HOSPITAL/CLINIC UPDATE: Novato Community Hospital

Note: Each issue of Marin Medicine includes a self-reported update from one local hospital or clinic, on a rotating basis.

I first came to Novato Community Hospital (NCH) in the summer of 2003 to join its hospitalist group. I arrived in the leafy suburbs straight from four years of training in San Francisco, after completing medical school and two years of surgery training in London. I thought I’d only be in Novato for a year or two, but I so enjoyed the hospital, the community it served and my coworkers that I never left. Since 2003 I’ve been involved in every facet of the hospital and formed the North Bay Hospital Medicine Group in late 2010.

NCH is a beautiful place to work. I enjoy that it is a small hospital where I can get to know every one of my 300 coworkers and identify almost all of them by first name, from the chief administrative officer down. For this reason, I was all the more honored to become chief of staff this year.

With the latest challenges in the health insurance exchange rollout under Obamacare, it’s been a tumultuous time for healthcare reform across the country. Here at home, we’ve also had our own personal challenges and lost important allies. In 2013 we mourned the passing of Dr. Palmer White, who was an instrumental figure in building the new NCH hospital, as well as a gifted general surgeon. We were also saddened to hear of the sudden and unexpected loss of Dr. Robert Van Herick after his recent retirement. Dr. Van Herick was a respected cardiologist both at NCH and in San Francisco.

Despite these changes and challenges, NCH has forged ahead and continued to thrive under new physician and administrator leadership. We have been excited to welcome new chief administrative officer Brian Alexander and a cadre of up-and-coming committee chairs who highlight NCH’s strength in a variety of fields. For a Londoner like me, it truly feels like a “changing of the guard.”

Under this new administrative leadership and our strong medical staff, NCH was fully accredited last year by the Joint Commission for a three-year period. The Joint Commission also certified the hospital as a Primary Stroke Center. Our program continues to collaborate with California Pacific Medical Center in San Francisco to provide acute telestroke services.

We are proud that HealthGrades presented NCH with its award for Excellence in Patient Experience and Patient Safety in 2013, placing the hospital in the top 5% of acute care facilities nationwide. The NCH emergency department also won the prestigious Press Ganey Guardian of Excellence Award for achieving 95% overall patient satisfaction over the course of a year.

To serve patients even better, our medical staff is participating in the CMS Bundled Payment Joint Replacement Program. NCH is one of just five hospitals in California participating in this unique program, which combines payments for the hospital, physician and provider services during 30-, 60- or 90-day care episodes into a single bundled payment. This bundling results in improved care coordination and patient-outcome monitoring among partnering caregivers. The project, created by Medicare, resonates with NCH’s goal to provide high quality and affordable services to the community by strengthening our relationships with physicians and community providers. Six orthopaedic surgeons, along with anesthesiologists and hospitalists, are participating and will submit quality data this year to ensure efficient care and excellent patient outcomes.

Another program at NCH close to my heart is our hospitalist group, which is turning four this year. In the last three years, NCH has established a cohesive group of career hospitalists to provide care to uninsured and underinsured patients who arrive at our emergency room and require hospitalization. The hospitalists have partnered with Hospice by the Bay to formalize our palliative care program, providing end-of-life care for not only dying patients, but also their grieving loved ones. The hospitalist program is yet another example of NCH’s commitment to the community and patients in need.

We strive to hold ourselves accountable for outcomes, quality of care, and all aspects of communication with a goal of continuous improvement. The clinical quality statement for the most recent 12 months puts NCH as one of only seven hospitals in the Sutter Health system at full performance. Our current sepsis mortality and overall mortality ratio are amongst the lowest in the system.

NCH’s high level of patient satisfaction is matched in equal measure by a satisfied physician staff. Our 2013 Physician Satisfaction Survey showed an overall mean score of 85.9, a national rank of 91st percentile, and a regional group rank of 93rd percentile--a marked 13% improvement compared to 2012. Moreover, NCH physicians, evaluating all managerial parameters such as accessibility, communication and responsiveness, ranked its administration at the 95th percentile nationally, also a significant improvement from last year.

For the last three years, NCH has worked hard to improve processes at the hospital by implementing the Quality Delivery System (QDS), a quality improvement project based on the lean manufacturing methodology pioneered by Toyota. At its core, QDS aims to reduce waste within healthcare, which we all know is abundant. It also helps us diminish the massive clinical variations inherent in healthcare and thus make it more affordable and evidence-based. This work flows from the point of view of the patient and what he or she would consider valuable. Our goal is to eliminate mistakes and provide error-free healthcare. To this end, staff members attend five-day QDS workshops, called kaizens (the Japanese word for “improvement”), where they dismantle a process, like discharging or transitioning a patient, and then rebuild it in a more efficient way. I myself am a physician lead on the West Bay QDS team. QDS has led to both quality and bottom-line improvements at hospitals like Park Nicollet Methodist Hospital in St. Louis Park, Minnesota, and the famed Virginia Mason Medical Center in Seattle, Washington. We believe QDS will lead to similar success within Sutter Health.

We’ve also grown efficiency with our biggest project of the last decade--the launch of an electronic health record (EHR) system powered by Epic software. After years of planning, we rolled out our new EHR on Feb. 1--the 16th of 26 rollouts in the Sutter Health system. I worked clinical shifts during the inaugural weekend, and I’m happy to report that the rollout, perhaps not seamless, was smoother than many of us could have ever hoped for. That’s in large part thanks to the ample training we received, and to user specialists offering at-the-elbow support throughout the rollout. Change is never easy, but we can now look forward to the EHR improving quality and safety for our patients through better coordination, more standardized work and real-time accuracy.

The future of healthcare in the U.S. looks uncertain with new federal mandates on the horizon, but NCH will continue to grow and evolve. We hope to build on our repertoire of inpatient services by establishing a center of excellence with our orthopaedic joint replacement program. We are also forging stronger relationships with Marin Community Clinics and other quality providers in the community so that we can offer more help to patients in need. The next decade will be challenging for hospitals, but I’m confident that NCH will continue to prosper and serve the people of Marin and Sonoma counties at our beautiful small hospital, a powerhouse of caring.

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Dr. Hundal, a hospitalist, is chief of staff at Novato Community Hospital.

Email: HundalR@sutterhealth.org