With acuity levels higher and lengths of stay longer than those in adult acute care hospitals, there are several differences that require special attention.

Take, for example, environmental service needs. Cleaning and sanitizing patient rooms require more time and greater frequency. This is because children tend to have higher visitor traffic and parents who are bedside for extended periods. The rooms are often larger as well, to accommodate greater numbers of diverse medical equipment.

On the food service side, a number of factors change the way an effective patient food operation is run. Convenience is important for parents and visitors who use meal times to bond with their loved ones. Menus also must take into consideration the differences in preference for different age groups. A five-year old will like something different than a 15- year old, and the parent prefers options that are different than both.

And with Chefs like ARAMARK Healthcare’s own Barry Giordano on the floor creating mealtime experiences for the kids, we know that support services staff make a difference.

And we know that the little things matter. Kids want to have variety and be empowered to make their own decisions around food. They also need to encounter friendly welcoming faces in all those who come into their rooms.

What other special touches are you aware of to create great environments for sick kids?

In these difficult economic times, it’s more important than ever for companies to evaluate potential channels of revenue.  For example, from a hospital perspective, on-site retail operations is one area that, when done right, can provide an important revenue stream.  However, health care facilities have to satisfy two goals: provide items most requested by customers in an effort to increase satisfaction and sales, and provide items that support the organization’s healthcare goals.  The problem is that when stressed, or rushed, patients and visitors tend to gravitate to the unhealthiest of snack options. It’s a difficult position to be in because while it’s crucial to stay financially solvent, it’s just as important to make healthy choices and options readily available to those who need it most. 

While it’s not the answer to every problem, with some research and planning behavioral economics can empower health care organizations to ensure that healthy choices are the easiest, but still financially viable, ones to make.

Recently, an Emergency Department nurse, Jasmin Aguilar, was named one of Bon Secours’ Shining Stars for authoring the enclosed essay.  The Emergency Department at this inner city hospital sees its share of tragedies.  What impressed me was the sense of purpose and optimism in the enclosed essay that Jasmin wrote. 

Jasmin is photographed with Marian Chima, MSN, RN, CDE/ Director, Clinical Practice and Education

Florence Nightingale initiated the beginning of nursing research by stressing the importance of cleanliness, white for purity and clean mind, the importance of fresh air and water. Her research provided knowledge to us and is still evident today, an example is simple hand washing, the key to preventing infection. Nursing today has expanded its path. There are many specializations and more advanced practices and clinical research. The future path of professional nursing is bright and will continue to be brighter.

Jasmin Aguilar, BSN, RN
Emergency Department
Bon Secours Baltimore Health System.

In terms of clinical quality, compliance to Hand Hygiene improved more than 74% from March 2009 to March 2010. A change in culture led to a safer hospital for patients, staff and visitors. How? Frequent access to hand sanitation stations. I saw Purell  stations outside rooms, inside rooms, in the halls, and (in the photo enclosed) at the entrance to each unit. OK, the stations in the photo at the entrance to each unit are not the prettiest…but they make the point. When I saw them,  I was reminded of the story of Lee Iacocca, former iconic CEO of Chrysler,  and how he brought back convertibles to Chrysler after their financial troubles in the 1970s.  As Chrysler was emerging from the recession, he felt a convertible would be a good idea. He asked his head of engineering how long it would take to make a convertible— and the exec came back after careful study, with his design and engineering team, described for Iacocca how they could build it in about three years. Iacocca told his engineer he didn’t understand — Iacocca wanted him to pull a car off the line, take a saw and cut off the roof. “That should take about four hours,” said Iacocca. The K-car convertible was released in 1982 to resounding success.

I’m wondering what would happen if more hospitals took the no-nonsense approach that Ottawa Hospital did. If you want staff and visitors to clean their hands, is it a simple as having Purell dispensers everywhere – with big Red Stop signs that say “Wash Your Hands”?  And measurement tools posted so staff can see results. Seems like it is working at Ottawa Hospital!

Simple but effective hand sanitizing stations were placed throughout Ottawa Hospital to encourage employee participation.

George Porignon, Health Policy Expert at the World Health Organization, presented a healthcare model that focused around primary care practitioners, and not around the acute care hospital. What was fascinating was the discussion that followed by Indonesia’s Muki Reksoprodjo, who stated that although his country was as large as the U.S., it consists of two-thirds water, making logistical access to primary care resources difficult. Pan American Health Organization’s Ciro Ugarte talked about the difficulty in treating patients with limited primary care resources, who then come to the acute care facility for access. 

AHA’s President Rich Umbdenstock discussed U.S .approaches and the difficulty of turning the massive system around to primary care, but provided examples of how primary-care centric organizations work in the U.S. Richard deFilipppi, a trustee at Cambridge (MA) Health Alliance and the Board Chair of the AHA discussed the Massachusetts system. Erick DeRoodenbeke, the Executive Director of the International Hospital Federation, nicely summed up the discussion….that more and more, the movement to Primary Care-centric practice is being led by state, regional, and local organizations, as legislating policy from a national body is hard to implement due to local variation. Lastly, a side conversation with the German Hospital Federation Chief Executive Georg Baum focused on how Germany controlled costs, especially drug costs, by having pharmaceutical organizations come in front of a panel and justify prices based on efficacy and value.

The perspective gleaned from discussions with international healthcare leaders served to broaden my view of things….removing some of my American myopia. Almost all nations are struggling with issues; most are not as fortunate as the United States to have our deep resources. More than once, representatives commented to me that it is hard to believe that the richest, most powerful country has so many uninsured. I tried to explain why, and the history that led up to where we are now, and that the answer was not easy. I was not sure if it was the language barrier or the shortcomings of our system that left my explanation somewhat lacking.

The Romanian Hospital Association’s First Vice President, Dr. Mircea Oltenu, stated to me that along with the recession, healthcare costs are crippling his country. Healthcare’s significant consumption of resources on each nation’s productivity, no matter what system is in place, is a common characteristic. As I left the meeting, my thoughts drifted to a hope that a cure for cancer, Alzheimer’s, and diabetes may be the only solution to solving the world’s healthcare issues. The eradication of these diseases could result in the same “dividend” that the eradication of polio in the 1950s and 1960s had for society, with its concurrent impact on lowering the need for iron lungs, long term care, human caregivers, and family’s resources. From a world-wide perspective, only miracles of cures for major diseases seem like the best hope.

This is a battle that we in healthcare fight each and every day.  If our goal is to have patients – and their visitors – leave a hospital healthier than when they arrived, then it’s crucial to consider the role their meals play in overall health.

Several industry efforts are underway to encourage hospitals and other healthcare facilities to not only make healthy food available, but also provide the information – and incentives – necessary to help patients make the right choices. Click here to read a Nutrition Today article on this very issue.

We’re also now beginning to see that it’s just as important to consider how that food is made available.  Is it accompanied with clear information about what makes one item healthier than another?  Are there indications of which food items are low in sodium, fat and/or sugar?

As I’ve mentioned before, a group of ARAMARK Healthcare Fellows are working with researchers Kevin Volpp, MD, Ph.D. with the Wharton School at the University of Penn School of Medicine, and George Lowenstein Ph.D. of Carnegie Melon University on using the theories of behavioral economics to alter food choice patterns. The premise is to make it easier for people to choose healthier food, and to “convert” food nutrition jargon into language that people understand. For example, one research project implemented at six hospitals across the US focused on using calorie information alone, exercise equivalents, and calories & exercise equivalents as part of an education process to determine if employees who use a cafeteria are likely to switch their food choices to healthier choices.

It’s an issue that is being tackled from several different angles and I’d love to hear about any other related studies out there right now.

We focused on how Vancouver Coastal Health (VCH) improved patient safety and throughput in a time of increased governmental control and decreased reimbursement.

We provided a perspective of not focusing on the differences between the Canadian and U.S. systems, but how a Canadian organization adapted and succeeded under changing legislative imperatives. 

David presented how VCH improved patient throughput. With occupancy rates over 100%, VCH requires quick bed turnaround times. Through a process of using call centers, patient service cards, and enhanced bed management processes in housekeeping, VCH was able to bring turnaround times down to 48 minutes, despite increased volumes and complexity of care.

David then went on to describe VCH’s focus on patient safety measures. Using a standardized visual provincial cleaning audit tool, and observational audits enhanced with technologies such as glo-germ, thoroughness of the physical cleaning practice was ensured. Staff training, standardized cleaning practices, resulted in improved predictability of results. 98% of all sites passed a quality audit score, up from 29% in 2004.

Click here to see a copy of the presentation.

I thought of this “new normal” as Peter Kaprielyan, Vice President of Organizational Improvement and Philanthropy, took me on a tour of Underwood-Memorial Hospital (NJ). I saw cross-functional employee teams sticking post-it notes on fishbone diagrams, discussing processes, and coming up with new more efficient ways of improving care.  There was a high level of energy, as employees were not focused solely on cutting costs, but on improving processes using a combination of Lean, Six Sigma, and “Theory of Constraints” to create efficiencies, eliminate waste, and remove limiting factors.

Peter then walked me through the renovated Emergency Department. I saw how Underwood increased the ED footprint, access points, and available rooms. The goal was to expand resources to allow more patients to come in through the ED…to improve patient throughput, and to create satisfied patients in a very competitive market. Peter shared with me satisfaction scores that increased significantly in the facility. 

Gulati reviewed companies responses to prior recessions based on the moves that they made. In terms of promotion-focused moves, companies could engage in “market development” and/or “asset investment”. In terms of prevention focused moves, they could reduce their employee head count, and/or engage in operational efficiency.

Underwood’s response would be categorized as one of hybrid approaches that Gulati saw as most efficient. In Gulati’s analysis, the companies that performed the best focused on operational efficiency (as a prevention-focused strategy), and market development and asset investment as promotion focused moves. Following a recession, Gulati saw companies that approached their market this way as having a 13% CAGR for sales and 12.2% for EBITDA over a three year period following the recession.  For comparison, companies that focused more on employee reduction (and not operational efficiency), with both market development and asset investment saw sales increase only 3.3% and EBITDA drop 5.2% over the same three year post-recession period.

Gulati simply explains that companies that respond to a slow down by reexamining aspects of their business model are poised to have their profits grow faster than those of competitors when demand returns. From my view, Underwood looks poised to be prepared for the “new normal.”

Following his career, Clarke became a General Manager and changed his first name to just Bob.  He held a variety of executive positions with the Flyers and, for a brief period, other NHL clubs.  Just this past week, Clarke was honored for his management success.  

One team Clarke managed was the (now defunct) Minnesota North Stars – which made a Cinderella run to the Stanley Cup in Clarke’s first year as a GM with the team.

Bob Ganey, North Stars coach, recalled Clarke’s management approach: “He’d pull out a pad of paper and he’d say, ‘What are our needs? Where are we weak?’ And then once that was established, it was, ‘How do we answer those needs? How do we attempt to solve those things?’ That’s a method of work that I still use, not only in my work capacity as a manager, but in other places. What’s the problem? Where are we weak? What do we need and how do we solve that problem?”

A simple approach…but an approach worth featuring as an example of excellence in operations.   To read more about Clarke’s management approach, go to the Flyers web site at:

http://flyers.nhl.com/club/news.htm?id=520693&navid=DL