September 24, 1998

The Board of Trustees has set aside the October 8-9 meeting to focus upon the strategic plan. The board, among other things, will consider four major strategic planning issues including ownership and legal structure, clinical enterprise relationships, organizational structure and infrastructure.

The development of the proposed strategic plan was accomplished through broad-based input from numerous sources, including ideas discussed at our January 29, 1998, management retreat. The Deloitte & Touche consulting firm, which has a great deal of expertise concerning the health care arena, has facilitated development of the proposed plan under the oversight of the MUSC Strategic Plan Steering Committee. The KPMG Peat Marwick consulting firm, at the request of the State Budget and Control Board, has conducted an assessment of how similar academic health centers have structured their organizations to prepare for the future and their findings will be considered in conjunction with the strategic plan proposal. I am confident the exhaustive efforts made to formulate our new strategic plan will serve MUSC well as we posture for the future.

In the meantime, progress is being made toward implementing a plan of action to reduce costs. As discussed in a recent Currents newsletter, the Balanced Budget Act will result in significant funding reductions and we must focus on all cost savings opportunities to offset the impact. Our objective is to control costs, while providing the highest quality of care, without adversely affecting employment.

I will keep you posted on progress with the strategic plan and cost cutting initiatives.

W. Stuart Smith, Interim Vice President for Clinical Operations Interim CEO, MUSC Medical Center

Parking

• Melinda Anderson, director of Parking Management, gave the management team an update on parking assignment policies, fall parking conditions, and plans for future parking improvements.
• MUSC parking policy provides that the waiting list for each location be separated into three lists, one for faculty, one for house staff, and one for classified (nonfaculty) employees. As spaces become available they are offered to the top name on each of the lists in a rotating fashion.
• For those situations where no waiting list exists, for instance when a new facility such as Rutledge Tower is acquired, one of several processes may be selected depending on the circumstances. Assignments can be made in hire-date order (Rutledge Tower); by lottery (G lot employee relocation in 1996); or by using an existing waiting list from another location (the existing G lot list was used to assign the employee garage when it opened in 1988).
• Parking policy also provides that where a building has a parking lot or facility contiguous to and dedicated to that building, work site may be established as the criterion for eligibility for a parking assignment to that parking facility. Examples are Family Medicine, Harper Student Center Garage, Sebring-Aimar House, and the lower two floors of Harborview Office Tower garage.
• Rutledge Tower is the most recent example of a work-site based criterion for parking. The Rutledge Tower garage is a patient parking facility, but not all spaces will be needed initially for patients. Two hundred seventy-five spaces have been made available for employees of Rutledge Tower. The assignments were prioritized by hire date. The assignment process is almost complete, and at present there are approximately 230 employees and 25 faculty members on the waiting list for the Rutledge Tower garage.
• This time of year is the busiest for parking. The commuter lot on Fishburne Street (the Hagood lot) fills to capacity on most days. MUSC leases this parking lot from the city and is doing the best it can to squeeze as many parkers into the lot as possible. However, vehicles which are parked so as to create a safety hazard, block a driveway, or block another parker in are subject to citation. Parkers are subject to citation by city police if they disregard any city parking regulatory signs such as the no-parking signs on Line Street at the south end of the Fishburne Street lot. Parkers are also subject to citation by city police if they should drive over the sidewalks to enter the parking lot.
• Anderson advised that MUSC has leased additional spaces at the Morrision Drive Annex of the Hagood commuter parking system and that the space there is not being fully utilized. The available spaces are at the south side of the parking lot and are most easily reached by entering from Morrison Drive at 995 Morrision Drive (next to the Charleston County Disabilities Board sign). The MUSC spaces butt up to the last row of parking in the parking lot property. Each space is marked “Reserved for MUSC.” Anderson encouraged utilization of the Morrison Drive lot by employees working day shifts who live East of the Cooper or who come in from I-26. The Morrison Drive Annex is served by a dedicated MUSC bus route.
• Parking Management has received word that an offer has been submitted to the Health Sciences Foundation to purchase the Spring Street Annex of the Hagood Commuter parking system. If the sale goes through 40 parking spaces will be lost.
• Short term solutions to the over-crowded parking conditions include leasing additional spaces near the Fishburne Street parking lot (November time frame) and construction of a 400-space parking lot near Harbor View Office Tower (construction to begin sometime after the first of the year).
• Parking, transportation, and campus circulation is a major component of the new campus master plan which is now being developed. Long-term parking solutions which focus on building addtional multi-story parking garages on campus are being considered.

JCAHO Accreditation Update

• Vivian Gettys, Joint Commission Accreditation Program Manager, welcomed back Shirley Wilson and Lois Kerr of Wilson, Cunningham, Kerr Associates. Wilson and Kerr will continue to provide consultation services on Joint Commission accreditation to MUSC.
• Wilson and Kerr outlined the proposed changes to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) hospital standards for 1999.
• Under Performance Improvement, the proposed changes are:
• PI.3—Measures NOT required to report data on: (optional)
• autopsy results
• appropriateness of admissions and hospital stays
• staff views on performance improvement opportunities q risk management q quality control activities
• PI.3—You ARE still required to report on these measures:
• anesthesia, operative and other procedures that place patients at risk q medication use
• blood and blood components
• behavior management
• services to high-risk populations
• patient satisfaction
• Additional minor proposed changes under Performance Improvement include:
• PI.2—Include redesign of existing procedures
• PI.4—Reworded “assessing data” to “aggregating and analyzing” data
• PI.5—Sustain performance improvement
• Leader’s Role in PI (now scored under Leadership - LD.4.2)
• Under Restraints, the proposed changes are:
• TX.7.5—New Standards
• Nurses CAN initiate restraints
• Verbal orders are still needed within 12 hours
• Written orders are needed within 24 hours
• Expanded use of protocols to initiate restraints (there is still some question about how these changes will apply to Behavioral Health)
• Regarding restraint use as a Performance Improvement:
• Focus is shifted from eliminating restraints to eliminating risks of restraint usage
• The Scoring Changes for 1999 consist of :
• RI.1.2.1.1 - 1.1.2.1.5—Informed consent/research (from a 3 to a 5)
• RI.2—Organ Procurement (from a 3 to a 5)
• PE.1.9.1—Range of lab services (from a 4 to a 5)
• NR.3—Nurse executive approvals (from a 3 to a 5)
• No Caps for: Continuum of Care; Performance Improvement; Information Management; Infection Control; and Management
• PI.4.5—Now includes Root Cause Analysis of Sentinel Events as part of a new standard, LD.4.3.1 - Organizational Response to Sentinel Event
• It is important to be prepared for the possibility of a random, unannounced survey by JCAHO in 1999. The Joint Commission normally provides 24-hour notice of the survey. However, JCAHO is considering conducting random unannounced surveys with no notice (similar to DHEC). Some of the critical areas involved in a random survey are:
• EC.1—Design - Life Safety Code
• HR.2—Adequate Staffing
• PI.4 - Intensive Assessment
• TX.7.1 - Restraint Use
• TX.3 - Medication Use
• HR.5 - Competence
• Wilson and Kerr concluded with a list of “1998 Top Hitters.” These are standards which have been most problematic for hospitals nationwide resulting in Type 1 recommendations.
• TX.3.5—Medication Use—There is appropriate control of medication
• TX.3.5.5—There are mechanisms that address emergency medications
• TX.1.3.2.8—Special Treatment Procedures—Orders for restraint or seclusion use define specific time limits
• TX.7.1.3.3—Documentation in medical records reflects organization policy
• EC.2.10—Management of the Environment of Care: Implementation—Fire drills are conducted regularly
• HR.5—Assessing Competence—Individual competence is assessed based on job description
• IM.7.6—Patient-Specific Data and Information—Entries are made in medical record as soon as possible after event
• Lois Kerr reviewed the JCAHO timetable for the ORYX initiative, the mechanism to track outcomes measures continuously as part of the accreditation process. She stated two additional clinical measures much be selected by Dec. 31, with data collection initiated the first quarter of 1999.
• Vivian Gettys announced that a JCAHO standards update is scheduled Oct. 9, for all staff involved in accreditation survey preparation activities. A mock survey is being planned to assist in targeting areas for improvement.

Weather Emergency Information Card

• Sue Pletcher, newly appointed director, Patient Access Services, reviewed with the management team the green MUSC Employee Weather Emergency Information cards. These cards inform employees of what to do during a weather emergency including appropriate telephone numbers for instructions and a listing of supplies needed by employees who report to work. Every employee should have one. They are available through Patti MacFarland at 792-1319.
• The telephone system is set up on Voice Max through Health Connection. During a weather emergency, employees should call either 792-1414 or 1-800-424-6872 (press 2), then enter the appropriate 4-digit code listed on the green card for your area. There is also a list of supplies needed by each employee who must report to work during an emergency.
• Each area on the card has an individual responsible for recording the appropriate message(s) during an emergency. A test will be conducted to double-check the system and make sure the messages are entered correctly. Hope Colyer, manager, Referral and Member Services in Marketing Services, can be contacted for instructions concerning the Voice Max system. She can be reached by pager #12030.