Vol. 20 •Issue 20 • Page 14
Best Department Division
Winners Show Heart of a Champion
Professional athletes have it easy. Baseball players need to focus on only 162 games per season. Football runs a scant 16-game schedule. Compared to working in a hospital, that’s a cakewalk.
Respiratory therapists, on the other hand, must prove themselves every 12-hour shift, 365 days each year. Nebulizers, ventilators, MDIs and spirometers are the equipment of their sport, the department their playing field. Stakes couldn’t be higher.
Yet at the end of the year, no Stanley Cup, Super Bowl ring or World Series trophy is awarded for superior patient care. After 20 years of devotion and excellence, no bust will grace a hall of fame when the steadfast RT retires.
But therapists are not completely devoid of recognition. The ADVANCE National Respiratory Care Awards Competition was designed specifically to honor therapists at the top of their game, the health care champions who deserve a parade past city hall.
Winners are announced as a prelude to Respiratory Care Week, which runs this year from Oct. 21-27. This is the contest’s seventh season of recognizing the nation’s elite departments, managers and practitioners.
Winners and honorable mentions were selected by an independent panel of judges who reviewed nominations submitted earlier in the year. The nominating essays offered a comprehensive view of the department or individual in supporting their nominees. This year’s submissions demonstrated that big and small hospitals alike deliver superior patient care.
Top finishers in each category received $1,000 and a plaque. Honorable mention winners earned citations.
2007’s Best Department award belongs to Texas Children’s Hospital, one of the largest pediatric hospitals in the United States. It is located in the Texas Medical Center in Houston and already has earned an international reputation for excellence.
“I have been at Texas Children’s for 20 years and seen the department grow,” said Suzanne Iniguez, respiratory care coordinator. “I don’t know of any place that does as much as here.” She was the nominator of the facility, which is nationally ranked in the top ten among children’s hospitals by U.S. News & World Report.
In her nomination, she highlighted the department’s many innovative programs including self-scheduling, overtime contracts and an innovative Caring Hands Reaching In Support (CHRIS) Committee. The first allows staff to select a primary area and then complete a schedule. This method gives therapists some flexibility in schedules and ensures everyone has ample time for holidays.
“Every single schedule there is some give and take,” explained Todd Bish, day shift manager. “But a majority of the time everyone is happy, and it does boost staff morale.”
Department leaders place a heavy emphasis on making sure the staff is happy with the schedules and the department has adequate workers, said Iniguez.
Kristine Knight, transport therapist, added that in cases of a work conflict, staff can adjust shifts. “They give us the schedule far enough in advance that there might be somebody to switch with.”
Overtime contracts have allowed the department to reduce costs and boost morale. Previously during the high census winter months, the department relied on traveling therapists to meet staffing needs. In 2005, a staff therapist suggested the hospital elicit extra shift commitments from staff therapists to help provide the coverage needed.
Therapists can elect to work an extra shift a month or an extra shift per pay period from November through February. The shift is scheduled by the therapist and is guaranteed regardless of the patient census. In the first year, the department reduced costs of travelers from $247,425 to $87,907.
“This is a two-way contract,” said Kim Davis, assistant director. “We have a 100 percent commitment to the shift.”
Because of the CHRIS Committee, staff who face hard times like the death of a family member get department support. The initiative began in 2005 and was named in memory of Chris, a therapist’s son who passed away.
“The support given by the committee has run the gamut from cards and telephone calls to paying for wheel chairs and insurance premiums,” said Iniguez.
The department makes a special effort to employ students in the hopes of bolstering recruitment. “We can’t depend on people with pediatric credentials showing up at the doorstep; we have to grow them ourselves,” said Lee Evey, director, who spearheads numerous special projects. He organizes medical missions to third-world countries and helped coordinate a patient evacuation from New Orleans during Hurricane Katrina. “We had a number of sick kids on ECMO. It was a very successful: not one patient was harmed in transport,” he said. “I’m proud we took the lead.”
That level of caring might just be the key to the department’s overwhelming success, according to Evey: “We all have a requirement to give back to those less fortunate. It’s our responsibility as human beings.”
Fantasy football nuts will appreciate Morristown Memorial Hospital’s unit-based team approach. Every two years, seven teams are organized to staff and manage various units within the Morristown, N.J., hospital, an honorable mention winner this year.
The unit approach closely resembles the fantasy football drafts conducted before the start of the NFL season where fans create teams of current gridiron players.
Only in the respiratory care version, staff members list their top choices for lead therapists who in turn select team members. The purpose of the unit-based teams is to improve clinical expertise, improve continuity and consistency of care and improve patient outcomes, according to Manager Beverly Natale, BS, RRT, who nominated the department for the award.
“Leader practitioners select–based on an applicant’s contributions and skill sets–the composition of the new team,” she explained. Ninety percent of the time, RTs receive their first choice.
“They need to demonstrate how they can move forward the goals of the area and have a positive impact, said Luke Stapleton, BS, RRT, staff therapist.
“You tend to gravitate towards an area based on your skills and interests, but sometimes you might want to try something new. It is the perfect opportunity to expand your skills,” said Ben Cortese, BS, RRT, clinical coordinator. “We also create an opportunity for new people, recognizing the need to introduce new blood.”
Morristown Memorial instituted rapid response teams in reaction to the Institute for Healthcare Improvement (IHI)’s 100,000 Lives Campaign. The multi-disciplinary team—composed of a respiratory therapist, a nurse and a physician assistant—is tasked with preventing deaths outside the ICU by providing a readily available resource team. The team can be called to duty by any health care professional who believes a patient is at risk.
“Teams run as quickly as they can when a beeper goes off,” Natale said. “There’s a little competitive angle because the goal is to make sure that you don’t have a call on your floor.”
From February to October 2006, the team responded to 173 calls with the average response time of three minutes. Fifty-four percent of the calls resulted in patients being transferred to a higher level of care and there was a 77 percent survival rate to discharge.
The Ventilator Associated Pneumonia (VAP) program, also an IHI initiative, has been a huge success at Morristown. As a Six Sigma project, VAP was reduced from 4.02/1,000 ventilation days in 2005 to 1.51 in 2006. During the first seven months of 2007, there has not been a single incident.
New graduates have a special place in the department. Leaders take care to ensure newcomers are nurtured and encouraged to offer input in the hospital’s practices. “We embrace them and include them. They are so computer savvy that sometimes they are teaching us,” she said.
“We have quite a few veterans in the department, but new grads fill a lot of FTEs,” Cortese said. “And they are coming with a lot to contribute.”
“Fresh eyes are sometimes clearer eyes,” Natale said. “That is why in our department, we not only train respiratory care students, we hire them and listen to them as well.”
Children’s Hospital of Orange County (CHOC) in Orange, Calif., an honorable mention winner, also prides itself on preparing new graduates for success. Its five-month residency program in pediatrics was the first comprehensive pediatric training program in the nation, according to Clinical Educator Mindy Pera, RCP, CRT, who nominated the department.
“Schools focus on adult therapies. We transition students from working in the adult world to the pediatric environment,” she told ADVANCE. “They basically become clinicians and not knob turners. We value the quality of care our children receive and need therapists who are at the top of their game.”
Since its inception, CHOC has trained more than 30 respiratory therapists to become high-level pediatric practitioners. Through evaluation and feedback, this initiative has improved the quality of care being provided by their therapists. The success of the pediatric training program has resulted in a significant increase in job applicants and has been spun off elsewhere at the request of other hospitals.
Pera credits a strong vision, which begins with the medical director. “It is seeing where you want to go and then developing a plan on how to get there. We’re constantly looking to raise the bar.”
The department is geared towards the positive and is designed to boost staff morale by using positive reinforcements such as redeemable STAR certificates, the CARE Award (Committed to Achieving Respiratory Excellence) and Associates can recognize each other’s accomplishments with KUDOS online, along with gatherings to celebrate staff.
CHOC recently earned the “Excellence in Patient Safety & Health Care Quality Award ” from the state’s leading health plans and was one of only nine children’s hospitals in the nation to be named to the Leapfrog “Top Hospitals 2006” list, based on results from the Leapfrog Group’s Hospital Quality and Safety Survey.
The implementation of Respiratory Councils has empowered staff to make departmental decisions in such areas as clinical practice, associate relations and engagement and education and advancement, resulting in increased moral and staff satisfaction. CHOC therapists are “empowered to take control”.
To provide support for newer staff, improve productivity and patient outcomes, CHOC developed a Unit Resource Lead position. The lead acts as a primary clinical resource and expert to the team in the assigned unit. Responsibilities include recommending changes in therapy to improve patient outcome, monitoring work assignments, attending and participating in multidisciplinary rounds and ensuring continuity of care and patient safety.
These programs may have increased recruitment and retention, but Pera believes it still takes a special kind of professional to care for this population. “People who work in pediatric hospitals don’t do it because of the money; they do it because they have a passion for taking care of children,” she said. “They see the kids get better and know that they have been a part of it.”
Shawn Proctor, associate editor and Web editor, can we reached at firstname.lastname@example.org.
Best Practitioner Division
2007 Winners Are Talented and Dedicated
We here at ADVANCE are picking up on a trend. Many of the most talented and dedicated practitioners of respiratory care fell into the profession by happy accident, a classic case of serendipity.
The latest example is our Best Practitioner for 2007: Jerry Edens, MEd, RRT, an education specialist and coordinator for the Respiratory Care Division at Cincinnati Children’s Hospital Medical Center.
While a student in search of a worthy subject at Lexington Technical Institute in Lexington, Ky., in 1982, “I didn’t know anything about (respiratory care),” Edens recalled.
“I was originally going into PT/OT, but the program was hard to get into. I was on the waiting list. My adviser said, ‘Well, there’s a new program, respiratory care.’ I did an observation and thought, this is kind of neat.”
Among others grateful that Edens took the path he did is Lisa Keegan, RN, MEd, an educational nurse specialist at Cincinnati Children’s who nominated Edens for our award.
Praising Edens’ ability to work well with others, Keegan called Edens “an untiring advocate for his profession” who has helped build a culture at Cincinnati Children’s “in which all are valued and sought out for their strengths in the care of our patient population.”
Among other accomplishments, Edens has developed, initiated and monitored the continuing education program for Cincinnati Children’s sizable (170-member) respiratory care staff.
He has developed a clinical advancement program, employee recognition programs, competency standards, an orientation program and the department’s Web page. He also introduced evidence-based practice to the department.
With his eyes always on the future, Edens has developed monthly grand rounds “to keep therapists abreast of technological and clinical advances and stimulate thinking about evidence-based practice and research,” Keegan told us.
Asked what accomplishment he’s most proud of, though, Edens cites kudos he earned from a source outside hospital walls.
The Cincinnati Business Courier nominated him as its “Health Care Hero for 2005” for his community outreach efforts, most notably designing and implementing a program for eight local school systems about the dangers of second-hand smoke. Edens also vigorously promotes the Campaign for Tobacco Free Kids.
“It gave me validation that the work I’m doing is being noticed,” Edens said of the Courier’s nod. “Someone outside the hospital said, ‘Wow, you’ve done some work outside in the community and we appreciate what you’ve done.'”
Eye on the Future
As is typical with leaders, Edens devotes much effort to grooming tomorrow’s leaders.
“You have to worry about who’s going to be taking care of you one day,” he said. “Your eye should always be on the future, finding the key people who are going to carry this forward. Many of us are looking at retirement in the next 10 years or so. We must identify people on our staffs now who are going to be leaders. What skills do they need? We need to give them the resources, send them to conferences, give them the things to trip that trigger a little more.”
Classroom-based educators in respiratory care programs should tell hospital-based educators (like him) of students with special promise, Edens said. “When I hear, ‘This person is a whip,’ I try to groom that person and encourage their growth,” he said.
Classroom educators should also encourage higher education, Edens continued. “Ultimately, I feel we’re going to a bachelor’s degree in the near future, 10 to 12 years, hopefully. I’d like to see that,” he said.
Edens also wholeheartedly endorses joining one’s professional association, in this case, the American Association for Respiratory Care (AARC).
“A concern is that people today don’t get involved,” he said. “Their focus is on themselves, not the profession as a whole. In professional organizations, we also have a lot of people who are older and looking at retirement. Young folks must step up and get invested in their careers. Your professional organization is going to affect your license, your practice.”
Stars of Tomorrow
Fresh-faced respiratory therapists should have on-site work mentors guiding their professional growth, he continued.
“These mentors should say, ‘OK, we have you up to speed, but now let’s look at getting involved in your professional organization, maybe with a political action committee,'” he said.
“Find out where their passions are. The older folks are going to have to identify these individuals. When we were that age, we stepped up and got involved. You joined your professional organization. It was what you did. I think the younger generation needs to be asked; they need a personal invite.”
Ownership “has to be taken by the people in the field right now,” Edens said. “They must find the stars of tomorrow. If you’re a manager, you must give those people your time and encourage them to find their passion and to develop leadership.”
Edens said he plans to “grow where I’m planted” when asked about his own future.
“I just look to continuous self-improvement,” he said. “I try to be the best I can be. I’m thinking about going to school again and getting my nursing degree. Someone’s going to have to do my job when I leave. I’d like to be a positive influence to others, a role model.”
Our honorable mention winners in the Best Practitioner competition for 2007 also excel at dedication, leadership and emitting an infectious enthusiasm for their chosen field.
Phil Panzarella, RRT, a respiratory care staff member at the University of California San Diego Medical Center, “can step into the role of leader at the drop of a hat,” says his department director, Richard Ford, RRT, FAARC.
“Phil masters nearly every challenge, from bringing the team together when there are four sick calls and no one to come in to personally driving up to our sister hospital 20 miles away to fill a shift,” Ford wrote.
Panzarella is “one of the most innovative therapists in the department” and “jumps into the most complex interventionsÉfrom PTEs to transplants to use of HFOV and nitric oxide,” Ford wrote. “Phil has also adapted respiratory care equipment for use at the San Diego Zoo and volunteers his time to the care of sick and rare animals.”
Our other honorable mention winner, Kimberly Clark, MBA, RRT-NPS, is also an education coordinator. Carolinas Medical Center in Charlotte, N.C., counts itself lucky to have her services.
Among other contributions, Clark has developed a database for employee orientation, served as a facilitator on the hospital’s Respiratory Care Education Team and “was a major force” in developing the Bachelor of Science for Respiratory Therapy program at the University of North Carolina in Charlotte, according to Anita Doster, BS, RRT, director of Respiratory Care at Carolinas Medical Center.
“A practitioner who works this hard to promote education should be commended by our profession and publicly recognized for her efforts,” Doster wrote.
Michael Gibbons, senior associate editor, can be reached at email@example.com.
Best Manager Division
Top Winners Reflect Innovations in Care
Rick Savage, RRT, is old school but forward thinking.
Named as Best Manager in the national Best in Respiratory Care competition, the 30-years plus veteran still wears a shirt and tie everyday and a polished demeanor that represents the smart way he does business. His programs, ideas and leadership style have changed the way his facility operates and how people perceive his department.
“I have a sense of pride in the role I play, but I also have a sense of pride in the profession, the hospital and the employees I represent,” said Savage, director of cardiopulmonary and diagnostic services at Summerlin Hospital Medical Center in Las Vegas.
Since joining its management team in 2005, the 55-year-old has strived to improve efficiency. He developed a unique mathematical formula respiratory therapists use to plug in a few numbers (e.g., treatment load) and then multiple and divide by a few constant figures.
The supervisor can then flex employees around that number based on skill sets and department needs. This formula assures Savage always has enough staff members to properly care for patients and routinely meet productivity standards, making administration happy.
Because of its success, other managers in the hospital have asked Savage to teach them his new math.
Instructing others is nothing thing new for the veteran, who holds degrees in respiratory care, emergency medicine, philosophy and religion. He has partnered with a local community college to promote the field and help recruit future stars for his department.
“It’s such a critical, critical issue,” said Savage, about the current health care worker shortage. “The deficit is clear and present at all times. We can sit back with HR and put together the finest recruiting plans in the world, but it’s a throw of the dice.”
Savage doesn’t need to gamble. His home-grown therapists have gone on to excel, earning specialty credentials.
This is one of the many reasons others at the hospital have a new-found respect for his staff.
A strained relationship between respiratory and the physicians once threatened to interrupt care, he noted. “Nobody was communicating.”
To bring everyone together, he sat down and asked how his department could meet their clinical needs. As a result, Savage helped create a dialogue allowing the two groups to speak freely and exchange ideas to improve patient outcomes.
While Savage has accomplished much in his short time at Summerlin, he’s quick to acknowledge those who have helped him at his current position.
“I’m sitting where I am today because of the culture my staff has built,” he said. “Their trust in me and my trust in them has allowed us to grow and be effective.”
Savage usually gets to work by 6:15 a.m. so he can stay in contact with both the night and day shifts. His dedication and positive influence have allowed confidence levels and skills to grow, explained staff therapist Miriam L. Kulle, RRT.
As two examples, she cites the neonatal course he initiated to develop NICU therapists and how he expanded the role of point-of-care testing throughout the hospital.
Colleague Mary Finayev, RRT, describes his mental toughness, critical decision making and ability to hold court. “When Rick talks,” she said, “people listen.”
In the midst of increasing demands on respiratory care and difficulty with recruitment, John Conrad, BS, RRT-NPS, an honorable mention winner in this year’s competition, has implemented changes to move his department forward.
The administrative team leader for respiratory care services at Geisinger Medical Center, Danville, Pa., developed a co-op program encouraging high school seniors to visit the facility. Already, one student opted to attend a college-level respiratory program after learning about the field from Conrad.
He also put into a place an extern program allowing senior year respiratory students to perform 10-week clinical rotations as an employee of the hospital.
Among other accomplishments, Conrad worked to completely computerize the scheduling process, and he helped create the respiratory care module for the hospital’s electronic medical record software program.
“One thing you can say without a doubt is John genuinely cares,” concluded nominator Angelo Venditti, RN, operations manager for respiratory care services. “He cares about his staff, his colleagues, his community and, most importantly, his patients.”
Kimberly Davis, BS, RRT, also an honorable mention in this year’s competition, considers her department a family. And when one of her therapists faced one of life’s most challenging events—the death of a child—she was there.
As assistant director of respiratory care at Houston’s Texas Children’s Hospital, she coordinated a special committee to help staff cope with difficult times, be it the loss of a loved one or dealing with health issues. Support could range from dinner to a phone call to money.
Davis coordinates with ICU medical directors to hold town hall meetings. Here, staff members can discuss goals for their respective units and share any concerns they may have.
“She ensures therapists know they have a voice in the way care is provided,” said Respiratory Care Coordinator Suzanne Iniguez, RRT-NPS, in her nominating essay.
In terms of improving patient outcomes, Davis facilitated a multi-disciplinary task force that developed an acute asthma protocol to make certain people receive timely treatment, education, discharge medication and, if necessary, transportation. The intervention reduced the average length of stay from 2.55 to 1.71 days.
Mike Bederka, senior associate editor, can be reached at firstname.lastname@example.org.
ADVANCE solicited submissions from readers around the country for best department, manager, and practitioner. Short-answer essays describing how participants have demonstrated excellence in respiratory care helped our judges pick the winners. The best department was awarded a $1,000 prize; the top manager and practitioner each received $500. In addition, first-prize winners earned plaques and nominators gift certificates to ADVANCE’s Healthcare Shop.
Meet the Judges for this Year’s Competition
Judges for the 2007 National Respiratory Achievement Awards Competition were: Lynn Long, RRT, RCP, respiratory care manager, Marion General Hospital, Marion, Ohio; Sally Whitten, RRT, respiratory care manager, Maine Medical Center, Portland; and Scott Wiley, MBA, RRT, director of cardiopulmonary services, Naples Community Hospital, Naples, Fla.