Knox's Blog

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Halloween decorations have sprouted up all over my neighborhood and have me reflecting on years past. My favorite costumes were the ones where I could either dress for my future career as a firefighter or astronaut or pretend I was a superhero. Halloween is one of the great kid holidays because of the candy of course, but also the opportunity to become someone else. My kids remember the fun of deciding what to be each year and helping design all aspects of their costumes. They also remember the cold nights and having to wear a coat on top of their fabulous creations. Mean old mom and dad. The same mean old mom and dad that would ration their haul and make it last for a few weeks.

Now that my kids are grown, the decorations I see as I walk around the neighborhood have me thinking – what does Halloween mean to me today? Well, I still get candy because what responsible home owner wouldn’t test the goods first? I still enjoy seeing the parade of firefighters, witches and ballerinas come to my door. Hmmm – what would I dress up as today, given the chance? Well, if you see Uncle Fester rounding at your facility today, it just might be me! Happy Halloween!

Do you know anyone who was a patient at an Inova facility several years ago – and then visited us again more recently? Chances are, if you asked them about their experience back then versus now, they would say: “There was an amazing difference. Everyone was so nice!”

Were we not nice back then? I don’t think that’s the case – we just didn’t communicate as well. Through the teachings of Quint Studer and his team, we learned to hardwire excellence. We learned that it’s not enough to simply pull the curtain around the bed. We have to explain why we act the way we do. For example: “I’m closing this curtain for your privacy.” We also learned that it’s not enough to check an identification band. Saying, “we are doing this for your safety” adds a layer of comfort. A layer of comfort reduces anxiety. Reduced anxiety improves patient outcomes. And improved patient outcomes improve the patient experience. Though we haven’t conducted any formal Studer training recently, we still very much believe in the principles of his program.

I know that our clinical staff practice AIDET, round hourly and use key words at key times. How about the rest of you? System Office folks – are you still rounding on your customers? Are you still managing up, sending thank-you notes and helping build a culture around service? Ultimately, the work we all do impacts our patients. When we manage requests in a timely manner, and when we go out of our way to provide excellent service to our clinical colleagues, we reduce their anxiety and stress and free up time for them to spend with patients. Try saying: “To provide you better service, I will …” Or: “To turn around your request in a timely manner, I will need …”

Let’s learn from each other as we continue to practice these Studer principles. Please submit your stories about how you have used the Studer principles and tactics to make a positive impact on a patient or a colleague.

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While we are a large system, each unit is a village unto itself where bonds are developed and everyone is working together for a common purpose. I remember the story of a colleague whose house caught fire and all her co-workers stepped in with offers of food, money, clothes and shelter. She also received money from United Way’s Inova employee fund. I hear touching stories all the time from our social workers, chaplains and human resource team about our “above and beyond” actions.

I also heard about someone in anesthesia who took it upon himself to get to the bottom of blood pressure cuffs that didn’t work right each and every time. The inconsistency was driving everybody nuts, so he spent hours researching and making calls. He called the manufacturer, other doctors; I think he even talked with someone in Germany. His persistence paid off. The issue was resolved and he shared the solution with everyone across the system. We all have moments like this when we cross the line from our “day job” to working with drive and passion for the common good.

Being in the healthcare field provides us with a unique opportunity to make a profound difference everyday. Many times we care for patients and families when they are most vulnerable. Even those of us who don’t work directly in patient care often feel that same passion. I think that this is the difference between having a job and having a calling.

At a job, we expect to get more than we receive. A calling is a bit counterintuitive. A calling is striving to serve others who need us. It’s expecting to give more than you expect to get back. Why would you sign up for such a thing? I think the answer is that we are all attracted to the opportunity to make a difference in another person’s life.  At Inova, we have the unique opportunity to give people something they couldn’t get any other way – a connection with another human who cares.

W. Edwards Deming said, “All anyone asks for is a chance to work with pride.” I would add to that most folks also ask for the chance to work for something larger than our own self interest. Long term, we learn that if we give to others, we get a whole lot more back. This calling is the blessing we have to share, and in my mind, it’s the blessing we HAVE to share!

What is your unique personal story? When did you feel the warmth of giving to someone else?  When were you the recipient of a special measure of someone else’s caring touch, embrace or gesture?  I would like to hear about your passion, your calling and the “power of love”!

While rounding in the Inova Fair Oaks Hospital emergency department, I found a great example of Inova’s culture of safety, thanks to Ann Stinely, RN. While in the staff lounge, I spotted a poster board that was a bright, simple display made from recycled material. Nothing fancy, but one that packed a powerful message. There had been some confusion with the administering of an antidote and Ann took the time to turn a risky situation into an opportunity to improve safety and provide a valuable education for others.

A 20-year-old-man came into the Inova Fair Oaks Hospital emergency department 6 hours after a Tylenol overdose.  We know that if the antidote is not administered on time, serious liver damage can occur. The recommended way to give IV Acetadote is a bolus given over an hour followed by a dose given over 4 hours and another dose given over 16 hours. The admitting doctor did not see the patient until 2 or 3 hours into his admission. There was a delay in giving the second dose of the drug and the doctor did not write for the subsequent doses.

As a safety coach and a nurse at a magnet hospital, Ann realized the holes in the Swiss cheese were starting to align and went into action. First, she reported the incident to Quality. Second, she created this board to present at Safety Huddle and to display in the staff lounge so other members of the team could learn as well.

This is what I call a win-win-win. Our patient was successfully treated and discharged. Our team is better educated about administering Acetadote. And the final win is Inova’s culture of empowerment, safety and trust is alive and well in the emergency department at Inova Fair Oaks Hospital. I am so proud of colleagues like Ann and I look forward to hearing similar stories on my rounds at your facilities. Look for me this Thursday at the anatomic pathology histopathology operations at Woodburn II facility and the anatomic pathology services at Inova Central Laboratory.

I recently took a process improvement training class taught by Ken Leeson. This particular class is called Lean which is “the relentless pursuit of the perfect process through waste elimination.” Ken takes this so seriously I had to laugh when he said, “My job is to eliminate my job.” When not teaching, Ken is out rounding. I asked him to be my guest blogger today to talk about his views on creating excellence.

A guest blog by Ken Leeson:

Hi Inova.  Knox asked me to briefly explain Inova’s initiative to weave continuous improvement into everything we do. We call this Inova Performance Excellence (iPEX).

The focal point of all we do is, of course, our patients. I recently tagged along with a clinician during patient rounding, and I was reminded again of how precious our patients are. Often they come to us vulnerable – fragile physically and perhaps also emotionally. We are so fortunate to have the opportunity to help our patients heal.

We consider it a true privilege to serve these patients. But the business of healthcare doesn’t always make it easy. Like others in our industry, we are challenged by the fact that our patients need higher- quality care at a lower cost. In a nutshell, we have to increase the value we provide.

We are not the first industry to face these challenges. Extreme global competition over the last four decades has forced many businesses to remake themselves. We are fortunate because we can learn from their experiences. The common theme? In order to effectively improve our performance and increase our value as an organization, it is imperative that we engage and empower our people. Our people are our most critical asset.

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The concept is simple enough – the staff that are involved in the day-to-day service to our patients have the greatest understanding of the value equation. We have to reach out to our frontline colleagues to tap their ideas for improvement and pull them in to the change process. Similarly, we have to empower our staff to reach out to Inova leadership when they feel our performance is anything less than the best we can do. And as leaders, when our employees reach out to us, we must listen and act.

Inova Performance Excellence is about people development – developing our knowledge of process improvement and customer value, developing our confidence and leadership potential, and most importantly, developing our ability to improve our performance for our patients.

On today’s guest post, Richard Magenheimer, our Chief Financial Officer, provides his one minute take on healthcare costs in relation to our local economy.

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We’ve made great strides, but have a long way to go. Please share with me your favorite cost-cutting measures to date and or the ones that you are currently working or planning to implement.

Many times I’ve been stopped by people wanting to thank me for the excellent care they received at an Inova facility. As much as I’d like to take all the credit, I can’t. The credit goes to the team of caregivers and all those who make care giving possible. It recently occurred to me that I should introduce you to the small but mighty team that makes this blog possible.

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Chris Boyer is our web/social media go-to guy. He and his team design, develop and update Inova’s web sites and help keep us on top of trends. For my blog, Chris interviews my guest hosts, makes my links active and finds images to use. He was even able to download the Beatle’s song, “I’m a Loser.”

Anne Doyle is usually found behind the camera, but I’ve asked her to trade a picture for a thousand words – or maybe just a few. Anne’s 18 years at Inova help me tie in where we’ve been with where we are headed. I also appreciate her dry wit, which you can find in headlines such as “I’ve been Squashed.”

Carrie Rich is our lead conductor and task master. She gathers ideas, filters them up, over and around, and keeps us all on track. Carrie has her finger on the pulse, her sight on the main thing and, incredibly, helps me translate my ideas into strategies for Inova.

You are the other member of my team. I thank you for your past feedback and comments and look forward to creating a more interactive forum. So let me start by asking what has been your favorite blog to date and/or what would you like to see us cover next?

Ask your staff for their feedback as well. I’d love to hear from everyone, since everyone is on my team.

A guest blog by Maureen Swick:

Knox offered me a slice of his blog real estate to briefly talk about how EpicCare will impact our nursing staff. Is this the part where I get to jump up and down and yell “WooHoo?” I can’t begin to tell you how excited I am! EpicCare will provide a data rich environment that will support nursing research, standardized education and, more importantly, a collaborative approach to patient-centric care.

Currently, there are a number of information systems that we use that do not speak to each other. As a result of these fragmented systems, nurses have been forced to document the same information in many places to meet regulatory guidelines as well as to provide patient information for other healthcare professionals.

EpicCare will eliminate many of the these barriers and support nurses in being more effective in their roles as patient advocates, educators and key members of the healthcare team.  We will have one medical record that will be accessible to all members of the healthcare team, no matter where they are physically located. EpicCare will provide nurses and other healthcare professionals with evidence-based literature to guide our practice in providing our patients and families high quality and safe care.

The more time our nurses have to devote to our patients, the better. Better efficiency, the safest care possible and more research opportunities for a better future. I’d do cartwheels if I could, but since I’m not quite that limber, I’ll simply end by jumping up and down and shouting, “WooHoo – I can’t wait!”