June 2005

Hospital Drives Toward Service Excellence

A comprehensive program aimed at improving patient and employee satisfaction is underway in the hospital. Titled The Strong Commitment, the service excellence program seeks to positively impact the experiences of both patients and employees at Strong Memorial.

"We know the two are intimately related," said Steven I. Goldstein, president of Strong Memorial. "How employees feel about their job has a direct correlation to their interaction with patients. We need to focus on both areas to ensure we’re doing all we can to make the overall experience at Strong be the best it can be for our patients."

Press-Ganey, a national leader in hospital satisfaction research, was hired by hospital leadership about three years ago to conduct a comprehensive assessment of patient satisfaction. Interestingly, initial survey results showed that Strong was doing average to above-average work in most areas. However, when benchmarked against similar institutions, Strong’s rating fell, in some cases dramatically so, leaving room for improvement.

"What we heard from Press-Ganey is that average and above-average performance in most cases doesn’t leave our patients feeling that they received excellent care," Goldstein said. "Excellence in everything we do, performed everyday, has to be our goal. It’s the only way we’ll make a difference in how our patients feel about the care they receive here."

Leading The Strong Commitment initiative is Jackie Beckerman, director of constituency relations. Already, the program is in full drive, with six teams focused on addressing a specific issue that directly impacts patients' and employees' experience at the hospital. Ninety employees, representing almost every division and level of employee within the hospital, are meeting on a monthly and sometimes bi-monthly basis. The teams and topic areas are:

• Impressions (Team Leaders: David Lane and Toni Smith) This group is working to create a stronger atmosphere of professionalism, caring, and helpfulness at Strong Memorial so that everyone’s first and last impression of the hospital is overwhelmingly positive
• Patient Service (Team Leader: Catherine Lyons) This team is looking at what’s happening in our clinical units and clinics to weave customer service values and practices into every interaction with patients
• Staff Morale (Team Leader: Jackie Beckerman) This team is exploring meaningful approaches to better recognize and reward our dedicated employees
• Learning Center (Team Leader: Susan Saunders) This team is creating and implementing an employee center for ongoing learning that focuses on productivity and performance excellence
• Communications (Team Leader: Teri D’Agostino) With an emphasis on internal communications, this team is working on how to keep staff well informed and engaged in the hospital’s vision and values
• Measurement & Accountability (Team Leader: Stephanie VanBacho) This group is working to standardize measurement tools used to gauge the success of The Strong Commitment initiative

At least four clinical areas in the hospital will serve as a test site on which to implement and measure the effectiveness of new programs identified by each of the six teams. The units include the Emergency Department, the Strong Surgical Center, 6-1200 (Short-term medicine) and 6-1600 (urology and transplant). The teams also will look for ways to introduce simple programs hospital-wide where appropriate.

"Our goal is to look at all aspects of our operations, and using input from every level of employee, develop programs that address issues at their root cause," Beckerman said. "We will then test those programs to make sure they are making a substantial difference before introducing them throughout the hospital."

The goal is to move all patient and employee satisfaction scores into the top 25% by 2008.

Hospital Hosts First Open Forum
As part of The Strong Commitment to improve the flow of information between senior management and all employees, the first Open Forum was held in mid-May. More than 550 faculty and staff took time out of their busy schedules to attend these sessions. Strong Memorial President & CEO Steve Goldstein, Chief Operating Officer Kathy Parrinello, and Chief Nursing Officer Pat Witzel used the hour-long sessions to update employees on the overall status of the hospital, to give an overview of the many challenges we face, and establish upcoming priorities for the next fiscal year. Time at the end of the sessions was reserved for employees to ask questions on any topic they desired.

Held at various times over a two-day period (including a weekend day), similar forums will be scheduled throughout the year to keep employees up-to-date on news and achievement of goals. Topics Covered in the Open Forum included:

• URMC/Strong Health is a major economic force in Rochester. Collectively, Strong Health employs well over 10,000, and generates $1 billion in revenue.
• Strong Memorial Hospital continues to grow, both in the number of programs and patient volume.
• Outpatient volume posts steady increases each year. In the past five years alone, outpatient visits have increased 44%.
• The Strong Health network continues to increase its overall marketshare, jumping from 40% in 1998 to 56% in 2004.
• While Strong is one of the few hospitals in the state to consistently turn a profit, every year it is a struggle to maintain a 4% margin given increased payroll costs, supplies and uncompensated care.
• Industry experts say that a 4% margin is critical if hospitals are to reinvest in facilities, recruitment and new programs.
• We maintain the margin only by growing volume AND controlling costs.
• Opportunities for Strong include continuing to forge partnerships with health systems in the upstate New York regions.
• The research infrastructure here is solid. We attract more federal research dollars than Buffalo, Syracuse and Albany combined--$140 million in 2004.
• Challenges facing Strong Memorial in the upcoming year:
• Providing care efficiently and ensuring timely discharge amid high occupancy
• Capital needs continue to increase (each year we spend up to $30 million in capital purchases)
• Maintaining technology and facilities needs
• Continued labor shortages
• Cost of providing care often outpaces reimbursement
• Growth in uncompensated care

The following is a sample of topics raised by employees at the meetings.

Emergency Department Congestion: The Emergency Department continues to struggle with being able to quickly admit patients into the hospital, thereby freeing up beds in the ED to treat other patients. Hospital and ED leadership continue to meet on a regular basis to address this on-going issue, and programs are being developed and implemented in various departments to try to alleviate some of the bottleneck areas.

Parking: With a limited footprint surrounding the Medical Center, parking options are extremely limited. Long-term, the solution will be an additional parking garage, but funds are not currently available to pay for this. Short-term, the Medical Center will continue its strategy of using shuttle buses and adding lots as real estate becomes available.

Medical Center Brings First Permanent PET/CT Facility to Region

Continuing a comprehensive expansion of its services and technology, the Department of Imaging Sciences (formerly Radiology) has opened the doors at University Imaging at Science Park, a diagnostic imaging and research facility that will improve diagnosis and treatment of cancer, help to discover new methods for treating other serious diseases, and generate new jobs in the city of Rochester.

A collaborative effort between the Department of Imaging Sciences and Cardinal Health, an Ohio-based company specializing in nuclear pharmacy services, the facility houses a state-of-the-art PET/CT scanner, as well as the region's first cyclotron unit and accompanying pharmacy.

Collectively, the facility and equipment is valued at $7.5 million, and the two sites are expected to create more than 25 new jobs. Expansion plans are already on the drawing board, with the Medical Center preparing to add the region's first 3-Tesla MRI machine to the facility in early 2006.

"As demand for PET scans increased over the past few years, it was critically important that we take a leadership role in making certain Rochester residents have convenient access to the latest technology," said C. McCollister Evarts, M.D., CEO of the Medical Center and Strong Health. "Now, this state-of-the-art equipment at University Imaging at Science Park will keep pace with the medical demand for advanced imaging technology."

According to David Waldman, M.D., Ph.D., chair of the Department of Imaging Sciences, PET scans have become the gold standard physicians use to diagnose and treat cancer. Recently, the PET technology has been made more powerful by adding a CT component to the machine.

"PET scans on their own help physicians pinpoint physiological processes taking place inside the human body, while CT scans help us map out the precise location of the disease," Waldman said. "By merging the two technologies, we have exponentially improved our ability to understand what's happening in the body, and exactly where it is happening. We are proud to make this technology available to the Rochester region in a convenient facility, and are excited about the research potential the facility holds as well."

Vaseem Chengazi, M.D., Ph.D., and John Strang, M.D., will be co-directors of the new facility.

Beyond Cancer
Less than five years ago, PET, or Positron Emission Tomography, was just becoming a mainstream tool to help accurately diagnose and treat various forms of cancer. As its usage increased, PET scans quickly became an integral component in accurately staging cancer and tracking the progress of chemotherapy or radiation treatments. Today, more and more groups of specialists are beginning to use PET scans, most notably neurologists (Alzheimer's) and cardiologists (myocardial viability and other cardiac diseases). University Imaging at Science Park will therefore reserve one day a week for research-related work.

"Researchers and physicians are increasingly turning to PET technology to comprehend the cell mechanisms that lead to other serious diseases," Waldman said. "Unlike any other imaging technology, PET scans allow physicians to see and track specific bodily processes, giving a bonanza of information to scientists seeking better understanding of how disease manifests itself in the cell and progresses throughout the body."

Already, URMC Alzheimer's specialists are planning to use the PET/CT facility for an upcoming NIH initiative studying the course of Alzheimer's. And radiologists plan to work on the development of radio-pharmaceuticals to aid in the detection and tracing of other diseases. Their research is made possible in part by the close proximity of Cardinal Health's cyclotron unit, which produces the radiopharmaceuticals used in PET scans.

The new facility is located at 110 Science Parkway in Rochester Science Park (just off the intersection of South Ave. and E. Henrietta Road). The Department expects to begin seeing patients at the new facility by the end of June. For more information, 785-5000.

Eastman Dental Launches Teledentistry Program

Child waits for Teledentistry exam

A new program aimed at preventing one of the most common oral health problems plaguing children is being launched by the Eastman Dental Center. The Teledentistry in Childcare Project is a novel approach to prevent and help with the early detection of early childhood caries (ECC), or as it is commonly called, "baby bottle tooth decay."

Like the rest of the country, in Rochester, ECC is prevalent in minority communities, and is caused by prolonged exposure to sweetened juices or other liquids, often from sleeping with a bottle. National estimates put up to 25 percent of minority children aged 1-5 suffering from the disease.

If caught early on, parental education, fluoride treatments and sealants can slow down the ravages of the disease. But when the disease progresses unchecked, invasive treatment is the usual course, including sedation and extraction, costing the community of Rochester close to $1 million annually.

"Eastman Dental Center is the Rochester area's safety net to ensure the underserved in our community have access to oral health care services," said Cyril Meyerowitz, D.D.S., M.S., professor and chair of the Eastman Department of Dentistry, and director of Eastman Dental Center. "We continue to research and develop new models of care to ensure effective oral health care for all in our community. The Teledentistry in Childcare Project is one such model, and we're proud to be able to offer it to the Rochester community."

Led by Dorota Kopycka-Kedzierawski, D.D.S., and Ronald Billings, D.D.S., professor in the Department of Dentistry, the program builds upon the successful application of Health-e-Access, a telemedicine program created by Kenneth McConnochie, M.D., professor of pediatrics.

Located at seven inner city child care centers in Rochester, Health-e-Access uses computer equipment to send digitized images and sounds of sick children via the internet to physicians across town. Physicians use the information and real-time videoconferencing capabilities to diagnose ailments and prescribe treatments for common childhood illnesses—while parents remain at work.

Kopycka-Kedzierawski and Billings are using this existing infrastructure at the seven child care centers to conduct an early intervention program to decrease ECC incidence while increasing access to oral health care for the underserved. A $48,000 grant from the Aetna Foundation funds their work.

A specialized dental camera is used to take photos of all children's teeth. Initial testing showed that the quality of the photos was outstanding, and in fact, allowed dentists to spot decay that was often not visible to the human eye. These photos are then emailed to the Eastman Dental Center, where a pediatric dentist reviews the images.

All positive screens will be referred to a dentist. At three and six intervals, all children will be rescreened to track the progress of the disease and, when appropriate, to remind parents to have the child visit a dentist. In addition, during the summer, the SMILEmobile will visit one of the sites to provide more convenient treatment to those identified with ECC.

"By catching ECC at its earliest stage, we will effectively save the patient and parent toothache and heartache, and decrease use of emergency room services," Kopycka-Kedzierawski said. "I am optimistic that we have developed a screening system that will be successful in not only identifying the disease in its formative stage, but will increase the usage of dentists by this population. You can't get any better than that."

Nation’s First Extended Accreditation Awarded to School of Medicine & Dentistry

The University of Rochester School of Medicine and Dentistry has received an unprecedented six-year accreditation for its residency programs from the Accreditation Council for Graduate Medical Education (ACGME).

The School of Medicine and Dentistry (SMD) is the first in the nation to obtain the extended accreditation. The accreditation also included no citations of inadequacies or deficiencies.

SMD "is the first to be judged by the Institutional Review Committee to actually earn it," said Cynthia Taradejna, the committee’s executive director. The ACGME decision means the next institutional review of the School by the ACGME will occur in 2011.

"The residents are here for an education, but they also are very involved in patient care," said Diane Hartmann, M.D., associate dean for Graduate Medical Education at SMD. "This accreditation reflects on the quality of training, but it also reflects on the quality of care our residents give our patients."

The ACGME evaluates individual residency programs as well as the sponsoring institution to determine whether an extensive and detailed set of standards are being met. ACGME representatives make one-day site visits for each program or institution during which they conduct interviews with program directors, faculty and residents. The evaluation also includes a review of documents. Currently, SMD has 27 residency programs with 496 residents and 41 fellowship programs with 115 fellows.

In its accreditation letter, the ACGME said "the residents lauded the institution for its many strengths," citing support from the graduate education office, leadership by program directors and department chairs, the collegial atmosphere demonstrated in the institution and computer informatics systems.

David Guzick, M.D., Ph.D., dean of the School of Medicine and Dentistry, praised Hartmann, saying "she has earned the respect of our residency and fellowship program directors for her high standards and expectations, her extraordinary attention to detail, and her fairness."

"Under Dr. Hartmann’s leadership, our residency and fellowship programs truly reflect the University’s motto of Meliora -- Always Better," Guzick said. "It is satisfying that the level of excellence that we have achieved is recognized nationally by this newly created commendation that has never before been awarded to any medical center."

C. McCollister Evarts, M.D., CEO, University of Rochester Medical Center and Strong Health, said the university has a deep tradition in excellence in medical education and training.

"This is another accolade for a medical school and Medical Center that always has established high standards for education and patient care," Evarts said.

This accreditation covers programs in the Medical Center, Strong Memorial Hospital and Highland Hospital.

Prestigious Awards Bestowed on Med Center Faculty

CEO of the University of Rochester Medical Center and Strong Health C. McCollister Evarts, M.D., recently was awarded the Albert David Kaiser Medal by the Rochester Academy of Medicine. The Kaiser medal is the Academy's highest honor and was presented to Evarts in recognition of his "long and distinguished career and pioneering work as a surgeon, mentor, educator and strategic leader."

"It has been a privilege to return to Rochester and once again serve a community that I have long considered my home," said Evarts. "The past recipients of this award include individuals who not only shaped the health care system in this community, but also built the Rochester medical institutions that are now recognized as national leaders in so many fields. It is an honor to join such esteemed company."

Other University of Rochester Medical Center faculty members recognized by the Academy were: Marilyn R. Brown, M.D., clinical professor of Pediatric Gastroenterology/Nutrition, Department of Pediatrics; Earl S. Lipman, M.D., clinical professor emeritus of Medicine; and Henry A. Theide, M.D., professor emeritus and former chair of Obstetrics and Gynecology. All received the Academy's Award of Merit.

Local Geriatrician Also Honored
Robert McCann, M.D., professor of Medicine at the Medical Center and chief of Medicine at Highland Hospital, was presented the 2005 Laureate Award from the American College of Physicians during a ceremony in New York City. The Laureate Award is presented annually to physicians in the United States who have demonstrated a commitment to excellence in medical care, education, research and service to their community. McCann was one of four physicians in New York state honored.

McCann has been chief of medicine at Highland Hospital since 1999. He has made significant contributions to the care of older adults through this research, academic pursuits and working as a licensed geriatrician in the community. Prior to joining Highland's medical staff, McCann was the medical director of Independent Living for Seniors. He earned his M.D. from SUNY Upstate Medical Center and completed his residency training at Rochester General Hospital and the University of Rochester Internal Medicine Residency Program.