Knox's Blog

When a patient, family member or friends of a patient transitions from that role into the role of becoming an active Inova community member, my heart jumps for joy!

And that brings us to Sadie’s story. At the young age of three months Sadie was diagnosed with neuroblastoma. Family and friends are concerned and want to help in any way possible. The journey of treatment begins. Surgery. Chemotherapy. Life saving blood transfusions.

And that brings us to blood donation. For infants like Sadie, O negative, CMV negative blood is preferred. Only a small percentage of the population is both O negative and CMV negative. And so friends formed a group to bring the importance of blood donation to the public. After all, there is no substitute for human blood.

And that brings us to my recent rounding at our Inova Blood Center in Sterling. While there I learned that someone needs blood every two seconds. One donation can save up to three lives. And as the largest hospital based blood donation center in America, we are stepping up to the plate daily to meet the needs in the community we serve. And that is in part, thanks to the hard work by our dedicated Inova blood donor team led by Terri Craddock.

And that is also in large part to all our donors which brings us to the Presidential Award for 2012 which recognizes a blood donor group not only for units of blood donated at their blood drives, but also for unusual and outstanding service to our community. This award is presented annually at the recognition dinner for both individual donors and those that form blood drives. The winner was Friends of Sadie, seven special women who were so inspired by one little girl’s cancer journey that they made it their mission to keep the topic of blood donation relevant and accessible. They have encouraged individual blood donations at donor centers and community blood drives. They created an annual Valentine blood drive where at least 500 units of blood are donated each year. They set an annual goal to continue to connect the dots between blood donation and pediatric cancer research. A patient like Sadie might require up to 50 units of blood during her treatment.

Congratulations on the award and thanks for giving so many others a chance at recovery. You do indeed make my heart jump for joy and I hope that everyone reading this is also inspired to make a difference one day at a time, one unit at a time.

Sadie is now four years old and doing well. Three cheers for all of our Inova blood donors!

Is anyone out there surprised we are in a major health care transition? Is anyone out there surprised we have to leave behind our old way of doing things and look for new methods of working? This is not being led from the top down. This is being led from the outside in. At the end of the day society speaks and they are saying we can’t afford what you do.

And just how will we do things differently? Well, quite frankly, I don’t know, because we are working on the plan. There are many things we will have to leave behind. Much of what we learned and knew isn’t going to work in the future. In order to succeed, we need to let go of our old attachments and beliefs and be open for new experiences. Remember the days when patient length of stay was 7-9 days? We let those days go. We won’t forget the past, our knowledge is too valuable. But we do need to be willing to let go of our grip.

It’s not worse, it’s different. It is painful, as change is always difficult in the early stages. You can make it easier on yourself though by becoming a part of the solution. As we continue to build useful protocols for best practice you will be counted on to help navigate our course. It’s not difficult, it’s just challenging. And it’s not been written yet. Surprised? So don’t sit back and wait for the answers, help us with the innovative process. Own it. Be accountable. Be intentional. We want it to work. Be an advocate of change and embrace the giving up of the old and the excitement of the new.

This change is way beyond, “we have to do more with less,” which is good news. This change requires changing from volume to value. From being institutional to being fluid, mobile and portable. From standard predictable care to making a unique difference in each unique life we touch. From treating illness to creating a healthy community.

Are you surprised that part of our focus these days is on customer service? The number one benefit of providing EXCELLENT customer service is that it makes your job easier. Think about it. This is true for so many different reasons, but I would think this would be our biggest motivator!

The future will become what we create. Surprised? Get engaged. Learn. And help me envision a future health care system where we are not surprised at our success but are able to stand up tall  and each one of us can say, “Inova is the best thanks to me.”

I recently had the privilege of meeting an InovaTV star the other day, Ansanus Obizuo, also known as Obi. Certainly you remember Obi from the piece that ran a few weeks ago called, “Unit 25 knows True North!” Larisa Golding’s unit at Alexandria is one of several units piloting the A3 board deployment and helping design the strategy for future roll-outs across the system. This a total team effort where the staff decides how the board will be designed, used and which issues to tackle first. The Lean team mentioned that the Unit 25 team is doing a phenomenal job so I stopped by again to have a look.

Obi, who has been with Inova for twelve years is excited that this new board streamlines the process and makes everything easy to understand. Obi says, “We know what the process is, we get the team around the problem and everyone contributes ideas.”  He also recognizes one of the barriers which is perception. Obi said, “Whatever we do – perception is the one of the great variables we have to change.” This really got me thinking because it is the same issue we discussed when I met with the Home Health team. At Home Health, we talked about patient perception and whether or not they remember being educated on medication side effects.

At Alexandria, we were talking about colleague perception and the importance of good communication. One of the issues Unit 25 is looking at is the No Pass Zone where everyone is responsible for answering call lights. This has the potential for bruised egos or hurt feelings if one perceived their toes are being stepped on. Good communication around our need for a patient centered focus improves trust, empowers everyone to act for the good of the patient and eliminates an “us versus them” misconception.

Perception is not necessarily the truth; it’s our view of the truth. Are you approaching your world as a victim or with a more optimistic positive outlook? We can learn a lot from leaders like Obi and do our part to encourage open and honest dialogue so that when fear and distrust comes knocking, no one will be home.

Obi says he goes home smiling everyday because he is part of the process that will change the future of healthcare delivery, keep our community safe and bring down the healthcare costs. Now that’s a perception I like!

We are off to a great start with our JustOne campaign and new ideas are hitting the website daily! Our goal is to improve the environment and create a greener healthier community with a mini-grant program to help find and fund innovative ideas. A healthier living environment is directly connected to the health and well-being of our patient population.

One great idea I saw posted on their web site is a request for a community garden at Inova Mount Vernon Hospital. There is enough green space and this would be a great way to get the community involved as well. Another entry is for a better way to recycle office furniture. There is absolutely no need to throw a perfectly good desk or file cabinet in the dumpster when there are many folks in our community that could put it to use. Roof top gardens, paper medicinal cups instead of plastic ones, composting, solar panels … the list goes on …log on and have a peek!

The JustOne campaign is an opportunity to make a positive impact on our future health. We will reduce landfills, energy consumption, decrease pollution and save money. Every small action makes a difference.  Why are we calling this JustOne? At the end of the month we will be able to tell a story of the massive impact achieved by everyone contributing just one action of their own. What is yours? Log on to  inova.brightidea.com/justone to let the world know!

The recent funeral of a colleague and friend reminded me of the importance of living by example. The near capacity crowd was such a powerful reminder of the difference one person can make. While the loss of friends and family is a sad occasion, I also find memorial services to be uplifting as I always leave wanting to be a better person.

It is the place where we learn all the tidbits about the person’s life and personality through a collection of anecdotes and stories delivered by family members, colleagues, and friends. Some of the stories that resonate with me are the small things. Simple thoughtful tasks that made a big enough impact to be recounted at a final send off. The funny stories bring additional light into the personality and provide a breath of fresh air. These coupled with the major accomplishments and wow moments create that magical window into a life well lived.

In our day to day activities, it’s easy to lose track of the impact we have on others. It’s also easy to forget to tell others the impact they have on us. As Mother Teresa reminded us, “We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop.”

So thank you dear friend for the reminder that I need to live in grace. I will continue building my ladder of personal and professional achievement. I will work on overcoming negativity and needless worry knowing that in the end, it will all be okay. And if it’s not okay, it’s not the end. I will continue to count my blessings and remember your legacy that I might also make a difference.

This is National Volunteer Week and I’d like to take a moment to recognize our hundreds of volunteers across the system.  Our volunteers choose to give their time and energy to improving the patient experience. Whether delivering flowers, working in a thrift store or helping with administrative tasks, this hearty crew of dedicated givers offers an extra dimension of support and assistance to hospital staff. In addition, their financial contributions have helped us launch many new projects, services and raise new buildings! Our volunteers are deeply committed to Inova and I hope you join me in taking a moment to say “Thank you, your service is invaluable.” I’ll conclude with a poem Phil Brooks, Manager of Chaplain Services at Fairfax, once read at a volunteer recognition dinner:

“I’d rather see a sermon
     than hear one any day;
I’d rather one should walk with me
     than merely tell the way.
The eye’s a better pupil
     and more willing than the ear,
Fine counsel is confusing,
     but example’s always clear;
And the best of all preachers
     are the men who live their creeds,
For to see good put in action
     is what everybody needs.
I soon can learn to do it
     if you’ll let me see it done;
I can watch your hands in action,
     but your tongue too fast may run.
And the lecture you deliver
     may be very wise and true,
But I’d rather get my lessons
     by observing what you do;
For I might misunderstand you
     and the high advice you give,
But there’s no misunderstanding
     how you act and how you live.”

EDGAR GUEST

Do you have time to run out to Stafford to attend a meeting? No? Okay, how about Gainesville? It’s not always easy pulling the whole team together for meetings. Some departments have day, evening and weekend shifts to work around and others have geographic issues. Although our Inova Home Health crew is scattered far and wide they were able to gather together to tackle their first Lean Process Improvement project. I had the pleasure of stopping by recently for a tour.

Elissa Clark, the AVP of Home Health, found the experience to be very beneficial. “We started with Value Stream Mapping.  It was amazing to bring together the schedulers and the field clinicians. Although they talk every day, they didn’t fully understand each other’s role and the number of steps it took for the scheduler or the clinician.” Elissa was also surprised because she didn’t realize just how much time the clinicians needed after they received the schedule each night. There was a serious work/life balance in need of modification.

So off they went to the Gemba (the place where the work is done) to observe, document and note the time required for each step. They determined that it takes 1,100 steps to schedule a patient.

Here is the before:

And here is where they plan to finish:

The team developed the Future State and created an action plan consisting of Kaizen Events, Standard Work, and a Software System Upgrade.  Through these activities they were able to achieve a more streamlined process. Wow! Nothing more exciting than making life simpler while improving outcomes!

Home Health is also the first in our System Office to implement Strategy Deployment.   They have developed their Visibility Wall and Strategic A3’s to achieve their Quality, Service, Affordability, and People targets.  It was interesting to hear about one of the Service issues on the board which is to ensure that patients understand the side effects of the medications they are taking. Although side effects may have been discussed, a patient might forget or still not fully comprehend the totality of everything they might experience based on the patient’s unique situation.  The team used A3 problem solving and is working to simplify side effect educational materials as well as different methods of delivering those materials in a visible way. Gaining a better insight into patient perception and building an educated team will improve clinical and operational performance.

Improving HCAHPS scores and quality indicators might not always be on the top of our excitement list, but Elissa said they are all having fun with it in part because progress is being seen. Everyone is on board as a team and they have already achieved a significant reduction in cost. Thanks to a software upgrade, the introduction of iPhones and exploring other ways to stay in closer contact such as Go-To-Meetings and iPads, I think they will reach their “future state” very soon. And although they are scattered far and wide, they are all on the same page of excitement when it comes to making noticeable improvements.

At our last Inova Learning Institute, we discussed the three questions most folks want answered at work. Watch to find out what they are!

Is your left brain in sync with your right brain? We think with the left side and feel with the right side. Our right side contains our passion. Where are you most dominant?

“Be inquisitive – never stop learning.”  – Grace Lucas

A member of my blog team recently unearthed from the archives a 3×5 card written by Grace Lucas, one of the original founders of Fairfax Hospital. On the card were very small, handwritten notes for a speech she was going to give at a nursing Capping Ceremony in 1974. (For the youngins out there, nurses used to wear caps!)

Grace noted that when she first became a nurse, there were no married nurses. There were no LPN’s. There was a lack of medications and back then patients used to stay in bed for over a week after a routine operation. Thankfully, some things have changed.

Also listed on the 3×5 card was the importance of anticipating the needs of the patient.  She also recognized the importance of  the team and continuing skills training. Thankfully, some things have stayed the same.

Grace’s words, “Be inquisitive – never stop learning,” sums up where we at Inova are today! We are still living those values. The changes we are facing today sometimes happen so rapidly that we must set aside the static PowerPoint slides and build the ship as we go. When our OneInova team is engaged and empowered and feels a strong commitment to building upon the creativity of fluidity, good things happen. Connections are created in the heart, not just on paper. The greater sum of all the individual efforts then moves mountains with ease. Instead of saying, “Oh no team, look at this mountain,” we can say, “Watch out mountain, look at this team!”  When we come together, there is nothing we can’t accomplish.