State of the System• Welcome

• High Reliability Organizations

• CaroMont Health Service Lines

• Healthy Eating with a Busy Work Schedule

• Closing

High Reliability OrganizationsPrimum Non NocereZero Patient Harm

Todd Davis, MD, EVP/CMO

Current State of Medical Care• Highly trained, intelligent professionals• Compassionate and want what is best for

their patients

How Are We Doing (IOM*)?• Medical errors are 8th leading cause of

death– >110,000 preventable deaths = 747 crash/day– >1,000,00 preventable injuries– >$30,000,000,000 cost

* Institute of Medicine- To Err is Human: Building a Safer Health System, 1999

How Are We Doing?• 55% of patients with chronic illness

receive current evidence based care

Why Do Errors Occur?

• 90% System Errors• 10% Human Errors

Why Do System Errors Occur?• Health Care is the most complex business

in world, operating 24/7/365• Communication is fraught with opportunity

for error• IT systems are not optimally developed to

support providers

• Variability • Resistance to Standardization &

Culture of individualism• Systems have not been built to

support the provider

Why Do System Errors Occur?

1.Perception: we see and hear what we expect

2.Assumption: we believe things are a certain way

3.Communication: we say what we mean, but others hear what they perceive

Humans Are Fallible

Why Do Human Errors Occur?

How Errors Occur

To err is human……but to persevere in error is only the

act of a foolCicero

The Solution

A Highly Reliable Organization consistently achieves the correct outcome by creating systems that reduce variability and errors, so

supporting humans.

High Reliability Organizations

Nuclear Industry Airline Industry

Proactive Culture

“A collective mindfulness in which all workers look for, and report, small

problems or unsafe conditions before they pose a substantial risk to the

organization and when they are easy to fix.”

The Culture1. HROs are preoccupied with failure.2. Recognition by members that threats to safety

are complex.3. Recognition and obligation to report any deviation

from approved operations.4. Resilience - errors occur, recognize and contain

them.5. Deference to expertise

Preoccupation with Failure• Paradigm Shift from Helping to Not Harming• Reporting Adverse Events• Standardizing Clinical Processes

High Reliability is a Transformation• Leadership commits to goal of Zero Patient

Harm• Transformation to a Culture of Safety• Process Improvement tools and methods

are widely adopted

Alignment• Board of Directors• Senior Leadership• Managers and Directors• Nursing• Physicians

Trust

Just CultureAlgorithm to manage human deviation

TeamSTEPPSEliminate Disruptive Behavior

Safety is Complex• Vital Clinical Processes• Reduce Human Variability• Multidisciplinary Approach to Care

Recognize and Report Deviation• Celebrate Reporting of Adverse Events• “Near Misses”• Transparency

Deference to Experts• Leadership sets vision• Staff empowered to accomplish goals

Resilience

Culture of Learning

High Reliability Organizations

“Clinically Led,Professionally Managed”

Doug Luckett, CEO

CaroMont Health Service Lines

Kathleen Besson, RN, EVP/COO

CaroMont Health Service Lines

“Service Line” is our management structure that aligns providers and

departments around a shared patient cohort to improve delivery of healthcare.

Service Lines evaluate their performance through the lens of the patient experience.

CaroMont Health Service Lines

Service Line structure is designed to: 1. Improve the Patient Experience2. Improve Patient Outcomes3. Increase the “Value” of healthcare

CaroMont Health Service Lines

Service Lines are the vehicles that improve our delivery of healthcare.

The teams plan, execute, evaluate and improve the care we deliver following the goals, objectives and

initiatives as defined by our board and leadership in the CaroMont Health strategic plan.

CaroMont Health Service Lines

• Physician Office

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Surgery Service Line

CaroMont Health Service Lines• Example: After 20 years of 5Ks, your knee

has finally called it quits. Time to trade it in on a newer model. – The Surgery Service Line stands ready to help.

The following providers and staff working in the different phases of surgical care work together to optimally manage your experience and outcome:• Emergency Department, Radiology, Surgeon Office,

Anesthesiologist, Registration and Scheduling, Pre-surgery Testing, Food and Nutrition, Environmental Services, Supply Processing, Operating Room, Recovery Room, Post Op Unit, Pharmacy, Physical Therapy, Outpatient Rehabilitation, Primary Care Office

CaroMont Health Service Lines• Surgery

– Improve the patient preoperative experience• Access, ease of use, efficiency

– Quantify the value of capital investment in new technology and services• Ortho Operating Table selection, new Ortho Power and Video

equipment

– Recruit surgeons to meet the needs of the community, referring primary care physicians and service line• Acute, Trauma

– Improve access to OP Rehabilitation• New Belmont location

– Improve quality• Eliminate surgical site infections

Service Line Leadership1. Executive Service Line Leadership - Todd Davis, MD,

EVP/CMO and Kathleen Besson RN, EVP/COO 2. Surgery - Harry Caulfield, MD and Allen Marsh3. Primary Care - David Rinehart, MD, John Scheitler, MD

and Lauren Wright4. Women’s - Ramada Smith, MD and Rick Varterasian5. Oncology- Steve Yates, MD and Rick Varterasian6. Musculoskeletal and Neuroscience - Ian Archibald, MD

and Allen Marsh7. Cardiac - Mark Thompson, MD, Jim Greelish, MD and

David Selby8. Acute Care - Costa Andreou, MD and Craig Greer

Oncology• Increase patient enrollment in oncology

clinical trials• Encourage development of an oncology

philanthropy program• Develop a palliative care program• Implement an oncology financial counselor

program• Quantify the value of capital investment in

new technology and services– Breast Tomosynthesis

Women’s• Develop high-risk OB navigation program• Develop a Women’s philanthropy program• Expand lactation services to include

OB/GYN outpatient offices• Extend OB/GYN footprint to increase

access to CaroMont Regional Medical Center physician services

• Quantify the value of capital investment in new technology and services– Ultrasound upgrade to 4D technology

Musculoskeletal & Neuroscience• Develop joint replacement, weight loss,

concussion prevention and back health programs

• Decrease the cost of spine procedures• Integration of neuroscience services

(neurology, neurosurgery, pain management, rehabilitation)

• Recruit two Neurosurgeons

Acute Care• Reduce admissions of pneumonia and

COPD patients• Imbed psychiatric services in primary care

offices• Establish continuing education offerings

for support staff• Improve access with a highly efficient

direct admit process• Expand pulmonology services• Decrease Emergency Department length

of stay• Develop Pediatric Emergency Department

Cardiology• Develop aortic rupture clinical practice

guidelines• Implement CaroMont Heart Access

Program to improve patient referral efficiency and effectiveness

• Improve staff satisfaction• Quantify the value of capital investment in

new technology and services– Hybrid Operating Room

• Investigate feasibility of offering transcatheter aortic valve replacement (TAVR) services

Primary Care• Support community education regarding

health insurance options• Pilot telehealth program• Develop retail clinic alignment strategy• Develop occupational medicine program• Conduct primary care needs assessment

CaroMont Health Service Lines• Next Steps in CaroMont Health Service Line

leadership structure evolution – Expand the service line dyad (Physician and

Administration Leadership) to a triad (Physician, Administration and Nursing Leadership)

– Demonstrate decreased cost, increased quality, improved patient experience and improved access across the CaroMont Health system

• Questions?

Healthy Eating with a Busy Work Schedule

Pam Cornelius, RD, LDN

Let’s get the whole picture

• Times of day when you are hungry?• Do you know what hungry feels like?• Left side of paper, write down the times

of day you are hungry.• Right side of paper, write down the times

you generally eat.• Do they match?

Help is on the way…

• Do you eat 3 meals per day?• Do you go for long periods of time without

food?• If you find that you are hungry during the

day and its not when you eat, do you need to add planned snacks?

• Can you change what you eat to make your meals or snacks more satiating? • See “my plate”

• If you eat and you are not hungry, could you find something else to do instead of eating?

Healthy Snacks

• What are your healthy snacks ? Apples Oranges Cheese sticks Yogurt Nuts Trail mix Celery & Peanut butter

• Other Ideas?

SUPER Snacking List

Keep in mind these tips when planning:

• “S” Simple to find• “U” Under 200 calories• “P” Protein is included, 6-8 grams• “E” Energizing nutrients• “R” Ready to pack and go

Ideas for Quick Healthy Meals

• When eating out check restaurant website for best options or try www.healthydiningfinder.com to find a restaurant in your area.

• Buy a rotisserie chicken, bagged salad, cut fruit or vegetables and crusty bread on the way home from work.

• Stop at grocery store and select dinner or sides from salad bar.

• Do batch cooking and freeze in single serve or family serve portions.

• Purchase frozen meals with less than 600mg sodium and add a fruit and veggie to the meal.

Ideas for Quick Healthy Meals

• Sautee olive oil, garlic, cooked pasta, frozen or fresh vegetables, and canned beans or cooked chicken for a stove top “kitchen sink.”

• Crockpot meals• Fast food or chain restaurant:• Look up several restaurants ahead of time and

have an idea of foods that meet your nutrition requirements (calories, sodium, fat)

• Other ideas?

Bottom Line

Know when you are hungry and have a PLAN with easily accessible (healthy) food to keep

you feeling well fueled throughout the day.