From the category archives:

Patient- and Family-Centered Care

Following is a letter sent from a patient to The Johns Hopkins Hospital about Jesse Grant

Dear Sir/Madam:

I just wanted to make a comment on one of your employees. There is a gentleman named Jesse that works out in front of the main hospital/emergency entrance. Jesse is the kindest soul.  I came there  with my grandson and my mom. My grandson had had eye surgery the day before and was coming for his day one post op visit.  I also had to bring my mom for her appointment.  I was feeling very overwhelmed and stressed out because my grandson had a very difficult night the night before, dealing with post op pain, and my mom is steadily declining and has been falling a lot.  I pulled up at the front entrance to get a wheelchair for my mom and drop her and my grandson off before going to park in the Orleans Street Garage.

Out of nowhere appears this Angel, Jesse.  He immediately got a wheelchair for my mom, helped me get her in the chair, made her laugh and assured me that he would keep an eye on them while I went to park.  My grandson is 14, and he was going to stay with my mom, so she was okay, but it was very sweet of him to offer that.

Several hours later, when I came back to the front entrance to pick them up, there he was again.  I was struggling to get my mom out of the wheelchair and into the car.  Jesse was right there helping me.

This man has the warmest smile and the kindest heart.  He truly got me through a very stressful morning, and after getting somewhat teary, I walked away with a smile.

What an incredible asset he is to Johns Hopkins!!  You are so lucky to have him as an employee, and I was lucky to have him as my Angel on Tuesday.  He is truly a SHINING STAR!!

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Dr. Paul Ladenson (Endocrinology, Radiology)

"He did not rush through the biospsy procedure. He was caring and cordial, warm bedside manner, he explained to me exactly what to expect. I felt confident and relaxed throughout the procedure."

Jenny Perry (CVISCU Nurse) and Sarah (CVSICU Tech)

"They were so great keeping my husband calm and communicated so he knew what was going on. It is hard to put into words how professional they both were and very compassionate to me."

Meghan Hill (Oncology Nurse)

"Each time we have had her she is attentive, efficient and through her body language we can tell she cares about our daughter. Megan anticipates our daughter’s needs, confirms with her, and then proceeds to see that she gets what she needs. Not only is she kind and compassionate, but her level of expertise excels far above the norm."

Jennifer (CCU Nurse)

"My husband is high maintenance, but Jennifer has remained extraordinarily kind, patient and encouraging. She has gone the extra mile to ensure his comfort by offering to reposition him rather than just offer pain meds. She also has helped to try to maintain his muscle tone  by using the lift to get him in a chair despite many tubes she had to manage. Perhaps less obvious to all is the quality of healing for patient and family members that her kind spirit provides."

Rose (Weinberg 4C Nurse)

"Rose showed tremendous maturity, knowledge, care and compassion toward me. She included my sisters, making them feel an integral part of the healing process."

Weinberg 4C (Krisha Patel, Nick Sacco, and Angela Reed)

"They all treated us as a family member and will be forever grateful."


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Grant and Lakadawala

Service Star winners

How do you use Johns Hopkins Medicine's core values (be the best, be kind, be open, be a role model) to make a difference for our patients? Click on the Leave a Comment box below to inspire us with your story about care that was compassionate, innovative and respectful.

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Transitional Care Services at The Johns Hopkins Hospital

Ms. U was referred to me for transitional care services from the Emergency Department in October 2015. She had presented to the ED after her blood pressure had become dangerously high. The patient confessed that she had run out of her medications one month prior to her visit. Her uncontrolled diabetes led to severe diabetic retinopathy and her vision was significantly impaired. She was evaluated by ED case manager Amy Cammer, who identified many barriers for the patient:

1) She can’t see any of the writing on her pill bottles

2) She has limited knowledge about her medications and only had a fifth-grade reading level

3) She was living alone in a rented room with no family in the state

4) She has no supplies for her glucometer

5) She receives a fixed income (SSDI) and is having difficulty paying for transportation to any of her outpatient appointments

6) She only speaks Spanish. Her medications were filled during her ED visit, a one week pill box was filled, and a referral for Transition Guide (TG) services was placed. It was unclear as to whether or not the patient had a primary care doctor so an After Care Clinic appointment was arranged for the following week.

I met Ms. U in her home for her initial home visit. I am bilingual and was able to communicate directly with the patient. The patient reported that she received primary care at a clinic outside of the Johns Hopkins System. I inquired about her social support system and she reported that her closest relative was her daughter, with whom she had resided with for a period of time, but who lives in out of state. She stated she wanted to have all of her care at Johns Hopkins.

I informed her that she lived within the ElderCare Plus eligible zip codes and would likely qualify for the services of a Medical Day program to assist with transportation, medication administration, and social support. I initiated the referral for two medical day programs that service her area, spoke directly with her primary care provider to obtain referrals for ophthalmology, diabetic testing supplies and an appointment with a mental health provider. I sent a referral to JCHIP because the patient lived within one of the seven eligible zip codes.

She began attending her outpatient appointments and was accepted into the JCHIP program rather quickly. Before attending her first primary care appointment, she was admitted at Johns Hopkins Bayview Medical Center for a condition due resulting from medication non-compliance. After discharge and due to the acuity of the patient’s conditions, skilled home nursing was ordered.

The providers she saw in clinic, Erin Perry, M.D., and Rahul Loungani, M.D., provided detailed emails to everyone involved in her care to provide updates to her plan of care after visits were completed and next steps. Erika Dixon, home care nurse, set up remote-patient monitoring to closely monitor symptoms related to heart failure. Melissa Lantz-Garnish, disease management nurse, monitored to patient’s daily weight, blood pressure and heart rate to assess for acute symptoms that needed immediate medical attention. A pharmacist in the JHOC internal medicine clinic met with the patient regularly to record blood pressures in clinic, provide medication teaching, and fill the patient’s pill boxes based on her most current medication changes. Pharmacist Tara Feller, PharmD, even dropped off the patient’s medications and filled her pill boxes on Christmas Eve, to ensure the patient would have her medications. A Spanish-speaking glucometer, as well as the needed supplies, were also ordered and obtained at a local pharmacy.

Despite our numerous interventions, the patient was admitted for heart failure.After discharge, she was seen in the Heart Failure Bridge Clinic by Johana Almansa, CRNP, where she could receive close cardiology follow-up with a provider that happened to speak her native language.

Her Johns Hopkins Outpatient Center providers gave her the medical records she would need to transfer care and provided a list of those in the area she would be moving to. The patient’s daughter came to pick up the patient, packed up her belongings, and helped her move in with her. I contacted her daughter and provided her detailed instructions about the patient’s current plan of care and how to apply for medical assistance in her state. To date, the patient has obtained medical assistance in her state, established primary care, and is living with her daughter where she received the love and support that she needs.

Each of her providers focused on providing patient-centered care that tailors care to the individual’s unique needs. This type of care provides optimal patient results and despite the complexity of this case, none of this could have been accomplished without the solid and outstanding care-coordination that each of her providers persisted in.

Margaret Elizabeth Arias, M.S., BSN, RN

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I live in Bel Air and have had to take my 86-year-old mother-in-law to the Wilmer Eye Institute twice in the past week. Last week was our first visit. It was a little confusing finding our way around the first time like any big building would be. From our initial stop to check in, to our two appointments at Wilmer, to our visit to both the Outpatient Clinic for blood work as well as the Imaging Clinic for an x-ray, every single Hopkins employee we interacted with could not have been more professional, helpful, and friendly.

My mother-in-law was apprehensive about going "all the way" down to Baltimore, but the way the staff dealt with her disarmed her immediately and made her feel comfortable and relaxed the entire time. I've been to hospitals around the country for a wide variety of reasons. Simply put, none of them comes close to our experience at Johns Hopkins. None. I even witnessed patients helping other patients. In a hospital!

When we were a little lost -- okay, fine, we were a lot lost -- people with Johns Hopkins badges went out of their way to help us find our way. My only regret is not getting the names of everyone who helped us. I've been to high end hotels who don't treat you like we were treated there. So please pass this along to whoever is in charge and include my sincere thanks for everything. As long as I'm in Maryland, I'll never go anywhere else!

Patient, The Johns Hopkins Hospital

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Dear Health Care Team Members:

I am a very happy and pleased Johns Hopkins patient. In January 2011, I was referred to Johns Hopkins for treatment of my lung disease. The only cure for my disease was a bilateral lung transplant, which took place on December 18, 2011. While I have had excellent success with my transplant, I have had the opportunity to return to the hospital (six admissions and nine outpatient procedures requiring anesthesia) and outpatient center (over 100 office visits and over 700 tests or studies) for subsequent medical care.  I realize I will continue to be a Johns Hopkins patient for the rest of my life.

Recently, I had the opportunity to be the patient member on the panel at the Town Meeting on September 8, 2015 discussing Patient and Family Centered Care (Also read the Patient Wish List blog of 10 things a patient would like to share with his or her care team.) One of the questions dealt with the patient survey, which patients receive and answer about their patient experience. As I mentioned in my remarks, one of the key factors that affects my patient experience is my health care team. While I was able to make a few remarks about my team members, I would like to take this opportunity to provide you with a little more information about my health care team. It is a very dynamic health care team composed of many members of Johns Hopkins Hospital and Outpatient Center staff.  I have divided my health care team into two groups: The face to face group and the behind the scene group.

The face to face group is composed of the following team members:

My Admitting Team

  1. The security guard who clears me for entering the hospital and, with colleagues, keeps me, my family and my health care team safe 24/7.
  2. The admitting clerk who process my paperwork to make sure I do not have to spend time with my insurance company or others doing paperwork.

My Patient Room Team

  1. All the physicians including fellows, residents and interns who are responsible for my medical care.
  2. All of my nurses who provide my nursing care and the nurse manager for the unit.
  3. The medical technicians who assist my nurses in my medical care.
  4. The environmental care associates and environmental care technicians who clean my room.
  5. The nutrition assistants who deliver my meals.
  6. The phlebotomists who draw my blood.
  7. The imaging technologists who take x-rays in my room.
  8. The case manager who is planning my discharge.
  9. The transportation specialists who transport me from my room to my procedures/diagnostic tests on time and to the right place.
  10. Administrative staff assigned to my nursing unit.
  11. Anybody else that walks in my room.

My Procedures/Diagnostic Test Team

  1. The receptionist who greets me and makes sure the paperwork matches why I am there.
  2. The physicians who provide my procedure/diagnostic tests.
  3. The radiologist and pathologist who review my results or pathology and interpret the results.
  4. The nurses involved in my procedure/diagnostic test and who try to keep me comfortable throughout.
  5. The technicians involved in my procedure/diagnostic test who are either performing the diagnostic test or making sure the equipment and instruments are ready.

My Telephone Team

  1. The dietary technicians who take my telephone meal order and assure I am ordering the right foods for me.
  2. The administrative staff I contact with all sorts of questions. They know just where to connect me for answers.

My Outpatient Center Team

  1. The physician, nurse practitioner or physician assistant who will be evaluating and taking care of me.
  2. The nurses who will be assisting the provider with their assessments and care.
  3. The medical technicians who is taking my vital signs.
  4. The front desk clerks who process my appointment paperwork.
  5. The discharge clerks who process my discharge and schedule my follow up appointments.
  6. The radiology administrative assistants who match my paperwork for the test.
  7. The radiology technicians who perform my test.
  8. The radiologist who reviews my test and writes a report.
  9. The lab admitting clerks who process my lab order.
  10. The phlebotomists who draw my blood.
  11. The lab technicians who perform the lab study and enter the data in my medial record.
  12. The pathologists who review my laboratory/pathology studies and interpret the results.
  13. The security guards who check me in when I enter the outpatient center and give me directions to my appointment or help guide me if I am lost.
  14. The parking cashiers who process my parking ticket and wish me a good day.

As you can see, this is a large and dynamic health care team, but that is only the face to face group. Let me discuss my behind the scene group. They are throughout the organization.

  1. The food preparers who will be preparing the food to be cooked for me.
  2. The cooks who will be cooking my food.
  3. The servers on the food line who will be preparing my tray.
  4. All the food supervisors who are responsible for my food service team.
  5. The pharmacists who review my medications to prevent negative interactions and side effects.
  6. The pharmacy technicians who prepare my medications for delivery to the floor.
  7. All the pharmacy supervisors who are responsible for my pharmacy team members.
  8. The lab technicians who conduct all my lab analysis and report the findings into my record.
  9. All the lab supervisors who are responsible for my lab team.
  10. The security staff throughout the campus who insure my safety and the safety of my family and those who work here.
  11. The administrative staff throughout the hospital and outpatient center who process my appointments, file my claims, record my payments or any other administrative action I require.
  12. The information technology team who keep all the information technology working together to assure all the data about me connects to those who need it including me (MyChart).
  13. All the supervisors and their supervisors of my health care team members.

When I, a patient, think about my health care experience as I fill out my survey form, all the actions by each member of my health care team members are carefully considered as I evaluate my patient experience. Some of you may not have considered yourself as part of my team, but to me you clearly are team members. Each of you plays a role in my patient experience regardless which group you are in. Naturally, my face to face team members get more of my direct attention, but I have not forgotten about the behind the scene team members and the role you play. Being one of my health care team members is not easy. You have to make sure that everything that I am experiencing works like a finely turned, well organized, coordinated, happy and respectful health care team.

Although, I will never have the opportunity to meet some of you, especially my behind the scene team members; I want you to know I value what you do for me as a member of my health care team. I want to thank each of you for providing me with a great patient experience. You have given me a very special gift – the gift of life – and I sincerely thank all my health care team members for their individual contribution.

Warmest personal regards,

Podge M. Reed, Jr.

Proud Johns Hopkins Patient

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