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April 2013
In This Issue
Farmers' Market to Return
Improving Patient Intake Process
Less Waiting for Appointments
CCRMC Doctors Working Abroad
ccLink Classes Prove Popular
Art Opening at West County Health Center
In the News: Doulas
Wright Institute Offers Groups
Send Us Your Story Ideas
Mud Runners
Mud Run 2 before
See what this group looked like after they finished the Mud Factor 5K Obstacle Run 
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Message from the CEO 
Anna Roth portrait
Anna Roth, Chief Executive Officer of CCRMC & HCs 
Staying Connected While Getting to Health Reform and Beyond   
I'm excited to debut our Contra Costa Regional Medical Center (CCRMC) and Health Centers' newsletter: The Update. My goal is that this will serve as a vehicle to showcase the great work you all do and help keep our delivery system connected and up-to-date on the many ongoing projects we have underway to transform our health system in this new era.

There is a tremendous amount of activity occurring at the local, state and national level with Health Care Reform. While there are many important aspects of the full implementation of the Affordable Care Act still emerging, we do know what we need to do right now to care for our community and be prepared for 2014 and the future.   


I presented our plan of action and priorities for the next year to our County Board of Supervisors in February (see my Powerpoint on our plan and priorities here). This is a critical period for us both in what we need to accomplish now, as well as the planning needed for the next several years. This is an ongoing process and we'll be talking about this more soon. Much of the work we need to accomplish has already been outlined in the hospital sustainability study and the Centers for Medicare and Medicaid Services' Delivery System Reform Incentive Payment Program (DSRIP). The CCRMC DSRIP plan describes the work we need to do to redesign our delivery system to improve care and increase patient access and how we'll measure our performance. We must meet the DSRIP measures to qualify for federal performance incentive payments (see our DSRIP factsheet here).


Under Health Care Reform, more people will be covered, competition will intensify, pay for performance or outcomes-based payment models will increase, and health providers and systems will be looking at new approaches to improve the health of those we serve through innovative approaches as well as partnerships with others to care for our communities. Based on what the changing environment will require, along with the hospital sustainability study, DSRIP, feedback from leadership and staff (and feedback from our electronic health record implementation and the Roster Reduction Task Force), we have identified critical areas to work on in the coming months. All these drivers help set our priorities with the ultimate goal to provide the best care for our community at the lowest cost in a way that those we serve need and want. 


The four priority areas are: Patient Safety; Health Home; Leadership and Oversight; and Best People/Workforce. Patient Safety includes supporting and strengthening our ongoing safety work, such as key areas outlined in our DSRIP plan. Health Home encompasses access and capacity with the focus on increasing primary care capacity and strengthening our primary care model. Best People/Workforce is about building, strengthening and supporting our employee workforce and increasing joy in work. Leadership and Oversight is an important area as we redesign our system. Having the organizational structure and the systems in place to monitor our performance will be essential to our ability to improve our system to meet the needs of our community.


As an integrated system, we are uniquely poised to implement Health Care Reform here in Contra Costa County. Programs like the DSRIP provide us with a unique opportunity to receive support for the innovative and outstanding work each of you are doing to redesign our system for the future. Our success has been due to every one of our employees' efforts on improving our system and focusing on our priorities and meeting the required performance measures. This will continue to strengthen us and allow us to serve our patients and community right now and in the future.


Please send us your feedback and story suggestions via the link at the bottom of this newsletter. I look forward to hearing from you.    


Thank you.






Anna Roth, RN, MS, MPH

Chief Executive Officer

Contra Costa Regional Medical Center and Health Centers


 Follow me on Twitter  Visit my blog 

Farmers' Market Returning to CCRMC 
farmers market
A member of our medical staff shops at the farmers' market last year.
Weekly market will take place every Tuesday starting May 7 

Looking for a convenient place to get locally grown produce or buy a tasty lunchtime treat? Then you'll be glad to hear that the CCRMC Farmers' Market is returning. The Farmers' Market will take place every Tuesday in front of the hospital from Noon - 4 p.m. starting on May 7. The weekly market, a joint venture between CCRMC and Contra Costa Certified Farmers' Markets, Inc., features locally grown seasonal produce, including organics, from small family farms.  There will also be delicious prepared foods, fresh popped kettle corn, gourmet coffee and an array specialty items throughout the season. There will be an ATM onsite if you need to get some cash. Cal Fresh EBT cards are welcome and can be redeemed for vendor-accepted tokens at the Information Booth.


Stop by the market information booth and ask about the new "Stamps for Salad" program, which rewards frequent shoppers with a 40% discount at the hospital café on non-market days.


If you would like more information, please visit the Contra Costa Certified Farmers' Markets website

Standardizing the Intake Process at Health Centers 
Louisa Niapis (center) served as the improvement team's patient representative.
Changes being tested at Concord Health Center

Last month an improvement team examined operations at Concord Health Center in an effort to standardize and streamline the patient intake process. The goals were to improve work flow and communication among staff, reduce waiting times for patients, and maximize the quality time patients get with their providers during appointments.The team, which included frontline staff and a patient partner, tested and developed standard work around the intake process over a four-day period. 


In order to improve communication between clinicians and nursing staff, the team organized quick huddles before clinics to help anticipate the patient needs that day. The huddles helped some clinics finish on time with fewer  interruptions. Tasks such as pending orders were also shifted from the provider visit to the intake process to level out the workload and to make the provider visit with the patient more valuable. The team also tested standardizing dot colors in ccLink's clinic roster "dot system" to better signal where the patient is in the visit so nobody is waiting unnecessarily.


Eventually, these changes -- after they're standardized and sustained at Concord Health Center -- will be rolled-out systemwide.


This was the first of seven rapid improvement workshops designed to improve primary care in the clinics. The next such workshop will look at how to more efficiently manage requests for narcotic prescription refills. The refill report out will take place on Friday, April 26. 

Faster, Easier to Get Appointments Under New System  

Hold times for Appointment Unit plummet 

The average amount of time patients are spending on hold to make appointments has dropped dramatically since the implementation of the redesigned appointment system in February. From the end of January to the end of March, the average amount of time patients spent on hold when calling the Appointment Unit went down from 14 minutes to about three minutes. At the same time, we now consistently have same- or next-day appointments available throughout the day. Before the system redesign, we usually ran out of those appointments by 9 a.m.


Ambulatory Care Medical Director Dr. Chris Farnitano said while it's premature to declare the new system a complete success, the early results are extremely promising.

This graph shows hold times dropping from an average of 14 minutes to about three minutes after the new appointment system began.

The redesigned system expanded the amount of available appointments by requiring that most return appointments must be made within two weeks of the visit. Previously, providers were scheduling follow-ups for patients that were weeks and sometimes months away. This practice resulted in appointment being reserved for people more likely to miss their office visits, so-called "no shows."


The appointment system redesign is part of our ongoing efforts to improve access and reduce our no-show rates. In mid-December, the North Richmond Center for Health implemented a pre-registration program in which patients are contacted prior to their office visits to remind them of their scheduled appointments and to handle administrative tasks in advance. Preliminary data suggest pre-registration has helped reduce the number of no shows at North Richmond from over 22% to just under 17%. The practice also has increased the number of available appointment slots because some patients cancel when contacted to pre-register. Preregistration is now being rolled out to clinics at West County Health Center and Concord Health Center.

Global Health Leadership Fellows From CCRMC Train African Doctors  in Family Medicine 
Current fellows working in western Kenya to support clinician education, systems improvement

Given resource limitations in Africa and a lack of specialist physicians, there is a critical need for well-rounded generalist physicians that can manage the most common medical, pediatric and surgical problems in the communities they serve. Family medicine is emerging as a specialty in Africa that is taking on this challenge. We have joined a fellowship program that trains African doctors who have finished internships and have basic medical skills -- known as medical officers -- in the practice of full-spectrum, high-quality family medicine. 

Dr. Jeff Pierce (far right) leads bedside rounds with clinical officers and medical officers at Sagam Community Hospital in Kenya.
 The CCRMC/MGH Fellowship in Global Health Leadership is a partnership between our Family Practice Residency Program and the Department of Emergency Medicine's Division of Global Health and Human Rights at Massachusetts General Hospital. The goal of the fellowship is to promote and support medical education and residency programs in developing nations that will produce home-grown doctors trained in comprehensive medical care, like family and emergency medicine. 
Local Director Dr. Neil Jayasekera said fellows will work with the medical school and help medical students and junior doctors learn the critical elements of care in tropical regions, such as labor and delivery, pediatrics, tuberculosis and HIV treatment. 
The current fellows from CCRMC, Dr. Michele Montandon and Dr. Jeff Pierce, are working with the Sagam Community Hospital in western Kenya to support clinician education, systems improvement and infrastructure development; a family medicine residency program is under development in collaboration with a Kenyan university, Maseno University School of Medicine.


To find out more about the fellows, click here

Providers Find ccLink Classes Useful 
Dr. Ron Cavanagh gets assistance from a ccLink instructor.
More efficiency courses planned 

Providers are praising ccLink efficiency courses we offered in late February. That's according to a survey filled out by 65 providers who took one or more of the classes, which offered tips and tricks on how to better navigate ccLink, our electronic health record system. Survey respondents overwhelmingly said they felt more comfortable with ccLink after taking a class and would recommend the class to others (see chart below).  More provider classes, which will be led by physician Super Users, are in the works. Efficiency training sessions for nurses are also being planned by Nurse Informaticist Jen Gossett


To find out more about ccLink training efforts, visit the ccLink page on iSITE


Opening for Art Exhibition at West County Health Center
Penny for a Thought by artist Milton Bowens will be one of the works on display at the opening.
Event at WCHC on Wednesday, April 17 

In the mid-1990s, medical staff at the old Richmond Health Center teamed up with local artists to create ArtsChange, a group dedicated to using art as a tool to improve community health and well-being. For the past 17 years, artists worked with patients and staff to create socially engaged works reflecting local culture and life. A collection of those assembled works are now going to be on display -- many of them permanently -- at the new West County Health Center in San Pablo, which replaced the aging Richmond facility last year.


An opening celebration will take place at the West County Health Center from 5:30 - 8 p.m. on Wednesday, April 17. Tours will be given by ArtsChange artists, expressive arts therapists from the California Institute of Integral Studies will encourage attendees to make their own art, and there will be live music as well. Admission is free.


For more information about the art opening, contact Dr. Alan Siegel at Alan.Siegel@hsd.cccounty.us. If you'd like to see more of the art, visit ArtsChange's tumblr

In the News: Volunteer Doula Program
Labor coaches at hospital help ease birthing process 
Recent stories in the Martinez News-Gazette and KGO Radio showcased CCRMC's volunteer doula program. Birth doulas -- aslo known as labor coaches -- provide non-medical support, encouragement and comfort to women in labor. The free service is offered to expectant moms when they arrive at the hospital. Research has shown that the presence of doulas lowers fear and stress, enhances the experience of birth, and improves birth outcomes. CCRMC is one of only a few hospitals in the Bay Area that have a volunteer doula program. 

To find out more about our doula program, visit the program's Web page. (You can also listen to the KGO stories on this page.) 

Credit: The Martinez News-Gazette
Proud new parents, Will Reynolds and Antoinette Castro, told the Martinez News-Gazette that their doula offered helpful guidance and advice while Antoinette was in labor.  
Photo via the Martinez News-Gazette


Mud No Obstacle for Pittsburg Crew MudRun
A group of Pittsburg Health Center employees and members of their families went to Sacramento on April 6 to participate in the Mud Factor 5K Obstacle Run, a charity event promoting the benefits of health and fitness. Of course, everyone got a little dirty, but Katherine Reece, an LVN at Pittsburg, was pleased to report that everyone went home healthy and happy. 

Before the Run 
Mud Run 2 before
From left to right: Billie Reed, Harley Reed, Anquanetia Reed-LVN, Sunshine Reece, Katherine Reece-LVN, Sharon Holder-LVN, Ann Bolen- RN, Dr. Cinnie Chou and tech Hazel Maldonado.

After the Run 

Mud Run 1
Wright Institute Offering Groups for Patients
The Wright Institute program at the West County Health Center, Martinez Health Center and North Richmond Center for Health is offering several behavioral health groups for patients. These groups are all open for referrals and are also available on a drop-in basis.   

At WCHC there is a Stress Reduction Group on Tuesdays, 2 - 3:30 p.m.; a Grief Group on Thursdays, 10:30 a.m. - noon, and an Alcohol and Drug Education Group on Thursdays from 3:30 - 5p.m.  All groups are held in Group Room A and are available for referrals.  For more information or to make a referral, contact Vaneeta Sandhu, PsyD at (510) 231-9572, Extension 1.


Martinez Health Center is currently offering two groups.  These are a Mood Management  Group  and a Stress Reduction Group.  The Mood Management Group is held on Tuesdays, 5:30 - 7 p.m. and the Stress Reduction Group is Thursdays, 5:30 - 7 p.m.  For more information or to make a referral, please contact Dr. Michael Changaris at (925) 335-7435.


North Richmond Health Center is offering a Stress Reduction Group on Tuesdays from 3 - 4:30 p.m.  For more information or to make a referral, please contact Kamil Jibril, PsyD at (510) 374-7342.


The group leaders listed above can also be reached by sending them an InBasket through ccLink.

Send Us Your Story Ideas contact
Let us know about upcoming events and important happenings going on at the Regional Medical Center or the health centers. 

Click here to contact us or contact Kate Fowlie at: 
(925) 370-5224