THE
BULLETIN
February 5, 2015
The Newsletter of Yale-New Haven Hospital
Safety coaches serve as mentors for HRO behaviors
In 2014, employees and medical staff members underwent
training on the safety behaviors that will help YNHH become
a high reliability organization (HRO). Training sessions
covered the five safety behaviors indicated by the CHAMP
acronym: Communicate clearly; Handoff effectively; Attention to detail; Mentor
each other - 200%
accountability; and
Practice and accept a questioning
attitude. Within the
safety behaviors are
techniques that have
been proven to help
prevent errors that
can lead to patient
harm.
and developing opportunities to drive high reliability habits
into their unit’s or area’s culture,” said Ellen Macone, patient
safety coordinator, Quality Improvement Support Services.
This year, the goal
is to work together
to reinforce these
techniques and
ingrain the CHAMP
behaviors into the
hospital’s safety
culture. That’s where
the safety coaches
come in.
A pilot group of coaches was selected to undergo training last summer and
deployed into their
specific units/departments this past fall.
Each coach attended
a four-hour HRO
session to learn how
to observe daily practices, facilitate habit
formation, gather and
share safety stories,
provide real-time
feedback to peers and
communicate vital
safety information
and concerns.
“Our goal is to
reduce infections,
patient falls, pressure
ulcers, phlebotomy
Herty Lawson, RN, (right),Yale-New Haven Psychiatric Hospital, one of the pilot safety
errors and readmiscoaches, explains the HRO bulletin board she created for the Inpatient Dual Diagnosis
Unit to Crystal Gibbs, milieu counselor.
sions, and ultimately,
save lives,” said pilot
Safety coaches are employees who have been trained
coach Jennifer Schobert, RN, Stroke/Telemetry unit (Verdi 5
to observe work behaviors and provide feedback on the
East). “As a safety coach, I act as a peer leader in establishing
CHAMP behaviors. “Coaches are responsible for looking for
Continued on page 4
Inpatient, ambulatory areas recognized for improving the patient experience
The hospital in January recognized employees
from more than 35 inpatient and ambulatory departments that met or exceeded their goals for improving Press Ganey patient experience survey scores
during fiscal year 2014.
responding to call bells within one to two rings. A
staff member on the unit – unit clerk, clinical technician or nurse – will quickly follow up by going
to the patient’s room to see what he or she needs,
whether or not it’s that staff member’s patient.
As part of a recognition program, Patient Relations staff delivered snack baskets for all three
shifts to the departments, located at the York Street,
Saint Raphael and Bridgeport Hospital campuses,
as well as off-site locations.
This and other improvements came from SLA 3
staff, who work in teams to come up with ways to
improve quiet, cleanliness and other patient experience measures.
“These departments worked very, very hard to
improve the patient experience and sustain those
improvements throughout the year,” said Lynn
Cermola, manager, Patient Relations and Guest Services. “Many other departments, while they did not
reach their Press Ganey goals, also made significant
improvements.”
Menillo said she and Patti Brown, RN, assistant
patient service manager, “have instilled in staff that
this is their unit. We want them to understand how
patient satisfaction affects what they do every day,
and vice versa.”
Staff with the York Street Campus Adult Emergency Department
were among the employees from more than 35 inpatient and ambulatory departments recognized for improving patient experience
scores in fiscal year 2014.
Press Ganey surveys are randomly sent to patients after discharge and ask patients to rate the
level of communication with physicians and nurses,
cleanliness, quiet and physicians’ and staff members’ responsiveness, among other
measures.
Staff on Medical Oncology/Telemetry (SLA 3), one of the units recognized last
month, are particularly proud of improving responsiveness to patient call bells,
said Jennifer Menillo, RN, patient service manager. Unit clerks have committed to
Sharing ideas to improve the patient experience also helped boost scores at Yale-New Haven
Children’s Hospital’s Bridgeport campus, where the
Pediatric and Neonatal Intensive Care units were
recognized for improving Press Ganey scores.
Once a month, the Pediatric unit patient experience committee emails 10 patient experience improvement tips to fellow staff
members, said Julie Brown, associate director, YNHCH Bridgeport. Staff know
that personalization is also important, so when patients arrive, nurses go to the
desk to greet them by name and meet their family members. When patients go to
Continued on page 4
A look at: Centralized Staffing and the Daily Operations Pool
When she begins her shift, Dayna Arduini, RN, doesn’t know who her patients
will be and what, specifically, she’ll need to do for them.
While nurses assigned to a unit often care for their patients for multiple days or
longer, Arduini might spend only four, eight or 12 hours with her patients, then
move to another unit. Fortunately, 23 years of nursing experience help her get up
to speed quickly.
“Every day is different,” said Arduini, who works in the Saint Raphael Campus
Daily Operations Pool (DOP). “I like that challenge.”
The DOP and the Centralized Staffing
Department at the York Street Campus
place nurses and other staff on units
throughout the hospital with temporary
vacancies due to employee illnesses,
time off or other reasons. The departments also provide extra staff during
patient census surges and staff who
can replace unit employees who are on
overtime.
Dayna Arduini, RN, (right), Daily Operations
Pool, discusses a patient with Casey Davis,
RN, SLA 4. The DOP’s 90 staff members work
throughout the Saint Raphael Campus.
Last year both departments integrated under one nursing director, Janet
Marseglia, RN, MSN, paving the way
for further integration. Staff at both
campuses share many similarities: they
are flexible, well-trained and provide a
valuable resource for medical/surgical,
intensive care and other specialty units.
At the SRC, the 90-member DOP includes nurses, clinical technicians, patient
care assistants, the IV Team and members of the SWAT Team – critical-care nurses
available to assist with acutely ill patients. The YSC’s 240 Centralized Staffing
employees include nurses, patient care associates, SWAT Team members, business
associates, constant companions and observation associates.
DOP and Centralized Staffing employees are scheduled for certain shifts, so
they are not “on call.” That makes the work of the staffing clerks/assistants who
coordinate their placements a little easier, but it’s still “like putting together a
puzzle,” said Sheila Coonan,
RN, patient service manager, DOP. Every four hours,
the clerks/assistants gather
information on different units’
staffing levels and needs and
patient populations, then
deploy the appropriate DOP/
Centralized Staffing people.
Staffing clerks/assistants also
coordinate the “floating” of
unit-based staff. If one unit is
overstaffed an employee from
that unit with the appropriate
skill mix can float to a similar
unit requiring assistance.
Centralized Staffing PCAs (l-r) Whitney Coles, Celisti
Hall and Ava Houston are among the department’s 240
staff members, who cover temporary vacancies on units
throughout the York Street Campus.
“The goal is to deploy staff in ways that best meet each unit’s needs and ensure
the safest and highest-quality patient care,” said Laura Jansen, RN, patient service
manager, Centralized Staffing.
Working on what Coonan calls a “virtual unit” has its challenges, but both
departments have found ways to manage them. Epic makes it easier to collect
performance data on safety, quality and patient experience measures. Both departments use multiple vehicles to encourage staff and manager communication. DOP/
Centralized Staffing employees are adept at quickly orienting themselves to units
– learning where things are, supply room codes and other information they need to
do their jobs, said Nana Boahemaa, RN, assistant PSM, Centralized Staffing.
Despite the challenges, Arduini enjoys working in the DOP, because of the more
flexible schedule and variety.
“It allows me to use many different skills,” she said. “I like the change of pace.
My role in the DOP allows me to meet and work with many wonderful people in
the hospital.”
“You really feel like a part of this great institution,” agreed Whitney Coles,
PCA, Centralized Staffing. “I enjoy it because I really get to see the hospital in its
entirety and I’m providing different types and different levels of care.”
Great Catch winners help YNHH become a high reliability organization
Congratulations to the October Great Catch winners, who used HRO safety behaviors to protect patients.
Saint Raphael Campus
York Street Campus
Maryann Lalumiere, patient care associate,
Smilow Cancer Care Center, noticed a patient
in an outpatient care area acting unusual.
She shared her concern with a staff member,
then used ARCC: Ask a question; Request
a change; Communicate a concern; use
Chain of command, recommending the
patient be seen immediately. Thanks to her
great catch, the patient received immediate
treatment for a serious condition.
Lori Coppola, central communications officer, Protective Services,
became concerned upon receiving a
phone call from a person threatening
to harm himself. She informed Lt.
Joseph Stoudmire, and both officers
connected the caller with a counseling
hotline. The caller would not provide
his location, but Coppola and Stoudmire practiced a questioning attitude and were able
to pinpoint the out-of-state origin of the call. They contacted authorities in the caller’s
area, who responded and were able to get the caller help.
Newsbriefs
Transforming Healthcare Grand Rounds Feb. 10
Employees are invited to Transforming Healthcare Grand Rounds, 5-6:30 pm
Tuesday, Feb. 10, Fitkin Auditorium. The speaker is Roy Rosin, MBA, chief innovation
officer, Penn Medicine Center for Health Care Innovation, University of Pennsylvania
Health Center. The talk is part of a series designed to help employees and physicians
enhance their clinical leadership by learning from national and international experts
on improvement science. Registration is not required. For information, contact
Marcia Johnson, 688-8475, or [email protected].
Medical records archiving available
For a limited time, Yale New Haven Health System’s Health Information
Management (HIM) department is offering departments throughout the health
system the opportunity to archive paper medical records in a secure, off-site archive
facility. HIM is coordinating the archiving effort. To learn more, department leaders
should contact Regina Alexander, associate director, HIM Operations,
[email protected] or (203) 688-2237.
High school student volunteer program applications available
for summer
Employees with teenagers interested in volunteering at the hospital this summer
should visit the Volunteer Services section of www.ynhh.org (click the community
tab at the top). Space is limited and fills quickly for the seven-week program, which
runs Monday, June 29 through Friday, Aug. 14. Applicants must age 15 by July 5
and able to commit to a minimum of eight hours per week for the entire program.
Student volunteers may assist hospital patients, families and staff, learn about
healthcare careers and satisfy community service hours.
YNHH honors students for keeping
Martin Luther King Jr.’s legacy alive
ICD-10 update: Dual coding under
way at YNHHS
In January, Yale New Haven Health System took a major step in preparing
for new, more specific codes that will be used in patients’ medical records.
From left, MLK community service award winners Koleyatu Sheriff, Arianna Taft and Mohamed
Mohamed were recognized by YNHH’s Patricia Worthy, RN, manager, Workplace Diversity, and
Paul Patton, vice president, Human Resources.
On Jan. 15, Dr. Martin Luther King Jr.’s birthday, Yale-New Haven Hospital recognized three New Haven high school students for community service
that honors the civil rights leader’s work.
“I can’t think of a better day to meet you three extraordinary people,” Paul
Patton, vice president, Human Resources, said before presenting the awards.
“One of the main things Dr. King preached about, in addition to justice, was
service. You’re keeping his dream alive.”
This year’s honorees, each of whom received $1,000, were:
• Mohamed Mohamed, who attends Wilbur Cross High School and plans to
study accounting in college. He volunteers at the hospital, coaches soccer, belongs to the Future Business Leaders of America club and is a peer
leader at his school.
• Koleyatu Sheriff, who attends Hillhouse High School and plans to attend
college to become a physician assistant. She has volunteered with a number of organizations, and currently serves as a patient aide at YNHH.
• Arianna Taft, who attends Career High School and plans to attend college
to prepare for a career in the hospitality industry. Her many volunteer
activities include serving as treasurer of the NAACP Youth Council and
president of the Elm City Youth Club of the National Association of Negro Business and Professional Women’s Club.
To be eligible for the Martin Luther King Jr. award, students must live in
New Haven, attend a New Haven public school and have performed over
40 hours of uncompensated community service that does not count toward
school credit.
By Oct. 1, 2015, the federal government is requiring healthcare organizations to change from ICD-9 codes – which have been used since 1979 – to
new ICD-10 codes, which indicate diseases, signs and symptoms, abnormal
findings and other information. Because ICD-10 codes are more specific, the
number of codes healthcare providers use will increase from around 14,000
to around 70,000.
In January, Yale-New Haven, Bridgeport and Greenwich hospitals began
“dual coding,” in which the Health Information Management (HIM) coders
who assign the ICD-9 codes to an inpatient medical record will also assign
ICD-10 codes to the discharged medical records. Clinical documentation specialists will be asking physicians for the documentation specificity required
to code completely and accurately in ICD-10.
Dual coding will provide valuable training and practice in preparation for
the October ICD-10 implementation, said Cindy Zak, executive director,
HIM and Coding. In addition, dual coding will help the health system identify opportunities for more specific documentation and its impact on reimbursements. YNHHS has been preparing for ICD-10 for nearly two years.
The government originally required ICD-10 implementation in 2014 but
extended the deadline.
YNHHS HIM coders and clinical staff who will use new ICD-10 codes
have been trained, along with physicians throughout the health system,
Northeast Medical Group and Yale Medical Group. Training for non-clinical
staff who will use codes, including employees in Patient Access, Radiology
and Billing, will be done closer to the compliance deadline.
Hospitals and other healthcare organizations that do not implement the
new ICD-10 codes by Oct. 1 will not receive reimbursement for the care they
provide from the government, insurance companies and other private payers.
For more information about ICD-10, including FAQs and helpful links, visit the
ICD-10 site on the YNHHS employee intranet, inside.ynhh.org/initiatives/ICD10.
Employees encouraged to use urgent-care, walk-in centers for non-emergency care
For non-emergency situations, employees are encouraged to use Yale New
Haven Health System’s urgent-care centers and walk-in medical centers, which
are less expensive than the emergency departments for employees with YNHHS
benefits.
For life-threatening situations such as chest pain or sudden and severe pain,
an ED is the only option, but urgent-care and walk-in centers are appropriate
for other, less-critical situations that still require immediate attention – such as
minor injuries, ear infections or flu-like symptoms. YNHHS has urgent-care and
walk-in centers in various convenient locations, and a visit to these centers is
usually shorter than an ED visit.
An employee’s copay for an ED visit is $150; for an urgent-care or walk-in
facility within the YNHHS health plan network, employees pay a $30 copay in
the Advantage Plus Plan and a $40 copay in the Advantage Plan.
strains, coughs, colds, and sore throats, ear infections, non-life threatening allergic reactions, fever or flu-like symptoms, rash or other skin irritations, mild
asthma, animal bites, broken bones and other, non-emergency conditions.
When in doubt about where to go for care, employees can call the ED or
urgent-care center first.
Yale New Haven Health System’s
urgent-care and walk-in centers:
YNHH/Bridgeport Hospital centers - $30/$40 copay plus any additional lab and
radiology services, which would apply toward employees’ annual deductible:
Urgent-Care Center,
309 Stillson Road, Fairfield
(203) 331-1924
Urgent-Care Center,
317 Foxon Road, East Haven
(203) 466-5600
“Employees’ use of the EDs for non-emergency situations not only costs them
more, it costs the health system millions of dollars a year,” said Michael Dimenstein, vice president, Compensation and Benefits, YNHHS. “It also affects our
hospitals’ ability to provide the most efficient care. By using urgent-care and
walk-in centers, employees can help ensure emergency department staff are free
to care for patients with more serious concerns.”
North Haven Walk-In Medical Center,
6 Devine St., North Haven
(203) 287-6900
First-Aid Immediate Care,
900 White Plains Road, Trumbull
(203) 261-6111
Employees should use the nearest emergency department for stroke, heart
attack, severe bleeding, head injury or other major trauma, chest pain, difficulty
breathing, sudden loss of vision or blurred vision and other critical situations.
West Haven Walk-In Medical Center,
500 Elm St., West Haven
(203) 479-3600
Huntington Walk-In Medical Center,
887 Bridgeport Ave., Shelton
(203) 225-6020
An urgent-care center is appropriate for minor burns or injuries, sprains and
Northeast Medical Group Centers - $30/$40 copay only
Safety Coaches • Continued from page 1
February 5, 2015
Editor: Nancy Martin
Next issues: Feb. 19, March 5
a culture of safety and making YNHH a safer environment for everyone.”
Designer: Paola Goren
Copy deadlines: Feb. 6, 20
Having safety coaches embedded within individual units creates opportunities to
review CHAMP behaviors in a smaller, more personal work environment, including
staff meetings and daily huddles, said Macone.
Contributors: Amy Brenner-Fricke
Submit story ideas to Nancy Martin,
688-7015, or to [email protected].
“It makes it easier for a coach to establish long-term relationships with other staff
members, which makes the coach feel comfortable suggesting changes in behavior,”
said pilot coach Candace Conway, RN, Smilow Cancer Care Center, Waterbury.
Photography: Kelly Jensen, Holly Gaydos
The Bulletin is available at www.ynhh.org/bulletin.
The ultimate goal, said pilot coach Herty Lawson, RN, Inpatient Dual Diagnosis
unit (WS 3), Yale-New Haven Psychiatric Hospital, is for all staff members in every
area to become a safety coach as a regular part of their own jobs.
“As CHAMP states, we should be mentoring each other for 200% accountability,”
she said. “As safety coaches, we are in effect training staff to train each other. When
everybody is a coach, we all help each other to prevent mistakes and save lives.”
Each unit or area within a department or service line will ultimately be asked to
designate at least one safety coach. Managers will determine the need for additional
safety coaches.
Upcoming safety coach training sessions are scheduled for March 4-6 at YNHH.
For details, contact Ellen Macone, [email protected].
Press Ganey • Continued from page 1
their rooms, they find a personalized card and welcome packet from their caregivers.
Neonatal Intensive Care nurse practitioners visit patients on a special maternity unit for women with high-risk pregnancies to provide information and answer
questions before they deliver.
“The interaction helps ease a patient’s anxiety before delivery; and when the
mothers come to the NNICU, they see a familiar face,” Brown said. “It’s a great
example of a positive clinician-patient relationship.”
After discharge, each Pediatric and NNICU attending physician sends a handwritten note to every patient’s home, thanking the family for coming to YNHCH
for care.
Phone charging
stations available
As a convenience for patients and visitors, the York Street Campus pediatric
and adult emergency departments are
offering free, secure Brightbox cell
phone charging stations. The chargers
are activated by swiping a credit card
but are free to use. Patients or visitors
swipe a credit or debit card to open
one of the secure boxes on the charging station and plug in their phones.
The box automatically locks, and users
can leave their phones in it to charge
as long as needed. They then use their
credit or debit cards to unlock the
box. The boxes will soon be installed
in the Saint Raphael Campus ED.
What’s impressive about these and other improvements units throughout the
hospital have made is that the focus is not just on survey scores, Cermola said.
“It’s about improving patients’ experiences,” she said. “The scores provide a
road map to help identify priorities; staff can then create plans to address those
priorities, make changes and sustain those changes.”
Congratulations to these units/areas recognized for improving the patient
experience:
• Celentano 3, Geriatric Medicine
• SLA 3, Medicine/Oncology
• Verdi 5 East, Stroke/Telemetry
• SLA 4, EP 4-7 and EP 5-5, Medicine
• EP 7-5, Renal/Medicine
• SP 6-2, Neuroscience Intensive Care Unit
• SP 6-1 and 7-1, Surgical Intensive Care
• WP 10, WP 11 and SLA 5, Mother/Baby Postpartum
• WP 7, Children’s Neurosciences Unit
• YNHCH Bridgeport campus Pediatrics and NNICU
• Yale-New Haven Psychiatric Hospital, WS-2 General Adult Behavioral
Health and WS-3 Dual Diagnosis Behavioral Health
• York Street Campus Adult ED
• Saint Raphael Campus ED
• Pediatric ED
• Behavioral Health, Adult Intensive Outpatient Program
• Mammography, Smilow Cancer Hospital
• Pediatric Ultrasound, Long Wharf Specialty Center
• X-Ray, York Street Campus
• MRI at Smilow, Shoreline and Fitkin Building
• Nuclear Medicine
• Heart and Vascular Center outpatient services
• Gynecologic Oncology
• NP 4 Multidisciplinary
• Photopheresis, Smilow
• Radiation Oncology, Shoreline Medical Center
• Rehabilitation, Smilow
• Smilow Cancer Care Centers in Derby, Guilford and Sharon
Never stop learning
Janie Shaver, 81, a patient on the Medical/Oncology unit, Smilow Cancer Hospital, received a certificate of recognition from Southern Connecticut State University Professor Troy Rondinone Jan. 16 for her work toward a bachelor’s degree
in history. NP 12 staff members were there to congratulate Shaver, who already
holds a half-dozen degrees – many of them master’s – in subjects ranging from
biology to education to art history.