Workshop on Agricultural Air Quality WATER9 – An Air Emission Model for Animal Feeding Operations – Software for Both Field Agents and Comprehensive Scientific Research M.E. Deerhake1, C.C. Allen2, and S. Nizich3 1RTI International, Research Triangle Park, NC 2RT Allen, Durham, NC 3U.S. Environmental Protection Agency, Research Triangle Park, NC
precision counts. Proton therapy, the most powerful combination of high-energy physics and radiation technology, is propelling cancer treatment into the 21st century and beyond. As a health care leader and innovator, Scripps is committed to transforming medicine, improving health care, and saving patients' lives. In the field of cancer treatment, nothing is as precise as the proton beam. The beam is so precise that it is measured at approximately one millimeter – smaller than the size of the head of a pin.
This life-enhancing therapy, used to treat cancerous tumors, is one of the key technological advances in our lifetime. In a unique partnership, Scripps is bringing it to San Diego for the benefit of cancer patients throughout the Southwestern United States. Construction is now under way on Scripps Proton Therapy Center, which will be the second proton therapy center in California and the West. Chris Van Gorder
Construction is under way on Scripps Proton Therapy Center, which is fully funded by Advanced Particle Therapy (APT), LLC. Set to open in 2013, the collaboration among APT, Scripps Health and Scripps Clinic Medical Group will create a 120,000-square-foot center with five treatment rooms that will serve approximately 2,400 patients each year. At Scripps, we continue to look for ways to advance medicine, from innovative therapies that shorten recovery time to new ways to prevent chronic disease or detect it at the earliest stages. As health care undergoes rapid changes, we keep one goal at the forefront – to offer high-quality care to our patients. Our commitment is clear and our quality has never been better. In 2010, we were named one of the country's Top 10 Health Systems by Thomson Reuters, the only California health care provider to make that list.
While other health care organizations are bracing to As a nonprofit health care system, these changes In this report, you will see examples of how Scripps deal with the financial effects of health care reform, will ensure we remain financially strong so that we physicians, nurses and other health care professionals Scripps is leading the way. Across our five hospital continue to meet the health care needs of our patients make a profound difference in the lives of our campuses and 23 outpatient centers throughout and their families now – and for generations to come. patients through innovation, education, research and San Diego, we have initiated a comprehensive It's our promise. collaboration. Our founder, Ellen Browning Scripps, restructuring effort to identify and eliminate once said, "The most important gift one person can unnecessary variations in how we deliver care and That promise is kept daily by more than 13,000 give to another is to make life a little better to live." how we operate our facilities. We are adopting new employees and 2,600 physicians caring for a half- And I am proud to say that Miss Ellen's legacy of care best practices that improve quality and access to care, million patients annually. and compassion has never been stronger than it is while being more efficient in how we provide it. today at Scripps. Always looking forward, we continue to grow to meet We will make these improvements through the work the health care needs of San Diego and beyond – from of our dedicated physicians and employees. We are the expansion projects on each of our campuses, to proud to be one of Fortune magazine's 100 Best Places plans to build Scripps Cardiovascular Institute, which to Work For, and recognize the vital role of our team will be a leading center for the diagnosis, treatment and Chris Van Gorder, FACHE
research of heart disease.
Scripps President and CEO
A New Frontier in Cancer CareWhen a Scripps cancer patient talks, a team of compassionate experts from across the Scripps system listens.
Scripps Cancer Center patients have a network of advanced care at their fingertips – no matter at which Scripps hospital or clinic they are treated, or which physician they see. As the first multi-hospital cancer program in California to receive the prestigious Network Cancer Program Accreditation from the American College of Surgeons Commission on Cancer, Scripps Cancer Center provides patients with access to cancer care resources across the Scripps system. Leadership of the cancer center is based on a co-management model, with physicians working in collaboration with hospital leadership to ensure the highest-quality and most cost-effective care.
That translates into the resources of five hospital campuses and more than 300 affiliated physicians in 22 different specialties working collaboratively on the prevention, early detection and coordinated treatment of cancer. Network accreditation also fosters cancer research through clinical trials with new diagnostics and drug therapies for patients. A myriad of leading-edge services are currently available to every cancer patient across the network: • In 1980, Scripps opened San Diego County's first blood and marrow transplant program, and during the past 30 years the program's patient survival rate has doubled. In 2010, the program received the Center of Excellence designation from the California Department of Health Care Services.
• Scripps Polster Breast Care Center, which is nationally accredited by the American College of Surgeons, offers personalized, compassionate breast care in one convenient location. • Scripps minimally invasive robotic surgery program provides unparalleled treatment options and is the fastest growing robotic surgery program in the county. • The most recent development in Scripps' never-ending quest to bring the best and most advanced care to patients is Scripps Proton Therapy Center, currently under construction. Scripps Proton Therapy Center
When Scripps Proton Therapy Center opens its doors in spring 2013 in Mira Mesa, cancer patients will have access to one of the most advanced technologies and treatments of the 21st century – the proton beam. As part of a unique partnership that is funded by Advanced Particle Therapy, the 102-square-foot facility is the first proton therapy center in San Diego County and only the second in the Western United States. The centerpiece is the superconducting 90-ton cyclotron with magnets and electric fields that can accelerate protons to super speed, about 100,000 miles per second. It sends the protons through computer-guided piping into five treatment rooms to destroy cancer malignancies up to 14 inches deep. While a patient lies comfortably on a bed, a beam of protons targets the tumor with control and precision unavailable through other radiation treatments. Protons destroy tumors just as X-rays do, but they are far more precise because they can release most of their radiation directly onto the tumor and nowhere else, sparing healthy tissue. Since proton beam therapy is an outpatient service, patients will find the treatment convenient and efficient. The patient is able to walk out and return home after completing treatment that day. The proton center's cyclotron will weigh 90 tons, or about the same as 11 African elephants. As protons The most precise form of delivering radiation therapy, a proton beam is magnetically swept are accelerated to the speed of light in a three-story gantry, specialists position the device's particle beam across a tumor, layer by layer, depositing the radiation dose like a painter's brush strokes. to enter patients from any angle. "Scripps is committed to consistently providing the highest quality of cancer care across our network of hospitals, clinics and affiliated physicians' offices. Our patients have peace of mind knowing they'll receive the very best cancer care close to home, while having access to the latest specialized technologies, clinical trials and services as needed at other Scripps locations." – William Stanton, MD Chair, Scripps Cancer Center Network Program Scripps Radiation Therapy Center
Beacon of LightAnother tool in Scripps' arsenal against cancer is a new state-of-the-art radiation oncology center, which will open in 2012. Scripps Radiation Therapy Center will feature one of the most advanced technologies of its kind in the world for treating cancer.
In May 2011, Scripps celebrated the groundbreaking of the $44 million treatment center. Located on the Torrey Pines Mesa, the 41,000-square-foot facility will consolidate all of the existing radiation oncology programs at Scripps Green Hospital and Scripps Memorial Hospital La Jolla under one roof, making it more convenient for patients to receive care. All cancer center patients and Scripps-affiliated physicians will be able to use the services at the two-story center. In the vanguard of radiation treatment, Scripps Radiation Therapy Center will feature three powerful and precise linear accelerators that deliver beams of radioactive particles. Carefully calculated doses of high-energy radiation speed along a straight line, damaging or killing cancer cells with pinpoint accuracy. In May 2011, physicians throughout the Scripps system helped break ground on the new Scripps Radiation Therapy Center. As men's basketball coach for San Diego State University, Steve Fisher knows what it takes to win: teamwork. And as a cancer survivor, he knows what it also takes to beat the odds: a stellar team of cancer specialists armed with state-of-the-art technology.
Fisher's life changed the day he was diagnosed with prostate cancer. After diligent research, Fisher discovered the minimally invasive robotic surgery program at Scripps. An alternative to more invasive surgery, robotic surgery using the da Vinci surgical system is performed through minimal incisions and results in less blood loss, less risk of infection, less pain and less scarring. I'm old school," says Fisher with a chuckle. "I was the last on the block to get direct deposit of my paycheck. I had to feel it, take it to the bank and put in the bank myself. But, once you learn about robotic surgery, you see the benefits." Fisher declares his was a "textbook" surgery at Scripps Mercy Hospital. He spent one night in the hospital and then the next day was able to relax and sit out on the patio with his wife, Angie. He says most people never even knew he had the surgery.
" If I had to tell my own son where to go, it would be right here at Scripps. I could have gone anywhere in the world and not have been treated better than I was at Scripps. I feel great." – Steve Fisher, San Diego State Men's Basketball Coach Leading the Way in Heart CareAt the forefront of cardiovascular care, Scripps is consistently honored as a heart care leader for innovative care, expansive scope of services and unparalleled commitment to quality, including being named in 2010-11 as one of America's Best Hospitals for Heart Care and Heart Surgery by U.S. News & World Report.* Scripps offers the latest in detection and treatment of heart disease, including the newest cardiovascular treatments, electrophysiology procedures, valve replacement and cardiac robotic surgery. Through wireless health care, Scripps is transforming medicine in unprecedented ways, through the use of sensors to monitor heart rhythms, blood pressure, vital signs and more. These technologically sophisticated procedures – many of Scripps Cardiothoracic
which are available nowhere else – are frequently performed by physicians Surgeon James Hemp, MD
who have earned international acclaim for cardiac care. In addition, landmark clinical trials and other scientific endeavors translate research results into improved patient care, often bringing results from "bench to bedside" to immediately benefit patients.
More than 55,000 patients receive their heart care from Scripps every year. Scripps is a statewide leader, performing more cardiovascular procedures than any other heart care program in California. Studies show that higher volumes result in better patient outcomes. Simply, those who do more, do it best.
This powerful synergy of quality, expertise and experience has established Scripps as the premier provider of heart care in the region. * See page 37. Technology Meets Expertise with Robotic Cardiothoracic When Murray Galinson, 74, was diagnosed with a leaking mitral heart valve in 2008, he wanted the best possible treatment. An active community supporter who had founded San Diego National Bank and was its president Scripps has the fastest growing robotic cardiothoracic surgery and chief executive, Galinson was not willing to risk the program in San Diego County.
respiratory symptoms and congestive heart failure that could result from his leaky valve, so he turned to Scripps Robot-assisted cardiothoracic surgery provides surgeons and patients with a Murray Galinson highly effective, less invasive treatment alternative for even the most complex cardiothoracic procedures. Rather than making a large incision through the sternum Scripps Clinic cardiothoracic surgeon James Hemp, MD, repaired Galinson's mitral to gain access to the heart, Scripps cardiothoracic surgeons use remotely controlled valve via minimally invasive robotic surgery using the da Vinci robotic surgical instruments to repair damaged mitral valves through a smaller incision at the side of system. After four and a half days in the hospital, Galinson returned home. Within the chest. The surgical instruments are connected to thin, robotic arms; the surgeon three weeks, he was back to his routine of walking to the office, and was soon able controls their movements from a nearby console where a high-definition camera to resume his daily two- to three-mile walks.
provides a magnified, three-dimensional view of the operating field. The robotic movements mimic the real-time movements of the surgeon's hand, down to the "I'd heard of robotic surgery before, but never for cardiac surgery," Galinson says. slightest turn of the wrist.
"I was very pleased that this amazing technology was recommended for my surgery. It got me out of the hospital in a matter of days, rather than weeks." Among the potential benefits of robot-assisted cardiothoracic surgery are smaller incisions, a reduced risk of infection, shorter hospital stays, less pain and scarring, Galinson has since retired from the bank, but he is as active as ever. He serves on faster recovery and a quicker return to normal activities.
the board of directors for The Weingart Foundation, is vice chair of the board at The Leichtag Foundation, and is a board member at San Diego Grantmakers and California Western School of Law. He "From investment in the still takes his daily walks, works out technology and ongoing funding several times a week, and plays with his grandchildren. He hasn't needed for the program to having any additional heart care, and says he world-class proctors come to the is feeling great.
hospital and train us in these "Scripps is as good as it gets," says procedures, Scripps is fully Galinson. "The quality of care was committed to being the leader impeccable, the innovation incredible, plus the concern for me and my family in robotic surgery." far exceeded my expectations. Quite – James Hemp, MD simply, we were treated like family." Scripps Cardiothoracic Surgeon Setting New Standards in Heart Care Scripps' unparalleled innovation and technological advances continue to set new standards for heart care. A Scripps physician invented the cardiac stent, now a standard treatment in repairing blocked arteries. Scripps was the first hospital in the United States to use minimally invasive tools to remove plaque from coronary arteries. Scripps was also first in the U.S. to use a dual chamber implantable defibrillator in the prevention of sudden death. Recently, Scripps became one of the first institutions to replace aortic valves using a catheter inserted through the femoral artery, a much less invasive procedure compared to conventional open heart surgery. Scripps cardiologists participated in the innovative PARTNER (Placement of AoRtic traNscathetER valves) clinical research trial, which Paul Teirstein, MD, and Scot Brewster, MD
compared transcatheter aortic valve replacement (tAVR) with conventional open heart surgery in high-risk patients. Annually, about 200,000 people in the U.S. need a heart valve replacement, but nearly half do not receive one because they're too sick to tolerate conventional open heart surgery. In the PARTNER trial, the valve is placed via a catheter inserted through an artery in the patient's leg, or directly through the left ventricle of the heart via a small incision in the chest. These techniques eliminate the need for a major open heart surgery.
Close-up of a transcatheter
"This procedure may represent a new treatment option for heart aortic heart valve used in
valve replacement that is less invasive, safer and more cost effective compared to open heart surgery. It can potentially improve the quality of life for hundreds of thousands of heart patients suffering with severe aortic stenosis." – Paul Teirstein, MD In the PARTNER trial, the aortic heart valve is replaced using a minimally invasive technique Scripps Interventional Cardiologist that eliminates the need for high-risk patients to undergo major open heart surgery. Using advanced imaging techniques and a small incision, the new valve is guided and placed through an artery in the leg or chest. The Regional Destination for Heart Care: Scripps Cardiovascular Institute When Scripps Cardiovascular Institute (SCI) opens it doors in 2015, it will usher in a new era of medicine and will redefine the heart care of tomorrow. Combining the renowned cardiac programs across the Scripps system with Kaiser Permanente, SCI will be the largest facility of its type in San Diego County and will serve as the destination hospital for heart care on the West Coast. Patients will have access to the nation's top cardiac experts, most advanced diagnostics, innovative treatments and latest research findings in the fight against heart disease.
SCI will be an impressive addition to the campus of Scripps Memorial Hospital La Jolla. The building will have eight floors and will span 358,000 square feet of integrated patient care, from prevention and health promotion to advanced diagnostics, surgical and interventional procedures. • In new catheterization labs, angioplasty and stent procedures will repair blocked arteries, while electrophysiology procedures will regulate erratic heart rhythms. • Operating suites will accommodate robotics. • Care for patients with complex cardiovascular conditions will be streamlined in hybrid suites where catheter-based procedures will be performed in tandem with heart surgery. • Up-to-the-minute cardiac imaging will guarantee timely diagnosis. As an added plus, much of the imaging equipment will be portable, bringing imaging services directly to patients. • Wireless technology will monitor patients' vital signs, heart arrhythmias and more.
"Our vision is to build the world's finest cardiovascular institute right here in San Diego. Scripps Cardiovascular Institute will bring together the clinical expertise of world-renowned physicians, the most advanced technology and groundbreaking clinical research." Construction of Scripps Cardiovascular Institute is under way,
with completion expected in 2015.
– Chris Van Gorder Scripps Health President and CEO Individualized MedicineIt's All in the GenesImagine being able to accurately predict your individual risk of developing certain diseases five, 10 or 20 years from now – and know how well your body will respond to various treatments. Though such highly individualized medicine sounds like a revolutionary concept, it's already happening at Scripps.
By studying the unique genetic structures and DNA that create a customized blueprint for every human being, Scripps researchers and physicians are more accurately and effectively diagnosing and treating illness, assessing future risk, and even helping prevent disease in individual patients. During the past several years, Scripps has spearheaded a number of landmark studies designed to categorize and evaluate the genetic profiles of individual patients through state-of-the-art science and technology. From a first-of-its-kind genetic scan that identifies increased risk of a wide range of serious diseases to studies that help physicians tailor treatments according to specific gene variations, Scripps is at the forefront of individualized medicine research. Results of these groundbreaking genetic studies have already enabled Scripps physicians and researchers to offer individualized care to patients. "Medicine today is widely practiced at a population level, with general guidelines for large groups," says Eric Topol, MD, director, Scripps Translational Science Institute. "At Scripps, we recognize that each individual is completely unique. Eric Topol, MD
Part of that can be determined through genomes, and part through physiological measurements like glucose, blood pressure, heart rhythm and other metrics. These enable us to establish far more information about individual patients than ever "We can define a human being today in a way that has never before, and translate that into valuable knowledge about their risks for disease, been possible in the past, and that enables this whole concept responses to treatment and prevention strategies." of individualized medicine and true prevention, which is so exciting. This is a momentous time in medicine – to be able to understand an individual's unique ‘black box.'" - Eric Topol, MD, Director Scripps Translational Science Institute Determining Individual Genetic RiskIn 2007, Scripps was the first and only health system in the nation to offer an innovative genetic study that gave participants a detailed scan of their individual genome based on DNA. Scripps Genomic Health Initiative (SGHI) assessed individual genetic risk for more than 20 health conditions, including such diseases as breast cancer, colon cancer, glaucoma, heart attack, multiple sclerosis, Type 2 diabetes, Alzheimer's, lung cancer and macular degeneration.
Each participant received a personal genetic report, along with information and recommendations to help prevent various conditions through healthier behavior, such as diet and exercise. Participants agreed to track their lifestyle changes through follow-up studies over the next 20 years.
In January 2011, The New England Journal of Medicine published the first results from the study. More than a quarter of participants reported improving their diet and exercise, and about half said they planned to seek additional medical screenings, such as a mammogram or glucose test, as a result of their genetic profile. "My mother and I enrolled in the Scripps Genomic Health Initiative together to see if we were genetically predisposed to any health conditions. As a result, we have both made lifestyle changes. I incorporate exercise in my daily routine, from taking the stairs at work to walking and riding my bike around the neighborhood." – Sarah Clarke, Nurse Practitioner Scripps Clinic Interventional Cardiology Sarah Clarke, NP
Genetic Testing in Heart Care Scripps was also first in the United States to apply genotyping to improve heart care. Already a renowned leader in cardiovascular care, Scripps now offers genetic testing to patients about to undergo stent procedures to determine their ability to respond to Plavix (clopidrogel), an anti-clotting drug given to most coronary stent patients. The test identifies common gene variants linked to the inability to metabolize Plavix; patients who have these variants carry double or triple the risk of death, heart attack or stroke compared to people without them. As a result of the testing and other metrics, physicians can offer these higher-risk patients treatment options Mathew Price, MD
and follow-up care tailored to their genetic profiles. Moreover, Scripps is moving forward with groundbreaking research to accelerate the genotyping process, enabling physicians to Genetic testing for this population of the American Medical Association carries significant implications for in March 2011, which studied the obtain results in less than an hour rather than several days. patient care. More than 1 million effectiveness of Plavix dosage changes people undergo stent procedures based on patients' measured responses. in the U.S. every year. The gene variants associated with an inability to "We're not only using individualized metabolize Plavix occur in more than medicine with our patients, we're "Thank you for helping me access 30 percent of people of European moving the field forward," says Scripps the gene test. Though I had planned ancestry and more than 40 percent of Clinic interventional cardiologist those of African or Asian ancestry. Matthew Price, MD. "We know that to switch to clopidrogel, the results people metabolize and respond to indicated that I am a non-responder. In addition to genotyping, Scripps drugs differently and much of that is physicians use a bedside test to based on DNA. By using genetics and I truly appreciate the wonderful work measure patients' platelet response other novel diagnostic tests, we can Scripps is doing in genomic medicine." to Plavix and determine how well the select the right amount of the right drug is working. Scripps also led an drug for a particular patient, as well – Ed Funkhouser international multicenter randomized as measure the response to ensure the Plavix Study Participant clinical trial, published in The Journal Paul Pockros, MD
Personalizing Hepatitis C TreatmentGenetic testing under way at Scripps offers hope to the more than 4 million U.S. patients diagnosed annually with hepatitis C, many of whom suffer unpleasant side effects from interferon therapy. Commonly prescribed for this condition, interferon causes flu-like symptoms and costs more than $50,000 annually per patient. Scripps researchers use genetic testing to identify a common gene variant that predicts successful treatment using a combination therapy of interferon and ribavirin. Specialists at Scripps Clinic now routinely order this genotyping on all hepatitis C patients who are potential candidates for antiviral therapy. Patients who have a favorable genotype can follow the current standard of care; for those with a less favorable genotype, doctors can recommend waiting for FDA approval of direct-acting antiviral drugs to improve their chances of response.
"I'm very impressed with the research Scripps is doing and glad to be able to contribute to it," says Loretta Roberts, a study participant. "The more information they find out about each viral type, the more it will help other patients in the future, including my son who contracted hepatitis C during my pregnancy." Later this year, Scripps researchers plan to offer an additional test to accurately predict anemia in hepatitis C patients taking the pegylated interferon and ribavirin drug combination. Anemia is one of the most common side effects of the regimen; this new genetic test will enable doctors to individualize therapy to prevent this problematic side effect. "This is a huge step forward in the movement toward individualized medicine. As a physician, knowing which drug therapies will have benefit and which ones won't based on a patient's genotype is a significant breakthrough. Now, we are able to target each patient's treatment." -Paul J. Pockros, MD, Clinical Director of Research Scripps Translational Science Institute As part of a clinical trial for hepatitis C patients, Loretta Roberts has received genetic testing to determine that for the best response, she needs a combination of antiviral therapies. the PadresAdvances in Orthopedic Care Benefit Players and PatientsScripps Clinic is celebrating more than 30 years as the official health care provider of the San Diego Padres.
Orthopedic specialists at Scripps Clinic are focused on new and innovative ways of caring for the team, and how their work with the Padres can translate from the specialized treatment of these high-performing professional athletes to the enhanced care of other orthopedic patients. Technology is at the forefront of sports medicine, including the development of a new iPad app, a Wii remote range-of-motion device, and the use of 3-D imaging of the shoulder to measure stress on muscles – all to keep better tabs on a player's health.
"Scripps doctors and Padres trainers have done a great job of keeping our players on the field – and if they do get injured, helping them return as high performers," says San Diego Padres Manager Bud Black.
A first-of-its-kind program using the Wii video game device is used to measure shoulder movement. Now in its second generation with enhanced technology, the application gives physicians an accurate starting point to work from, in case players encounter trouble later in the year. Heinz Hoenecke, MD, and Daryl D'Lima, MD, collaborated on the development of the technology. The goal of the device is to help doctors to measure In his fourth season with the San Diego Padres, relief pitcher
Mike Adams throws a fastball at more than 90 mph. The repetitive
players' flexibility and spot potential trouble spots early, before they motion can cause strain on his shoulder.
become injuries. Photo courtesy of the San Diego Padres
Technology Firsts The San Diego Padres are believed to be the first team in Major League Baseball to use iPad and iPhone technology as part of a pitcher's care. Dr. Hoenecke says the new app he developed will provide trainers with accurate day-to-day reporting of their health symptoms, charted out clearly with graphics and statistics. Data is stored on a secure server and is accessible only by the team – and Scripps doctors if medical intervention is needed. These examples and more are part of extensive research conducted over the last eight years at Scripps. Dr. Hoenecke's work has led to important changes in how shoulder injuries are treated. His breakthrough research began with the goal of As the official health care provider of the San Diego Padres, Scripps Clinic orthopedic physicians are using finding the best way to implant and align prosthetic shoulders, which he found was innovative approaches to treating athletes, including San Diego Padres relief pitcher Mike Adams. different and more complex than other weight-bearing extremities, such as knees Heinz Hoenecke, MD, is using Wii video game technology to identify potential problems with players' range of motion to avoid injuries. Knowledge gained from the research has enabled Scripps to develop an expertise in Orthopedic physicians at Scripps are focused on finding positioning and refining the alignment of shoulder prostheses. Using a 3-D shoulder innovative approaches to preventing injuries and treating athletes, simulator model, physicians have the ability to perform virtual surgeries on a laptop computer in preparation for a procedure.
and technology plays a big role in that quest. We're proud that a wide range of athletes trust us with their care, from elite-level The research, technology and care helps lead to "saves" on the field for Padres pitchers and better health assessments and treatment options for recreational competitors all the way to the recreational sports enthusiast." athletes who rely on Scripps for orthopedic care.
– Heinz Hoenecke, MD, Scripps Clinic Surgeon and Head Team Physician for the San Diego Padres "Throwing a baseball at a high speed is not a natural movement. Whenever I have an ache or pain, I turn to my Scripps doctors, and they explain the mechanics of the pitching motion. I have learned a lot about how to avoid shoulder injuries that way." San Diego Padres Relief Pitcher Scripps is preparing for significant changes coming in the next several years as a result of health care reform and the struggling economy. Scripps President and CEO Chris Van Gorder announced a major strategic move in 2010: a proactive new co-management structure designed to prepare Scripps to meet these challenges head on while continuing to provide superior quality care to patients and the community. Working together horizontally across campuses instead of just vertically within them, Scripps administrators, physicians and employees are collaborating on rigorous, in-depth decisions that will benefit the organization and patients by eliminating redundancies, reducing variations and adopting consistent best practices in policies, procedures, equipment and services – all to help create a sustainable, seamless health system where quality, efficiency and value are strengthened, not sacrificed.
"Scripps' intention is that our patients will receive the same consistent, quality standards of care at every Scripps facility across the system, inpatient and outpatient," explains Mary Ellen Doyle, corporate vice president of nursing operations. "At the end of the day for our patients, it is about value, and value is delivering the highest-quality care at the lowest cost." Examples from across the Scripps system illustrate how horizontal co-management is already improving care, reducing costs and enhancing patient satisfaction across the system – and many more are in the works.
Davis Cracroft, MD
in 30 Minutes or Less Scripps Mercy Hospital was the first in California to implement an innovative, patient-focused process that has transformed emergency care and virtually eliminated wait times.
The transformation began in early 2010, when physicians, nurses and technicians partnered with ancillary and support leaders from across the Scripps system in a six-day workshop focused on improving patients' emergency care experience, including streamlining processes, improving "door-to-doctor" assessment times, eliminating the need to send ambulances to a different site, and reducing the number of patents who left without being treated. A computer simulation model and 30-day pilot project with real patients helped refine the process; both Scripps Mercy San Diego and Chula Vista campuses put it into action in February 2010. Now, patients are greeted, quickly registered, and immediately assessed by a nurse to determine whether they will likely be treated and discharged, or admitted to the hospital. A detailed assessment by a physician and nurse team Patients are quickly greeted and assessed as part of emergency department redesign follows, and tests are ordered, if needed. The physician then treats the patient, at Scripps Mercy Hospital, as well as other hospitals throughout the system. who is cared for by a team of nurses until discharge. Radiology, laboratory, engineering and information services departments have also made changes to support the new protocol. "Our physicians, nurses and staff worked together to develop a consistent, patient- From increased efficiency and patient satisfaction focused approach to delivering emergency care. to decreased wait times and shorter stays, the redesign The patients' responses to the shortened wait has been a resounding success. As a result of Scripps times have been overwhelmingly positive." Mercy's achievement, the new process is now in – Davis Cracroft, MD place at all four Scripps emergency departments Emergency Medicine Physician and Scripps Clinic Torrey Pines Urgent Care.
Scripps Medical Laboratory uses automation to reduce the number Formulating More Effective Lab Services of analyzers, processing steps and manual tasks. The automation solution provides a more efficient work flow, improves productivity and decreases the cost and complexity of managing the laboratory. Scripps Medical Laboratory is another horizontal integration success story. For several years, management from clinical laboratories across the system has been working to streamline, standardize and integrate all lab services. The new co-management structure brings pathologists and administration together to design, build and operate one unified lab at Scripps.
Already, patients and the organization are enjoying real benefits from this new so that all labs will use the same codes to order tests and enter results. These structure. Patients can now call one number to find out about available lab decisions to standardize laboratory testing will reduce the risk of errors, improve appointments anywhere in the system, rather that just at one site. Procedures that efficiency and bring about cost savings.
used to be outsourced are now done in-house with less expense because of shared access to staff and equipment. In-house testing also brings quality improvement to "Once separate laboratory information systems are now being integrated into patients and physicians, with faster turnaround times than were previously possible a single database, so that no matter where a patient has their lab work done – from an outside laboratory.
in the physician's office, at a laboratory site, in the emergency room or hospital – the systems communicate with each other and with the patient's electronic medical Specialized technical committees composed of clinical laboratory scientists and record," explains Chris Nicholson, senior administrative director of Scripps Medical pathologists have systematically reviewed every lab test offered at Scripps and made decisions to standardize instrumentation, procedures and reference ranges where possible. Variations in laboratory computer programming are also being eliminated, Rethinking Rehab Care The horizontal alignment between hospitals is already having a profound effect on rehabilitation care, as a growing partnership between Scripps Mercy Hospital San Diego and Scripps Memorial Hospital Encinitas changes the way acute inpatient rehabilitative care is delivered to patients. With nearly 90,000 emergency department visits annually, Scripps Mercy has one of the busiest trauma centers in San Diego County. Many of these patients, such as stroke or car accident survivors, require rehab before being discharged. Prior to the restructuring, Scripps Mercy patients had historically been transferred outside of Scripps for rehab care – despite the fact that Scripps Encinitas has a nationally recognized, 30-bed inpatient rehab center.
Scripps brought together a team of physicians, nurses, case managers, social workers, therapists and financial staff from both campuses to develop a process for the safe, effective and timely transfer of these patients from Scripps Mercy to Scripps Encinitas. The new system approach enables patients to receive comprehensive, coordinated care using resources from across the Scripps system.
Upon discharge from inpatient rehabilitation at Scripps Encinitas, some patients continue their rehab care with Scripps home health therapists. This is often followed by outpatient rehab at a Scripps facility. The partnership enables patients to consistently receive the Scripps' personalized rehab care they need from start to finish to regain independence and restore quality of life. The inpatient rehabilitation program
at Scripps Memorial Hospital Encinitas
"Scripps Encinitas has one of the best rehabilitation facilities in Southern provides occupational therapy for
patients to re-learn motor functions, as
California, and by working together we're helping ensure our patients receive well as physical therapy to help them
the most comprehensive rehab care available in this region." regain balance and build body strength.
– Michael Lobatz, MD System Medical Director for Rehab Services An Idea Ahead of Its TimePhysician Co-Management More than a decade before health care reform mandated that physicians and administrators work together to develop smarter, more cost-effective approaches to medical care, Scripps was already making it happen. In 2001, Scripps President and CEO Chris Van Gorder established the Physician Van Gorder co-chairs the PLC with Chief Medical Officer and Corporate Senior Leadership Cabinet (PLC). His vision was to bring medical and administrative leaders Vice President Brent Eastman, MD. The group meets to share information and together to focus on a common goal – to make joint decisions that are in the best address challenging issues as a team. Though the PLC was established as an interest of every patient, every time. advisory group, Scripps has accepted 100 percent of its recommendations to date.
Founded on the basic tenet that neither physicians nor administrators could be truly "It made sense that if physicians, administrators and executive leaders all had the successful independent of one another, the PLC includes chief executive officers, same information and analyzed the same data with the goal of doing what is best chiefs of staff, chiefs of staff-elect from each of the five hospital campuses, and the for our patients, we would all come to the same conclusions," says Dr. Eastman. corporate vice president of nursing operations.
"Over the past 10 years, that collaboration has helped us reach solutions together that neither side would likely have arrived at separately." Physician Leadership Cabinet
One example of how physician co-management is directly benefitting Scripps patients is cancer care. When Scripps was preparing for accreditation by the Commission on Cancer in 2006, our oncology physicians and executive team jointly committed to achieving quality and operational standards at our five hospital campuses. The collaboration and operational transparency required to achieve accreditation was the springboard for a co-management model that continues to evolve to improve patient care and outcomes. Scripps now uses a multidisciplinary co-management model to ensure the best possible quality and outcomes for patients at every site. Additionally, Scripps leadership has established quality and operational task forces and work groups to identify and implement best practices for areas, including breast cancer, lung cancer, chemotherapy, colorectal screening and genetic testing; with each work group chaired by a physician. The benefits of this co-management structure include improved outcomes and patient satisfaction, increased operational efficiencies and greater physician communication.
James LaBelle, MD, was recently named corporate vice president of quality, medical management and physician co-management. In 2009, Scripps added the Physician Business Leadership Cabinet (PBLC), which includes elected medical Dr. LaBelle (left) and Brent Eastman, MD, chief medical officer and group leaders.
corporate senior vice president, are focused on expanding physician partnerships. Through the PLC and PBLC, Scripps continues to build the foundation for more physician co-management and more effective management of clinical care. Increasing collaboration throughout the organization will In spring 2011, Scripps selected physician leader lay the groundwork for integrated delivery systems.
James LaBelle, MD, to serve as corporate vice president of quality, medical management and physician co-management. Working in conjunction with our chief executives, Dr. LaBelle leads the work to develop a co-management structure that empowers the physicians to improve the value of care. In addition, he supervises our case management, hospitalist and intensivist programs.
" The key to the future is providing value by managing quality and cost. We don't know the exact business model that will result from health care reform, but if we wait to find out it will be too late. The time to come together and get in front of this is now." – James LaBelle, MD Corporate VP of Quality, Medical Management and Physician Co-Management Thomas Chippendale, MD
Graduate Medical Education Scripps Health has been training future physicians longer than any other institution Teaching Future Physician Leaders in San Diego, and that legacy continues today with three nationally respected graduate medical education programs. Measured by in-training scores, board pass rates, trainee research productivity, national leadership appointments and ongoing community service, Scripps residents rank among the top in the nation. And with 58 percent of program graduates remaining within the Scripps Health system, GME remains one of our strongest physician recruitment tools. Scripps Mercy Hospital's Graduate Medical Education (GME) Program began in 1946, and through the years has set a gold standard for innovation and leadership. With a list of graduates including dozens of nationally prominent researchers and clinicians, the program's 16-year internal medicine board pass rate of 100 percent establishes Scripps Mercy's place among outstanding institutions like Harvard and Johns Hopkins.
In March 2011, Scripps Green Hospital was named one of the nation's top teaching hospitals by Thomson Reuters. The Scripps Clinic and Scripps Green Hospital Internal Medicine Residency Program engages young physicians in basic science and clinical research as an integral part of their education.
Scripps' newest GME program, the Scripps Mercy Hospital Chula Vista Family Medicine Residency Program, is celebrating its tenth graduating class in 2011, and draws from a deep pool of talented medical students. Many program graduates grew up in San Diego and commit to stay here, providing excellence in patient care in their home communities.
Excellence Rooted in the Community Training physicians who come from and remain in the local community is one of the unique strengths of the Scripps Mercy Hospital Chula Vista Family Medicine Residency Program. Marianne McKennett, MD, program director for the family medicine residency, is proud of all the program's residents, especially the current graduating class. "This program attracts many outstanding medical students who grew up in the South Bay, went to great medical schools all across the country, then came home to care for their community," says Dr. McKennett.
Of 60 program graduates, 70 percent have stayed in the San Diego region. Graduates provide much-needed primary care for diverse patient populations in the South Bay, serving patients in community clinics based in San Ysidro, Imperial Beach and National City. Many also maintain privileges at Scripps Mercy Hospital, Chula Vista, where they admit and treat patients long after their graduation.
"I grew up 10 minutes away from Scripps Mercy Hospital, Chula Vista," says Esther Dalugdugan, MD, a third-year resident. "When I found an outstanding family medicine program right in my own hometown, I knew I had to come back. After graduation, I'll be staying in the South Bay and practicing locally." A graduate of the program and emerging physician leader, Willard Chung, MD, was recently elected co-chair of the family medicine department at Scripps Mercy Hospital, Chula Vista. "We see a wide variety of patients and medical problems here because of our proximity to the international border," says Dr. Chung. "By the end of our training, there's nothing this group of residents isn't prepared for. That's a distinct advantage over residency programs in other geographic areas." Willard Chung, MD, a graduate of the Scripps Mercy Hospital Chula Vista Family Medicine Residency Program (left), now mentors young physicians in the program, including Emma Smith, MD, and Esther De la Rosa-Dalugdugan, MD. Research and Service "Graduate Medical Education is an integral part of being a physician at Scripps," says Natalie Sweiss, MD, chief resident of the Scripps Clinic and Scripps Green Hospital Internal Medicine Residency Program in 2011. "When you train young physicians, you become a better physician." The highly competitive Scripps Green Graduate Medical Education (GME) Program began in 1986 with four residents. Today, the program, which combines clinical excellence with rigorous research and community service, receives more than 800 applications each year for 12 available positions. In addition to conducting original research that commonly leads to publication and national poster presentations, residents also staff the St. Vincent DePaul Village Family Health Center Clinic in downtown San Diego one evening per week, providing much-needed care to homeless and low-income patients. "Young physicians bring with them leading-edge knowledge of the latest advances in molecular and genetic biology," says Dan Dworsky, MD, internal medicine division head for Scripps Clinic Medical Group. "Health care is undergoing a fundamental transformation. In the future, teams of specialized caregivers will work together to meet all a patient's needs. GME lets us prepare young physicians for this kind of practice, and help them develop the leadership skills they'll Mayra Mendoza Dillon, MD
need to direct such teams." Where They Are NowGraduates of all three Scripps Graduate Medical Education programs are providing outstanding patient care, conducting innovative research and educating future physicians through leadership positions at Scripps and at prominent institutions across the nation, including: Stanford University; University of California at San Francisco; Emory University; Harvard University; Cleveland Clinic; Mayo Clinic, Cedars-Sinai Medical Center; University of North Carolina School of Medicine; Loyola University Chicago Medical Center; Tufts University; University of Oregon Health Sciences Center; Mercer University; University of Illinois Chicago; Boston University; Brigham and Women's Hospital, a Harvard teaching affiliate; University of Oklahoma; University of Arizona; University of Utah; University of Pennsylvania; and University of Florida.
Physician Leadership Kevin Hirsch, MD, president of Scripps Coastal Medical Group, is a case study in home-grown physician leadership. A 1989 graduate of the Scripps Mercy Hospital Internal Medicine Residency Program, Dr. Hirsch says he was initially attracted to the program by the visionary leadership program of Stanley Amundson, MD, and Jack Geller, MD, who together shaped the future of Scripps Mercy.
The program, based at the hospital's San Diego campus, emphasizes outstanding care delivered according to common values: service, compassion, integrity, professionalism and stewardship. "Technical expertise alone isn't sufficient," says Dr. Hirsch. "This is an innovative, humane program that consistently creates and adopts best practices in GME." As San Diego's longest established GME provider, the Scripps Mercy Hospital Internal Medicine Program has trained generations of nationally recognized leaders in clinical and academic medicine. "This program is, first and foremost, a premier program for technical training of outstanding internists," says Dr. Hirsch. "But it is much more than that. Scripps Mercy has a rich history, culture and tradition of nurturing and developing physicians who have the ability and desire to lead. It's a compliment that so many outstanding graduates choose to remain with us after they graduate and build their careers at Scripps." Kevin Hirsch, MD
" The Scripps Graduate Medical Education Program doesn't just create great doctors – it creates great human beings." – Kevin Hirsch, MD President, Scripps Coastal Medical Group The Scripps Mercy Hospital Internal Medicine Residency Program has prepared generations of physician leaders like Kevin Hirsch, MD, president of Scripps Coastal Medical Group (seated). During his tenure, he has invited more than a dozen outstanding graduates of the program to join the practice, including Stacy Schlocker, MD; Alma Harb, MD; and Christopher Holt, MD. A Legacy of Giving Past, Present and Future When Ellen Browning Scripps founded Scripps Memorial Hospital more than 87 years ago, she envisioned meeting the health care needs of the community for years to come. The Sisters of Mercy had a similar vision when they established Mercy Hospital decades earlier. Today, Scripps has generous supporters following in these auspicious footsteps, leaving a legacy that will benefit San Diegans for future generations.
Philanthropy advances the prevention, diagnosis and treatment of disease, which will help people live longer and healthier lives. It funds robotic technology for physicians to treat patients with a variety of conditions, such as cancer and heart disease, with precise Sisters of Mercy surgical techniques that will result in less pain and scarring, and a quicker recovery. Community support allows Scripps to build Scripps Cardiovascular Institute, which will bring together the clinical expertise of world-renowned physicians, the most advanced technology and groundbreaking clinical research. It also furthers discoveries in genomic medicine that determines the genetic underpinnings of diseases and develops more effective, personalized treatment for patients.
Ellen Browning Scripps
Philanthropy Supports Innovation and Growth Through the years, philanthropy has played a critical role in Scripps' growth. The Polster Breast Care Center at Scripps Memorial Hospital La Jolla; the Shiley Center for Orthopaedic Research and Education at Scripps Clinic; the Leichtag Family Birth Pavilion at Scripps Memorial Hospital Encinitas; and the Conrad Prebys Emergency and The Leichtag Family Foundation made a $10 million leadership gift to support The Campaign for Scripps Encinitas. Trauma Center under construction at Scripps Mercy Hospital, are just a few examples of how generous donors have invested in the health of their community.
As the longest-established health care system in San Diego, Scripps has a demonstrated commitment to our patients – and those patients, and the community, are generous in return. Capital campaigns are under way to support growth and expansion across the region.
"As a nonprofit health system, Scripps relies on community support. From our founder Carol Salem, MD
Miss Ellen to the many generous philanthropists of today, our donors leave a legacy that will help save the lives of countless patients who trust Scripps with their care. Philanthropy helps fund the most advanced robotic surgical equipment.
Philanthropy makes progress possible." – John Engle, Scripps Corporate Senior Vice President and Chief Development Officer "It feels good for me to be able to give back in such a meaningful way to a community that has been so good to me. I really get a kick out of it." – Conrad Prebys, Philanthropist Construction has begun on the Conrad Prebys Emergency and Trauma Center at Scripps Mercy Hospital. Scripps Health at a Glance Philanthropy Revenue Inpatient Days of Care Provided Major Gifts/Cap Campaigns Average Length of Stay Special Gifts & Tributes Average Daily Inpatient Census Direct Mail Annual Giving Program Total Inpatient Discharges/Visits Planned Gifts and Bequests Total Net Contributions
Selected ServicesSurgical Cases – Inpatient Diagnostic Imaging Exams Total Uncompensated & Charity Care Professional Education & Research Interventional Radiology Charity Care & Under-reimbursed Community Health Improvement Services Nuclear Medicine & Community Benefit Operations & Subsidized Health Services & Cash and In-kind Contributions Cardiac Procedures Under-reimbursed Medicare Shortfalls Maternity – Number of Newborns Community Building Activities Rehab Services – Number of Visits Radiation Therapy Visits Outpatient VisitsHospital Outpatients Emergency Services Joint Venture Ambulatory Surgery Clinic Outpatient Visits/Surgeries Home Health Visits Total Outpatient Visits Facilities & StaffTotal Number of Employees Scripps Home Health Care
Total Number of Medical Staff Total Number of Licensed Beds Total Number of Medical Residents/Fellows Scripps Health Administrative Services
Scripps Memorial Hospital Encinitas
Scripps Memorial Hospital La Jolla
Scripps Coastal Medical Center
Scripps Green Hospital
Scripps Cardiovascular and Thoracic Surgery Group
Scripps Mercy Hospital
San Diego Campus
Chula Vista Campus
Scripps Health Plan Services
Employees: 152Locations: 1 Scripps Health Financials Consolidated Statement of Financial Position
Year ended September 30, 2010
Liabilities and Net Assets Current Assets:
Cash and Cash Equivalents Current Portion of Long-term Debt Accounts Receivable, Net Accounts Payable Assets Limited As To Use Accrued Liabilities Other Current Assets Total Current Liabilities
Total Current Assets
Assets Limited As To Use Long Term Debt, Less Current Portion Other Liabilities Total Liabilities
Property, Plant and Equipment, Net Total Assets
Net Assets: Unrestricted Temporarily Restricted Permanently Restricted Total Net Assets
Total Liabilities and Net Assets
Consolidated Statement of Operations
Year ended September 30, 2010
Liabilities and Net Assets
Nonoperating Gains (losses):
Patient Services Investment Income Capitation Premium Holding Gain on Trading Portfolio Net Assets Released from Restrictions Used for Operations Gain on Disposal of Property Total Operating Revenues
Market Adjustment on Interest Rate Swaps
Excess of Revenues Over Expenses
Wages and Benefits
Provision for Uncollectible Accounts Receivable Depreciation and Amortization Loss on Impairment Total Operating Expenses
Scripps Health Board of Trustees Chairman, 2010 & 2011 Vice Chair, 2010 & 2011 Market President, General Manager, San Diego County Bank of America, Retired Mary Jo Anderson, CHS
Virginia Gillis, RSM, EdD
Mary Jo Anderson, CHS
Martin C. Dickinson
Health Care Executive, Retired Health Care Executive, Retired Health Care Executive, Retired Douglas A. Bingham, Esq.
Richard L. Hall, MD
Richard C. Bigelow
Virginia Gillis, RSM, EdD
Executive Vice President, Chief Physician, Retired CEO, Luce Forward Hamilton Health Care Executive, Retired Operating Officer, TSRI Earnest S. Rady
Richard L. Hall, MD
Founder, American Assets Douglas A. Bingham, Esq.
Physician, Retired Fire Chief, Retired Chairman, ICW Group Executive Vice President, Chief Operating Officer, TSRI Katherine A. Lauer, JD
Judy Churchill, PhD
Chris Van Gorder, FACHE
Partner, Latham & Watkins LLP Clinical Psychologist, Retired President and CEO, Scripps Health Judy Churchill, PhD
Clinical Psychologist, Retired
Marty J. Levin
Gordon R. Clark
Broadcast Journalist, Retired Board Chairman, Access Information President and CEO, National Steel Gordon R. Clark
and Shipbuilding Co., Retired Board Chairman, Access Information Chris Van Gorder, FACHE
President and CEO, Scripps Health Martin C. Dickinson
Abby Silverman Weiss
Attorney, Dispute Resolutions Abby Silverman Weiss
Attorney, Dispute Resolutions
Scripps Health 2011 Board of Trustees
Scripps Health 2010Physician Leadership Cabinet Chris Van Gorder, FACHE
James Mason, MD
A. Brent Eastman, MD
Paul Pockros, MD
Marc Sedwitz, MD
Ricardo Soltero, MD
Robin Brown, FACHE, Scripps Green Hospital
Juan Tovar, MD
Carl Etter, FACHE, Scripps Memorial Hospital Encinitas
Donald Vance, MD
Gary Fybel, FACHE, Scripps Memorial Hospital La Jolla
Tom Gammiere, FACHE, Scripps Mercy
Chief Nursing Executives Larry Harrison, Scripps Medical Foundation
Lori Burnell, RN
Mary Ellen Doyle, RN
Cindy Steckel, RN
Tom Chippendale, MD
Marlys Vespe, RN
Kent Diveley, MD
Valerie Walsh, RN
Scott Eisman, MD
Jan Zachry, RN
Shawn Evans, MD
Physician Business Leader Cabinet Davis Cracroft, MD
Chris Van Gorder, FACHE
Dan Dworsky, MD
Kevin Hirsch, MD
Jim LaBelle, MD
A. Brent Eastman, MD
Michael Lobatz, MD
Robert Sarnoff, MD
Mark Sherman, MD
Frank Stewart, MD
Awards and RecognitionBest Employer Surgical Intensive and Cardiac Care Named one of the country's 50 best employers for Scripps Health selected as one of America's top * Scripps Memorial Hospital La Jolla and Scripps workers age 50 or over (2010, 2009, 2008, 2007, 10 health systems based on quality, safety, Green Hospital, Scripps Clinic and Kaiser Permanente, 2006, 2005, 2004). – AARP efficiency and patient satisfaction (2009). San Diego, ranked 34th nationally in heart and – Thomson Reuters Named to the Working Mother 100 Best Employers list – U.S.News & World Report's 2010-11 Best Hospitals (2010, 2009, 2008, 2007, 2006, 2005). Scripps Green Hospital recognized as one of the – Working Mother Magazine nation's "100 Top Hospitals," in 2010. The surgical intensive care unit and cardiac care unit – Thomson Reuters at Scripps Memorial Hospital La Jolla awarded the Named one of Fortune Magazine's 100 Best Beacon Award for Critical Care Excellence. Companies to Work For (2010, 2009, 2008). Best Respiratory Therapy – American Association of Critical Care Nurses – FORTUNE Magazine Scripps Memorial Hospital La Jolla earned Quality Respiratory Care Recognition from the American Scripps Mercy Hospital ranked in the top 4 percent Association for Respiratory Care. of U.S. hospitals for survival after heart failure. Scripps Green Hospital, Scripps Memorial Hospital – Centers for Medicare & Medicaid Services Encinitas, Scripps Memorial Hospital La Jolla and Imaging Excellence Scripps Mercy Hospital earned Certificates of Scripps Mercy Hospital Chula Vista honored as a Breast Excellence for superior health care quality, patient Imaging Center of Excellence (2010, 2009, 2008). Scripps Cancer Center earned network accreditation – experience and safety measures. – American College of Radiology the first multi-hospital cancer program in California – California Hospital Assessment and Reporting and one of only 28 nationally. Task Force Top Stroke Programs – American College of Surgeon's Commission Scripps Mercy Hospital (San Diego campus) certified on Cancer Scripps Coastal Medical Group and Scripps Clinic as an Advanced Primary Stroke Center, joining Scripps Medical Group ranked No. 1 and No. 2 in San Diego Green Hospital, Scripps Memorial Hospital Encinitas Scripps Polster Breast Care Center one of two region for health care (2010).
and Scripps Memorial Hospital La Jolla in stroke centers in California to be granted a three-year – California Cooperative Healthcare Reporting accreditation. – The Joint Commission full accreditation for breast cancer care. – National Accreditation Program for Breast Centers Blood and Marrow Transplant Scripps Memorial Hospital La Jolla was the first Scripps Green Blood and Marrow Transplant Center hospital in San Diego to be re-designated as a Magnet received Center of Excellence designation. Hospital by the American Nurses Credentialing Center – California Department of Health Care Services Mission, Vision, ValuesMission Scripps strives to provide superior health services in a caring We provide the highest quality of service. environment and to make a positive, measurable difference in the health of individuals in the communities we serve. Scripps is committed to putting the patient first, and quality is our passion. In the new world of health care, we want to anticipate the causes of illness and encourage health behavior for all who rely on us for service. We teach and encourage patients We devote our resources to delivering quality, safe, cost-effective, socially to participate in their care and to make well-informed decisions. We will be their responsible health care services. We advance clinical research, community health advocate when they are most vulnerable. We measure our success by our patients' education, education of physicians and health care professionals, and sponsor satisfaction, their return to health and well-being, and our compassionate care for graduate medical education. We collaborate with others to deliver the continuum of care that improves the health of our community.
dying patients, their families and friends.
We demonstrate complete respect for the rights of every individual. Scripps strives to be the health care leader in San Diego and Scripps honors the dignity of all persons, and we show this by our actions toward one another and those we serve. We embrace the diversity that allows us to nationally by becoming: draw on the talents of one another. We respect and honor the cultural, ethnic and religious beliefs and practices of our patients in a manner consistent with the The provider of choice for patients highest standards of care. All this is done in a compassionate setting. Our goal is to The employer of choice for the community create a healing environment in partnership with all caregivers who are committed The practice environment of choice for physicians, to serving our patients. nurses and all health care professionals We care for our patients every day in a responsible and efficient manner.
Scripps serves as a major community health care resource for San Diego County and, as such, we are accountable for the human, financial and ecological resources entrusted to our care as we promote healing and wholeness. We begin from a base of excellence and collaborate with co-workers, physicians, patients, and other providers to find new and creative ways to improve the delivery of health care services. All members of our community will have access to timely, affordable and appropriate care.
2011 Scripps Health
Reishi or Ling Zhi (Ganoderma lucidum) Solomon P. WasserInstitute of Evolution, University of Haifa, Mount Carmel, Haifa, Israel and locust (Quercus, Acer, Alnus, Betula, Castanea,Coryolus, Fagus, Fraxinus, Populus, Pyrus, Magnolia, Ganoderma lucidum (reishi mushroom, Ling Zhi) has Tilia). G. lucidum is less frequently found on conifer- been an economically important species, particularly