Monthly Archives: January 2011

Children’s earns Patient Family Engagement Award

The Lean team for family-centered rounds receives the Patient and Family Engagement Award. From left back row: Renee Trier, Walid Maalouli, Patricia Santos. From left, front row: Heidi Lyons, and Bruce Fehr. Not pictured:Maran Stoderl RN, Megahn Hollenbeck RN, Micah Benson, Stan Weinberger MD, Dave Tetzlaff MD, Emily Chapman MD, Mary Erickson APRN

Families as Partners Volunteer highlighted: Heidi Lyons

Staff member and department highlighted: Bruce Fehr, MD, Lean Resource Office

Involving families in rounds and transitions in care has had a remarkable impact on safety and satisfaction for patients, families, and care providers. As a result of a recent family-centered rounding Lean project, Families have a better understanding of the plan of care and feel more confident to care for their children after discharge.

An inefficient rounding process was the main reason for the family-centered rounding Lean project. The team was led by Bruce Fehr, MD, MBA, Lean Fellow, and Heidi Lyons, a Families as Partners volunteer since 2003, and included people from a variety of departments at Children’s. The team focused on creating beneficial partnerships between health care providers, patients, and families; engaging patients and families in decision-making; and creating an environment that respects and supports the best interests of the patient.

Heidi is in a unique position to see where changes can be made at Children’s that will have a positive impact on the delivery of care through her involvement in the Families as Partners Program, and other Children’s programs. Heidi’s daughter, Olivia, was hospitalized at Children’s multiple times. Heidi has served as a family representative for numerous Rapid Process Improvement (RPI) events, served as a Family Educator within Medical Education, and has been a member of the Family Advisory Council, the PICU Experience Team, and numerous committees, including the Institutional Review Board.

Dr. Fehr actively recruited Heidi and another member of Families as Partners to be part of the Lean team. Families shared their personal experiences and provided vital information on process improvement, patient safety, and patient and family satisfaction. Family representatives are viewed as equals with the staff team members, and their involvement in Lean workshops is very beneficial.

Team receives Patient and Family Engagement Award
The Patient and Family Engagement Award was presented to the Lean process improvement team in November for their work on the family-centered rounding process.The award, presented by the Minnesota Alliance for Patient Safety, is an example of Children’s unique approach to involving families in the Children’s care model.

Family involvement programs at Children’s
The Families as Partners program promotes, coordinates, and supports family involvement throughout Children’s and includes opportunities for families of Children’s patients (past and present) to be involved in programs that give families the opportunity to be involved in decisions and processes for how care is given at Children’s. Staff has worked collaboratively with patients and families through these programs to provide positive change in the areas of process improvement, program and policy development, and care delivery. Programs include:

* Family-to-Family
* Family Advisory Council (FAC)
* Family Advocates
* Family Advisors
* Youth Advisory Council (YAC)

Read the press release about the Patient Family Engagement Award.

Teaching Children Mind-Body Skills

Kathleen Farah, MD, is board certified in both family and holistic medicine, and joins Marti and Erin Erickson for an important and encouraging discussion of the power of mind-body skills to help children face a wide range of everyday challenges, as well as more serious health problems. From simple breathing exercises to guided imagery and biofeedback, these skills can improve the quality of life for people of any age, whether included as part of formal health care or taught and practiced in the home. Erin and Marti already have discovered the importance of these skills in their own lives, so they add their own stories of how these skills now are helping even the youngest members of their family..

Listen to the podcast (30:16)

More Children’s of Minnesota integrative medicine resources

Why Are Children’s Hospitals Necessary?

Now I admit an inherent bias in my thinking, but the question arises constantly: Why do you need a free and independent children’s hospital versus a children’s hospital within a larger system?  Is it because of my job at Children’s when I think in these terms or is there some data behind thinking this is better for children?

A recent white paper by the Chartiss Group that was presented to CEOs of children’s hospitals discussed the evolving nature of these hospitals in light of what is happening in our economy. They remind us that birth rates have declined dramatically over the past few years, which of course will have a great impact for us over the next four to five years.  Hospitals that take care of children are seeing an increasing prevalence of chronic diseases and an increasing prevalence of children with technology dependencies.  Both of those groups have an increasing demand for pediatric services.  At the same time, we are seeing thankfully a greater and significantly improved survival rate. Along with this there is a major increase in the growth of obese populations and socioeconomic shifts in Medicaid.  There are more and more children having their care done in the outpatient world and there has been a reduction in neonatal discharges.

What the Chartiss Group found was that the adult hospitals and adult systems do not have the ability to compensate for volumes and other service lines, thus the country is seeing an increased consolidation of pediatric care, more and more within free-standing children’s hospitals.

Also, a few years ago we felt there might be a 3 percent annual growth in pediatric patient days; in reality it is now closer to just 1 percent.  Between 2003 and 2009, the number of patients with at least two or more complex, chronic conditions admitted to hospitals went from 5.6 to 7.7 percent and those children with technology dependencies went from 10.9 to 13 percent.  What we also know is that when the Medicaid population goes up, their utilization of hospitals also goes up.

What was most important — and for all of you out there who sometimes wonder if you should be taking care of children in community hospitals or hospitals within hospitals — to remember is that there is also superior, quality performance at children’s hospitals.  Outcomes at free-standing children’s hospitals are better. Their actual mortalities percentage of expected mortality is lower whether it is in complex children or technology dependent children.

In this healthcare economy, we also have to look upon price.  Children’s hospitals need to differentiate themselves based upon low-cost services, access and quality; they need to promote innovative care models to better leverage subspecialties; align with community; and access additional market opportunities to preserve regional positions.  They also need to invest in an achievable set of destination programs, begin partnership discussions with dominant adult systems, manage financial performance, prepare for Medicaid fee reductions and improve performance. We must also rapidly develop contingency to manage population and work with health plans in the state to shape payment reform.

It’s scary, but also leaves us with great opportunities.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.