KEY LEADERS IN CHANGING THE CULTURE OF ST. ALEXIUS MEDICAL CENTER

1
TRANSFORM THE
CULTURE OF ST. ALEXIUS MEDICAL CENTER TO INCREASE
PALLIATIVE AND/OR HOSPICE CARE Betty Skonieczny,
BCC, MPS ACE Project - Course 3 St. Alexius
Medical Center - Hoffman Estates, Illinois 60169
KEY LEADERS IN CHANGING THE CULTURE OF ST.
ALEXIUS MEDICAL CENTER Left to Right
Linda Gump VP of Operations
Communication link to CEO and corporate
offices
Dr. Jenny Kang Co-Chair of Full Life
Committee and Communication link to
Physicians on Med Ex
Committee Betty Skonieczny Co-Chair of
Full Life Committee - Plans agenda, all around
resource
person and passion behind the project
FULL LIFE COMMITTEE MEMBERS Seated,
Left to Right Bonnie Kochan, Quality Manager,
Kathy Montalbano, Recording Secretary, Linda
Gump, Vice President of Operations, Dr. Jenny
Kang, Co-Chair of Committee, Betty Skonieczny,
Co-Chair of Committee, Rebecca Davis Mathias,
Phd, Ethicist Standing, Left to Right Rev.
Domingo Hurtado-Badillo, Chaplain, Midge Hellmer
RN, Oncology Nurse, Mark Kosla RN, Nurse
Educator, Dr. Scott Neeley, Medical Director ICU,
Dr. Barry Bikshorn, Neurologist, Dr. Edwin
Priest, Oncologist, Dr. Teo Alvia, Internist,
Sandy Kraus, Director of Risk Mgmt, Chris Johns,
VP of Patient Safety and Quality Missing Dr.
Elizabeth Schupp, Pulmonologist, Denise Iberle,
Case Mgr. Oncology, Barbara Wallace, RN, Director
of ICU, Lonnie Hicks, Mgr. Social Services

• BACKGROUND
• Changing the culture of an institution is an
  enormous, multi-layered, complicated task. Why
  would a chaplain, new to St. Alexius, away from
  hospital chaplaincy since her residency over 30
  years ago, want to take on a monumental task of
  transforming the culture of a 250-bed community
  hospital?
• The answer is simple NEED!
• 50 to 60 of palliative care patients live
  longer, with better quality of life, in LESS
  resource-intensive
• settings (home, nursing home, hospice) (S.
  Morrison, Hertzberg, Palliative Care Institute,
  Mt. Sinai Medical Center, NYC)
• Hospitals can save between 500 to 2,300 per
  day for each patient using palliative care
  services
• (White, K., Journal of Health Care
  Management)
• Palliative Care can lead to more appropriate
  use of resources patient, family, hospital,
  medical (CAPC, 2010)

DISCUSSION STRENGTHS 1. VP and CNO
support palliative care 2. Respected staff
on Full Life Committee 3. Intensivist
physicians role model good communication with
patients and families CHALLENGES1. Failed
attempt to begin palliative care 2 years earlier
soured physicians attitude2. Physicians resist
change3. Physicians dont attend education
programs4. Poor communication between physicians
and patients ADJUSTMENT 1. Sought
support from Medical Director from the beginning
2. Physician Co-Chairs Committee 3.
Used various ways to have physicians take
ownership of culture changes 4. Hopeful
Pre-Arrest / DNR Order will significantly
influence delivery of care 5. Attend local
conferences and report back to Full Life
Committee 6. Research journal articles and
provide monthly article for committee to read
7. Provides committee with monthly research data
from Illinois Health Institute (IHI) NEXT
STEPS 1. Hire Palliative Care Nurse
Practitioner 2. Involve Palliative Care
Nurse Practitioner on Full Life Committee 3.
Complete patient video for in-house TV 4.
Need Palliative Care Physician to join hospital
staff 5. Continue educating physicians and
nurses 6. Continue speaking about
palliative care at area churches 7. Create
way to track palliative care and hospice
statistics

• OBJECTIVES
• Form a multi-disciplinary team to develop
  palliative care
• Educate physicians, nurses, and
  multi-disciplinary staff about palliative care
• Improve communication between patient,
  physician, and family
• Increase the option for patients to receive
  palliative and/or hospice care earlier

• METHODS
• 1. Administrative support from VP and CEO
• 2. End-of-Life (EOL) Committee is
  multi-disciplinary
• 3. Recruited six key physicians to EOL
  Committee (oncologist, pulmonologist,
  intensivist,
• hospitalist, neurologist, internist)
• 4. Monthly report to Med Ex Committee of
  Physicians to solicit their support, approval,
  and
• ownership of palliative care
• 5. Agenda for Full Life Committee monthly
  meetings include education, discussion, and
  debate.
• 6. Created Pre-Arrest/DNR Order Form to
  increase physician communication with patients
  and
• families about end-of-life care
• 7. Small test of change for Pre-Arrest/DNR
  Order Form on med/surgical unit
• 8. Education for nurses and physicians about
  form
• 9. Offered two educational opportunities
  using well-known leaders in palliative care
  Rev. Dr.
• Myles Sheehan and Dr. Martha Twaddle
• 10. Study hospital palliative care models and
  choose model to fit our hospital culture
• 11. Chaplain provides education to 16 clergy
  of Ministerial Association and 46 Ministers of
  Care
• about palliative care

An indirect approach to increase and improve
communication between physicians, patients,
families and nurses
IMPLICATIONS FOR PATIENTSThe project is much
like a snow ball rolling downhill slow at first,
gradually picking up momentum. In August, 2010,
it became mandatory for any patient in ICU for 5
days that a multi-disciplinary care conference
with family will occur on day 5. As physicians
have grown in their understanding and realization
that palliative care positively impacts their
patients, the direct implication for patients has
begun to be seen. Since the Pre-Arrest/DNR Form
was initiated on August 3, 2010 early data
reveals that patients are going on hospice 1 to 5
days sooner. Change is happening. This next year
will be exciting. Solid data will be available as
the Palliative Care Nurse Practitioner begins
developing a patient case load.
RESULTS 1. Develop and
implement Pre-Arrest/DNR Order Form with all
physicians August, 2010 2. Educate and
train physicians and nurses to use form
3. Committee changes name from End-of-Life to
Full Life Committee to reflect goals of
palliative care 4. Choose
Palliative Care Nurse Practitioner Model to
continue changing the culture of St. Alexius
5. CEO approves hiring Palliative Care Nurse
Practitioner 18 months after Full Life Committee
begins 6. Creating patient video
for in-house television
Evidence of Culture Change - Pre-Arrest Order
Form approved from tie-breaking vote on 12/3/09
to an affirmative 12-4 vote on 3/3/10
VISION STATEMENT INCREASE THE OPTION OF
PALLIATIVE AND/OR HOSPICE CARE FOR PATIENTS AT
ST. ALEXIUS MEDICAL CENTER