May 18, 2020

As Texas Children’s begins its fifth official week of phased reopening and redesign, the organization continues to focus on a careful, strategic plan that supports family-centered care for our patients and meets our organizational expectations around quality and safety.

What this means for our patients and families is that services will open in phases, not all at once. For employees, a phased reopening means some of us will resume a full work schedule either at home or at one of our Texas Children’s facilities sooner than others.

“Patience and prudence are key,” said Chief Information and Innovation Officer Myra Davis. “We want to ensure everything we do operationally is safe and volume-driven. This means that just as we flexed down to demand, we will also flex back up to demand, where appropriate. The next few weeks and months ahead will be a thoughtful balance between the two and will help pave the way toward a successful future.”

Davis, along with Surgeon-in-Chief Dr. Larry Hollier and Executive Vice President Dan DiPrisco, are leading the Phased Reopen and Redesign Command for Texas Children’s.

Signs of success

Two areas of our system that have seen early success during the phased reopening and redesign are Surgery and Radiology. Since reopening in late April, the Department of Surgery, Anesthesiology and Perioperative Services have opened schedules in operating rooms across the system to nearly 50 percent capacity. To date, 700-plus cases have been completed at our community locations and more than 1,000 pediatric and women’s cases have been conducted at the Texas Medical Center Campus.

Two weeks ago, Radiology began its phased reopening and redesign, aiming for 50 percent of pre-COVID-19 imaging volume that week. The service line exceeded that goal, completing more than 640 studies per day. Pre-COVID-19, daily activity across the system was about 1,100 studies per day. During COVID-19, daily activity dropped to 350-400 studies per day. As a result of the steady uptick in patient volume, Radiology has completely reopened all of its appointments.

“We are encouraged by the quick response from the community to our thoughtful and agile reopening and redesign plans,” said Radiologist-in-Chief Dr. Thierry Huisman. “We are committed to continuing to serve our patients and families while keeping them and our staff safe and healthy during this pandemic.”

Hollier said his department plans to thoughtfully open additional ORs to match demand, all while maintaining social distancing protocols and other rigorous safety measures.

“Our primary goal has been and always will be to keep our patients and families safe and healthy,” he said.

Safety first

Safety measures and protocols have been put into place to protect our patients and families during their entire experience with Texas Children’s. This experience begins before they walk into one of our facilities and doesn’t end until long after they leave.

Before anybody comes into our facilities, they’re screened, to the best of our ability to make sure they are safe and healthy. This means all doctors, nurses, staff, patients and family members. Once they’re inside, everyone is required to wear a mask and adhere to social distancing.

“We want to respect these rules because we feel they protect patients from contracting the virus,” Hollier said. “We also feel it’s very important to test patients who are undergoing surgery and other procedures for COVID-19.”

No more than 48 hours before a surgical procedure, patients will receive a COVID-19 test, typically at one of our drive-through facilities for convenience. If the test is negative, the surgical procedure will proceed. If a patient tests positive for the coronavirus, the procedure will be delayed and retesting will occur to ensure the patient is negative before they undergo surgical or any other procedure that deems prior testing.

Radiology implemented a new process that allows patients to wait in their vehicle and call from the parking lot/garage upon arrival at our community locations, rather than entering the building and having to sit in the waiting area. Radiology services at Texas Children’s Hospital The Woodlands went live with pre check-in for patients who have a MyChart account. After a brief trial period, Radiology will implement this at West Campus and at our Medical Center Campus as well.

A mom who had rescheduled her daughter’s MRI due to safety concerns related to COVID-19, said she was relieved to learn about all of the safety measures and protocols Texas Children’s has in place to protect patients and families.

“Everything was easy and very smooth,” the mom said. “I appreciated calling from the garage, and I felt very safe.”

To learn more about additional precautions Texas Children’s is taking to protect our patients, families and staff click here.

Moving forward

This week, we launched plans for the reopening of our Ambulatory services and are working to ensure our facilities can accommodate increased activity while maintaining infection control guidelines.

Ramping our services back up at Texas Children’s is a welcoming indicator. It’s exciting, but this is merely the start for us. We are reopening thoughtfully and in phases, based on where we have the most demand for our services.

It will take much more time and careful planning to reopen completely. But moving strategically is what will restore us for the long-term, and what will ultimately ensure our organization’s future success and sturdiness.

“Thank you for all you are doing,” DiPrisco said. “The care you are providing for our patients and their families through this evolving situation is outstanding and proves that our challenges of the past few months have made us even better equipped for what’s ahead.”

 

In less than a year, the Member Services team at Texas Children’s Health Plan has completely transformed the way they work, the way they win, and the way they are regarded across the system. A true Cinderella story.

Once known for struggling to meet performance expectations, Member Services now shines in team spirit, employee performance, and the delivery of services to members and providers.

April 2020 marked the most successful performance month for the department in over four years – an accomplishment that is beyond remarkable considering the changes they’ve faced during the current global pandemic.

A comparison of May 2019 and April 2020 demonstrates a number of key accomplishments including but not limited to an increased answer rate of 19 percent, decreased abandonment rate of 7 percent, and a decreased rollover rate of 22 percent to our back up vendor.

“I am so proud of my team and what we have been able to accomplish together. Most importantly, I am especially pleased that our improvements are having a positive impact on the members and providers that depend on us,” said Opera Wagner-Ross, director of Member Services.

Wagner-Ross, who joined the Health Plan in May of 2019, is the undeniable linchpin who has made this transformation possible; however, she doesn’t see it that way. She readily credits her team and the incredible leadership she has received from Richelle Fleischer, senior vice president; and Mark Mullarkey, president of Texas Children’s Health Plan and executive vice president of Texas Children’s Hospital.

“Even the best leaders benefit from good leadership,” she said. I feel incredibly lucky to have the opportunity to work with both Richelle and Mark. They are both dynamic leaders with high expectations. I have learned a great deal over the past year and feel lucky to be a part of the team.” Wagner-Ross went on to say that having great coworkers and a friendly dose of competiveness is also a great motivator. She credits the Claims department at the Health Plan as being an inspiration and a motivator.

“April Riggs, director of Claims, and her team have been very successful in turning things around in the Claims Department. She has been a great partner in that she challenges me, holds me accountable, and can be counted on to make me laugh when faced with challenging situations. She’s the best!”

So how did they do it? How exactly did they spark this kind of change within the department?

Here are the major keys:

  • A defined career path for members of the team. By creating a clear career path, employees understood what their options were for growth. With increased opportunity for growth, department retention improved.
  • An increase in the number of Spanish speaking agents. A large percentage of health plan members speak Spanish; however only 16 percent of our agents spoke the language. Today, that number sits at 46 percent.
  • Appropriate span of control for managers. With a more appropriate span of control, managers are now able to provide better support, coaching and accountability to their teams.
  • Improvement in the training of employees. Staff members received an increased amount of training including a special course taught by the Patient Experience staff, which specifically focused on customer service.
  • Allowing data to drive change. Whether it was a process to improve, a system to introduce or a technology to enhance, all decisions were made based on information.
  • Improvement in the quality of all phone calls. Increased quality review and monitoring of phone calls and improved handling of escalations with a focus on customer satisfaction.
  • Celebrating the small wins. The team looks for every reason to celebrate and highlight accomplishments.

Wagner-Ross says that as a leader she really doesn’t have a secret sauce. She simply believes in finding the right people and always looking for opportunities to improve.

As COVID-19 hit, Medical Director of Emergency Management Dr. Brent Kaziny and members of Texas Children’s Facilities team raced to invent a new device that would better protect doctor’s nurses and patients during intubation procedures. Kaziny then open-sourced the novel product design for others to use, and found a manufacturing partner called Sawbones that put the “Airway/Respiratory Containment System” up for sale. Read more

As the COVID-19 pandemic continues to dominate the news and impact our normal way of life, there is one thing that has not changed – our commitment to ensuring our patients and families have convenient access to the care they need, when they need it, while also continuing to protect their health and safety.

As we begin to adapt to this new normal, more in-person visits are being converted to video or phone appointments. Texas Children’s e-Health team, in collaboration with multiple departments across the system, has rapidly expanded and enhanced these e-Health services to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving their home.

In less than three months, the organization has seen a rapid growth in e-Health visits across the system. On March 2, Texas Children’s completed 39 video and telephone appointments. As of May 8, our providers had completed 72,285 telephone and video visits across Texas Children’s Hospital, Texas Children’s Pediatrics, Texas Children’s Urgent Care, Texas Children’s Health Plan and Texas Children’s® Anywhere Care. Along with this impressive milestone, over 1,000 providers have been trained to provide care through video visits to their patients across the system.

The Health Plan’s e-Health platform, Texas Children’s® Anywhere Care, which has been a major focus in the organization’s e-Health efforts, has seen an uptick in patient visits. Since launching the platform last summer, over 1,520 video appointments have been completed. A total of 750 e-Health visits were completed from March 1 to May 5 of this year.

“Our recent successes are attributed to the collaborative efforts that went into building the infrastructure that has enabled us to expand our e-Health capabilities more broadly across the system,” said Laura Laux Higgins, director of strategic projects in Information Services and member of the e-Health Executive Steering Team. “Not only did we investigate the technology solutions and invest in them, we had a team of e-Health experts in place across information security, EPIC, MyChart, billing, compliance, legal, credentialing, risk, and administrative and physician leadership who were able to help us move forward quickly because of the work they had done over the past year.”

With the demand for e-Health services on the rise due to COVID-19, Texas Children’s Heart Center, like many other subspecialties across the system, are leveraging the mutual benefits of e-Health services.

Shortly after the COVID-19 pandemic set in and local, state and federal governments asked non-essential businesses to close and residents to stay home, the Heart Center worked swiftly with physicians and staff to engage e-Health services for new and existing patients 6 months old and older who did not need to be seen in person.

Within about a week, the Heart Center was booking about half of its appointments at the Texas Children’s Medical Center Campus via video or phone. Although that number has decreased since Gov. Greg Abbott has started to reopen parts of the state, the Heart Center is still using e-Health services and is dedicated to the virtual patient care model for the foreseeable future.

“Our will to continue to work hard and keep our patients, families and staff safe has never been stronger,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “e-Health is a way we can continue to serve our patients without putting them at unnecessary risk.”

All potential e-Health appointments at the Heart Center are reviewed by a pediatric cardiologist or advanced practice provider to determine whether it is clinically appropriate for a child’s appointment to be completed using one of these modes of virtual visit. If the cardiologist considers that a child’s appointment can be completed in this way, the clinic staff will contact the child’s family to provide more details and guide them through the new system.

Dr. Jeffrey Kim, director of the Arrhythmia and Pacing (Electrophysiology) Service at Texas Children’s Hospital, said his patients are good candidates for e-Health visits because they typically don’t need surgical intervention. For about a month during the pandemic, Kim said almost all arrhythmia and pacing patients were utilizing e-Health visits. Now, about half are using the service.

“Patients are very appreciative of the virtual visits,” Kim said, adding he conducted an appointment with a patient while they were standing in the middle of a field on their ranch. “They are thankful they don’t have to come in and expose themselves if they don’t have to.”

In addition to safety, Kim said e-Health services can be used to treat people in areas where there are limited pediatric cardiology services. Patients in these areas might not be able to drive into places like Houston for an appointment forgoing care altogether or seeking it in less-than-ideal places. e-Health would bring the visit to them, allowing our experts to reach more children and families.

“e-Health has a lot of benefits and possibilities,” Kim said. “I’m excited to see how it develops.”

Finding Hope 

The following passage was written by Texas Children’s Chaplain Natalie Peters.

This week marks eight years since I’ve graduated from college and six since graduate school. I remember being so proud of all my hard work and having my family celebrate with me. I am the oldest of three children but both of my parents come from much larger families and we support each other through it all. As I reminisce on my celebrations those years ago, I can’t help but think of all of those who are missing out on these milestones this year.

And of course as my thoughts spiral, which they often tend to do, I realize this pandemic has changed much more than just graduations. Wedding plans have had to change or be postponed, vacations that we have been working hard to plan and save for have now been put on hold, and so much more. This week, I was supposed to be at my first conference as a board certified chaplain, but like so many other things, the conference was canceled. As I write this, I find myself daydreaming about what I would have learned if I had gone.

I imagine so many of us are feeling this way. I not only find myself with the fear of missing out but also hoping. Hoping for the best. Hoping for normalcy. Hoping for things to go back the way they were before. But yet I know they aren’t. This pandemic has forever changed the way we gather and social distancing will be a part of the “new normal.” There are also so many lessons that have been learned and much more to learn as well.

Fear often paralyzes us. But yet with the hope, we are able to carry on. We as a Texas Children’s team carry each other through this fear. Our celebrations have changed, but we find a new way to celebrate. Nurses Week last week looked drastically different, yet we still celebrated. In the middle of pandemic, we celebrated. As the world adapts, so do we.

May this new normal we face be filled with hope. Hope that we will get that celebration, hope that life will go on. Life has continued moving forward, just not in the way we expected. As we have learned, sometimes we can plan as best as possible then life gets in the way and steers us another direction. But yet, as we join with the rest of the world, we too will continue to hoe for whatever is next.

“It is because of hope that you suffer,” said Maxime Lagacé, a Canadian professional ice hockey goalkeeper. “It is through hope that you’ll change things.”

You can use Cigna Virtual Care by Amwell to talk with a doctor or nurse any time, day or night, via secure video on your computer, tablet or smartphone.

This service is available at no cost through Sunday, May 31, to Texas Children’s employees and their dependents enrolled in a Texas Children’s medical plan.

Visit the COVID-19 Resources site and follow the “Employee Health” link for the different ways to get connected and more information on telehealth options.

May 14, 2020

In this edition of the Voice of Nursing, we share a special video montage of heartfelt letters our patients created to show just how much they appreciate their nurses at Texas Children’s. Read more