In this CHOC Children’s grand rounds video, Dr. Eric Handler, Orange County public health officer, highlights a unique public-private partnership focused on eliminating hunger and reducing food waste.
The Waste Not OC Coalition uses a three-pronged approach: educate the community about food donations; identify “food insecure” individuals; and connect those individuals to sources of food. The coalition facilitates the donation of wholesome surplus food from various facilities, including restaurants and hospitals, to local pantries that serve individuals in need.
Since the coalition was formed in 2012, it has increased the visibility of food pantries, raised awareness among business owners of the need for food donations, and empowered clinicians to refer patients to food sources.
It is an exciting time to be at CHOC Children’s. Since the opening of the Holmes Tower in spring 2013, we have clearly adopted a campus-wide “can do” mentality. Our focus on innovation, the acceleration of new and expanded clinical programs, and our increasing academic emphasis are propelling us forward on the path to greatness, and I am very proud to be on this journey with you.
As the CHOC Clinical Leadership Council (CLC) enters its fourth year of the New and Expanded Clinical Program Process, I am encouraged by both the caliber of concept proposals that are developed each year, as well as the level of support and guidance that CHOC Executive Leadership continues to bring to this process. The result of this model of physician and administrative partnership is the advancement of our clinical vision at CHOC. On a parallel path, earlier this year, Kim Cripe, CHOC Children’s President and Chief Executive Officer, launched our Transformational Program Process, which has to date far exceeded our expectations. The level of enthusiasm has driven a collaborative process that has resulted in some truly transformational concept proposals. I have summarized details on both the New and Expanded Clinical Program and Transformational Processes below.
Again, I would like to share my appreciation along with my true sense of pride at being a part of this this legacy-creating time in CHOC’s history. I look forward to working with you on our continued clinical and academic advancements made on behalf of the children that we serve.
CHOC Clinical Leadership Council – New and Expanded Clinical Programs
FY17 New and Expanded Clinical Program Process
I am pleased to share with you that the CHOC Clinical Leadership Council (CLC) has recently launched our fourth year of the New and Expanded Clinical Program process. For fiscal year 2017 (FY17) projects, the CLC has received a number of exciting concept proposals. The physician and EMT proposal champions have been invited to formally present their concepts to the CLC on November 2nd. The concept proposal ranking provided by the CLC will result in recommendations to the CHOC Senior Leadership Team (SLT) to develop full business plans for the top ranked concept proposals. Our goal is to complete the business plans in time for inclusion in the FY17 budget, which means that they must be finalized by February of 2016 for final presentation to CLC and SLT for approval, allowing them to move onto “green light” implementation stage starting as early as July 2016.
Approved New and Expanded Clinical Programs
During the first three years of the New and Expanded Clinical Program process, CLC recommendations to SLT have resulted in several “green lighted” programs, which are now in various stages of implementation. To date, the CLC has received SLT approval for implementation of the following clinical programs:
Sleep Program expansion at CHOC, providing a third sleep station, along with introduction of a new Sleep Program at CHOC at Mission. In Mission we built an entirely new 3-bed sleep lab, and at CHOC we completed physical plant enhancements along with Children’s Specialists (CS) recruitment of Dr. Neal Nakra, board certified sleep and pulmonary specialist, allowing CHOC’s sleep labs to become accredited.
Gastroenterology Pill Cam was added as a new service at CHOC; implemented in 2014, the Pill Cam program is serving a growing number of GI patients.
Craniofacial Program expansion, including purchase of the Cone Beam CT Scanner (with the first cases completed in August 2015), addition of a physician assistant (to be hired), and expanded marketing and business development support, including robust web-content.
Vascular Anomalies Program expansion, including addition of Pulsed Dye V-Beam Laser services at CHOC. Our first three cases were performed on October 6th. The team also added Kim Hai, RN as the full-time nurse coordinator. The team is currently working with CHOC business development and marketing to launch enhanced web-content and print materials to promote the expanded program.
Feeding Program expansion provided for dedicated, renovated, fully-equipped inpatient space including 3 beds and the addition of a third feeding team to support program growth. The inpatient unit and 3rd team went live earlier this year.
Adolescent and Young Adult (AYA) Program includes design plans that were recently completed, as the team is working toward a build-out and an implementation plan to create a uniquely adolescent space and program for adolescent and young adult patients.
Inpatient Telemedicine Program expansion plans include the hiring of our full-time manager, Michelle Jones. In partnership with Dr. Jason Knight, who received a formal Medical Director role, they are focused on increasing utilization, adding subspecialty participation, and bringing on new hospital partners to provide inpatient telemedicine services.
Visualase, which provides minimally invasive tumor ablation, will be added to the CHOC Neurosurgery service line as a one-year pilot project approved by Matt Gerlach, CHOC Executive Vice President and Chief Operating Officer. The team is finalizing steps to bring Visualase to CHOC by December of this year.
In addition to these program approvals, CLC received approval for purchase of a portable CT scanner now in use in the CHOC ICU’s, along with several other equipment purchases. Matt Gerlach, has actively engaged the CLC membership to assist in prioritization of requested clinical capital equipment as part of the annual budget process, and is providing additional support to the New and Expanded Clinical Program process through the newly created CHOC Project Management Office (PMO).
The CLC also has several programs in the business plan development stage for consideration. These business plans include expansion of the CHOC Pain Program, creation of an Aerodigestive Disorders Center, and the potential for a Neuro-Intensive Care NICU Program. CLC is also working toward completion of business plans evaluating expansion of the Inflammatory Bowel Disease (IBD) and Eosinophilic Esophagitis (EoE) Programs, as well as review of a plan to develop an Undiagnosed/Rare Diseases Center. As these plans move through the process for consideration, we will keep you posted on their status. While all proposed programs that come through the CLC process are not approved for implementation, the process provides a venue and dedicated resources to all ideas to be further developed, actively discussed, and formally evaluated.
CLC Review of Existing Clinical Programs
As the CLC is focused on advancing the clinical mission of CHOC, we not only support proposals for new and expanded clinical programs, but also focus on promoting the growth and development of programs including the CHOC Institutes, house-based programs including anesthesiology, emergency medicine, pathology, and radiology, along with other premier programs at CHOC. The CLC is the perfect venue for clinical program advancement, bringing together physician and administrative leadership into a cohesive council, working together to help raise CHOC to the next level, as we secure our position as a nationally recognized children’s hospital.
Transformational Program Process
I am so proud of the preliminary results of a very exciting CLC-led concept, The Transformational Program Process. In January 2015, Kim Cripe, CHOC President and Chief Executive Officer, invited CHOC clinical, scientific, and administrative leadership to “dream big.” She asked for ideas that would transform not only CHOC, but change aspects of pediatric healthcare nationally/internationally. This call for ideas resulted in thirty-four proposals, igniting unique and exciting collaborations; ultimately culminating into fourteen transformational concept proposals. Through a formal evaluation process, the CLC recommended that the ten top ranked proposals move forward for further development.
CHOC recently engaged Lori Baker Schena, a talented medical writer, to work with each of the ten groups to develop compelling case statement “briefs.” These case “briefs” will first be shared with CHOC Senior Leadership Team (SLT) for concept approval, and then ultimately with key mega-donors in a collaborative process to develop truly transformational programs at CHOC Children’s. With the case statement writing actively underway, we are excited to move to the next stage of the process.
The somewhat unanticipated early outcome of this Transformational Program Process has been the overall level of commitment and enthusiasm, the unique and dynamic collaborations that have resulted, and the overall sense of “we can do this.” We feel this is a result of the evolving culture of innovation and collaboration at CHOC as we work together to create our legacy for the future. I am so proud to be leading this effort with Jan Lansing, with the dedicated support of Debra Beauregard, along with the entire CLC membership. We will continue to share our progress with you as we continue the Transformational Program Process.
I wish you all my best as we enter the fall of 2015. Please feel free to contact me any time at email@example.com to discuss ideas, new or expanded clinical program concepts, or your thoughts regarding the CHOC clinical vision or strategic plan.
CHOC Children’s is the nation’s first pediatric hospital to implement iRounding, a digital survey tool on an iPad that allows staff to identify and respond to CHOC families’ needs in real time. CHOC received the 2014 Ventana Research Award for its pioneering use of this technology.
For years, hospitals have relied on paper surveys mailed home after a visit to assess patient satisfaction. While very important, this survey method also has limits. Paper surveys can only ask questions. But at CHOC, iRounding has started very important conversations.
“We want to know what is important to our patients and families, and iRounding is about so much more than checking boxes,” said Carmen Namenek, manager of CHOC Primary Care Clinic Operations and Community Education. “This portable, HIPAA-compliant tool allows our staff to engage with patients and families, and gather more robust data than we can with traditional survey methods. We may now also get information from populations previously not surveyed, such as adolescents.”
She said families’ top concerns are not always what the staff thinks they are. At one CHOC outpatient clinic, the staff thought waiting time was most important. But iRounding revealed that families would rather wait a little longer in order to see the same provider at each visit.
Automatic, real-time iRounding reports allow CHOC staff to act more quickly to resolve and follow up on opportunities for improvement. Positive comments may also be shared immediately with physicians and staff.
Further, iRounding allows staff to quickly spot trends and modify or add questions if the survey focus changes. And as issues are resolved, spot checks may be conducted with families to make sure the new changes are working. CHOC staff found iRounding an invaluable tool to assess family perceptions during recent changes to hospital parking and laboratory registration procedures.
“Eliminating the costly, time-consuming manual process of collecting data has freed our staff to do more of what they do best,” Namenek said.
Leading the Nation
Implemented in 2013 in part by a grant from Tustin Toyota, iRounding is now taking place at all CHOC locations, including CHOC Children’s at Mission Hospital. CHOC has expanded the web-based application to some private practices in the community.
“It’s an opportunity to share best practices with each other,” Namenek said. “We realize families may be seeing community physicians as well as specialists at CHOC, and the experience at all locations is important.”
Dr. Mark Colon, who practices at the CHOC Children’s Clinic, Santa Ana, at the Boys & Girls Club, quickly saw the benefits of real-time results.
“The thing I love about iRounding is that I don’t have to wait up to three months for the NRC Picker results,” Dr. Colon said. “If there is a negative comment or issue, my staff and I will see it right away, and address it right then and there. We can clear up any kind of misunderstanding before the family leaves the office.”
CHOC continues to participate with The Advisory Board Company, a national organization dedicated to sharing best practices and further leveraging iRounding technology within the pediatric healthcare setting. While CHOC was the very first pediatric organization to utilize iRounding, several pediatric hospitals have since followed suit.
“For many of them, CHOC was a big influence in the decision to use this product,” Namenek said. “They are looking to us as the leaders.”
A CHOC Children’s neonatologist has been recognized by the California Medical Association (CMA) for his extensive volunteer work.
Dr. Sudeep Kukreja has received the 2015 Presidents’ Forum Award, which recognizes CMA members or physician organizations that show altruism or volunteerism. Award recipients’ work benefits the CMA, the component medical society, or the general profession of medicine by promoting patients’ health, health care delivery and physician branding.
In addition to his role at CHOC, Dr. Kukreja founded Arpan Global Charities, a nonprofit volunteer medical organization that provides free health care, supplies and support to people in developing countries. In the past 10 years, he has organized 17 volunteer medical missions to nine countries, providing free medical care to more than 9,500 people in the most underserved areas. More than 700 major surgeries, 900 non-invasive procedures and 450 dental procedures have been performed. His next medical mission is slated for November.
At CHOC, Dr. Kukreja serves as medical director of the newborn hearing screening program, as well as associate medical director of the neonatal intensive care unit.
Locally, he also participates in charitable clinics and health fairs, and is the past president of the Orange County Medical Association.
Dr. Kukreja will be formally recognized in October at the Presidents’ Forum meeting, where he will also give a presentation about his volunteer work.