Volume 24
Number 9
May 3, 2013
Hospital of the University of Pennsylvania
EMOTIONAL
FIRST AID
A trauma nurse faces the tragic loss of a young patient close to his own son’s age. A transporter must bring an infant who died in the Neo-ICU down to the morgue. A pharmacist hears that his patient had an anaphylactic reaction to a medication. He discovers the medication allergy was documented but not acknowledged during the patient’s admission. A housekeeper learns that a long-time patient she has grown close to has coded and is now in an intensive care unit.
`` Offering emotional support to a staff member after an adverse event (enacted above by Kirsten Smith, MSN, clinical nurse specialist and Angelo DeFeo, BSN, of Dulles 6) is a key component of HUP’s Caring for the Care Provider program.
It’s a stigma in the medical profession; you don’t get upset, but how can a provider help someone else when he or she is suffering emotionally?
INSIDE The Impact of Health-Care Changes on Penn Medicine.....2 Annual Total Compensation Statements: Now Online!.........3 Helping People All the Time.....3 Free Trees for Penn and UPHS Staff & Faculty................4
What do all these hospital employees have in common? They are ‘second victims’ of a tragic patient outcome. For years, many have suffered in silence, trying to retain the expected stoic facade. But, now, at HUP, a new program will pro-actively provide immediate ‘emotional’ first aid to those who need it.
Lingering Feelings of Inadequacy Studies show that health-care providers often have strong feelings of guilt or inadequacy following an unanticipated bad outcome or medical mistake. “They feel responsible and may see it as a personal failure,” said Jill Huzinec, RPh, director of Patient Safety, who’s leading the initiative. A recent survey of HUP employees mirror these results. Nearly one-third reported experiencing personal problems after an event. Even more concerning: 30 percent seriously contemplated leaving their profession as a result of the event. “It’s a stigma in the medical profession; you don’t get upset ,” she said. “You just go on to care for the next patient. But how can a provider help someone else when he or she is suffering emotionally?” While most staff are resilient and will recover after a traumatic event, “this program is essential for those adversely affected by it.” Huzinec said the new program — Care for the Care Provider — will be available to any employee who might be emotionally traumatized by an event: all disciplines, all departments, all shifts. And it will be available 24/7. “No one should have to wait till Monday to talk about their emotional distress related to an event that happened on Saturday night.” The program will also support those who have experienced violence in the workplace, such as employees who have been attacked by patients or family members. “They’re all victims.” (Continued on page 4)
Survey Says...............................4
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THE
IMPACT OF HEALTH-CARE CHANGES ON PENN MEDICINE
A Special “Speaking with HUP’s Leaders” Hospitals around the country are facing mounting financial pressures, including reduced revenues from government and commercial payers and decreasing admissions. What effect will they have on Penn Medicine? At the most recent ‘Meal with An Administrator,’ HUP executive director Garry Scheib provided a point-by-point explanation of the changing health-care market and what we’re doing to keep the Health System strong.
The Current Environment Sequestration — the across-the-board Federal reduction enacted in March — automatically cut health-care spending by two percent. For UPHS, Scheib said, that equaled $23 million in reduced annual revenue and $20 million in research funding from the government. If adopted, the president’s recently proposed budget for FY14 would repeal sequestration, but it would also cut $400 billion to both Medicare and Medicaid over the next 10 years. Although Scheib did not yet know the financial impact on UPHS, he said it would probably cut “substantially more than sequestration.” In addition, Pennsylvania faces significant financial challenges, which he said will lead to cuts in health care as well in the next few years. Fiscal year 2013 does not end until June 30, but Scheib said that, based on the first eight months, UPHS will be $40 to $45 million short of reaching its budgeted target. One of the main reasons for this shortfall is reduced admissions, primarily from ‘observation status’ patients. According to current coding, these patients are too sick to go home but not sick enough to be admitted. Previously they would be admitted for one night but now “the same patient stays about the same amount of time [up to 23 hours] and receives the same care but we’re paid an average of 20 percent instead of 100 percent for a one-day admission,” he said. “That represents about 50 percent of the decline in admissions.” An increase in services delivered on an outpatient basis has also decreased admissions, as has the current economic climate, in which people are putting off elective surgeries. UPHS has seen admissions drop 3.8 percent over the past three years but it’s not alone. All of the other large hospitals in the region have experienced decreases in admissions, with the average decline of 7 percent over the past three years.
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Taking Advantage of Opportunities “The good news is that we have a strong balance sheet and a strong market position,” Scheib said, “but we need to keep making investments to help guarantee our future.” This is especially true in our outpatient services. The Perelman Center for Advanced Medicine is an excellent example of this successful strategy. “The Perelman Center has exceeded expectations, with tremendous growth that has, up to this year, more than offset the decline in inpatient revenue,” he said. “As a result of this growth, we’ve added almost 500 jobs in the last few years.” The success with the Perelman Center has led the Health System to construct similar centers to house outpatient services from Pennsylvania Hospital and Penn Presbyterian. The expansion currently under way at the South Pavilion of the Perelman Center will allow even more outpatient services to move out of both HUP and Penn Tower. Shifting ambulatory services out of the hospitals not only generates more patient activity, it also allows inpatient services to expand. “We’re in high demand to receive transfer patients but we don’t always have available beds.” Moving outpatient activities into the ambulatory centers will open space at all three hospitals. In addition, moving trauma services to PPMC in early 2015 will open between 40 and 50 beds at HUP. Long term, there are plans (not yet Board-approved) to tear down both Penn Tower and its garage and put up a new patient tower with underground parking. It will provide several hundred beds to further expand our inpatient services.
Cutting Operating Costs With the continued downward pressure on revenue, increasing patient activity alone will not counter balance the decreasing reimbursements, Scheib said. “We need to continually look for ways to cut costs.” The Health System needs to maintain at least a four percent margin just to keep reinvesting in facilities and staff. This means that, for every dollar we receive in revenues, we can spend no more than $.96 in expenses. It doesn’t sound like much but, in a $3.5 billion organization, annual revenue must outpace expenses by at least $140 million.
ANNUAL TOTAL COMPENSATION STATEMENTS: NOW ONLINE! Your annual Total Compensation Statement gives you a “big picture” view of the value of your UPHS pay and benefits. The newest statement, showing the total value of your benefits and compensation for the period January 1, 2012 — December 31, 2012, is now available online. Visit the Human Resources website, www.uphshrandyou.com and click on one of the links for the Total Compensation Statement.
NEW THIS YEAR: It’s easier to access your statement! Just use your network ID and password.
DID YOU KNOW YOUR STATEMENT IS ALSO A VALUABLE TOOL TO USE IN RETIREMENT PLANNING? Review the Retirement section to be sure you’re participating in all the retirement plans that you’re eligible to join and that you’re making the most of your opportunities to plan for your future.
In order to receive a Total Compensation Statement, you must be a UPHS employee, enrolled in UPHSflex benefits, and have a hire date on or before June 30, 2012.
The Health System’s projected operating margin for FY13 is $140 million. To maintain that operating margin in FY14, $50 million must be cut from operating costs. Right now, Penn Medicine leaders are examining ways to cut from nonpayroll areas — such as getting better prices from vendors and working with physicians to reduce variations in care, which would allow us to get better prices on clinical supplies. In addition, “chairs of clinical departments are looking for ways to increase clinical time in their practices.” When one employee asked about future job cuts, Scheib said, “While I can never say never, our goal is to minimize job loss.” Penn Medicine is one of the only health systems in our market that has not had layoffs since the economy started a downward turn in 2008. Last year, The Big Idea tournament brought in thousands of ideas to improve the patient experience. Soon, Penn Medicine will ask employees for their ideas to reduce costs. There is also a new dedicated website, Securing Our Future (www.uphs.upenn.edu/ securingourfuture), which provides information about the impact of health care reform on Penn Medicine and the actions we are taking as well as an interactive Q&A with Penn Medicine leaders. “We must create a new ‘normal,’ finding ways to provide the same — or improved — quality care with less money,” Scheib said. “But our financial strength and strong market position will allow us to meet these challenges and take advantage of the opportunities they present.”
Helping People ALL THE TIME Below are the winners in the November Helping People All the Time raffle. Congratulations and thank you for helping to improve the patient experience. John Abraham . . . . . . . . Rhoads 6 Catherine Alfano. . . . . . Pharmacy Carry Clarke. . . . . . . . . Founders 9 Kristina Clayton. . . . . . . Radiology Michael Daly . . . . . . . . . Pharmacy Heidi Elgart. . . . . . . . . . . . . Trauma Sheri Erby. . . . . . . . . . . . . Dulles 6 Patricia Fink. . . . . . . . . . . Dulles 6 Christopher Graham . . . Rhoads 7 Holly Greenberg. . . . . . . Radiology Janelle Harris . . . . . . . . . Ravdin 9 Brittany Horvath. . . . . . . . Ravdin 9
Pam Jackson . . . . . . . . . . . . . . . . . The Admission Center Randi Jackson. . . . . . . . . . . . . OR Rosanna John. . . . . . Silverstein 7 Kathryn Keating. . . . . . . . Dulles 6 Yvonne Mapp. . . . . . . . . Rhoads 7 Lauren McKeon. . . . . . . Radiology Marcia McNeely. . . . . . Radiology Tiffany McWilliams . . Silverstein 7 Adriana Messina. . . . . . . Ravdin 9 Dennis Smith . . . . . . . . . Rhoads 6 Sarah Tolbert . . . . . . . . . . Ravdin 9 Heather Warren. . . . . . . Radiology
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FREE TREES FOR PENN AND UPHS STAFF & FACULTY We are spreading roots for a greener region! Thanks to an exclusive partner this year (The City of Philadelphia Department of Parks & Recreation), Penn is able to offer a free yard tree to Penn and UPHS staff and faculty who live in the city limits. More than 100 free trees will be given away on a first-come, first-served basis. Preregistration is necessary. For registration links, tree species, pick-up dates, and more information, go to the Green Campus Partnership website, www.upenn.edu/sustainability, and click on “Creative Canopy.” The registration deadline for City of Philadelphia residents is Monday, May 6.
QUESTIONS? EMAIL SUSTAINABILITY@UPENN.EDU.
EMOTIONAL
FIRST AID
(Continued from cover)
A Three-Tiered System of Support The program’s ‘Rapid Response Support System’ comprises three tiers of support. A leader in the department or unit, such as the supervisor, manager, or charge nurse, who has been trained in basic ‘emotional’ first aid, will provide the first level. “Staff are supposed to inform a supervisor when an event happens. This is the perfect opportunity to see if that person needs a brief respite — five minutes to take a walk, clear their thoughts or just talk with someone,” she said. “We need to offer this support proactively, not wait until for the employee seeks it.” An adverse or unexpected event usually affects many more on the unit or department than the involved care providers. “Two things need to happen after an adverse event: determine how to prevent the event from happening again and provide emotional support for the staff,” she said, adding that the entire team needs to be involved in the discussion. “We want to continue to strengthen the non-punitive environment, ensuring that people feel comfortable speaking about the event and its emotional impact.” In the program’s second tier, specially trained peers will provide the support. “They’ll have their finger on the pulse of what’s going on in the unit at all times,” she said. “If support peers observe an increased level of stress in their area, they can call a huddle, a moment to talk. This lets the staff know someone is listening and is there to support their needs.” The third tier will be for employees who need professional counseling from those specially trained to do so, such as a chaplain, EAP (employee assistance program) personnel, social workers or clinical psychologists. Huzinec said that training for Tier 1 and 2 is planned to begin in June. The scheduled go-live date is July. “We want staff to know this kind of support is available, is confidential and is nonjudgmental,” Huzinec said. “It is a human response to feel sad when someone dies or when something bad happens to a patient…. We want to make this support system part of normal practice, a part of our culture of safety.”
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SURVEY SAYS … Medication Reconciliation
A patient’s medication list must be reviewed and reconciled as needed, prior to providing care and at the conclusion of care. All medication lists must include: • Medication name • Dose • Route • Frequency • Purpose To obtain this information might require ‘good faith’ effort, ie, doing whatever is possible to get a complete, accurate list. In the case of medication reconciliation, this may include speaking with patient’s family, reviewing patient’s medical records, and contacting the home pharmacy.
HUPdate EDITORIAL STAFF Sally Sapega Editor and Photographer Trissy Harding Designer
ADMINISTRATION
Susan E. Phillips Senior Vice President, Public Affairs CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.