美国UCLA医院的服务理念

Mark Goulston, M.D.Posted: November 4, 2010 09:00 AMBIOBecome a FanGet Email AlertsBloggers' IndexPutting the 'Care' Back in Health Care -- the UCLA TransformationMe:Can you please connect me to Dr. Ian Cook?UCLA Hospital operator (in a super friendly and super helpful voice):I'd be pleased to connect you and would you like his direct number for future reference? I'd never heard such a pleasant and helpful response from an operator. It was not the UCLA that I remembered when I trained their as a psychiatric resident in the late 1970's. For the longest time UCLA Medical Center received an A for care and a D for caring. When I firsthand experienced their caring and learned that UCLA Health System's mission is "seeking to heal humankind, one patient at a time" I needed to hear more.I had to find out what had happened and if what I hoped was really true, that UCLA had become an oasis and hopefully a model for caring in health care that is too often devoid of it. I reached out to Roxanne Moster, Director of UCLA Health Sciences Media Relations to find out more. In my email I asked her, "What has happened to UCLA? It's so different than I remember it when I was an Assistant Clinical Professor of Psychiatry there." I was especially interested because the CEO of the whole shebang was David Feinberg, M.D. who I remembered as the psychiatric resident I had helped train in the 1980's.I couldn't be prouder when this is what she wrote me:For most hospital CEOs, leading a medical center equipped with the newest and most sophisticated medical technologies in the field would be the ultimate career pinnacle. But for UCLA Hospital System and our CEO Dr. David T. Feinberg, it's the low-tech, personal touch that keeps him going.You may not know this since your time in the 1980's when you worked with Dr. Feinberg, but for him, medicine is all about people. And that's more than a philosophy for him when he was promoted to CEO over a complex enterprise that includes four hospitals and an outpatient network of clinics.It's the basis of a "people-first" attitude he's put in place at the UCLA Health System and the Ronald Reagan UCLA Medical Center, ranked one of the top five American hospitals -- and the best hospital in the western United States for the 21th consecutive year -- according to U.S. News & World Report Survey.Instead of attending nonstop meetings or sequestering himself in his office, David starts every day by meeting the people who are at the core of every hospital's, and every doctor's, mission -- the patients. That, he emphasizes, makes all the difference in setting an example for hospital employees.David says, "I spend 40 percent of my time literally sitting on the patients' beds and I introduce myself to them. Then I ask how the person is feeling about the care they've received and whether we've communicated in a way that the patient can understand."Without a moment's hesitation, David then hands over his business card as well as his cell phone number with an invitation to a patient or relative to call. To soothe ruffled feathers of those with a complaint, he digs into his pockets for complimentary gas cards, meal vouchers or valet-parking stickers that he regularly carries with him.That's very unusual for a doctor who's triple board-certified in the specialties of child and adolescent psychiatry, adult psychiatry and addiction psychiatry. Along with his title as associate vice chancellor, David is also a professor of clinical psychiatry in the David Geffen School of Medicine.David graduated cum laude in economics from UC Berkeley and then went on to graduate with distinction from the University of Health Sciences/The Chicago Medical School. In 2002, he earned an M.B.A. from Pepperdine University.When David left his job as the medical director of the Resnick Neuropsychiatric Hospital at UCLA to take over as CEO, he tried to understand why, despite the miracle medical interventions that were happening at UCLA Medical Center, one out of three patients and their families, when surveyed, said they would not recommend the hospital to a friend.David discovered that something was missing from the hospital experience. What he discovered after talking to many patients and their families was that the food wasn't hot enough, the drapes didn't completely close, the air conditioning wasanemic, among other things. Plus, sometimes staffers weren't making direct eye contact with them when they asked a question.David realized that he had to make patients and their families rank first in the eyes of everyone who worked there, including the hospital's leaders. That's why he advocates patient visits for all of his senior staff.Several times a month, UCLA's Hospital Operations Team (HOT), composed of nearly 100 department heads, fans out to visit patients. They interact directly with patients and staff and listen to their concerns.Said one HOT team member: "Dr. Feinberg sets an example of how he expects his leadership to learn from patients and then translate these findings into improved care at the bedside."Our Chief Operating Officer Amir Rubin tells us: "Our rounds inform our performance improvement initiatives and they can highlight issues withcaregiver/patient communication and challenges in navigating the system. We often identify facility improvements as well.""Not only does Dr. Feinberg 'round'," said Heidi Crooks, the hospital's senior associate director of operations and patient care services, "he responds to e-mails, letters, visits and solicits feedback on how well we are meeting expectations. He is the first CEO I have experienced who welcomes visits from staff to discuss patient care issues and takes an active role in problem-solving."David's people-centric focus has yielded concrete results, as demonstrated by recent surveys of patient and employee satisfaction. Surveys show that the percentage of patients now willing to recommend the UCLA Health System, for example, has skyrocketed.According to NCR Picker, an outside organization that surveyed UCLA patients on their willingness to recommend the hospital to others and then compared their responses with those from other NRC Picker hospital clients:More patients at the Ronald Reagan UCLA Medical Center said they were willing to recommend the hospital to others, lifting scores from the 57th percentile in July 2006 to the 95th Percentile in March of 2010.At the Santa Monica UCLA Medical Center & Orthopaedic Hospital, scores rose from the 43rd percentile in October 2006 to the 72nd percentile in March, 2010.At the Santa Monica UCLA Medical Center & Orthopaedic Hospital's Emergency Department, scores jumped from the 12th percentile to the 95th percentile.For the Santa Monica UCLA Medical Center & Orthopaedic Hospital's maternity service, scores are now at the 99th percentile.For the Ronald Reagan UCLA Medical Center maternity service, scores are now at the 97th percentile for would recommend question.David also recognized there is a direct correlation between staff satisfaction and patient satisfaction. So he encourages town hall, breakfast and nighttime meetings with daytime and evening workers -- and is genuinely interested in creating an "employer of choice" environment.David says,"If you want employees to care about others, you have to make sure they know someone cares about them." He ensures that his COO and senior management follow up on strategies to keep employees happy, resulting in increased morale that can be tied to improved patient care.A recent employee satisfaction survey showed that UCLA Health System employees' opinions of their work environment have improved from the year before.A few examples include such statements as:"UCLA supports me in balancing my work life" was up by 12 percent."Different units work well together" and "communicate effectively" were also up by 14 percent."My work unit is staffed adequately" was up by 19 percent.David says: "I believe in the servant model, where, in our business, the patient at the bedside is at the top of the organizational chart. The doctors, nurses and support staff are the ones providing that care. This team makes up the second level. I'm at the bottom of the chart. My job is to support those who are taking care of our patients. Nothing else matters."So much for hearsay. I knew I needed to go straight to the horses' mouths. I knew that David was the visionary, but his COO Amir Rubin was the designer and implementer extraordinaire that made it happen. I wrote to Amir and asked him how UCLA did it.Amir wrote back:The UCLA Operating System represents our organizational approach to performance management and improvement. By linking our mission and vision, with goals, dashboard metrics, and lean performance improvement efforts, we strive to continuously improve.One highlight of this approach is our CICARE service program to improve the patient experience. By engaging our staff and physicians in the C-I-CARE program, UCLA now ranks in the 97%ile in customer satisfaction compared with all hospitals in the nation. In fact, of the more than 100 academic medical centers and their nearly 200 affiliated hospitals that are members of the nationwide University HealthSystem Consortium (The University HealthSystem Consortium represents about 90% of the nation's non-profit academic medical centers), Ronald Reagan UCLA Medical Center is ranked No. 1 in the U.S. for patient satisfaction.The CICARE program takes the best practices for patient interactions for multiple departments, and then codifies these approaches in staff training materials and training videos. Managers then make observations to review execution of performance, and track performance in a detailed computer system. Staff are rewarded and recognized in daily brief "huddle" meetings. Moreover, all leaders make rounds to interact with patients and address improvement opportunities. The UCLA Operating System and CICARE approaches successfully link organizational purpose with people and performance management.Finally I needed to reconnect with David, who I had helped train twenty five years earlier to hear some more and beam with pride. David is a great story teller and shares them not with any hint of pridefulness but with a child like wonder, enthusiasm and a smile to match that broadcasts: "Listen to this, isn't it great to help people?"Here is what David told me:A woman stopped me in the lobby of the hospital and asked if I was in charge. (She had seen our website where I pop out and welcome people to UCLA.) I introduced myself and answered her with my stock answer when I am asked if I am in charge. "Certainly, not. Our patients and their families are in charge. Next in charge our doctors, nurses, residents, students, pharmacists, social workers, care partners, support staff, etc. My job is just to help them make sure our patients get the best care.This woman went on to say how incredible the care her husband had received over the last week for his prostate cancer. She told me that starting with the valet parker who opened their door on arrival and said "welcome to the world's best hospital" they knew they were in the right place. I listened as she spoke about the how attentive the housekeeping staff was, how engaging the care partners were, about how incredible the nurses were, how amazing the doctors were and of course she commented on the beautiful architecture and our food service (on demand room service, prepared by our culinary chefs on site). She recounted about 12 staff members by name and asked me how do we get everyone on the same page and how do we find so many compassionate people.I get compliments like this every day and it has been so for about the last two years.I get letters, email, gift baskets, etc. from countless families that pretty much say the exact same thing as this woman was telling me. I think that I had become so accustomed to hearing what she said that I wasn't listening carefully enough. That is when she stopped me and said, "You don't get it". She went on, "My husband and I just got back from a one week cruise in the Caribbean and we are having a better time spending this week in the hospital!。