We recently had some visitors come to see how we're doing common things uncommonly well. In January, we welcomed Derek Feeley, executive vice president of the Institute for Healthcare Improvement.

In February, Dr. Neal Kohatsu, the medical director for the California Department of Health Care Services, joined us for a learning session of our Improvement Academy.

 

During these visits, we had the opportunity to showcase the great innovative work being done by all of you. Thanks to the efforts of our improvement teams and frontline staff, we've improved patient safety, expanded patient-centered medical homes, and launched the innovative and award-winning Telephone Consultation Clinic. Our Ambulatory Care Redesign efforts are also showing excellent results as teams test ways to improve services and access to care (see related story).

 

These are just a few examples of all the work being done. I invite staff to visit the CCHS Dashboard on iSITE (accessible on the Reports page) to see detailed data showing the progress we're making on several fronts. I am so proud of all of you for making us a shining example of how a public hospital system can embody the principles of continuous improvement.

Dr. Neal Kohatsu (second from the left) rolled up his improvement sleeves and worked with CCRMC staff during a recent visit. He's shown here participating in a discussion with (from left to right) Drs. Rajiv Pramanik, Sonia Sutherland and David Goldstein.

 

I want to share what Dr. Kohatsu said about the incredible work you're doing during his recent visit to CCRMC:

 

"I am so appreciative to you and your outstanding staff for allowing me to see, firsthand, how quality improvement is carried out in hospital, clinic, and community settings," Dr. Kohatsu said. "I was overwhelmed by everyone's enthusiasm and passion for continuous improvement to benefit the community that you serve. It was so inspiring to actually see what a Culture of Quality looks like."

 

Strategic Planning Update

Our improvement work is a reflection of our values and priorities as an organization. As you may know, those values and priorities are currently being integrated into a new strategic plan for CCRMC and Health Centers.

 

Our strategic plan will guide us through the next five years--a period that promises to be both dynamic and exciting. The process for creating this roadmap to our future is heading into the final lap.

 

I want to recognize the hard work, passion and creativity of everyone involved in the strategic planning process, which includes both staff and patients. The process has led to the creation of a new purpose statement that truly captures the essence of what CCRMC and Health Centers cares about and aspires to be: "Creating optimal health for all through respectful relationships and high quality services."

 

Late last month, the Strategic Planning Task Team members met for the final time and put forth three top priorities that will serve as the foundation for future CCRMC and Health Centers activities:

• Always placing the patient and family at the center of their health
• Transforming care through continuous improvement
• Delivering value on the community's investment in health

Final steps are now underway to create concrete plans to deliver on these priorities.  We will be seeking input from staff as well as key community contacts to help finalize our plan. I look forward to working with all of you (patients, families, community members and staff) to move from the planning stage to action!

 

More very soon,

 

Anna

 

At the Concord Health Center, the redesign team has reduced the third to next available appointment for its two providers, Drs. Cremin and Lively, from 14-15 days to 4-5 days, and even lower at times. The Concord ACR team has also reduced the no-show rate for its two providers, which was around 8% last July, to less than 5%.

 

Click to enlarge image

 

The team at Martinez Health Center is now using diabetes registry reports to reach out to patients with overdue labs, has an RN and LVN backing up the care coordinator for requests not requiring action by the provider, and is testing other improvements such as post-visit calls to patients to review their care plans.

 

The Pittsburg Health Center team has increased continuity among pediatricians, added the registration clerk as part of their team to focus on the entire patient visit cycle, and developed visual cues to help clinic efficiency including red/green signs if the clinic falls one patient behind which serves as a signal to float and/or treatment nurse to help out.

 

The West County Health Center team has rolled out consistent standard visit intake for the nurse and medical assistant including pending screening tests, vaccines and refills. The team also developed a wait-time board that updates patients when the clinic is running behind schedule and triggers the resource nurse to help out with clinic flow. 

 

These are just a few samples of the great work these teams are doing. CCRMC and Health Centers staff interested in seeing more details about their efforts, read a post from Ambulatory Care Medical Director Dr. Chris Farnitano on the Hospital/Health Centers page on iSITE. 

Candace Andersen

Karen Mitchoff

Two new faces will be on hand for the upcoming Joint Conference Committee (JCC) meeting in March. Candace Andersen and Karen Mitchoff will now represent the Board of Supervisors on the JCC. They replace Supervisors John Gioia and Mary Piepho on the committee. 

 

The JCC is one of the mechanisms the Board of Supervisors uses to oversee CCRMC and Health Centers. The committee promotes communication and provides a forum to share updates on operational and financial data, quality reports, policy issues and strategic planning.

 

Andersen and Mitchoff join Dr. Taiyun Roe and Dr. Samir Shah, the medical staff representatives, as the JCC's voting members. Non-voting members include CCRMC and Health Centers CEO Anna Roth, Medical Staff President Dr. Ori Tzvieli, CCHS Director Dr. William Walker, CCHS Chief Financial Officer Patrick Godley.

 

The JCC meets every other month. The next meeting is March 21.

 

For more information about the JCC, visit the committee's webpage. 

Welcome to Timothy Thompson-Cook, who joined CCRMC and Health Centers as our new Chief Operations Officer on Feb. 24.

 

Tim has more than 25 years of health care and operations experience, including 15 years as a Navy Hospital Corpsman in both active and reserve military service. Most recently, Tim served as the Vice President for Service Excellence, Outpatient Services, Ambulatory Care and Imaging Services at Los Angeles County's Harbor-UCLA Medical Center in Torrance, California. During his time at Harbor-UCLA, he created numerous forums in support of partnering with patients and their families, as well as improved operational efficiencies throughout the ambulatory care settings. 

Tim also brings a record of exceptional leadership and strategic vision along with a sincere passion for Lean and Patient - and Family-Centered Care. Prior to joining Harbor-UCLA Medical Center, Tim was a Lean Fellow at California Pacific Medical Center (CPMC) in San Francisco and the Manager for Radiology Operations where he played a significant and instrumental role in organizational efforts to improve the patient experience from 2005-2011. Before arriving at CPMC, Tim was the Chief Radiologic Technologist at the University of California San Francisco Medical Center, where he improved patient safety and image quality.

Tim is married and has a 9-year-old son who enjoys soccer and playing chess. His family will be relocating this summer from Los Angeles to the Bay Area where they have a home in the East Bay's Richmond Marina.

A CCRMC lactation consultant demonstrates hand expression to a first-time mother using a breast model knitted by Dr. Larry Boly.

Nurses and lactation consultants at CCRMC are using models of breasts to demonstrate "hand expression" to new mothers learning how to breastfeed. What makes these pillow breast models unique is they have exteriors knitted by members of our medical staff.

 

Staff began using the breast models about five months ago as part of a broader effort to educate mothers about hand expression, said Dr. Francine Jolton, CCRMC's chief of pediatrics. The models are useful for teaching hand expression-which involves squeezing the breasts to help stimulate the flow of milk-because patients often don't like someone touching their breasts to demonstrate the method, Dr. Jolton said. The models are also being used to train staff about hand expression.

 

Dr. Jolton said Dr. Jamie Navel, a member of the hospital's Breastfeeding Task Force, got the idea for doing the knitted breast models during an international conference in Australia. She came back and recruited some knitters on staff to help out including Dr. Joanna Chin and Dr. Larry Boly.

 

Dr. Boly, an Internist who cares for adult patients at the Pittsburg Health Center, has been knitting for 20 years.  He said that he was happy to help the cause to facilitate breast feeding.  Dr. Boly said it takes him about six to eight hours to knit the breast-model covers and, so far, he's made about eight of them.

 

"Doing this allows me to connect to another patient population," said Dr. Boly. "I'm honored to be able to contribute to the cause." 

 

For more information, contact Dr. Francine Jolton at francine.jolton@hsd.cccounty.us 

Despite improvements to our appointment system and the reduction in average hold times over the past year, there is still room for more improvement. A multidisciplinary team--including one of our patients--examined the main Appointment Unit for a week in January to create a "value stream map" and assess ways to further enhance access to services.

The improvement team learned that more than 300 canceled appointments go unfilled every month.

 The team identified several areas where improvements could be made including reducing the number of appointments that go unused every month. The team learned that more than 300 canceled appointments per month go unfilled, while nearly 850 short-notice appointments go unutilized due to a lack of space or a nurse.

 

This is the second kaizen process focused on the Appointment Unit in the past three years. It is standard practice to construct an updated value stream map every three years, so the time had come to reanalyze the current state and build a new vision for the future of our central Appointment Unit.  In the coming months, the team will hold a series of rapid improvement events to address the issues they identified in January.

 

To see a video of the team's report out, visit iSITE. 

 

At 10 a.m. on February 28 in CCRMC's main lobby, there will be a dual kaizen report out by the Appointment Unit team and the patient-safety team. The teams will share their findings from recent rapid improvement events. 

The farmers' market is returning April 1 with an earlier starting time than in previous years. The farmers' market--a partnership between Contra Costa Certified Farmers' Markets and CCRMC--will take place every Tuesday from 10 a.m. to 2 p.m.

Stay tuned for updates as the opening date nears. 

 

For more information about health education services at our health centers, contact Health Education Specialist Sana.Mazhar@hsd.cccounty.us

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