c u s t o m e r s e r v i c e

red coats, Blue Zones

John Robinette recounts a short history of customer service efforts at DUH.

Page 7

Pat i e n t c a r e

new space, many smiles

Duke Perinatal Clinic moves to newer larger space — giving patients easier access and more services.

Page 4

i n Q u i r Y

easing gout pain

Duke researcher Michael Hershfield helps develop new treatment for gout.

Page 8

VOLUME 18 NO. 7 n inside.dukemedicine.org n July 2009

Putting the patient first:

On first glance, the Duke University Hospital Emergency

Department has nothing at all in common with a Ritz Carlton.

In the waiting room sit patients who are, more often than not, suf-fering from physical discomfort and anxious about getting help. Emotions can run high and waits can be long.

However, within the past year, new renovations coupled with a sea of changes in staff attitudes toward

service has led to significant increases in the level of patient satisfaction. “Your hard work and dedication to quality improvement is evident in the

increase in your Emergency Room Service score Overall Satisfaction,” read a letter from Press Ganey, the patient satisfaction reporting and consulting company used by the Health System.

“Our new attitude echoes the Ritz Carlton motto: ‘Ladies and gentleman serving ladies and gentle-man’,” said Michael Hocker, M.D.,

see EMERGENCY, p.2

A busy placeOn average, the DUH Emergency Department cares for 190 to 220 patients a day, and up to 260 patients at peak periods.

Kevin Sowers, MSN, RN, FAAN, who began his career at Duke University Hospital 24 years ago as an oncology nurse, has been named the hospital's chief executive officer.

In making the announcement, William J. Fulkerson, Jr., M.D., senior vice president of clinical affairs for Duke University Health System, highlighted Sowers' exemplary service over the past six years as chief operating officer at DUH and, for the past year, as interim CEO.

"Kevin is a proven leader who has made valuable contributions across the operational functions of the hospital, ranging from enhanced quality and safety measures to financial management," Fulkerson said. “His excellent relationships with physician faculty and employees at large illustrate that he is a highly-respected leader and superb choice to execute our vision for continuing to extend the legacy of excellence associated with Duke University Hospital."

Sowers was named to this position following a national search process conducted by one of the country's leading executive recruitment firms.

In his roles as COO and interim CEO at DUH, Sowers has been responsible for implementing the hospital's strategic objectives in collaboration with the physician faculty, administrators and staff, and has had responsibility for the manage-ment of the hospital's clinical service units.

Sowers has driven organizational initiatives to improve clinical quality, patient satisfaction, work culture and finance. He also launched the Strength, Hope and Caring program to recognize hospital employees who exemplify those characteristics. He has also led several major expansion and renovation projects within DUH.

"Throughout his two decades of service to DUHS, Kevin has played a significant role in the rise of Duke University Hospital to one of the elite medical institutions in the country," said

DUH veteran Sowers named CEO

ED sets the standard for service excellence

Appointment continues 24-year career at DUH

see SOWERS, p.3

The entire staff of Duke University Hospital's Emergency Department, plus affiliated staff, banded together to improve patient satisfaction scores by focusing on improving service. That effort led to a significant increase, from the 30th percentile to the 95th. PhOtO by JArEd LAzArUs, dUkE PhOtOgrAPhy

o n t h e c o v e r

Inside Duke Medicine

chief of the division of Emergency Medicine.

That simple shift in attitude, from one that focused primarily on healthcare delivery and not service, along with a number of procedural changes, has led to tangible rewards in a relatively short period of time. “Our scores were consistently in the 25th to 30th percentile. Feedback from patients indicated that our staff members were not communicating and that we didn’t care,” said Hocker.

The key behind the changes has been teamwork of the ED staff, from the front-desk receptionist to the nurses to the attending physicians and administrators. As a unit, they brainstormed ways to improve how business was done in an increasingly busy emergency department. The department now serves between 190 to 220 patients a day.

First, Hocker traveled with clinical operations director Frank DeMarco, patient visitor relations representative Matthew Rougeux and other ED staff members to Hackensack, New Jersey to visit a highly rated emergency department to see what they were doing differ-ently. They brought some of those tips back to Duke and, with those guidelines, the division got to work.

“We set up a committee of nurses, physicians and administra-tors to devise ways to respond to common patient concerns,” said Candi Van Vleet, RN, nurse manager of operations.

They began to realize that a consistent theme was not the level of care, but communication, or the lack thereof.

“Before, patients’ perceptions were that that staff members had an attitude, were short with them or weren’t forthcoming with informa-tion,” said Matt Rougeux, patient advocate. Rougeux handles patient concerns within the ED.

Patients waiting to be seen for

long periods of time often felt as if they were forgotten. One of the most successful initiatives has been the installation of “Nurse First,” in which a nurse is stationed at the reception area to triage patients upon arrival. That nurse can begin basic lab work until there is room for a patient on the unit. Waiting patients are also reassessed every two hours.

“Patients tell me that this step makes them feel like someone is paying attention to their needs,” said Theresa Davis, RN.

The staff report that Nurse First has also led to improved patient flow. “Before we started this, we were rarely able to empty the waiting room and now that occurs regularly,” said Bill Lyons, RN.

Once inside the unit, patients are now more informed about who is caring for them and what their

treatment course consists of thanks to two other initiatives. The first, bedside reporting, has nurses and assistants updating each other at shift changes at a patient’s bedside, so that the patient can listen and give feedback. The second is a white board on the wall of each room, listing the date, the name of the patient’s nurse, attending physician, the plan for the day and space for questions or comments.

“Our communication is much more patient centered. We’ve made

a conscious attempt to keep them in the loop so that they feel more in control of their treat-ment,” said Van Vleet.

Administrators, such as the charge

nurse, physician team leaders and representatives from ancillary services such as food service and radiology, are now more actively involved as well, performing rounds to ensure, in real time, that patients are getting the care they deserve.

And that care continues even after a patient has been discharged.

Within 48 hours, attending physi-cians will now call patients to touch base. “Physicians will ask how they are doing and ask about their service. The follow-up calls have provided an additional element of safety, allowing physicians to clarify treatment instructions if needed,” said DeMarco.

Finally, real-time surveys have empowered staff to be proactive about patient concerns. Each patient is given a form with 10 questions about their treatment, while they are still on the unit. If they score below a certain number, the charge nurse checks in with them to see what can be improved.

“Getting positive feedback in real time has resulted in our feeling better about the job we’re doing,” said Casey Baughman, RN.

As one patient wrote: “The entire staff from triage to the resi-dent and attending physicians was superb. The bedside manner of the physicians was absolutely wonderful. My nurse was very kind, as well as the lady taking my insurance information.”

All of this change hasn’t been easy. “There has been a lot of trial and error in the process, with some improve-ments working well and others not at all. But we’ve remained flexible and the administration has done a great job at being receptive and open to our suggestions,” said Lyons.

“This is an amazing accomplish-ment,” said Kevin Sowers, CEO of DUH. “It’s the staff that have really driven this process. It was a team effort that led to rapid cycle improvement.”

Baughman summed up the staff’s new attitude this way: “It’s now the universal goal of the unit to recognize patients as human beings with needs and wants, not just medical conditions, and to respond accordingly. Whatever we can do to improve their experience while they are here is worth it.” n

2 July 2009

I N s I d E V O L U M E 1 8 , I s s U E 7 nCONTaCT US Campus mail: DUMC 104030 Deliveries: 2200 W. Main St., Suite 910-B, Durham, NC 27705 Phone: 919.660.1318 E-mail: editorinside@mc.duke.edu

CREDITS Cartoon: Josh Taylor

STaff Editor: Anton Zuiker Managing Editor: Mark Schreiner Science Editor: Kelly Malcom Designer: Vanessa DeJongh Inside Online Editors: Bill Stagg and Erin Pratt Copyright © 2009 Duke University Health System

Inside Duke Medicine, the employee newspaper for the Duke University Health System, is published monthly by Duke Medicine News & Communications.

Your comments, story ideas and photo contributions are always welcome and appreciated. Deadline for submissions is the 15th of each month.

EMERGENCY, continued

a simple white board placed in each Emergency Department patient room helps patients remember the names of the physicians and nurses treating them and the details of their treatment.

“Whatever we can do to improve

(a patient’s) experience while they

are here is worth it.“ — Casey baughman, rN

o n t h e c o v e rc o m m u n i t Y

Duke University Hospital and Duke’s Area Health

Education Center are teaming up to provide summer internships for students at a Durham high school that specializes in health care careers.

Eleven City of Medicine Academy students will spend four weeks in July at DUH and Durham Regional Hospital. They will participate in group educational activities, plus one-on-one activities with assigned health care profes-sionals who match the students’ areas of interest – which range from cardiology to anesthesiology to neonatal nursing and more. The goal is to create a unique learning experience that fuels the students’ desire to work in health care.

The DUH side of the effort was spearheaded by Associate Vice President MaryAnn Black of the Office of Community Relations and by Pamela Edwards, associate chief nursing officer for education and deputy AHEC director. Also involved was Linda Chambers, a health careers coordinator and fiscal director of the Duke AHEC program.

AHEC is part of a statewide program establishing a community training network for health profes-sionals and addressing concerns about their supply, distribution, retention and quality.

“Each student expressed an interest in a particular specialty, and we tried to get them a close match to the field they chose,” Chambers said. “DUH educators and clinical staff have been excited

about working with the students.”The AHEC Health Careers

staff will follow the CMA students as they move into their final year of high school — and into college or other post-secondary educational program.

That makes sense for Duke and for the interns, Edwards said, especially since they are minority students, a group under-represented in many health care professions.

“Diversity is one of our core values,” she said. “The health care workforce isn’t representative of our population, so it’s important to keep improving the number of minority care providers.”

Chambers said the internships are part of Duke being a good community partner. “Some things you do just because it’s the right thing to do,” she said.

As DUH and Duke University Health System continue to grow, the students’ career path could lead them back to where they spent this summer.

“Our hope is that they may work at Duke,” Edwards said. “It makes sense to grow our own right here in the community.”

Elizabeth Shearer, Ph.D., principal of CMA, said DUHS is a “wonderful partner” with the school in many ways, especially through the internship program. “These internships will provide our students with invaluable and authentic experiences that will significantly increase their prepara-tion for college and careers, as well as enhance their competitiveness in the college market,” she said. n

3July 2009 Inside Duke Medicine

DUH, Duke aHEC offer internships to future health care providers

Victor Dzau, M.D., DUHS president and CEO and Duke University chancellor for health affairs, mingles with students from the Durham Public Schools’ City of Medicine academy on a recent visit. PHOTO COURTESY OF DPS

SOWERS, continuedVictor J. Dzau, MD, chancellor for health affairs at Duke University and president and CEO of the Duke University Health System.

"The dynamic nature of today's health care environment requires leaders who can effectively adapt to regulatory and reimbursement changes while always keeping the interests of patients as a primary focus. Kevin has demonstrated that he is exactly this kind of leader and he was a clear choice for this critically important position."

Prior to his roles as COO and interim CEO at DUH, Sowers had held a variety of administrative positions of increasing responsibility within DUHS, including those of associate vice president for hospitals and clinical facilities for DUHS, and as interim chief executive officer of Durham Regional Hospital.

"It's an honor to be selected as the CEO of a world-class hospital with such highly skilled and dedicated faculty and staff," Sowers said. "I'm committed to furthering the hospital's mission of providing excellence in patient care through the clinical translation of innovative research, while maintaining a healthy operational and financial foundation."

Duke University Hospital has been recognized as one of the world's best health care providers by such publications as Time and U.S. News & World Report. A full-service tertiary and quaternary care hospital, Duke University Hospital is licensed for 924 acute care beds.

Sowers is internationally known for his lectures and writings on the issues of leadership, organizational change, mentorship and cancer care. His clinical research has focused on human responses to chronic illness. He received the Duke University School of Nursing Distinguished Alumni Award in 2006 and was inducted into the American Academy of Nursing in 2008. He has also served in a variety of leadership roles at the national level within the Oncology Nursing Society. n

Bio facts: Kevin Sowers, RN, MSN, faaN• He began his career at Duke University Hospital as a nursing leader in oncology beginning in 1986.

• From 2003 to 2009 Sowers was Duke University Hospital’s chief operating officer. He also served as interim CEO in 2008-2009.

• Under his leadership, Duke University Hospital received approval for major renovations to the Emergency Department, a modernization and expansion of the operating rooms, development of a pediatric cardiac care unit, expansion of the intensive care nursery, and construction of a new ICU/OR bed tower and cancer center.

• Sowers serves as an adjunct faculty member to Sun Yat Cancer Center in Taipei, Taiwan; the University of North Carolina's MPH program, and the Duke University School of Nursing's graduate program.

• His professional honors include receiving the Duke University School of Nursing Distinguished Alumni Award and induction into the American Academy of Nursing.

Q&a: On leadershipConsidering organizational improvement, what do you see

in the future?

There has to be a strong alignment among the entities: the School of Medicine, the School of Nursing, the practice group, the hospitals and the clinics. Over time, we need to evaluate and understand what integrated service lines look like and how that will allow us to better serve our patients. At the same time, we have to continually look at how much more efficient we can become in serving the patients who need our care, especially when we consider how alignment between our hospitals can create the capacity and efficiencies.

It will take an entire team of people, from every part of the organization, to drive the progress to advance the organization’s success.

What is your vision for the hospital’s

work culture?

Our patients and families are at the center of everything we do. As a team, Duke University Hospital has worked to build a work culture that supports patient-centric models that improve the quality of our clinical outcomes and patient satisfaction. It takes focus and tactical strategies that the organization has to follow through on. Most importantly, it takes a team of committed individuals to accomplish these goals.

What’s your philosophy of

organizational improvement?

Every day when you get up, you say, “What did we do yesterday that we could do better today?” and let’s try it. Challenge yourself to be better today than we were yesterday. You do rapid-cycle improvement, to figure out how you can do it better today. Each and every day you come up with ideas on how to improve over yesterday. You work as a team, and you let the staff drive the process, coming up with ideas to better serve our patients and families.

W o r K i n G @ D u K e

4 Inside Duke Medicine July 2009

Larger obstetrics clinic, in new location, focuses on customer serviceAmanda Herrera Lira knows first

hand that customer service is an important part of the care a patient receives. As a patient service associate in Duke Medicine’s obstetrics clinic, she encounters patients with different backgrounds and needs every day.

But she is also a patient at the same clinic, and recently she has witnessed the impact a patient-friendly clinic can have on both patients and employees.

Having natural lighting in the new clinic makes a big difference, she said.

“Sunlight brightens everyone's mood and a good mood is contagious, which makes the day pleasant,” Herrera Lira said.

To better meet the needs of patients with high-risk pregnancies, Duke Perinatal Durham Clinic and Fetal Diagnostic Center is now offering patients added conveniences at a new and larger location. The clinic moved from its old location in Duke Clinic in March to Pavilion East at Lakeview, at the corner of Erwin Road and Downing Street, and now sees some 2,400 patient visits each month.

“Our focus is to make sure that we are providing not adequate, but excellent patient care,” said Geeta K. Swamy, M.D., medical director of Duke Perinatal in Durham. “Patients are always grateful for good care, but they also are focused on good customer service, too.”

The new clinic creates a patient-friendly environment conducive for providing excellent care, she said. That service begins even before patients walk in the door by offering free, on-site parking.

“One of the biggest conveniences for our patients is free parking,” said Kim Adcock, RN, nursing program manager of Duke Perinatal in Durham. “Since we are a clinic for high-risk patients, having parking available right outside the door is a big plus. Patients love it.”

That team takes care of women, a large number of whom are Duke employees, who have complications

during pregnancy. Their complications either pre-date their pregnancies – such as diabetes, high blood pressure, heart disease, kidney problems and other medical related complications – or can occur during pregnancy, such as gestational diabetes or complications related to the fetus.

Inside, patient flow through the clinic is much better. That's because the new location dedicates 20,115 square feet to clinical

services with an on-site lab, nine exam rooms, two procedures rooms, six consultation rooms and nine ultrasound rooms. The additional space allows a team of providers – 19 physicians, nine midwives, three genetic counselors and eight sonographers – to care for all of the patients’ needs in one location.

The new clinic features a larger waiting room with a kid’s area, a quiet space and more comfortable seating. The new space also includes separate physician and nursing workrooms, as well as designated areas for social work, WIC/nutrition and genetic counseling.

With more space, the team of providers at the clinic is able to offer new services to patients and their families.

On June 1, the team began to offer a psychiatry clinic within the obstetrics clinic, said Krista Wilson, RN, health center administrator of Duke Perinatal. One afternoon a week psychiatry residents, under the supervision of

William S. Meyer, MSW, and Marla Wald, M.D., see patients with postpar-tum depression.

“It’s nice that we can combine some of the care for these patients during the course of their pregnancy at one location,” Swamy said.

In an effort to bring even more convenience to patients, the clinic is now the first OB clinic in the state to participate in the Vaccine for Children program, which offers free vaccines to patients up to the age of 19. The clinic also has the North Carolina registry live and running on site to assure accuracy in providing the vaccinations.

“In addition to this new program, we also stock and offer other vaccines to our patients, such as vaccines for pneumonia, hepatitis A and B, menin-gitis, and the flu,” Adcock said. “Last year, we gave about 600 flu vaccines to our patients.”

Patient satisfaction surveys show that patients are pleased with all the new clinic has to offer, and Adcock has received positive comments about the front desk check-in being a pleasant experience.

Added benefits, said Swamy, are the restaurants and food vendors elsewhere in the building, since family members who accompany the women to their appointments appreciate the dining options.

The clinic staff, too, is enjoying the new space.

“It makes it a nicer day just to come to work and want to come into your office and the space that you work in,” Swamy said. n

Patient Service associate amanda Herrera Lira — like other staff and patients at Duke Perinatal Durham Clinic — is all smiles about the new space. PHOTO BY ERIN PRATT

“since we are a clinic for high-risk patients,

having parking available right outside the

door is a big plus. Patients love it.“— kim Adcock, rN

Duke Raleigh again named a nursing leaderThe N.C. Nurses Association named Duke Raleigh Hospital a second-time recipient of its Hallmarks of Healthy Workplaces award for creating positive work environments for registered nurses.

A special project of NCNA and a result of a Duke Endowment grant, the Hallmarks of Healthy Workplaces program is designed to recognize exceptional workplaces for nurses and to help health care providers create workplaces in which communication flows freely and nurses contribute actively to facility governance.

Recognition is based on three basic criteria: support of nursing professional development, system support for nurses to provide quality service, and integration of nursing into operations and governance.

Duke Raleigh was the first hospital to receive Hallmarks recognition in 2006. Since the initial award, the hospital has paved the path for several North Carolina facilities to achieve recognition.

“We are delighted that Duke Raleigh Hospital has been re-designated as a North Carolina Hallmarks of a Healthy Workplaces Hospital,” said Rosemary Brown, chief nurse officer. “Since our initial award in 2006, we have continued to strive for a work environ-ment that supports our nursing staff with the resources necessary so that they can provide extraordinary care. Our 2009 application and on-site survey confirmed that our nursing staff report high satisfaction with the organization’s support in the areas of leadership, professional development, empowerment, safety and quality.”

The awards will be presented at an Aug. 7 awards ceremony.

DUHS’ James E. Davis Ambulatory Surgical Center also successfully renewed its Hallmarks status this year.

Previous recipients include Duke University Medical Center’s Cardiac Intensive Care Unit, and Durham Regional Hospital’s Post Anesthesia Care Unit (PACU) and Endoscopy Services Unit.

e D u c at i o n

5July 2009 Inside Duke Medicine

The surgeon’s toolkit doesn’t include a mousetrap, of course, but that

doesn’t mean Danny O. Jacobs, M.D., MPH, isn’t thinking about how to design a better one.

Jacobs, the David C. Sabiston, Jr. Chairman of the Department of Surgery, is leading his department in exploring innovations in training the next genera-tion of surgeons.

“The model that we’re using to train surgeons hasn’t changed substantially in 200 years, but the circumstances have,” said Jacobs.

While that model — See one, do one, teach one — has worked very well and trained some great surgeons, he said, academic institutions have to ask the question, “Can we do it better? Can we build a better mousetrap?”

In recent years, new regulations limiting resident workloads, a shift from open surgery to minimally invasive surgery, massive expansion of the knowledge base, and generational differences in how residents learn have all increased the need to broaden the ways in which surgery is taught.

Duke Surgery is doing just that with a variety of educational initiatives.

Practice makes perfect

Surgery residents by nature like to do things, rather than read about or discuss them, said Ranjan Sudan, M.D., vice chair of education. “That’s where the Surgical Education and Activities Laboratory comes in.”

In the SEAL, surgeons, fellows, resi-dents and medical students use surgical simulators to practice their techniques, like airplane pilots honing their skills in a flight simulator. The Duke SEAL has received the highest accreditation rating from the American College of Surgeons, and it’s just what Duke’s surgeons need to “see five hundred, do one, teach one” — another way to say “practice, practice, practice.”

“We get to ask ‘What’s the safest environment in which to perform that operation?’ as well as ‘What’s the safest environment in which to introduce new technologies?’,” said Jacobs, explaining that those dual questions are part of the duty of an academic medical center.

In that vein, Sudan will soon un-dertake a study of how guided imagery might help surgeons prepare for and improve their surgical performance. He’s interested in learning if surgeons who mentally practice before making

incisions can, like Olympic ski jumpers visualizing their slide down the ramp, improve their performance.

In this study, Sudan will teach guided imagery techniques to surgical residents and track if and how the residents learn surgical skills faster. His research will be funded through the Chancellor’s Graduate Medical Education Innovation Fund.

actors and patients

Another Innovation Fund grant to the Department of Surgery just wrapped up last month. It, too, has implica-tions for preparing residents to be better surgeons, said Marnelle Alexis, Ed.D., director of the Comprehensive Education Institute (CEI) in the Department of Surgery.

Alexis coordinated the standard-ized patient training program pilot, an attempt to capture the level of readi-ness in surgical residents. Nationally, residents are tested by the American Board of Surgery on their knowledge, she said. But Duke Surgery is interested in measuring the ability of residents to comprehensively work up a disease process based on dynamic, real-time interactions with patients.

So, Alexis collaborated with Aurora Pryor, M.D. medical director of the CEI, to create five in-depth patient care scenarios. They invited seven residents

just finishing their two years of research to spend a whole day interacting with nine local actors — and one SimMan programmable mannequin.

Surgical resident Loretta Erhunmwunsee, M.D., spent the last two years in the lab on research into the genomics of lung cancer and was preparing to return to surgical duties this month. She jumped at the opportunity to get practice at caring for patients and confronting different medical issues.

In her first standardized patient scenario, she was presented with a 50-year-old man with blood in his stool, and had to diagnose his colon cancer. “I understand you are a resident, and I’m wondering why we’re not talking to the surgeon,” the actor-patient confronted Dr. Erhunmwunsee, who calmly assured him that the attending surgeon would check in.

Immediately after the playacting, Erhunmwunsee faced Alexis, Pryor and the other participants for their constructive criticism for how she’d performed.

“It reminded me that we’re all in this together, to get practice and feedback, and to always be learning,” she said.

Bettering the books

In his office inside the recently com-

pleted Hospital Addition for Surgery, Jacobs makes a reference to the books on his desk and bookshelves.

“If you look at my shelf, there must be 10 major textbooks all dealing with overlapping subject areas. How does a learner go through that?” he said.

With so many sources of information, he said, it’s natural that surgeons and residents are experiencing information overload, and much more challenging for the educator to ascertain what needs to be learned. It’s also more challenging for the learner to wade through all these books.

Sapan Desai, M.D., Ph.D., another surgical resident, is trying to remedy that. He’s edited a textbook that will better prepare residents for the ABSITE exam by distilling the most relevant materials. He’s also collaborating with Jacobs and other department leaders to develop a new tool that could transform surgical education materials.

Their grand dream is to cre-ate a collection of tools — texts, photographic images and three-dimensional illustrations, videos and social networking — that will become the standard resource for learning to be a surgeon in the modern world.

“The goal is to make surgical education more efficient, more effec-tive, more accessible for all learners,” said Jacobs n

Surgery department explores new ways to learn

In the Surgical Education and activities Laboratory, Duke surgical residents practice their skills on simulators. The lab is one of the Departmet of Surgery efforts to train residents and fellows with new learning tools and techniques. PHOTO BY JARED lAZARUS

6 Inside Duke Medicine July 2009

at a G L a n c e

I N s I d E J O k E n I t f I g U r E s n

”“I tell everybody I know that you guys are the best in the world,says a patient about her recent visit to the DUH Emergency Department. Want to give kudos to a Health System employee? Visit http://inside.dukemedicine.org/ and look for the High Fives section.

As of June 25, there were

179known and suspected cases of H1N1 in North

Carolina. Cases of influenza-like illness and H1N1 flu are affecting Duke summer camps,

Duke Medicine employees and other local individuals. A June 30 message from Chancellor

Victor J. Dzau reminded employees of the importance of good hand hygiene as one way to

protect yourself and the community.

Source: Centers for Disease Control and Prevention

r E C O g N I t I O N n

Covington named Social Worker of the Year

With only the faintest sense of hyperbole, his colleagues say the recent history of Duke Children’s Primary Care can be divided into two periods – now, and the time before social worker David Covington arrived.

“Since arriving, David has quietly elevated the visibility and importance of social work in the holistic care of children and families, to the point that when families present with psychoso-cial needs, David is quickly sought for wise counsel,” said pediatrician John W. Moses Jr., M.D. “David’s input has become so important and helpful that it’s hard to remember how

clinicians, and families, managed in the days ‘before David.’ ”

Covington was recently honored by his col-leagues in Duke University Hospital’s Department of Clinical Social Work with the

2009 Brandy McDaniel Award for Outstanding Social Worker of the Year.

The North Carolina native has been at the clinic for four years and with Duke Medicine for nine. Covington is a licensed clinical social worker who holds a master’s degree in social work from the University of North Carolina.

But more than academic and professional credentials, Covington is seen as a valued member of the busy pediatric clinic located not far from Durham Regional Hospital. At Duke Children's Primary Care, his work, as the practice clinical social worker helps clinicians, patients and families navigate the network of services and programs in the medical center and the community designed to help them when they need it most. Covington serves as a valuable resource for clinicians, who together as a team must not only address medical issues, but issues related to the quality of home life and mental health. Key to that work is serving as an advocate for each young patient.

“David has the courage and strength it takes to help families who are challenged to face complex social, financial, psychological and sometimes legal dilemmas,” said Barbara Donadio, RN. “He tries to address cultural diversity in his practice of social work. We have a growing population of latino families. David works closely with our Spanish interpreters to help address the social needs of this patient population. David also conveys respect for parents and children, affirming their right and responsibility for self determination while keeping children safe.”

Covington’s work includes many tasks, from performing social work assessments to helping pediatric and medical-pediatric residents understand the psychosocial element of the practice of medicine.“Even though his work is often behind the scenes, he has an unwaver-ing dedication to the children and families, but also to helping the physicians, residents, and other clinicians in the practice as they tackle challenging situations,” said Patricia Cheng, Ph.D. “It has truly been an honor to work with and learn from David every day.”

DAVID COVINGTON

nurse manager sharon Zimmerman (left) and rns christie Preddy (center) and mary ellen hill admire one of several new sculptures now beautifying the garden area outside the main entrance to Lenox Baker children’s hospital. in their effort to spruce up the garden, Lenox Baker employees decided to reach out to students at the Durham school of the arts. several Dsa classes worked for months to create and install two large sculp-tures, plus several small ones. PhOtO by bILL stAgg

t h E b I g P I C t U r E n

7July 2009 Inside Duke Medicine

John Robinette, assistant director of the Private Diagnostic Clinic, knows

all about the importance of helping patients find their way through Duke’s labyrinthine hallways. Not for nothing did he earn the nickname “Mayor of Duke Hospital.”

Speaking recently from his PDC office in the Erwin Square tower, from where he can look out on the sprawl-ing Duke University Medical Center, Robinette reminisced about his work to improve the hospital experience for patient and physician alike.

That experience, he said, often starts right inside the front doors.

“This is a big and complicated place. We need to make every effort every day to make it as simple as possible for the people who we take care of – the patients and the families and the staff – to move through our system as efficiently and as safely as possible.”

In 1974, Robinette was the youngest administrator on the staff of William Anlyan, M.D., then dean of the School of Medicine and vice president for health affairs. After experiencing the exceptional hands-on customer service of an airline, Anlyan had returned to Duke and tapped Robinette to literally don a red coat and prowl the halls of Duke Hospital looking for ways to assist hospital visitors.

“I smiled a lot,” said Robinette, explaining his approach to the 12-hour days in the hospital hallways, helping lost patients, answering employee complaints and triaging the issues of the moment.

A year later, the red coat gave way to visitor information desks positioned at key entries. The color-coded hallways of the hospital, painted for easy recognition, were redecorated and labeled as numbered clinics and zoned

areas, just like airport concourses with their ordered and easy-to-follow gates. The Marriott Corp. even came to campus to train managers in the best practices of hospitality industry customer service.

Now, DUMC is even bigger – Duke North was built in 1980, and DUH is making plans for more expansion.

That makes it even more important for employees to be on the lookout for visitors in need of a helping hand. Indeed, many Duke Medicine employ-ees wear a reminder of this core value on their name badges – Service Begins With Me.

“Customer service is everyone’s responsibility — not just that of a guy in a red coat,” said Robinette, who still stops to help patients fumbling with their wrinkled paper directions.

Three years ago, it was him.For the first time ever, Robinette

was faced with a mortal threat to a close family member. “She may not make it,” he was told in the Emergency Department.

“I’d been here at Duke for 32 years, but the moment I got hit with that, I couldn’t find my way. ‘How do I get from here to there?’ – just POOF.”

Recounting the tale in the familiar confines of his office, his face reflected the panic of that moment.

“All of a sudden, I became someone else. I wasn’t the guy who knows where the sewer runs” – he really does know where the sewer runs. “All of a sudden I’m a guy with someone near death, and somebody’s helping me get from Point A to Point B. I was just totally overwhelmed.”

Robinette composed himself, and got to where he needed to go. But that lesson has stuck with him. “It certainly is different on the other side,” he said. n

Customer service: everyone’s responsibility

b E N E f I t s n

Direct deposits to get electronic statements

Starting July 1, 2009, Duke University and Duke University Health System fully adopted electronic pay statements for direct deposit.

Employees can easily access their electronic statements via the Duke@Work Web site: http://hr.duke.edu/selfservice/. The Web site has already been embraced by about a third of Duke’s workforce to eliminate printed pay statements and manage personal information.

The final paper statements were distributed on June 25, 2009, for monthly-paid employees and on July 2, 2009, for biweekly-paid employees. This action is the latest in a series of steps to reduce costs and environmental impact.

Eliminating paper pay statements was one of the ideas submitted by faculty and staff through the Enduring a Troubled Economy Web site (http://www.duke.edu/economy/).

For instructions on using Duke@Work, go to http://hr.duke.edu/selfservice/

L I V I N g n

No bull: Durham makes ‘best places’ list

U.S. News & World Report confirms what many of us already know: Durham is one of the best places to live in the country. U.S. News selected its 10 Best Places to live 2009 based on their strong economies, low living costs and fun things to do.

The article notes that Durham is called the “City of Medicine,” has an expansive health care industry and is home to “prestigious Duke University.”

Read more by going to http://www.usnews.com and searching ‘Durham.’

A t h L E t I C s n

Good deals on tickets, comfy seats

Attention cost-conscious employees who are fans of Duke football and Duke women’s

basketball:

The Employee Athletic Pass offers faculty and staff reduced prices on season tickets to every Duke football and women’s

basketball home game.

last year, about 2,700 employees took advantage of the pass — sponsored by the Duke Credit Union — nearly double the number from the 2007 season. New this year is tiered pricing, based on sports team.

Meanwhile, fans can rent cushioned stadium seats for all football home games.

Get all the details here: http://news.duke.edu/2009/06/game.html

John Robinette has never forgotten the lessons he learned as the red-coated hospital customer care pro:

smile, and always be quick to help. PHOTO BY BIll STAGG

P A r k I N g n

Duke parking renewal in progress; fees to hold

While parking rates for Duke faculty and staff will not increase in 2009-10, adminis-trators continue to urge employees to use alternative transportation to save money and help reduce Duke’s carbon footprint. Despite increased operating costs for parking lot maintenance, bus fuel and other expenses, administrators decided to hold rates steady to reduce the impact on employees during the economic downturn.

“The demand for limited parking space continues to grow, and adding capacity will increase the cost,” said Kemel Dawkins, vice president of campus services. “The best way to manage the future cost of parking and reduce our environmental impact is for more people to adopt alternative ways of getting to work and around campus. We are continuing to develop more alternatives to commuting alone.”

To help manage future increases, Duke is also exploring innovative ways to curtail expenses, such as evaluating campus bus routes to improve efficiency and offering alternative transportation incentives, such as discounts for local and regional bus passes and free parking permits for cyclists and people who carpool.

“Each time someone opts to use alternative transportation, it helps keep the budget down for maintaining parking lots or building new garages,” said Melissa Harden, assistant director for Parking & Transportation.

More information: http://parking.duke.edu

2009-10 Monthly Parking Permit Rates

University

• Remote Lots - $9.65

• Gated/Proximate Lots - $30.50

• Premium Lots - $62.50

• Universal Access - $80

• Reserved Spaces - $96.50

Medical Center

• Remote Lots - $6.80

• Gated/Proximate Lots - $34.75

• Garages - $52.25

• Premium Lots - $62.50

• Universal Access - $80

• Reserved Spaces - $96.50

8 Inside Duke Medicine July 2009

this month: inside online

the daily dUhs news site gets a makeover this month. Watch for it at http://inside.dukemedicine.org

online any time

you can download a Pdf of this issue, suitable for emailing or printing, at http://inside.dukemedicine.org

next issue

the next print edition will appear later this month. the deadline for submissions for that issue is July 10.

The Science & Research Supplement to Inside Duke Medicine

On June 16, an FDA advisory panel recommended approval

of the drug Pegloticase for patients with severe gout for whom other treatments failed.

For Duke rheumatologist Michael Hershfield, M.D., June 16 was a day he’ll never forget. The advisory panel was reviewing work he had begun more than 15 years ago that led to creation of Pegloticase — and to positive results for many patients with advanced gout.

Gout is an inflammatory arthri-tis that affects about five million Americans. Its hallmark is sudden, searing pain, usually starting (for reasons unknown) in the big toe, followed by formation of knotty deposits of uric acid around joints and tendons.

In most people, medicines avail-able for decades can ease the pain and prevent progression by reducing uric acid in the blood. But for a small fraction – perhaps as many as 50,000 – nothing works. For them, life is a nightmare of disability and pain.

Hershfield was involved in testing a novel chemically modified enzyme called PEG-ADA, which the FDA approved in 1990 against a very rare, inherited immune deficien-cy disorder. He saw an opportunity for a new, enzyme-based therapy for severe gout. In 1993 he applied for a grant to develop a PEG-uricase to eliminate uric acid deposits in patients with resistant gout.

The Duke scientists showed that PEG-uricase (today’s Pegloticase) lowered uric acid in animals by converting it into a product easier to

excrete. In 1998 the clinical-develop-ment rights to the drug were licensed to Savient Pharmaceuticals. In 2001 the FDA designated it as an orphan drug — a pharmaceutical developed

to treat a disease that afflicts rela-tively few people — for patients with chronic, refractory gout.

The first clinical trials began at Duke in 2001 under the direction of John Sundy, M.D., Ph.D., a rheuma-tologist with no financial investment

in the product. Several patients felt so strongly

about their improvement during the phase III trial that they traveled to Washington, to testify at the June

16 meeting. Pegloticase, to be called Krystexxa if it wins FDA approval, was on the line. Hershfield sat in a “bullpen” awaiting potential panel

questions about his laboratory’s research.

Would the benefit to patients demonstrated in the trial outweigh uncertainty about risk? “That’s often the bottom-line question with new drugs, and Pegloticase was in a

brand new class of drugs for gout,” said Hershfield.

A vote to recommend approval seemed far from certain. But every-thing changed when the patients spoke.

“Here were some patients who had been in constant pain and were so debilitated that they couldn’t even walk,” said Hershfield. “Before this drug, some were in wheelchairs, or had entered long-term care facilities. And they actually walked into this meeting and stood at the microphone to say how much this drug had improved their lives.”

Among them was Lonnie Matthews, 76, of Burlington and a former Duke employee. His gout was so bad that he spent most of his time in bed. He couldn’t take care of himself, feed himself, do much of anything, he told the panel.

“After they told their stories, there wasn’t a dry eye in the house,” Hershfield said. “I had a feeling at that point how things would go.”

The panel recommended approval by 14-1. It did have reservations about safety and recommended long-term follow-up studies, but Hershfield is optimistic the drug will become available for the patients who need it.

Hershfield said a final FDA rul-ing is expected in about six weeks.

“There are not many physicians who can point to one — let alone two — discoveries they have made that have dramatically changes patients’ lives,” Sundy said. “Duke is very fortunate to have someone like Mike Hershfield.” n

for gout patients, renewed hope

Research by rheumatologist Michael Hershfield has led to a promising new drug to treat the worst cases of gout. PHOTO BY MICHEllE GAIlIUN

“before this drug, some patients were in

wheelchairs... And they actually walked

into this meeting and stood at the

microphone to say how much this drug

had improved their lives.“