It was a long but productive 24 hours. A team of us from the health system flew to Durham, NC, on Tuesday evening, spent a 10 hour day on Wednesday at Duke Medicine, and then flew home. It was a site visit aimed toward learning from each other and determining opportunities for collaboration.
UMHS and Duke have similar profiles: our overall size, IT infrastructure and core applications. We are in similar places on our EHR journey with Epic. And we are both very focused on analytics – the impetus for our visit.
Duke’s CIO, Dr. Jeff Ferranti, and I know each other; we thought the proposal for a visit was a great idea. Our Chief Medical Information Officer, Dr. Andrew Rosenberg, and Duke’s Chief Health Information Officer, Dr. Eric Poon, planned and organized the day’s agenda. We let Andrew and Eric run with it and they did a terrific job!
Two important clinical leaders joined our Michigan team of several senior IT leaders — Dr. Jeff Desmond, our Chief Medical Officer, and Dr. Steve Bernstein, Associate Dean for Clinical Affairs. We needed them there as we talked broadly about analytics and support for population health. Continue reading
Each year UMHS celebrates Quality Month and this year is no exception. Last week as part of our Lean Thinker’s Series, Dr. Richard Shannon, EVP Health Affairs, University of Virginia Health System, gave an excellent talk titled “Patient Safety and Quality: The New Currency in Academic Health Centers”.
It was good to hear how another academic medical center is approaching similar challenges and applying lean. Some of my takeaways from his talk and the lunch discussion that followed:
- Dr. Shannon described their Be Safe initiative – “Our Be Safe initiative is advancing our status as a high performing organization by systematically applying the scientific method (Lean Principles) to improve the safety of our patients and workforce through real time problem solving.” He shared examples of how they have reduced the incidence of hospital acquired infections, a problem for all hospitals.
- Senior executives hold a “situation room” and digital report out each morning. They spend 15 minutes reviewing critical problems that have been reported and then spend the next 45 minutes actually going to the units to understand the specific problems more deeply. And they do it on Saturdays as well.
- Their IT team plays a central role in providing data and reporting in support of their daily management system. They have developed the “Be Safe” reporting system. It is a common platform that supports daily manual entry from any employee and takes automated updates from other feeder systems. He emphasized the importance of having actionable data. All of their A3s are done online and uploaded to a library that can be queried. Patient safety events are documented with an online form as part of the system. I plan to reach out to their CIO, Rick Skinner, who has shared some of their lean stories with me in the past. Having heard Dr. Shannon’s talk, it’s time to get a much better understanding of their system.
“Huddles, not just another meeting;” I wrote that when we started our twice a week IT leadership huddle in April. How true! And as of three weeks ago, we have another leadership huddle experiment in progress – the daily hospital leadership huddle. It is part of our developing lean Daily Management System.
Our Acting CEO and COO for the University of Michigan Hospitals and Health Centers, Tony Denton, runs the daily huddle. As Tony said in his initial communication, “The purpose of the leadership huddle is for senior leaders to have daily awareness of issues that may impede our ability to provide service. The leadership huddle is the “top tier” of a daily management system designed to surface issues and problems, assign leads for pro-active problem-solving efforts, examine trends and track progress. It is a key aspect of developing a more effective Michigan Operating System. If successful, we expect to see continuous improvement in our safety, quality, timeliness and financial results, and enhanced ability to deliver ideal patient and family care experiences through the engagement of our people.”
The value of these leadership huddles was clear the first week. Continue reading
Against all odds and in spite of personal risk – doctors and nurses provide health care, especially emergency responders. We’ve all seen the stories and images from recent disasters and war zones.
The Hospital in the Rock Museum in Budapest, Hungary is one of the most vivid examples of providing care under adverse conditions. On a recent trip to Europe, I toured the museum; it’s an actual underground hospital built in a cave system inside Budapest’s Castle Hill.
We walked along long and twisting corridors into a series of irregularly shaped rooms. I could see that the rooms were, in fact, caves; the walls were painted rock. The ceilings curved domes. Now, the passageways and rooms are brightly lit, but I could imagine them lit more dimly in the past. The walls and ceilings were lined with pipes for water, air and electricity. Our guides told us that they turn off the ventilation systems during the tours because it would be too noisy for anyone to hear the narrations.
The Hungarians built the underground hospital in the 1930’s for about 60-70 patients. During WWII, and especially in the 1944-45 Siege of Budapest, it cared for 600 wounded soldiers. During the Cold War, it was converted to be a shelter in case of a nuclear war.
During WWII, the focus was on broken limbs and wound care and of course preventing infection. We saw small, narrow wards with bunk beds pushed next to each other; three patients could be fit into two beds if needed. We saw an operating theater that accommodated two patients. Talk about major infection prevention challenges! Continue reading
It doesn’t matter what you think about beauty pageants. It doesn’t matter if it’s been years since you watched one. If you have ever been cared for by a nurse you need to know about the dust-up last week following the 2015 Miss America pageant. Miss Colorado, Kelley Johnson, is a nurse and she was named second runner-up for Miss America. Her talent offering was a monologue describing how she cared for an Alzheimer patient and how it helped her realize how she was more than just a nurse. It is a talent clip that has been seen by millions at this point.
The women who host the daytime TV show, The View, disrespected Kelley and all nurses with their comments the day after. It sparked a social media firestorm for several days. Hashtags such as #NursesUnite were all over Twitter. Once advertisers pulled out of The View, the co-hosts apologized. Media outlets have covered this including Time Ideas and Huffington Post with posts describing what it means to be a nurse. Our own University of Michigan Health System video, “Day in the life of a nurse” was shared again widely on social media.
In support of nurses everywhere, I’m sharing “A salute to the nurses among us” post I published on May 12th during National Nurses Week. Continue reading
Last Saturday was a wake-up call that Fall is fast approaching. With morning temps under 50, it was fleece time. It was also the first home football game for the University of Michigan under new coach Jim Harbaugh. Blue and maize was everywhere I went in Ann Arbor. Our new coach and football team delivered a resounding victory in the first home game to everyone’s delight. But this isn’t about football or fleece, it’s about adapting to change – something we are expected to do often.
Yes, I donned a fleece when I ran errands and walked the dogs but I didn’t fully adapt – I still wore my sandals. I will only make that adaptation when I have to. I figure I can hold out for a few more weeks at least.
Season changes are to be expected and there’s no use fighting them. For us Northerners, yes, that means cold and snow as well in another few months. But there are many changes that we can’t anticipate, even some that seem to smack us upside the head. There are changes we choose, often after much thought and deliberation. And there are the ones we don’t choose or have no control over. But we eventually learn to embrace or at least live with them.
In our work lives there are always new processes and tools to learn and adjust to. Continue reading
Except for maybe start-up technology companies, there isn’t an IT department anywhere that has an open checkbook. In health care, we know all too well the need to manage costs while answering what seems to be an insatiable demand for technology solutions. CIOs need to understand the technical debt of a large application portfolio and the total cost of ownership (TCO) for systems. They need to find ways to reduce the cost of commodity services, and to create capacity for new work.
At UMHS, we have an initiative called Value and Margin Improvement, or VMI. The VMI program is a multi-year effort across the health system. UMHS leadership launched VMI to help achieve our financial stewardship goals by empowering collaborative teams to design and implement sustainable improvements that enhance value and financial results.
VMI aims at reducing duplication, inefficiencies and non-value added work in order to more effectively manage our costs, improve the value we provide and increase our margin. A positive operating margin allows us to invest in the future and better serve our patients, referring physicians, students, the research community, and other key stakeholders.
VMI projects take a balanced approach to improve and sustain overall value while still maintaining the desired safety, quality, service delivery, and employee engagement metrics. The program promotes the use of lean methodologies and collaborates with our central lean team, the Michigan Quality System (MQS).
We are systematically moving through Continue reading
1 in 9 people in the U.S have used it. Its reach extends to 236 countries. In 2014, 2.2 million new people joined communities. 300,000 people visit every day. More than 72,000 families created a website in 2014. Any idea what I’m referring to?
Those are some of the key stats for a social media tool called CaringBridge. It works like this: patients set up a private and secure website where they post journal entries about their health journey. They invite close family and friends to join their site, creating a caring and supportive community. Family and friends are kept up to date and they can post encouraging and supportive messages. It takes the communication burden off the patient and their immediate family so they can focus on healing. It replaces the black hole of not knowing for those who care and worry.
I first learned about CaringBridge many years ago when I was the CIO at Brigham and Women’s Hospital. We jointly sponsored it with Dana Farber Cancer Institute and encouraged our cancer patients to use it. At the University of Michigan Health System, we make patients and families aware of this service and another similar one called CarePages.
For all my years working in health care and using the main social media platforms, I’m finally experiencing firsthand the healing power of CaringBridge. Continue reading
It’s back to school time! College bound students and their parents are having a lot of mixed feelings. There’s the excitement and anxiety of starting something new, maybe far from home. And for the parents, the goodbyes and the reality of being an empty nester may just be sinking in. Parents sense that they’ve done their job and now, it’s launch time.
There are questions college students hate to hear – “what are you planning to study?”; “what do you want to do when you graduate?” They need to find their passion first. And who knows what kind of jobs will be there come graduation time.
Many of today’s jobs didn’t even exist 5 or 10 years ago. If you are on social media at all, you will see tons of job opportunities for just that – social media experts. But it’s just over a decade for two of the giants – Facebook and LinkedIn, and less than 10 years for Twitter.
And at the intersection of cars and technology, do you suppose the people working at Mcity thought 10 years ago that this is what they’d be doing? Continue reading
I’ve written about gemba walks. Gemba is the Japanese word for “the real place” or that place where the work is done.
I am fond of a quote from President Dwight D. Eisenhower: “Farming looks mighty easy when your plow is a pencil and you are 1,000 miles from the corn field.” While I don’t know the specific context for the quote, it applies to business today. As leaders, unless we see the way work happens on the front line, we cannot understand the problems we need to solve and the barriers we need to remove. That doesn’t happen by just meeting in a conference room.
All hospital leaders were assigned to do at least three gemba walks this summer. The walks are supposed to be an example of each of the following:
- patient and family experience such as observing check-in
- front line staff experience such as shadowing someone or attending a unit’s daily huddle
- “break out of your silo” experience such as observing one of your downstream customers or walking a “value stream” (a high level view of how work gets accomplished across multiple departments and physical locations)
We are expected to Continue reading