Friday, April 29, 2016

five questions may

Published in VC's Notes on April 29, 2016

Five Questions

Happy Friday and happy third payday of the month!

Sanderson GiftIt's been an eventful week.  On Monday, we announced that Joe and Kathy Sanderson will lead the largest fundraising campaign in Medical Center history -- $100 million to expand and modernize our children's services.  The Sandersons are making a personal gift of $10 million to get the campaign off to a lightning-fast start.  On Wednesday, we said a last goodbye to one of UMMC's most beloved and influential leaders, Dr. Norman C. Nelson, who served as vice chancellor for an astonishing 21 years.  The same day, we held the annual Ceremony of Thanksgiving for a record number of families whose loved ones donated their remains to science and became our students' “first patients.”   

Today I will answer some of your questions.  Just as a reminder, I read all your questions and comments and respond to those that I think are relevant to the most people.  I forward the rest to senior managers who are in a position to evaluate and act on them, where feasible.

There have been a lot of good questions lately. Some, like a couple today, require a little longer answer to provide a complete response.  

On to the questions: 

Q:  I have a concern over where patients and family members smoke. Maybe it's the spring weather, but increasingly they are using the corner where the majority of employees cross. It's frustrating to have to stand there while waiting on the light to change and have smoke blown all around you. Since they obviously ignore the "no smoking" signs, can we not designate a better area for these people to smoke? One that isn't directly in the path of so many employees?

A:  Smoking on campus is prohibited, so creating a designated smoking area is at odds with that policy and frankly, it seems to bestow our institutional blessing on an activity that is clearly harmful to one's health and the health of those around him or her.  There are other practical concerns with creating smoking areas, including the cost of providing a weatherproof shelter and the fact that we have a large campus, so multiple areas would be required to meet the need.  Since our policy only extends to the city sidewalks on the perimeter of campus, smokers are directed to those areas if they feel they must smoke.  Unfortunately, as you say, many seem to gravitate to the crosswalk in front of University Hospital, as well as the nearby bus stop.  My suggestion to you, when a smoker is clearly in the path of others using the walkway, is to politely ask that person to move farther down the sidewalk so you are not exposed to their secondhand smoke.  Above all, it's important to be civil and non-confrontational, but you are well within your rights to ask for this consideration.  

Q:  After hearing of the accident with the handgun at one of the hospitals in town, are our hospital and off-campus clinics “no weapons” areas?  If so, I know our off-campus clinics don't have the “no weapons allowed” sign on the buildings. I think for everyone's safety that we should put this in place so no one has to experience what happened at the other hospital. Thank you for reading this and responding.

A:  The new State Institutions of Higher Learning policy, adopted in February and conforming to the revised Mississippi statute, does not allow IHL institutions to prohibit guns on campus as the previous policy did, but does allow the universities to designate public and non-public areas and to prohibit weapons in non-public areas except those in the possession of law enforcement personnel.  Due to the nature of our operations, all of our buildings have been designated as non-public areas and we are producing signage that instructs properly licensed owners of firearms to leave their weapons in their vehicles before entering a campus building. This policy will be in effect in our off-campus clinics and appropriate signage will be posted in those locations as well.

Q:  Dr. Woodward, as a medical student who consistently finds myself studying in the UMMC library, I really feel the library's hours should be extended (a sentiment I hear echoed by anyone I bring it up to). Could we not employ students to sit at the front desk during the weekend or at nights to make the library accessible 24/7? I'm sure plenty of the "night studiers" would be happy to make a little extra money and sit behind the desk and study and make coffee and help anyone who needs it. You could even close off the upstairs and make the door “badge access only” to increase security. Weekends and nights are prime times to study because those are times we don't have class. And having the library close early on these days and times is really inconvenient, especially for those of us who don't have access to a printer or quiet place to study elsewhere. I attended a public university with a 24-hour library and it was a vast improvement.

A:  I asked Rowland Medical Library Director Susan Clark to respond.  Her answer:  According to the most recent survey of the 138-member Association of Academic Health Sciences Libraries (AAHSL), of which our library is a member, the mean for “open hours” is 83 per week, while the median is 96 per week for the 128 responders. Rowland is currently open 105 hours per week.  Extending the hours in the evenings is not currently feasible because of security concerns - not just in the library, which can't be easily reconfigured to enhance internal security, but also for stepped-up late-night security for patrons coming and going in the wee hours on this part of campus.  We have considered the possibility of opening earlier in the mornings and will look at this more closely if the budget permits. Thanks so much for your question and the opportunity to respond.

Q:  If the hospital is operating beyond capacity, and if employees are clearly leaving because they are being asked to take care of too many people at one time, why did we just move to the "no diversion" policy?

A:  It is true that at times for the last few years we have struggled with capacity challenges.  These challenges, which are related to limited beds, operating rooms and other hospital resources, combined with increasing patient volumes and worsening severity of illnesses, have become acute in the last 18 months. Because the problem had largely been sporadic for years, rather than develop a systematic strategy to deal with this issue, we went on “diversion” to signal to outside hospitals that we could no longer take additional patients.  We came to recognize that there were many different beliefs and misconceptions about what exactly the word “diversion” meant, both internally and externally.  We knew that a new, different and systematic approach to utilizing our precious resources was needed. Therefore, a new policy was implemented in March to manage transfers of patients into our facilities in a systematic and much more thoughtful and disciplined manner during high-census periods. During these times, designated now as Capacity Alert Status, medical control officers for the emergency department and the adult hospital are responsible for managing individual transfer requests in a way that, in the medical control officers' best clinical judgment, meets the needs of that particular patient. These determinations are made in conjunction with direct input from referring providers and from UMMC physicians on duty.  In some situations, these individual patient needs may be met by delaying transfer of the patient until a bed is available here, while in other circumstances either transfer of the patient to some other hospital or continued care at the patient's current facility may be suitable. This decision process helps to assure appropriate resource utilization and optimal care, not only for the patient for whom transfer is being requested, but also for those patients who are already being treated in our hospital, and allows for us to proactively manage our resources rather than react when we are already overwhelmed. This new system also assures that we continue to be in compliance with existing health-care laws to which we are bound.  Finally, keeping our patient volumes at manageable levels helps protect our staff from exhaustion and burnout.  Although this new system has been effective and is meeting expectations, the longer-term answer to our capacity issues is to bring additional beds and operating rooms online, and we are actively reviewing several options to accomplish that.

Q:  Hi Dr. Woodward, I hope that you will give an official position on behalf of the Medical Center against the discriminatory undertones of HB1523. As a large employer and an academic medical center, it is important that we acknowledge to our employees, patients and students that we value diversity and would not purposefully discriminate against potential patients, students, faculty or employees. Passage of this bill will make recruitment to Mississippi much more difficult. Thanks very much.

A:  As a large employer (the state's largest employer of Mississippians) and an academic medical center training future health professionals and providing care to patients from every county and every town in Mississippi, I say loudly and proudly that we value diversity and are committed to treating all individuals with respect.  Regardless of the intent of the law, it is perceived by some as discriminatory toward certain groups, and that perception colors how the rest of the world - including potential students, staff and faculty - view the prospect of living and working here.  As health professionals, scientists and teachers, our professional oaths, creeds and ethics call us to serve everyone without regard to personal characteristics, whether it be race, sex, sexual preference, gender identity, financial status or some other factor.  None of these characteristics or how we may view them supersedes our ethical duty to provide compassionate care to our patients and behave in a respectful and professional manner toward our learners.  Regardless of what goes on around us, commitment to diversity and inclusiveness remain UMMC core values that will not change.

Thanks again for all your questions and comments.  Keep them coming!  And let's keep moving toward our goal of A Healthier Mississippi.



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