Quality Care

Diabetes Language Matters

Posted on Nov 13, 2020 in Quality Care, Scroll Images, Uncategorized

Diabetes care teams across Sutter Health are talking differently these days. That’s because the effect language has on patient care and patient outcomes can be profound. Endocrinologist Melissa Weinberg, M.D., affiliated with Sutter Pacific Medical Foundation and lead physician of Sutter’s Diabetes Clinical Improvement Community (DCIC), explains that as our U.S. healthcare system moves toward a more patient-centered approach, it’s necessary for providers to reexamine their words.

“When we started looking at diabetes care through a linguistic lens, we found unintended judgmental language across chart notes, patient education handouts, and even in our conversations. Beginning this November, to recognize American Diabetes Month, our teams are working on using person-first language whenever possible,” Weinberg says.

Talking the Talk

Person-first language puts a person before their diagnosis, describing what a person “has” rather than asserting what a person “is.”

“Despite even the best intentions, words can result in patients feeling like they are their diagnosis,” says Michelle Bradley, an exercise physiologist with Palo Alto Medical Foundation, who also serves on Sutter’s DCIC and is working to promote World Diabetes Day on November 14.

Referring to a patient as ‘diabetic’ can reinforce that as their identity, i.e. “I am diabetic.” Rather, Bradley says, it would be better to say “a person with diabetes” which puts the patient first and shows compassionate and encouraging language that may help enhance their outcomes and experience.

Stigma around certain language can impact care. According to two different studies (here and here), possibly because of perceived judgment from healthcare professionals, people with diabetes sometimes altered or underreported blood glucose levels or omitted information during provider visits.

Neutral Language Helps Remove Stigma

While a language movement in healthcare isn’t a new concept, there is greater emphasis to use language that empowers and supports. Here are four examples of phrases that Sutter diabetes care teams are working to incorporate in patient communications:

  • Monitoring blood sugar/glucose” instead of “Testing blood sugar/glucose”
  • A person who…” (takes medication 3/7 days, unable to access supplies, continues to eat ice cream before bed) instead of “Non-compliant, non-adherent, unwilling”
  • Managing, Working towards…” instead of “controlled, uncontrolled, sub-optimal”
  • Use “Guidelines or Recommendations are…” instead of “You should, have to, need to, must”

“The way we speak affects the way we think and ultimately how patients feel,” says Weinberg.

More Than Their Diagnosis

Sutter Health is committed to improving healthcare outcomes for all, which includes communication with and about patients.

“When we change our language, we change the perception. Simple wording changes can go a long way in helping to build and strengthen patient relationships,” says Bradley.

Six Sutter Medical Network Organizations Achieve IHA Honors

Posted on Nov 6, 2020 in Quality Care, Scroll Images

SACRAMENTO, Calif. —Integrated Healthcare Association (IHA) has recognized six Sutter Medical Network (SMN) organizations for achieving top marks on quality and/or patient experience measures while effectively managing cost of care for Commercial HMO patients in 2019.

Excellence in Healthcare Award

The Excellence in Healthcare Award represents the highest level of achievement awarded by the IHA. To earn this award, physician organizations must perform in the top 50th percentile across three domains: clinical quality, patient experience and total cost of care for their commercial HMO population.

Sutter Medical Group, part of Sutter Medical Foundation, was one of just 20 physician organizations statewide to receive a 2020 Excellence in Healthcare Award from IHA. Of the nearly 200 physician organizations statewide participating in the Align. Measure. Perform. program, one in ten received an Excellence in Healthcare Award this year.

Exemplary Performance

IHA also recognizes physician organizations that demonstrated exemplary domain-specific performance. Sutter-affiliated Mills-Peninsula Medical Group and Palo Alto Foundation Medical Group, both affiliated with the Palo Alto Medical Foundation, achieved high performance (top 10th percentile) in the clinical quality and patient experience domains. Three more Sutter-affiliated physician organizations, Sutter Medical Group, Gould Medical Group, and Sutter East Bay Medical Group achieved high performance (top 10th percentile) in the patient experience domain only.

Most Improved

IHA also recognizes eight physician organizations—one from each region— that demonstrate the greatest year-to-year improvement in clinical quality and patient experience domains. Sutter Independent Physicians* earned the Ronald P. Bangasser Most Improved honor for making the greatest improvements in quality and patient experience from 2018-2019 among all physician organizations in the Sacramento and Northern California Region.

Sutter Medical Network is part of Sutter Health’s not-for-profit network of care, which proactively implements programs across its system that continuously improve the quality and value of healthcare for patients. Integration across Sutter’s regions, clinical settings and data environments is delivering care models with some of the best clinical outcomes in the nation.

* Sutter Independent Physicians contracts with Sutter Valley Medical Foundation to provide care to its HMO and SutterSelect patients. 

Sutter Announces Nurse of the Year Award Winners

Posted on Nov 2, 2020 in Quality Care, Scroll Images

Pandemic underscores value of nursing and midwifery excellence

SACRAMENTO, Calif.—Sutter Health has announced its first-ever Nurse of the Year Award winners at a virtual Nursing Symposium attended by hundreds of nurses and midwives from across Northern California.

In addition to recognizing excellence in nursing and midwifery, celebrating the not-for-profit health system’s first Nurse of the Year award winners during the pandemic also serves to highlight the critical role of nurses and midwives who demonstrate nursing excellence, courage and compassion for patients and families and keep them safe during this challenging time, says Sutter Health’s Chief Nurse Officer Anna Kiger, DNP, DSc, RN.

The World Health Organization and the American Nurses Association designated the year 2020 as the Year of the Nurse and Midwife.

At the virtual event, Kiger announced three nurses and one nurse midwife out of nearly 300 nominees as the first winners of the awards. Each award winner was chosen for excelling in one of the four pillars of Sutter’s Nursing Philosophy of Care.

Sutter Nursing Philosophy of Care Pillars

  • Unlimited Potential: Our nurses are curious, life-long learners, teachers, mentors and leaders.
  • Unique Contribution: Our nurses honor the holistic needs of those in their care and find creative, evidence-based ways to promote health and healing.
  • Force of Good: Our nurses take pride in advocating for what is right for our patients, families and the communities we serve.
  • Humble Presence: Our nurses are a steady force for patients and their families during life’s most vulnerable moments.

“Each of these winners of Sutter’s first Nurse of the Year Award bring their best every day, living our organization’s values and the Sutter Nursing Philosophy pillars while making a profound difference for the patients and families they serve,” Dr. Kiger says. “They also stand out because their co-workers see them as leaders in our noble profession. We are truly blessed to have them as a part of our organization.”

John Fassett, CNM, Sutter Pacific Medical Foundation, Unlimited Potential

Out of more than 20,000 certified midwives across the nation, only about 1% are male. John Fassett, a certified nurse midwife (CNM) at Sutter Pacific Medical Foundation demonstrated his pioneering spirit by becoming one of the first male midwives in San Francisco 26 years ago and has been a registered nurse for 40 years.

John Fassett, CNM

Patients and staff alike talk about how his ability to listen and his sense of humor keep them relaxed, even during the tense times that accompany pregnancy, labor and delivery. Fassett, a military veteran, has demonstrated his Unlimited Potential by showing leadership during his 8-year tenure with Sutter by chairing the Advanced Practice Committee and serving as a nurse reviewer for Nurse Midwife practice with the California’s Board of Registered Nursing.

Cara Phillips, RN, Pre-Admission Testing, Memorial Medical Center, Unique Contribution

Cara Phillips, RN

Cara Phillips, RN, started her nursing career at Sutter’s Memorial Medical Center in Modesto in 1979 as a nurse on the surgical unit. She transferred to the Preadmission Testing (PAT) Department 10 years later and became the PAT charge nurse/coordinator in 2008. She partnered with Dr. Tamim Wafa, chief of Anesthesia, to bring the evidence-based Perioperative Surgical Home (PSH) model to Memorial Medical Center in 2017.

The PSH is a patient-centered, team-based system of coordinated care that guides patients through the entire surgical experience. One year after Phillips helped implement PSH at Memorial, the hospital realized all eight quality goals set by the American Society of Anesthesiology. Through Cara’s Unique Contribution, more than 1,000 orthopedic, bariatric, vascular, and high-acuity patients have benefited from the enhanced care of PSH.

Deborah Swartz, RN, Education, Palo Alto Medical Foundation, Community Health Resource Center, Force of Good

Deborah Swartz, RN

Deborah Swartz, RN, has been a calming Force of Good for patients and staff since 2006 as the nurse educator at Sutter’s Palo Alto Medical Foundation Community Health Resource Center (CHRC). She works with clinicians to develop educational lectures and videos intended to help patients make choices toward healthier lifestyles. Most recent, she developed a free online asthma management course that’s expected to be a Sutter systemwide class soon.

Since becoming a registered nurse in 1977, Swartz has served in emergency rooms, at the bedside, in clinical departments, and at the VA, but has spent most of her career at Sutter. The CHRC provides compassionate guidance to patients and families—educating them about various diseases, caregiving responsibilities and how to make informed treatment decisions.

Andrea Trimble, RN, Med/Surg, Alta Bates Summit Medical Center, Humble Presence

Andrea Trimble, RN

Andrea Trimble, RN, a charge nurse, demonstrates Humble Presence as a steady force in Sutter’s Alta Bates Summit Medical Center’s medical/surgical unit in Berkeley. She reviews charts and researches patients to anticipate their needs and needs of their families. In nominating her, her colleagues said they appreciate her respectful way of leading and working with nurses. Nurses maintain their close bond with patients while Trimble supports them and guides them in the background.

Co-workers describe Trimble as calm, poised and interactive as she finds the balance of supporting both staff and patients with the daily goal of providing the best possible care.

Sutter’s Nursing Philosophy of Care

Sutter’s Nursing Philosophy of Care and the four pillars are the product of many interviews with Sutter Health nurses, who shared their stories, beliefs and experiences. The philosophy provides a framework to inspire nurses, remind them why they entered the profession and highlight their unique role in their patients’ healing process. It is designed to support nurses from their first entry into nursing through retirement.

Award Winners with a Common Purpose

In different ways, Sutter’s first Nurse of the Year Award winners serve patients and families as they help them navigate through the complexity of healthcare today. This year’s winners also partner closely with doctors and other healthcare professionals as they seek to provide patients with a quality, personalized experience, no matter where they enter Sutter’s integrated healthcare system.

Safety First

Posted on Oct 27, 2020 in Quality Care, Scroll Images

The Hippocratic Oath has a special significance in the field of medicine. While its meaning has evolved over centuries with modernized text, its core truth remains: safety.

Hospitals across Sutter Health’s integrated network recognize safer care is fundamental to high-quality care. This approach has helped Sutter’s performance exceed state and national averages in the six main quality measures.

  • Key Quality Measures
    • Sepsis
    • Central line-associated blood stream infections (CLABSI)
    • Catheter-associated urinary tract infections (CAUTI)
    • Surgical site infections from colon surgery (SSI)
    • C-section rates for first-time mothers with uncomplicated deliveries (NTSV)
    • Clostridium difficile intestinal infections (C-Diff)

Why do these measures matter? They are the most common to prolonging hospital stays, complicating care patient care plans and most importantly, influencing patients’ experiences. They also increase costs that can impact overall affordability in healthcare.

The Information Exchange

William Isenberg, M.D.

“Teams across our organization share a common goal of high quality care, so it becomes a question of, ‘How do we partner to meet that goal?’” said William Isenberg, M.D., chief quality and safety officer for Sutter Health.

The collective sharing of best practices—in support of high-quality, safer care—is made easier through integrated networks like Sutter Health. Standard approaches and protocols can spread across integrated systems through numerous channels.

And that collaboration goes both ways. Sutter has hospital-based committees and subcommittees working on lowering rates all the time. These groups then team up with other hospital departments as “communities of interest” to tackle quality measures that may be more prevalent in their respective areas. These intersections of information amplify quality efforts, which are bolstered too, through Sutter’s single electronic health record platform.

Communication is Key

Dr. Isenberg reminds us there is one major element to quality improvement that can’t be overlooked. Beyond understanding metric baselines and best practices, healthcare teams must clearly communicate with each other.

This can make a considerable difference when clinicians understand the implications their decisions have for patients, as well as other clinicians caring for them. Dr. Isenberg gives the hypothetical example of catheter use and keeping care teams accountable throughout the process.

“For me to be reminded by others on the care team to be sure to place an order for prompt catheter removal to prevent post-operative bladder infections, not only reminds me, but also demonstrates that all of us on the team have shared goals for our patient,” he said. “And those cues and conversations continue along the way.

“Our Informatics team created a reminder for doctors in our electronic health record. Once doctors place the order to have a catheter removed, our nursing teams will need to step in to remove it in a timely fashion. Our nursing leaders then monitor the time interval to make sure it’s completed within that appropriate window.”

That continuous real-time communication and collaboration among care teams minimizes waste, decreases errors, increases efficiency and ultimately improves quality of care.

Patients as Partners

Patient participation plays an important role in quality improvement, too. Dr. Isenberg says having conversations early and often with patients about care goals and expectations establishes a place of understanding and sets the stage for ongoing dialogue. For example, doctors can emphasize that vaginal deliveries are normal and most often the safest option for babies and moms. Clinicians can educate patients they may have catheters during their surgeries and the goal is to remove them as soon as possible post-operation to help avoid infection.

Dr. Isenberg acknowledged sometimes circumstances will lead to changes in care—but the communication clinicians had all along will help patients know their safety always comes first.

Continuous Improvement

Dr. Isenberg recognizes while Sutter appreciates the progress that has been made in key quality areas, the organization continuously strives to do better.

He points out the network is expanding beyond to look into social determinants of health and health equity. Teams are examining what other impacts are hitting different racial and ethnic groups, those who are uninsured or underinsured, or who have chronic health conditions like obesity, high blood pressure or diabetes. Sutter is also looking into how COVID-19 has further exacerbated those issues.

“We need to constantly look at these issues through different lenses,” Dr. Isenberg said. “What other creative ways can we do our work? How can we expand upon our learnings? This is how we will continue to serve the diverse needs of our communities and improve overall health.”

CPMC’s HELP Program for Older Adults Receives Top Designation from AGS

Posted on Oct 22, 2020 in Quality Care, Scroll Images

CPMC becomes fifth U.S. medical center to achieve elite ‘Center of Excellence’ status

California Pacific Medical Center (CPMC) in San Francisco is now one of only five organizations in the United States to achieve the American Geriatric Society (AGC) CoCare: HELP™ Center of Excellence designation for its Hospital Elder Life Program (HELP). CPMC was recently awarded this elite status after demonstrating the highest level of best practices in geriatric care.

“I am so proud of our dedicated team at CPMC for all their hard work in building a world-class geriatric care program,” says hospitalist and geriatrician Wendy Zachary, M.D., who directs CPMC’s Acute Care for Elderly (ACE) unit and is the HELP physician-champion. “This accreditation from the American Geriatric Society validates and strengthens our mission to provide patient-centered, advanced care for older members of our community who are particularly medically vulnerable–especially during the COVID-19 pandemic.”

Watch this video about CPMC’s ACE unit.

Targeted Interventions Lead to Better Outcomes for People Ages 70+

The AGC CoCare: HELP™ program is designed to prevent both delirium and functional decline in patients 70 years and older. CPMC’s HELP program uses an interdisciplinary team (Advanced Practice Nurses, specially-trained Elder Life Specialists, and trained volunteers) to integrate principles of geriatric care into standard nursing and medical care at all three CPMC hospital campuses in San Francisco, including the ACE unit at the Mission Bernal Campus, as well as the Van Ness Campus and Davies Campus.

Geriatric syndromes include conditions typical of aging such as delirium, incontinence, falls, pressure injuries, and functional decline. CPMC’s HELP program works to prevent these geriatric syndromes in the hospital setting by helping re-orient patients to their surroundings through conversation and social support, assisting with range-of-motion and breathing exercises, walking, offering companionship during meals, implementing a schedule, and more.

Benefits of HELP at CPMC include:

  • Helps maximize independence and physical functioning of high-risk patients (age 70+)
  • Improves overall quality of hospital care for older patients, including improvement in hospital outcomes and satisfaction with care
  • Helps decrease the length of stay for patients by an average of 1- 1.5 days
  • Helps reduce hospital readmissions
    • Van Ness Campus’ HELP program saw a decrease in readmissions by 11% in 2020 Q1, 17% in 2019, and 24% in 2018
    • Mission Bernal Campus’ HELP program prevented more than 30 readmissions in 2019
  • Helps reduce falls for older patients by as much as 50% at the Van Ness Campus and Davies Campus (2019)
  • Provides cost-effective care, with reduced overall hospital costs by as much as $2 Million across each of the three campuses in 2019

“The HELP program is making a meaningful difference in changing the course of lives for elderly patients and their loved ones, and I am truly grateful for our staff, volunteers and support from our philanthropic donors who helped make this elite recognition possible,” said Warren Browner, M.D., CEO of CPMC.

Mission Bernal Campus Hub of Geriatric Care in San Francisco

While CPMC’s HELP program is carried out across all its three campuses, its Mission Bernal Campus is home to the medical center’s comprehensive ACE unit and one of only three accredited Geriatric Emergency Departments in Northern California.

“These differentiators of specialty care for older adults and this recent acknowledgement from the AGS further highlights CPMC’s commitment to geriatric care and cements our Mission Bernal Campus as a hub of geriatric patient care in San Francisco and the broader Bay Area,” says Vernon Giang, M.D., chief medical executive of Sutter’s CPMC.

Musical B-I-N-G-O Brings Moments of Levity for One Hospitalized Elder

Posted on Oct 22, 2020 in Quality Care, Scroll Images

Callie Cowart, a full-time board-certified music therapist at Sutter’s California Pacific Medical Center (CPMC) in San Francisco uses music to heal.

Cowart recently offered her therapy sessions to an older patient undergoing care at CPMC’s Mission Bernal Campus Acute Care for Elderly (ACE) unit. Cowart explains that the patient had many recurring hospitalizations over the span of four months this year.

“She and I worked together originally to use music to provide a competing stimulus to pain, which she unfortunately experienced a lot of during her time here,” said Cowart.

A B-I-N-G-O Playlist to East Anxiety & Pain

As Cowart and the patient got to know each other, the patient would look forward to sessions with “her Callie” as an energy booster and motivator.

“One morning I read in the physical therapist’s notes that prior to shelter-in-place this patient would frequent a local BINGO hall, but she’s not been able attend since the start of the pandemic. Since I knew her favorite songs, I surprised her in our next session with a customized BINGO card with each square having a different song title,” said Cowart.

To give the full effect, Cowart cut out strips of paper with the matching song titles, placed them in a bag, and used the strips as her BINGO balls that the patient could pull out. Once a BINGO “ball” was drawn, the two would sing and play together.

Music Therapy at CPMC

The Music Therapy Program at CPMC offers patients and their families the opportunity to receive therapy services from a board-certified music therapist, at no cost to the family. Music therapists are seen as an integrated part of the patient’s multidisciplinary care team and work closely with doctors, nurses, child life specialists and other therapists as part of care for the patient’s whole self.

The Sound of Music on Health

According to an article published on Harvard Health, a growing body of research attests that music therapy is more than a nice perk. It can improve medical outcomes and quality of life in a variety of ways.

For example, music therapy can help people who are recovering from a stroke or traumatic brain injury that has damaged the left-brain region responsible for speech. Because singing ability originates in the right side of the brain, people can work around the injury to the left side of their brain by first singing their thoughts and then gradually dropping the melody.

Sessions that Strike the Right Chords

Cowart says that the patient was an excellent handheld shaker player and developed a sort of fan club among the ACE unit staff for her spunky personality.

“She told me time and time again that this musical intervention gave her an increased sense of social support and mood/energy boosting during her hospitalizations at ACE because visitors had not been allowed in the hospital during COVID,” shared Cowart.

“Having something and someone to look forward to in a place that can sometimes be scary or associated with negative memories and emotions can prove to be very important,” she adds.

As for the patient, thankfully she has not had to return to the ACE unit and appears to be doing well, which is music to Cowart’s ears.