vaughn Peterson, NexTalk's executive vice president, sales and alliances, NexTalk is being used in over 300 health care sites, including some long-term care facilities.

"This is a huge patient satisfier," said Laura Robidoux R.N., B.S., C.P.N., manager, nursing administration and IV therapy, St. Joseph's Hospital. "We used to have to wait for about an hour for an interpreter to drive to the hospital and pay by the hour for the interpreter's service, including drive time. Now we can

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A PUBLICATION FOR THE SPONSORS, BOARDS, REGIONAL LEADERSHIP, SYSTEM OFFICE AND COLLEAGUES OF CATHOLIC HEALTH EAST

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Creating a Competitive Advantage

CHE Innovation Center:

wo trains are traveling on similar paths. Their tracks will cross many times. Their arrivals are planned for the same point in time. Their destinations are near neighbors.

One train is Catholic Health East. We are driving our train of transformation toward Vision 2017--a place where person-centered care creates healing partnerships through relationships that strive to achieve optimal health and quality of life while honoring individuals, offering informed choices and respecting innate dignity. Indeed, Vision 2017 is a place where the right care is delivered at the right time in the right setting every time. The second train is our government's Centers for Medicare and Medicaid Services (CMS). CMS is also driven by the year 2017, for that is when Medicare's Hospital Insurance Trust Fund is projected to become insolvent. Pushed to its limits by inflation and the aging of the Baby Boomers (the first Boomers will turn 65 in 2011), CMS is pushing providers to deliver care in more efficient, cost-effective ways. The unifying theme for CMS is patientcentered care, which places the individual, including family members and other informal caregivers, at the center of each care team. The fuel for the CHE train is our Mission and our commitment to being a transformative, healing presence within the communities we serve. The fuel for CMS is the health care reform legislation passed earlier this year,

The CHE Innovation Center will help identify, mobilize and accelerate the development and implementation of local and system-wide innovations. Toolkits, internal and external collaborations, and multi-disciplinary input will be used to help replicate and scale successful RHC/JOA pilots, innovations and grants throughout the ministry.

which includes a directive for CMS to test innovative payment and health care delivery methods that help to reduce costs while enhancing quality.

As Robert Mechanic and Stuart Altman reported in the March 3, 2010 issue of The New England Journal of Medicine, a key component of the new Center for Medicare and Medicaid Innovation (CMI) "Positioning CHE as a health care leader initiative includes a $10 billion and an attractive partner to CMS will be appropriation for the CMI through 2019. critical for our future success," said Ken This would "... allow the CMI to pay for Becker, vice president, advocacy and fund services such as care coordination that development, CHE. "CMS will likely begin aren't covered by traditional Medicare and creating innovation labs across the to support activities such as electronic data country, partnering with local, regional sharing, performance measurement and and national leaders who have quality improvement at participating demonstrated their ability to closely health care systems." The CMI would also collaborate within established systems. To encourage delivery innovation by creating that end, all colleagues across our ministry alternative payment structures for will have a role in our success. We, as a organizations that are motivated to reduce system, will need to focus our efforts on clinical waste but that have been held back establishing new person-centered care by the negative financial implications of models that improve the coordination, quality and efficiency of how health care is continued on page 3 delivered."

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doing so under fee-for-service reimbursement. As Mechanic and Altman report, "... although pilot projects will not have much effect on national health care spending in the short run, they can encourage innovation in health care delivery by reducing or eliminating the link between service volume and provider revenue." What does all of this mean for CHE? It means that a window of opportunity has opened for us ... because our trains will meet many times as we travel toward 2017. CMS will seek models of care that are embodied by our ACT, comprehensive care management, and CareLink initiatives--models that are centered on the patient; create ways to make patients meaningful participants in their own care; utilize technology to coordinate care over time and across settings; and utilize comprehensive care plans to coordinate care for complex, chronically ill patients. "We believe that we can position CHE as a "one stop shop" for many of CMS's future pilots and anticipated program funding," said Scott Ash, vice president, business development, CHE. "Unlike many other more homogenous health systems, CHE is a `real world', geographically dispersed ministry, representing the entire spectrum of services along the health care continuum. We have teaching hospitals in urban locations, community hospitals in suburban and rural locations, and home care, assisted living and long-term care facilities located throughout the East Coast." Indeed, innovation will be an engine for attaining our Vision for 2017. Our public commitment to innovation--

CHE Innovation Center:

through the establishment and development of the CHE Innovation Center--can create a competitive advantage for CHE. "We believe that the CHE Innovation Center is the vehicle that will enable us to bring our Vision 2017 to life ... and `to scale'," said Ash. A coordinated, system-wide effort will allow CHE to mobilize and accelerate person-centered care initiatives, replicate and scale practices and programs, coordinate initiatives, accelerate and cultivate local and system-wide innovation, operate as a data repository of innovative practices, and serve as a resource for information and idea exchange. The CHE Innovation Center will serve as a resource for RHCs developing innovative initiatives and seeking funding opportunities, serve as a public face of real-world "demonstration/pilot" sites, partner with external organizations, identify funding possibilities and pursue system-wide initiatives. Local participation will be key to the success of the CHE Innovation Center. System office leaders will work hand-inhand with local RHC/JOA experts to develop work plans, create replicable tool kits, prioritize and seek funding opportunities and implement a communications plan.

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We believe that the CHE Innovation Center is the vehicle that will enable us to bring our Vision 2017 to life ... and `to scale'.

Scott Ash, vice president, business development, CHE

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We have recognized from the beginning that the journey to 2017 brings risk. After all, we are transforming our delivery model and the ways we are paid for our services. Fortunately, CMS is giving the industry an opportunity to mitigate those risks while learning from others. We will utilize the CHE Innovation Center as a cornerstone to help us make the transition, as our train crosses the final planks on the bridge to 2017. "The CHE Center for Innovation will be another vehicle to achieve person-centered care and Vision 2017," said Daniel Feinberg, M.D., vice president, clinical excellence, CHE. "We will take advantage of the current landscape to replicate pilots of truly innovative, evidence-based care to other settings in our ministries." Years ago, Dwight D. Eisenhower observed, "Neither a wise man nor a brave man lies down on the tracks of history to wait for the train of the future to run over him." We are fortunate that our leaders set the Catholic Health East train into motion years ago. Today, the industry has its own train as well. We will be leaders--not because we get out of the way, but because we will travel alongside and transform communities along the way. All aboard! For more information about the CHE Innovation Center, contact Scott Ash at [email protected]

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to Improve Service to the Community

n affiliation agreement between St. Peter's Health Care Services, Northeast Health and Seton Health is expected to bring significant improvements in health care to the capital region of New York State.

"What is really driving us is our desire to develop a system which better meets the needs of the community," said Steven P. Boyle, president and chief executive officer of St. Peter's. Together, the new system will bring together St. Peter's Hospital's state-of-the-art tertiary care services, its community hospice, and two skilled nursing facilities; Northeast's Albany Memorial and Samaritan hospitals, Sunnyview Rehabilitation Hospital and The Eddy's renowned eldercare services including skilled nursing, Alzheimer's, adult day services, home care and community services, and retirement and assisted living; Seton adds St. Mary's Hospital, a skilled nursing facility, certified home care agency, 14 physician office locations and an array of specialty services. "By transforming health care at the regional level, our organizations will be much better positioned financially to meet future challenges," said Boyle. "Our system can be proactive, not simply reactive, to the changing environment and lowering overall community expenditures on health care and reinvesting those dollars in clinical development and better patient care." The three systems have drafted a preliminary "blueprint" for the new unified system. The design calls for the continued operation of all five hospitals: two in Albany, two in Troy and Sunnyview Rehabilitation Hospital in Schenectady. A key aspect of the plan is the estimated investment of $55 million in facilities and information technology upgrades, including nearly $50 million in facility upgrades to the

St. Peter's President, CEO Steven P. Boyle, center, signs an affiliation agreement that clears the way for a merger between St. Peter's and two neighboring health systems--Northeast Health and Seton Health. At left is Seton president and CEO Gino Pazzaglini, with Northeast president and CEO, James Reed, M.D., at right.

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Northeast, St. Peter's, and Seton are affiliating to explore health care reform ­ to improve when, where and how care is provided.

Steven P. Boyle, president and chief executive officer St. Peter's Health Care Services

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two hospitals operated by Seton Health and Northeast Health in Troy. Troy will also benefit from the availability of more sophisticated cardiac services and a new outpatient cancer treatment center. The new corporation is expected to be formally created by the end of the year. It could take as many as three years for the new corporation to fully integrate the three current health systems. Working with a consultant, the three systems will also be selecting a name for the parent corporation. This new not-for-profit organization will become the "parent corporation" for the Northeast, St. Peter's and Seton health systems. The new company will be a member of Catholic Health East and will abide by the Ethical and Religious Directives of the Catholic Church. However, the new company will not be a Catholic entity. St. Peter's and Seton Health's St. Mary's

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Hospital will retain their Catholic identities and Northeast Health will remain a secular organization. No disruption of staff or management personnel is expected during the planning and integration process. Most changes will likely occur over a three-year period following the merger. "St. Peter's core philosophy is to preserve jobs," Boyle said. "The primary reason for this affiliation is not to reduce jobs. Northeast, St. Peter's and Seton are affiliating to explore health care reform--to improve when, where and how care is provided." Prior to the formal affiliation, Northeast is creating a separate health care entity at Samaritan Hospital to provide prenatal care, birthing and sterilization procedures (tubal ligations and vasectomies). Known as the Burdett Care Center (BCC), it will be a separately-licensed, independent organization, governed by its own board.

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Rebuilding Haiti: Seven Months Later

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ince the January 12 earthquake that devastated the nation of Haiti, Catholic Health East colleagues and friends have come together to provide support through donations and volunteer support. Through Global Health Ministry, colleagues have helped to provide supplies, clothing, food and medical care to thousands of Haiti earthquake victims.

Now seven months later, although the immediate crisis of treating trauma victims has passed, Haiti continues to struggle with its long-term needs. A number of Haitian clinicians have found themselves in need of employment, not for a lack of need ... but due to two factors: 1) Most private hospitals, medical practices and clinics were destroyed, and 2) the few hospitals still providing inpatient and outpatient care need funding support to employ them. "Except for specialists not available in Haiti, it is crucial for the long-term revitalization of the country to employ Haitian clinicians who want to stay in Port-au-Prince and care for their people," said Sr. Mary Jo McGinley, executive director, Global Health Ministry. Some of the donations to Global Health Ministry have assisted in providing Haitian physicians to staff outpatient clinics for this year. However, the majority of the donations will be used to help build the new hospital. The generosity shown by colleagues, volunteers, Sponsors, board members and other donors has been enormous. To date, donations to Global Health Ministry for Haiti total $612,123*. Figure 1 is a snapshot of how our colleagues and friends have showed their support to date. Of the funds received, $514,831 has been earmarked for the rebuilding of Hospital St. Francis de Sales; $57,292 has been allocated for operations at the hospital; and $40,000 is being used to provide supplies and medical care to the Haitian people. At this time, inpatient and outpatient services are still continuing in the two

Rendering of the plan for the new Hospital St. Francis de Sales to begin construction in early 2011 in Port-au-Prince, Haiti.

The new Hospital St. Francis de Sales will be built with an eye to the future ... [and] will provide up-to-date quality care for the people of Haiti.

Sr. Mary Jo McGinley, executive director, Global Health Ministry

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buildings still standing at the Hospital St. Francis de Sales site. During August, these services will be relocated to a temporary site at nearby St. Charles Seminary so that demolition can take place and construction can begin on the new hospital. Services at the temporary site will include inpatient, outpatient, surgical, emergency and rehabilitation services. There are also plans for the rehabilitation center to become a permanent facility for persons who need ongoing care as a result of earthquakerelated trauma. Construction of the new hospital is expected to begin in early 2011, with hopes for completion during the first half of 2012. Once the new hospital is completed, the Maternity Services Unit will be dedicated in honor of Robert V. Stanek, former president and chief executive officer of Catholic Health

East who helped to spearhead fundraising efforts for the new hospital. There is a strong commitment to continuing the Catholic health care ministry in Haiti. Catholic Relief Services (CRS) and the Catholic Health Association (CHA) have teamed together to assist in the long-term planning to support Catholic health care in Haiti. And CHE has been at the forefront in responding to the request for professional and technical support to assist HSFS. "The hospital now has a chance to start over and make improvements," said Sr. Mary Jo. "The new Hospital St. Francis de Sales will be built with an eye to the future, including plans for telemedicine, as well as other technologies and advances that will provide up-to-date quality care for the people of Haiti." For more information or to make a donation, contact Sr. Mary Jo McGinley at [email protected]

*As of July 21, 2010

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Provides Executives with Tools to Lead

n 2007, in order to provide our leaders with a comprehensive understanding of and commitment to the Catholic tradition, Catholic Health East launched the Program for Excellence in Ministry, which was developed as a requirement for all executive leaders throughout CHE.

Program for Excellence in Ministry

The Program for Excellence in Ministry is an ongoing program, consisting of six `modules' which are completed two per year over a period of three years. Each module is a two-day session focusing on a specific topic. The first `cohort' consisted of 27 colleagues, all members of executive teams from across the system, who gathered to begin a multilayered process of enrichment and growth as ministry leaders. In Spring 2010, they became the first leaders to complete the program. "As the first Cohort completed the Excellence in Ministry program, there was a palpable sense that something significant had occurred in the course of the shared threeyear experience," said Martha Conroy, director, sponsorship education and ministry formation, CHE. "Colleagues expressed a deepened commitment to their work as a ministry, along with a greater sense of responsibility to be stewards of the Catholic health care ministry. It was not uncommon to hear participants describe this responsibility as `awesome'." The robust curriculum explores important topics from the biblical foundations of Catholic health care and Catholic social teaching to servant leadership and organizational ethics. Each teaching segment is balanced by a time of "reflective integration," including table discussion, journaling, partner walks, large group discussion, silence and artwork. The goal of the program is to provide CHE leaders with competencies including the

Participants from the first cohort use time during the retreat at the Bethany Center to reflect and discuss ideas with each other. Pictured from left: Sharon Beales, vice president, foundation and Terri Rivera, vice president, mission, St. Mary Medical Center (Langhorne, Pa.); and Kenneth Becker, vice president, advocacy and fund development, CHE.

ability to: · Apply the principles of the tradition in daily work. · Make decisions aligned with CHE values. · Lead reflective processes. · Nurture one's personal spirit. · Glean strength and courage for today's work from the richness of our heritage. · Call others to servant leadership in the ministry. One of the noticeable outcomes of the process was the gradual growth of a sense of connectedness among cohort participants. Meeting with a group of colleagues over the course of three years allowed the group to become true partners and created within itself a sense of systemness. "We knew we wanted our colleagues to belong to `stable learning communities'," said Conroy. "But we underestimated how quickly and deeply the bonds of community would grow." According to participants, who were asked to evaluate the program upon completion,

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this outcome was definitely shared. Here is a sampling of their responses when asked to complete the following sentence: "The best part of the Excellence in Ministry Program was ... ... collaborating with others across the system." ... meeting and spending time with colleagues from across CHE who I might otherwise not have met." ... the people coming together to deepen our shared ministry." ... getting to know others within the system, sharing thoughts, understand struggles others encounter in their work." ... the creating of community." "The routine of meeting twice per year and the reflection time incorporated into each module provided me the opportunity to slow down and consciously reconnect with my calling to serve in Catholic health care--from both a professional and a personal perspective," said Greg Wozniak,

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Provides Executives with Tools to Lead

president and CEO, St. Mary Medical Center, Langhorne, Pa. "As the three years progressed, it became very evident that we face similar issues and can rely on each other to assist with our daily ministry activities. I left each module with a heightened appreciation of CHE and the greater Catholic health care ministry, and additional knowledge and energy to serve it." Participants learned that they are all part of something larger and that they are not alone in the decisions they make or the issues that come across their desks. The program allows them to not only learn about the foundations of our ministry, but to become partners with each other in the growth of CHE's ministry. "The Excellence in Ministry Program was an exceptional experience; it enriched my life and `took me away from the day-to-day experiences' to focus on the values and essence of Catholic health care," said Sr. Maureen Reardon, R.S.M., Ph.D., senior vice president, mission services and compliance, Mercy Community Health in West Hartford, Conn. "The times for reflection and sharing highlighted the importance for leaders to continue self-development and to network with those who share responsibility for leading today and preparing for tomorrow. The prominent role of Scripture as an educator and storytelling as a means of communication created new ways of forging ownership with colleagues. At all times standards of excellence were before us and challenges created new opportunities to excel." The capstone retreat, which is the final module of the program, was designed to be an integrative experience enriched by prework completed by each participant. In the previous five modules, presentation time was balanced by opportunities to discuss issues with colleagues, apply the material to real-life situations or to be reflective as an individual. During the retreat, far less content was presented and more time was provided for reflection and personal integration of the material. Participants even responded to an invitation to "fast from Blackberries" for portions of the day. Many participants noted that the beautiful environment of Bethany Center in Tampa, with its lakes and walking trails, contributed to the reflective atmosphere and enhanced the entire experience. "It has been a wonderful experience to be part of the journey of cohort one," said Sr. Juliana Casey, I.H.M., executive vice president, mission integration, CHE. "The members' participation exceeded our hopes. Their wisdom and their commitment to the ministry of Catholic health care are deep and wide. Our ministry is in safe and blessed hands. All of us are blessed to have so many dedicated women and men as colleagues and as system leaders." This first cohort paved the way for other cohorts which currently involve 210 CHE colleagues. Two of these groups will complete the program in the fall of 2010 with a retreat in Tampa, Fla.; and four more groups will continue their progress through 2011. While the program came to a successful conclusion, participants were already asking "What comes next?" Plans are underway for future opportunities to continue the mutual learning and development that has begun. Colleagues who have completed CHE's Foundations course and who are members of executive teams are eligible to be part of the Excellence in Ministry program. For more information about the Program for Excellence in Ministry, please contact Martha Conroy, director, sponsorship education and ministry formation, at 610.355.2067 or [email protected]

Program for Excellence in Ministry

This ongoing program--a requirement for executive leaders--is comprised of six two-day sessions which take place over the period of three years.

Program for Excellence in Ministry

Module 4: Catholic Social Teaching

which supports and sustains those who serve as ministry leaders.

Module 1: Biblical Foundations of Catholic Health Care

Relating their own experiences to the fundamental biblical themes of call, relationship, suffering, healing, and caring for those who are poor. Recognizing that the stories of their organizations are contemporary expressions of the biblical story of caring for those in need.

Understanding at a deeper level the key concepts of Catholic Social Tradition; exploring the scriptural roots and modern sources of these practices; applying these practices to our local ministries in ways consistent with the "signs of the time."

Module 5: Organizational Ethics

Evaluating the moral choices of individuals and the organization itself in pursuit of the organization's mission; focusing on organizations as moral agents.

Module 2: Church and Sponsorship

Understanding the various characteristics and dimensions of the Catholic Church; identifying the mission of the Church and how we share in it; exploring the meaning, responsibility and challenge of contemporary sponsorship.

Module 6: Capstone Retreat

Providing colleagues with an opportunity to internalize more deeply the principles, insights and values of the first five modules; exploring the connection of these elements to Vision 2017; celebrating the experience of community in a reflective, prayerful atmosphere. Each teaching segment is balanced by a time of "reflective integration," such as table discussion, journaling, partner walks, large group discussion, silence and artwork.

Module 3: Ministry and Servant Leadership

Exploring how Catholic health care is an official ministry of the Church and how the executive's role is one of `ministry leader'; deliberately integrating principles of servant leadership into one's own personal style of leadership; recognizing how spirituality is a key element 7

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Builds Teamwork, Positive Outcomes

Rapid Process Improvement

n accounts payable office was struggling to find ways to improve the processing of invoices. A hospital faced obstacles in trying to develop and implement a centralized patient scheduling system. At another hospital, the process of admitting emergency room patients and getting them to their rooms in a timely fashion needed to be improved.

What do these three situations have in common? They are typical of the "high volume, low complexity" problems that are commonplace at all busy hospitals across the country ... and they can be addressed using a management tool known as rapid process improvement (RPI). Several CHE Regional Health Corporations (RHCs), as well as the System Office, are now using the RPI process to simplify how key day-today operations are performed, increase employee morale through enhanced teamwork and increase revenue. Based on a five-day, intensive examination of an identified crossfunctional process, stakeholders from all levels analyze the process at hand, discuss barriers and develop "low cost, no cost" solutions to the barriers. A "playbook" is created from the strategies developed with the steps defined to ensure that the solutions are properly executed. RPI has been used at several RHCs including St. Francis Hospital, Wilmington, Del., Mercy Health System of Maine, Portland, Maine and Holy Cross Hospital, Fort Lauderdale, Fla., in various hospital departments with results that have stood the test of time and provided a considerable return on the investment of time and energy with quantifiable financial returns to the organizations. At CHE, the accounts payable shared services (APSS) department recently examined the way their non-purchase order (PO) invoices were being processed and recognized the need for improvement. Mary Thibodeau, accounting manager, St. Francis Hospital, was asked to take part in the

Mercy Health System of Maine team members used stuffed animals as a team facilitation tool. The squirrel allowed team members to keep fellow team members `on track'; "Taz" was thrown for bad jokes; the bear was given to someone with a good idea; and the grapes were given to fellow team members for `whining'.

Using the rapid process improvement process, RHC and System Office colleagues discuss ways to improve the processing of invoices.

process at the System Office. "We were given the task to dissect every step that is taken in the nonPO invoice process--from entering invoices through final approval." Irene Pilarz, administrative assistant, information services, processes hundreds of invoices for the IS department. "Having a visual of the hundreds of steps and how many duplications and unnecessary steps there were made such an impact on everyone." "Our week started with creating a detailed baseline process map that described the way the process was currently being worked. We then identified the barriers that are encountered throughout the process," said Thibodeau. "The barriers included issues as basic as the quality of the invoices that were received in AP to the more complex issues such as receiving an electronic invoice. We got together as a team and went through each barrier and the recommended solutions and agreed as a team on our final solutions. Of the 105 barriers identified, there was only one that we felt we could not solve." "Barriers can be looked at as opportunities or solutions," said Stephen Dickinson, president, Practical Quality Services, Inc., (PQS), who is a consultant in the process and who served as the facilitator for the RPI effort. "One way barriers can develop is out of a lack of standardization in the work process. They also develop over time by

making incremental changes to the process without stopping to look at the impact on the entire work system. Processes that worked well years ago can now be clumsy and filled with `workarounds'. The PQS RPI process allows us to look at the entire work system with the people who perform the work every day and allow them to design the process so that it works best for them and the customer. The best way to approach the lack of standardization is to redesign the process so that customers are not learning frequent updates but are utilizing what is called the playbook. The playbook provides step-by-step instructions on the process. The team has to ask themselves, `how can we redesign the process so it will not fail?' At St. Francis Hospital one charge was to improve their central scheduling process. "We identified each step of the process to schedule an appointment for a procedure from the perspective of a patient, a physician and an internal user of the system," said Maria C. Phillips, director of imaging and cardiology services. "We identified many barriers to the process and like other RPIs, developed solutions for each of the barriers and developed our operations playbook which detailed a step-by-step process to accurately and quickly schedule a patient for an examination." Earlier this year, St. Francis also used the process in the emergency department to decrease the time it took for a patient to get to an inpatient bed once the decision had been made to admit the patient.

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Rapid Process Improvement

"I have found that RPIs have been great team building and culture changing agents," said Amy Davis, PHR, interim director of process improvement, Mercy Health System of Maine. Thibodeau agrees. "... I am honored to be part of the team at CHE. It was great working with colleagues from CHE and other RHCs. I was also glad that I could represent the RHC side of the process."

"The RPI process has helped the ED move our patients across the continuum of care. Our patient satisfaction is improving as a result of less time spent waiting for an inpatient bed. We want our patients to share their experience with their families and friends so that we are the hospital of choice in our community," said Mary Beth Holland, R.N., B.S.N., director of nursing, emergency services, St. Francis Hospital. Since RPI is intended to work on low cost, no cost solutions identified by the people who actually do the work, teamwork is crucial for this process. "It's a people-driven process," said Dickinson. "Together they must work with one another in the weeklong event, as well as work with their colleagues post-event for full implementation in order for RPI to have validity and sustainability." RPI is a detailed and standardized process that requires minimal technical skills. Employees can be trained to facilitate these events without the need for consultants. For example, at Mercy Hospital in Portland, Maine, 10 colleagues from various departments have been trained to be inhouse facilitators and some will be involved in RPI initiatives at Mercy.

care physician practices," said Wayne Bennett, CFO, Mercy Health System of Maine. "We estimated a savings of several hundred thousand dollars from our first project on timeliness of billing using RPI."

Phillips was also on site at the System Office during the training. "The week has helped to solidify relationships that were previously formed only through e-mails--it was great to put faces to names! I look forward to working with them as we complete the steps of our operations work plan and participate in follow-up events." In addition to a bonding experience for the colleagues and having a more productive work environment, delivering quality patient care and saving money are two other significant results of the RPI process. "In our facility RPI has reduced variation in the time it takes to submit a patient's bill, reduced the time to transfer patients from the ED to an inpatient bed and reduced variation in the patient registration process for our primary

At St. Francis Hospital, one of the positive outcomes of its improved centralized scheduling process is the ability to attract more ancillary testing appointments. For example, the ease and convenience of the new system resulted in an additional 37 radiology procedures in a two week period from patients seen in its family practice office--appointments and revenue that probably would have been lost to competitors prior to the RPI initiative. Mercy Maine is sold on its outcomes. "As an organization we would like to continue to use RPIs on processes that will drive the Mercy strategic plan," said Davis. Bennett agrees, "We've been using RPI for a year and plan to use RPI as one of our key tools to elevate organizational performance." And at the System Office in APSS, the process is progressing. "I'm looking forward to seeing the playbook come to life," said Bob Leposki, APSS mail/scan clerk who participated in the training process.

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provide that service in a matter of minutes." Using NexTalk's Healthcare Suite, the hospitals provide immediate, reliable, high quality audio and video access to a qualified interpreter 24hours-a-day, seven-days-a-week for their patients. BayCare facilities--including St. Joseph's Hospital, St. Joseph's Hospital emergency room, St. Joseph's Children's Hospital, St. Joseph's Women's Hospital and South Florida Baptist Hospital--are each equipped with a Workstation on Wheels (WOW). When clinicians need to communicate with a deaf patient or his/her caregiver, they check out a laptop to allow for the virtual interpreter to communicate via live time using the NexTalk software while it sits on the WOW. The WOW is then rolled to the patient's bedside and the clinician signs on. The patient is immediately connected to an ASL interpreter who is medically certified to do medical interpreting and meets the requirements of the Americans with

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Disabilities Act. Nurses, physicians and family members can communicate quickly with the patient as their voices are translated via the interpreter.

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... the patient can see the live, real time interpreter on the screen and the webcam is directed to the patient so the interpreter can see the patient.

Judy M. Plouffe, R.N., H.C.R.M., South Florida Baptist Hospital

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"The inpatient psychiatric services staff and a hearing impaired patient benefited greatly from using this device," said Leokadia Bryk, R.N., charge nurse, St. Joseph's Hospital psychiatric department. "This patient, although he was able to write, had never learned to make coherent sentences. During his video sessions, he was very literate with his sign language and very communicative. As a result we were able to comprehend his needs." Consistent with our Mission and Core Values, CHE's Culture of Inclusion (COI) is represented in this example. By definition, a COI is "an environment that rewards and motivates all individuals to fully realize their potential while seeking, receiving, providing or contributing to care." Therefore, both the patient and caregiver are involved in the process and helping to contribute to optimal patient outcomes. For more information about BayCare's experience using this technology, contact Beverly Littlejohn at [email protected]

"It works a lot like SkypeTM where the patient can see the live, real time interpreter on the screen and the webcam is directed to the patient so the interpreter can see the patient. There is audio so that the caregiver can hear the interpreter and communicate what the patient has signed to them. The interpreter speaks, as well as signs so that the caregiver knows what the interpreter is saying to the patient," said Judy M. Plouffe, R.N., H.C.R.M., risk management/medical staff quality improvement, South Florida Baptist Hospital.

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St. Joseph of the Pines' Health Center and The Coventry (Southern Pines, N.C.) received awards for deficiency-free surveys at a recent board meeting. Pictured: John Capasso, president and CEO, continuing care management services network; Caroline Hendricks, administrator, The Coventry; Raymond Esteves, director of health services, St. Joseph of the Pines. This is the fourth deficiency-free year for The Coventry.

(Photos courtesy of Busch Gardens/Matt Marriott.)

Residents at BayCare Health System's John Knox Village (at left) and team members welcomed the arrival of new "residents." The koi, donated by Busch Gardens Tampa Bay, will live in the pond at Serenity Place. Serenity Place incorporates boardwalks, a bubbling waterfall, a pond, picnic tables and canopies. It is a relaxing space for residents who enjoy feeding the aquatic occupants. Pictured at right: Mike Malden, Busch Gardens zoological supervisor, releases the koi into their new home.

Members of the OR Fire Safety Committee at Holy Cross Hospital (Ft. Lauderdale, Fla.) practice their fire extinguishing skills during a recent drill. As part of its `Journey to Safety', the committee wanted to move beyond theory to practice by extinguishing fires as well as evacuating patients.

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Saint Michael's Medical Center (Newark, N.J.) was one of only a handful of U.S. hospitals selected to participate in a sequel to the Pink Glove Dance, the wildly popular YouTube sensation profiled on Fox and Friends in the Morning and ABC World News Tonight. Members of the hospital's central sterile processing department (pictured) joined more than 70 colleagues in performing choreographed dance routines for a music video intended to shine the spotlight on the fight against breast cancer. The video will be released in October to coincide with National Breast Cancer Awareness Month.

Dr. Catherine Plzak (second from right), medical director, St. Mary Breast Center, and her office staff won the Team Spirit Award in the St. Mary Medical Center (Langhorne, Pa.) walking challenge. The challenge, presented by St. Mary's Colleague Wellness Program, encouraged colleagues throughout the hospital to walk more than 6,000 steps a day. The Colleague Wellness Program provides activities, tools, resources and screenings to help them adopt healthy, lifelong habits and improve their quality of life.

Mary Borel, left, telehealth RN coordinator at Mercy Medical (Daphne, Ala.), helps Mable Lamar take her vitals using the telehealth system. Telehealth is a home-based monitoring system designed to reduce the number of hospital readmissions through daily monitoring of patient's vital signs. Lamar is a retired cardiac nurse, with 40 years' experience. She was one of Mercy's first patients to experience telehealth. Mercy Home Care introduced telehealth in March and many patients have successfully used and now advocate its great benefits.

Ray Hoover, R.N., a night shift nurse in the emergency department at St. Mary's Health Care System (Athens, Ga.), was named one of Georgia's 10 best nurses in the fifth annual AJC Jobs Nursing Excellence Awards in May. Ray was nominated by Tom Folds, a patient who came to St. Mary's ED with severe and worsening breathing problems. AJC Jobs recognized Ray from among more than 330 nominees for going above and beyond the call of duty to provide his patients with high quality, compassionate care.

Nazareth Hospital (Philadelphia, Pa.), a member of Mercy Health System of Southeastern Pennsylvania, celebrated its 70th birthday with cake, ice cream, a display of historic photos, a Nazareth trivia contest and a birthday poster for colleagues and visitors to sign. The signed card was framed and placed in the visitor lobby.

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ichael McCoy, M.D., joined Catholic Health East as the system's chief medical information officer (CMIO) in May 2010. Dr. McCoy, a practicing OB/GYN for over 20 years, previously served as CMIO at a multi-hospital health system and as an executive with several electronic health record (EHR) vendors. McCoy participated in the American Recovery and Reinvestment Act and HITECH Meaningful Use testimonies before the Health Information Technology Standards and Policy Committees in 2009. He received his medical degree from the Medical College of Georgia and is a board-certified fellow of the American Congress of Obstetricians and Gynecologists. The role of CMIO is a new position at CHE. Can you explain a little about your role and how you will interact with the RHCs? Chief medical information officers serve as the "universal translator" between clinicians and IT professionals, helping each side understand what the other wants and needs to do their jobs effectively. It is somewhat ambassadorial in nature, helping communicate and set expectations, guiding people to an understanding of what is possible or not. This role was set up to help guide our RHCs in this process. Communications with our RHCs about the role of CareLink in supporting their day-to-day activities caring for patients is very important. I plan on visiting every RHC to gain an understanding of their specific concerns and interests. Given the number of RHCs, this will take me a while, but I look forward to it! How do you view your role as part of CHE's overall goal to shape the future of health care system-wide? My role is simply as the facilitator and messenger for a much larger team with whom I am privileged to be involved. I am looking forward to working with the talented and resourceful team of clinicians and information technology people that is really making this possible. CareLink is a major step in CHE's journey to person-centered care, and our senior management team began emphasis on evidence-based care over a year ago. With CareLink as a supporting part of that program, we are beginning the process of ensuring the best possible quality care is delivered using data and measuring outcomes. Reducing variation in care given improves outcomes. The federal government is now

HORIZONS is a publication for the Sponsors, Boards, Regional Leadership, System Office and Colleagues of Catholic Health East. Published by:

M

10 Minutes with... Michael McCoy, M.D.

others will be "nice to have" features that may not be done for quite some time. What do we need to know (the System Office, RHCs, JOAs, etc.) about the CareLink initiative? What do you feel are the most important points for us to understand--not just the clinical staff; but colleagues in non-clinical areas as well? CareLink is the biggest, most significant investment in ourselves as a project that CHE has ever undertaken, period. The impact on our RHCs is significant, and is causing (or will cause) significant angst among users of the system, because it is new to them, or is a new way Michael McCoy, M.D. of doing things, or it is impacting their workflow. But the good thing about CareLink is the power it will bring recognizing this via "meaningful use" measures that, to CHE in being able to evaluate the care given in ways in part, require reporting quality and outcomes to we never could before. Having accurate, real-time data receive payment. allows us to refine treatments, provide clinical decision support to providers of care when and where they What are some of your need it, and allows us to give better care to our immediate goals and priorities? patients. One immediate goal is to help our RHCs identify As an example, allow me to compare this process to the people, physicians and clinicians such as nurses how most of us now transact our banking. How many or pharmacists, who may have the desire and/or people would still want to go to a bank where there knowledge to assist in the process, and providing was no ATM services to withdraw cash after banking them with further mentoring and assistance so they hours, or at a location remote from the one branch in turn may help their colleagues with CareLink where you did business? Technology has enabled the deployment. Another high priority is facilitating consumer to do financial transactions when we want creation of evidence-based content, orders, order and need to, not encumbered by the artificial times the sets (collections of orders based on a disease or bank is open. Over time, CareLink will allow physicians, procedure) and pathways/guidelines (collections of clinicians and patients to all have that same freedom interventions or treatments that may include and improved experience. Physicians will have clinical nursing, diets, physical or respiratory therapy, etc.). decision support helping give them important information to optimally treat patients. With What are some of the challenges you expect computerized entry of orders, legibility is no longer an to face as we move forward with CareLink? issue, and the length of time it takes from an order to It is much easier to do the routine and familiar fulfillment is decreased. Patients receive better care, rather than change, even when we know that with better outcomes. change is needed and appropriate. So, a major challenge will be helping everyone see that the focus What are the most crucial elements must be on the reason for change: better care for to ensuring the CareLink initiative is a success? the patient. It will also be challenging to get The most critical element for success is one we everyone to see that Catholic Health East must think already have: support of senior leadership for this more about how to work together as a system, project and in providing evidence-based care for our collaboratively, cohesively. External pressures from patients. A second crucial element is in the active payers and the federal government demand it. We participation of our physicians and clinicians. We must must also ensure that we are responsive to our continue to demonstrate and communicate the value physicians and clinicians as we deploy the Meditech CareLink brings to CHE, to the patient, to our clinicians, and Siemens systems. We must quickly evaluate and to the physicians. Finally, success is contingent on feedback, and provide acknowledgement of issues, all of our CHE colleagues understanding the enormous and our expected resolution for that issue. Some positive impact CareLink will have for our patients, and issues will be prioritized and quickly resolved because being supportive of changes coming through the they have a patient safety or quality impact, while redesign and optimization of our care processes.

Horizons Editorial Staff Scott H. Share Vice President, System Communications Maria Iaquinto Communications Manager Meg J. Boyd Communication Specialist

3805 West Chester Pike, Suite 100 Newtown Square, PA 19073 Phone 610.355.2000 Fax 610.271.9600 www.che.org Please direct comments and suggestions to [email protected]

Design, Production, Printing & Mailing Fulfillment by JC Marketing Communications · jcmcom.com · Southington, Conn. Catholic Health East is a community of persons committed to being a transforming, healing presence within the communities we serve. Locations: Located in 11 eastern states from Maine to Florida. Workforce: Approx. 54,000 employees.

Sponsors Congregation of the Sisters, Servants of the Immaculate Heart of Mary, Scranton, Pa. Franciscan Sisters of Allegany, St. Bonaventure, N.Y. Hope Ministries, Newtown Square, Pa. Sisters of Charity of Seton Hill, Greensburg, Pa. Sisters of Mercy of the Americas: Mid-Atlantic Community, Merion Station, Pa. New York, Pennsylvania, Pacific West Community, Buffalo, N.Y. Northeast Community, Cumberland, R.I. South Central Community, Belmont, N.C. Sisters of Providence, Holyoke, Mass. Sisters of St. Joseph, St. Augustine, Fla.

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