VOLUME 18 NO. 7 n inside.dukemedicine.
org n July 2009
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
Putting the patient first:
ED sets the standard for service excellence
O n 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
IN Q UIR Y
Easing gout pain
Duke researcher Michael
Hershfield helps develop new
treatment for gout.
Page 8
A busy place
On average, the DUH Emergency
Department cares for 190 to 220
patients a day, and up to 260
patients at peak periods.
service has led to significant increases
in the level of patient satisfaction.
“Your hard work and dedication to
quality improvement is evident in the
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
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
DUH veteran
Sowers
named CEO
Appointment continues
24-year career at DUH
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
see SOWERS, p.3
customer service
Red coats, Blue Zones
John Robinette recounts a short
history of customer service
efforts at DUH.
Page 7
2 Inside Duke Medicine July 2009

on the cover

emergency, continued Within 48 hours, attending physi-

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
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.
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 so that the patient can listen and
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.
“Whatever we can do to improve
(a patient’s) experience while they
are here is worth it.“
­ — Casey Baughman, RN
The staff report that Nurse First nurse, physician team leaders and
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,
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
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.
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

■ ■ I N S I D E V olume 1 8 , I s s ue 7
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
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Staff
Editor: Anton Zuiker
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Inside Online Editors:
Bill Stagg and Erin Pratt
Copyright © 2009
Duke University Health System
July 2009 Inside Duke Medicine 3

COMMUNIT Y on the cover

sowers, continued
Victor 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,

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
DUH, Duke AHEC offer internships
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 Q&A: On leadership
executive officer of Durham Regional Hospital.
Considering organizational
"It's an honor to be selected as the CEO of a improvement, what do you see
world-class hospital with such highly skilled and in the future?
dedicated faculty and staff," Sowers said. "I'm
committed to furthering the hospital's mission of There has to be a strong alignment

to future health care providers providing excellence in patient care through the
clinical translation of innovative research, while
among the entities: the School of
Medicine, the School of Nursing, the

D uke 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
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.
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.
4 Inside Duke Medicine
W OR K IN G @ D U K E
Duke Raleigh again
named a nursing leader
The 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.
July 2009
Larger obstetrics clinic, in new location,
focuses on customer service
A manda 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 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
with high-risk pregnancies, Duke
Perinatal Durham Clinic and Fetal during pregnancy. Their complications William S. Meyer, MSW, and Marla
Diagnostic Center is now offering either pre-date their pregnancies – such Wald, M.D., see patients with postpar-
patients added conveniences at a new as diabetes, high blood pressure, heart tum depression.
and larger location. The clinic moved disease, kidney problems and other “It’s nice that we can combine some
from its old location in Duke Clinic in medical related complications – or of the care for these patients during
March to Pavilion East at Lakeview, at can occur during pregnancy, such as the course of their pregnancy at one
the corner of Erwin Road and Downing gestational diabetes or complications location,” Swamy said.
Street, and now sees some 2,400 patient related to the fetus. In an effort to bring even more
visits each month. Inside, patient flow through the convenience to patients, the clinic is
clinic is much now the first OB clinic in the state to
“Since we are a clinic for high-risk patients, better. That's participate in the Vaccine for Children
because the program, which offers free vaccines to
having parking available right outside the
new location patients up to the age of 19. The clinic
door is a big plus. Patients love it.“ dedicates also has the North Carolina registry live
— Kim Adcock, RN 20,115 square and running on site to assure accuracy
feet to clinical in providing the vaccinations.
“Our focus is to make sure that services with an on-site lab, nine exam “In addition to this new program,
we are providing not adequate, but rooms, two procedures rooms, six we also stock and offer other vaccines
excellent patient care,” said Geeta consultation rooms and nine ultrasound to our patients, such as vaccines for
K. Swamy, M.D., medical director of rooms. The additional space allows a pneumonia, hepatitis A and B, menin-
Duke Perinatal in Durham. “Patients team of providers – 19 physicians, nine gitis, and the flu,” Adcock said. “Last
are always grateful for good care, but midwives, three genetic counselors and year, we gave about 600 flu vaccines to
they also are focused on good customer eight sonographers – to care for all of our patients.”
service, too.” the patients’ needs in one location. Patient satisfaction surveys show
The new clinic creates a patient- The new clinic features a larger that patients are pleased with all the
friendly environment conducive for waiting room with a kid’s area, a quiet new clinic has to offer, and Adcock has
providing excellent care, she said. That space and more comfortable seating. received positive comments about the
service begins even before patients walk The new space also includes separate front desk check-in being a pleasant
in the door by offering free, on-site physician and nursing workrooms, as experience.
parking. well as designated areas for social work, Added benefits, said Swamy, are the
“One of the biggest conveniences WIC/nutrition and genetic counseling. restaurants and food vendors elsewhere
for our patients is free parking,” said With more space, the team of in the building, since family members
Kim Adcock, RN, nursing program providers at the clinic is able to offer who accompany the women to their
manager of Duke Perinatal in Durham. new services to patients and their appointments appreciate the dining
“Since we are a clinic for high-risk families. options.
patients, having parking available right On June 1, the team began to offer The clinic staff, too, is enjoying the
outside the door is a big plus. Patients a psychiatry clinic within the obstetrics new space.
love it.” clinic, said Krista Wilson, RN, health “It makes it a nicer day just to come
That team takes care of women, center administrator of Duke Perinatal. to work and want to come into your
a large number of whom are Duke One afternoon a week psychiatry office and the space that you work in,”
employees, who have complications residents, under the supervision of Swamy said. n
July 2009 Inside Duke Medicine 5

e d u c at i o n

Surgery department explores new ways to learn

T he 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
In the Surgical Education and Activities Laboratory, Duke surgical residents practice their skills on simulators. The lab is one of the
differences in how residents learn have Departmet of Surgery efforts to train residents and fellows with new learning tools and techniques. Photo by jared lazarus
all increased the need to broaden the
ways in which surgery is taught. incisions can, like Olympic ski jumpers just finishing their two years of research pleted Hospital Addition for Surgery,
Duke Surgery is doing just that with visualizing their slide down the ramp, to spend a whole day interacting with Jacobs makes a reference to the books
a variety of educational initiatives. improve their performance. nine local actors — and one SimMan on his desk and bookshelves.
In this study, Sudan will teach programmable mannequin. “If you look at my shelf, there must
Practice makes perfect
guided imagery techniques to surgical Surgical resident Loretta be 10 major textbooks all dealing with
Surgery residents by nature like to
residents and track if and how the Erhunmwunsee, M.D., spent the overlapping subject areas. How does a
do things, rather than read about or
residents learn surgical skills faster. last two years in the lab on research learner go through that?” he said.
discuss them, said Ranjan Sudan, M.D.,
His research will be funded through into the genomics of lung cancer and With so many sources of
vice chair of education. “That’s where
the Chancellor’s Graduate Medical was preparing to return to surgical information, he said, it’s natural that
the Surgical Education and Activities
Education Innovation Fund. duties this month. She jumped at the surgeons and residents are experiencing
Laboratory comes in.”
opportunity to get practice at caring information overload, and much
In the SEAL, surgeons, fellows, resi- Actors and patients for patients and confronting different more challenging for the educator to
dents and medical students use surgical Another Innovation Fund grant to the medical issues. ascertain what needs to be learned. It’s
simulators to practice their techniques, Department of Surgery just wrapped In her first standardized patient also more challenging for the learner to
like airplane pilots honing their skills in up last month. It, too, has implica- scenario, she was presented with a wade through all these books.
a flight simulator. The Duke SEAL has tions for preparing residents to be 50-year-old man with blood in his Sapan Desai, M.D., Ph.D., another
received the highest accreditation rating better surgeons, said Marnelle Alexis, stool, and had to diagnose his colon surgical resident, is trying to remedy
from the American College of Surgeons, Ed.D., director of the Comprehensive cancer. “I understand you are a that. He’s edited a textbook that will
and it’s just what Duke’s surgeons need Education Institute (CEI) in the resident, and I’m wondering why we’re better prepare residents for the ABSITE
to “see five hundred, do one, teach Department of Surgery. not talking to the surgeon,” the actor- exam by distilling the most relevant
one” — another way to say “practice, Alexis coordinated the standard- patient confronted Dr. Erhunmwunsee, materials. He’s also collaborating with
practice, practice.” ized patient training program pilot, an who calmly assured him that the Jacobs and other department leaders
“We get to ask ‘What’s the safest attempt to capture the level of readi- attending surgeon would check in. to develop a new tool that could
environment in which to perform that ness in surgical residents. Nationally, Immediately after the playacting, transform surgical education materials.
operation?’ as well as ‘What’s the safest residents are tested by the American Erhunmwunsee faced Alexis, Pryor Their grand dream is to cre-
environment in which to introduce new Board of Surgery on their knowledge, and the other participants for their ate a collection of tools — texts,
technologies?’,” said Jacobs, explaining she said. But Duke Surgery is interested constructive criticism for how she’d photographic images and three-
that those dual questions are part of the in measuring the ability of residents performed. dimensional illustrations, videos and
duty of an academic medical center. to comprehensively work up a disease “It reminded me that we’re all social networking — that will become
In that vein, Sudan will soon un- process based on dynamic, real-time in this together, to get practice and the standard resource for learning to be
dertake a study of how guided imagery interactions with patients. feedback, and to always be learning,” a surgeon in the modern world.
might help surgeons prepare for and So, Alexis collaborated with Aurora she said. “The goal is to make surgical
improve their surgical performance. Pryor, M.D. medical director of the education more efficient, more effec-
He’s interested in learning if surgeons CEI, to create five in-depth patient care Bettering the books tive, more accessible for all learners,”
who mentally practice before making scenarios. They invited seven residents In his office inside the recently com- said Jacobs n
6 Inside Duke Medicine July 2009

AT A G L ANCE
■ ■ r eco g ni t ion

Covington named Social

“ ”
Worker of the Year
I tell everybody I know that you guys are the best in the world, With only the faintest sense of hyperbole, his
says a patient about her recent visit to the DUH Emergency Department. Want to give colleagues say the recent history of Duke
Children’s Primary Care can be divided into two
kudos to a Health System employee? Visit http://inside.dukemedicine.org/ and look
periods – now, and the time before social
for the High Fives section. 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
■■INSIDE JOKE ■■it figures
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
As of June 25, there were and helpful that it’s hard to remember how
clinicians, and families,
managed in the days

179 ‘before David.’ ”

Covington was recently

honored by his col-
known and suspected cases of H1N1 in North leagues in Duke
Carolina. Cases of influenza-like illness and University Hospital’s
H1N1 flu are affecting Duke summer camps, DAVID COVINGTON Department of Clinical
Social Work with the
Duke Medicine employees and other local
2009 Brandy McDaniel Award for Outstanding
individuals. A June 30 message from Chancellor Social Worker of the Year.
Victor J. Dzau reminded employees of the
The North Carolina native has been at the clinic
importance of good hand hygiene as one way to for four years and with Duke Medicine for nine.
protect yourself and the community. Covington is a licensed clinical social worker
who holds a master’s degree in social work
Source: Centers for Disease Control and Prevention
from the University of North Carolina.

But more than academic and professional

■ ■ t h e b i g pic t u r e
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-
Nurse manager Sharon Zimmerman (left) and RNs Christie Preddy (center) and Mary Ellen Hill admire one of ing dedication to the children and families, but
several new sculptures now beautifying the garden area outside the main entrance to Lenox Baker Children’s also to helping the physicians, residents, and
Hospital. In their effort to spruce up the garden, Lenox Baker employees decided to reach out to students at other clinicians in the practice as they tackle
the Durham School of the Arts. Several DSA classes worked for months to create and install two large sculp- challenging situations,” said Patricia Cheng,
tures, plus several small ones. Photo by Bill Stagg Ph.D. “It has truly been an honor to work with
and learn from David every day.”
July 2009
■ ■ b ene f i t s
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/
■ ■ a t h le t ic s
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
■ ■ livin g
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.’
Inside Duke Medicine
Customer service:
everyone’s responsibility
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
J
ohn 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
7
■ ■ pa r k in g
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
For gout patients, renewed hope
O n 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
This month: Inside Online
The daily DUHS news site gets a
makeover this month. Watch for it
at http://inside.dukemedicine.org
July 2009
The Science & Research Supplement to Inside Duke Medicine
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
Research by rheumatologist Michael Hershfield has led to a promising new drug to
treat the worst cases of gout. Photo by michelle gailiun
was so bad that he spent most of his
time in bed. He couldn’t take care
excrete. In 1998 the clinical-develop- in the product. of himself, feed himself, do much of
ment rights to the drug were licensed Several patients felt so strongly anything, he told the panel.
to Savient Pharmaceuticals. In 2001 about their improvement during the “After they told their stories,
the FDA designated it as an orphan phase III trial that they traveled to there wasn’t a dry eye in the house,”
drug —
­ a pharmaceutical developed Washington, to testify at the June Hershfield said. “I had a feeling at
16 meeting. that point how things would go.”
Pegloticase, to be The panel recommended
“Before this drug, some patients were in called Krystexxa approval by 14-1. It did have
wheelchairs... And they actually walked if it wins FDA reservations about safety and
approval, was recommended long-term follow-up
into this meeting and stood at the on the line. studies, but Hershfield is optimistic
microphone to say how much this drug Hershfield sat the drug will become available for
in a “bullpen” the patients who need it.
had improved their lives.“ awaiting Hershfield said a final FDA rul-
potential panel ing is expected in about six weeks.
to treat a disease that afflicts rela- questions about his laboratory’s “There are not many physicians
tively few people — for patients with research. who can point to one — let alone
chronic, refractory gout. Would the benefit to patients two — discoveries they have made
The first clinical trials began at demonstrated in the trial outweigh that have dramatically changes
Duke in 2001 under the direction of uncertainty about risk? “That’s patients’ lives,” Sundy said. “Duke
John Sundy, M.D., Ph.D., a rheuma- often the bottom-line question with is very fortunate to have someone
tologist with no financial investment new drugs, and Pegloticase was in a like Mike Hershfield.” n
Online any time Next issue
You can download a pdf of this issue, The next print edition will appear
suitable for emailing or printing, at later this month. The deadline for
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