Great article from the Merc highlights tai chi practice at VMC Rehab

Mercury News: Ancient art of tai chi finds new disciples

By Marissa Cevallos

Every Monday afternoon, a handful of people roll, hobble and shuffle to Santa Clara Valley Medical Center to learn an ancient art that students say reduces pain, steadies their balance and makes them feel happy.

For patients with spinal cord injuries-about 475 at Valley Medical alone-exercise options are slim, and most are done alone. Patients with spinal cord injuries are more likely to be depressed, and Shem hopes that tai chi, which is often done in a group, will help them feel more “emotionally connected.”


On the eve of the President’s health care summit, I spent a day in Sacramento with my American Leadership Forum class. We’re a small group, but represent a cross-section of industries at fairly high levels – so we got a high-level look at how things roll at the state-level.

In short, things are NOT rolling well.

Whether you care about health care reform or solving the $20B budget shortfall mess, Sacramento is “broken”. We heard this consistently, starting with Senator Joe Simitian, who painted a grim picture of what he called Hyperpartisanship. “If you even appear to reach across the isle”, he told our group, “you wake up to find you’ve been stripped of committee assignments or that no one will support ANY bill you author – regardless of the topic.”

We met with Possibly-Maybe-Soon-to-Be Lieutenant Governor Abel Maldonado, who agreed. “Used to be,” he said, “that we were Republicans or Democrats when debating on the floor, and then Californians when spending time together after hours. No more.” I agree that he should be confirmed, and that the hold-up is a great example of Simitian’s Hyperpartisanship. It’s also silly. It’s the Governor’s choice, and unless Abel has a screw loose, they should give him the job and move on (his screws aren’t loose; I’ve gotten to know him and although I don’t agree with him much of the time, he’s a good man and incidentally, really loves Valley Medical Center).

Speaking of the Governor, I got to visit his cigar-smoking tent. Yes! No one gets to do that! More importantly, we had lunch with his Chief of Staff, Susan Kennedy, who is one of the most experienced and brightest bulbs in the chandelier. A career-long Democrat, she risked (and lost) life-long friendships when she agreed to work for Arnold Schwarzenegger.

She lost ME only when I asked her if she could provide her opinion of just how the partisan divide grew so wide over the past dozen years or so, as described by every legislator we’d met with that day. Ms. Kennedy shot back that it hadn’t; it’s always been this way, and in fact we’ve gotten lots of great stuff done in the past couple years. I kept myself from reminding her that 2007 was supposed to be the Year for Health Care Reform in California. Other than supporting Obama’s plan, let’s be honest: Schwarzenegger hasn’t shown up for health care at all.

So we cannot even agree on the problem.

Can we agree on any solutions? Possibly.

Pretty much everyone we met with understands that term limits have screwed everything up (I agree) and should be extended or even abolished. We met with many moderate Dem’s and Rep’s who all want the “Open Primary” to pass in June (I’m not sure yet). Pretty much everyone opposes the idea of a Constitutional Convention (me too), and I have to disagree with Assemblywoman Fiona Ma’s suggestion that “Democrats dislike public/private partnerships”. This Democrat doesn’t, and in fact many VMC Foundation successes have come from them.

We ended the day with a final meeting with Joe Simitian, where he handed out hankies to dry our crying eyes. We’ve got to change the system – we all agree. How long has it been broken, you ask? Well, in thanks for reading this far, two quick stories offered by Assemblyman Nathan Fletcher: He was asked recently how he felt about California’s legislature having a 9% approval rating. His response: Who are those 9% and what could they possibly be thinking?

Second, he took us back to the 1850’s and why Mount Whitney is called that. It’s the highest peak in our state, and is named for a geologist/surveyor named Josiah Whitney. When legislators moved the State Capitol to Sacramento, it was to be near and with the railroads. Railroads attracted mucho dinero in Federal subsidies to build track, and building in mountainous regions cost more – and therefore meant the fed’s paid more dollars per mile than those built on flat ground.

Can you guess? According to Assemblyman Nathan Fletcher, our legislature (largely controlled by railroads then) benefitted greatly when Mr. Whitney reported to the federal government that all land east of Sacramento in California was mountainous. Cha-ching! To show their gratitude, our elected officials named our highest peak for Mr. Whitney.

So some things change…and some don’t!

Increased Efficiencies in VMC’s Emergency Department

To say that Dr. Jeffrey Arnold, VMC’s chief of the Emergency Department (ED) is a busy man is a dramatic understatement. He is in charge of heading up the team of docs and nurses responsible for providing emergency medical services in the busiest hospital in Santa Clara County, home to San Jose, the 10th largest city in the United States. We had a chance to sit down with Dr. Arnold and talk about some of the advancements in patient care and increased efficiencies that have been implemented over the past three years. We’re so glad we did, because the accomplishments the ED has seen since 2006 are truly remarkable.

When Dr. Arnold joined the ED in 2006, VMC was just starting to feel the impact of a surge in patient demand from the closure of the San Jose Medical Center, among other factors. They knew that if more and more people kept coming to the ED and did not act, they would run over capacity. Understanding the urgency of the situation, Dr. Arnold and his team of talented physicians and nurses went to work implementing changes to the way things were run in the ED. Just to give you an idea of the type of changes we’re talking about here, since taking over in 2006, the collective ED team has reduced the time to provider rate (the amount of time you wait to be seen by a doctor) by 9,000 hours each month. If you multiply that out over the entire year, just for fun, the residents of Santa Clara County were saved 4,500 days of human wait time in 2009. 4,500 days! Oh, and did we mention they save lives during all of that, too? Because they do.

2006: a new beginning

To get a true sense of how far patient care has advanced over the past three years, we should take a step back to 2006. In 2006, the average number of patients visiting the ED each day was around 200, or 73,000 a year. At that point in time, new systems weren’t yet in place to help accommodate such a large patient population, and wait times often suffered as a result. “Back in 2006,” Dr. Arnold explained, “what the patient experienced in our ED was going directly against why they came to see us in the first place. From a patient perspective, they came to see a doctor. They didn’t come to see anybody else. From a treatment perspective [the way we were running things] was preventing the patient from being united with what they came to get.” So Dr. Arnold and his team went to work immediately implementing two key processes to begin the process of repairing the patient experience: the expansion of the Express Care Clinic, and the adoption of Rapid Medical Evaluation (RME).

Express Care Clinic

Most patients who present at the ED throughout the day do not have immediately life threatening conditions. Those that do are, of course, rushed into the ED and treated immediately. But what happens to those people who aren’t having a heart attack? Before, they would wait for hours to be seen, or go elsewhere. But now they have a third, and much more reasonable, option: the Express Care Clinic at VMC.

“The Express Care Clinic serves patients coming to the hospital with urgent problems by combining an urgent care setting with doctors and nurses who are experienced in Emergency Medicine,” Dr. Arnold explains. This is a 14 bed unit directly adjacent to the ED. Each bed is in a private room that is stocked with medical equipment, and by the time each patient gets to a room, they have already seen a doctor. That’s right; the first person a patient talks to when they present at Express Care is a doctor. The intake doctor takes the patient through a filtering process called a Medical Screening Examination. They take a “why wait?” attitude with the goal of “keeping vertical patients vertical.”

“Once you take somebody, put them on a bed and put oxygen on them, they start looking a lot sicker than they actually are,” says Dr. Arnold. “If someone comes in complaining of pain when they urinate, it’s kind of a no-brainer; they need a urine test. Why would we make them wait another hour to get a room, to see a doctor, who then orders a urine test, etc. Why not just see them then? Send them to get the test, and by the time they get back the test results are there and a room is ready.” Today, nearly 70% of patients coming through the ED doors know to head directly to the Express Care clinic, a huge win for both the patients and VMC.

Rapid Medical Evaluation (RME)

This type of common sense approach to emergency medicine has gone a long way in improving the patient experience. A similar approach to care has been adopted by Dr. Arnold’s team in the ED proper. RME take is a small 4 bed unit right next to the ED proper which takes low acuity patients out of the pool that goes into the ED. RME is used for outer extremity injuries that are easily observed without need for additional observations like x-rays or CAT-scans. The same “why wait” approach is still applied to slightly more serious cases, preventing the unnecessary clogging of ED beds. Patients are treated in this small unit, and released directly from there.

Essentially, the team of doctors and nurses have created three levels of injury treatment to slot patients in to when they come to VMC: the ED proper, where people with life threatening emergencies should go. RME, where patients that present with non-life threatening but still emergency situations like lacerations can be treated. And Express Care, for less acute patients like those with chronic low back pain.


If these changes were implemented during a period of time when patient use of the ED was staying steady, they would be impressive and still needed; but the results Dr. Arnold’s team have seen have been remarkable. In 2006, VMC’s ED department treated 73,000. In 2008 they treated 102,220 patients. In 2009, they hit 127,750. In the first month of 2010, the ED treated 12,144 patients. If they patients keep coming at that rate, VMC’s ED will treat 145,728 patients in 2010. That means that the patient rate will have doubled in 4 years. While the patient population has doubled, our VMC ED has reduced the left without being seen rate from 40% in 2006, to 2.5% in 2009.

“Statistics show that 1 out of 10 patients who leave an ED without being seen need to hospitalized later with greater morbidity and cost,” Dr. Arnold points out, “the difference we make is that four people every day are now getting care that wouldn’t have. That means that there are around 1,500 people out there who you have really done an incredible service to by preventing them from leaving without being seen.” To add to the degree of awe, these improvements have taken place with 50% fewer beds than what a patient population of that size is expected to have. They have streamlined processes, dramatically reduced patient wait times, improved the quality of patient care, and saved countless lives all within the context of a doubling in the patient population, having a deficit of patient beds, and budget cuts.

When asked what he was most proud of about his and his team’s work in the ED, Dr. Arnold summed things up with humility:

“We always have stories in the ED about how we heroically do something, or we make the right diagnosis, or save someone’s life by intervening at the right moment, and they are real stories. But the thing we are the most proud of over the past three years is affecting so many people in a positive population way. We have really good patients at Valley. They are really grateful, good patients.”

Weekend health headlines from Santa Clara County

Santa Clara County Executive Jeff Smith is featured in Biz Journal and is working hard on balancing big projects against big budget cuts:

Full article here:

Santa Clara County President Ken Yeager calls for the creation of a “Council on Health” in opinion piece.

Full article here:

Middle School students weigh in on VMC Foundation and Health Care

It has been a busy week here at the VMC Foundation. We’ve submitted a grant to Cisco to help expand the reach of our Technology Access Program, toured 40 members of Community Leadership San Jose, and even took time to send staff member Andy Groggel to speak at Roosevelt Middle School’s Career Day in San Francisco!

The presentation focused around the expansion of our work with Social Media, and we thought it would be a fun exercise to have the 7th and 8th grade students (who were GREAT participants, by the way) write their own observations on the presentation down Tweet-style. Take a look at what some of them had to say:

I hope I can go to one of your fundraising events. I don’t have a Facebook, Twitter, or a blog, but this job seems like fun. I’m excited to learn more about these jobs ~ Sally

Health care is important. Everybody should be allowed to use the hospital, even if they don’t have money.

Help the poor please!

Whoa! This is such a great association to use when at a hospital.

Raising money? Hard to do in this economy. Our Washington D.C. club needs your tips on how to do that. ~ Susan, Teacher at Roosevelt M.S.

VMC Foundation Champion and Donor Dick Levy recieves 2010 David Packard Award.

Reposted from this story.

SAN JOSE, Calif. February 8, 2010 Joint Venture: Silicon Valley Network announced today that Varian Medical Systems board chair and longtime Silicon Valley community leader Richard M. Levy is the recipient of the 2010 David Packard Award.

The Packard Award is Joint Venture’s highest honor, presented annually to an individual who brings an entrepreneurial, cross-boundary, problem-solving approach to Silicon Valley’s challenges. Recipients embody the spirit of David Packard, Silicon Valley’s legendary pioneer who set the highest standard for civic engagement.

“Richard Levy’s long record of selfless personal and professional commitment to our region made him the unanimous choice of the jury,” said Russell Hancock, president and CEO of Joint Venture.

“He has been willing to step outside his normal role in order to tackle hard problems,” Hancock added. “It’s one thing to serve on boards and commissions; it’s quite another to lead them, and to start new ones. This is what Dick has done for decades, most recently by chairing Joint Venture’s Smart Health Initiative.”

“One of the many things that make Dick Levy such a special volunteer is his passion for the mission of improving lives,” said United Way Silicon Valley president and CEO Carole Leigh Hutton. Levy chaired the organization for the past two years. “Working under his leadership is as inspirational as it is informative.”

Tim Guertin, president and CEO of Varian Medical Systems, said Levy “is consistently looking for ways to make the world better, from working to transform healthcare to meeting the most urgent needs of our community.”

Levy, who has been with Varian since 1968, has been chair of the Varian Medical Systems board of directors since 2002 and was CEO of the company from 1999 to 2006. Levy is also vice chair of the board of trustees of the Palo Alto Medical Foundation and a board member of the Sutter Health.

Don Watters, director emeritus of McKinsey & Company, will present this year’s award to Levy at the annual State of the Valley conference this Friday, February 12, in San Jose.

Previous David Packard Award honorees are Paul L. Locatelli, S.J. (2009), William F. Miller (2008), Eric Benhamou (2007) and Bruce Chizen (2006).

Hospitals and Social Media- good to reflect on your strategy

It is always a good idea to take a step back and evaluate the effectiveness of your Social Media strategy. This blog post from Mark Horoszowski is a good reminder of that.

He links to two great resources: VMC Foundation friend, and hospital Social Media pioneer, Ed Bennett, and to a great presentation by Phil Baumann.

This is a must read reflection piece for all of you #hcsm followers out there.

As H1N1 fears subside, support for Public Health Departments should not

Fifty-seven million Americans were infected with H1N1 since last April, according to a new estimate for The Center for Disease Control released today. That’s roughly the population of all of Italy. While thousands did sadly perish form the disease, the rate of mortality was nowhere close to previous flu pandemics, thanks in large part to the aggressive response by local, state and federal public health agencies.

Of course, the danger from this pandemic and others is still present. And while we breathe easy that our worst fears about H1N1 never materialized, major weaknesses to our public health infrastructure have been exposed, so says Dr. Marty Fenstersheib, public health officer for Santa Clara County. Many public health agencies, including the one in Santa Clara County, are have seen budgets and staff slashed in recent years, slowing the ability to monitor and respond to major public health crisis.

As we think about health care reform in this country, it is critical that we remember how essential Public Health Departments are to our safety net. It seems we dodged a bullet this time with H1N1 – but it’s a game of Russian Roulette not worth playing.

Chef Jamie Oliver on America’s obesity epidemic

This is an eloquent summary of the obesity issues we have been discussing on the blog this week. Please take the time watch this video.

VMC Foundation and Santa Clara County take action against Childhood Obesity

If you have been following us on Twitter this week, which we know you have, you’ll know that First Lady Michelle Obama launched her obesity awareness, called “Let’s Move.” Let the record show that we think this is a great program with tons of potential. By changing the food served to children in our schools, promoting active lifestyles, and actively educating youth through a social media campaign, Let’s Move will make a huge difference in the lives of our nation’s youth.

1-in-3 three children in the United States are obese. The rate of obesity in children has tripled in the past three decades for children aged 6-11. The first step in any recovery is admitting that you have a problem, so articles like this one published in the Mercury News in January is an encouraging first step; but action is needed to help stymie this epidemic.

Thankfully, we have been directly addressing this at the county level for some time. Currently, the VMC Foundation helps support a program, VMC’s Pediatric Healthy Lifestyles Center, which intervenes directly with populations at the highest risk for childhood obesity. The SCC Board of Supervisors is also making this epidemic a priority. County President Ken Yeager committed to promoting prevention and healthier living for all residents today in an opinion piece in the Mercury News. Supervisor Liz Kniss with support from the SCC Library, SCC Office of Education, and San Jose Public Library Foundation, is also taking action by using the Silicon Valley Reads program to educate both adults and children on healthy eating habits.

When we work together to combine our resources, our ability to affect change grows exponentially. Let’s hope these actions are sustained far into the future.

If you would like to support any of the programs run by the VMC Foundation, please contact us at 408-885-5299