Good morning!

Today marks a bit of a milestone. This is my 100^th VC Notes!  I've enjoyed doing this weekly column and have been so encouraged by your participation and the positive feedback I have received from so many of you. Thank you. 

It's the last Friday of the month so today I'll answer your questions. I read all of your questions and comments and appreciate them all. If you don't see your submission answered here, I have passed it along to senior administrators for their consideration and possible action.  

On to your questions.

Q:  I am a unit secretary here at UMMC and I notice that the nurses have the Daisy Awards to reward them for their exemplary service, but there is nothing in place to reward the techs and the unit secretaries. Our roles are very important to the patient as we assist the nurse in providing critical information as well as personal care from the techs. My question is, what can we do to show appreciation to these other staff members for their hard work?

A:  I agree with you that all of these roles are important and deserve recognition for outstanding service.  We have an organization-wide AWARDS team in place to recognize all UMMC employees.  AWARDS stands for Appreciating Winning Attitudes and Recognizing Deserving Staff.  According to staff who support this effort, the team was created in 2010 by hospital leadership and expanded to include all Medical Center employees in January 2014.  Their committee meets monthly to review submissions from managers and peers and coordinate recognition efforts accordingly.  A copy of all nominations is sent to the employee's manager to share with the employee. There are four recognition categories:

• individual person
• unit/group
• quality/"good catch" award
• Daisy Award (nursing specific) 

Nominations can be made on the campus Intranet under the Administration tab (Administration>Awards for Nomination and Recognition>Awards Nominations). They can also be made by email to awardsteam@umc.edu. In addition to these channels, the team also receives patient compliments through Patient Affairs and paper nominations completed in the same manner as Daisy nominations for LPNs, patient care technicians, nurse anesthetists, unit secretaries and other job categories. The committee receives between 30 and 40 nominations a month.  Two or three employees are selected for recognition and receive a surprise visit in their work unit.  The team welcomes nominations of all deserving employees who go above and beyond in the performance of their duties.

Q:  As a quality improvement and patient safety physician and researcher for the last 20 years, I know from experience at multiple academic institutions in the United States that measures of quality, such as patient satisfaction, safety and quality culture, and employee engagement only significantly improve (as a direct result of improved quality of medical care) when process changes are made by front line staff who always know where quality is limited in our current processes and how to collaboratively problem-solve to plan and execute very feasible, simple and inexpensive ways to improve these processes. When approached this way, quality improvement can be measured with non-subjective measures (unlike satisfaction and engagement). Does UMMC leadership really want to do what it takes to improve the care and outcomes of our patients? If so, which I think they do, then process change at the level of the front line has to be the strategy and quality has to be measured with quantitative measures. When positive process change outcomes are fed back to the front line, employee engagement and safety culture improve. Engagement and culture only improve when front line teams are given the trust, freedom and support to solve quality problems they know are limiting their ability to do their best work and thus provide the best care for our patients. Is the leadership of UMMC willing to "go out on a limb," so to speak, to trust and support their front line staff to work together to improve the quality of our patient services and outcomes in 2017? I hope so.

A:  I agree with you that the front line is where the action is and where the most consequential work occurs with respect to clinical quality improvement, but I also think this work has to be organized, monitored and reported across the clinical enterprise. It also must account for the fact that front line teams don't operate in isolation but rely on other services they don't control. The challenging balance our quality improvement leaders face is, on the one hand, having leadership define performance gaps, set priorities and allocate resources to support the work to close these gaps, while on the other hand, truly engaging the front line, because these employees have the best knowledge of what is likely to succeed, as you rightly point out. That's why open communication, trust and mutual respect are so crucial in this process. I have a great deal of confidence in our clinical quality leadership and equal faith in our front line staff who are embracing this challenge every day. As they say, the proof is in the pudding. Our metrics are improving and we are making progress. Thank you for your insight that this would not be possible without the full involvement and buy-in of our staff.

Q:  One of the great advantages of the milder winters is the ability to be outdoors. I've noticed that there is a large courtyard west of the McBryde building (just behind Methodist) which is locked and vacant. This area appears underutilized. Is there any reason this open space couldn't be opened for staff on breaks, outdoor meetings/lunches, or perhaps a farmer's market such as the Vanderbilt Medical Center has? It seems prudent as a medical center devoted to the health of Mississippians to encourage outdoor activity and/or healthy eating. Why not popularize it on our own campus?

A:  The courtyard you mention and the building adjacent to it are part of the Addie McBryde Rehabilitation Center for the Blind, a unit of the Mississippi Department of Rehabilitation Services, a state agency. As far as I know, we do not control the property and I expect there are legal and practical reasons why sharing it in the way you describe would be difficult. The good news is that as part of our campus master plan, which is currently being updated, we are exploring options for adding new green spaces around campus. When the plan is finalized this spring, I look forward to sharing these ideas with the campus community. One thing I'd like to see are updated and well-defined walking paths for our faculty and staff, students, patients and visitors. In the meantime, thank you for thinking of ways to promote wellness for our campus community. 

Q:  As a shuttle rider, I am getting frustrated, along with other employees, at how hard it is for our drivers to navigate to the stadium parking lot. Once we make it past shuttle stop 22 (Medical Towers), there's an excessive wait just to get into the main parking lot. Shuttle drivers are forced to patiently wait until someone politely lets them enter. UMMC police will be parked right there at the gate with flashing lights, but not directing traffic. Cars rarely stop to let buses through, and once they finally try to, there's another blockage from the other way. Not only does this take up time, but it also puts other drivers in danger of hitting cars that they can't see coming. What is the purpose of UMMC police being present there at this time without helping us? Can we please get someone to direct evening shift traffic, just as they do in the morning in front of the main hospital?

A:  I think we all agree that rush hour at the stadium is a huge challenge and I appreciate the frustration you feel in getting to and from work. If we were in a position to redesign the traffic flow today, we would put shuttles on different routes from personal vehicles in the stadium parking lot. Although some traffic direction by our police may be helpful at times, what happens as a practical matter is that we are directing vehicles from one congested area to another, so it's not really a comprehensive solution to the problem. I think the most important rule of the road to bear in mind is that personal vehicles should yield to shuttles, getting them on their way and out of yours. Obviously, vehicles should yield to pedestrians, but pedestrians should also be thoughtful and allow vehicles to pass when they are bunched up at peak hours. I've shared your comment with the appropriate campus officials and encouraged them to be on the lookout for any refinements that could improve stadium traffic flow.

Q:  I've heard people say how they were not getting the services/care they need with local clinics after hours as well as getting shuffled around from doctor to doctor because they don't know the patient or their insurance is no longer being accepted by that doctor. When people are sick, these things are the last issues they are needing to deal with. Have we ever thought of having a clinic after hours in the Jackson area? I know in this day and time it's more about politics and money, but it seems that in general, people are given a Band-Aid and rushed through, with no real sense of diagnosing/curing issues; it's more about prescribing medicines with side effects that will pop up down the road. I feel that we here at UMMC, and as you have stated, we want the best for Mississippi. We need to show that, advertise that, provide that, which is in your heart and mine. I know we don't do miracles, but I honestly feel that we can provide the closest possible thing to it, and that would not only impact the patients, but the staff and all of Mississippi.

A:  You've certainly put your finger on a lot of what's wrong with health care today and I appreciate your passion for doing what's best for patients. First, I want to say that UMMC does offer after-hours urgent care. Our Children's After Hours Clinic is open from 5-9 p.m. Monday-Friday and from 9 a.m.-1 p.m. Saturday in the Eli Manning Clinics for Children. For adult patients, UMMC's RapidTrack is open from 7 a.m.-11 p.m. Monday-Friday and from 8 a.m.-8 p.m. Saturday and Sunday.  RapidTrack is open on all holidays and operates in the ground floor of the Conerly Hospital adjacent to the Emergency Department. Bear in mind, these are urgent care centers and are not meant to be a patient's “medical home.”  The other part of your question/comment provides a good description of our fragmented health care system and what the patient experience can be like. What I find encouraging is that we are gradually moving toward a more integrated system in which health care providers are not just dealing with episodes of illness or injury but are becoming accountable for the overall health status of the patient. This new model puts much greater emphasis on preventive care and wellness and involves the patient in his or her care and the cultivation of healthy behaviors.

It's taken decades to develop our current fragmented system and we won't change it overnight. But we are making progress on many fronts and UMMC is leading the charge to more holistic patient care and A Healthier Mississippi.