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About Smoke signals. (Grand Ronde, Or.) 19??-current | View Entire Issue (Sept. 1, 2004)
Smoke Signals Quality Improvement iihead For Clinic Nancy May brings 10 years of experience to the job. 10 SEPTEMBER 1, 2004 By Ron Karten Nancy May, the Wellness Clinic's Quality Improvement Coordinator, wants clinic patients to bring prob lems to her as soon as they occur, if possible, and to look at patient sur veys with fresh eyes. "It's really important that people respond with constructive com ments," she said, "and suggestions for improvement." It is easy to blow off surveys and many do. One day in June, the clinic served 90 patients who were then sent follow-up surveys. Only 13 responded and of those, eight had no name or address for the per son commenting. May is bringing back to life the formal process of quality improve ment at the clinic. She comes to the job with some 10 years of experi ence as a Registered Nurse, Qual ity Improvement and Peer Review Specialist for the Good Samaritan Regional Medical Center in Corvallis. Patient surveys represent one part of quality improvement. May also works with clinic physicians and other staffers to make sure that the clinic's policies and procedures "are reflecting the care we give." Her work takes her into each area of care to develop "quality improve ment studies" showing how far the clinic has come and how far it still has to go. The new effort is a way to formal ize what is too often an anecdotal process. "If people have concerns," she said, "they need to do it in a formal process." Making a complaint formal is done with an incident report in May's office upstairs at the clinic. Forms are also available at the windows of each section in the clinic. "I'll follow-up with you or just take care of it," she said. "But it's important to do it as soon as the incident oc curs. It makes it more difficult if we go three weeks down the road (before a complaint is filed)," she said. "If we see a trend," she said, "we can work more effectively with a formal complaint (filed right away). "Since starting in June, the office has received only a handful of for mal complaints," said May. Principle concerns for staffers in clude customer service, safety is sues, particularly with equipment, infection control and patient care. For patients of the clinic, concerns should include the other side of cus tomer service: that is, suc cessful interactions with staffers, access to services needed and cases of poor out comes from service provided, said May. Patients should not expect solutions overnight. When May learns of a problem, she wants to learn how wide spread it may be, and she wants to know if others have different perspectives on the issue. A complaint about waiting too long to see a clinic staffer, for example, could be an in dividual problem but May al ready knows that in many cases, the system itself plays a role. "For example, we know that emergency cases go be fore routine cases (sometimes causing longer waits than desirable)," she said. "We may try a few solutions be fore we find a good one," she said. "There may not always be a simple answer," she said, "but if we hear about it, we can try to improve it. If we don't, we can't address it." "Every organization can improve," said May. "The main thing is that we have a process here." However, she added, success "re quires the cooperation of the staff and the community." For questions or comments, May can be reached at 503 879-2098. Nancy May Health Clinic Administrator Balances Care And Cost David Foss continues his health care career in Grand Ronde. By Ron Karten David Foss, Administrative Of ficer for the Tribe's Health Clinic, is an Oregon boy. His great grand parents homesteaded in Moro, Or egon - "wheat country." His grand parents lived along the Siuslaw River near Florence. His grandfa ther was a Forest Service Engineer who designed "a lot of parks and roads around Mount Hood" includ ing Eagle Creek Park. "He used to take me up there," he said. So, it should be no surprise that he looks at his recent life in Oregon that began again in January when he started working for the Tribe, as a homecoming. He came from a career in hospital management serving both small, federally-sponsored clinics and ma jor hospital corporations. He started as an orderly at Stanford Univer sity Hospital in California and has since worked across California, Washington and Oregon. What brought him back to Oregon this time, however, was his daugh ter, who was attending George Fox University in Newberg and decided to stay in Oregon. "It was a chance to come home," he said. He commutes twice as far to work from his Oregon home in Sandy, but said that the two-hour commute is so beautiful that it's easier to take than the hour he used to struggle through every day in the Bay area of California. Over the years, he has seen over all health care improve dramati st v -' J .... David Foss cally, mainly in his view, because of improved technology and meth ods, he said. The big issue with care has always been delivery that is, how to get care to all who need it. "Access is the problem in any sys tem," said Foss. "I don't know that that has changed over the years." In that regard, Foss has lobbied Congress for improved access for the poor and in many cases been successful. His observations over the years about service have left him with the impression that health care in this country is great for those with money or a job that provides health insurance and OK for the very poor. To a great degree, the poor have been served by federally funded clinics, though he said that access, again, is spotty. Here in Oregon, for example, feder ally funded clinics can ba sically be found in the ma jor metropolitan areas of Portland, Salem, Eugene and Klamath Falls. Big gaps can also be found among those with too much money for feder ally funded clinics but no health insurance and not enough money to pay cash for health services. And likewise, while ser vices and techniques and pills are better than they've ever been for curing or maintaining patients with many serious conditions, another big gap in America's health care system is prevention. Relatively few dollars are available for preventive ser vices, said Foss. "If you're having a heart attack," he said, "they'll take you. If you want to prevent a heart attack, that's another story." But here in Grand Ronde, Tribal members are participating in a growing effort to bring preventive care to the forefront (See "Dog Days Walk" story on page 7 for one recent example). The Tribe also of fers diabetes aquatic classes and support groups, alcohol, tobacco and drug education, safety classes for Pre-school, HeadStart and Af tercare programs, including such messages as the importance of hand washing in preventing colds. Different programs at the Tribe offer culturally attuned prevention-type messages using to bacco in a sacred way only, for ex ample as part of what Tribal Wellness Manager Bonnie Tom called, "a holistic approach to pre vention including mind, spirit and body. You have to use all three to prevent illness," she said. As Administrative Officer, Foss described his goal for the Tribe as "buying the best care possible with limited resources." Put another way, he added, "I'm basically watching our finances and I'm available for day-to-day problems," said Foss. Foss has been married for 39 years. His wife, Denise, is a teacher for Clackamas County, and together, they have three grown children. Over the years, the family has enjoyed "a fair amount of camping, hiking and water skiing," he said. "I tried windsurfing but I spent all day try ing to get back on the board. It's easier," he supposed, "if you learn when you're younger." He has been a scout leader and a church leader for years, but now, he is reaping the reward for a life well lived: "I'm leaving it to the kids," he said. c 2
