Stanford Health Care People - Fall/Winter 2018 by Stanford Health Care

STANFORD HEALTH CARE

A PUBLICATION FOR EMPLOYEES OF STANFORD HEALTH CARE

FALL/ WINTER 2017

QUALITY IMPROVEMENT VALLEYCARE AND UHA STANFORD STORYBANK

AROUND SHC Deepak Sisodiya (left, bottom) is pictured at a special “Spirit Rally” rounding session at Li Ka Shing Center to boost enthusiasm and celebrate all that SHC has accomplished over the last year—specifically SHC’s ranking in the top 10 of U.S. News & World Report’s Best Hospitals in the nation, as well as SHC’s outstanding Likelihood to Recommend scores. …SHC President and CEO David Entwistle and School of Medicine Dean Lloyd Minor, MD, (left, middle) addressed a standing-room-only crowd of almost 400, with another 1,500 employees watching the first-ever online, interactive broadcast, making it SHC’s biggest Town Hall ever. The two laid out the collaborative work being done across all three organizations—Stanford Health Care, Stanford Children’s Health and the School of Medicine—and they used the new interactive polling system to get input from employees attending both onsite and online…Entwistle also shared his presentation with an employee audience at the Tech Center in Palo Alto, and with employees at the SHC office in Newark…UHA employees in Newark (left, top) celebrated Diwali, which is a Hindu festival of lights held in the period of October to November. It is particularly associated with Lakshmi, the goddess of prosperity, and marks the beginning of the fiscal year in India. …Following the North Bay fires, Ty “Kaipo” Thompson and Ricardo Semedo (right, top) in Patient Access Services delivered food and supplies to people affected by the fires.

from the CEO Dear Colleagues, When you think about quality at Stanford Health Care, what comes to mind? Ratings and rankings? Patient outcomes? Safety, or a broader set of indicators? This issue of SHC People focuses on quality so that we can all have a common understanding of this very important topic. While there is much we can be proud of regarding quality at SHC, there are

clearly areas in which we can do better. I appreciate being part of an organization committed to continuous improvement and am excited by the more targeted approach we are developing. Stanford is distinctive in many ways, but we are not unique. By benchmarking against leading academic medical center peers, we can monitor how we are doing on quality more effectively. Just as we can all contribute to improving patient experience, we can all learn more about how to make a difference in the quality of care we provide. Our goal is to keep raising the bar. We want to do this not only for our ongoing development as health care professionals, but for the patients who rely on SHC to meet or exceed the

ON THE COVER: Top row, left: Juana Camacho (L) and Rachel Seamen, MD (R) from the Los Gatos Collaborative Primary Care Clinic; Middle: staff from E2 include (L to R) Leean Rodolfich, Johnathan Clevinger, Maureen Fay, Christine Henley, Theresa Vidal; Top row, right: John Jackson from CareCounsel.

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highest standards. Thank you for your inspiring dedication to excellence. DAVID ENTWISTLE PRESIDENT & CEO

STANFORD HEALTH CARE PEOPLE is produced by the internal communications department. Send comments to shcnow@stanfordhealthcare.org.

US News

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WHILE SHC HAS RECEIVED HIGH MARKS NATIONALLY IN SOME QUALITY METRICS, MORE TARGETED AND STRATEGIC APPROACHES TO IMPROVE QUALITY ARE HAPPENING THROUGHOUT THE ORGANIZATION. LISA FREEMAN (ABOVE), INTERIM VICE PRESIDENT OF QUALITY, PATIENT SAFETY AND CLINICAL EFFECTIVENESS, AND INTERIM CHIEF QUALITY OFFICER ANN WEINACKER, MD (BELOW), ARE SPEARHEADING EFFORTS THAT ARE ALREADY PRODUCING POSITIVE GAINS.

THE RISE OF QUALITY IMPROVEMENT AT STANFORD

UALITY IMPROVEMENT EFFORTS ARE NOT A NEW PHENOMENON AT STANFORD. THEY HAVE BEEN ONGOING FOR THE PAST DECADE OR MORE. But this past year, efforts

to improve quality have become more targeted in response to national quality rankings that show Stanford excelling in many areas, but declining in some key quality measures. US News & World Report ranked Stanford as one of the top 10 hospitals in the nation this year, placing it ninth, up from 14th just a year ago. Hospital Compare, which looks at medical data on Medicare patients, awarded Stanford four stars. These outstanding marks reflect the level of care that Stanford strives to CONTINUED ON PAGE 4

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deliver. But at the same time, a scoring system that uses more current patient data saw Stanford drop in key quality measures such as mortality and hospital-acquired infections. Vizient—formerly known as the University HealthSystem Consortium—ranked Stanford 71st out of 107 similar hospitals, down from Stanford’s ranking of 42 last year. “Stanford always strives to provide the highest quality care in a very safe environment for our patients,” said Ann Weinacker, MD, Interim Chief Quality Officer. “As we look at each of these ranking systems, we see opportunities to improve the value of the care we deliver.” Over the past five years Stanford has launched a lean management system to reduce waste and inefficiency. It created quality improvement training courses to give employees at every level the tools they need to conduct improvement work in their own areas. It developed high-value care teams to reduce the variability of surgical care and recovery. It launched C-I-CARE to improve the patient experience. It created unitbased medical directors partnering with patient care managers to lead quality studies. This all-out approach set the foundation for the more targeted work being conducted today.

How Are We Going to Improve? Today, the quality effort led by Weinacker and Lisa Freeman, Interim Vice President of Quality, Patient Safety and Clinical Effectiveness, under the direction of Chief Medical

Officer Norm Rizk, MD, is a targeted assault. At the highest level, President and CEO David Entwistle has partnered with Lloyd Minor, Dean of the School of Medicine (SOM), and Christopher Dawes, President of Stanford Children’s Hospital. These three leaders formed the Safety, Quality and Value Committee to enhance the improvement capability of their respective clinical and administrative staffs. At the departmental level, the SHC quality team has deployed specialists, invested resources, and provided data to help inpatient units, outpatient clinics and every SOM department in leading efforts to improve the value and safety of the care they deliver. “In a much more tangible, measurable way, we are engaging faculty from the department chairs to the front-line clinicians and unit-based medical directors and their patient care managers in achieving both departmental-level goals and unit-based goals in achieving quality,” said Freeman. Every department was given a standardized list of quality improvement opportunities from which to develop plans. These efforts target key measures set by SHC and SOM leadership— observed to expected mortality, length of stay, cost and the patient experience—measures that are equally important to patients and their families. Already, these efforts are paying off. High-value care teams in colorectal, pancreatic, spine and gyn-onc surgery have begun to reduce variability of care and length of stay by

QUALITY IMPROVEMENT SUCCESS STORIES

Results: Since implementing ERAS, length of stay for Whipple patients has decreased from an average of 14.1 days to nine.

Reducing Hospital Acquired Infections in the ICU

THREE EXAMPLES OF HOW MULTIDISCIPLINARY TEAMS ARE WORKING TO IMPROVE CARE INCLUDE ENHANCED RECOVERY AFTER SURGERY (ERAS), REDUCING HOSPITAL ACQUIRED INFECTIONS IN THE ICU AND REDUCING WASTE IN TRANSFUSION SERVICES.

Improving Surgical Recovery with a Team Approach Problem: Variability in patient care before, during and after surgery can factor into longer-than-average hospitalizations. Background: There are a number of multidisciplinary care teams throughout the hospital working to optimize patients’ recovery from surgery and reduce length of stay. “With all ERAS protocols, we are 4 / STANFORD HEALTH CARE PEOPLE

Problem: ICU patients have higher-than-average rates of catheter-associated urinary tract infections, often caused by long-term catheter use.

trying to reduce variation in the care we’re providing, and deliver the appropriate level of care at every step,” said John Ratliff, MD, spine surgeon.

Background: Careful monitoring of urine output drives many treatment decisions. However, catheter overuse can lead to catheter-associated urinary tract infections (CAUTI). Length of catheter use is directly related to the infection rate, so decreasing length of use was key to this project.

Solution: ERAS protocols begin at a patient’s initial appointment. There is a scripted care pathway to follow and specific goals that must be met at each step to ensure that patients receive standardized, evidence-based care that is based on best practices. For pancreatic resection patients, these include immune-boosting nutrition and aggressive ambulation goals.

Solution: A quality task force that included E2 nursing managers and educators, medical and surgical ICU attending physicians and infection control nurses and physicians created evidence-based catheter necessity and urinary retention protocols. The new policy asks nurses to consider which patients need catheters, how long they should be catheterized and when an alternative, external catheter might be used.

“Stanford always strives to provide the highest quality care in a very safe environment for our patients. As we look at each of these ranking systems, we see opportunities to improve the value of the care we deliver.” creating new Enhanced Recovery After Surgery (ERAS) care pathways that are patient-centered, evidence-based, integrated and multidisciplinary. The goal of these efforts is to reduce a patient’s surgical stress response, optimize physiologic function, and facilitate recovery. A second system-wide quality effort involves improving Stanford’s accuracy in documenting the complexity of its patient population. This effort will help improve the “observed to expected mortality rates” measure, in which Stanford currently ranks below the national average. Hospital-acquired infections is another area identified for improvement. A team in the E2 ICU has significantly reduced the rate of catheter-associated urinary tract infections by considering alternatives to catheterization and managing the length of time patients are catheterized. Their efforts have proven so successful that new protocols are being implemented hospital-wide.

“This quality improvement effort puts a lot of emphasis on empowering nurses,” said Maureen Fay, RN, Patient Care Manager. “Bedside nurses are critically thinking about how to monitor urine output safely.” Results: E2 went from a 72 percent catheter usage rate in March 2017 to 49 percent in July 2017. E2’s CAUTI incidence has decreased from 18 in the first six months of FY17 to seven in last six months.

What Do the Rankings Mean? US New & World Report, which ranked Stanford ninth among top hospitals in the U.S., analyzes data from nearly 5,000 medical centers and survey responses from more than 30,000 physicians. It ranks hospitals in 16 specialties from cancer to urology, and looks at survival rates, patient safety, hospital structure, specialty staff and hospital reputation. Hospital Compare uses Medicare patient data on 57 different quality measures. Vizient looks at multiple domains—survival, safety, patient experience, effectiveness, efficiency and equity—and benchmarks Stanford’s performance against that of other similar institutions. While all three of these ranking systems look at similar quality measures, they differ in the weight they give to each measure, and in some of the categories they analyze. For example, US News’ ranking relies heavily on hospital structure and reputation, two factors that are not part of the Vizient ranking system. Vizient, instead, attributes more than half of its score to patient safety and mortality alone. “We have been painting quality with a broad brush,” said Weinacker. “The Vizient report focuses our efforts, and forces us to pay attention to areas where we need to improve. It uses the most current data, which makes it the most actionable measure to follow.”

Reducing Waste in Transfusion Services Problem: Stanford surgeons and physician assistants (PA) were duplicating orders and consistently over-ordering blood products prior to surgery, which contributed to wasted blood products and inefficient use of staff time. Background: When ordering blood products, the goal is to achieve a cross-matched to transfusion ratio of 1:1—one unit of blood ordered for every one unit transfused. The ratio at Stanford was as high as 8:1. “There is an institution-wide effort to reduce blood product waste, in addition to misusing the time of transfusion services staff, wasting the time of donors who gave blood and increasing the cost of surgery for our patients,” said Raina Shankar, Transfusion Services Supervisor. Solution: Starting several months ago, a team in Transfusion Services singled out one of the largest users of blood products, cardiothoracic surgery, to conduct its quality improvement effort.

They educated the surgical teams about duplicate ordering and are updating the blood-ordering guidelines. They also set a trial period for all cardiothoracic surgeries to order just two units of blood per procedure. Results: Since implementing these changes in July 2017, the cross-matched to transfusion ratio has decreased from 8:1 to 4:1 for cardiothoracic surgeries. Additional efforts are planned to decrease the ratio even further and apply these changes to other departments ordering blood products. STANFORD HEALTH CARE PEOPLE / 5

The design team challenged with improving LOA communications included representatives from HR Compliance, Occupational Health and nursing management. The team found that LOA materials were in several locations making it difficult to access and the information was considered to The HR Service Menu brings information about all HR offerings into one central location, with searchable categories such as My Joining, My Rewards, My Team, My Wellness, My Growth, My Transition and My Support.

be too complex. For their quick win, the project team simplified the language in all of its materials. They revised the Manager’s Toolkit, rewrote the employee and

HR Transformation Under Way: We Heard You Stanford Health Care’s Human Resources (HR) Department is undergoing a transformation. Its first step was to take stock of its current state through surveys and interviews with employees, managers and executives. Based on feedback from these outreach efforts, HR created project teams tasked with developing “quick win” solutions to make immediate improvements in areas where employees could experience immediate improvements. Two key areas identified were Customer Awareness and Leave of Absence.

Customer Awareness What the employee survey made crystal clear was that HR was not effectively communicating the vast scope of its services to its customers. SHC Human Resources is large and complex with a vast number of offerings that were not readily available for employees to navigate. That’s the reality described by the Customer Awareness project design team, which included representatives from HR Compliance, Talent Acquisition, HR Operations and Employee and Labor Relations. 6 / STANFORD HEALTH CARE PEOPLE

During the 12-week design window, the team developed a new HR Service Menu, which can be accessed on the SHC Connect Human Resources home page. The HR Service Menu brings information about all HR offerings into one central location, with searchable categories such as My Joining, My Rewards, My Team, My Wellness, My Growth, My Transition and My Support. The design teams also created Frequently Asked Questions (FAQs) for every service line. The new HR Service Menu more clearly defines the scope of services available and provides contact information for each area.

Leave of Absence When staff members take a Leave of Absence, there are multiple impacts that must be addressed, such as pay, benefits, wage replacement and job protection. But finding and understanding available leave of absence (LOA) information was overwhelming for employees and their managers, and contacting HR for more information was often difficult.

manager’s brochures and updated the Leave of Absence packet. The team also set up a central call-in number, and educated the HR Operations team about how to answer the most commonly asked LOA questions.

HIDDEN GEMS Educational assistance, discounts to movies and restaurants, and career development opportunities are just three hidden gems available to SHC employees. • At BenefitHub, our online discount marketplace, benefit-eligible employees can get discounts to hotels and air travel, sports and entertainment tickets, electronics, wellness devices, local deals, and much more. Learn more at healthysteps4u.org. • Tuition reimbursement—Employees are eligible for $2,000 per year to offset the cost of pursuing courses, seminars and degree programs. • SHC employees can receive an 18 percent discount on their personal mobile device plans for AT&T, Sprint and Verizon. Go to uit.stanford.edu/mobile/personaluse to learn more.

Q & A

WITH...

David D. Jones Chief Human Resources Officer

David Jones has been SHC’s Chief Human Resources Officer since Jan. 3. He comes to Stanford with nearly three decades of experience in human resources, primarily in the health care field. In his first year, Jones and his team have been busy redefining and remaking the Human Resources operation. Here, we learn what inspires and motivates this West Virginia University graduate and self-described guacamole connoisseur.

What is the HR Transformation?

It’s a comprehensive change activity. We surveyed employees, assessed our current processes and benchmarked our capabilities against industry best practices. All of that data shows where we have areas of strength and where we have some gaps. The transformation effort is about closing those gaps and building an HR function that is able to deliver and execute on a level the organization requires. This includes upgrading our HR technology infrastructure, because our current technology is obsolete and a detriment to our ability to deliver a worldclass employee experience. And it’s about developing a people strategy that solidifies our ability to attract, retain and inspire our workforce to deliver on our mission.

What is HR-CARES? HR-CARES is our internal HR culture initiative. There were some areas within our own

HR function that were not as strong and healthy as we needed going forward. So we developed “The 12 Commitments” to articulate the work environment that we’re committed to creating and providing for our workforce. As part of that effort, we branded our HR culture HR CARES—Collaboration, Accountability, Respect, Excellence, Service. It’s a way to demonstrate our commitment to our culture, with the belief that if we create and reinforce that culture within our own function, then it will translate into how we deliver outcomes and results to the business.

What is the HR People Strategy?

We need to understand why people come here, why people stay here and what are the things that we can offer that distinguish us in the competitive Bay Area marketplace. We don’t have the stock options, the cultural agility and the workplace novelty that you find in startups or technology companies. Our

currency has more to do with our mission and our clinical reputation, and the impact we have on our community and society. It has a lot to do with the innovations and discoveries that are coming from our School of Medicine, our University and our faculty research partners, and our reputation as a preeminent health care organization. But we need to identify the other elements that go along with that in terms of rewards, compensation, career support and development. Our People Strategy will help us identify our top priorities, and have a multiyear roadmap of initiatives that will align with and help drive our overall business strategies.

What attracted you to Stanford Health Care?

First and foremost, the Stanford brand and reputation, and the new leadership team driving transformational change. It’s exciting to join SHC at a time when we are re-creating our strategic plan, and it’s a great opportunity for me to help contribute to shaping the culture. I was also compelled by the opportunity to step into the chief human resources officer role, to bring my vision, passion, sense of urgency and desire to upgrade the HR function and drive that preeminent employee experience. I find myself consistently drawn to health care because the mission is so compelling and the opportunity for impact is so great.

Tell us a little bit about yourself.

Besides my family and my work, cooking is my other passion. We have vegetable beds, fruit trees and grapevines that inspire my culinary exploits. I enjoy trying out new recipes with friends and family, and bringing my favorite dishes, like my guacamole, baked beans and pear tart, to work.

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FOCUS ON… CareCounsel A difficult situation became even worse for one family when they needed inpatient treatment for a member struggling with addiction, but their new health plan wasn’t covering it. The family turned to CareCounsel, Stanford Health Care’s advocacy provider. On their behalf, CareCounsel’s member care specialists negotiated the complex web of health insurance benefits, and eventually their plan covered inpatient treatment. CareCounsel also ensured that while the family waited for the coverage to be approved, the patient received outpatient treatment. “That was very, very gratifying,” said contact center manager Doris Maloney. “We had to make all the pieces work together, but we got the family what they needed.” SHC acquired CareCounsel in 2012 as part of its overall goal to help patients. “Anytime someone has a health care issue, they have a benefit issue,” said John Jackson, executive director of corporate health programs at SHC. “CareCounsel fills the customer service gap that exists at most health plans.” “Even those of us who work in health care don’t have a good understanding of how the insurance end of things work,” he added. CareCounsel, which operates out of San Rafael, was founded in 1996 to help patients navigate the often-mysterious world of health care coverage. Employees of organizations that sponsor CareCounsel can call 8 / STANFORD HEALTH CARE PEOPLE

LEFT TO RIGHT: JOHN JACKSON, TOM TANG, DORIS MALONEY, NANCY FASE-GUERNON, AND TANISHA BESS ARE PART OF THE CARECOUNSEL TEAM THAT HELPS PATIENTS NAVIGATE THEIR HEALTH CARE COVERAGE.

whenever they need help with a variety of insurance-related questions. Member care specialists assist employees in choosing a plan, resolving billing disputes, using wellness benefits and obtaining support for managing their diseases. They resolve a wide range of problems, from simple questions about co-pays to parsing coverage for fertility treatment. And if a plan does not cover a service, they’ll try to negotiate with the provider to see if they can reduce the cost for the patient. “Anytime we see a question out there we try to help,” said Nancy FaseGuernon, director of service excellence. “We really find meaning in our job when we can take over and be a solid rock for people who are sick. We want them to concentrate on themselves or their loved ones, not insurance. The work we do makes a world of difference to people.” Fase-Guernon said that the member care specialists are usually able to resolve a problem during the first phone call—within 20 minutes. They typically set up a conference call with the patient and the insurance carrier because of HIPAA (Health Insurance

“Anytime someone has a health care issue, they have a benefit issue, CareCounsel fills the customer service gap that exists at most

Portability and Accountability Act) requirements for patient consent. Conference calls also help patients learn about health insurance, FaseGuernon said, so they can resolve questions more easily in the future. Maloney added that they often try to work with the insurance carrier to smooth things for the next patient. “We not only resolve a problem for one patient, but we like to make sure the same thing doesn’t happen in the future. We try to improve the process.” CareCounsel’s services are available to all SHC and Stanford University employees, regardless of the health plan they’re enrolled in. Patients who are not employees of SHC but are enrolled in SHC Alliance may also use CareCounsel’s services.

FOCUS ON… Clinical Nutrition Clinical dietitian Janine Berta was facing a nutritional conundrum: She had a pregnant patient on a feeding tube in the ICU who didn’t eat meat, but couldn’t tolerate the vegetarian protein supplement. “I had to honor her religious food preferences, but make sure she received enough protein for the pregnancy,” said Berta, who prescribes nutritional supplements for patients in Stanford Hospital. To solve the problem, Berta applied some nutritional math: She mapped out the calorie and protein needs for later in the pregnancy so the patient was able to get everything she needed without supplements. “Every individual patient has different nutritional needs,” Berta said. “Sometimes it’s putting pieces of a puzzle together. That’s what makes the job interesting.” Simply put, Stanford Health Care’s Clinical Nutrition department ensures

that patients consume what they need to heal or stay healthy. That means everything from calculating nutrients for intravenous feeding to counseling patients to eat more vegetables. The 45 members of the department, all registered dietitians, hold various specialty certifications: for conditions such as diabetes and cancer, for weight management, or for artificial nutrition. They care for patients in the hospital and out. The inpatient dietitians use information gathered by nurses at admission to identify patients who are at nutrition risk. They develop care plans for any patient at high risk or with special needs based on their weight, their disease, the treatment, allergies and other factors. They monitor patients as long as they’re in the hospital in case their needs change. The outpatient dietitians counsel people with eating disorders, patients undergoing treatments for cancer and other diseases, and those with chronic conditions—such as bowel or cardiovascular diseases—that require special diets. They also work with patients to avoid heart disease or to ensure that they are receiving proper nutrition during pregnancy or after hospitalization. Patients in need of nutritional therapy can receive a referral from a physician. “We provide custom therapy based

on their disease state and their medical care plan,” said the director of clinical nutrition, Heather Filipowicz. “We have a big impact on a patient’s care.” The department encounters some patients who struggle to feed themselves properly because of low income, Filipowicz said. In those cases, the dietitians refer them to programs such as Meals on Wheels or local food banks, and connect them with social workers. While Berta only sometimes speaks with her patients—many of them are sedated—clinical dietitian Dania Saarony does mostly that. She specializes in treating obese patients, counseling them on weight loss techniques and instructing them on how to eat after bariatric surgery. Saarony meets with patients one-onone, feeling out their food habits and motivation behind eating, and guides them on making lifestyle changes. She also teaches classes on weight management and bariatric surgery. When patients are willing to share their experiences, the classes can double as support group therapy, she said. Saarony said she loves “seeing patients make positive changes in their lives.” “We’re here to give people a second chance, and when they’re ready to take it, amazing things happen.”

LEFT TO RIGHT: CLINICAL DIETITIAN JANINE BERTA REVIEWS NUTRITIONAL INFORMATION FOR AN INPATIENT. SANDY SUN AND HEATHER FILIPOWICZ, BOTH CLINICAL DIETITIANS, ARE TWO OF 45 MEMBERS OF THE CLINICAL NUTRITION DEPARTMENT. DANIA SAARONY MEETS WITH PATIENTS ONE-ON-ONE IN THE BARIATRIC AND METABOLIC CLINIC.

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KUDOS May C-I-CARE Service Spotlight Award BOBBY ESQUIVAL Bobby Esquival, a medical assistant, was recognized for helping a patient who had accidentally stepped on the accelerator instead of the break in her vehicle outside of a SHC clinic. After the car got stuck on a planter box, Esquival opened the car door and calmly got the car into park. The patient was not physically injured, but was shaken up the by event. Throughout the next couple of hours, Bobby demonstrated exceptional patient care by aiding the patient and ensuring she was able to make it to her appointment.

June C-I-CARE Service Spotlight Award ELIZABETH SAINT Elizabeth Saint was honored outstanding ability to take initiative and execute on tasks to make the lives of everyone around her easier, including her colleagues and patients. A urologic oncology nurse coordinator, Saint is known for thinking of the small details that make a huge difference for patients, such as scheduling the appointment at times with less traffic for patients traveling from a distance for their appointment.

connected with a social worker. Because of her dedication and quick-thinking, the patient received the help he needed.

July C-I-CARE Service Spotlight Award NATALIE DICKSON Natalie Dickson, a nurse practitioner, recently met a terminally ill patient. The patient had expressed an interest in spending his last moments on the Stanford Golf Course—joking that this had been his lifelong dream. Even though she knew the patient wasn’t expecting anything to come of his comment, Dickson began working diligently to contact anyone who might be able to help set up a visit to the golf course. With the help of her colleagues, she was able to reserve the practice facility and golf coaches so that the patient, and his golf buddy of the last 24 years, could enjoy this special occasion.

August Patient Safety Star Award ELISA CUNEO, TRIXIE XU, RENEE OLIPHANT After admitting a patient into the Coronary Care Unit (CCU) from another hospital, clinical nurse Elisa Cuneo noticed an issue with the patient’s central catheter and alerted her colleagues, Trixie Xu and Renee Oliphant. The nursing team ran additional tests and alerted the physician. The physician confirmed that the line was placed in the carotid artery, and the patient had a surgical procedure to remove the central line and repair the

June Patient Safety Star Award THELMA ARGUETA-LOPEZ After helping a patient with suicidal thoughts, medical interpreter Thelma Argueta-Lopez was honored with the Patient Safety Star Award. During a video-translation, ArguetaLopez sensed a patient needed additional assistance and quickly escalated the issue to her supervisor. She also ensured that the patient 10 / STANFORD HEALTH CARE PEOPLE

artery. Because of the team’s astute observational skills and strong collaboration with the physician team, the patient was safely managed, and potential risks were mitigated.

August C-I-CARE Service Spotlight Award ANNA QUINTANA When insurance wouldn’t cover a patient’s consultation at the Stanford Neuroscience Health Center, her friends and family donated money to cover the cost of the visit. After her initial appointment, the patient was looking into ways to cover subsequent visits. When Anna Quintana, a financial counselor at SHC, found out about this patient’s situation, Quintana took action and was instrumental in finding her enough funding to cover the cost of her treatment.

September C-I-CARE Service Spotlight Award EDWARD NGUYEN, JET TOLENTINO, EMILINE GARLAND, CHASE ENTWISTLE Edward Nguyen, a valet attendant, assisted an elderly woman out of her car and into a wheelchair after her husband dropped her

off at Stanford Hospital. After waiting for more than 20 minutes for her husband, the woman started to worry about her husband. Meanwhile, outside of the parking garage, Jet Tolentino, a tram supervisor, assisted a guest who had started to fall. Tolentino then called 911. When Emiline Garland, a customer navigator, arrived at the garage to help, she realized the man was the husband of the woman waiting at the entrance of the hospital. Chase Entwistle, a junior volunteer who had been sitting with the woman, brought the woman to her husband. Ngyuen, Entwistle, Tolentino and Garland were honored for their compassion, quick thinking and teamwork.

THE

NEW Stanford Hospital NEW HOSPITAL CONSTRUCTION: THE HOME S-T-R-E-T-C-H

After nearly a decade of planning, design, and construction, the 824,000-squarefoot new Stanford Hospital is in the home stretch. While from the outside it may appear nearly ready for occupancy, inside it is teeming with activity as more than 600 workers each day bring it to life—installing drywall, wiring, ducting and electrical, framing rooms, building gardens and walkways, and readying the interiors for all the major medical equipment that will be delivered onsite next year. “Next year at this time, the hospital construction will essentially be complete,” said Chad Reeder, Controls Manager for the new Stanford Hospital. “It will look like a hospital inside and out.” Today, if you walk inside, you will find the bones of a major hospital. Nearly every room and surface has been built, with drywall up in most of the building, and structural beams in place to handle all the heavy equipment that will attach to the ceiling. All 368 single-occupancy patient rooms on levels 2, 4, 5, 6, and 7 have been built out, as well as 29 procedure rooms on the second floor. Electrical systems, air-handling units and generators are in place, and the telecomm platform has been built. But there is still much to do before the first patient can be admitted in 2019.

What’s to Come in 2018?

Medical Equipment

The most significant activity to occur in 2018 will be the installation of all medical equipment, everything from MRI and CT machines to hospital beds and trash cans, said Jason Holbrook, Senior Project Manager for the New Stanford Hospital. “We are currently working on the logistics of getting 27,000 pieces of medical equipment into the building in the most efficient way possible.” This includes storing pre-purchased equipment in a San Jose warehouse for just-in-time installation. Here are some of the major milestones to come to get the hospital ready for activation.

• All major medical equipment—three MRIs, one interventional MRI, three CTs, five x-ray machines, fluoroscopy, hybrid ORs and image-guidance equipment—will be installed.

Building and Gardens • All interiors will be painted, and all flooring will be installed. • The 32-foot-high Donor Wall will be built, one 400-pound travertine stone at a time. • All electrical, air-handling units, environmental systems and fire systems will be up and running. • 2.1 acres of rooftop gardens will be complete. • 2.5 additional acres of gardens and walkways on the ground level will be completed, including a dog park.

THE NEW STANFORD HOSPITAL IS COMING TO LIFE. TOP TO BOTTOM: A VIEW OF THE DONOR WALL CONSTRUCTION IN ATRIUM; THE NEW EMERGENCY DEPARTMENT; JASON HOLBROOK, SENIOR PROJECT MANAGER, INSPECTING A NEW OR; AND A NEW PATIENT ROOM.

• Roadways and pathways will continue to be built to connect the new and existing Stanford adult facilities with the Children’s Hospital and the Cancer Center. • Pasteur Drive will reopen with two one-way lanes in both directions.

• All movable medical equipment— everything from hospital beds, case carts and monitors to soap dispensers and trash cans—have begun installation.

Technology The telecom room is complete, with 33 telecom closets connected and ready to fire up a network that will support a myriad of integrated systems throughout the hospital. These include lights, telephone, paging, temperature, accelerometer, synchronized fire/sheriff/EMS, security (access control and 900 cameras), nurse call, irrigation, a real-time location system and patient entertainment. “All of this integration has never been done before,” said Camilo Barcenas, Senior Technology Program Manager, who coordinates and integrates all systems across the vendors and Stanford IT. “Stanford has pushed the limits. We’ve built a system that can flex to accommodate capabilities that are not even built yet.”

Interior Design Much of the interior work completed to date will never be seen by patients or staff. It is merely the backdrop to the finishing touches that will make the building a place of medical innovation and healing. In 2018, much of the artwork and furnishings will be installed. STANFORD HEALTH CARE PEOPLE / 11

UHA

Rachel Kitson, PA-C Valley Medical Oncology Consultants

Christina Pagano, MD Family Medicine, Sports Medicine, Menlo Medical Center

Mary Imig, MD Los Olivos Women’s Medical Center

Karen Kunzel, MD Los Olivos Women’s Medical Group

Rachel Seaman, MD Collaborative Primary Care

Kris Borrison, MD Los Olivos Women’s Medical Group

Elizabeth Anthony, MD Alliance Medical Group

Elizabeth Bashman, MD Los Olivos Women’s Medical Group

Kim Harvey, MD Menlo Medical Clinic

Eve Ladwig-Scott, Los Olivos Women’s Medical Group

Elizabeth Buescher, MD Los Olivos Women’s Medical Group

Suzanne Bovone, MD Los Olivos Women’s Medical Group

Mariah Grace, DO Menlo Medical Clinic

Charlene Reimnitz, MD Los Olivos Women’s Medical Group

HONORING

WOMEN IN MEDICINE UHA joined the American Medical Association to celebrate Women in Medicine Month in September. This year’s theme, “Women in Medicine: Born to Lead,” demonstrated the commitment to increasing the influence of women physicians and advocating for women’s health issues. Nominated by their colleagues for their leadership, compassion and demonstrating of exceptional C-I-CARE, these physicians have offered their time, wisdom and support to advance women with careers in medicine.

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COLLABORATION STARTS BEFORE THE CLINIC OPENS EACH DAY IN LOS GATOS WITH A TEAM HUDDLE, WHICH BEGINS WITH A CELEBRATION OR RECOGNITION.

Delivering Care With Teamwork and Collaboration in Los Gatos Los Gatos Collaborative Primary Care is aptly named. As one of two model care clinics in the University HealthCare Alliance network, this small practice lives and breathes teamwork and collaboration at every level of its structure. “The model clinic approach is really a collaborative effort at finding best practices for workflow efficiencies, empowering everyone to have a voice and really tackling projects as a team,” said Rachel Seaman, MD, Medical Director for the clinic, which includes four physicians, four medical assistants, two patient services representatives and a practice supervisor. “My belief is that in order to provide health care to the masses, we need to work as a team.” In Collaborative Primary Care’s open structure, doctors are not tucked away in private offices, but instead sit side-byside with medical assistants (MAs). This co-location helps improve communication between the clinical teams, provides patients with answers to their questions more quickly, and reduces the backlog of paperwork and emails that can pile up at the end of a long clinic day. Instead, physicians and MAs manage the workflow in small bites throughout the day, tackling patient

questions, emails and calls between patient appointments, which average 18 to 20 per day for each doctor. “What’s nice about sitting next to your doctor, what we call cohabiting the space, is that you can talk with them in between patients,” said Madeline Perez,

“We all work together to figure out action plans that will benefit our patients, our providers and our front-line staff.” lead MA for the clinic. “You can take the two minutes that you’re both at your desk to get things done.” These Provider-MA dyads are not the only teams that exist in Collaborative Primary Care. There’s an equally synergistic relationship between the administrative supervisor and the physician lead. “The effective communication I can have with the staff and the doctors here is unlike anything I’ve ever experienced before,” said Practice Supervisor Marian Palacios. “We all work together to figure out action plans that will benefit

our patients, our providers and our front-line staff.” Collaboration starts before the clinic opens, when the entire staff gathers for daily huddles. They always begin with a celebration, a moment to call out a coworker, recognize a birthday or provide an update on clinic operations, and then go over quality metrics and the day’s patient load. One of the hallmarks of the model clinic structure is that staff members work to their full training. For medical assistants, that means doing more than rooming patients and taking vitals. It includes administering immunizations, managing patient calls and conducting health maintenance discussions. “Because we’re a smaller clinic, we’re able to trial different ideas from staff to help the flow of the clinic, and get immediate feedback from our doctors because we’re working right next to them,” said Perez. “I really like that we’re constantly looking to make things better.” Staff engagement extends beyond making the clinic run more efficiently, said Belinda Jones, Lead Patient Services Representative. “I’m grateful for the focus on the well-being of the employees here,” she said. “That’s the type of culture we’ve built here,” said Jones. “All of the staff, even the doctors, want to be involved in feeling better ourselves while helping our patients feel better.” STANFORD HEALTH CARE PEOPLE / 13

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THE QUIET CAMPAIGN IS A TEAM EFFORT AT VALLEYCARE. (LEFT TO RIGHT) LAVINIA MEDINA, DAN SLAVEC AND KAREN LANEY, ALONG WITH JOLENE DUFFY (FAR RIGHT), HAVE HELPED FIND SOLUTIONS TO REDUCING NOISE.

It’s Becoming Quieter at ValleyCare At ValleyCare in Pleasanton, the physical therapists started taking their most “vocal” patients down to the gym so as not to disturb the patient’s roommate. The housekeeping staff buffed the floor later in the day, when most patients were awake. The emergency room registration desk replaced an especially noisy printer. Each action is fairly simple, but along with many more accomplishments, they add up to a quieter hospital, one that affords patients better rest. The changes were prompted by the hospital’s Quiet Campaign, launched in February because of patient feedback about noise and a desire to create a healing environment. “There’s been a lot of improvement, but it’s still a work in progress,” said Lavinia Medina, emergency room registrar. A team at Stanford Health Care— ValleyCare started the campaign by interviewing patients and staff to learn what was causing the noise. The team found that while patients didn’t mind

“Everyone’s being really respectful to each other and trying to think outside the box to reduce noise. Now, if someone’s loud, we can look at them and they’ll say, ‘Oh, sorry.’” staff conversations about patient care, they disliked talk about weekend plans. They also objected to noisy equipment, such as squeaky-wheeled food carts, slamming doors and screeching curtain rings. The next step was to make staff members aware of the problem. As Dan Slavec, a physical therapy assistant at ValleyCare, said, “We get desensitized to it.” The team educated staff about patient surveys regarding noise, but an initiative such as the Quiet Campaign

requires a change in culture. To create a new, quieter workplace, they recruited champions among nursing, patient access services, food service, engineering and other departments. These champions—Medina and Slavec among them—meet monthly with SHC’s service excellence department to discuss their progress in reducing noise; they also present any new ideas about reducing the decibel level further. Because the staff weren’t always comfortable speaking to their coworkers about lowering the volume, the champions devised phrases and signs that anyone could use to ask fellow staff members to lower their voices or park food carts away from patient rooms, for example. “Everyone’s being really respectful to each other and trying to think outside the box to reduce noise,” said Jolene Duffy, RN, a perioperative nurse manager at ValleyCare. “Now, if someone’s loud, we can look at them and they’ll say, ‘Oh, sorry.’” Amanda Felix, project manager of service excellence at SHC, said that reducing noise isn’t just for patients. “The quiet is helpful for everyone,” she said, noting that auditory distractions are linked to medical errors. While ValleyCare employees have lowered their voices, replaced noisy equipment and rejiggered routines to keep the volume down, technology has done its part. Overhead paging, except for emergencies, has gone the way of the typewriter—physicians now receive a text message on their cell phones. In the six months since the launch of the program, patient feedback regarding noise levels has improved. Although the new Stanford Hospital is designed to dampen noise, the service excellence team will apply what they’ve learned at ValleyCare to keep the noise level at the new hospital as low as possible. “The chatter has reduced dramatically,” Slavec said, “but we keep chipping away at it.”

VALLEYCARE

AWARDS C-I-CARE Service Spotlight Award BETTS DEMOTT-CRAVOTTO Betts DeMott-Cravotto, a volunteer ambassador at ValleyCare, walked into the room of a patient suffering from a progressive illness and wondered, What can I offer him? “He was so smart and well educated, very into politics,” she said. “He had lost the use of his hands, so I said, ‘Can I read the newspaper to you?’ He was thrilled.” For her work with the patient, DeMottCravotto received a C-I-CARE award, but she emphasized, “It’s not about me. It’s about helping people have dignity and still enjoy life to the extent they can.” DeMottCravotto has volunteered every Tuesday at ValleyCare since May 2016. As an ambassador, she speaks with patients, asking if they’re receiving excellent care and whether she can get them anything, such as crossword puzzles to pass the time. Volunteering as an ambassador at the hospital was a natural fit for DeMott-Cravotto, who cared for her father and her parentsin-law and accompanied them to physician appointments. “I feel very comfortable advocating,” she said. “I’m grateful for the opportunity to do this.” When she learned the patient was nearing a wedding anniversary, DeMott-Cravotto requested an in-hospital anniversary dinner for the patient; and when she discovered he was a man of faith, she arranged for him to receive Communion.

Diane Frazier, the president of the hospital’s auxiliary, who runs the volunteer program, said that DeMott-Cravotto “always looks for opportunities to do what she can. She thinks outside the box.” “What she did for this man was beyond what we ask our ambassadors to do,” Frazier said. “But she did it because it needed to be done and she wanted to do it.”

C-I-CARE Service Spotlight Award SUSAN KENDALL Susan Kendall’s patient at ValleyCare had long been looking forward to a Hawaii vacation with her husband—their first to the islands. But soon after the patient landed in the hospital, the couple learned that her condition prevented her from traveling. When the hospitalist asked if they could do anything for the patient, Kendall said, “If they can’t go to Hawaii, we’ll bring Hawaii to them.” The next day, her day off, Kendall bought leis and cardboard cutouts of hula girls, birds and palm trees. While the patient was sleeping, she and the other nurses on the floor decorated the room, and every visitor who came to the room received a lei. “It looked like a full-on luau,” Kendall said. “It brought a brightness to her day.” Kendall, who’s worked at ValleyCare for 12 years, earned a C-I-CARE spotlight award Aug. 10 for her party-throwing prowess. She received a platter of cookies, which she shared with her floor. “This isn’t the first time that Susan has gone above and beyond to help a patient,” said Carole Shurko, her director. “That’s the way she approaches everything.” Kendall, who hails from Pleasanton and whose mother worked as a nurse at ValleyCare for 23 years, said that she is just one of a team of nurses who provide care for patients beyond their medical needs—such as bringing in clothing for homeless patients. “I’m seriously lucky,” she said. “I work with really caring, compassionate people.”

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THE STANFORD STORYBANK

“SHE’S SUCH AN INSPIRATION,” SARAH FOAD (LEFT) SAYS ABOUT HER MOM, WENDY, SHC’S ASSOCIATE CHIEF NURSING OFFICER. “I HOPE THAT ONE DAY I WILL BE A FRACTION OF WHAT SHE IS.”

Mother-Daughter Duo Share Passion for Health Care on Stanford’s Storybank When Sarah Foad was growing up, she always imagined working in the health care field, just like her mom, Wendy, a nurse for 33 years. But Sarah’s squeamishness around blood put a damper on her dreams. “I always wanted to do something clinical, but I just cannot do blood,” said Sarah, who was studying to become a psychologist. A summer college internship in Stanford’s Patient Experience Department solidified her belief that she belonged in health care but changed the trajectory of her career. “It opened my eyes,” she said. “It showed me that health care is more than just clinical care.“ After graduation, Sarah came back to Stanford as a Project Coordinator in Service Excellence. This mother-daughter duo shared their passion for health care, and how it has shaped their relationship and their lives, in an audio interview with the producers of the Stanford Storybank. In

September, Stanford Health Care launched the Stanford Storybank, in partnership with StoryCorps, to create a space for patients, families and staff to share their experiences. It’s built on the premise that everyone has a story to share, and provides a platform to amplify the voices of the SHC community. “It was interesting to talk about our own story,” said Wendy Foad, MS, RN, Associate Chief Nursing Officer, who will be leaving her position at SHC after 15 years in early December. For 40 minutes, they talked about their life experiences and desire to work in the health care field. “She’s the reason I wanted to be in health

care,” Sarah told the Storybank interviewer. “She’s such an inspiration. I hope that one day I will be a fraction of what she is.” For Wendy, the path to nursing was a bit more circuitous. As a young woman working for a stockbroker in England, she signed up for a first aid/ CPR course. “While bandaging and performing CPR during the class, it hit me,” said Wendy. “This is what I want to do.” Today, Wendy is more likely to be found wielding a pen than an infusion bag. But she sees her administrative role as still impactful to patient care. “What brings you into nursing in the first place is caring for people,” said Wendy. “But I realized when I went into a leadership role that the focus of my concern and who I care for now is the nurses themselves, rather than the patients. If I can make an environment where nurses can thrive and do their best and have everything they need to do their jobs, then I am still directly affecting patients and how they experience some of the most challenging times in their lives.” Both Foad women have firsthand knowledge of the impact every member of the health care team can have on patients and families. When Sarah was hospitalized and underwent an appendectomy as a teenager, Wendy, a career nurse, was as anxious as any parent with a sick child. When the transporter came to take Sarah to the OR, he told Wendy that everything was going to be ok. That simple reassurance was all she needed to feel at ease. “In that moment, I saw how important it is to make connections with families and patients,” said Wendy. “I never imagined that kind words from someone on the hospital staff could mean so much. I understand now how those little things make such a difference.” For information on how to participate in the Stanford Storybank, contact cicare@stanfordhealthcare.org.