August 2, 2018

Over the course of a two-and-a-half-day meeting in late February, 18 Texas Children’s system leaders came together to strategize streamlining business operations between Texas Children’s Hospital and the Texas Children’s Health Plan. Led by Lou Fragoso, president of the health plan, and Richelle Fleischer, senior vice president of Revenue Cycle at Texas Children’s Hospital, the group worked to challenge business as usual, with an eye toward transforming how the system runs.

This “rapid improvement event,” organized and facilitated by the Texas Children’s Business Process Transformation team, was a key step in the We Are Family initiative, a multi-month undertaking by Texas Children’s system leaders committed to breaking down barriers between the hospital and the health plan in an effort to help the organization work more efficiently as a singular entity. Among the working group’s goals was to plot a roadmap of and deconstruct the revenue cycle process between the hospital and the health plan in order to identify waste and collaborate on solutions that will increase the system’s efficacy.

“We sought to take advantage of our ‘system-ness’ to create a seamless interchange of claim processing, with the potential to save over $30 million in the process,” Fleischer said.

The driving force behind this effort is a desire to leverage the shared organizational identity between Texas Children’s Hospital and Texas Children’s Health Plan in order to reach the common goal of improving patient care.

“During the rapid improvement event, we had a room full of people who wanted to do the right thing for Texas Children’s,” Fragoso said. “When we work together, we can reduce unnecessary or duplicative work, improve the member or patient experience, use data to help deliver better health outcomes, and ultimately make Texas Children’s a leading force in advancing how care is delivered.”

“The biggest accomplishment of the event was the building of relationships between the health plan and the hospital team,” echoed Dr. Heidi Schwarzwald, chief medical officer of Pediatrics at Texas Children’s Health Plan. “Opening new lines of communication, creating efficiencies, and reducing waste will allow for more resources to be available for innovation and improvements in care coordination and delivery throughout our system.”

The We Are Family initiative kicked off in December 2017 with the initial process assessment and event design planning phase taking place between January and February 2018. Further implementation planning followed February’s rapid improvement event, with project kickoffs beginning in April. Implementations and transitions are now underway, with reports of these projects’ measurable results expected in Q4.

Of the 71 ideas suggested at February’s event, the team consolidated and selected 14 high-impact solutions, with 12 projects centered around these solutions currently ongoing. One project has focused on improving antiquated communications technology between the health plan and the hospital. The health plan and the hospital previously relied on fax communications to exchange patient information, a cumbersome and time-consuming process.

Based on the collaborative solutions recommended at the rapid improvement event, the system has transitioned to an entirely digital communications process, thereby reducing administrative burden and allowing employees to focus on timely claims processing and communication with members and providers.

“Ultimately, we’re giving our most important assets, our people, time back in their days,” said Dr. Lia Rodriguez, medical director at Texas Children’s Health Plan. “We’re reallocating resources to focus on what we do best: providing our patients and their families with the best care possible.”

Projected improvements resulting from the We Are Family initiative include:

  • 25,000 hours saved
  • 85,000 fewer phone calls
  • 68 percent fewer handoffs
  • 11,000 reduced paper claims
  • 12,000 faxes eliminated
  • 1,200 reduced appeals

“Just imagine if we take the results from our collaborative effort in February and apply that same concept across the rest of our system,” said Fragoso, who revealed that Texas Children’s Hospital and Texas Children’s Health Plan are already working on a second We Are Family initiative, this time focused on improving outcomes and experience for health plan members by using the hospital’s specialty pharmacy. “As we begin to think differently about how we interact, Texas Children’s will redefine what it means to be a health system in the future. When we unite as one amazing team to improve the lives of the families we serve, Texas Children’s has the ability to completely transform the way care is delivered.”

Dr. Allen Milewicz, chief surgical officer at Texas Children’s Hospital West Campus and chief of Community Surgery, recently assumed a new role within the Department of Surgery – associate chief of Clinical Affairs.

“Dr. Milewicz is uniquely positioned for this important new role,” said Surgeon-in-Chief Dr. Larry Hollier. “After operating at Texas Children’s for more than 25 years, he has experienced the growth of both the hospital and the Department of Surgery, has helped guide community outreach efforts for the department, and has a keen understanding of the needs of our referring providers.”

Aligning activities for one of the nation’s largest and most comprehensive pediatric surgery programs – with 120 surgeons, over 130 highly skilled advanced practice providers and 800 staff working across three different campuses – requires continuous oversight and attention to detail. In his new position, Milewicz will work closely with Hollier and other hospital leadership to provide that high level of oversight, as well as enhanced medical, operational and strategic leadership across the entire surgical enterprise, ensuring continuity of the efficient, high-quality care for which Texas Children’s Department of Surgery is known.

“I have had the good fortune to spend my entire career at Texas Children’s Hospital, and the growth of the organization has been tremendous and inspiring,” Milewicz said. “We want our Department of Surgery to be top of mind as the standard whenever a parent, pediatrician, health care specialist, resident, medical student or medical school faculty member thinks about surgical challenges in children.”

Additional aspects of the position will be the continued professional development of Texas Children’s surgeons and advanced practice providers, and improved patient and family experiences.

“I am thrilled to have the opportunity to help guide and serve,” Milewicz said. “We have so many talented, motivated people in our department that I think the best thing I can do is make it easier for everyone to do the job they come here to do. This means simplifying processes, facilitating flow and communication, and utilizing technology to improve access and help patients navigate our large organization. Of course, this must all be done under the umbrellas of safety and compassion. In everything we do here, whether it’s a highly complicated procedure or a condition that requires a simpler solution, I’m proud that we always remember that the child and the family are our focus.”

In addition to his new role, Milewicz will retain his duties as chief surgical officer at Texas Children’s Hospital West Campus and chief of Community Surgery.

July 24, 2018

It’s been two months since Texas Children’s Legacy Tower opened its doors for the first time to care for our most critically ill patients. Since May 22, 2018, our critical care, surgical and radiology teams have been extremely busy.

“We’ve seen over 300 ICU patients since we moved into Legacy Tower so the space is being well used,” said Shannon Holland, director of Nursing for critical care services. “We’re excited that our patients are getting the care they need in the place they need it with a lot of family amenities that they didn’t have in West Tower.”

Besides caring for patients in the pediatric intensive care and transitional care units, our surgical teams have been hard at work. Between May and June, the hospital’s surgical volumes have tripled. Approximately 330 surgeries have been performed since Legacy Tower opened, which equates to about 1,400 surgical hours.

“The first two days, we had a few rooms open, but since then, every room is full almost all day,” said Janet Winebar, assistant vice president of Perioperative Services. “We’ve seen a real change in the intraoperative MRI cases since the MRI is located completely adjacent to the operating room, resulting in more efficient delivery of care. Prior to this, we had to transport patients down to the MRI suite on a different floor and then back to the operating room.”

While being in the intensive care unit can be tough on patients and their families, many of them are giving the design of Legacy Tower a thumbs up. Patient families have expressed how comfortable they are in their new, much larger spaces, and how warm and inviting the new amenities and environment offer them.

“To have an ICU that has a comfortable bed and you never have to leave your kid’s side is really important,” said Clare Bensh. “For a baby who sadly has never been outside, it’s at least the next best thing to turn her around in the bed and she can have a lot of natural light. I think it’s a better environment for her to thrive in.”

Dr. Frank Gerow, an orthopedic surgeon and one of the leaders for the Legacy Tower project, credits our team’s steadfast dedication to the success of the phase one opening of Legacy Tower.

“The reason this whole process has come off as flawlessly as it has is because of the expertise and the experience that the directors, the executives and that the staff to this hospital bring,” Gerow said. “They’re the reason this has worked as well as it has.”

Meanwhile, excitement is building once again. In less than 60 days, the second phase of Legacy Tower will open.

On September 25, Texas Children’s Heart Center®, ranked No. 1 in the nation for cardiology and heart surgery, will move into Legacy Tower. The Heart Center will occupy eight floors and will feature four cardiac catheterization labs including integrated MRI scanner, four cardiovascular operating rooms, three cardiovascular ICU floors with 48 private rooms, two cardiac acute care floors with 42 private patient rooms, and a dedicated space for families.

“The Heart Center staff is very excited,” Winebar said. “They are collaborating together across disciplines from the CVOR to the CVICU and cardiology, to ensure we make this space work to benefit our patients and their families.”

July 17, 2018

On July 9, Texas Children’s Hospital and the Angelman Syndrome Foundation celebrated the official opening of the Angelman Syndrome Clinic at Texas Children’s, one of only seven Angelman syndrome-specific clinics in the United States – and the first in Texas.

Several patient families gathered on the 16th floor of Wallace Tower to attend the ribbon cutting ceremony. Debbie Sukin, the daughter of the late Dr. Ralph Feigin, delivered the opening remarks and shared how this new clinic will benefit her 16-year-old son Jacob and so many other children diagnosed with Angelman Syndrome.

“The hardest part of advocating and managing a child with Angelman Syndrome is trying to understand what might be wrong when they aren’t feeling right, looking right or acting right,” Sukin said. “We’re confident that this multidisciplinary clinic here at Texas Children’s will provide all children the expertise and best chance at meeting their maximum potential and provide guidance to ensure the best outcome.”

Occurring in one in 15,000 live births, Angelman syndrome is a neurogenetic disorder often misdiagnosed as autism or cerebral palsy that causes severe neurological impairment. Often times, these patients experience developmental delays, lack of speech, seizures, and walking and balancing disorders.

With the creation of this new clinic established through the generosity of donors and in partnership with the ASF, patients and their families now can access multiple specialists – experts in Angelman syndrome, clinical geneticists, neurologist, psychiatrist, speech language pathologist, genetic counselors and social work – in one setting rather than visiting multiple locations across the nation to manage and treat this disease.

“Thanks to the help of the ASF, we are proud to further our mission of providing very specialized care for patients with Angelman syndrome,” said Chief of Neurology Dr. Gary Clark. “Given the science that’s being developed at the NRI at Texas Children’s in genetics and neurology, we are making great strides in helping these patients.”

The ribbon cutting event also included remarks from Dr. Carlos Bacino, chief of the Angelman Syndrome Clinic, Carrie Rys, assistant vice president, and Eileen Braun, executive director of the Angelman Syndrome Foundation, whose organization donated $50,000 to advance Angelman syndrome research at Texas Children’s.

“Opening this clinic brings us one step closer to our commitment to establish a network of clinics across the country,” Braun said. “We could not be more proud to support Texas Children’s and their remarkable team of professionals in bringing this clinic to life. We look forward to impacting the lives of so many more families.”

Click here to learn more about our Angelman Syndrome Clinic at Texas Children’s.

Texas Children’s Hospital’s Emergency Management and Bone Marrow Transplant teams recently conducted their first large scale functional radiation injury treatment exercise. As a member of the Radiation Injury Treatment Network (RITN), our organization conducts annual exercises as part of our emergency preparedness activities.

“This was new for us. We’ve never done an exercise on this scale,” said manager of the Emergency Management department, Aaron Freedkin. “Normally, we just do our own internal tabletop exercise, last year was a regional tabletop, and this year we wanted to make ours a large and more complex functional exercise.”

RITN is a system of hospitals affiliated with the National Marrow Donor Program providing comprehensive evaluation and treatment for victims of radiation exposure or other bone marrow toxic injuries.

This year’s exercise was a simulation of the arrival of 30 patients to the Medical Center Campus, six patients to Woodlands, and six patients to West Campus, that are victims of a terrorist event. The scenario starts two weeks after a nuclear explosion in Los Angeles and the victims are all suffering from acute radiation syndrome. The patients that are coming to Texas Children’s are in need of a bone marrow transplant or specialized supportive medical care.

To prevent overcrowding the Emergency Center, a Patient Reception Center (PRC) for the exercise was created in the first floor auditorium of Feigin Tower. Several supportive care staff were positioned strategically for the arrival of victims. Conference rooms at West and Woodlands Campuses were also set-up to simulate a reception center.

“You can kind of call it a stress test for how our hospital’s going to deal with an influx of real patients. It’s really a medical surge exercise for us,” Freedkin said. “We’ve done it with mass casualties where we’ve simulated a bus crash or a terrorist event for the ER, but we’ve never done something quite on this scale and in this vein.”

Prior to the exercise, the team had a quick introductory briefing to make sure everyone knew their roles. The simulation then began with patients arriving, some even on gurneys as they would possibly be during a real event. Upon arriving, patients and their family members or guardians received a preliminary health check for safety precautions before visiting with Patient Experience to offer comfort and any necessary information needed along with Language Services to assist with any language barriers.

“They are scanned for radiation contamination so that the Communications Team can make sure all of our current staff and patients who are in the hospital know we are ensuring there’s no risk from these patients arriving,” Freedkin said. There’s a lack of understanding among the general public about the difference between contamination and exposure to radiation. So they definitely would go and get checked first.”

The initial step of the process was registration before the patient and their family members were escorted through triage. They then met with a physician for a simulated exam, followed by a simulated blood drawing session. Texas Children’s Patient and Family Services departments such as Social Work, Chaplaincy, and Child Life were also available to offer patients whatever kind of support they needed. This is very important because in a real event they would have been taken from a familiar environment where the incident happened, to an unknown field hospital, and possibly even another level of care before arriving at Texas Children’s.

“They might not know where all their family is. They might not know who survived. There’s some big emotional issues there,” Freedkin said. “They might not have any belongings either. We’re going to bring them here and make sure that we’re meeting all of their physical and emotional needs.”

The simulation ended after the last patient went through the entire process successfully. Essentially, they would have gotten all of the stations checked off on their card, then transferred to a patient care room if necessary.

“The exercise was very successful in testing our PRC,” Freedkin added. The PRC was a new concept that we developed to allow the hospital to process a surge of patients into the hospital without putting stress on the Emergency Center.”

For next year the teams hope to do a more complex full scale exercise where they would be able to move a larger number of patients to and from Ellington Field, a local military airport, and create a greater simulation to possibly include other outside emergency services such as the fire department, state entities, and federal agencies.

“I look forward to seeing how the lessons learned from this exercise improve the process for the next time that we simulate it,” Freedkin said. “It’s something we hope never happens, but it’s something that we need to be prepared for and be able to support if something really does happen. In the big picture, it helps us with overall preparedness that we can use the lessons here to manage any large scale surge event.”

July 10, 2018

The countdown clock is ticking. Texas Children’s Nursing will host its fifth virtual town hall from 11 a.m. to noon on Tuesday, July 17, at the Pavilion for Women Conference Center.

Nursing has partnered with the Corporate Communications team to organize this event to engage our team of more than 3,000 dedicated nurses that make up Texas Children’s largest employee population.

Hosted by Chief Nursing Officer Mary Jo Andre’, the town hall will include a discussion of recent nursing accomplishments including our successful opening of the first phase of Legacy Tower, as well as highlight our priorities and system updates. The town hall also will include time for Q&A. Nurses watching the livestream remotely will be able to participate in the Q&A session thanks to our use of virtual technology.

“By leveraging new technology at our first town hall, we were able to engage more nurses in a town hall than we ever had before,” Andre’ said. “As our team continues to grow, it will be increasingly important for us to identify and leverage opportunities to make communication easier and more effective.”

For nurses who cannot attend the live event, there will be several gathering locations to view the live stream:

Wallace Tower (for Ambulatory Services) – D.1000.35 (tenth floor)
West Campus – WC.150.10 (first floor)
The Woodlands Hospital – Conference rooms A (second floor)
Health Centers – Sugar Land, Cy-Fair, The Woodlands, Kingwood, Clear Lake, Bellaire
The Center for Children and Women (Greenspoint and Southwest)
Forming your own huddles? Please submit sign-in sheet to jcchilds@texaschildrens.org.

As always, patient care is our first priority, and we know not all nurses will be able to attend the live event or view the live stream. However, those nurses will still be able to participate by viewing the event on-demand at their convenience.

Click here to pre-register for the Nursing Town Hall.

July 3, 2018

“Thanks to online scheduling, it’s super easy to make appointments through MyChart now,” wrote a Texas Children’s family. “The past several times we’ve been here, we have been in and out in less than 45 minutes with the same level of quality and care. It seems like they heard our concerns loud and clear, and it shows that they care.”

This touching comment from a patient family in our Texas Children’s Pediatrics Cinco Ranch location is one of several inspiring patient testimonials that demonstrate our continued commitment to improving patient access.

Several months ago, Texas Children’s Access and Patient Scheduling Task Force conducted a baseline assessment of the hospital’s current landscape which revealed several opportunities to improve access for our patients. The Task Force proposed more than 30 recommendations and prioritized which ones would be implemented first.

Since implementing these solutions in four waves across different specialties throughout the system – the first wave went live on March 1 and the fourth wave went live on June 1 – patient families have noticed a positive difference.

Below are several impressive results during the implementation of Waves 1 to 4:

Increase appointment capacity: After evaluating 944 provider templates, we found extra slots where physicians could see patients for a duration of four hours. By standardizing clinic sessions for all specialties, over 53,000 new appointments were added to the system annually, 44 percent of those offering availability for new patients.

MyChart activation: Since launching MyChart Madness in March, Texas Children’s has seen a significant increase in MyChart activation rates. In October 2017, we had less than 8,000 monthly activations compared to over 18,000 in March. To date, Texas Children’s has a total of 72,006 same-day MyChart activations. A similar competition will be launched in July to ensure we’re getting as many patients to sign up on MyChart as possible by the end of FY18.

Online scheduling: More than 100 patients have already used this online feature to schedule their appointments. Six specialties have gone live with online scheduling for MyChart users. Nine more specialties will go live on July 23 and by September all specialties will offer online scheduling. Texas Children’s has partnered with a vendor to set up an online scheduling infrastructure for new patients who do not have a MyChart account.

Fast Pass Waitlist: Since implementing an electronic waitlist in MyChart that automatically offers up available appointments to patients desiring a sooner appointment, over 200 patients have accepted. On average, patients are getting into earlier appointments 60 days faster. So far, 16 specialties have gone live with this new feature.

One of these patients who benefitted from the electronic waitlist feature on MyChart was 10-year-old Aiden Blancas whose mother was able to get him into a dermatology appointment a lot sooner than expected.

“My son’s original appointment date was scheduled for September 4, but when I got an electronic notice via MyChart asking me if I wanted to accept an appointment in June, I accepted it,” said Monica Blancas. “While we usually go to the medical center for appointments, I didn’t mind driving a little further for my son’s appointment in Katy if it meant that I could get him in to see a doctor a lot sooner than originally scheduled.”

While improving patient access at Texas Children’s continues to remain a priority, more system-wide solutions are being considered that will further enhance patient access across the hospital system.

“Since implementing our patient access initiative, we have made significant progress to ensure our patients get into our system according to their urgency and timeline,” said Texas Children’s Assistant Vice President Carrie Rys. “We plan to continue these efforts into the next fiscal year with additional goals aimed at improving patient access.”