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customer service
rd , Bl Z
John Robinette recounts  shorthistory o customer serviceeorts t DUH.
Pg 7
Patient care
nw p, y l
Duke Perintl Clinic moves tonewer lrger spce — givingptients esier ccess nd moreservices.
Pg 4
inQuirY
eg g p
Duke resercher MichelHershfeld helps develop newtretment or gout.
Pg 8
VOLUME 18 NO. 7
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inie.uemeicine.o
n
Jul 2009
Putting the ptient frst:
O
n rst glance, the DukeUniversity Hospital EmergencyDepartment has nothing at all incommon with a Ritz Carlton.In the waiting room sit patientswho are, more oten than not, su-ering rom physical discomort andanxious about getting help. Emotionscan run high and waits can be long.However, within the past year,new renovations coupled with a seao changes in sta attitudes towardservice has led to signicant increasesin the level o patient satisaction.“Your hard work and dedication toquality improvement is evident in theincrease in your Emergency RoomService score Overall Satisaction,”read a letter rom Press Ganey, thepatient satisaction reporting andconsulting company used by theHealth System.“Our new attitude echoes theRitz Carlton motto: ‘Ladies andgentleman serving ladies and gentle-man’,” said Michael Hocker, M.D.,
see EMERGENCY, p.2
A u place
On average, the DUH EmergencyDepartment cares or 190 to 220patients a day, and up to 260patients at peak periods.Kevin Sowers, MSN, RN, FAAN, who began hiscareer at Duke University Hospita 24 years agoas an oncoogy nurse, has been named thehospita's chie executive ocer.In making the announcement, Wiiam J.Fukerson, Jr., M.D., senior vice president ocinica aairs or Duke University Heath System,highighted Sowers' exempary service over thepast six years as chie operating ocer at DUHand, or the past year, as interim CEO."Kevin is a proven eader who has made vauabecontributions across the operationa unctions othe hospita, ranging rom enhanced quaity andsaety measures to nancia management,"Fukerson said. “His exceent reationships withphysician acuty and empoyees at arge iustratethat he is a highy-respected eader and superbchoice to execute our vision or continuing toextend the egacy o exceence associated withDuke University Hospita."Sowers was named to this position oowing anationa search process conducted by one o thecountry's eading executive recruitment rms.In his roes as COO and interim CEO at DUH,Sowers has been responsibe or impementingthe hospita's strategic objectives in coaborationwith the physician acuty, administrators andsta, and has had responsibiity or the manage-ment o the hospita's cinica service units.Sowers has driven organizationa initiatives toimprove cinica quaity, patient satisaction, workcuture and nance. He aso aunched theStrength, Hope and Caring program to recognizehospita empoyees who exempiy thosecharacteristics. He has aso ed severa majorexpansion and renovation projects within DUH."Throughout his two decades o service toDUHS, Kevin has payed a signicant roe in therise o Duke University Hospita to one o theeite medica institutions in the country," said
DUH veternSowersnmed CEOED sets the stndrd or service excellence
Appointment continues24-year career at DUH
see SOWERS, p.3The entire st o Duke University Hospitl's Emergency Deprtment, plus flited st, bnded together to improve ptientstisction scores by ocusing on improving service. Tht eort led to  signifcnt increse, rom the 30th percentile to the 95th.
PhOtO by JArEd LAzArUs, dUkE PhOtOgrAPhy
 
on the cover
Inside Duke Medicine
chie o the division o EmergencyMedicine.That simple shit in attitude,rom one that ocused primarily onhealthcare delivery and not service,along with a number o proceduralchanges, has led to tangible rewardsin a relatively short period o time.“Our scores were consistently in the25th to 30th percentile. Feedbackrom patients indicated that our sta members were not communicatingand that we didn’t care,” said Hocker.The key behind the changes hasbeen teamwork o the ED sta, romthe ront-desk receptionist to thenurses to the attending physiciansand administrators. As a unit, theybrainstormed ways to improve howbusiness was done in an increasinglybusy emergency department. Thedepartment now serves between 190to 220 patients a day.First, Hocker traveled withclinical operations director FrankDeMarco, patient visitor relationsrepresentative Matthew Rougeuxand other ED sta members toHackensack, New Jersey to visit ahighly rated emergency departmentto see what they were doing dier-ently. They brought some o thosetips back to Duke and, with thoseguidelines, the division got to work.“We set up a committee o nurses, physicians and administra-tors to devise ways to respond tocommon patient concerns,” saidCandi Van Vleet, RN, nurse managero operations.They began to realize that aconsistent theme was not the level o care, but communication, or the lackthereo.“Beore, patients’ perceptionswere that that sta members had anattitude, were short with them orweren’t orthcoming with inorma-tion,” said Matt Rougeux, patientadvocate. Rougeux handles patientconcerns within the ED.Patients waiting to be seen orlong periods o time oten elt asi they were orgotten. One o themost successul initiatives has beenthe installation o “Nurse First,”in which a nurse is stationed at thereception area to triage patients uponarrival. That nurse can begin basiclab work until there is room or apatient on the unit. Waiting patientsare also reassessed every two hours.“Patients tell me that this stepmakes them eel like someone ispaying attention to their needs,” saidTheresa Davis, RN.The sta report that Nurse Firsthas also led to improved patientfow. “Beore we started this, wewere rarely able to empty thewaiting room and now that occursregularly,” said Bill Lyons, RN.Once inside the unit, patientsare now more inormed about whois caring or them and what theirtreatment course consists o thanksto two other initiatives. The rst,bedside reporting, has nurses andassistants updating each other atshit changes at a patient’s bedside,so that the patient can listen andgive eedback. The second is a whiteboard on the wall o each room,listing the date, the name o thepatient’s nurse, attending physician,the plan or the day and space orquestions or comments.“Our communication is muchmore patient centered. We’ve madea conscious attempt tokeep them in the loopso that they eel more incontrol o their treat-ment,” said Van Vleet.Administrators,such as the chargenurse, physician team leaders andrepresentatives rom ancillaryservices such as ood service andradiology, are now more activelyinvolved as well, perorming roundsto ensure, in real time, that patientsare getting the care they deserve.And that care continues evenater a patient has been discharged.Within 48 hours, attending physi-cians will now call patients to touchbase. “Physicians will ask howthey are doing and ask about theirservice. The ollow-up calls haveprovided an additional element o saety, allowing physicians to clariytreatment instructions i needed,”said DeMarco.Finally, real-time surveys haveempowered sta to be proactiveabout patient concerns. Each patientis given a orm with 10 questionsabout their treatment, while they arestill on the unit. I they score belowa certain number, the charge nursechecks in with them to see what canbe improved.“Getting positive eedback inreal time has resulted in our eelingbetter about the job we’re doing,”said Casey Baughman, RN.As one patient wrote: “Theentire sta rom triage to the resi-dent and attending physicians wassuperb. The bedside manner o thephysicians was absolutely wonderul.My nurse was very kind, as wellas the lady taking my insuranceinormation.”All o this change hasn’t been easy.“There has been a lot o trial and errorin the process, with some improve-ments working well and others not atall. But we’ve remained fexible andthe administration has done a greatjob at being receptive and open to oursuggestions,” said Lyons.“This is an amazing accomplish-ment,” said Kevin Sowers, CEOo DUH. “It’s the sta that havereally driven this process. It was ateam eort that led to rapid cycleimprovement.”Baughman summed up thesta’s new attitude this way: “It’snow the universal goal o the unit torecognize patients as human beingswith needs and wants, not justmedical conditions, and to respondaccordingly. Whatever we can do toimprove their experience while theyare here is worth it.”
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2
Juy 2009
INsIdE VOLUME 18, IssUE 7
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CONTaCT USCmpus mil:
DUMC 104030
Deliveries:
2200 W. Main St.,Suite 910-B, Durham, NC 27705
Phone:
919.660.1318
E-mil:
editorinside@mc.duke.edu
CREDITS
 
Crtoon:
Josh Tayor
STa
 
Editor:
Anton Zuiker
Mnging Editor:
Mark Schreiner
Science Editor:
Key Macom
Designer:
Vanessa DeJongh
Inside Online Editors:
 Bi Stagg and Erin PrattCopyright © 2009Duke University Heath SystemInside Duke Medicine, the empoyeenewspaper or the Duke University HeathSystem, is pubished monthy by DukeMedicine News & Communications.Your comments, story ideas and photocontributions are aways wecome andappreciated. Deadine or submissionsis the 15th o each month.
EMERGENCY, continued
a simple white bord plced in ech Emergency Deprtment ptient room helpsptients remember the nmes o the physicins nd nurses treting them nd thedetils o their tretment.
“Waeve we can o o impove(a paien’) expeience wile eae ee i wo i.“
— Cae bauman, rN
 
on the covercommunitY
D
uke University Hospitaland Duke’s Area HealthEducation Center are teaming upto provide summer internships orstudents at a Durham high schoolthat specializes in health carecareers.Eleven City o MedicineAcademy students will spend ourweeks in July at DUH and DurhamRegional Hospital. They willparticipate in group educationalactivities, plus one-on-one activitieswith assigned health care proes-sionals who match the students’areas o interest – which rangerom cardiology to anesthesiologyto neonatal nursing and more. Thegoal is to create a unique learningexperience that uels the students’desire to work in health care.The DUH side o the eortwas spearheaded by Associate VicePresident MaryAnn Black o theOce o Community Relationsand by Pamela Edwards, associatechie nursing ocer or educationand deputy AHEC director. Alsoinvolved was Linda Chambers,a health careers coordinator andscal director o the Duke AHECprogram.AHEC is part o a statewideprogram establishing a communitytraining network or health proes-sionals and addressing concernsabout their supply, distribution,retention and quality.“Each student expressed aninterest in a particular specialty,and we tried to get them a closematch to the eld they chose,”Chambers said. “DUH educatorsand clinical sta have been excitedabout working with the students.”The AHEC Health Careerssta will ollow the CMA studentsas they move into their nal year o high school — and into college orother post-secondary educationalprogram.That makes sense or Dukeand or the interns, Edwards said,especially since they are minoritystudents, a group under-representedin many health care proessions.“Diversity is one o our corevalues,” she said. “The health careworkorce isn’t representative o our population, so it’s importantto keep improving the number o minority care providers.”Chambers said the internshipsare part o Duke being a goodcommunity partner. “Some thingsyou do just because it’s the rightthing to do,” she said.As DUH and Duke UniversityHealth System continue to grow,the students’ career path could leadthem back to where they spent thissummer.“Our hope is that they maywork at Duke,” Edwards said. “Itmakes sense to grow our own righthere in the community.”Elizabeth Shearer, Ph.D.,principal o CMA, said DUHS isa “wonderul partner” with theschool in many ways, especiallythrough the internship program.“These internships will provideour students with invaluable andauthentic experiences that willsignicantly increase their prepara-tion or college and careers, as wellas enhance their competitiveness inthe college market,” she said.
 
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Juy 2009
Inside Duke Medicine
DUH, Duke aHEC oer internshipsto uture helth cre providers
Victor Dzu, M.D., DUHS president nd CEO nd Duke University chncellor orhelth irs, mingles with students rom the Durhm Public Schools’ City oMedicine acdemy on  recent visit.
PHOTO COURTESY OF DPS
SOWERS, continued
Victor J. Dzau, MD, chanceor or heath aairs atDuke University and president and CEO o theDuke University Heath System."The dynamic nature o today's heath careenvironment requires eaders who can eectiveyadapt to reguatory and reimbursement changeswhie aways keeping the interests o patients as aprimary ocus. Kevin has demonstrated that he isexacty this kind o eader and he was a cear choiceor this criticay important position."Prior to his roes as COO and interim CEO at DUH,Sowers had hed a variety o administrative positionso increasing responsibiity within DUHS, incudingthose o associate vice president or hospitas andcinica aciities or DUHS, and as interim chieexecutive ocer o Durham Regiona Hospita."It's an honor to be seected as the CEO o aword-cass hospita with such highy skied anddedicated acuty and sta," Sowers said. "I'mcommitted to urthering the hospita's mission oproviding exceence in patient care through thecinica transation o innovative research, whiemaintaining a heathy operationa and nanciaoundation."Duke University Hospita has been recognized asone o the word's best heath care providers bysuch pubications as
Time
and
U.S. News & World Report 
. A u-service tertiary and quaternary carehospita, Duke University Hospita is icensed or924 acute care beds.Sowers is internationay known or his ectures andwritings on the issues o eadership, organizationachange, mentorship and cancer care. His cinicaresearch has ocused on human responses tochronic iness. He received the Duke UniversitySchoo o Nursing Distinguished Aumni Award in2006 and was inducted into the American Academyo Nursing in 2008. He has aso served in a variety oeadership roes at the nationa eve within theOncoogy Nursing Society.
n
Bio cts: Kevin Sowers,RN, MSN, aaN
• He began his career at Duke University
Hospita as a nursing eader in oncoogybeginning in 1986.
• From 2003 to 2009 Sowers was Duke
University Hospita’s chie operating ocer.He aso served as interim CEO in 2008-2009.
• Under his leadership, Duke University
Hospita received approva or majorrenovations to the Emergency Department, amodernization and expansion o theoperating rooms, deveopment o a pediatriccardiac care unit, expansion o the intensivecare nursery, and construction o a new ICU/ OR bed tower and cancer center.
• Sowers serves as an adjunct faculty member
to Sun Yat Cancer Center in Taipei, Taiwan;the University o North Caroina's MPHprogram, and the Duke University Schoo oNursing's graduate program.
• His professional honors include receiving
the Duke University Schoo o NursingDistinguished Aumni Award and inductioninto the American Academy o Nursing.
Q&a: On ledership
Considering organizational improvement, what do you seein the future? 
There has to be a strong alignmentamong the entities: the School o Medicine, the School o Nursing, thepractice group, the hospitals and theclinics. Over time, we need to evaluateand understand what integratedservice lines look like and how thatwill allow us to better serve ourpatients. At the same time, we have tocontinually look at how much moreecient we can become in serving thepatients who need our care, especiallywhen we consider how alignmentbetween our hospitals can create thecapacity and eciencies.It will take an entire team o people,rom every part o the organization,to drive the progress to advance theorganization’s success.
What is your vision for the hospital’swork culture? 
Our patients and amilies are at thecenter o everything we do. As ateam, Duke University Hospital hasworked to build a work culture thatsupports patient-centric models thatimprove the quality o our clinicaloutcomes and patient satisaction.It takes ocus and tactical strategiesthat the organization has to ollowthrough on. Most importantly,it takes a team o committedindividuals to accomplish these goals.
What’s your philosophy of organizational improvement? 
Every day when you get up, you say,“What did we do yesterday that wecould do better today?” and let’s tryit. Challenge yoursel to be bettertoday than we were yesterday. Youdo rapid-cycle improvement, to gureout how you can do it better today.Each and every day you come upwith ideas on how to improve overyesterday. You work as a team, andyou let the sta drive the process,coming up with ideas to better serveour patients and amilies.
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