Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF September 6, 2019 | Archived Issues

President's Perspective: Systemness

By Thomas M. Priselac, President and CEO

What does it mean to be a health system? As Cedars-Sinai Health System continues to evolve, it is a good time to take stock of where we have been, review some key principles and consider what the future will hold.

» Read more

Albert, MD, Named Founding Chair in Cardiology

Following an extensive national search, physician-scientist Christine M. Albert, MD, MPH, has been named founding chair of the newly established Department of Cardiology at the Smidt Heart Institute. The new Department of Cardiology that Albert will lead aligns with another new department, the Department of Cardiac Surgery.

» Read more

Physician Wellness Tip: Walking to Better Health

Walking helps you stay fit and healthy. Being active even lowers your risk for serious health problems, like heart disease, stroke, Type 2 diabetes, depression and some cancers. Check out this whiteboard video by Mike Evans, MD.

» Read more

Letter From Chief of Staff: Sexual Harassment Prevention Training

By Clement C. Yang, MD, Chief of Staff

In order to ensure a safe and supportive workplace, the Medical Staff has partnered with Cedars-Sinai to implement a new online sexual harassment prevention training program. The new program offers a smoother experience and more relevant content on both sexual harassment and civility.

» Read more

Flu Shots for Staff Coming to Cedars-Sinai

Staff members are asked to help Cedars-Sinai protect patients, visitors and colleagues by getting an annual flu vaccination by Friday, Oct. 18. The 2019-20 flu season is expected to extend from Nov. 1 to April 30. All employees, medical staff, vendors, contracted personnel, volunteers, faculty and students must get their annual flu vaccinations. Exceptions may be given for those with approved medical exemptions per guidelines from the Centers for Disease Control and Prevention.

» Read more

Task Force Lowers Turnover Time in Robotic Cases

A multidisciplinary task force reduced turnover time in fifth floor robotic surgery rooms from an average of 73 minutes to 45 minutes, freeing up staff time and allowing for extra surgery cases on the schedule. After closely observing 20 transitions, watching the progress from start to finish, the group identified several system inefficiencies.

» Read more

Morris C. Katz: 1927-2019

Morris C. Katz, an active member of the medical staff in the Department of Medicine who began at Cedars-Sinai in 1980, has died. He was 91. For more about Katz, see his Los Angeles Times obituary.

» Read more

Call Goes Out for Christmas Extravaganza Performers

The Spiritual Care Department is seeking actors, comedians, singers, dancers, magicians, poets and other talented employees for its annual event.

» Read more

Are You a Veteran? Let Us Know

Were you in the military, or do you know a co-worker who was? For Veterans Day, The Bridge wants to honor Cedars-Sinai's military veterans. Please email thebridge@cshs.org to let us know when and in which branch you served, and any notable details about your service. Also, please include your current position at Cedars-Sinai.

» Read more

CS-Link Tip: Order Panels

CS-Link-co.jpg

In CS-Link™, clinicians can now create their own order panels in the regular ordering workflows. Clinicians can select some orders in the "Visit Taskbar," then click "Create Panel" to save a new panel containing those orders to their preference list. For more information, visit the CS-Link Tips and Training website.

» Read more

President's Perspective: Systemness

By Thomas M. Priselac, President and CEO

What does it mean to be a health system? As Cedars-Sinai Health System continues to evolve, it is a good time to take stock of where we have been, review some key principles and consider what the future will hold.

In the 1990s, as consumers began seeking more ways to conveniently access more coordinated, higher quality and efficient care, hospitals and physicians began forming new relationships, recognizing that a new framework was needed to better serve patients and the community.   Cedars-Sinai's evolution began during that time with the formation of the Cedars-Sinai Medical Network.

The development of our health system has greatly accelerated in the past few years, with the addition of many quality medical practices throughout the region, along with the continued expansion of our faculty and academic programs; the opening of new Cedars-Sinai primary care and urgent care facilities; the acquisition of Marina del Rey Hospital; the creation of the Cedars-Sinai Health System and the affiliation with Torrance Memorial; and joint ventures such as the California Rehabilitation Institute (partnering with UCLA Health and Select Medical), Providence Cedars-Sinai Tarzana Medical Center and the Vivity HMO plan (where we are partnering with Anthem Blue Cross and six other prominent local health systems). 

There are several key principles reflected in the development of our system. The first is that the system's purpose is to best serve the community and carry out our mission of providing accessible, affordable care of the highest quality. The question then becomes how best to do that in a large, densely populated urban area with both a diverse patient population and diverse physician and hospital community. Answering this question in the Los Angeles area leads to the second principle, pluralism, which recognizes that the health system must balance the needs and goals of each of its entities within the larger goals of the health system.

A third principle is that the success of the system will be defined by the success of each of its entity organizations, and that the role of the health system is to enable its organizations and physicians to better serve their patients and their local communities.

Some examples of Cedars-Sinai Health System's pluralism are in the variety of different structures and organizational relationships: Torrance Memorial and its physicians—with an excellent reputation and longstanding strong relationship with the South Bay community—operates separately but coordinates with the rest of the health system in numerous ways; Marina del Rey Hospital was an acquisition purchased and now operated by Cedars-Sinai; and our joint ventures, such as the California Rehabilitation Institute, provide yet another structure for more convenient and coordinated expert care. In all cases, our goal is to have each relationship, regardless of organizational structure, best meet the healthcare needs of the patients and communities served and enable high-quality, accessible and efficient clinical care.

Within each of these relationships are certain common strategies being pursued to achieve the goals and purpose of the system.

Shared expertise (clinical and nonclinical)

Enabling each organization in the system to better meet the needs of its community includes enhancing the scope of available clinical services. Cedars-Sinai physician sub-specialists and their teams (in neurology, heart, cancer and neurosurgery, for example) have already helped numerous patients at Cedars-Sinai Marina del Rey Hospital and are partnering with their colleagues at Torrance Memorial to complement the excellent care already provided. Also, our nonclinical leaders in Quality Improvement, Finance, Enterprise Information Services and Human Resources are working with their counterparts throughout the health system to enable all of us to operate more effectively and efficiently.  In addition, clinical and nonclinical teams from the various organizations are working on common interests such as patient flow and reducing opioid use.

Coordination of care

Sometimes a patient needs highly specialized care, and at other times they don't.  Our health system can serve them best by having them cared for in the most appropriate facility.  The various hospitals and outpatient centers in the health system have been working hard to coordinate care among the different facilities so that it is as easy as possible for patients to receive a higher level of care when needed and—just as importantly—be treated at a facility closer to home when they no longer need a higher level of care.

Economies of scale

By centralizing purchasing (such as supplies, pharmaceuticals and equipment), all of the institutions within the health system have begun seeing cost savings as a result of the larger purchasing volume.  In addition, teams are working in every administrative area to identify the best approaches to optimize effectiveness and reduce operating costs.

Cedars-Sinai Health System will continue to grow and evolve in the years ahead, using a pluralistic model that enables a variety of structures. What doesn't vary throughout the system, however, is our shared commitment to a culture focused on meeting the needs of the patients and communities we serve. Our ability to do that in multiple geographic locations is greatly enhanced by the use of technology and other innovations. But more than anything else, our ability to succeed depends on each of you. Thank you for all you have done to make us who we are. I look forward to working with you as we build our path for future success.

 

Albert, MD, Named Founding Chair in Cardiology

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Christine M. Albert, MD, MPH, is the founding chair of the new Department of Cardiology at the Smidt Heart Institute. 

Following an extensive national search, physician-scientist Christine M. Albert, MD, MPH, has been named founding chair of the newly established Department of Cardiology at the Smidt Heart Institute.

"Dr. Albert is a national cardiology leader with seminal clinical and scholarly contributions toward better understanding of heart rhythm disorders, one of cardiology's great mysteries," said Eduardo Marbán, MD, PhD, director of the Smidt Heart Institute. "She is a highly respected cardiovascular and preventive medicine specialist, and will no doubt help us conquer heart disease, the world's leading cause of death."

The new Department of Cardiology that Albert will lead aligns with another new department, the Department of Cardiac Surgery. Both departments are part of the Smidt Heart Institute, which encompasses all Cedars-Sinai heart care, research and education under the leadership of Marbán. Albert will have responsibility for leading the strategic direction of clinical, operational, academic and research programs in the Department of Cardiology.

Albert's leadership will build on institute accomplishments that include the leading heart transplantation and transcatheter valve repair and replacement programs in North America, as well as a robust research program in Albert's specialty, heart rhythm and sudden cardiac death. Cedars-Sinai is ranked No. 3 in the U.S. for Cardiology and Heart Surgery by U.S. News & World Report.

Albert has more than 160 peer-reviewed publications and serves on various editorial boards of scientific journals. She is president-elect of the highly respected Heart Rhythm Society and the principal investigator on two large ongoing research projects funded by the National Institutes of Health. One of her current research projects is a 5,800-patient, multicenter clinical study that aims to identify those at increased risk for sudden cardiac death by employing combinations of clinical, lifestyle, biomarker, genetic and imaging data.

Albert joins Cedars-Sinai from Boston's Brigham and Women's Hospital where she directs the Center for Arrhythmia Prevention and is a professor of Medicine at Harvard Medical School.

"Dr. Albert is best-known for making major contributions to understanding how diet and lifestyle affect heart rhythm disorders, including atrial fibrillation and sudden cardiac death," said Shlomo Melmed, MB, ChB, executive vice president and dean of the Cedars-Sinai faculty. "The impact of her scientific and clinical achievements is far-reaching."

Albert earned her medical degree and master of public health at Harvard, and completed her clinical fellowships in cardiology and cardiac electrophysiology at Massachusetts General Hospital and a research fellowship in epidemiology at Brigham and Women's Hospital, both in Boston. She is board-certified in cardiovascular disease and cardiac electrophysiology and is a graduate of the Executive Leadership in Academic Medicine program.

In addition to the new Department of Cardiology led by Albert, the Smidt Heart Institute has created a new Department of Cardiac Surgery that will be led by Joanna Chikwe, who also joins Cedars-Sinai this fall from the Mount Sinai Health System in New York.

 

Physician Wellness Tip: Walking to Better Health

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Walking helps you stay fit and healthy. Being active even lowers your risk for serious health problems, like heart disease, stroke, Type 2 diabetes, depression and some cancers. Check out this whiteboard video by Mike Evans, MD.

Yet more than half of adults in the U.S. don't get enough physical activity. What is enough? Adults need at least 2.5 hours—and children about an hour—of "moderately intense" aerobic activity each week for better health. This can include walking briskly, dancing, gardening and biking. A good test to see if your workout is making an impact is whether you can talk, but not sing, as you're doing it.

Besides the numerous fitness center discounts available to you, the next time you are on campus try taking the stairs instead of the elevator. Not only might you find it faster, but you will discover hand painted murals and quotes to inspire your day.

Letter From Chief of Staff: Sexual Harassment Prevention Training

In order to ensure a safe and supportive workplace, the Medical Staff has partnered with Cedars-Sinai to implement a new online sexual harassment prevention training program.

The new program offers a smoother experience and more relevant content on both sexual harassment and civility.

As a reminder, the Medical Staff Rules and Regulations require a two-hour training which must be completed at initial appointment and reappointment. The 45-minute "refresher" course will no longer be available.

Physicians and Allied Health Care Professionals who supervise five or more employees should note that the new training also satisfies a new state law, SB 1343, which becomes effective January 1, 2020.

We hope this update will be beneficial to you all, and we thank you for your continued support and commitment to helping Cedars-Sinai provide a safe workplace environment.

Clement C. Yang, MD
Chief of Staff

Flu Shots for Staff Coming to Cedars-Sinai

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All employees, medical staff, vendors, contracted personnel, volunteers, faculty and students must get their annual flu vaccinations.

Staff members are asked to help Cedars-Sinai protect patients, visitors and colleagues by getting an annual flu vaccination by Friday, Oct. 18. The 2019-20 flu season is expected to extend from Nov. 1 to April 30.

All employees, medical staff, vendors, contracted personnel, volunteers, faculty and students must get their annual flu vaccinations. Exceptions may be given for those with approved medical exemptions per guidelines from the Centers for Disease Control and Prevention (CDC).

Those who decline the vaccine without an approved medical exemption or religious accommodation will not be able to work and are subject to termination of employment.

Flu vaccinations are free of charge and will be available to all employees, medical staff and volunteers. Vaccines have been ordered, and a schedule of flu clinics will be emailed to all employees soon and will be available in issues of The Bridge and on the intranet homepage.

All vendors and contracted personnel must provide proof of vaccination and wear badge buddies while they are in any Cedars-Sinai-licensed area. If they wish to get their flu vaccination at Cedars-Sinai, they will have to show their ID badge and pay a $25 fee; however, the fee will be waived if the vaccine is received during the flu clinics Sept. 9-Oct. 18.

"Influenza is a serious infection, particularly for our most vulnerable patients who count on us to provide them with safe care through the flu season. Vaccination is the most important step towards protecting ourselves, our families and our patients from the complications of influenza,” said Jonathan Grein, MD, medical director, Department of Hospital Epidemiology, and infection control officer. "Thank you to all staff for continuing to provide for the health and safety of our patients and their families."

Employees with a confirmed egg allergy that has been documented with Employee Health Services (EHS) may schedule a vaccination appointment with EHS in My CS-Link™.

Green badge buddies will be issued at the time of vaccination, and people with an approved medical exemption or religious accommodation will receive a gray badge buddy. All badge buddies must be visibly worn by Nov. 1. These HIPAA-compliant badge buddies are the easiest method to ensure all employees are in compliance with Cedars-Sinai policy and the County of Los Angeles Public Health Order.

Per the County of Los Angeles Public Health Order, masks must be worn in all patient care areas, even by those with an approved medical exemption or religious accommodation. For those employees with an approved medical exemption or religious accommodation, masks are not required to be worn in nonpatient care areas such as administrative offices, cafeterias, break rooms and parking lots.

To request a medical exemption, an employee must have a medical provider complete the Physician's Verification of Request for Medical Exemption From Influenza Vaccination form available from EHS. The request for exemption will be reviewed by a physician panel, who will determine if it meets criteria for an exemption based on CDC guidelines. Please return the completed form to EHS on the second floor of Spielberg by Friday, Oct. 18.

Employees requesting a religious accommodation should contact their HR business partner or call 310-423-5459 to receive the Request for Religious Accommodation form. Completed forms are given to your HR business partner. Your request will be evaluated, and an approval or denial letter will be issued to you. The deadline to request a religious accommodation is Friday, Oct. 18.

Family members of employees are invited to get their vaccines on Sunday, Oct. 27, 10 a.m.-noon, at the Ambulatory Care Center on the second floor of Spielberg. During this time, vaccines also will be available for community members over the age of 18. Vaccinations for children 6 months or older will be available for children of employees only.

For more information, please call EHS at 310-423-3322 or Hospital Epidemiology at 310-423-5574 or read the FAQs below.

Flu Immunization Policy FAQs 2019-20 (PDF)

Task Force Lowers Turnover Time in Robotic Cases

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Some members of the multidisciplinary team that helped reduce turnover time in the fifth floor robotic surgery rooms are shown.

When general surgeon Daniel Shouhed, MD, first explored opportunities to improve efficiency and turnover time on the fifth floor robotic surgery rooms, he reached out to several individuals across disciplines.   

"I approached fellow surgeons, nurses, human factors researchers and performance-improvement experts," said Shouhed. "Everyone jumped at the opportunity to help understand how the system might be improved."

The multidisciplinary team reduced turnover time in fifth floor robotic surgery rooms from an average of 73 minutes to 45 minutes—thereby, freeing up staff time and allowing for surgery cases on the schedule.

"Instrumental to the success of this project was the commitment of staff to improve these processes," said Shouhed. "But first, we had to understand what caused our lengthy turnovers."

The team closely observed 20 transitions, watching the progress from start to finish. They noted each step, and the challenges individuals or teams encountered.  

"Our eyes were set on identifying inefficiencies in the system," said Tara Cohen, a human factors research scientist in the Department of Surgery who worked with Shouhed and team on the project.

The group identified several system inefficiencies, including clean-up time after each procedure, setup for the next procedure, preparation for the surgical bed mattress—a timely process of taping and its removal—and the transport of patients. 

Once the inefficiencies were addressed, the task force identified other groups of employees—including nurses, scrub techs, EVS personnel and log techs—who could describe the process behind each inefficiency and target potential solutions.

"The team worked to understand the barriers to efficient turnover time, without pointing blame at any one individual," said Cohen. "Collectively, the group reduced barriers to efficient flow without creating new roadblocks, all while bringing cost savings to the department."

Among their assessments, the team noted that nurses were responsible for both prepping rooms for surgery and transporting the next patient back to the operating room for their procedure—a dual role that was time-consuming and stressful.

Once this issue was raised, different individuals stepped up to help prepare the room, even if it wasn't their primary responsibility.

Nurses stepped in to help open instruments and assist with the count. Scrub techs volunteered to help keep the rooms as tidy as possible during the surgery to reduce the amount of cleaning required by EVS following the procedure. Moreover, anesthesiologists volunteered to wheel patients from pre-op into the operating room to reduce the time-consuming task for nursing staff.

Finally, the team developed a better method to deal with the foam-top mattresses, which are taped down before each procedure and then removed and replaced prior to the next surgery.

"Taping the mattress, then removing the tape post-surgery, was a time-consuming part of the process that fell to nurses and cleaning staff," said Cohen. "To make the process more efficient and inclusive, log techs intervened to assist with bed setup and breakdown."  

The task force hopes to take their approach beyond the 5th floor.

"We have seen tremendous success by merely opening up the dialogue and seeing where we can help people in a way that encourages openness, honesty and ongoing process improvement," said Shouhed.

 

Morris C. Katz: 1927-2019

Morris C. Katz, an active member of the medical staff in the Department of Medicine who began at Cedars-Sinai in 1980, has died. He was 91.

Katz, who was born on December 17, 1927, in Detroit, Michigan, and served in the medical corps of the U.S. Navy, received his medical degree from the University of California Irvine.

Katz's contributions and invaluable service to the medical center and to the community will be greatly missed.

For more about Katz, see his Los Angeles Times obituary.

Call Goes Out for Christmas Extravaganza Performers

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Danielle Matrow (left) and Gergory Eichelzer, MSN, RN, perform at the Christmas concert.

Although the weather still says summer, it's time to start thinking about Christmas! The Spiritual Care Department is gearing up for the 2019 Christmas Extravaganza, which will be held on Dec. 19 at noon in Harvey Morse Auditorium. Organizers are putting out the call for actors, comedians, singers, dancers, magicians, poets and other talented staffers.  

"The annual extravaganza aims to bring joy, laughter and celebration to all employees, patients and visitors," said Rev. Peggy Kelley, lead Christian chaplain and former improv performer. "We hope for a variety of performers and look forward to showcasing comedy pieces, Santa and perhaps even children and therapy dogs!"  

Auditions will take place in early October. Anyone interested in auditioning for the show should contact Janelle Beatty at janelle.beatty@cshs.org.

 

 

Are You a Veteran? Let Us Know

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Were you in the military, or do you know a co-worker who was? For Veterans Day, The Bridge wants to honor Cedars-Sinai's military veterans. Please email thebridge@cshs.org to let us know when and in which branch you served, and any notable details about your service. Also, please include your current position at Cedars-Sinai.

CS-Link Tip: Order Panels

In CS-Link™, clinicians can now create their own order panels in the regular ordering workflows. Clinicians can select some orders in the "Visit Taskbar," then click "Create Panel" to save a new panel containing those orders to their preference list.

Clinicians can give this panel a name of their choice. The next time the name is entered, or chosen from this panel preference list, the grouping will be there. 

For more information, visit the CS-Link Tips and Training website.

To learn more, attend a CS-Link Efficiency and Review for Physicians meeting on the second Thursday of each month. The classes, which begin at 7:30 a.m., are held in PEC 4.

If you have questions, contact groupeisphysicians@cshs.org.