In between chats with friends and quips with her fitness trainer, Margaret Rookes spent a recent morning walking on the treadmill, stepping on a NuStep and leg pressing 100 pounds.

When it comes to maintaining her three-times-a-week, 75-minute workout routine, Margaret makes no excuses – not even the fact that she just turned 100 years old.

“I wouldn’t be in this condition if I didn’t come here,” says Margaret, sporting white sneakers while switching between strength and cardiovascular machines and stretching exercises. “It’s kept me moving. It’s kept me young.”

At age 89, Margaret was one of the first three participants to enroll in the Functional Fitness for Older Adults class that started at the University of Michigan Health System more than a decade ago. The class, which is offered by the Department of Physical Medicine and Rehabilitation for people age 65 and over, has since grown to more than 60 gym-goers.

For Margaret, the class offers a social outlet and place to connect with peers while improving her strength, balance, endurance and mobility – components that typically decline with age and can pose major health risks for older adults.

“I wouldn’t be in this condition if I didn’t come here. It’s kept me young,” says Margaret Rookes, 100. Margaret has been coming to UMHS’s Functional Fitness for Older Adults class since she was 89.

She says the class kept her so fit that at age 95, she was able to take a trip back to Bermuda – her home of five years in the 1930’s where she waitressed after college and met her late husband. Along with her daughter and son-in-law, she was able to visit all of her favorite landmarks and even walk up and down the 39-flight of stairs that took her from her beach cottage to the ocean.

“There’s no getting around it – I’m old,” says Margaret, sitting near a photo from her recent birthday celebration that pictures her with a bottle of sparkling cider under the caption “still partying at 100.” “Coming here is good for my body and mind. It gives me a reason to get out of bed every day. My doctor told me ‘whatever you’re doing, keep doing it.’”

The eight-week Functional Fitness For Older Adults class is intended to combat the detrimental physical and cognitive effects of aging such as muscle loss, worsened posture and balance, memory loss, bone loss and arthritis. After getting their doctor’s clearance, attendees are offered on-going instruction on exercise equipment in the PM & R’s Transitions Studio, which includes strengths, treadmills, bikes, elliptical bands and balls. Participants are also introduced to home exercises.

“This is about helping older adults get stronger and more confident in an effort to improve their quality of life,” says health educator Britt Michel, CSCS, director of UMHS’s Transitional Therapy Programs. “Everyone has different goals. Some want to be able to keep up with their grandkids or enjoy travel, while others want to simply climb a flight of stairs or work in their garden with greater ease.

Margaret Rookes chats with health educator Britt Michel, CSCS, director of UMHS’s Transitional Therapy Programs during her regular exercise routine at PM & R’s Transitions Studio.

“Margaret is a great example of how to live life to its fullest – even at 100.”

Margaret, who formerly worked at the U-M School of Dentistry, has battled several health issues, including high blood pressure, cancer and sciatica. She says her physician credits her exercise program for helping reduce some prescription medications.

“I think a lot of people think they’re too old to start going to the gym but they’re not. You’re never too old,” Margaret says. “I started at age 89 and kept going until 100 and look, I’m still here.”

More on Functional Fitness:

Classes meet for 75 minutes twice a week with sessions offered Mondays through Thursdays at 9:30 a.m., 11 a.m. or 1 p.m. All participants have access to the studio on Fridays from 8 a.m. to noon during the eight weeks.

The initial cost is $175 for eight weeks, which includes an exercise interview/consult, fitness assessment, equipment orientation and  eight weeks of classes (twice a week) with supervision.  Renewal cost is $100.

More details here: http://www.med.umich.edu/pmr/patient/classes.htm

For more information call (734) 232-1262 or email pmr-transitions@med.umich.edu.

How well do we keep our patients from getting infections or complications related to their care?

How often do we make sure that patients with diabetes, asthma and heart disease get tests and medications that can keep their condition in check?

What’s the survival rate for patients who have transplants or complex operations at UMHS?

How often do our clinicians wash their hands?

The answers to these questions – and many more – can be found on a website that’s open to everyone, anywhere in the world.

It’s all there in the charts, graphs, easy-to-understand explanations and more on www.uofmhealth.org/quality, the UMHS Quality & Safety site.

Putting this huge amount of data on a public website makes UMHS one of the most “transparent” health systems in the country. It’s part of our commitment to patient safety and high-quality care.

That website has just been named Support Services Program of the Year for 2012, and the award was given to the team that built and maintains the site with no additional financial support. They call themselves “Team Transparency”, and they include members of the Performance Assessment & Clinical Effectiveness (PACE) division of the Office of Clinical Affairs, and of the Public Relations & Marketing Communications department. PACE includes members of the former Clinical Information and Decision Support Services (CIDSS) and Customer Performance Metrics & Improvement units.

Working with no additional funding, the team designed the UMHS Quality & Safety site from the ground up to offer comprehensive, easy-to-understand, easy-to-navigate and fully transparent data and information about UMHS clinical performance.  It’s fully integrated into UofMHealth.org, the Health System’s patient-focused web presence.

Teamwork & Collaboration: 

The development, launch and ongoing expansion and maintenance of the site is a true team effort. When they began their work in 2010, the team benchmarked sites offered by other health systems and nonprofit groups, evaluated ways to present data and supporting information, gathered reams of data from clinical information systems and clinical leaders and created layperson-friendly descriptions for all measures. They got feedback from patients and clinical leaders.

Since the public launch in spring 2011, the team has continued to improve the site, publicized its existence internally and externally, and integrated it into the UMHS web environment. The site receives between 2,000 and 4,000 page views a month, almost a third of which are from computers on the U-M medical campus – suggesting that the site is of use to both patients and UMHS staff/trainees alike.

The team is also continuing to update and expand the range of data that is presented on the site. Work is now under way on a major update.

Members of “Team Transparency”, who won the Program of the Year award for support services for building and maintaining the UMHS Quality & Safety website, include, from left: Barb Chapman and Gail Sinwell, Performance Assessment and Clinical Effectiveness (PACE), Kara Gavin and Geoff O’Connor, Public Relations & Marketing Communications (PRMC), and Vinita Bahl and Ed Karls, PACE. Missing are team members Sam Jessie, Cathy Mellett and Chris Africa, PRMC, and Glenn Ogletree and Megan Winningham, PACE.

In today’s environment of growing consumerism among patients, and heightened attention to clinical performance by insurance companies and government coverage plans, the site serves many external audiences. It also helps UMHS clinicians and trainees see how well their areas are performing, and spark conversations on opportunities for improvement.

What’s on the site?

The UMHS Quality & Safety site includes both inpatient and outpatient measures on a broad range of conditions in adults and children. It also provides a wide array of patient satisfaction data, and a range of stories and links related to our quality improvement efforts, leadership in state and national quality efforts, and the awards and honors we’ve gotten for our clinical quality.

Visitors can find far more data than is publicly available through sites such as HHS Hospital Compare, Leapfrog, the Joint Commission, Consumer Reports and sites maintained by the Greater Detroit Area Health Council and Michigan Health & Hospital Association.

For instance, the site offers data from national and regional benchmarking systems that are not public, such as the Society of Thoracic Surgeons’ cardiac surgery and esophageal cancer care outcomes, and infection rates from the National Healthcare Safety Network. There’s also data from our internal Patient Safety Culture data, and patient safety measures such as hand washing and radiation exposure.

Most of these data are updated at least semiannually.

Each chart or graph on the site is accompanied by a “Details” section, written in plain English, which explains the information and gives reference information for its source. Many outcomes graphs also include national benchmarks. If national standards are not available, the charts show our own internal goals.

The site takes a “warts and all” approach, publishing data even when UMHS performance falls below the desired level. In those cases, the site explains why this is so and what we are doing to improve.

If you haven’t yet visited the site, take a look. And if you have ideas for more types of data, stories or links that could be added, email umhsquality@umich.edu . 

But for uninsured people in Washtenaw and western Wayne counties, a charity called the Hope Clinic helps keep uninsured patients from falling too far.

For decades, U-M doctors, nurses, staff, medical students and residents have volunteered at Hope’s location in Ypsilanti, helping weave a safety net that has served thousands of people.

Accepting the Program of the Year award for clinical services on behalf of the dozens of UMHS faculty, staff and trainees who have volunteered for the Hope@UMHS program are, from left, Perry Schechtman, Ophthalmology, Heather Pontasch, Dermatology, Julie Brown, Hope Clinic, Trisha Goodridge, Plastic Surgery, Robbi Kupfer, Otolaryngology, Katherine Simpson, Hope Clinic, Seyi Aliu, Plastic Surgery, and Paul Salow, Otolaryngology/Anesthesiology.

Now, Hope has come to UMHS in the form of a specialty clinics held at the Taubman Center and Kellogg Eye Center – a major step made possible through the tireless efforts of faculty, staff and trainees in several specialty departments.

This effort, called Hope@UMHS, has earned the UMHS 2012 Program of the Year recognition – as well as the gratitude of the hundreds of patients who have already been seen there.

The Saturday-morning specialty clinics – - staffed by an all-volunteer team – - help uninsured patients get free access to advanced care that can’t be offered at Hope’s own locations.

The U-M-held clinic is considered an extension of Hope Clinic’s activities, and patients receive routine follow-up at the Hope locations in Ypsilanti or Westland. But Hope@UMHS acts as a gateway for those patients who need even more advanced care to receive it through UMHS programs for patients without insurance.

The program began in October 2010, following a proposal by then-resident Andrew Shuman and Otolaryngology  faculty member, Erin McKean, M.D.  The initial clinics involved faculty, staff and trainees from the Department of Otolaryngology at their regular Taubman Center location. Together, they evaluated 74 patients in the first five clinics, and performed 60 procedures. They even diagnosed four potentially life-threatening conditions. In 2011, Kellogg Eye Center began offering bi-monthly Hope clinics as well.

Fast forward to 2012, when members of the Plastic Surgery, Dermatology and Ophthalmology teams have joined Oto’s volunteers – including those from Speech/Language Pathology and Audiology.

In 2012 alone, Hope@UMHS clinics handled 401 appointments, and helped 50 patients enroll in the UMHS program for uninsured patients. Everything from audiograms, endoscopies, ear procedures, biopsies and excisions of cancerous lesions, and examinations for serious eye conditions, takes place during the clinic.

The need for clinic sessions has grown steadily. Depending on the specialty, volunteers at each clinic include attending and resident physicians, nurse practitioners and/or physician assistants, optometrists, audiologists, technicians, nurses, medical assistants, and clerical staff.

“It is a great opportunity for all of us who take part,” says Jean Forbes, R.N., of Otolaryngology. “Patients are always so thankful, offering hugs and blessings to us for giving our time. But, really, I am grateful for this opportunity. We are the fortunate ones to be experiencing this.”

The effort to get the clinic off the ground, and operating in a U-M facility, took many hands – and had to address legal, medical record, educational and facilities issues. UMHS has committed to supporting the cost of disposable supplies and cleaning.

The Hope@UMHS clinic complements many other efforts that UMHS units and individuals make at the other Hope locations. It also adds to clinical services contributed by Trinity Health hospitals, health centers and staff too.

In 2012, Hope@UMHS won the Ludwig Award for community service from the Michigan Health & Hospital Association. Learn more here.

For more on volunteering for the Hope Clinic, see http://www.thehopeclinic.org/volunteer/index.htm.  Hope always needs volunteer physicians, nurse practitioners, physician assistants, pharmacists, nurses, and office staff.

(From left) William Palazzolo, clinic director; Jennifer Tomford, clinic manager; and Linda Schaffier, medical assistant, discuss process improvement ideas during a leadership walk in front of the visual metric board.

Would you jump at the chance to improve employee satisfaction in your area if you could? Even if you weren’t sure you totally believed in the methods at hand?

Eighteen months ago, Bill Palazzolo, M.S.., P.A.-C, clinical director at Domino’s Farms Surgery Pre-Op Clinic, rolled out Michigan Quality System’s (MQS) lean in daily work system in his area and was pleasantly surprised.

“If you had told me years ago that lean worked, I wouldn’t have believed you,” he says. “But now I get it. I’m a believer.”

Knowing that patient satisfaction and employee satisfaction are linked, Palazzolo was looking to improve communication and satisfaction among his team, with the goal of improving the patient experience.

The clinic, which has been in existence for over 4 years, provides perioperative risk assessments and pre-operative risk optimization for scheduled surgical patients for the majority of surgical departments. Its patients are primarily adults—12,000 patients a year and growing—from ophthalmology to cancer to orthopaedic surgery, who have complex medical problems or potentially difficult airways.

Clinic staff sees 50 to 70 patients a day with appointments that last about an hour each.

The clinic has a full-time staff of 10 PAs, two registered nurses and five medical assistants. Rotating anesthesia staff as well as PAs and nurse practitioners from other surgical services also provide pre-operative care in the clinic space.

Since the clinic began its lean journey:

• Employee engagement (a willingness to recommend your area to other employees) has seen a jump from 53.3 percent in March 2009 to 82.3 percent in March 2012.
• Employee satisfaction, measured by the Lean Culture Survey, has seen an overall improvement of 20 percent. The two largest improvements—working in a fear-free environment and seeing waste and problems as opportunities—have risen 36 percent and 31 percent, respectively.
• Time from patient check-in to check-out decreased 17 minutes—from 97 minutes to 80 minutes.
• Employees submitted 170 everyday lean ideas —from assigning patients to employee workflow.
• In their most recent survey, 90.9 percent of patients were pleased with the care they received, and 95.8 percent would schedule another appointment with the clinic.

Palazzolo attributes these successes to a number of lean-in-daily work activities, including 10-minute daily huddles in which the entire staff meets at the clinic’s metric board to discuss what they can do better or differently. Each employee takes the lead for a full week. “So we all own it,” he says.

“With our patients’ needs, what we do can be very complex. Lean helps us achieve highly coordinated patient-centered care.”

Associate Dean for Clinical Affairs and Professor of Internal Medicine Jack Billi, M.D., agrees. “The Pre-Op Clinic at Domino’s Farm’s is a ‘model line’ for the Michigan Quality System’s lean in daily work system,” Billi says.

“Bill and his staff integrate robust teamwork, visual management and structured problem-solving into how they do their work every day. Their employee engagement and patient satisfaction results prove out the lean maxim that ‘Good process produces good results.’”

“We aim to put patients first. That’s why we focus on breakdowns in process,” says Jeffrey Myers, M.D., A. James French Professor, and director of the Divisions of Anatomic Pathology and MLabs. AP provides diagnostic and consultative services in the areas of surgical pathology, cytopathology, neuropathology, dermatopathology, and renal and autopsy pathology for U-M and outside health care organizations.

The last time the Division of Anatomic Pathology lost a specimen was 1 year, 25 days ago, and counting. It’s an amazing feat considering that AP processes about 85,000 pathology specimens a year—and that every single one of those specimens goes through 17 separate steps.

Dr. Jeffrey L. Myers, director, Anatomic Pathology and MLabs, and John Perrin, quality assurance coordinator, Department of Pathology, stand in front of the “No Time to Lose” clock outside the Anatomic Pathology and Histology labs in the main hospital. The clock is Myers’ brainchild, and Perrin has the key. Every day, the AP team works to prevent errors—and no one wants to restart the clock.

If you do the math, AP’s current risk of losing a specimen is 2.94 per million opportunities. Their performance surpasses the Six Sigma level, the quality standard of “near perfection.”

They credit their success to a lean journey that began when Myers took the helm in 2006. Myers came to U-M from Mayo Clinic, where he also led lean endeavors.

By 2007, Myers began introducing lean training, lean teams and onsite gemba walks throughout AP that have paid off big by reducing lost specimen errors for weeks, months, years at a time—and by reducing lead times for selected services by 50 percent.

AP’s average turnaround time went from 7 days in 2005 to about 3 days currently.

These improvements occurred while AP’s workload rose 25 percent—from approximately 68,000 specimens in FY2007 to about 85,000 in FY2012.

As a result of lean thinking, AP has:

• Implemented an operating room (OR) runner to bring specimens to the lab, freeing up OR nurses to spend more time with the patient. For permanent specimens alone, average time of delivery fell from 1 hour, 19 minutes to 7 minutes—an 88 percent decrease.
• Eliminated the opportunity for specimens to go missing by creating an action plan to limit distractions for lab staff, reorganizing the lab bench to work towards single piece flow, and standardizing workflow.
• Developed a lost-specimen policy and orienting new residents, pathology assistants, histotechnologists, fellows and faculty.
• Created an environment in which technicians are encouraged to “stop the line” and ask for help when they are having difficulty with a piece of tissue.

Myers has elevated the visibility of lost specimen errors—by installing a clock outside of the Anatomic Pathology and Histology laboratory that continuously ticks off time AP has spent with no lost specimens. The clock creates transparency around this key value metric.

John Perrin, quality assurance coordinator for Pathology, says, “The last time we had to reset the clock, everyone stopped me in the halls to ask what happened, what caused the error. They were all very concerned.”

Where patients are concerned, pursuing perfection is AP’s goal—and every second counts.

To view videos about U-M Pathology, visit:

Part 1, http://www.youtube.com/watch?v=0C8bA_zaCjg

Part 2, http://www.youtube.com/watch?v=nVmEF_HaLs4&feature=relmfu

Part 3, http://www.youtube.com/watch?v=4IeuuPAIhR4&feature=relmfu

The new law requires the Michigan Department of Community Health to develop educational materials and training about concussion-related injuries and treatments for athletes, parents and coaches. It also requires coaches to immediately remove athletes suspected of having concussions from play and let them return only after getting a health professional’s written approval.

Where concussion education is concerned, U-M is already ahead of the game, thanks in no small part to Teddy’s efforts.

Michigan NeuroSport’s concussion education website, which Teddy developed, contains free education modules for parents as well as youth and high school coaches.  Coaches can receive a certificate of completion if they successfully answer the quiz at the end of the module. A student athlete edition is coming soon. The information is endorsed by the American Academy of Neurology.

C.S. Mott Injury Prevention Program Manager Amy Teddy represented U-M by testifying about the need for concussion education and being present at the signing of a new Michigan concussion education law.

Teddy has also been involved in Michigan High School Athletic Association’s decision to have its required online rules meetings for coaches and officials include Michigan NeuroSport’s education module.  The module illustrates the serious nature of concussions; recognition of the signs and symptoms; and a review of return to play protocols.

Further using technology—and supported by a Fostering Innovation Grant (FIGS)—in partnership with NeuroSport, Teddy developed a 99-cent iPhone app called Return 2 Play, which can help athletes through concussion recovery. An Android version of the app will soon be available in 2013 thanks to a second FIGS grant.

“Return2Play helps concussion patients track their activities and symptoms, and share that information with their health care team,” Teddy says. The app is a complement to the online materials and was developed by the same vendor, TorranceLearning of Chelsea, Mich.

Under the direction of a physician, the patient—or a parent or coach—can enter activities, symptoms and their severity, notes, and appointment dates to the app. Return2Play allows users to email a recovery progress history in chronological order to a physician, trainer or coach.

Teddy emphasizes that the app is not a tool for recognizing concussion.

A member of the Mott team for the past five years, she remarks that her work in concussion injury was spurred by one patient in particular.

“Spencer inspired me to continue to do more about concussion. He suffered for months, and it was so preventable. His story really highlights the importance of educating those on the front line of youth athletics.”

Teddy invites everyone to download Return2Play, check it out, and post an opinion.

“We’d love to know what’s missing, what’s clunky, what could work better. Anyone who has had some experience with apps could give us the benefit of their knowledge.”

It will cost 99 cents, but to improve concussion recovery education for young athletes, the benefits are priceless.

To read more about Return2Play, visit http://umhsheadlines.org/24/tracking-concussion-recovery-is-as-easy-as-picking-up-your-phone-with-new-app-from-u-m/

Gabe Owens, M.D., Ph.D., clinical assistant professor, U-M Congenital Heart Center.

This is the second time the UMHS team has traveled to El Salvador as part of an international collaborative sponsored by Gift of Life International (GOLI). After the team’s visit last year, GOLI and Hospital Bloom asked that they return.

This time, the team trained the Salvadoran surgeons to perform more advanced cardiac surgeries on lesions such as tetralogy of Fallot and atrioventricular septal defects (AVSD). They also continued training on the new echocardiogram machine concentrating on transesophageal echocardiography, trained a newly hired perfusionist, enhanced the skills of the ICU nurses and respiratory therapists as they began taking care of more complex patients, and helped improve communication among the entire pediatric cardiac team.

In addition, they provided training in diagnosis, medical management, cardiac anesthesiology, post-operative cardiac care, intensive care nursing, and discharge planning.

“The goal for the entire international collaborative has been to help El Salvador develop its own sustainable pediatric cardiac surgery program,” says team leader Lisa Beckman, BSN, MSMI, Pediatric Cardio-Thoracic ICU (PCTU).

Wendy Watson, Respiratory Therapist holds one of her patients

That goal is close to being achieved. After several successful missions with several institutions, including U-M, Hospital Bloom’s pediatric cardiac program can now perform close to 150 surgeries a year, providing previously unavailable medical treatment to children with significant heart disease.

“There is no greater reward than seeing the pride on the faces of the Salvadoran cardiac team as they successfully care for and ‘cure’ one of their own desperate children,” says Gabe Owens, M.D., Ph.D., clinical assistant professor, U-M Congenital Heart Center.

“Having the University of Michigan involved in this type of program highlights the incredible efforts of the Congenital Heart Program and exemplifies the desire to help children locally and afar, further pushing us as a leading pediatric cardiac center,” he adds.

“One is forced to think about the patient and the physiology in a different light, without one’s usual technological resources,” says Owens. “You end up with a rejuvenated respect for medicine and nursing care.”

In addition to the missions to El Salvador, this past summer, the Congenital Heart Center here at the University of Michigan hosted an intensivist, a nurse manager and a senior staff nurse from El Salvador.

“Our Salvadoran colleagues were of course impressed with our beautiful new Children’s Hospital when they visited,” says Beckman. “But what they were most impressed with was our multidisciplinary collaboration and teamwork in the PCTU.”  They soon began incorporating these lessons in their own Pediatric Cardiac Program in El Salvador.

If you would like to learn more, read the 2012 mission trip report.

The Oct. 4 drill simulated the detonation of an improvised nuclear device in Detroit, resulting in 150 simulated victims arriving at the Adult Emergency Services (AES) and new Children’s Emergency Services (CES) at the U-M Hospitals and Health Centers. The full-scale exercise was intended to increase hospital all-hazard preparedness and to specifically increase hospital and regional nuclear incident preparedness.

One hundred victim scenarios were simulated at AES with 50 more at the Children’s ED.  The drill gave UMHS an opportunity to test our Code D (Disaster) Plan, Burn Surge Plan, Radiation Incident Procedures, and decontamination operations.  It was also the first ED drill conducted at the C.S. Mott Children’s and Von Voigtlander Women’s Hospital.

UMHHC staff, U-M School of Public Health employees, EMT students from Huron Valley Ambulance, and children of staff members all volunteered to be victims during the drill.

The Victims

Victims were played by more than 30 UMHHC staff, U-M School of Public Health employees, Emergency Medical Technician students from Huron Valley Ambulance, and children of staff members who volunteered to be victims during the drill. Volunteers drew cards instructing them on their roles, which included patients exposed to radiation or contaminated with radioactive material, burn victims, and victims immobile or unable to hear or see.

Volunteers were dropped off in front of both emergency entrances and triaged by ED nurses through the decontamination tent as necessary, before entering the ED.   Some of the volunteers agreed to get wet to allow staff the opportunity to practice decontamination processes.

What We Gain

Bruce Cadwallender, Director of Safety and Emergency Management, along with Carrie Wright, Emergency Management Specialist, planned and executed the drill for UMHHC, in partnership with many other staff and faculty from AES, CES, and other departments.

“To paraphrase from military experience, we perform the way we train,” said Cadwallender. “When we press ourselves in drills and exercises, we practice critical skills, while also identifying opportunities for improvement.”

“Conducting exercises and drills helps our organization to identify our strengths, test our emergency plans, and identify gaps in our overall response to incidents,” says Wright, who writes the UMHHC emergency response plans and develops the exercises to test these plans.

Radiation monitoring devices brought by RSS for the CES exercise.

Occupational Safety and Environmental Health/Radiation Safety Service were represented well, with six RSS staff members participating in the exercise.   The group provided simulated health physics support (including pre- and post-decontamination monitoring of victims) and helped evaluate the drill’s adherence to the established UMHHC Radiation Incident Procedures at both EDs.

“Practice makes perfect and when we have the opportunity to exercise our abilities in mass casualty response from a healthcare perspective it can only increase our chances of properly handling a critical situation in crucial time,”  added Matthew Walter, M.P.H., C.I.H., Environmental Health and Safety representative, Safety Management Services.

Walter served as an Adult ED Safety Officer, which involved identifying and correcting unsafe conditions during the decontamination of victims.  He also made sure staff remained safe while managing the response process.

Radiation Safety Service staff scan a decontaminated victim to avoid contaminating the inside of the ED or personnel without personal protective equipment.

After the clinical portion of the drill, participants attended a debrief session to discuss strengths, lessons learned, and improvement opportunities.  Many suggestions involved patient flow and staffing needs.  Additional observations for improvement dealt with decontaminating patients, contamination control, and controlling the traffic flow into the ED.

Emergency Operations During a Disaster

In the afternoon, the second phase of the exercise focused on activation of the Emergency Operations Center (EOC).  The EOC is a dedicated, fully staffed and equipped room used to manage emergencies and disasters.  The EOC was staffed by members of the Incident Management System Team (IMS) from Hospital Administration, Office of Clinical Affairs, Public Relations, Safety Management Services, Hospital Security, Facilities, Materiel Services, Nursing, Legal, MCIT, Admission & Bed Coordination, Infection Control & Epidemiology, Survival Flight, Social Work, EOC support staff, and physician leads from Nuclear Medicine, Trauma Burn, Hematology/Oncology, Otolaryngology, Ophthalmology, Pediatrics, Hospitalists, AES  and CES.

The role of the IMS team is to work together to manage the event.  This includes managing the communication response internally among UMHS staff, externally to the public, and also with other hospitals impacted by the simulated disaster scenario.

Public Relations staff practiced getting the word out about the disaster through media, social media, and internal channels. Other team members gathered information from departments on supply management, pharmaceutical supplies, blood supplies, bed capacity, and potential cancelation of elective surgical cases.   Departments responded to these requests for information as they would in a real event.  IMS Team discussions included the expected influx of patients requiring decontamination and treatment, staffing for a prolonged event, staff safety, access control, traffic control and whether to evacuate or shelter-in-place.

Now UMHHC Security and Entrance Services is the recipient of C.S. Mott’s 2012 Evan Newport HOPE Award as the year’s outstanding program or service that best exemplifies what patient and family-centered care is all about.

“Winning this award acknowledges that Security and Entrance Services staff are successfully achieving their long-standing, ongoing mission to be irreplaceable partners in the healthcare team,” says Director, UMHHC Security and Entrance Services, Marilyn Hollier, CPP, CHPA.

Marilyn Hollier, CPP, CHPA, director, UMHHC Security and Entrance Services, and Perry Spencer, manager of Uniformed Operations, Security and Entrance Services, display the 2012 Evan Newport HOPE Team Award

Security work, because of its very nature, is full of nuance—and the need for flexibility. Particularly so for security operations that take place within a healthcare environment.

Because Security Operations, for instance, recognizes the difference between working as a security officer in an adult hospital versus one working in a children’s and women’s hospital, it has identified a core of 15 officers with a lead officer who are assigned to C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital.

In addition, due to the nature of their jobs, Security has representatives on the Decedent Affairs Bereavement Committees (both adult and pediatric) and the Diversity at End of Life Committee. The diversity committee was actually formed after Security noticed a difficulty on the part of clinical staff when faced with the grieving behaviors of diverse cultures.

“Our department recognized that education was required not only on the diversity issue but the resources that were available to staff upon the imminent or sudden death of a patient,” says Hollier.

When the new C&W Hospital opened, one of Security’s biggest culture changes was establishing an employee entrance and reserving the main entrance for patients, families and visitors.

“Change is never easy but it was important that the Guest Service Specialists (security screeners) working in the main lobby be able to easily differentiate between employees and customers,” Hollier says. “It’s gratifying now to stand in the lobby and watch as patients and families are greeted, assisted/screened and badged, without undue delay because there is an entrance that is reserved just for them.”

Security plays a major role in enforcing the family presence and visitation policy in ways that also take account of special situations. Working as mediators between staff and family, they locate places for family members to spend the night, provide a link between the unit and the family, and ensure that safe limits are adhered to.

UMHHC Security and Entrance Services receives C.S. Mott’s 2012 Evan Newport HOPE Award

The Guest Service Specialist division issues parent, grandparent and spouse cards which identify families who can have a 24/7 presence.

Security has even encouraged and supported family presence during procedures including emergency procedures such as cardiac arrests.

Hollier says, “Our employees are a dedicated group who do more than ‘just the job.’ They get involved, listen to the patient’s story, and give patients and families outstanding support each and every day.”

When Philip Zazove’s parents discovered their four-year-old son was deaf in 1955, they were given a best-case-scenario they wouldn’t accept: that he’d complete special education classes, get a non-skilled job and be “functional.”

Instead, Zazove went to college, then medical school and on to become the third known deaf doctor in the country.

Today, along with his family, Zazove, M.D., clinical professor and interim chair of Family Medicine, University of Michigan, aims to help other deaf students achieve their goals through the Louise Tumarkin Zazove Foundation. The national foundation awards high-achieving deaf students with college scholarships.

Louise Zazove persistently pursued her dream of being a physician during an era when few women were accepted into medical schools. She then helped make sure her son achieved his own dreams.

“Once you get in the door, you want to open the door for other people,” says Zazove, 61, a Chicago native. “Access to education is one of the biggest barriers for people who are deaf and hard of hearing.”

The foundation is a fitting memorial for Zazove’s mother Louise who not only advocated for her son’s education rights but her own. The eldest child of poor Russian immigrants, Louise dreamed of being a physician herself but it was an era when few women –especially Jewish women – were accepted at American medical schools.

Undeterred by several rejections, Louise was ultimately accepted into Chicago Medical School as the only woman in an entering class of 92 students.

When Louise learned her son was deaf, she learned all she could about deafness, consulted experts and devoted herself to seeking the best ways to educate him. She and Zazove’s father Earl, also a doctor, made a radical decision: to send their son through public schools so he could thrive in the hearing world.

It meant adamantly protesting when teachers asked to move their son out of mainstream classes, advocating for accommodations when necessary, and even visiting skeptical college admissions directors who couldn’t believe how well their son had excelled in high school.

“My parents fought hard so that I would be treated the same as everyone else. If it wasn’t for them, I wouldn’t be here,” Zazove says. “They always told me I could do whatever I wanted to do.”

“My mom really valued education because it was the reason she succeeded,” he adds. “It’s gratifying to see this foundation make a difference for other people and to help them succeed. It honors my mother. It continues her work.”

The foundation awards roughly $25,000 a year and has helped more than 25 students from around the country since being established in 2003.

The scholarship has made a big difference to recipients such as Alison Stroud, 28, who is now pursuing a master’s degree in public policy, specifically on disability rights, at U-M.

Philip Zazove, M.D., interim chair of Family Medicine at U-M and late mother Louise. The Louise Zazove foundation helps deaf students pay for college. “It honors my mother. It continues her work,” he says.

“It allowed me to focus more on school and not worry so much about paying for tuition. Additionally, having the scholarship proved to be a continual reminder that there are people besides my family who believe in me,” she says.

Stroud, who was born profoundly deaf, has spent a lot of her life convincing others of her capabilities. The three-sport, high-school athlete had to prove to basketball, volleyball and softball coaches that she was a key player when she had visual cues in the game. In high school, she worked hard not to fall behind in classes that required listening and note-taking. In social settings, she had to ask people to slow down conversation so she could read lips.

She credited the Zazoves for investing time and resources to help others through the foundation.

“I think it is amazing the Zazove family is willing to take time out of their already hectic schedules to help provide opportunities for young students so that they can continue the hard work and education they need to do to achieve their dreams,” she says.

“The Zazoves, especially, Phil, are very insightful and understanding that deaf and hard of hearing students usually, if not always, must work harder and longer hours than an average student to overcome the communication barriers and succeed.

“The Zazove Foundation did not just help me pay for my tuition. The scholarship, as well as Philip Zazove, inspired me to become a stronger advocate for people with disabilities.”

To learn more about the foundation, visit the website at http://www.ltzfoundation.org/.