Stanford Hospital People - Winter 2014

A PUBLICATION FOR EMPLOYEES OF STANFORD HOSPITAL & CLINICS

ISSUE SIX / WINTER 2014

OUTPATIENT CENTER TURNS 5 SLEEP CENTER & SPARC DISASTER RELIEF: SEMPER

from the CEO

PAGE TWO News and Notes From Around SHC...

Dear Colleagues, As we seek to continue our excellence in 2014, our efforts are focused on delivering Leading Edge and Coordinated Care across four key strategic domains: Complex Care, Virtual Care, Accountable Care, and Network Care. Complex Care initiatives include developing the New Stanford Hospital, a new Neuroscience Outpatient Center at the Hoover Campus, and a new South Bay Cancer Center. Virtual Care initiatives include’s our rollout of online primary care video visits.

Accountable Care efforts include initiatives to improve the well-being of an enrolled population—for example, in our new Stanford HealthCare Alliance benefit plan. Our Network of Care efforts include expansion of patient access and services with the highest levels of convenience and excellence.

One of our key locations within our Network of Care strategy is our Outpatient Center in Redwood City. In this newsletter, you’ll read more about this showcase center and how it provides top-notch clinical services to a regional population, while excelling in accessibility and C-I-CARE service.

In addition, you will learn about colleagues who give selflessly of their time, and those with highly creative and competitive interests. This level of compassion and diversity of talents helps to make SHC a special place for our employees and our patients. As always, thank you for all you do to support Leading Edge and Coordinated Care at SHC.

February is American Heart Awareness Month. Join your SHC colleagues and participate in the Heart Health Challenge. Visit stanfordhospital.com/heartmonth for more information. Also during heart month, SHC will sponsor the Racing Hearts Palo Alto Run/Walk on Sunday, March 23, on the Stanford University campus. The event, a 5k run or 10k walk, helps raise funds for the Racing Hearts Organization, which advocates and empowers access to saving lives with AEDs (automated external defibrillator) …

The Cancer Center is expanding, taking over the third floor of the Blake Wilbur building. The third floor will become the new home for the Head & Neck and Cutaneous Oncology Cancer Care Programs (CCPs). An Endocrine center is also being developed at this location in conjunction with the creation of the Head & Neck program … Since the eCare program was launched this past fall, more than 1,000 telemedicine visits across phone, video, and image sharing have been completed. eCare offers quick and easy access to Stanford physicians

via phone and video visits, as well as image sharing through our MyHealth electronic health record portal …

New hospital update: Mass excavation of the 824,000-squarefoot new hospital facility is now complete. More than 200,000 cubic yards of dirt was removed on the former site of Parking Structure 3 and the offices at 1101 Welch Road to a final depth of approximately 35 feet. In order to support the foundation of the new hospital facility, more than 1,445 steel beams have been installed. These beams act as the deep foundation legs and will support the future building …

The American Association of Critical-Care Nurses (AACN) recently presented SHC’s E2 nursing unit with its Beacon Award for Excellence.

The award signifies exceptional care through improved outcomes and greater overall satisfaction.

Stanford Hospital People is now available in a digital format! Go to: stanfordhospital.org/shp to view this issue.

STANFORD HOSPITAL PEOPLE IS PUBLISHED BY

SHC OFFICE OF COMMUNICATIONS GARY MIGDOL EDITOR, DIRECTOR OF INTERNAL COMMUNICATIONS KATIE LIPOVSKY COMMUNICATIONS COORDINATOR ASHLEY GEORGIAN MEDIA RELATIONS MANAGER GRACE HAMMERSTROM CONTRIBUTING WRITER JAMES LARKIN DIRECTOR OF CORPORATE COMMUNICATIONS/PR SARA WYKES CLINICAL AFFAIRS WRITER NORBERT VON DER GROEBEN PHOTOGRAPHY

Sincerely, AMIR DAN RUBIN PRESIDENT & CEO

2

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

Send comments and story ideas to communications@stanfordmed.org ON THE COVER: Outpatient Center employees (L to R): Gema Diaz Campos, Orthopaedic Clinic; Kevin Helenius, Orthopaedic Surgery; Ann Fehring-Larkin, Guest Services; Jodi Harper, Orthopaedic Surgery; Victoria Fontenot, Clincal Labs.

THE OUTPATIENT CENTER TURNS

FIVE

Offsite Clinic Thriving After 2009 Opening

M

AUREEN BURKE LOOKS BACK FIVE YEARS TO THE OPENING OF THE STANFORD MEDICINE OUTPATIENT CENTER IN REDWOOD CITY AND REMEMBERS MANY THINGS—THE MANY MONTHS

OF PREAPPROVAL MEETINGS AND RENOVATION, THE THOUSANDS OF SMALL BUT CRUCIAL DETAILS, THE HUNDREDS OF PEOPLE BROUGHT

TOGETHER WITH NEW TRAINING AND BUSINESS ATTIRE. Conquering all the challenges was part of the job for Burke, then the Outpatient Center’s director of operational planning. The unspoken hurdle, however, went beyond the center’s bricks and mortar.

”It was our first true offsite project,” Burke said, “our first foray away from our

home base. And we weren’t just opening a building.” The Outpatient Center, she said, would be the first Stanford location to incorporate certain new standards of patient care and to gauge the impact on patient satisfaction of the consolidation of exam rooms, imaging and operating rooms.

CONTINUED ON PAGE 4

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

3

CONTINUED FROM PAGE 3

Burke and others are pleased to say now that the Outpatient Center has passed all its tests. In fact, said Helen Wilmot, SHC’s Vice President of Transitional Planning and Strategic Space Management, “it has outdone our expectations. People really do see it as part of our family—and that was one of the primary hurdles— that it was psychologically and physically distant from our main ship. But it’s become a beacon and a model for how we can be successful away from campus.”

The Outpatient Center, which opened with some spaces still unfilled, is now just about at capacity.

“Being here near the physicians’ offices means we can just walk over and talk to doctors face-to-face to get clarity about a patient goal...

It makes teamwork and communication so fantastic.”

Step-by-step, the square footage has been snapped up.

The most recent addition is an infusion therapy center, another first offsite location. Earlier this fall, the vastly

When the Outpatient Center opened in 2009, the

expanded physical therapy center opened, with an

rehab space was just 1,200 square feet, big enough

enviable view of the San Francisco Bay and an array

for five therapists, a handful of therapists in training

of new therapy equipment.

and about 150 patient visits weekly. The new space

The location of that facility reflects the philosophy at

measures 10,500 square feet, quite necessary since the

the heart of the Outpatient Center. “Being here near the

therapists now number 15, patient visits have climbed

physicians’ offices means we can just walk over and talk

to nearly 600 weekly and those therapists-in-training

to doctors face-to-face to get clarity about a patient goal,”

are still part of the picture.

said Steve Pavlet, manager of the rehab center. “It makes

QUICK FACTS

teamwork and communication so fantastic.”

ABOUT THE OUTPATIENT CENTER CLINICS: DERMATOLOGY, IMAGING, ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, PAIN MANAGEMENT, SLEEP MEDICINE, REHABILITATION SERVICES

4

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

Putting everything and everyone orthopaedic together at the Outpatient Center was the idea of Orthopaedics

CONSTRUCTION ON OUTPATIENT CENTER BEGAN:

1/26/06

TOTAL COST OF CONSTRUCTION:

$100

MILLION

GRAND OPENING:

2/17/09

OUTPATIENT CENTER EMPLOYEES:

725

Department Chair William Maloney. “We wanted state-of-the-art equipment, the most up-to-date imaging and technology and proximity to other services we knew our patients needed,” Maloney said. Many orthopaedics patients experience pain, so it made sense to have the Pain

12

THINGS TO KNOW

Management Clinic within the Outpatient Center complex.

Maloney knew that some people were hesitant about the move. But the reality has convinced them, he said.

“The doctors who work here really enjoy having their offices, the clinic and the ORs all in one location. There was some anxiety about moving off campus, but people now appreciate the efficiency. We’ve also found that patients don’t have a loyalty to a place—they will go to where they will get care from the best doctor.”

Orthopaedics is also expanding its roster of physicians, Maloney said, and looking forward to being part of the multidisciplinary Wound Center, which will occupy the last major piece of available space at the Outpatient Center.

The other distinguishing feature of the Outpatient Center was its décor, especially the lobby, complete with piano that plays automatically or with human help. That beautiful environment, however, aided more CONTINUED ON PAGE 6

CLINIC VISITS 2009:

47,044 2013:

104,518

APPROXIMATE SQUARE FEET:

360,000

SURGICAL PROCEDURES 2009:

2,167 2013:

6,022

OUTPATIENT CENTER EXAM ROOMS:

96

The Stanford Sleep Medicine Center has two parts: a sleep disorders clinic and a sleep studies lab where overnight sleep tests are performed. It’s a little like having our own 14-room hotel.

Orthopaedic Clinic total patient visits have increased 39% since moving to the Outpatient Center.

The physical therapy area has grown in size from 1,200 square feet in 2009 when it opened to its current size of 10,500 square feet.

Dermatology was the first service at SHC to provide telemedicine appointments.

Pain Clinic total patient visits have increased 92% from 2009 (FY09: 6,814 visits. FY13: 13,114) One of the most visible works of art is the heartshaped “Siesta in the City,” a 400-pound glass sculpture.

The Sleep Center has three specialty clinics: Narcolepsy, Restless Legs Syndrome, and Parasomnias.

Music is heard in the main lobby from the Steinway grand piano Monday through Friday from 9:00 am–6:00 pm. If there isn’t someone playing live, automated music is played.

A former patient, Steven Scholom, plays the piano in the main lobby from noon to 3 pm on Mondays and Fridays.

There are a total of 171 pieces of fine art in the Outpatient Center, which consist of 90 photographs, a large heart sculpture, four whimsical ceramic sculptures, an assemblage of a horse from found wood, 10 oil/acrylic paintings, 15 watercolors and 50 monoprints.

Some non-clinical departments who call the Outpatient Center their home are Revenue Management, HIMS and interpreter services.

The mail room for the entire medical center is located at the Outpatient Center. Twentythree employees handle the mail for SHC, the School of Medicine and Packard Children’s.

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

5

CONTINUED FROM PAGE 5

important changes. Supported by then operations director Wendy Foad, now SHC’s associate nursing officer, all employees received special training in customer service that’s now visible hospitalwide as C-I-CARE. The organization of desks, exam rooms and other areas at the Outpatient

SHC’S GOT TALENT

Center was done according to principles similar to those now being added as part of the main hospital’s lean operating system approach.

Business attire to help patients identify various professionals debuted first at the Outpatient Center.

And the Outpatient Center became the home of the transformation of SHC’s method of answering patient telephone calls. In a move that proved highly successful, those phone calls were no longer answered at clinic desks, but by a dedicated team in what’s now called the Stanford Patient Access Response Center (SPARC).

Cheri Lewis, administrative director of patient access and intake, has a veteran’s perspective. She and SPARC’s manager, David Lee, started with nine call agents. Now, they have 57—and by this summer had tallied up more than 3.7 million answered calls since those first days in 2009.

“We never could have imagined that, plus we have added centralized New Patients (PATH) and Referrals/ Authorization (COAR) to the services,” Lewis said.

FUN FACT The Outpatient Center was the first major relocation of specialty clinics away from the main hospital.

6

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

For Love of Training … and Winning Buffie Wuestewald has been an athlete her entire life, so when knee issues prevented her from running, playing basketball and hiking, she took to her bicycle. She was introduced to racing on a velodrome track in 2006, and realized pretty quickly that she was fast. The same year she took up the sport, she participated in her first race and won medals in all five of the events she entered.

Today, Wuestewald is a recognized leader in the bicycle-racing world in the 45+ division. This past summer, she competed in her first Master’s Nationals Championships in Indianapolis, and took first in the team sprint, and second place in the 500m time trial and the match sprints. She also competed at the Master’s World Championships in Manchester, England, taking third place in the 500m time trial and second in the match sprints.

She qualified second in the exhibition team sprint.

“I love the thrill of riding a fixed gear bike with no brakes and the excitement of a banked track,” says Wuestewald, who directs clinical transformation for Information Technology Services. “There’s no coasting in this sport.

If your pedals aren’t moving, you come to an abrupt stop.”

Wuestewald continues to train five to seven days a week, sometimes twice a day. She races for the San Jose Bicycle Club and regularly visits Los Angeles to train on their indoor track that has 45-degree banked turns. She aspires to beat her nemesis, a former Olympic athlete who holds several world records.

“I like winning,” she says. “I want to do better next time.”

“I love the thrill of riding a fixed gear bike with no brakes and the excitement of a banked track...

There’s no coasting in this sport. If your pedals aren’t moving, you come to an abrupt stop.”

KUDOS October Service Spotlight Winner SAM PLASCENCIA When Sam Plascencia, an anesthesia technician, saw a family in need of assistance on his way to work, he did not hesitate to act. The family had driven six hours to get to their child’s doctor appointment and were stopped by a flat tire near the hospital. They were upset because they thought they might miss the appointment.

When Plascencia saw them on the side of the road, he pulled over and asked the family if they needed help. Moments later, he took out his tools and began fixing the flat tire. With Plascencia’s help, they were able to make it to the appointment on time and avoid the added stress of calling a tow truck.

December Service Spotlight Winner

November Patient Safety STAR Award

TRISH CLAYBURGH, RN

ANGELA GIDDINGS, RN

As an emergency room nurse, Trish Clayburgh is known for her ability to respond quickly in emergency situations. While on her lunch break at Page Mill Pastures, Clayburgh helped a 15-year-old girl who had fallen from a horse and was knocked unconscious. Her airway was blocked and Clayburgh quickly stabilized her spine and changed her position so she could breathe. She then calmly took control of a chaotic situation and ordered someone to call 911. She continued to kneel on the ground next to the girl, who has cerebral palsy, protecting her from further injury. At the family’s request, Clayburgh rode in the ambulance with them to the hospital. The family was grateful for Clayburgh’s calming response during the emergency situation.

Known by her colleagues on C2 as a clinical expert and an advocate for her patients and their families, Angela Giddings takes pride in the nursing care she delivers. During a recent shift, Giddings used her nursing assessment skills to recognize a situation and took immediate action to avoid a potential medication error.

Not only did Giddings take the appropriate actions to ensure the patient’s safety, she also reviewed the situation with the transferring unit to prevent the situation from reoccurring. Giddings’s action in preventing a possible medication error is an example of her commitment to patient care and focus on patient safety.

December Patient Safety STAR Award October Patient Safety STAR Award CHRISTINE MARION, RN

November Service Spotlight Winner HARRIET HARRIS After waiting an hour for a patient’s wife to come to the Outpatient Center to pick up her husband, Harriet Harris, a clinical nurse, became a bit concerned. She called the patient’s wife and found out that she had lost her way in San Carlos. Harris tried to give her directions over the phone. However, the patient told Harris that his wife suffers from dementia and can become confused when following directions.

Other colleagues of Harris tried to help without success, so Harris drove to the wife’s location and the two made their way safely back to the Outpatient Center.

Christine Marion is well-known on her unit for being a caring and conscientious nurse who is dedicated to her patients on the Neurosurgical Unit. When a patient voiced personal safety concerns during a hospital admission, Marion followed appropriate hospital policy and took immediate action to ensure that the patient was safe. She contacted the necessary departments to address the patient’s concerns and documented the event within the patient’s medical record. Following Marion’s response to the situation the patient stated that she felt safe at Stanford, evidence that Marion’s prompt actions and communication skills were effective in addressing the patient’s concerns.

MARTHA BERRIER, RN As a patient care manager on D1, Martha Berrier is a role model for promoting a culture of safety. She has successfully increased safety awareness on her unit through event reporting into the SAFE system.

Berrier’s active daily management of the unit includes leader standard work with the unit’s SAFE reports.

During her monthly staff meetings, Berrier reviews the unit’s SAFE events in detail and highlights areas for improvement, giving her staff effective and timely feedback from the reports submitted. Because of her dedication to increasing safety awareness through event reporting, Berrier has made D1 a model patient safety advocate for all staff to follow.

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

7

ROBERT TOGNOLI IS A 17-YEAR VETERAN OF THE SLEEP CENTER.

GETTING A GOOD NIGHT’S SLEEP

FOCUS ON...

Sleep Medicine Center When Robert Tognoli joined SHC in 1997, its Sleep Medicine Center was celebrating its 25th anniversary. Tognoli was a research assistant at Stanford and a part-time instructor at a local community college when a colleague who worked in sleep research at Stanford mentioned a job opportunity that could incorporate Tognoli’s interests—and Tognoli was intrigued. Instead of the somewhat fractured schedule dictated by his teaching and research, he could combine all his interests in a full-time job at Stanford.

Seventeen years later, Tognoli is one of the most veteran employees at the sleep center, where more than 5,000 patients are treated annually in a facility that includes 14 clinical and four research beds. Tognoli works the afternoon and early evening shift, helping 8

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

patients to get settled in the somewhat cumbersome set of electrodes they wear for their sleep studies. He also walks them through the data produced by the sleep studies so they understand better what their challenges are. Later, when those studies have yielded treatment recommendations, he works with patients to adjust to the changes sometimes needed to improve their sleep.

One of those measures is a monthly meeting he facilitates that combines patient education and advocacy. “Patients and community members can participate in an interactive discussion group and hear presentations from sleep physician specialists,” Tognoli said. “It’s a wonderful resource for patients to empathize and learn from one another.” He was also asked to be part of a task force to design research under a grant from the National Patient-Centered Outcomes Research Institute. “The idea is to make the patient the center of treatment within a model of coordinated care,” Tognoli said.

He did finish work on a master’s

DID YOU KNOW? The Stanford Sleep Medicine Center is widely considered the birthplace of sleep medicine.

In 1970, Dr. William Dement opened the nation’s first sleep disorders clinic at Stanford.

degree in Creative Arts and Interdisciplinary Studies, something he’d started many years ago before he arrived at Stanford—and he’s proud of that. But what still gives him the greatest pleasure is helping patients, watching them progress from the distress they’re feeling about sleep when they first begin care to reach a place where there is objective data to show they’re doing better.

“Seeing their success,” Tognoli, “is my greatest reward.”

BY THE NUMBERS SPARC HAS ANSWERED MORE THAN

3.7

MILLION CALLS INCLUDING 1.1 MILLION IN FY13 SPARC HAD NINE EMPLOYEES IN 2009. TODAY THERE ARE

57

ON STAFF THE FAX MACHINE IS ALIVE AND WELL. THE REFERRAL CENTER NOW RECEIVES MORE THAN

7,400

FAXES PER MONTH

UP FROM 2,100 IN 2009 CENTRALIZED OUTPATIENT AUTHORIZATIONS & REFERRALS (COAR) RECEIVES

38,000

AUTHORIZATIONS PER MONTH

Stanford Patient Access Response Center Kevin Ward and Aimee Alvarado are symbolic bookends for the 61 people who answer the phones 12 hours a day at the Stanford Patient Access Response Center (SPARC). Alvarado joined the team less than a year ago; Ward has more than a decade’s experience at SHC. What both share equally is a passion for service represented by all their colleagues—and one expressed perfectly by David Lee, SPARC’s manager: to take care of the patient.

SPARC, a centralized call center for Stanford’s clinics, was one of the Outpatieint Center’s original occupants and is nearing its four millionth call answered.

Alvarado had long wanted to work at Stanford, and when the Outpatient Center opened five years ago, she’d drive by and tell friends, “One day, I’m going to be working there.” Doing what, however, she didn’t know. For several years, she was an office manager at a dermatology clinic.

She did not interact with patients, and that’s one of the things she enjoys most about her new job. “We’re encouraged to share our compassion and sympathy to help our patients,” she said. “That’s especially important because we are

DID YOU KNOW? When the Outpatient Center opened in 2009, SPARC supported eight clinics and received 17,000 calls per month.

Today, it supports 44 clinics and receives 109,000 calls per month.

the first point of contact with Stanford for our patients.”

Ward, about 20 years older than Alvarado, has a perspective tempered by that age difference and by several years working at SHC in medical records, scheduling and clinic front desk. “Often when people call us, they are feeling upset by their medical condition—and one day we are all going to be that way. I am prepared to listen,” he said. What makes him feel particularly good are the relationships he can build with people he speaks on a regular basis. “When someone says to me, ‘Whenever I speak with you, I feel better,’ then I know I’m doing my job with passion.”

Every SPARC employee is assigned to a set of clinics, and that does allow center employees to get to know some patients over time, something Ward believes is another bridge to build trust between patients and Stanford. “We are part of the continuity of care.”

CALL COORDINATORS AIMEE ALVARADO AND KEVIN WARD ARE PART OF THE SPARC TEAM THAT ANSWERED MORE THAN ONE MILLION CALLS IN FY13.

CALLING ALL STANFORD CLINICS

FOCUS ON...

UP FROM 3,200 IN 2009 STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

9

GOOD WORKS In the Community Oncology Nurse Brings Love of Yoga to Patients with Cancer Hematology-oncology nurse Julie Locke, RN, loves two things—her patients and yoga. A devoted student of yoga for the past four years, Locke trained to become an instructor and took an extra certification course to teach yoga to patients undergoing treatment for cancer. In addition to teaching Vinyasa classes five days a week, Locke offers free yoga classes for cancer patients and their caregivers twice a week. The Yoga Tree in San Francisco donates the studio space, and Locke donates her time.

“I have always wanted to do more for this population of patients,” says Locke, who began taking yoga as a means of finding peace and balance in her busy nursing life. “My life has been so enhanced by my patients and their stories. This is a way for me to pay it

forward and provide them a shelter from the storm of their treatment.”

Twice a week, Locke gives patients an hour to themselves, a safe haven away from the clinical hospital setting.

“I find the yoga studio to be a nurturing place in which to connect,” she adds.

As a nurse, Locke is sensitive to the varying degrees of fatigue in her students and is trained to modify poses for students with ports or those who are experiencing side effects or nausea from treatment. Of her students, she says, “I definitely see their energy level change over the course of the class.”

To bring the healing spirit of yoga to more patients with cancer, Locke has teamed up with partner Yujiro Hata to create True Blue Yoga, a nonprofit organization that plans to develop yoga classes for cancer patients in more studios throughout California.

Crisis Counseling Around the World Kim Woolley has been to the small Philippines island of Leyte twice this past year—once for vacation and the second time as part of the Stanford Emergency Medicine Program for Emergency Response (SEMPER) team. For 10 days, Woolley and her Stanford colleagues, 10 in all, saw more than 250 patients in clinic per day.

JULIE LOCKE, RN, TEACHES YOGA TO CANCER PATIENTS AND THEIR CAREGIVERS. Photo By Scott Finsthwait

10

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

As a social worker in Stanford’s emergency department, Woolley provided crisis counseling to the people affected by the storm and to her SEMPER teammates. Her skills were especially valuable since most of the patients coming to clinic were suffering from symptoms of anxiety from enduring the storm and its devastation.

This most recent trip with SEMPER was her first international deployment but not her first experience helping out in a crisis. As a disaster mental health volunteer for the Red Cross in San Francisco, she was on hand at San Francisco International Airport to help passengers on the Asiana Airlines flight deal with the mental stress of the event.

“I have always been interested in disaster management work,” says Woolley, who worked as an EMT during college and volunteered with the Red Cross as a teenager. She was inspired at an early age by her aunt who is a paramedic.

“I think it’s an important part of humanity to offer assistance to other people who are in need of an extra hand,” says Woolley. “There’s a lot to be said for human-to-human contact, for people to know they’re important, that they’re not forgotten. I think it’s a loving thing to do to help another person.”

KIM WOOLLEY PROVIDED CRISIS COUNSELING IN THE PHILIPPINES AFTER THE RECENT TYPHOON.

ACTIVE DAILY MANAGEMENT HAS HELPED CHAD HANNAH AND HIS COLLEAGUES IMPROVE OR ROOM READINESS TO 90 PERCENT.

At SHC Active Daily Management Improves OR Efficiency Maintaining an on-time operating room (OR) schedule relies on an interconnecting set of of variables—patients must be prepped, medical staff must be present, and supplies and equipment must be in order. A new active daily management routine created by nurse manager Chad Hannah, RN, uncovered a big flaw in the system—the preference cards being used to order supplies were not up to date, so getting a room prepped correctly was difficult and time consuming.

With coaching from Performance Excellence, Hannah began actively rounding OR rooms twice a day to collect information on every case and evaluate room readiness. He now shares this responsibility with his team of assistant nurse managers. This new routine, which started in August, greatly improved communication between front-line nurses and nurse managers and exposed long-standing problems with the existing system.

“There’s less stress getting rooms ready, so staff morale has greatly improved,” says Hannah. “And we now have a system for identifying and correcting issues as they arise, so room readiness has greatly improved.”

LUPE HOGAN LED AN RPIW THAT REDUCED REFERRAL-TO-SCHEDULED THE APPOINTMENT TIME FRAME FOR LIVER TRANSPLANT PATIENTS.

Before implementing active daily management, OR room readiness was about 75 percent. Today, that number is 90 percent.

Hannah also implemented daily huddles at the beginning of each shift and created a new visibility wall in the main OR corridor to share room readiness data. He believes these changes have made the nurse managers more engaged with the staff, and vice versa.

“The staff really likes the new process,” says Hyacinth McIver, RN, assistant nurse manager, who credits Hannah with leading the effort. “They like the visibility by the management team, and they like seeing that issues are getting fixed.”

Liver Transplant Team Overhauls Appointment-Scheduling Process Patients facing the prospect of a liver transplant at Stanford had to first overcome a surprising hurdle—getting an appointment scheduled. Just six months ago, scheduling an evaluation appointment took nearly six weeks.

Today, the referral-to-scheduledappointment time-frame has been whittled down to one or two days, thanks to the concerted effort of the liver transplant team, led by transplant nurse manager Lupe Hogan, RN.

“ We felt it was important to get patients here efficiently and make their first experience with us very reassuring and caring...”

With help from Performance Excellence, Hogan guided a multidisciplinary team through a Rapid Process Improvement Workshop (RPIW).

“We felt it was important to get patients here efficiently and make their first experience with us very reassuring and caring,” says Hogan, transplant nurse manager. Hogan carried the weight of the improvement work and really drove the process, bringing her team along every step of the way, says Michael Espinoza of Performance Excellence.

Today, patient appointments are scheduled almost immediately, even if necessary authorizations and financial information are not in place. Staff members then work together behind the scenes to get the work complete before the patient arrives for an evaluation.

According to Laura Denton, RN, pretransplant coordinator, Hogan did a great job leading the effort and keeping staff engaged and informed. “The end result is that the process is now focused on the patient, not on what is convenient for us, and that’s a good thing.”

STANFORD HOSPITAL PEOPLE / ISSUE SIX 2014

11

THE STANFORD EMERGENCY MEDICINE PROGRAM FOR EMERGENCY RESPONSE (SEMPER) BUILDS, TRAINS AND MAINTAINS TEAMS OF EMERGENCY MEDICAL CARE PROVIDERS READY TO DEPART FOR A DISASTER SCENE WITHIN SIX HOURS FOLLOWING A CALL FOR HELP.

SPECIALLY TRAINED VOLUNTEERS MOBILIZE FOR DISASTER RELIEF When disasters occur, such as the recent typhoon in the Philippines, medical teams from around the world mobilize to send help. But these medical relief missions tend to be large and slow.

After returning from such an effort to Haiti four years ago, Bob Norris, MD, and Paul Auerbach, MD, decided to create a different type of disaster relief team at Stanford—the Stanford Emergency Medicine Program for Emergency Response (SEMPER).

“We recognized the need for a small, nimble team—one that stayed in a state of readiness with preplanned equipment and pharmaceuticals so it could be out the door within six hours,” says Norris.

The SEMPER program holds ongoing classes and seminars that allow its members to develop and hone the skills needed to treat large numbers of victims in the chaotic environment of a disaster area. The team also participates in local and state disaster drills, and keeps prepacked bags of medical supplies and pharmaceuticals ready at all times.

“I firmly believe having people trained in this regard makes the institution stronger,” says Colin Bucks, MD, associate director of SEMPER and clinical assistant professor of emergency medicine. “If we have a local disaster where we have to treat patients with limited medical supplies, there are folks here on the ground with this type of training.”

SEMPER’s membership includes more than 40 volunteers, all of whom use their own paid time off to train and deploy. But the team is always recruiting new members, says Bucks.

“The deeper the bench, the better we are.”

When Norris and Bucks get the call to help an international relief effort, assembling a team of 10 can be tricky. “We need a balanced set of medical skills, disaster experience and cultural knowledge, and then we have to identify who is most available,” says Bucks.

The recent deployment to the Philippines was SEMPER’s first official mission, and it differed from traditional medical relief because the team saw very little major trauma. Instead, the SEMPER crew provided support to the disrupted health care system, giving the local staff the opportunity to recover and regroup.

“We set up under tarps in front of their clinics and took care of their patients,” says Bucks, who estimates that the team saw more than 4,500 patients in just eight days. “Hardly glamorous,” he adds, “but essential.”

LET US KNOW WHAT YOU THINK Follow Stanford Hospital on Twitter at @StanfordHosp. Like us on Facebook at facebook.com/stanfordhospital.