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    Department Spotlight Community Care Management

    When thinking about taking care of your total health, what comes to mind? Perhaps participating in your annual check-ups, taking your prescribed medication, eating a nutritious diet, checking in with your mental health, the list goes on and on.   Now, put yourselves in the shoes of someone who may not know where their next meal may come from, someone who may be homebound and not have access to transportation, someone who may be on a fixed income, someone facing homelessness or even someone who may be struggling with substance abuse issues. Getting healthy – and staying healthy – comes with a unique set of obstacles, or social determinants of health, for these patients to overcome. Inequities around social determinants and health behaviors have an outsized impact on patient outcomes, and social and economic factors make up 40 percent of those inequities.  This is where the caring and compassionate community health workers, social workers and registered nurses that make up Renown’s Community Care Management (CCM) department rise to the occasion. As the need for resources grows in northern Nevada, these dedicated team members fill those gaps and ensure every patient feels prepared, educated and equipped with everything they need to continue their care journey and live a healthy, fulfilling life.  Defying Disparities  When our community at risk faces healthcare disparities, it can create complications in each patient’s life that may keep them from addressing their healthcare needs and affect the likelihood of them being admitted or readmitted to the hospital or continuing to struggle with their care management – but not on CCM’s watch. Whenever possible, the CCM team steps in to provide critical resources, education and care journey guidance for any patient that finds themselves in need.  “In the simplest terms, we do outpatient case management with vulnerable populations,” said Barb Mader-Scherrer, Director of Community Care Management. “It may be anyone from elderly people who need help managing chronic diseases, to patients experiencing homelessness who are being discharged from the hospital. We work with folks who are facing all sorts of challenges.”  Several roles make up the CCM department, including Community Health Workers. These team members are the resource experts, on the front lines of helping educate patients and supporting them as they navigate through the facets of their care. Their main goals? Avoid admissions and readmissions to the hospital and continue to meet their unique goals.  “I have the pleasure of working with patients who may need financial help, transportation help or even help utilizing the food pantries in our community," added Steve Arm, Community Health Worker. “We help patients navigate healthcare and social services, address social determinants of health, encourage self-efficiency and provide general health education for many chronic conditions. We also provide home visits for our patients who need extra support.”  “The day in the life of a Transitional Community Health Worker is to outreach to the patient while being admitted, do a bedside assessment, complete the social determinants of health evaluation and provide any resources needed to avoid readmission,” added Sherrie Skaggs, Community Health Worker. “Our main population is Medicaid, and many are homeless and financially challenged. As needed, we continue to ensure that follow-up is completed, and all needs and goals are met.”  For those learning to cope with their condition and needing hands-on help especially after discharge, the CCM Social Work Care Coordinators take on this complex aspect of the healthcare journey. These individuals provide support and intervention for Renown patients facing a chronic, behavioral health or substance dependency condition to improve their overall quality of life beyond hospital walls, developing a strong framework to build a long-term healthcare plan.   “As social work care coordinators, we help connect patients with mental health resources, welfare programs, community support, caregiver burnout resources, placement for loved ones with terminal illnesses and much more,” said Irina Osmolovska, Social Work Care Coordinator. “Requests that come to us run the gamut of homelessness, family crisis, food insecurity and even situations where a patient has no electricity for their life-saving medical equipment. We receive challenging requests and are always ready to go above and beyond to advocate for our patients.”  Possessing a profound understanding of the delicate balance between medicine and the patient spirit, the CCM RNs help bridge the gaps between the hospital or primary care practice and post-discharge settings, ensuring a smooth transition for patients as they move from one healthcare setting to another. With their expertise in care coordination and patient education, these RNs help enhance patient outcomes and promote continuity of care.  “Our group is responsible for making discharge follow-up calls to patients who have Medicare, as well as scheduling their hospital follow-up visit if needed,” said Vanessa Alford, Consulting RN. “The goal is to have every patient see their primary care physician within 14 days of discharge for continuity of care and to prevent readmissions. We also screen patients for eligibility for Chronic Care Management or Personal Care Management. In addition to setting up the patient for follow up, I review each patient's medications, answer any questions they may have about their medications and health conditions.”  As another important part of unpacking the intricate web of social determinants impacting health, CCM RN Care Coordinators have the extraordinary opportunity to extend this department’s compassionate care beyond the boundaries of the traditional in-office environment. Whether it be through virtual connections, heartfelt conversations over the phone or in-person encounters outside the hospital, RN Care Coordinators create holistic and enduring plans of care for individuals facing chronic challenges – including behavioral health issues and chemical dependency struggles – at every stage of life.  All in all, the CCM department recognizes the interconnectedness of physical, emotional and social well-being for all patients, fostering a sense of wholeness and empowerment to ensure they continue to meet their goals and live healthier, happier lifestyles.  “Our team has a holistic approach to our work,” said Barb Mader-Scherrer. “We look at the whole picture. What are the medical things we can do for this person? What education do they need to help them manage their condition? Do they have food in their house? Do they have a safe living environment? Are there substance abuse issues? Do they need help in managing their medications?”  “My 18 years of experience in various areas of hospital nursing and home health have given me the knowledge to serve patients in our community holistically, and I feel good about what I do,” added Vanessa Alford. “I hope that I am able to lessen the load on the medical assistants and providers in the clinics so they can focus on their patients on site.”

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    Department Spotlight: Patient Experience

    At Renown Health, our commitment to the experience of all our patients and guests is not just a mission – it's a way of life. Our unwavering dedication to creating exceptional experiences for the communities we serve is what sets us apart. Every day, we strive to build a service culture of excellence, one that ensures that every person who walks through our doors has an extraordinary encounter that exceeds their expectations.  Renown’s Patient Experience department is the team that fulfills this mission and more. These passionate individuals intimately understand that top-of-the-line service involves the entire healthcare continuum, from the first phone call when scheduling an appointment to the final discharge and follow-up instructions and everything in between. With this collective dedication, Patient Experience is consistently on a journey to redefine what it means to leave a lasting impact in the minds of patients, setting a new standard for healthcare excellence in our community.  Our In-House Jack-of-All-Trades  It takes a village to ensure every patient and guest continues to have a positive experience at every Renown location and maintains trust in our providers and employees. Our Patient Experience team serves as the mayors of that village, encompassing four main aspects of healthcare service:  Service Excellence: Compiles, reviews and resolves patient complaints and concerns to help with service recovery and identify opportunities for improvement. Volunteer Services: Enhances the patient experience by leveraging dedicated youth, adult and college-aged volunteers in a variety of volunteer programs, including pet therapy, healing arts, hospice and more. Language Access: Provides qualified interpretation and translation services to assist our limited- or non-English-speaking populations. Data Management: Uses patient experience data, research and surveys to prioritize system, location and unit-specific service needs to improve clinical and quality outcomes.  “Because our department has many segments, no day is the same, which keeps the work week exciting,” said Shelbi Whitehead, Manager of Patient Experience. “Whether we are hosting a pet therapy parade for patients, de-escalating and rounding with upset patients to provide service recovery, offering interpretations for our Limited English Proficiency (LEP) patients, or managing data for the organization, we have one goal in mind: to enhance the experience for our patients and guests at Renown Health.”   Cultivating a sense of community and fostering trust in our health system, the Service Excellence team steps in to ensure no concern goes unnoticed and every opportunity to make a positive chance is addressed.  “My day consists of listening to patient concerns, connecting with different department leaders and providing support, and working on projects to improve processes,” said Julianne Revilla, Customer Experience Specialist. “To help enhance the patient experience, I round with patients on different floors to know more about their stay and experience with us. If they have any issues or concerns, I let floor staff know and do our best to resolve the issue in the moment.”  “My team and I have an amazing opportunity to work with multiple leaders throughout the organization to resolve any patient concerns and provide valuable feedback on how patients are doing while using services that we offer,” added Ricky Garcia Sanchez, Senior Patient Experience Specialist. “A typical day will involve calling patients, rounding with patients, communicating with leaders to resolve events, handling grievances and staying in compliance with Centers for Medicare and Medicaid Services (CMS) guidelines.”  “It’s all about hearing what is upsetting them and letting them know that we care about them,” added Shay Morgan, Customer Experience Specialist. “We ask ourselves, what is the main concern the patient has, and what is it they are seeking? From there, we do our internal investigation through Midas and send it to leadership, and then we find a reasonable and appropriate solution or response to let the patient know we are looking into their concern.”  As the only not-for-profit health system in the region, Renown depends on the dedicated service of our volunteers. Our Volunteer Services team deploys volunteers across many programs who make a significant difference in the lives of patients and their families.  “On a typical day, I may be going between the volunteer information desks assisting that team with anything that comes up while they are helping guests,” said Wendy Peukert, Volunteer Coordinator. “We find wheelchairs for departments, provide guest escorts, deliver flowers and mail to patients, locate doctors’ appointments or anything else that helps someone that walks in the door. We ensure all our programs go smoothly by planning ahead while also being flexible to be ready for anything that comes our way and by keeping communication open with our volunteers. Patients and guests being greeted by friendly, knowledgeable volunteers who show empathy and care is my goal!”  “Some of my best days at Renown are volunteering with my dog Moose, who is a certified therapy dog, and watching the healing he provides to patients and employees,” added Shelbi Whitehead.  At Renown, we believe that language should never be a barrier to receiving care. Our Language Access team ensures that this goal is realized through providing expert interpretation and translation services.  “Renown has many different resources we use to ensure LEP patients and visitors receive a positive, quality visit to our health system,” said Seth Rubin, Supervisor of Language Access. “With signage strategically placed at front desks and check-in areas, patients can point to their preferred language, and we can use the Language Line iPads, phone lines or a dual-role Qualified Medical Interpreter to communicate with the patient or visitor. Within EPIC, we can also set a patient’s preferred language indicating to Renown staff what language to use with the patient and prepare forms in that language. I always ensure all patients are provided with these proper language services, and I also help with employees taking our online interpreter certification course, as well as help when a department needs new Language Line equipment. Additionally, I enjoy meeting with community groups to stay informed on community updates, events and trends around language, immigration and more.”  Renown values and utilizes the opinions of our patients across all corners of our health system Maintaining service transparency is a promise, and that promise is fulfilled by our Data Management team, who use all the research and survey tools at their disposal.  “My daily work includes a lot of updating scorecards across the network, working with the tech teams to ensure the patient data is getting to the right places, training leaders, analyzing market data and maintaining the reports that go to every corner of Renown,” said Brooke Cyphers, Market Data Analyst. “Through a partnership with our patient satisfaction survey vendor, PRC, Renown ensures data integrity, neutrality and credibility in surveying patients in all our care areas. The data from completed surveys are compiled and disseminated to our providers and leadership at all levels with the goal of transparency and patient-centric practice. These surveys are incredibly important to process improvement directly targeted at addressing areas that have been mentioned by our patients. I love it when people reach out to dive into a particular initiative they want to track or an issue they want insights on.”  In their relentless pursuit of excellence in service across many programs, the Patient Experience team remains steadfast in their commitment to delivering the highest quality care and experiences.

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