Laura Winner is the Director of Lean Sigma Deployment for the Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine. She has overseen the introduction, launch and evolution of the Lean Sigma Program including training and project mentoring of over 1100 healthcare professionals since 2004. Laura is herself a Lean Sigma Master Black Belt and serves as course director for the Lean Sigma Prescription for Healthcare® courses through the Armstrong Institute for Patient Safety and Quality. She completed Six Sigma Green Belt training with General Electric and Black Belt training and certification through Motorola. Laura has led Johns Hopkins Lean Sigma collaboration on several projects with the Joint Commission Center for Transforming Healthcare including Hand-off Communication, Hand Hygiene and Preventing Avoidable Heart Failure Hospitalizations.
Laura holds a Bachelor of Science in Nursing from The Johns Hopkins University, an MBA from the Business of Medicine program at The Johns Hopkins University School of Professional Studies and has a joint appointment with the Johns Hopkins University School of Nursing. She has over ten years of clinical nursing experience at The Johns Hopkins Hospital in Emergency Nursing and Cardiology.
My second orthopedic surgeon began each day’s medical record with the phrase “Patient Kerry O’Connell is a very personable 48-year-old male with a very complicated arm.” I grew pretty fond of that brief summary of my life. My complications started when I fell off a ladder painting my house and dislocated my left elbow. The dislocation included a fractured radial head and a displaced coronoid process. Years later I would learn that surgeons call this injury “the terrible triad of the elbow” or in orthopedic slang just “triad.” The ominous name comes from some very poor rates of successful outcomes.
My first surgery was a medical disaster. The surgeon elected to use an off-label configuration of an external elbow fixator to save 30 minutes on a late Friday afternoon. The configuration placed his drill directly over my radial nerve. He then decided to use small ½-inch long incisions, which didn’t allow him to see the nerve. The assistant holding the soft tissue guide didn’t keep it tight to the bone; my nerve slid under the guide and wrapped around the spinning drill bit, grinding about four inches of the nerve into mush. One third of the muscles in my left arm became permanently paralyzed. My doctor couldn’t muster the courage to tell me what had happened. We tinkered with electrical stimulation and physical therapy for four months to no avail. Eventually I consulted four other doctors who all told me I needed a nerve graft.
I found a new doctor who transplanted the sural nerve from my left leg into my left arm. Unfortunately long nerve grafts like mine seldom work. Months later we decided to clean the scar tissue out of my elbow to restore supination and pronation. We had a very aggressive post-surgery therapy plan that involved placing my arm in a continuous passive motion machine that would bend my arm back and forth 24 hours a day for a week. The surgery seemed to go well. The range of motion was great. I noticed that a surgical drain tube that came out my arm just above the elbow was only secured with a piece of gauze. It slid in and out of my bending arm for three days, then fell out. This seemingly minor detail led to a deep Staph epidermidis infection which took four debridement surgeries and two months of Vancomycin to kill off. A month after the infection was gone I rolled back into the OR for last-chance tendon transfer surgery which thankfully worked pretty well.
Looking back over my two-year ordeal I am struck by the profound contrasts I found within the medical profession. I was privileged to meet dozens of competent, kind, and compassionate people who taught me many wonderful lessons in life. Yet I also experienced a handful of the most brutal individuals I have ever known, who caused emotional wounds so deep that they may never fully heal. I told this sad tale to the chief medical officer of a local hospital who replied that he had never met another person who had experienced all of healthcare’s major problems in such a short time. I believe that God gave me this very complicated arm for a reason. It has taken a few years to figure that reason out but I now spend a great deal of my time promoting infection control, helping wounded patients, and promoting compassion and empathy within the healthcare Industry. Along the way I have been privileged to meet dozens of fellow wounded patient advocates who are making a profound difference in this world. The bottom line is, perhaps non-fatal medical errors can have the unintended side effect of extreme personal growth.
M. Narendra Kini, M.D., MHA is President and CEO of Miami Children’s Hospital. He is committed to expanding the hospital’s network to bring Miami Children’s Hospital (MCH)-quality pediatric care to children and families throughout the region. Dr. Kini, who is a board-certified pediatrician, is also committed to improving the health status of children. Before joining Miami Children’s, Dr. Kini served as Executive Vice President for Clinical and Physician Services at Trinity Health, the fourth largest Catholic health system in the United States. He was responsible for physician issues, clinical informatics, patient safety, comprehensive tertiary care and pharmacy operations for the $5.7 billion health system.
Prior to Trinity Health, Dr. Kini held various positions related to information technology at GE Medical Systems, the latest as Director of the GE Healthcare Leadership Institute. He previously served as Ancillary and Support Vice President at the Children’s Health System in Milwaukee.
Michael Fosina is the Senior Vice President and Chief Operating Officer of NewYork-Presbyterian/Lower Manhattan Hospital, one of six campuses of NewYork-Presbyterian Hospital (NYP). A member of the senior management team, Mr. Fosina was responsible for the successful merger between the former New York Downtown Hospital and NewYork-Presbyterian Hospital in 2013, including the development and implementation of the overall strategic, financial and operational plans of the campus.
Mr. Fosina has spent over twenty years at NYP. Prior to his current position, he was the Vice President and Executive Director of NYP/The Allen Hospital. In his thirteen years in this position, he has helped make The Allen Hospital a premier community teaching hospital and trusted health care provider for the communities of Upper Manhattan, the Bronx and beyond. Mr. Fosina was instrumental in integrating NYP/Allen with NYP/Columbia University Medical Center to improve quality, access and care transitions. In addition, he played a significant role in the development of both the Division of Geriatric Medicine and Aging and the Division of Podiatry at NYP/Columbia University Medical Center. He focused a significant amount of his time working with the local nursing homes on transition-of-care issues, which resulted in increased quality of transitions and reductions in readmissions. In a previous role, he helped facilitate one of the largest hospital mergers in the country between The New York Hospital-Cornell Medical Center and the Columbia-Presbyterian Medical Center. Through his efforts, the hospital achieved success through its first JCAHO survey as a newly merged entity.
Mr. Fosina received his BS from the University of Delaware and his graduate degree from Columbia University School of Public Health. He is a Fellow in the American College of Healthcare Executives (ACHE) and is board certified in healthcare management. In 2011-2012 he was a Congressional Fellow and an Atlantic Philanthropy Health and Aging Policy Fellow. During his fellowship he worked as an advisor to the Centers for Medicare and Medicaid Services, focusing on improving the services to senior citizens, which included the transitions of care from the hospital to a nursing home.
Mr. Fosina has spoken in national broadcasts on transitions of care between hospitals and post-acute facilities and on designing environment of care programs for hospitals. In addition, he has lectured on patient safety initiatives and other healthcare issues both regionally and nationally. Mr. Fosina is active on the boards of numerous community organizations, nursing homes and senior centers. He has received several awards for both his professional accomplishments and for his community work. He was honored by the American College of Healthcare Executives (ACHE) as the Senior Healthcare Level Regent Award winner for his contributions to the Advancement of Health Care Management Excellence. Mr. Fosina was elected to the ACHE Council of Regents, representing over 2,000 healthcare administrators in metropolitan New York to the College Board of Governors. Most recently he was inducted as a Fellow into the New York Academy of Medicine.