We are in the summer months but our work continues at an amazing pace as we move forward with the many exciting efforts we have underway to ready our delivery system for Health Care Reform. As part of our ongoing strategic planning efforts, I wanted to update you all on some of these efforts that support our four priority areas (Patient Safety; Health Home; Leadership and Oversight; and Best People/Workforce).

Planning Process

Our strategic planning efforts continue with our four subcommittees meeting this week in preparation for the next planning retreat August 29. The committees (Purpose, Whole System Measures, Linkage Map and Voice of the Patient) were developed in response to our Planning Session in May and will focus on: our role in the changing health care environment; how we measure improvement; how we link to the rest of our system and community as a whole; and how we ensure the voices of our patients are heard and that our mission is communicated. More on this soon. 

Ambulatory Care Redesign

This week we also are holding the first learning session for our Ambulatory Care Redesign project, an ambitious effort to improve how we deliver outpatient care by blending best practices with optimal care for the best patient outcomes. Planning for this year-long mission began in early May in partnership with the Institute for Healthcare Improvement (IHI). Frontline staff are coming together this week to learn about improvement tools and share design ideas and best practices. The project involves five teams from a mix of small, medium and large sites and initially includes the Pittsburg, Concord, Martinez, and West County health centers and North Richmond Center for Health. This effort focuses on improving access and developing our workforce and will help us meet some of our DSRIP milestones (see separate story on DSRIP) and our goals of providing better care for patients, improving the health of our community and lowering costs. 

First Anniversary of ccLink

This month, we celebrate the first anniversary of our electronic health record (EHR), ccLink. Implementing an EHR is an enormous undertaking. When we launched ccLink on July 1 last year, we knew this work would be ongoing and we are indeed still refining our system but are also seeing the many benefits of the EHR. Previously, it often took weeks to get medical records completed in the old paper system. This is less of an issue now with electronic records. Turn-around time for routine prescription refills previously could take up to a few days because doctors had to sign them. Now, 75% of routine prescriptions are responded to within 24 hours. Another benefit is that staff caring for a patient can now quickly see what all team members are doing. The EHR also allows for more collaboration. As more area hospitals also implement an Epic EHR, we will be better able to share info more seamlessly with patient consent.

Partnering for Better Care

While there remain some aspects about Health Care Reform that are not fully clear, we do know that systems like ours will need to partner with other health providers to help ensure the needs of our community are met. We recently had a visit on July 2 from a small group of UCSF leaders who toured our Regional Medical Center, Martinez Health Center and the West County Health Center and met with staff from across the county. We have a long history with UC. We are just finalizing an affiliation between UCSF and our Residency Program and have started conversations to explore additional partnership opportunities, though it is too early to know how any might take shape. The UCSF leaders told us they were impressed by what they saw and commented on how talented and dedicated you all are. I couldn't agree more, and I'll keep you updated as we learn more.

You all play an important role in making Health Care Reform a reality for our community. These are exciting and historical times for our delivery system and systems across the nation. Thank you for continued and relentless dedication to ensuring our community members receive the high quality, compassionate care they deserve.

More very soon, 

The 14 incoming residents were selected from over 600 applicants.

The latest group of 14 new residents were selected from an applicant pool of more than 600, based on their qualifications and interviews. Each tested high for resourcefulness, social consciousness and enthusiasm for our local brand of family medicine. New resident Dr. Kaitlyn Van Arsdell said the emphasis on full-spectrum care and care for the underserved attracted her to the program. "The staff has been really great," Dr. Van Arsdell added. "They are very supportive, and I have felt very welcome."   

Congratulations to the graduates and the newcomers. To learn more about the Family Medicine Residency Program, visit cchealth.org/residency

The number of patients leaving without being seen and the length of stay have improved in our Emergency Department thanks to triage efforts. In January, a triage area staffed with a physician was set up in the ED lobby to help speed up evaluation of patient needs and start the ordering of any needed tests as early as possible. 

Though more work is needed, the results are encouraging: The rate for patients leaving without being seen (because of long wait times) dropped from 10% to 4% since last September, according to Dr. Brenda Reilly, who was ED chief when the effort was launched. The average length of stay for patients also dropped by 18% from five-and-a-half hours to four-and-a-half hours, Dr. Reilly said. 

The process was shepherded Dr. Tom McCoy, who took over as the head of the ED on July 1 (see related story). Dr. Reilly credited the success of the triage effort to the entire ED team, including nurses, registration staff, financial counselors, and doctors. She pointed out that all service providers in the ED had to work differently in order to make the effort successful, and it would not have worked without all of their commitment. 

As part of our efforts to communicate with staff about the importance of the Delivery System Reform Incentive Payments Program (DSRIP), members of leadership including Chief Medical Officer Dr. David Goldstein and Ambulatory Care Medical Director Dr. Chris Farnitano have been attending staff meetings at the hospital and health centers to discuss the our five-year delivery system redesign program, which began in July 2010. 

Dr. Chris Farnitano and DSRIP Manager Karin Stryker attend a staff meeting at the Concord Health Center to discuss the DSRIP.

The DSRIP pay-for-performance program is designed to improve patient safety and care, as well as access to care. Under the DSRIP, CCRMC & Health Centers and other public hospitals and health systems in the state receive funding for achieving specified benchmarks in five categories: infrastructure development, innovation and redesign, population-focused improvement, urgent improvement in care, and HIV transition projects (a category that was added more recently). 

At a recent staff meeting at the Concord Health Center, Dr. Farnitano and DSRIP Manager Karin Stryker said we have met our goals during the first two years of the program and are hopeful we will do so in the third year. More DSRIP outreach efforts are planned.  

For more information, contact DSRIP Manager Karin Stryker at karin.stryker@hsd.cccounty.us or 925-370-5141.

Referrals for services outside our system have the potential to be highly complex with multiple handoffs. Our non-Contra Costa Health Plan (CCHP) patients are at increased risk for delays in care as Care Coordinators must search for an organization that will accept their insurance. As an organization we are in pursuit of a patient-centered referral process that is free of defects and unneeded waits.

In May, a team of four Care Coordinators, a Clinic Coordinator, a provider, and our patient partner, Amanda, came together for one week to work on our external referral process, with specific emphasis on non-CCHP referrals. Among other things, the group tested sharing a resource list between the Care Coordinators at all eight of our health centers. Prior to this improvement event, information regarding vendors who would take Medi-Cal and Medicare insurance was person dependent, often hidden in individual rolodexes or written on papers tacked to walls. This list will streamline work for Care Coordinators and reduce waiting for our patients.

To see what else this improvement team did, watch the Report Out video on iSITE.

Nine new department heads and committee chairs assumed leadership roles on July 1 after being elected to their posts by medical staff. Medical Staff President Dr. Ori Tzvieli, who was re-elected earlier this year, also began serving his second term July 1.

Below is a list of those who were elected and whether they are new or continuing in their posts.

Anesthesia: Dr. Maritza Vukalcic (continuing)

Emergency Medicine: Dr. Thomas McCoy (replacing Dr. Brenda Reilly)

Family Medicine: Dr. Taiyun Roe (replacing Dr. Jose Yasul)

Family Medicine Central County: Dr. Ken Katzman (continuing)

Family Medicine East County: Dr. Teresa Madrigal (continuing)

Family Medicine West County: Dr. Will Sheldon (replacing Priscilla Hinman)

Internal Medicine: Dr. Gabriela Sullivan (replacing Dr. Sara Levin)

Pathology: Dr. Shweta Das (replacing Dr. Xiaohui Xiong)

Pediatrics: Dr. Francine Jolton (replacing Dr. Guenter Hofstadler)

Credentials Committee: Dr. Guenter Hofstadler (replacing Dr. David Hearst)

Ambulatory Policy Committee and Interdisciplinary Practice Committee: Dr. Dayna Parish (replacing Krista Farey)

Administrative Affairs Committee: Dr. Ori Tzvieli (replacing Dr. David Hearst)

Congratulations to all those who were elected and many thanks to those who are departing for their dedication and service. 

The California native has spent the past five years working in the ED after graduating from our Residency Program. He says he is drawn to the ED because he enjoys treating high acuity patients and handling a variety of different cases. He also really loves the people he works with. "You truly have the sense working here that we are all on the same team with a shared mission: providing high quality care to the medically underserved," Dr. McCoy said. 

Dr. McCoy succeeds Dr. Brenda Reilly as ED chief. He says he hopes to continue the strong work and numerous improvement projects initiated by Dr. Reilly.

Dr. Sonia Sutherland, former Medical Staff President, has a new role: Medical Director of Quality and Safety. In her new post, Dr. Sutherland will work to better integrate the Performance Improvement Committee and Utilization Management Committee, with system-wide Safety and Performance Improvement at CCRMC. She also will provide leadership and support of continuous improvement in our system so we provide the best care for those we serve.

Dr. Sutherland has been with CCRMC & HCs for 18 years in a variety of roles such as Inpatient Attending in Internal Medicine, Residency Leadership Group, and chair of the Unsatisfactory Patient Provider Relationship Committee. Even though she has a new job title and duties, she will still see patients at the West County Health Center and continue to play a role in the Hansen's Disease Program. Currently, in her spare time, she's helping organize her biennial family reunion, which will attract more than 200 of her relatives from all over the country to the Bay Area this summer. 

Dr. Felicia Tornabene, a physician who has worked at CCHS for 10 years since coming here for her residency in 2003, has been named CCRMC's  new Hospitalist Medical Director. As Hospitalist Medical Director, a newly created position, Dr. Tornabene will play a key role in CCRMC's ongoing efforts to improve patient care and safety.  

Two of her main goals will be to improve flow in the hospital so patients are admitted and discharged in an efficient way and to improve care at all hours of the day in order to provide the appropriate care at the appropriate time. 

Dr. Tornabene, who grew up in San Mateo, is from a family that has produced doctors for four generations. Her father has been a physician for 40 years and her brother is a surgeon. As family lore has it, her great grandfather was a family doctor in Chicago where he was known to be paid in wine and chickens.

Cancer survivors gathered at CCRMC to share stories of life before, during and after the diagnosis of cancer last month at "Celebrate Life," an annual event organized by the Cancer Program. People who beat cancer - or who intend to do so - were invited to share their experience at the open-mic event that included food, music and games. A gift-basket raffle for cancer survivors, sponsored by several CCRMC departments, was also held. 

Cancer patient Siosiana Falekakala says, "You can live a long time, but you have to fight."

The annual event gives past patients and their families an opportunity to reunite with the health care team that battled cancer with them and for them, and current patients an opportunity to interact with others who share a common experience.

Among those who attended was Siosiana Falekakala, whose battle against stomach and lymph cancer began last November. "I learned that you don't sit in bed, feeling sorry for yourself. You have to walk, keep busy," said Falekakala, who visits CCMRC for chemotherapy. "You can live a long time, but you have to fight."

Know somebody who wants to give something back to the community? The CCRMC Auxiliary urgently needs new volunteers to staff the hospital gift shop. Proceeds from the gift shop benefit patient care in the hospital.

Volunteer Jackie Yamamoto (left) shows off some Gift Shop merchandise.

Volunteers are entitled to discounts at the gift shop and free beverages during their shifts. They also receive free annual flu shots and a letter of recommendation after completing 200 hours of service.

Meanwhile, the Volunteer Program also needs magazines to offer patients in waiting areas at the hospital and Martinez Health Center. Hospital volunteers distribute more than 150 magazines a week, all of which are received through generous donations from the community. For those interested in donating magazines, keep in mind they should  not be older than 6 months from the publication date.  There is an urgent need for Spanish edition publications. If you don't have magazines but want to support the effort, gift a subscription to the hospital. 

If you or someone you know is interested in becoming a volunteer, donating magazines or gifting a subscription, contact Volunteer Program Coordinator Rhonda Smith at rhonda.smith@hsd.cccounty.us or at 925-370-5440. You can also visit the Volunteer Program's Web page  for more information.