June 2015

Aloha, and welcome tothe June issue of PaliMomi's PhysicianEnews Brief for medicalstaff.

IN THIS ISSUE

A Message From Jen

Art Gladstone Named New Pali Momi CEO

Aloha From Your CMO: My Swan Song

A Welcome From Your New CMO

The Joint Commission's Prescription for Health

Epic Update: Electronic Media for Our Patients

Hawaii Pacific Health among TopOrganizations in Employee Engagement

Pali Momi Awarded Advanced Certification forPrimary Stroke Center

Pali Momi Women's Center Earns NationalBreast Center Accreditation

Healthy Pursuits: A Monthly PatientEnewsletter

Be Prepared

Pali Momi Celebrates 25 Years

In the News

Upcoming Events

Welcome New Members and Allied HealthProfessionals

A Message From JenAs I take on this new challenge in my career, I am honoredand humbled by all the well wishes from our medical staffand physician leaders. Many of you have shared yourthoughts on my time at Pali Momi and what we have allaccomplished together. Those are the memories I take withme. It's what makes my 11 years at the hospital someaningful.

Jen H. Chahanovich, CEO

I have been privileged to work with a medical team that I hold in the highest esteem. Youhave my sincerest gratitude for the work you do with patients, their families and ourcommunity. The true commitment that has been made by all of you – to provide qualitycare for West Oahu – has made all the difference to the people we serve.

Because of your efforts, in an ever-increasing number of areas, Pali Momi has beenrecognized, certified or accredited among the top providers in the country. Our patientexperience ratings for four years in a row are among the top 10 percent. Our qualityresults continually improve, and our cardiac, breast imaging, stroke care and bariatricprograms have achieved designations that place these programs with the nation's finest.

In families, even if members move away, the closeness and ties remain, and they docome together again. I believe that is true, especially within the Hawaii Pacific Healthohana, where our work extends throughout the system.

And so I extend my heartfelt mahalo to you, and for now, say aloha.

Art Gladstone Named New Pali Momi CEOThe following announcement was made by Hawaii PacificHealth President & CEO Ray Vara on June 24, 2015:

"With Jen Chahanovich's upcoming move to WilcoxMemorial Hospital and Kauai Medical Clinic, Hawaii PacificHealth will be restructuring our senior leadership team.

As part of the restructuring, I am pleased to announce thatArt Gladstone will expand his CEO role to includeresponsibility for both Pali Momi Medical Center and StraubClinic & Hospital effective July 1, 2015. Given Art’s longhistory of operational and administrative leadership at bothPali Momi and Straub, he is the ideal executive to overseeboth facilities. During his time at Pali Momi, Art held boththe vice president operations as well as chief operatingofficer positions.

Art Gladstone, CEO

In 2004, Art assumed responsibility at Straub as its chief operating officer and waspromoted to CEO for Straub in 2013.

Art will also be restructuring his leadership team and will have chief operating officers forPali Momi and Straub reporting directly to him. He is currently looking at internalcandidates for the chief operating officer positions."

Ray VaraPresident & CEO

Aloha From Your CMO: My Swan SongHugh N. Hazenfield, MD, FACS, outgoing Chief MedicalOfficer

On June 30, I am making my third attempt at retirement –and this time, I may get it right!

I have had the privilege to work with many of you ascolleagues not only at Pali Momi, but also at other Oahuhospitals since my arrival in Hawaii in 1989. I have beenhonored to be the recipient of your trust in caring for yourpatients, your encouragement and your friendship.

I accepted the position as your chief medical officer andstarted in this role on July 13, 2009. I promised Jen twoyears of service, but somehow – as I stated to her – I forgotto retire because I was enjoying this job.

Hugh N. Hazenfield, MDChief Medical Officer

The main reason for my accepting and remaining in this position was because of what Iviewed as your unique collegiality, as well as your dedication to quality care for yourpatients and your willingness to serve in leadership roles and on committees to strive foran even better medical center.

Because of your participation, Pali Momi is truly an unusual and outstanding hospital,having won national recognition for quality.

It also includes:

The administration, which is very supportive of the providers, and each individual inthis hospital;The employees, who not only see themselves as members of "the team," but smileand greet us every morning;The unselfish volunteers; andThe dedicated board members.

Being the first CMO, I have attempted to develop the chief medical officer position as aresource and support for you, the physicians, in these rapidly changing times in thepractice of medicine. I hope that I have succeeded.

I am leaving the CMO responsibilities in the good hands of Dr. James Kakuda. He is anoutstanding physician. He has proven himself as an administrator as chief of staff and inother leadership roles. He has quality care at heart, and he will serve you well.

Treasure what you have here at Pali Momi. Maintain your collegiality, and enjoy yourfriendships. Continue to strive for the best quality care possible for your patients. Lookforward to each new day and its challenges and triumphs.

You are what makes and keeps this place such a great place in which to practice.

Aloha,Hugh

A Welcome From Your New CMOJames T. Kakuda, MD, incoming Chief Medical Officer

It is with great excitement that I write this column as Pali

Momi's incoming chief medical officer.

For the past quarter-century, Pali Momi has grown to be animportant part of the West Oahu community. Through thework of many, the medical center has brought to WestOahu new technology, improved access, better service andtop-tier quality.

I view my new position as an opportunity to facilitate thecontinuance of this good work.

The coming years will be difficult, as there are manychallenges that face us. The transition to ICD-10 in only afew months is but one example of impending disruption.

James T. Kakuda, MDChief Medical Officer

Pali Momi recently hosted a CME on this topic. Our speaker estimated private practicesshould have 60 days cash on hand to weather the transition! On top of this, more stressesarise from the changing landscape of health care providers in our region, ongoingchanges with health care reform, and the ever-increasing administrative burden borne byphysicians.

While there are many challenges, there are also many things to look forward to:construction of a comprehensive oncology treatment center, development of a newcardiac catheterization lab and recruitment of new physicians – both private practice andemployed – are but a few examples of work that will allow us to better fulfill our mission.

I look forward to sharing these challenges and opportunities with you.

The Joint Commission's Prescription for HealthMark Baker, MD, Chief of Staff

Pali Momi Medical Center is now in its time window of aJoint Commission survey that extends until October! Thismeans that between now and then, a team of surveyorscan show up essentially unannounced and have access tohospital areas and patient information that would otherwisebe considered confidential.

The Joint Commission is well-intentioned. From its website,I read the following:

"For more than 60 years, The Joint Commission has been achampion of patient safety by helping health careorganizations to improve the quality and safety of the carethey provide. Our many patient safety-focused initiativesencourage and support organizations in their efforts tomake patient safety a continuous priority."

Mark Baker, MDChief of Staff

Sometimes, I am a skeptic. I scoured the literature, looking for an answer to somequestions. Has The Joint Commission improved health or health care? Has The JointCommission overstepped its boundaries? Is The Joint Commission good for patient care?

As with any question, the answer is, it depends.

Glassman provides evidence that The Joint Commission's "Do Not Use" abbreviation listhas decreased medication errors.1 These were announced in 2003 and includeabbreviations such as MS and MSO4, both of which had been confused with morphine.

At that time, I thought the inability to abbreviate morphine was silly because nobody couldconfuse a pain medication with magnesium sulfate. I stand corrected. The articledocuments that 10 percent of medication abbreviation errors were attributed to confusionbetween these two. The electronic health record has made some of these areas ofconfusion obsolete; thank you, Epic.

Has The Joint Commission overstepped its bounds? On The Health Care Blog, KarenSibert describes how the standards are a moving target:

The Joint Commission decrees that syringes containing medications should be labeledwith the name of the drug. No, that's not good enough. All syringes should be labeled withthe exact concentration in mg/cc as well as the name of the drug. That's not good enougheither. All syringes should be labeled with the drug name, the concentration of the drug,and the date and time they were drawn up. No, wait. They should be labeled also with theinitials of the person who drew them up. And some medications should be labeled not withthe time the drug was drawn up, but with the time it expires.

Certainly, The Joint Commission is motivated to continue its effort to improve health care,essentially ratcheting down on the providing organizations to the point where we wonderwhat their purpose is.

If health care organizations could be trusted to maintain a defined level of quality, TheJoint Commission would be out of business. Unfortunately, that is not likely to happen;health care may never be safe enough from a reviewer's point of view.

Pali Momi Medical Center truly has a culture of safety. So, if you have the opportunity tomeet one of the inspectors between now and October, smile, and tell them you are happyto show them what you do and how you take the best possible care of patients.

1 Glassman P. The Joint Commission's "Do Not Use" List: Brief Review (NEW) In: MakingHealth Care Safer II: An Updated Critical Analysis of the Evidence for Patient SafetyPractices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar.(Evidence Reports/Technology Assessments, No. 211.) Chapter 5. Available from:http://www.ncbi.nlm.nih.gov/books/NBK133373/

Epic Update: Electronic Media for Our PatientsSubmitted by Mark Baker, MD

Epic has matured, and we are now using the 2014 version of Epic.

As with all upgrades, there were problems, but all things considered, the transition wassmooth. Future versions allow increased efficiency for the providers with betterdocumentation. I don't have a timeline for implementation.

Up until this point, most of the focus of the electronic health record is on providers and

delivering care. My focus with this newsletter is patient education. This is traditionallyoutside of the scope of the electronic health record, but it is one of the most importantaspects to patient care.

Epic allows access to prepared aftercare instructions. Patients receive pages of printedinformation (too many in my opinion). What do a lot of them do when they get home? Theylook things up on the Internet. Do they find a reputable source? Do they find a blog thatindicates that we did the wrong thing? Do you know how to tell if a source is reputable?Do you know how to guide your patients related to use of the Internet?

Health care providers typically have not promoted, encouraged or taught effective use ofthe Internet to obtain medical information. Care is not delivered by the Internet!

Teaching patients home care and dissemination of information to the patient or caregivershas traditionally been verbal with written instructions. Saidinajad et. al. found that EDpatients and families were interested in access to Internet-based patient care information.1

Internet-based medical content is increasing and may aid with patient understanding oftheir injury or illness. Bloch et. al. describe improved understanding when patients usedvideo presentations for aftercare instructions.2 I look forward to this in the future!

How do you know what is reliable? There are medical content certification sites likeHONcode or URAC.

HONcode stands for Health On The Net Foundation. As stated on its website:

The Health On the Net Foundation (HON) promotes and guides the deployment of usefuland reliable online health information, and its appropriate and efficient use. Created in1995, HON is a nonprofit, non-governmental organization, accredited to the Economic andSocial Council of the United Nations.

URAC is an independent nonprofit organization. Both WebMD and the Mayo Clinic Siteare certified and believed to have good patient information. UpToDate has recently beenincreasing its supply of patient-related information, but it does not display anyaccreditation.

You and your patients can look for the logos below, typically found at the bottom of thewebsite.

 

Technology is changing health care providers, our patients and the way we deliver care. Inspite of this, we will still need to focus on human-to-human interaction, compassion andunderstanding of patients' wants, needs and fears.

Digital media for patient should be considered a supplement to and not a replacement ofthat human interaction.

1 M. Saidinejad and J. Zorc. "Mobile and web-based education: delivering emergency

department discharge and aftercare instructions." Pediatric emergency care 30.3 (2014):211-6. Print.

2 S. A. Bloch and A. J. Bloch. "Using video discharge instructions as an adjunct tostandard written instructions improved caregivers' understanding of their child'semergency department visit, plan, and follow-up: a randomized controlled trial." Pediatricemergency care 29.6 (2013): 699-704. Print.

Hawaii Pacific Health among Top Organizations in EmployeeEngagementHawaii Pacific Health has been recognized with the prestigious Gallup Great WorkplaceAward for the fourth year in a row.

The award recognizes HPH as one of 40 organizations leading the world in employeeengagement with winners based in a wide range of countries including Canada, China,India, Indonesia, Netherlands, Singapore, Thailand, the United Arab Emirates, the UnitedKingdom and the United States.

A team from HPH accepted the award on behalf of our organization earlier this month atthe Gallup Workplace Summit in Omaha, Nebraska.

HPH is currently ranked in the 86th percentile when benchmarked to a Gallup database ofmore than 1.3 million health care employees, and averages nine engaged employees forevery one actively disengaged employee, which is five times the rate in the U.S. and morethan 16 times the rate for workforces globally.

All of the companies honored with the award are recognized for the business impactachieved by integrating engagement into four areas that Gallup has identified as vital tocultivating a workplace culture of engagement: strategy and leadership, accountability andperformance, communication and knowledge management, and development andongoing learning.

Pali Momi Awarded Advanced Certification for Primary StrokeCenterPali Momi Medical Center recently earned The JointCommission's Gold Seal of Approval® and the American HeartAssociation/American Stroke Association's (AHA/ASA) Heart-Check mark for Advanced Certification for Primary StrokeCenters. The Gold Seal of Approval® and the Heart-Check markrepresent symbols of quality from their respective organizations.

Pali Momi underwent a rigorous onsite review by Joint Commission experts who evaluatedthe hospital's compliance with stroke-related standards and requirements, includingprogram management, the delivery of clinical care and performance improvement.

"We are honored to be certified as a Primary Stroke Center and to be acknowledged forthe quality, coordinated care we provide patients in the event of a stroke emergency," said

Pali Momi CEO Jen H. Chahanovich. "Time is a crucial factor in treating a stroke andensuring a successful outcome, so we are especially proud that we can provide access tonationally-recognized stroke care close to home for the residents of Central and WestOahu."

The Primary Stroke Center certification recognizes centers that follow the best practicesfor stroke care. Certified primary stroke centers:

Use a standardized method of delivering care.Support patient self-management activities.Tailor treatment and intervention to individual needs.Promote the flow of patient information across settings and providers, whileprotecting patient rights, security and privacy.Analyze and use standardized performance measure data to continually improvetreatment plans.Demonstrate their application of and compliance with clinical practice guidelinespublished by the AHA/ASA or equivalent evidence-based guidelines.

Established in 2003, Advanced Certification for Primary Stroke Centers is awarded for atwo-year period to Joint Commission-accredited acute care hospitals. The certification wasderived from the Brain Attack Coalition's "Recommendations for the Establishment ofPrimary Stroke Centers" (JAMA, 2000) and the "Revised and Updated Recommendationsfor the Establishment of Primary Stroke Centers" (Stroke, 2011).

Pali Momi Women's Center Earns National Breast CenterAccreditationThe Women's Center at Pali Momi Medical Center has been granted a full, three-yearaccreditation designation by the National Accreditation Program for Breast Centers(NAPBC), a program administered by the American College of Surgeons. Accreditation bythe NAPBC is given only to centers that have voluntarily committed to provide the highestlevel of quality breast care and that undergo a rigorous evaluation process and review oftheir performance.

"We're extremely proud of the quality of care and service provided to our patients at thePali Momi Women's Center," said Pali Momi CEO Jen H. Chahanovich. "This designationvalidates the efforts of our Women's Center physicians, nurses and staff to maintain thehighest standards of care and our commitment to ensure access to quality breast healthservices, particularly for residents of Central and West Oahu."

During the NAPBC survey process, the center was required to demonstrate compliancewith standards established by the NAPBC for treating women who are diagnosed with thefull spectrum of breast disease. The standards include proficiency in the areas of centerleadership, clinical management, research, community outreach, professional educationand quality improvement. A breast center that achieves NAPBC accreditation hasdemonstrated a firm commitment to offer its patients every significant advantage in theirbattle against breast disease.

The NAPBC is a consortium of professional organizations dedicated to the improvementof the quality of care and monitoring of outcomes of patients with diseases of the breast.

This mission is pursued through standard-setting, scientific validation, and patient andprofessional education. Its board membership includes professionals from 20 nationalorganizations that reflect the full spectrum of breast care.

Healthy Pursuits: A Monthly Patient EnewsletterPali Momi launched a monthly patient enewsletter earlier this year, and we want allemployees and physicians to have the opportunity to receive it too.

By subscribing to our patient enewsletter, you will have access to useful health andwellness information to share with your patients. You also can stay informed of the topicspatients are interested in learning more about.

You can opt-in via the website link here to subscribe to receive the enewsletter via yourpersonal email address at home.

We have similar e-newsletters for each HPH hospital that you may also want to receive.

For questions or feedback, please send an email to palimomi@healthypursuits.org.

Be PreparedHurricane season began on June 1 and will last through Nov. 30. Please see the 2015Hurricane Season memos for employees and managers for preparation instructions.

Contact your Safety Officer for questions or more information.

Pali Momi Celebrates 25 Years

In observance of Pali Momi's silver anniversary, a celebratory gala was held May 2 atAulani at Ko Olina.

Presented under the theme "By the Light of the Silvery Moon," the gala included music, asilent auction, dinner under the stars and a look back at 25 years of providing the highestquality medical care to West and Central Oahu.

Click here to view more photos.

In the NewsHere is a look at some of our physicians and specialists who have been featured in thenews recently:

Dr. Maria Ver – surgeon

Hawaii News Now, March 12: Ver highlights some of the activities and thepurpose behind Pali Momi's newest community event to promote health andwellness.

See the video – Pali Momi launches Girls Night Out event for women's health

Dr. Huidy Shu – neurologist

KITV, May 31: The Doctor is in: Shu talks stroke awareness.

See the video – Warning signs of a stroke

KITV, May 31: Shu talks about the warning signs and treatment for stroke,and his patient shares how getting to the hospital fast enough helped himrecover fully from a stroke.

See the video – Quick thinking helped save a man from a stroke

Dr. John Kao – cardiologist

KITV, June 3: Kao talks about the new technology available at Pali MomiMedical Center to prevent and detect heart failure in patients.

See the video – Pali Momi Medical Center first in Hawaii to offerCardioMEMS HF System

Hawaii News Now, June 4: Kao talks about the new technology available atPali Momi Medical Center to prevent and detect heart failure in patients.

See the video – Pali Momi implants new heart disease monitor

Upcoming EventsCATCH Conference

Congenital heart disease (CHD) is the most common defect in the United States,occurring in one out of every 110 births.

Currently, there are more than 1 million adults in the U.S. living with congenital heartdisease, and this number continues to rise.

To address this growing need, Hawaii Pacific Health will host CATCH: Caring for Adults

and Teens with Congenital Heart Disease Aug. 22 at the Hilton Hawaiian Village, CoralBallroom 1 and 2.

Adolescents and adults with CHD face unique challenges that require a specialized teamof clinicians that includes primary care physicians, cardiologists, internists, nurses andother health professionals.

At CATCH, an expert faculty from Hawaii and California will provide a comprehensiveoverview of research-based, cutting-edge care by medical professionals with specialexpertise in the complexities of CHD.

By the end of the conference, participants will be able to:

Identify potential comorbid conditions and complications in adults and teens withCHD.Review diagnostic and treatment options for adults and teens with CHD.

HPH is accredited by the Hawaii Medical Association to provide continuing medicaleducation for physicians.

HPH designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credit(s).Physicians should claim only the credit commensurate with the extent of their participationin the activity.

The HPH Continuing Education Department is accredited as a provider of continuingnursing education by the American Nurses Credentialing Center’s Commission onAccreditation. HPH designates this live activity for a maximum of 6.0 ANNC contact hours.

Early registration by June 30 costs $95 for physicians and $75 other health professionals.Regular registration costs $125 for physicians and $105 other health professionals.

To register, please complete the form found in the brochure here and return to HawaiiPacific Health Conference Services, or call 522-3469 for more information.

Department & Committee MeetingsAll meetings will be held in the Executive Conference Room unless noted otherwise.

Operative & Other Procedures: July 1, 12:20 p.m.Emergency Medicine Peer Review: July 6, 7 a.m.Cancer Committee: July 14, 12:30 p.m.Division of Radiology: July 14, 6 p.m.Division of Emergency Medicine: July 27, 12:30 p.m.Department of Medicine: July 27, 12:30 p.m., PMMC Conference CenterDivision of Anesthesia: July 29, 7 a.m.Metabolic and Bariatric Surgery: July 30, noonAlapono Committee: Aug. 7, 12:30 p.m.Medical Records Committee: Aug. 13, 12:30 p.m.ED Peer Review: Sept. 28, 7 a.m.

Continuing Medical Education (CME)Pali Momi Medical Center is accredited by the Hawaii Medical Association to providecontinuing medical education for physicians. This live activity is designated for a maximumof 1 AMA PRA Category 1 Credit(s)TM. Physicians should only claim creditcommensurate with the extent of their participation in the activity.

All CMEs will be held at 12:30 p.m. in the PMMC Conference Center unless notedotherwise.

"Hypothermia Protocol" by Yash Trivedi, MD: July 13"Current and Emerging Therapies for the Treatment of Congestive Heart Failure" byJohn Kao, MD: July 20"Hand Hygiene" by Krist Pottorff, MPH, BSN, RN: Aug. 17"Enhanced Recovery" by James Kakuda, MD: Aug. 24Cancer Conference: Sept. 14"Health Information Systems and Technology Safety" by Steve Robertson: Sept. 28

CMEs are subject to change. Please check the MSO Intranet calendar for updates, or call485-4209 to confirm a meeting.

Holidays & Observances

Independence Day – Saturday, July 4 (Observance Friday, July 3)Admission Day – Friday, Aug. 21Labor Day – Monday, Sept. 7

Welcome New Members and Allied Health ProfessionalsEddie S. Fiore, MD

Diagnostic RadiologyProvisional Consulting Staff

Susan L. Tan, MDOtolaryngology

Provisional Active Staff

Joseph Varcadipane, MDOrthopedic Surgery

Provisional Active Staff

Questions? Contact James T. Kakuda, MD, Chief Medical Officer at 485-4544 orjames.kakuda@palimomi.org.

Pali MomiMedical Center98-1079 Moanalua RoadAiea, HI 96701

The Pali Momi Physician enews brief is produced quarterly to keep themedical staff informed of the latest news at our hospital. This enewsletterreplaces the printed version of the Pali Momi Physicians News Bulletin.

Pali Momi is part of the not-for-profit Hawaii Pacific Health network.