Week In Review - collected

Automatic subscription in Radio Userland. Clicking on this coffee cup will automatically take you to your subscriptions page if you are using Radio Userland.
If you want to subscribe to this feed but you are using another news reader, you may subscribe using this orange XML button to see the XML feed.

	Parallel, sequential, distributed, or ORGANIC?. Imagine this. You are asked to create a human body. You choose a hospital in California to create a gastrointestinal system,  a health system in New York to create a heart and blood vessels, a city in Vermont to create a brain, a hospital Iowa a peripheral nervous system, group of hospitals in Illinois the lungs, etc., etc. Enough. Some things can't be done separately, some can. Organic things typically cannot. Some complex things can be "componentized" and assembled, some things must interact to even come into existence. Some people at the Robert Wood Johnson Foundation read the Institute of Medicine Report, Crossing the Quality Chasm and ask organizations to make proposals to radically improve American health care. Experienced people in organizations in Whatcom County took the request very seriously. We had the same hopes and desires and we had been working separately and collectively for the same goal for more than ten years. With much thought and discussion and with collaboration with patients we developed a radical plan for radical change--no piece of it was radical, it was the understanding that it all had to be done together that was radical, in the history of US healhtcare. To extend the analogy started above we understand the we needed a small GI system, a small cardiovascular system, a small nervous system etc for any of it to work. And that with all the essential systems working to support each other they could grow together to a mature effective health system of care--better than anything in existence. The minimum "parts" we have are: 1) direct patient involvement in all teams and in governance, 2) using evidence as the basis for care design, 3) starting with two diseases [heart failure and congestive heart failure] and then moving to all others over a few years, 4) information systems designed and deployed so that everyone including the patient has the information that the patient wants them to have when and where they need it, 5) clinical office and hospital work flow reconfiguration so that the new work is integrated into the old and the old is made less frustrating and more efficient for everyone, and finally 6) modeling of the health care benefits and the economic impact on all of the stakeholders so that winners and losers can cooperate for the good of the patients and the whole community. We have been at this for just over one year. It no longer seems unattainable. It is clearly attainable. What is difficult is getting all of this done in less than two years so that it is self-sustaining. We are hopeful that some of the agencies and foundations that fund parallel, sequential, or distributed "demonstration" "projects" can see the difference here and fund an organic, systematic approach. Nothing less will create the radical transformation called for by the IOM Chasm Report and the American public. Reductionist approaches can do much. They cannot build an organism, not yet, perhaps never. Supporting the growth of a small, complete, organism may be the right approach to radical transformation of US healthcare. We believe it is. Do you? "...program is so simple, it's brilliant, "Bellingham Herald editorial board. Link to Bellingham Herald Editorial Link to more about program Helping chronically ill manage care improves lives, cuts costs HEALTH CARE: "Pursuing Perfection" program is so simple, it's brilliant. The whole point of "managed care" started out, at least in theory, as an attempt to contain health-care costs through prevention. It's no secret that's not what happened. In fact, navigating the medical maze has become more difficult than ever, it seems. But there is a solid movement afoot to change that and Whatcom County is one of the ground-zero sites for a program called "Pursuing Perfection: Raising the Bar for Healthcare Performance." Its method isn't complicated. It seeks to help people manage their own health care, sometimes by doing something as simple as regular telephone calls to check up on patients and answer their questions. By heading off potential problems, extensive and pricey hospital visits can often be avoided and a patient's health better maintained. It's so simple, it's brilliant. The Whatcom Community Health Improvement Consortium last year was one of seven groups in the nation to win a $20.9 million grant from Robert Wood Johnson Foundation and the Institute for Healthcare Improvement that funds the program. It's not just some kind of feel-good program, either. The foundation wants to document measurable results in improvement of patients' access to care, patients' self-management and satisfaction, and a decrease in medical errors. Caring for chronically ill people consumes as much as 70 percent of the nation's health-care dollars, so it makes sense that helping them manage their own conditions would reduce those costs and help those people lead more productive and less frustrating lives. In Whatcom County, two of the most common chronic illnesses are diabetes and congestive heart failure. In 2000, St. Joseph Hospital had almost 700 admissions related to diabetes and almost 900 related to congestive heart failure. Empowering patients with better information and better access to people who monitor their progress and can quickly answer questions can help keep many from becoming dangerously ill and compromising their health further. Medical advances happen quickly as new drugs are developed, more information is discovered about drug interactions and new technologies help people monitor their blood sugar. Keeping patients active in helping to make their own decisions will result in better outcomes. After all, who better to "manage" the care than the person living with the illness? CONNECT--First Trip to Washington DC to meet our Members of Congress. Robert Wood Johnson Foundation's CONNECT PROJECT guided meetings in Washington DC this week.  Six of the seven US pursuing perfection sites met with their congressional members.  The Whatcom county team consisted of Rebecca Bryson (patient), Marc Pierson (me, project executive), and John Hayward (CEO of PeaceHealth). We met with Senators  Patty Murray and Maria Cantwell and with Representatives Rick Larsen and Jim McDermott. The meetings were informational and well received. Each member agreed to work with us to learn more about what we are doing and to lend their support to comprehensive clinical quality improvement efforts. There was also a meeting with the National Health Policy Forum. The subject was "Pursuing Perfection in Health Care Delivery: Insights from Innovators". There was good attendance by congressional staffers and health agency leaders. Donald Berwick, MD, led off and presented context for the briefing. Honor Page, the mother a patient with cyclic fibrosis spoke next. She gave the patient's or consumer perspective on the current status of health care as well as on her interactions with Pursuing Perfection project at Cincinnati Children's Hospital. Next was Dr. Brian Rank from HealthPartners, Bloomington, Minnesota, explaining the frustration and challenges from the perspective of a physician leader pursuing perfect care in today's environment. Finally John Hayward spoke about the need for change and his rationale for the work going on in Whatcom County, WA, as well as explaining his personal commitment to transformational change in his organization. Rebecca, John, and I all felt like the relationship building with our congressional members is off to a good start. As you all know, for the improvement that we have started to be sustainable, both Medicare and Medicaid will need to become more flexible in matching payment to innovations in care. Our short and long term goals will be some small appropriation to help cover the short fall on our start up of this transformation, then a demonstration project that will provide the needed flexibility to this county. Ultimately the payment structure of Medicare and Medicare will need to be modified based upon the successes of the demonstration projects. Click on this link if you would like to study most current recommendations by the Institute of Medicine to CMS (medicare/medicaid) for demonstration projects aimed an transforming health care and aligning payment. Four out of five proposed types of demonstration projects are highly aligned with what we have already begun with Pursuing Perfection and Robert Wood Johnson Foundation. Week in Review December 2 through 6 Ferndale Guidance Team Strategize the roll-out of P2 in their second site, Family Health Associates (FHA). Stacey and I are strategizing the development of staff leadership skills in Ferndale, so they can take over her facilitation Brainstormed goals for the staff retreat scheduled for Jan. 25. Decided to develop an appreciative interview protocol addressing teamwork and team issues to begin FHA's P2 journey Identified plan to develop the FHA Guidance Team North Cascade Cardiology Guidance Team shared baseline clinic data results from the initial surveys which included patient wait times, provider interruptions and the office staff survey. Discussed strategy to bring all the doctors in this clinic on board with P2 Agreed to begin staff interviews utilizing an appreciative approach in preparation for all staff retreat Feb. 1 Building International Bridges Marc and I met with Helen Lingham and Gabriele Cuff from Fraser Health System in B.C. Canada. We shared information about the Pursuing Perfection project and did some thought partnering around effective organizational development approaches in the health care system. Specifically, we shared our common interest, learnings, and plans for using appreciative inquiry in our respective systems. What's ahead Developing appreciative interview protocol and strategy for staff and providers at Family Health Associates and North Cascade Cardiology. Retreat planning for both sites. Interviews with staff at Center For Senior Health Meeting with Bill Mahoney and deepening my understanding of the Team Development Measure Week of September 16 through Sept. 20. Week in Review Here's what has been on my radar screen and what I'm looking forward to: Ferndale Clinic This has been the identified site of the two Family Care Associate sites as the one that will undergo the transformation process first. Team Development Measure completed and results are being analyzed. Preliminary results suggest an improvement in identification as a "team". Is this an outcome of the appreciative interviews? The process facilitators' gathering baseline metric data, or the brief presentation I gave them regarding change and transition (William Bridges)? What these interventions have in common is that they bring to life the start of this project and interjects the concept of "team" into the clinic. On 9/25, Stacey (process facilitator) and I will meet with the Guidance committee to identify their goals for the 10/5 staff retreat. We will share information from the Baseline Metrics and the Team Development Measure as well as a proposal for issues/topics to be covered at the retreat. North Cascade Cardiology Appreciative interviews of leadership staff to be scheduled through October. Team Development Measure has been administered. We'll receive results soon that will indicate specific areas to address with the group. SeaMar clinic Team Development Measure will be completed next week. We will also set up the first meeting with the SeaMar Guidance Team. Center for Senior Health Next Guidance Committee meeting 9/30 will include information in helping staff cope with change and transition. Stacey and Terry (process facilitators) will go over baseline metric results. We will plan next steps for action and team development based upon this information and the results of the Team Development Measure. Other work or issues on the table: Clarify role/responsibilities of Guidance Teams Planning retreat for Pursuing Perfection Leadership Team retreat 10/14. Marc, Mary and I will be meeting on the 25th to put finishing touches on the appreciative interview questions and the process/agenda for the retreat. Had a conversation with Connie (Patient Care Manager) regarding coping with the loss of patients. We came up with several ideas: creating a patient memory book with their photo, names and qualities we appreciated about them; a memory wreath, with patient names; sending a card to the family signed by all staff; lighting a candle and pausing for a reflection at staff meeting. Week in Review: 5 December 2002. Deliverable/Project: Shared Care Plan  Update Summary:  > Bulk of coding for the SCP interface done > Security work nearly finished > Data entry person has entered 16 SCPs > Both CCSs registered and oriented > Print version of SCP available > Doctor demographic data imported from LW into person database Tasks Scheduled Next 2 Weeks: > Streamline registration process  > Add instructions > Add Confidentiality Statement pop-up > Register docs at clinics > Have CCSs double check data entry work > Create test/development system (copy database and website) > Move live site to Internet > Auditing functionality > Usability testing > Implement new tabs for interface > FDB Medication data source? > Thorough testing and troubleshooting of the application Coming up: > 12/18/02: doctors and CCSs give feedback on SCP at implementation meeting  > Week of January 6th: register a few patients to use SCP via Internet Week in Review: November 14th. Deliverable/Project: Shared Care Plan Update Summary: > Bulk of coding for the SCP interface done; should have enough in place for a data entry person to start adding existing SCP data late next week. > Hammered out remaining issues with medications > Registration screens nearly finished > Progress on integrating SCP with rest of web site (conceptually) > eSCP shown to both patients and clinicians with good feedback Tasks Scheduled Next 2 Weeks: > Finish building interfaces > Some amount of testing before data entry begins > LW data dump > Medication entry screen > Polish some functionality for usability (e.g. Next Steps) > Polish look with graphic designer > Thorough testing and troubleshooting of the application Week In Review (Week ending 11/22/02) 1)  Completed and submitted the analysis of the SJH Inpt PSAT P2 specific questions for the month of August.  In addition, August data was compared to July using a line (run) chart.  This chart will be transitioned into a SPC chart once we have enough data points to do so.  Thanks to Sarah Jane Satre of the PeaceHealth MOMS Team for her strong knowledge of SPSS and continued help with this analysis. 2)  Later this week we will begin the first analysis of the Clinic PSAT Touchscreen Survey data.  We currently have >250 completed surveys in the hopper which is a perfect amount to create the necessary anchor file.  In addition to the creation of the anchor file we will also be able to provide the clinics with actual PSAT scores.  With the feedback gathered from the most recent Implementation meeting we will hope to reformat the clinic specific PSAT report into a more user friendly manner.  The PeaceHealth Survey Subteam of Aaron Ignac, Sarah Jane and of course Bill Mahoney will be instrumental in making this analysis a reality. 3) Began work on the Systems Dynamics data pull for Congestive Heart Failure.  This has proven to be a bit confusing and more complex than the Diabetes data pull.  At the very least it looks like an impressive challenge that we look forward to tackling. One of the main challenges is staying in compliance with the patient confidentiality rules and regs, especially the new HIPAA regs that go into effect April 2003.  While all of us truly have patients at the center and have an enormously high regard for patient confidentiality the new HIPAA regs are creating some challenges not previously experienced.  Simply relying on our self judgment of what is "reasonable" doesn't cut it anymore.  The HIPAA regs are very specific and have teeth.  Violating these regs, even inadvertently, could sink our efforts, on a personal level as well as community level. The first step of the Systems Dynamics pull is fairly straight forward and we should be able to submit "Phase I" data to the consultants in the very near future.  The phase I data does not involve the release or sharing of any pt identified data so we will be able to move quickly on completing this request. Many thanks to Dori Robart from SJH and Sarah Donelson of the MOMS Team for providing their continued support and guidance with the security and confidentiality rules and regs. 4)  We created a database to assist us in tracking the rate of completion of the clinic PSAT survey.  This has proved useful in providing the clinics with immediate (daily) feedback on the # of surveys completed at their offices.  Run charts are faxed or emailed to each pilot site on a weekly and/or daily basis depending on their preference. 5)  Data collection for the measure: 3rd Next Available Appt was conducted and completed.  This is the second month of data collection for this measure.  The processes, established last month, created a very useful and efficient template for this month's data collection.  We hit a few barriers with contact folks being out of the office but in each instance the specific clinics responded positively and quickly to getting the issues resolved and helping us complete the data collection.  A big thanks to all of the pilot sites!! SeaMar - Pursuing Perfection Project A Month At A Glance- November 2002 Accomplishments to date: 1. Wiring/hardware installation for computer touch screen patient satisfaction survey -done. 2. Basic Metric Data Collection - done. 3. Team Development Survey - done . 4. Training for Clinical staff for Diabetes Registry - done. 5. 273 diabetic patients have been identified and accounts set-up in Last Word for implementation of the Diabetes Registry. Thanks Tracey! 6. Spanish translation for patient satisfaction touch screen survey -done. Thanks Wendy and Norma! 7. Focus Group for Spanish Diabetic Patients in regards to group visits, email access, and phone consultation/follow-up- Thanks Jennifer! 8. Clinical Snap-shot completed in preparation for Diabetic registry - done. 9. Patient Satisfaction Survey - computer touch screen "LIVE" as of 10/28/02. This will be an on-going process everyday.......... Upcoming Meetings/ Events: 1. Daily random patient selection for Patient Satisfaction Survey - computer touch screen. 2. Friday November 8, 2002 9-9:30 am (Jackie, Lyly, Terry) meeting to discuss process for patient satisfaction computer touch screen survey; meeting 9:30-11:00 am ( Jackie, Terry, Jean Marie) to discuss implementation of Diabetic registry. 3.Next Guidance Team meeting on Wednesday 11/13/02 12 noon - 3 pm @ SeaMar ( Dr. Adams,Jackie Coggins, Lyly Cummins, Terry, Mary, Cindy, Mary Bartolo ( via phone) ). 4. Next Implementation Team Meeting Wednesday 11/13/02 7-10 am @ FHA ( Dr. Adams) . Terry Wagner RN BSN Process Facilitator Whatcom County Pursuing Perfection Project twagner@peacehealth.org Cell # 360 319-9786 Week of November 4-8, 2002. Continiuing prepartion on scoping of the implementation for the hospital project. Marla Sanger, the new AVP will be the process owner for the hospital project and the Cindie Becker will be the sponsor. Met with Marla Sanger and Judy Pratt twice in the past two weeks discussing a number of potential changes that could be done in the inpatient environment. Also discussing different strategies to on how to do the work involved.  Getting feedback about membership of the implementation team vs. the hospital guidance team. The decision was made to combine the team for both inpatient units, vs. two separate teams. We are developing a spreadsheet identifying all of these change items that could be considered, identifying measurements, barriers, questions, and possible infrastructure needs to bring forth these changes.  Will have a meeting with Cindie Becker in the next week to begin these discussions regarding areas for change.  Our sense is that we would need to prioritize these items and do them over different stages. We will be meeting with Carol Boston this week to have a discussion about how the potential implementation changes will interface with other hospital initiatives.  We want to build a direct link with creating healing and compassionate care. Aniticpate finalizing the Project Charter in the next two weeks, and then preparing for the first kick-off meeting for the Hospital guidance team and Implementation team. Spoke with 3 different health care organizations this past week about how they are provding care for inpatients with CHF. Had phone interview with Ron Stock from the Senior Health Center with Sacred Heart in Eugene, Oregon.  Discussed what he found most important in the clinic changes they have accomplished. Two key recommendations are improving flow in the workplace and focus on team development. Reading a new publication about "Magnet Hospitals" and how to create a healthier work environment Reviewing articles about use of clinical pathways in hospitals, including the DM guidelines from the International Diabetes center. Reviewing more articles about extended care pathways presented by the National Chronic Care Consortium Did 3 presentations about the grant with the Med-Surg and Float unit staff at their staff meetings on 11-6.  Generally, staff were receptive and agreed that management of chronically ill patients was not working well Month At A Glance - November 2002.. Month At A Glance - November 2002. Center For Senior Health - Pursuing Perfection A Month at a Glance- November 2002 Accomplishments to date: 1. Wiring/hardware installation for touch screen patient satisfaction survey -done. 2. Training for clinical staff for CHF Registry-done . Thanks Jean Marie! 2. Clinical snap-shot for 94 patients complete for CHF Registry- Thanks Liz! 3. Basic Data Collection -done. 4. Team Development Survey -done. 5. CHF Registry is actively being piloted. 6. Patient Satisfaction Survey Computer Touch screen - is "Live" as of 10/28/02. 7. Matt Groening - oriented to Pursuing Perfection Project . Upcoming Meetings/Events: 1. Monday 11/4/02 CSH Guidance Meeting 11:30 am - 1 pm ( Matt Groening, Erin Baumgart, Cindy Manning, Mary Minniti, Stacey Pruim, Terry Wagner). 2. Wednesday 11/6/02 9:30 -11:30 am meeting with Project Evaluators (Erin, Mary, Terry). 3. Tuesday 11/12/02 12 - 1 pm Nurses meeting ( Terry to attend) . 4. Wednesday 11/13/02 Next Implementation Team Meeting 7-10 am @ FHA ( Erin , Matt ). 5. Thursday 11/14/02 11:30 am - 1 pm Technical Support Round Table Luncheon (Erin, Matt). * Location to be announced soon. Future Meeting: 1.Monday December 2, 2002 Next CSH Guidance Team meeting 11:00 am -12:30 pm ( Mary, Terry, Cindy, Matt, Erin ). Terry Wagner RN BSN Process Facilitator Whatcom County Pursuing Perfection Project twagner@peacehealth.org Cell # 360 319-9786 SeaMar - Pursuing Perfection Project. SeaMar - Pursuing Perfection Project A Month At A Glance- November 2002 Accomplishments to date: 1. Wiring/hardware installation for computer touch screen patient satisfaction survey -done. 2. Basic Metric Data Collection - done. 3. Team Development Survey - done . 4. Training for Clinical staff for Diabetes Registry - done. 5. 273 diabetic patients have been identified and accounts set-up in Last Word for implementation of the Diabetes Registry. Thanks Tracey! 6. Spanish translation for patient satisfaction touch screen survey -done. Thanks Wendy and Norma! 7. Focus Group for Spanish Diabetic Patients in regards to group visits, email access, and phone consultation/follow-up- Thanks Jennifer! 8. Clinical Snap-shot completed in preparation for Diabetic registry - done. 9. Patient Satisfaction Survey - computer touch screen "LIVE" as of 10/28/02. This will be an on-going process everyday.......... Upcoming Meetings/ Events: 1. Daily random patient selection for Patient Satisfaction Survey - computer touch screen. 2. Friday November 8, 2002 9-9:30 am (Jackie, Lyly, Terry) meeting to discuss process for patient satisfaction computer touch screen survey; meeting 9:30-11:00 am ( Jackie, Terry, Jean Marie) to discuss implementation of Diabetic registry. 3.Next Guidance Team meeting on Wednesday 11/13/02 12 noon - 3 pm @ SeaMar ( Dr. Adams,Jackie Coggins, Lyly Cummins, Terry, Mary, Cindy, Mary Bartolo ( via phone) ). 4. Next Implementation Team Meeting Wednesday 11/13/02 7-10 am @ FHA ( Dr. Adams) . Terry Wagner RN BSN Process Facilitator Whatcom County Pursuing Perfection Project twagner@peacehealth.org Cell # 360 319-9786 A Month At A Glance - October 2002.. A Month At A Glance - October 2002. Center For Senior Health - Pursuing Perfection A Month at a Glance- October 2002 Accomplishments to date: 1. Wiring/hardware installation for touch screen patient satisfaction survey -done. 2. Training for clinical staff for CHF Registry-done . Thanks Jean Marie! 2. Clinical snap-shot for 94 patients complete for CHF Registry- Thanks Liz! 3. Basic Data Collection -done. 4. Team Development Survey -done. Upcoming Meetings/Events: 1. Wednesday 10/09/02 Implementation Team Meeting 7-9 am Erin ; Jean Marie and Terry to observe CSH-CHF Registry process 9-11 am. 2. Friday 10/18/02 @ 3-4 pm meeting set to discuss process for patient satisfaction touch screen survey. ( Matt, Terry ) 3. Monday 10/21/02 meeting - Terry, Jean Marie, Dr.Cummins, Dr.Vanderbilt, Dr. Jones, Dr. Roberts to discuss Pursuing Perfection Project and CHF Registry. 4. Wednesday 10/23/02 Next Implementation Team Meeting 7-10 am @ FHA Erin or ?? 4. Friday 10/25/02 date for Terry to pilot the touch screen survey all day. 5. Wednesday 10/30/02 Terry to observe CSH for day. Future Meeting: Monday November 4, 2002 Next Guidance Team meeting 12:30-1:30 pm ( Mary, Terry, Cindy, Matt, Erin, Penny) I hope this is helpful to all, please let me know if I missed anyone. Thanks! North Cascade Cardiology - Pursuing Perfection Project A Month At A Glance - October 2002 Accomplishments to date: 1. Wiring/hardware installation for computer touch screen patient satisfaction survey -done. 2. Basic Data Collection -done. 3. Team Development Survey -done. Upcoming Meetings/Events: 1. Wednesday 10/9/02 Implementation Team meeting 7-9 am @ FHA ( Andrew , Dr. Trenouth); 11- 12 noon Terry, Stacey, Andrew, Cheryl meeting to discuss process for patient flow for touch screen survey. 2. Monday 10/21/02 5 pm meeting with Terry, Stacey, and NCC staff to go over process for touch screen survey. 3. Tuesday 10/22/02 Terry and Stacey to pilot touch screen survey all day. 4. Wednesday 10/23/02 Next Implementation Team meeting 7- 10 am * @ FHA (Andrew, Dr. Trenouth) . * Note time change* 5. System Dynamics Presentations 10/28/02 3- 7 pm @ SJH Conference room 5/6 ( Dr. Trenouth - 2 hrs ) Open to ALL interested ; Wednesday 10/30/02 7-9 am @ CSH Conference room ( Dr. Trenouth , Dr. Lombardi) . SeaMar - Pursuing Perfection Project A Month At A Glance- October 2002 Accomplishments to date: 1. Wiring/hardware installation for computer touch screen patient satisfaction survey -done. 2. Basic Metric Data Collection - done. 3. Team Development Survey - done . 4. Training for Clinical staff for Diabetes Registry - done. 5. 273 diabetic patients have been identified and accounts set-up in Last Word for implementation of the Diabetes Registry. Thanks Tracey! 6. Spanish translation for patient satisfaction touch screen survey -done. Thanks Wendy and Norma! Upcoming Meetings/ Events: 1. Monday 10/7/02 Terry, Stacey, Lyly and staff meeting to discuss process for computer touch screen survey implementation. 2. Wednesday 10/9/02 Implementation Meeting 7-9 am @ FHA. ( Dr. Adams , George Minor). 3. Thursday 10/10/02 Terry, Stacey, Lyly meeting to discuss process for computer touch screen survey implementation. 4. Wednesday 10/16/02 First Guidance Team Meeting 10 am-12 noon @ SeaMar ( Dr. Adams, George Miner, Jackie Coggins, Mary Bartolo, Shanon Daws, Terry, Mary, Cindy ). 5. Friday 10/18/02 8:30 - 9:15 am Cindy Manning to meet with Clinical staff on Change /Transition. 6. Wednesday 10/23/02 Terry to pilot computer touch screen survey all day ; Implementation Team Meeting 7- 10 am @ FHA ( Dr. Adams, George Minor). 7. System Dynamics Presentations 10/28/02 3- 7 pm @ SJH Conference room 5/6 ( Dr. Adams - 2 hrs ) Open to ALL interested. 8. There is on-going work being done for the Diabetes Registry in gathering data for a Clinical Snap-shot as to a patients current status regarding there last A1c value , B/P , foot exam etc. Thanks Jean Marie for all of your help in facilitating this! Future Meetings: 1.Next Guidance Team meeting on Wednesday 11/13/02 12 noon - 3 pm @ SeaMar ( Dr. Adams,Jackie Coggins, Lyly Cummins, Terry, Mary, Cindy, Mary Bartolo ( via phone) ). Terry Wagner RN BSN Process Facilitator Whatcom County Pursuing Perfection Project twagner@peacehealth.org Cell # 360 319-9786 Week of October 21-25th. th-Oct. Week of October 21-25th. th-Oct Oct.21-22, 2002 At school Oct. 23-27th Oct.22- Met with Judy Pratt -process facilator for the P2 project-and discussed the planning for the hospital kick-off meeting for Nov. 4th. Outline the presentation about the grant for foundational information Discussed role of the management guidance team vs the team members and who should be on it. á Should we break out in smaller work groups under the team member category? Discussed what are the key deliverables that we might do and timeline considerations around interfacing with the electronic shared care plan, medication list, & registry. Drafting a timeline and action steps to prepare for the implementation of the project. Judy and Mary will meet with Marla Sanger, the new Asst. VP tomorrow to brief her more about the P2 project. It is understood that I will co-facilitate the change project with Judy, still focusing on the team development interventions. Week in Review: November 1st.. Week in Review: November 1st. Deliverable/Project: Shared Care Plan (SCP) Update Summary: > SCP database created. > Coding of the SCP interface well underway, including linking fields to the SCP DB. > Most security/access issues for v. 1.0 addressed, including proof of identity, security classes, use of LastWord accounts, and how to alert LastWord users of SCPs. > Confidentiality and privacy statements being written; first drafts available for review by November 8th. > Best data source and method for medication lookups identified. > Reference tables filled in > Interim URL identified for patient portal: www.patientpowered.org/com Tasks Scheduled Next 2 Weeks: > Finish building interfaces  > More work need on registration work flow > Putting together the big pieces: SCP interface, security/access piece, medication lookups, process and workflow considerations > Polish look with graphic designer > Thorough testing and troubleshooting of the application Week in Review: October 18th. Deliverable/Project: Shared Care Plan Update Summary: Wire frames nearly finished; shown to patients and P2 staff with good response and feedback. Some more polishing needed (especially with Medications portion), but parts will be ready to build. Security/access modelpresented on Friday (Oct. 18th) at meeting with all the right people in attendance. Good progress made - group will meet again next week to continue work. Tasks Scheduled Next 2 Weeks: Finish wireframes Begin building the SCP User interviews, focus groups and usability testing to inform the above tasks Finalize security/access model Meet with graphic designer Work on integrating Medication lookup tables Note: URL selection on hold until overall website strategy is addressed. Week in Review: October 3rd. This is a "week in review" I completed for another audience, but will probably be useful here as well: Deliverable/Project: Shared Care Plan Update Summary: SCP Requirements Document approved by the Implementation Team on September 25th. Task analysis underway with SCP workgroup. Tasks Scheduled Next 2 Weeks: Finish task analysis Build wireframes User interviews, focus groups and usability testing to inform the above tasks Prioritized list of Deliverable/Other Issues Priority Issue Status Medium URL selection will be made and finalized at the Communication Team meeting on October 8th. Good Low Pilot test of the English version of the touch screen patient satisfaction survey at North Cascade Cardiology has been moved to October 10th. SeaMar still on track to pilot on October 8th. Good Week in review: September 18th. This is a "week in review" I completed for another audience, but will probably be useful here as well: Deliverable/Project: Shared Care Plan   Update Summary: á         Favorable reactions to the SCP Requirements Document from customers whoâve seen it (IT Technical Team, P2 Staff, Clinicians; very recently circulated to Directors, Team Leaders, and the Guidance Team). Iâll have a chance to discuss the contents of this document with the Implementation Team on September 25th. á         Reporting needs of the SCP are being clarified with the assistance of Sarah Donelson and the addition of a Data Analyst (Christine Kelley) to the SCP Work Group. The Work Group will meet Friday morning to finalize these needs for inclusion in the requirements. á         Some initial implementation planning has occurred around the best scope for the release of SCP v.1.0. Due to persistent process and security/access issues, the recommendation is that only patients at one clinic and with a Clinical Care Specialist use the SCP. Additionally, only patients and healthcare professionals will be given passwords and electronic access, excluding for now ãout-of-systemä care team members such as pharmacists, family, and friends (who could possibly be given ãpaper accessä in the meantime). Will make another attempt to discuss implementation planning at next P2 Staff Meeting (Monday). Tasks Scheduled Next 2 Weeks: Task analysis Begin process modeling (could possibly wait until SCP v.2.0 with a limited initial release?) Begin building wireframes User interviews, focus groups and usability testing to inform the above tasks Initiate formalized implementation planning Tasks Falling Behind/Obstacles: Security/Access Issues Prioritized list of Deliverable/Other Issues Priority Issue Status Medium Weâve had a lot of input regarding the URL naming of the portal and have a process to make a decision. Nailing one down by October 1st still on track. Good Low Pilot test of the English version of the touch screen patient satisfaction survey will take place at North Cascade Cardiology on Tuesday October 1st.  The English version will also pilot at SeaMar on October 8th. Good Patient Story: Rewards and Challenges. I called one of my diabetic patients this week to see how she was doing. She said she was better after her fall and trip to the ER. She elaborated: She'd gone for a walk with her dog. She has severe neuropathy in her feet and so tries to use a trail near her home because it has an even surface. Anyway, in spite of her efforts, she took a fall and landed onto her shoulder. She was in extreme pain and feared she'd broken something. Somehow she managed to get up and get back to home where a kind neighbor took her to the ER. She said she knew they would ask her about what medicines she takes so she remembered to take her copy of the Shared Care Plan(SCP) with her. She said it was wonderful! All the nurses and doctors were so excited and pleased to have a clear, up-to-date copy of her meds. She was glad she remembered the SCP because it made it much easier for her while she was in pain. She did not want to take the time to find all her medicines and take them to the ER. Yes, I'd call that a success! However, the situation highlights many problems as well. 1. I had no idea she'd had the fall and gone to the ER. Her primary care provider will no doubt get the summary via the hospital. However, as Clinical Care Specialists, we are not yet in the communication loop. I am not sure how to address this problem. 2. Since she received new medications to deal with her shoulder injury, her meds list is no longer accurate.I will need to revise her SCP and then get a copy to her. Logistically this can be a challenge especially as our case loads increase. 3. So far, there is no electronic method of up-dating patient information. I am so very much looking forward to the electronic Shared Care Plan. It seems like such an obvious necessity and will improve patient safety and multi-provider communication. The logistics are challenging because it will require that the entire medical community embrace and implement this for it to work. The vision is compelling! "TEAM" says it all!. Last week we did not have the Thursday staff meeting because so many were out of town. Nancy is currently on leave as well so I'm covering her patients as well as mine. There were three patients who got admitted, a major case conference to deal with a particularly challenging patient of mine, and just lots of stuff to deal with. We are in the trenches; it feels like we're hitting the ground running from morning to night. I'd have to say that the "keyword' for this week is TEAM. Frequently through the week, I was impressed by the sense of team and focus I've encountered everywhere. We had a lengthy and challenging Implementation Core Team meeting on Wednesday, starting at 0700. There we were around a large table: an amazing gathering of physicians, nurse practitioners,  IT specialists, hospital quality staff, and our own project staff wrestling with the realities of implementing parts of the project. Something as simple as installing a computer in each clinic has become a formidable task. This isn't a complaint, it's merely a reality. Sheer logistics, budgets, timelines and tons of real work all become barriers to completion of a task. And it's only one task of many. But here we have a determined group of people willing to take on their part whenever and wherever they can. Our TEAM was suffused with support by Mary Minniti, our Project Manager. I wonder how many who read this can remember starting a staff meeting with a comment of appreciation for each individual staff member. It is so affirming! I do not believe I have ever encountered this level of team building in any other work setting in my entire professional life! This positive energy flows forward and out into the pilot sites. It seems like I always receive a positive welcome from clinic staff, in spite of the usual hectic pace in all our sites. So, it's a bright crisp autumn day in northwestern Washington. Think I'll enjoy the weekend! Week in Review 10/31/02   1) Updated and ran weekly macros for providing information to the Clinical Care Specialists on Diabetes and CHF ED visits as well as patient surveys. 2) Gained perspective on systems dynamics information from meetings with systems dynamics people. Diabetes model explained. 3) Updated queries and macros with new provider info for new care providers at clinics. 4) Researching CHF community statistics through the CDC to attain a percentage of CHF patients in this community. 5) Systems dynamics meeting with consultants to discuss CHF measures and data to use for model. 6) Starting month end IHI and clinic reports. Week in Review 10/24/02   1) Completed first frequency reports on hospital inpatient patient satisfaction survey questions around P2. Learned SPSS and process from Sarah Jane Satre on MOMS team. Distributed report to Marc P. and Mary M. via email. 2) Installed SPSS and started tutorials for processing of info for both frequency reports and upcoming initial RASCH analysis data for clinic PSAT reports. 3) Created Macros in Statit to improve efficiency of monthly reporting needs. 4) Added new CHF queries for additional CHF reporting needs brought up in Implementaion meeting for info relating to patients taking beta blockers, ACE inhibitors or both. Integrated these measures into the IHI-CHF report. 5) Working on P2 storyboard for upcoming HID university. 6) Continued to assist in adjusting the clinic PSAT survey. Week in Review 10/17/02   1) 3rd Next Available Appointment info collected from all the clinic pilot sites. 2) Documentation of CSH systems dynamics queries. 3) Macro for updating CHF scratch pad created. 4) Further adjustments and tweaking of Clinic Pt Satisfaction Survey.      -Bolded some text to provide more emphasis to key words      -Changed the response categories for the following questions: Can I email my provider· and There are group visits at my clinic· to Yes, No, I donât know.  This change was approved by Bill.      -Discovered some errors in the Spanish translation.  Working through those now and should have them fixed shortly. 5) Contact made with the Bellingham Fire Dept for gaining access to their data.  Need to report to IHI: # of pts with known CHF that called 911.  Will hope to set up a meeting with them and the necessary members of the P2 team as soon as possible. 6) Agreed on an initial reporting template for the PSAT reports as well as identified the process to create those reports.  Will look for continued support from the MOMS Team, specifically Sara Jane and Aaron Ignac, to get Brian and I up and running. Source: collected Weeks in review; Updated: 8:13AM PST.