"In a service-oriented culture of care, we ask ourselves, 'What do our patients need?' 'Are we being the best co-workers we can be?' Everyone is part of the solution. Everything we say and do counts."

—Eric Dickson, MD

Patients and families traveling to University of Iowa Hospitals and Clinics often worry about coming to an unfamiliar place far from home.

Fortunately, those anxieties usually disappear upon arrival.

In fact, once here, most people express confidence in the quality of care provided and gratitude for the personal attention received from the whole team of health care professionals and other employees who staff the hospital day and night. Their satisfaction reflects the hospital's service-oriented culture of care where no detail is too small, no concern too frivolous.

As part of the strategic plan for years 2006 through 2010, many special programs and services are being developed or enhanced to make sure every patient has the most satisfying experience.

"As a core service principle, we believe that patients and family members are not mere passive recipients of treatment," explains Eric Dickson, MD, a designated "champion" for excellent service. "Rather, everyone benefits when patients and families are engaged in the plan of care."

Excellent service champion Eric Dickson, MD

No Detail is too small, no concern too frivolous

Dignity and Respect

Kortney Heald of Packwood, Iowa, harbored a disquieting assumption six years ago during an urgent 65-mile trip to University of Iowa Children's Hospital with her teen-age daughter, Bethany.

Surely patients are just a number here, she remembers thinking.

Fortunately, Kortney had no reason to worry.

The physicians, staff, and volunteers she encountered were friendly and helpful. Furthermore, the entire Heald family was encouraged to be fully engaged in Bethany's plan of care.

"We were always treated with dignity and respect," Kortney says. "Someone was always there to tell us what was happening and why. That was extremely important to us as a family."

Bethany, now age 20, says she appreciated being involved in every decision.

"It's really important that doctors treat you like a person, and not a case," she says.

Bethany Heald, a 20-year-old brain cancer patient, enjoys a peaceful moment on her parent's acreage near Packwood, Iowa.

Confidence and Comfort

The Heald family vividly recalls how many staff members and volunteers played important roles in making their stay less stressful … people like a cheerful, helpful ward clerk, a comforting nurse, and a tactful housekeeper who recognized and respected an intimate moment between mother and daughter.

Over time the entire family became confident in the care process. This, in turn, helped them deal with Bethany's life-threatening brain tumor.

In fact, Kortney appreciated the concept of family-centered care so much she became a volunteer member of the University of Iowa Children's Hospital Family Advisory Council. She also speaks about her experiences to newly hired staff, pediatricians-in-training, nurses, and rehabilitation therapists.

Bethany became similarly engaged through the Youth Advisory Council.

"UI Hospitals and Clinics does a great job of extending family-centered care," Kortney says.

Family-centered Care

Family-centered care is a philosophy embraced by every clinic and service at UI Hospitals and Clinics. In fact, University of Iowa Children's Hospital has been a national leader in the field since the mid-1980s.

Tami Barrett, RN, MSN, MBA, University of Iowa Children's Hospital's coordinator of Family-Centered Care, recalls a time when virtually all hospitals prohibited visitation by a pediatric patient's sibling.

"This was due mostly to infection control concerns," she says. "But after extensive nursing research here, we began a sibling visitation program that has been highly successful."

Other changes soon followed. In 2000, the Pediatric Intensive Care Unit implemented the unusual and now successful practice of including parents in medical rounds.

Since October 2002, Barrett has developed and implemented programs and services that support pediatric patients and families receiving health care services at University of Iowa Children's Hospital.

"Patient- and family-centered care is a core philosophy upon which all our pediatric health care is based, recognizing that the family is the child's primary source of strength and support," she says. "Patients and their parents are included as fullpartners on the health care team."

Family-centered care is a passion for Tami Barrett, RN.

Performance Improvement

The philosophy of patient- and family-centered care is kept alive and well at UI Hospitals and Clinics through many different programs and initiatives. Among them is the Patient Satisfaction Program, which measures, analyzes, and reports the degree to which the hospital's service goals are being met.

"Most patients who stayed in the hospital receive a survey within a week of their visit," explains Randall Aitchison, PhD, program coordinator. "These surveys are managed by Press Ganey, the nation's leading supplier of patient satisfaction services."

Similarly, patients who visited a specialty clinic are randomly surveyed every week.

Survey data can be useful in all kinds of ways. For instance, based on patient feedback, the

Department of Food and Nutrition Services developed a new program that earns high marks and serves as a benchmark for other hospital food services.

All patients, both adult and pediatric, can now order their meals and snacks whenever they choose—a perfect recipe for hot food and more satisfied patients.

"The data we collect are invaluable in helping us meet the hospital's goals for improving care and service to patients," he says.

Randall Aitchison, PhD, Patient Satisfaction Project Manager

Front-line Service

In yet another refection of patient- and family-centered care, the Department of Guest Services has introduced a Concierge Program at the Main Entrance, similar to what one might find at a hotel.

Headed by Sharon Artman with oversight from Robin Hennes,the program provides patients and visitors with a centralized resource for securing hospital and community amenities, information, and services.

"We have the luxury of time to help people get answers to their questions in a more efficient way," Artman says. "Even if we don't have the answer, we can direct them to someone who does."

The program's internal initiatives extend to other areas of the hospital as well. For instance, Volunteer Floor Hosts are assigned to various patient care units. Their job is to greet and inform guests about matters of importance to their visit.

"The people who come here are often already under stress," Artman says. "Anything we can do to reduce their anxieties is all for the good."

Hennes notes that the program will receive a significant boost when it relocates next spring to a new Main Entrance now under construction. The project will include a stand-alone Guest Services area that will accommodateConcierge services and a new Business Center for patients and guests.

Physicians as Partners

While patients occupy center stage in the hospital's culture of service and satisfaction, the community-based physicians who referred them here are equally valued. That's because referrers are partners in the care process. As such, they are equally dedicated to quality care and rightfully expect to be kept "in the loop" as the care plan evolves.

To improve communications with referring physicians and serve as a springboard to action, the hospital created the Office for Referring Physician Relations. Among various initiatives, the office launched a pilot project to automatically fax patient discharge summaries rather than send them by mail

"We are also coordinating visits between community physicians and our UI Physicians with an eye towards encouraging stronger personal relationships," says Christine Miller, director of Strategic Relations.

In addition, a new customer relationship management tool is being used to enhance service to physicians by identifying and fixing problems early.

"We're off to a great start but it's only a beginning," Miller says. "Look for many more improvements to come in our ongoing quest to provide the highest quality care to all our patients."

Outreach Innovation

To find out first-hand what his cardiology colleagues throughout Iowa had to say about UI outreach heart care services, Mark Anderson, MD, PhD, hit the highway to listen and learn.

His travels to 10 different sites enabled him to meet personally with dozens of physician colleagues. The helpful hints he received will prove useful as the Joint Office for Clinical Outreach Services and UI Heart and Vascular Center tailor their programs to meet the future needs of referrers.

Anderson's travels yielded an additional bonus in the form of a new program that represents an innovative approach to UI outreach services. At four of the sites—Muscatine, Keosauqua, Southeast Iowa City, and North Liberty—the program will designate one cardiologist to exclusively serve that site.

In the past, different cardiologists had been sent to each site. To promote even more accessibility, the designated cardiologists will carry pagers so they can be reached at any time, day or night.

"We believe this new approach will allow for patients and referrers to establish a stronger, more personal relationship with our outreach physicians," Anderson says.

"I have been listened to by everyone I encountered. University of Iowa Hospitals and Clinics is patient-centered, timely, efficient, equitable, and safe. This is important as I continue my health care journey with you all. Thank you for the care you give to Iowans."

—Elizabeth Hanken
Clarion, Iowa

Focus on Rural Service

Once a week, Paul Lindower, MD, packs his stethoscope for a 45-minute ride with an outreach nurse to Muscatine, Iowa. It's a labor of love for Lindower, who is now the designated cardiologist for the University of Iowa's outreach heart care clinic located in the eastern Iowa city of 23,000 people.

His weekly presence there provides the community with convenient access to a leading cardiologist and a direct link to the multi-disciplinary expertise of specialists at one of the nation's top academic medical centers.

"I'd like to think I'm very approachable and open to suggestions," Lindower says. "Being here on a more consistent basis will speed our evaluations and better integrate our services."

These new types of partnerships represent exciting transitional times for the University's outreach efforts, according to John Fieselmann, MD, director of Clinical Outreach Services.

"It allows us to share new technologies and the latest in research with our rural partners," he says. "We also have opportunities to extend our educational programs to communities around the state, whether on-site or through our growing telemedicine program."

UI outreach cardiologist Paul Lindower, MD, (center) consults with Muscatine providers Robert Weis, MD, and Teresa Benda, RN.

Recognizing Performance

While all 7,200 UI Hospitals and Clinics staff members are encouraged to personally reflect the hallmarks of high-quality care—compassion, vision, and integrity—many individuals take one step more.

Nursing assistant Tyeisha Washington is one such person.

Washington received a CEO Above and Beyond Award for the special attention she gave to a severely injured patient in the Surgical Intensive Care Unit.

The patient was feeling depressed as she started on the long road to recovery. Washington did what she could to help cheer her up. After learning the patient was a Chicago Cubs fan, Washington secured an entire box of baseball merchandise from the Cubs front office.

"She told me it was the best gift anyone had ever given her," Washington says. "She recovered fine and now is back in high school hanging out with her friends. We e-mail each other from time to time."

The CEO Above and Beyond Award that Washington received—one of seven given during 2005—is just one way in which staff members earn recognition for exceeding the needs of patients, visitors, and fellow staff.

Another example is the Heart & Hands Award, which recognizes outstanding individual contributions to the local, regional, and international community. There were three honorees in 2005.

"Our staff members don't do these things to win awards," says Diana Leventry, director of Hospital Human Resources. "But I definitely think our awards programs contribute to a patient- and family-focused environment. It is staff members like Tyeisha who make the Iowa Difference."

2005 CEO Above and Beyond Award recipients

• Connie (Fountain) Hinz—Ophthalmology
• Michelle Jackson—Nursing
• Jill Kordick—Clinical Outreach Services
• Gloria Rolfson—Nursing
• Tyeisha Washington—Nursing
• Amy Werner—Nursing
• Ardalia Williams—Nursing

2005 Heart & Hand Award recipients

• Rhonda Cass—Nursing
• Doris Hughes—Volunteer Services
• Michael Maharry, MD—Family Medicine

CEO Above and Beyond award Winner Tyeisha Washington.

Nursing Excellence

The Department of Nursing Services and Patient Care at UI Hospitals and Clinics, which was the first hospital in Iowa to receive the Magnet Award for Nursing Excellence from the American Nursing Association, supports many initiatives that recognize and encourage professional nursing excellence.

One such program is the statewide 100 Great Iowa Nurses celebration.

Inspired by a similar event in Louisiana, the Iowa recognition program was organized by the UI College of Nursing, Iowa Nurses' Association, Iowa Nurses Foundation, and the Iowa Hospital Association.

"These exemplary nurses were selected by patients or peers based on their concerns for humanity and their contributions to the community and the nursing profession," says Linda Q. Everett, RN,PhD, FAAN, director of the Department of Nursing Services and Patient Care and Chief Nursing Officer.

Selected from over 300 nominees, the final 100 nurses for 2006 included 19 from UI Hospitals and Clinics:

• Linda Abbott, RN
• Rosemary Adam, RN
• Julie Aschenbrenner, RN
• Heide Bursch, RN
• Michele Farrington, RN
• Myrna Gordon, RN
• Renee Gould, RN
• Colleen Hoxmeier, RN
• Elizabeth Hradek, RN
• Sara Kendall, RN
• Barbara Kindred, RN
• Linda Moeller, RN
• LouAnn Montgomery, RN
• Laura Pheraman, RN
• Barb Ryan, RN
• Karen Stenger, RN
• Cheryl Vahl, RN
• Michele Wagner, RN
• Susan Wells, RN

A service-oriented culture of care means a lot to patients like 8-year-old Heather Markus of East Dubuque, Illinois. Heather, shown here with Child Life Specialist Robin Ostedgaard, was born with spina bifida. Her parents say the programs, accommodations, and amenities available at University of Iowa Children's Hospital have helped ease the family's stress and anxiety, and even played a role in defining her care. "It's a small miracle she has learned to walk, and that she attends public school with her classmates," says her mother, Patty. "The care has been phenomenal."