Knox's Blog

I received an image of the patient letter below that was posted on Inova Fairfax Hospital’s Ambulatory Surgery Center’s PACU wall. I took a moment to appreciate the sincere care and exceptional hospitality that is being given at Inova. It brings me great joy to see how the hard work of every individual at Inova plays a significant role in the experience of each patient we serve. We are blessed to have caring teams of professionals who only deliver the best possible care to every one of our patients.

Thank you for everything you do and keep up the exceptional work.

Knox

P.S.: I would love to hear more patient stories. Please send them my way!

I asked a quiz question in the Pharmacy Department while visiting Inova Alexandria Hospital. The question: “Who would you rather have on your team to help solve an issue from your Creative Solution Board, me or Kathleen?” Kathleen Maloney is a Pharmacist and a valued member of the Pharmacy team. The good news is they all passed the quiz by voting for the expert, Kathleen.

This is a double win! The first win of course is that they recognize the true experts are the folks on the front line. The second win is that they felt comfortable expressing their opinions. We like to foster safe spaces at Inova and as I round across the system, I am glad to see so many productive and fun huddle environments. Safe space is the key to progress.

Towards the end of my tour, I paid a visit to the Larisa Golding’s team on Unit 25, IMCU to check out the space for their performance improvement initiatives. In addition to the Creative Solution Board, and the Kensa 5, they have A3’s with their two initiatives – decreasing the door to needle time for stroke patients to 60 minutes and decreasing the average time for internal transfers to less than 60 minutes.

Jalil Bentaleb, RN and Stroke Coordinator,  says that in addition to looking at processes that don’t work, they look at all the processes and for ways to improve upon that which is already working just fine. The door to needle time at Alexandria went from 26 steps to 12 steps and is down to 37 minutes. Wow, no wonder the entire IAH Stroke Clinical Effectiveness Team is recognized by so many as one of the leaders and have been asked to present at the International Stroke Conference in Hawaii and at the National Training Institute.

Internal patient transfers were sometimes taking longer than two hours. The staff formed a team involving ICU, Transport and IMCU and they have cut that time in half. Their new goal is 45 minutes.

And my final quiz question, which is better for Inova, spending $1.99 for a Personal Belongings Case and having a happy patient, or risk being responsible for between $2,000 and $5,000 when hearing aids or dentures are lost and having an unhappy patient? Tony Paduano, Patient Representative, and his team knew the right answer and took advantage of the Empowerment Fund to jump start this fabulous idea.

Being a member of the Inova family, means that we look out for each other. It’s not about blaming someone else for missing dentures; it’s about finding a solution together with all involved parties and sustaining that process until a better one comes along. It’s about making the day in the life of a patient more pleasant by creating less waiting time for the next test. It’s about looking at our successful stroke program and not resting on our laurels. It’s about feeling safe enough to say, “Thanks for stopping by, Knox, we got this area covered.” And it’s this trust that I reckon will move the needle and get us to where we need to be. On the top!

Our operating units across the system are seeing an influx of achy, sniffly, coughing patients. While I’m not happy certain germs found their way past the flu vaccine, I am grateful we all pulled together and protected ourselves the best we could. I shudder to think the outcome had we not all been vaccinated. Flu seasons are unpredictable and we would be putting ourselves and our patients at increased risk had we not done our part.

Each season, some people who were vaccinated still test positive for influenza and it’s hard right now to say whether or not this year will be worse than other years. It’s still early in the season and while the flu bug may not be predictable, our responses will continue to be predictable. We will monitor the situation closely and make the best decisions based on suggestions from the experts.

Thanks team Inova for stepping up and taking responsibility. And Dr. Knox also reminds everyone to drink plenty of fluids, get plenty of sleep and exercise and wash your hands frequently.

Blessings for a healthy and happy 2013.

Do you realize that the part of our service promise, “every touch every time” probably means a different story every time? Stories help make abstract concepts more tangible. Stories define us. And most important, they are meant to be shared.

Hopefully you watched the InovaTV story about the Wheeler family called, “Circle of Care.”  Two nurses from Inova Loudoun Hospital, Regina Barnett and Todd Rockwell, made quite an impact on this family. How? By caring. Which is what we all do every day.  In the video, Regina talks about the importance of healing not only the body, but the heart and soul as well. Todd says the whole unit is the same way – wired to care. The family was so profoundly impacted by the care they received, the Wheelers decided to make a significant leadership gift to the hospital which now proudly has “The Wheeler Family Emergency Department.” If you missed this one, pull out a tissue and view the video below.

I love a good story and here’s another that was passed on to me. A high school student was hit by a drunk driver, suffered a brain injury and was being treated at Inova Mount Vernon Hospital. The patient progressed quickly in her motor skills, but cognitively was very impaired and had difficulty engaging in therapy. Her PT Rehab Clinical Specialist, Kathy White-Wenger, wanted to address one higher level of balance before moving her from physical therapy to speech therapy. The patient had been on her high schools dance team before the accident so Kathy asked that she teach her one of the school’s drill team routines. Kathy’s colleagues as well as the other patients in the gym had the pleasure of watching Kathy and the patient perform this high-kicking, hip shaking routine in the gym. In that one session, Kathy got more out of the patient in terms of initiation, memory and attention than the patient displayed her entire stay. That hysterical dance routine even got the patient smiling for the first time as Kathy tried to keep up with this 16 year old! Years later the patient came back to visit and catch the staff up on her progress. She finished high school, went to college and studied to be a physical therapist, just like Kathy.

Now tell me that didn’t put a little lump in your throat! This story was recently read at Inova Mount Vernon Hospital’s service awards by Angie Knutson in celebration of Kathy’s 30 years with Inova and I’m so grateful it was shared with me.

We all love to hear a good story. So please share them. Share them with your colleagues and leaders. Share them with InovaTV. Share them with me. Stories create fond memories and set a guide for the future. They unlock the why behind what we do, which is seek every opportunity to meet the unique needs of each person we are privileged to serve – every time, every touch.

A colleague recently shared with me, what was for her, a difficult moment. She complained. Why was that difficult? She’s a non-complainer. It’s very difficult for her to complain, makes her quite uncomfortable and creates much anxiety. It’s easier in situations where the recipient is a stranger, much harder when it’s a colleague.

Why did she complain? Inova did not live up to its service promise and she didn’t want the next patient to have the same experience. A simple matter of miscommunication added unnecessary stress to an already stressful series of medical tests. I won’t go into the details, but I loved her analogy. She explained to me that she actually received the type of service she would expect from, say another hospital or from a retail store delivering a dishwasher.

They said the dishwasher would probably be delivered on Monday. No one called, but that wasn’t a surprise because it would be over the top to receive this item the same day. She called the next day to inquire. No one called her back. So she stopped by on Wednesday and they promised to call either way before the end of the day. No call. She called again, quite upset now as this wasn’t really a dishwasher but results of a test. They called at the end of the day Wednesday to say the results weren’t in yet and promised to track them down on Thursday. Thursday – no call back. No results.

And what do patients do when they are left in the dark? Imagine the worst. Major surgery – doom and gloom.

Finally, that Friday after leaving a meeting at 3:00, my friend picked up a voicemail to call the office. She had to pull over to the side of the road to receive her test results. And as she puts it, they delivered the dishwasher but forgot to include the instruction manual. She asked several questions, and could hear on one hand the news was good, but on the other hand was confused because it didn’t sound good. She asked several questions, but still couldn’t fully comprehend the results.

And because, and only because she works here, the following Monday she found someone to review the results with her page by page. Her dishwasher is now installed and functioning and she is happy about that. However, she felt it important to take the time to find the right person to talk to and complain about the experience. Her tip to all involved was better manage patient expectations and follow through with your promise to call back and keep patients informed. The doctor was waiting for the results, the folks holding the results thought the doctor could access them. The patient was left in the dark, imagining the worst.

Thanks for speaking up and reminding your colleagues that the patient is always at the center of everything we do. It’s the only way we can improve. Thanks for listening, it’s the only way we can hear what needs improving.

Yikes, I had to pull out my calculator to write this blog! A letter from a grateful mom was forwarded to me and as I read through it, I was struck by how many members of our Inova family she listed by name. Two pages of names and she even acknowledged that she probably left a few out. One, that’s some awesome record keeping by the mom, and two, that’s some awesome care provided that warranted such note taking and a two page letter. I pulled a few bits and pieces from the letter to share with you.

“I sincerely believe that it takes a village to get a family through the diagnosis and treatment of cancer in a child. This village to us also includes those who may work behind the scenes but have been a huge source of knowledge, comfort and support. I am writing this letter to you to commend you on the absolute BEST and most PROFESSIONAL staff there at Inova Fairfax Hospital. It’s no wonder your hospital has such a good reputation for quality care. I have never met a more compassionate and loving group than the ones you employ on the HEM/ONC floor.”

This family has a 12 year old child who was diagnosed with acute myeloid leukemia. Certainly, as they noted, it was a life changing day. While to us, our day to day routines are often second nature, it’s letters like this one that remind me to stop and remember that hospital visits for our patients are not second nature and certainly not routine. It reminds me that learning about best practices and implementing them pays off when it makes the difference in even one family who has experienced a “life changing day.” As I mentioned, I had to use my calculator to count all the names listed, which was a total of 45. Forty five names in one letter. Wow, that’s forty five people that made a difference to this child and her family.

So, who was mentioned? Well, there were the doctors, “They have been an exceptional team to work with….” The social worker who … “made it all happen for us and helped us out tremendously.”  The housekeepers who “made sure that all the rooms and the entire floor were always in sterile shape to ensure “her babies” stayed healthy.” Child Life … “was a lifesaver …were always there for a procedure, an activity, a movie, a walk, a smile and a laugh.” Okay, let me pause for a minute to reflect that at this point, ten names were mentioned and we haven’t even gotten to the nurses and techs yet.

“There are not enough complimentary words to describe your nursing staff. They are truly top notch. I cannot imagine a more caring group of nurses anywhere in the country. They have set the bar high and after being in four different hospitals now, no one has been close to their professionalism, management of medicine, creative ways to handle difficult situation and their deep awareness to connect with these very ill children. The techs were also very important. It takes a special person to care for these children and they do it better than anyone I’ve seen without complaint. They deserve recognition for their hard work and dedication to the wellbeing of these very special patients.” And another 29 names were mentioned.

And she concludes with the educators, secretaries and chaplains. “This village to us also includes those who may work behind the scenes but have been a huge source of knowledge, comfort, support, prayers and visits.”

The amazing thing is that while she named 45 people, we all know there were many more folks involved. Food services, warehouse, finance, administration, pharmacy ….. okay, I could go on and easily list an additional 45 departments. So I’ll wrap this up by saying, please know that your attention to detail is working. Your patient centered care is being noticed. We indeed have an Inova village that all worked together as a team to better one patient and one family and isn’t that what it’s all about?

Ten minutes before her shift in the SkyLight Cafe at Fairfax Hospital began, Sylvia Turkson noticed a visitor who seemed a bit confused. “I like working around people,” Sylvia said, “so it was natural for me to approach her and offer assistance.” The woman was from Chicago and had been on vacation with her husband who became ill and was now a patient. Sylvia helped the woman make some food choices, escorted her to a table and sat and listened for a few minutes as the woman shared with Sylvia her exhaustion from being up all night and out of sorts. “In that ten minutes,” Sylvia said, “we became friends.”

You never know how your life can change in an instant. One moment you are a tourist from Chicago, the next you are so stressed you don’t know what to eat early in the day after no sleep. Then you are helped by someone like Sylvia who says, “I love working here and I’m always happy when customers come to me. Every little thing I do for them makes their day a bit better. And mine too. Once I asked a staff member how he was doing and he said I was the first person all day to ask him that. And it was 5:00 p.m! But these are all my friends. In the morning I leave home and get on the bus and I come to my Inova home.”

I heard this story through the grapevine from an astute director who, like Sylvia, is a people person. She saw Sylvia engrossed in a book one day and stopped to ask her what had her so intrigued. Turns out the woman visiting from Chicago had stopped by Sylvia’s station one more time before leaving town to thank her for her kindness and friendship and left her with the book she’d just finished reading. Sylvia was appreciative, but embarrassed by the attention, my friend told me, because in Sylvia’s mind, she was the beneficiary of feeling good. The director who passed this story on is so impressed that Sylvia not only nourishes the staff and visitors with food, but with kindness and wisdom too. What have you heard through the grapevine lately?

You know you’re at Inova when you are greeted by smiles! A patient recently sent Reuvan Pasternak, CEO at Fairfax Hospital a two page letter that is peppered with the word smile. Being a patient, especially a radiation oncology patient, is not much fun. The writer points out, that patients are often scared and under some level of emotional stress. He wanted to mention a few names of those folks who helped to reduce his anxiety. Here are a few excerpts from his letter:

“Each morning that I got off the elevator, I was greeted by two women with phenomenal smiles, Stephanie Morgan and Linda Carter. The smiles that they provided me and everyone that enters the department radiated reassurance and pure pleasure that they were really glad to see me and stood ready to help…..”

“David Tong, Christine Ku and Cora Johnson were the radiation technicians I saw the most. They all have great smiles ……”

“Amy Bohnslav, the RN in the unit, is just outstanding. She is involved, professional, caring, attuned to what is happening around her, answered dumb questions and is not afraid to say I don’t know but will find out. She does find out and gets back to you. She always has a smile and is looking to comfort and assure all the time.”

“Pethos Andgmichael, the blue parking garage attendant, is super. He too always has a smile, is friendly, is quite a conversationalist, is an encourager and is the last person you see leaving the facility. Because he is the person he is, you leave with a really good feeling of Inova Fairfax Hospital.”

So, while I may not be a math wizard, how do I know that 7 = a whole? Because of the following excerpt from his letter:

“I know there had to be some days when they didn’t feel like being nice, friendly or cheerful but that was never shown. I saw several other technicians and other nurses and they all displayed the same attitude of professionalism, care and knowledge. I consider you very fortunate to have a staff the caliber of these individuals. From casual observation, they are representative of the whole staff at least in the Radiation Oncology Department.”

Thank you mighty seven for representing the whole with your radiant smiles. Thank you for reminding the rest of us that each encounter counts towards the whole. You made a difference in the life of one man and that’s what it’s all about – improving lives, one patient at a time.

It’s quiz time! What do Stephen Perez, nurse practitioner with the Juniper Program, and Cathy Williams, nurse in Loudoun Hospital’s ICU, have in common?

Cathy Williams with Mildred O’Meara-Lett

Stephen Perez with Tina Grannis

I’ll give you a hint. Here are two quotes from a recently published article:

Perez:  “It’s probably two-thirds human interaction and one-third medical intervention. In a lot of cases, they’re at a point where they feel there is nowhere to turn. We help them get through the difficult times and come out the other side.”

Williams: “If you have the right people around you, there isn’t anything you can’t accomplish.”

Yup, you got it – they both know what it takes to be the Inova difference. They get that it’s the patient at the center of all we do.  They get that excellent care is possible because of our fabulous colleagues and teams. There is one other thing they have in common.

Stephen and Cathy were selected by Washingtonian Magazine for their first ever Excellence in Nursing Awards. Out of hundreds of nominations, ten were chosen and two of the ten were Inova nurses! Wow! Congratulations on your achievements and helping keep Inova on the map of world class healthcare.

One example that motivated Tina Grannis, nurse manager with the Juniper Program, to nominate Stephen involved a patient who was discharged from the hospital with a diagnosis of failure to thrive. She was new to the clinic and had not received care for her HIV in years because she was actively using crack cocaine, was severely malnourished and neglected her health. It was evident that she was too weak to come to the clinic, so Stephen went above and beyond by visiting her frequently in the nursing home where she was staying to support her and help treat her HIV. When this person was unable to care for herself, Stephen was there to support her, care for her and guide her back to good health. At the present time, this patient is in recovery, sees a substance abuse counselor to help her maintain her sobriety, is maintaining a healthy weight and is in overall good health.

Cathy was nominated by Mildred O’Meara-Lett who said that it was easy to nominate Cathy because “She matches my description of what a nurse should be. She is caring, attentive, detail-oriented and always puts our patients first.” Cathy says that she loves working here because for her, the Inova difference is commitment to excellent patient care at every level.

Both Cathy and Stephen recognize that engaging the patient is what helps the patient succeed. It is that special human touch, the kind of touch that comes from the heart, that is a key factor in healing. To read more about Cathy and Stephen, visit http://www.washingtonian.com/articles/health/21790.html

All right Inova family, who will you nominate next year?

If you are looking for Lisa Klein, you won’t find her in her usual place of business. Normally this clinical nurse specialist is on the 3rd floor of Fair Oaks Hospital, floating between Women’s, Children’s and Perinatal Services.

No, she’s not there. She’s on vacation and is giving new meaning to the term “staycation.” Lisa is hanging out in Fairfax Hospital’s NICU department, which is actually where Lisa started her Inova career in 1985. Full circle – but why? Lisa recently attended a scholarship award ceremony here at Cambridge Court. When I heard about her vacation plans, I just had to dig a little bit deeper. Don’t get me wrong, I love this place, but why in the world would you choose to vacation at Inova?

I learned that Lisa is pursuing her Doctor of Nursing Practice at Marymount University and is doing research. Lisa isn’t looking to get a different job with her DNP.  She just wants to do her job better. Her goal is to take the research that’s already been done and see if it really works at the bedside. Lisa says that she really appreciates that Inova has always supported nursing research and is willing to practice based on evidence. Lisa also really enjoys being a mentor to other nurses.

Lisa, we appreciate you spending 2 ½ years to get a degree that will be so beneficial to so many. This reminds me of a quote I was recently sent in response to my passion blog, “I came to get; I stayed to give.” You know you’re at Inova when you see such dedication!

Enjoy your vacation, Lisa. Send a card!