I continue to enjoy following all the quality and patient safety work being led across the country by resident physicians. In this spirit, we want to share another wonderful example of how resident physicians are changing the landscape of quality and safety in healthcare for the better.
Description: In support of the Best Practices for Better Care Initiative commitment area to teach quality and patient safety to the next generation of doctors, this webinar will spotlight two institutional approaches to creating a culture of safety and openness by leveraging House Staff Patient Safety Councils to improve care processes and outcomes.
House staff patient safety councils create a culture of safety, engage residents in process improvement, and help satisfy ACGME requirements.
Objectives: We examined the associations of sociodemographic and social contextual factors with computer ownership and frequency of use among 1554 adults living in urban public housing.
Methods: Bivariate associations between dependent variables (computer ownership and regular computer use) and independent variables were used to build multivariable logistic models adjusted for age and site clusters.
There has been a growing emphasis on technology-based strategies to increase reach, efficacy, sustainability, and cost-effectiveness of preventive health interventions.
Certainly, disparities in health outcomes can be attributed to cultural and societal factors, such as access to health care [2], but health disparities in the United States are likely influenced by a lack of access to health information [3]. There have been very few studies of the association between social contextual factors and computer access and use. The previous restrictive "visitation" policy reflected in this sign at the entrances to the ICUs. The previous restrictive "visitation" policy reflected in an additional sign at the entrances to the ICUs. After moving to guidelines that promote and support family presence 24 hours a day, this is the messages that greets families and visitors at the entrances to the ICUs. Vidant Health's efforts to advance a culture of patient- and family-centered care began in the late 1990s in the James and Connie Maynard Children's Hospital and the Regional Rehabilitation Center at Vidant Medical Center.
The Vidant Health executive team and senior leaders heard these inconsistencies firsthand in the spring of 2007 when Christy Odom, an employee of the Regional Rehabilitation Center, shared her family's experiences during her brother's hospitalization in an adult intensive care unit at Vidant Medical Center. After hearing their employee Christy's experiences firsthand, the system's executive team, board of directors, and physician leaders committed to transforming the organizational culture to advance patient-family partnerships across Vidant Health. In 2009, Vidant Health established a Corporate Office of Patient-Family Experience to guide the spread of this cultural transformation across the entire health system, while respecting each Vidant Health entity's local culture and community. Patient and family advisors partner across the health care system with leaders, physicians, and front line staff on quality, safety, and patient experience teams.
In addition to engaging patient-family advisors on organizational decision-making teams, Vidant Health is committed to patients and families engaging as active members of their health care team. Connections—a collection of care experiences authored by staff at Vidant Medical Center. Since Vidant Health's executive and senior leadership team heard Christy's powerful story, the strategic use of storytelling has flourished across the system. Vidant Health's patient engagement curriculum, The REAL DEAL, connects to standards of performance: ownership, service excellence, commitment, and etiquette.
As a result of Vidant Health's long-range quality plan, and its practice of patient and family engagement, in 2010 Board members began to hear quality concerns directly from patients and families by inviting patients and families to board meetings to share their stories. Vidant Health continues to embed patient engagement in key documents and has established a team dedicated to advancing patient engagement as part of the system's clinical strategy to improve the health of eastern North Carolina. Advancing partnerships with patients and families is considered foundational for Vidant Health's future success and is a deliberate strategy.
Embedding committed patient-family advisors in meaningful roles at all levels of the organization, such as the design of the new cancer center, clinical integration for population health, and bedside registration within our emergency departments.
One of Vidant Health's projects for FY15 is the Small Hospital Improvement Program (SHIP) to improve the Patient and Family Experience in the Emergency Departments in five of its eight hospitals. I have lost my brother however, I know without a doubt that changes need to be made to make it a more positive experience for those coming behind my family. This is an exciting time for residential care design, as new architectural models bring great promise for enhancing the way elders relate to their physical environment, their families, caring staff, and other residents. In this article, we profile five extraordinary alumnae who have built successful careers in government, hospital leadership, research, nursing education, and advanced clinical practice. For Sally (Rogin) Dreslin ’94, serving as executive deputy commissioner of the New York State Department of Health often demands many of the same skills as working in a busy hospital emergency department, which she once did.
Many of Dreslin’s most important management skills—promoting teamwork, encouraging open communication, and prioritizing—were developed two decades ago during her nursing education and training at Columbia Nursing and in her early days in the ER.
Her experience as a practitioner also gives Dreslin credibility with the nursing staff in the department, many of whom also know how hard she fought to help pass the Nurse Practitioner Modernization Act—state legislation that allows advanced practice nurses in New York to work at the top of their license without a collaborative physician.
Her first step in starting her new career, enrolling in Columbia Nursing’s Entry to Practice program, introduced Velez to the clinical practice of nursing and also to what she calls “really the best health informatics program anywhere.” She went on to earn a master’s degree from the Mailman School of Public Health and a PhD in health informatics, focusing on the use of phones and mobile devices to improve the health of mothers and infants. At HealthEnabled, Velez is working to design and promote mobile health applications for use at the national level. Having a PhD in nursing research and a background in informatics has been a great advantage for Velez.
Velez says that Columbia Nursing gave her strong leadership skills and helped foster an interdisciplinary approach to tackling complex global health problems. Janet (Cook) Ready ’81 is the first nurse to serve as president of the University Medical Center of Princeton in Plainsboro, New Jersey. Ready leads the senior management team, oversees patient care services, and is responsible for maintaining the medical center’s high level of clinical quality and keeping it fiscally sound.
Overseeing strategy and operations, Ready is responsible for advancing innovations in care delivery and introducing new services, such as a neonatal unit that can care for premature babies born as young as 28 weeks, sophisticated robotic surgery capabilities, and a center for pelvic wellness. In her three decades as a hospital executive—with a six-year stint operating a large physician practice—Ready has found that when the going gets tough, she is quick to fall back on her basic nurse training. When it comes to designing a business strategy for the medical center, Ready’s decisions are made from a nursing perspective.
Marlissa Belay ’97 ’00 is a dedicated nurse practitioner immersed in what she calls the “art and science” of clinical practice.
In 2007 she developed a new approach that uses nurse practitioners to provide daily, on-site primary medical care for residents of long term care facilities. Belay believes she is filling a “huge unmet need” for primary care among the underserved population living in the area—especially residents of nearby Newark. Belay puts an emphasis on understanding the social and emotional sides of her patients along with addressing their physical health needs.
The confidence to go it alone came after several years of working in long-term care and on a surgical floor at Hackensack University Medical Center. That Columbia Nursing now offers such an option is due in no small part to Honig’s commitment and passion. Columbia Nursing admitted its inaugural class of 20 nurse practitioners into the DNP degree program in 2004—the first such program in New York and one of only a handful in the nation. As much as she loves her “little pediatric practice,” Honig continues to spend much of her time envisioning and shaping the future of nursing education.
Honig sees education as “super-important” in providing the chances to advance and grow over her long career. Research shows that the quality of your work environment directly impacts patient care and outcomes. NRCC Employee Experience tool is grounded in the Quality Healthcare Model and tailored to work effectively across the continuum for all healthcare settings and varying types of employees. When you measure the loyalty and commitment of your healthcare employees, you will find that work environment influences their level of dedication. The NRCC Employee Experience Survey measures the drivers, individual outcomes, and organizational outcomes describing a healthy and high-performing workplace. Healthcare models continue to evolve with increased focus on cross-continuum delivery and smoother care transitions. NRCC provides comparable measures and domains for other key stakeholder groups such as Patient Experience and Physician Experience. After your data is collected and reported back to you, NRCC works with your team to identify priority areas and create a plan of action.
For more information,call 866-771-8231, write to us, or join our email list to get invites to free educational webinars and more.

Many have come into healthcare with a much different perspective regarding quality, safety and outcomes than my generation did years ago. The AAMC webinar highlighted below,The House Staff Patient Safety Council: Creating a Culture of Safety and Openness, is being led by Nate Margolis and Say Salomon, both Telluride Patient Safety Summer Camp Scholar Alums, who are helping inspire resident physicians on how to lead change in their own academic institutions.
A successful resident driven project will be described in which the distribution of badge buddies, incident report guidelines, and an incident reporting presentation increased house staff adverse event reporting in a 3-hospital academic program.
Larger social contextual factors, such as social networks and neighborhood factors, may influence computer ownership and the number of places where individuals have access to computers. A unique finding of our study is that it may be equally as important to consider specific social contextual factors when trying to increase access and use among low-income minorities, such as social network ties, household responsibilities, and neighborhood safety.
It is well known that access to communication technologies is differentially associated with social class. It is likely in this regard that in addition to socioeconomic resources a combination of other factors, such as personal time constraints and multiple role responsibilities (eg, caregiving responsibilities) [11], as well as larger societal forces, such as social network ties and neighborhood factors, influence computer ownership and the number of places where individuals have access to computers.
This is an important omission because we posit that attempts to reduce communication disparities may fail if focused solely on sociodemographic factors. Vidant Health has primary and specialty physician office practices in over 70 locations, a 900-bed academic medical center flagship hospital, 7 community hospitals, ambulatory surgery center, and home health and hospice services. These efforts, while valuable for these clinical areas, failed to spread across Vidant Medical Center and Vidant Health, creating inconsistencies in experiences of care for patients and their families. She shared how the health system's visitation policy restricted her family's access to her brother to fifteen-minute increments, six times a day. Speakers from the Institute for Patient- and Family-Centered Care (IPFCC) and the Institute for Healthcare Improvement (IHI) provided educational opportunities and conducted a system-wide assessment of current and desired states of patient-family engagement. Advisors serve on performance improvement teams, make safety rounds, serve as faculty in education programs, interview applicants for key positions, serve on population health work groups, assist in facilities design and development, and develop and edit patient education materials. Patient engagement principles are imbedded in bedside strategies such as hourly rounds, bedside shift report, and leader rounds that include physicians and nurses functioning as a team. Individual's share stories during staff and leadership meetings, providing insights into experiences of care in ways that data and facts alone cannot. A patient with ventilator-associated pneumonia shared her experiences with the Board and stated, "That scorecard you see every month, I am one of those numbers." This patient's compelling story set the stage for a Patient Advisor to join the Board as a Patient Advisor on the Board Quality Committee for Vidant Health and Vidant Medical Center. Leaders from human resources, education, patient experience, and patient-family advisors developed a standardized patient engagement curriculum, which is incorporated into the continuous education of employees. Vidant Health knows that this type of cultural change takes time and does not happen overnight. A health library is available via the Vidant Health intranet with content linked to the patient portal.
For Columbia Nursing graduates the answer has long been “as far as you want to go.” Having participated in innovative programs in clinical nursing, research, and informatics, as well as taking advantage of opportunities to earn advanced degrees in public health, policy, and business, Columbia nurses are pursuing careers in a diverse array of fields. For these five women, nursing education has been a springboard to opportunity, allowing each to follow her unique passion and trajectory. Overseeing individuals and departments responsible for such major state programs as Medicaid, public health, health systems management, and quality and safety is “a very challenging, exciting position, and it’s important to be able to juggle corresponding crises and major policy initiatives, and negotiate with multiple stakeholders,” she said. Vincent’s Medical Center in New York City—the epicenter of the AIDS crisis—there were few treatments to offer the HIV-positive patients she cared for. After graduating with an undergraduate degree in computer science, she spent eight years designing software for use in health care settings. For example, the group is part of a team supporting the rollout of South Africa’s MomConnect program, a government initiative to register all pregnant women in the country and provide them with stage-based messages about pregnancy, birth, and care of an infant. For her, “Columbia Nursing was all about ‘you’re never just a nurse, you’re a leader, an advocate, you have to be in the political space at all times, you have to be in the research space at all times.’” By combining her skills in nursing, public health, and digital technology, Velez is advancing health care for women and children throughout the developing world. She is also the first woman to hold the position since the hospital’s founding 96 years ago. True to her background, Ready is dedicated to making University Medical Center more “patient-centric” by better managing care transitions— transitions— from hospital to home, for example—and care coordination between inpatient providers and primary care practices.
But Belay also possessea a savvy business sense that is breaking new ground for nurse entrepreneurs. The idea was to supplement the weekly or monthly visits physicians usually make to these centers, and manage emerging health issues before they require distressing and costly transfers to the hospital. Last year Belay added a new venture to her repertoire: She opened a private primary care practice in Montclair, New Jersey—one of only a few headed by a nurse practitioner in the physician-heavy state. Ultimately, it came to her: a doctoral degree for nurses like herself who weren’t interested in becoming hospital administrators, health policy experts, or researchers but instead wanted to attain the highest level of expertise in clinical practice. She played an integral part in the design and implementation of the school’s doctor of nursing practice (DNP) degree. She was instrumental in developing Columbia Nursing’s new accelerated Master’s Direct Entry program for non-nurse college graduates. National Research Corporation Canada (NRCC) has developed an Employee Experience tool to help health care organizations focus on improvement efforts that can increase quality of care, reduce staff turnover, and enhance the likelihood that your healthcare customers will recommend your services. With the Employee Experience tool, healthcare providers can facilitate culture change and improve organizational performance.
These work environment factors include safety culture, collaboration, workload, learning and improvement, the quality of supervision and leadership, resources and supports for patient-centered care, and relationships with patients. Core questions cover such topics as job characteristics, work environment factors, and individual outcomes. This means that the results of your employee experience surveys can be linked to the results of your patient experience and physician experience surveys. As a source of actionable information, NRCC's employee experience solution can be very effective at helping organizations meet Accreditation Canada requirements for improvements in quality of work life, patient safety, and patient-centred care.
Be it the daily focus by the media on preventable medical errors, required transparency of outcomes, or the newer reimbursement models based on quality and safety, this new generation of physicians is asking the right questions and looking for the right solutions. In addition, the Safety Council activities and outcomes from Woodhull Medical Center will be shared. More recent findings from the Health Information National Trends Survey (HINTS) show that more than 60% of black and 56% of Hispanic online users looked for health or medical information online [5]. For example, income, education, and employment are positively associated with subscriptions to Internet services and newspapers [3]. Therefore, this study examines the combination of sociodemographic and social contextual factors and their influence on computer ownership and frequency of use among adults living in urban public housing.
The region is largely rural and poor, with an estimated 16% of people living in poverty and approximately 21% of residents uninsured.
To realize improved health and outcomes for people and communities, there must be productive interactions and trusting relationships between prepared proactive practice teams and informed, activated patients. These restrictions limited access to their loved one, and to information, as well as heightening the fear and anxieties of her brother, family, and friends. Vidant Health embraced IHI's 2008 Seven Leadership Leverage Points For Organization-Level Improvement in Health Care. Patient-family advisors are embedded in every Vidant Health entity including hospitals, home health and hospice, ambulatory surgery center and physician practices and are engaged in the work of key committees at the entity and corporate levels to advance the quality agenda. Patient Family Advisors (PFAs) also round throughout all care settings and are able to best articulate the patient's perspective.
Annually, Vidant Health develops and produces an Experience in Care video for use with leaders, staff, patients, and families. A Patient Advisor provides the unique perspective of patients and families at every meeting. This environment is also a poor place for families to visit, especially families with young children. They may, at times, be confrontational or even verbally abusive, and you have to remain calm and understand the fear and stress they’re experiencing.
Her job required her to “spend thousands of hours shadowing nurses, doctors, and midwives” to better understand how clinicians interact with patients and use electronic health records.
As in much of Africa, cellphones are widespread—some 93 percent of South Africa’s population has access to one, even in remote areas far from hospitals and clinics. The institution also aims to be responsive to the broader community’s needs by operating a clinic for indigent patients who live in the area.

Now, eight years later, Belay—who earned an MS in the adult-gerontology nurse practitioner program at Columbia Nursing—and two other NPs provide primary care for hundreds of residents of three long-term care facilities in New Jersey. And she served on two national task forces charged with defining the essential competencies for graduates of a clinical doctoral program. Although the concept of a DNP had enthusiastic support from many physicians and university colleagues, there were a few dissenters.
Starting in 2016, students will follow a curriculum that emphasizes cultural competency, the importance of evidence-based practice, and care coordination—all of which will better prepare them for the demands of a continually changing health care world.
Equally, research indicates that the ability to provide quality care is a main driver that affects employee loyalty.
These questions can also be found on the physician experience surveys, allowing you to make direct comparisons between employees and physicians. You can now gain unprecedented insight into how the experiences of employees, physicians, and patients are interrelated. It is why the premise “Educate the Young” is such a critical component to any enduring culture change. Some examples of their core projects include: the triaging of critical care value from an ambulatory care clinic, standardization of hand off processes and just culture conferences to improve quality of care delivered to its patients. However, the influence of social contextual factors on computer use, specifically computer access, still needs to be determined. For example, a 2003 report by the Public Access Computing Project [12] found that while low-income families living in lower income neighborhoods and low-income families living in higher income neighborhoods reported computer use at similar rates (~ 58%), low-income families living in lower income neighborhoods reported slightly less computer ownership than their counterparts living in higher income neighborhoods.
In the remaining sites, with a population greater than 300 adult residents, researchers obtained a 35% sample, with a minimum of 250 participants per site.
Many communities have little or no public transportation and over 80% of the region is designated as medically underserved.
A proactive practice team is an interdisciplinary health care team that is committed to partnering with patients and their families and is positioned to learn what is most important to the patient when deciding together about the best care plan. Christy highlighted how staff in the Regional Rehabilitation Center engaged patients and families as partners and how, in contrast, the adult intensive care unit treated Christy and her family as visitors in her brother's life.
This office initially focused on educating leaders and staff on patient- and family-centered care, and organizing staff champions and patient-family advisors who led efforts to eliminate the restrictive visitation policy and replace it with flexible guidelines that promote and support family presence and participation. IHI notes leverage point four, "Put Patients and Families on the Improvement Team" as the leverage point with the greatest potential to drive the long-term transformation of the entire system. Staff at Vidant Medical Center also authored Connections, a collection of stories inspired by care experiences and modeled after Privileged Presence by IPFCC's Bev Johnson and Liz Crocker. Now patients and families sharing their experiences of care with the Board is a regular agenda item. TeachBack is a way to check how well one did explaining health information to the patients or caregivers by asking them to repeat back in their own words what they need to know or do; it's interactive and encourages dialogue. The Baptist Leadership Group (BLG), a HealthStream company, will conduct an onsite Emergency Department assessment at each entity to identify performance strengths and challenges, learn from the voices of patients and families, provide training on patient- and family-centered communication (AIDET and Tell Us Now), and to understand and incorporate key patient and family expectations.
In response, many providers are now moving toward taking a healing environment approach and designing from the perspectives of residents, family members, and staff.The Sitrin Health Care Center in Central New York recently implemented an innovative cottage-oriented design, inspired by the culture change movement in long-term care. These traits come in handy now in the heat of policy skirmishes and similarly demanding situations,” she said.
She is also involved in the state’s Medicaid redesign efforts, responsible for enacting reforms that lead to improved health and better cost control at a time when the program is expanding to cover more New Yorkers. Becoming disenchanted with simply doing programming but without a clear goal for the future, Velez describes herself as “going into nursing kind of on a whim.” That whim turned out to be life-altering. The women are registered by health care workers and then receive text messages for the remainder of their pregnancy and for the first year of their child’s life. Specific questions on the Employee Experience tool covers items such as resources, decision input, and supervisor support.
In 2003, 64% of whites reported having one or more computers in the home; the number of African American and Hispanic households with a computer was 45% and 44%, respectively [6]. Access to computers can potentially link disenfranchised communities to greater informational, social, and economic resources, thereby potentially building neighborhood social capital [13]. Vidant Health's mission is to enhance the quality of life for the people and communities served. Activated patients understand the importance of taking a role in their own health care and are continuously building upon their knowledge and skills in order to better manage their care alone, and in partnership with their practice team. Unfortunately, because of the system's restrictive visitation policy, her brother died alone with no family by his side. This has guided Vidant Health's work to advance meaningful roles for patient-family advisors in patient safety, performance improvement, and patient experience.
The words and actions of leaders and staff are intended to encourage patients and families to speak up when they have concerns. The Tell Us Now Program is an innovative program that encourages patients and families to actively share compliments, comments, or concerns in real time so that issues and concerns cab be addressed when they occur. Other notable examples of innovative design and systems philosophy are the Eden Alternative, the Planetree model, The Green House Model, and the Adards Community in Tasmania.Culture change may be realized with renovations in the built environment and changes in caregiving practices, as well as the more profound implementations embodied in the homelike cottage-based models.
Earlier this year, she moved her family to Capetown, South Africa, where she is now executive director of HealthEnabled, a new nonprofit organization that works with government and NGO partners to develop digital health initiatives in South Africa and other low- and middle-income countries. Healthcare employees want to make a difference and provide high-quality care experiences for patients, client, residents, and their families. Likewise, among those with very low incomes (< US $20000 per year), studies have shown that ownership is greater for whites compared to African Americans and Hispanics [7]. We chose a social ecological framework to illustrate social contextual factors across multiple levels of influence [14-17]. Vidant Health displays patient engagement tips on digital signage in public lobbies, on print materials in ambulatory offices, and on the websites of the patient-centered medical homes in Vidant Medical Group. This creates a more pleasant patient and family experience and makes everyone happier in the end.
Among these were individual factors, which include material circumstances such as owning one’s own car or having adequate resources for child care.
Summary findings and recommendations will be shared with all Vidant Health entities in an effort to share "lessons learned" and to identify areas for improvement. The ultimate goal is to provide patient- and family-centered care to each patient, regardless of what emergency department provides care.
Organizational factors may reflect the work setting, for example, job stress, control, and exposure to a hazardous work environment. Neighborhood and community factors measured on an individual level include access to a safe neighborhood. Finally, larger societal forces, such as racial discrimination, may also shape health behaviors and outcomes.Social contextual factors, in turn, may influence health behaviors directly or indirectly through individual psychosocial factors.
Fireplaces in living rooms serve as positive distractions and create focal points to enhance social interaction.
Social cognitive theory [18,19], the theory of reasoned action [20,21], and the transtheoretical model of behavior change [22,23] are guiding models that highlight specific individual psychosocial factors that predict a change in behavior. The cottages also offer therapeutic benefits by having greater access to sunlight and views of nature.Cottages have private kitchens, allowing for meal preparation and private family meal experiences. This allows the resident to have enhanced opportunities for visitation and socialization, and families with children can have a much more relaxed time with their loved one. Residents are encouraged to ambulate from their rooms and sit in the dining room for meals.The dining experience is more pleasurable, with large picture windows and the immediate community of 11 other residents.
This contrasts positively with the traditional dining experience in a large cafeteria with as many as 50 to 80 residents.

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