The BMC Brief
November 11, 2011 Volume 1, Issue 13
On Nov. 1 President and CEO Kate Walsh hosted Town Hall Meetings where she presented the medical center’s strategic plan to the BMC community.
BMC’s strategic planning work began over the summer, with a committee of members of the Board of Trustees, clinical and administrative leaders working with consultant McKinsey & Company to determine a plan that charts the course for BMC’s future.
“We have defined a strategy for improvement that lays the foundation for BMC to thrive as a leader in integrated care over the long haul while allowing us to succeed today,” Walsh told the standing-room-only audiences at the 7:30 a.m., noon and 4 p.m. meetings held in Keefer Auditorium. “Under this plan, our mission and tagline, Exceptional Care, Without Exception, will not change; in fact, fulfilling our mission is how we will thrive.”
“We are crucial to this community,” she continued. “No one is as expert as we are in providing health care to the populations we serve, and no one is better positioned to deliver on the promise of truly coordinated, integrated care for that population.
Walsh explained that the work was necessitated largely by ongoing challenges in the health care environment, with all providers under pressure to reduce costs and BMC under particular pressure due to reduced government payments for the low-income population it serves.
Under the plan, titled Be Exceptional, for the next two years the focus of BMC’s work will be on Providing the Right Care to Every Patient … No Less, No More, the first of the plan’s five themes.
Walsh explained that this means BMC will deliver the care staff would want for themselves and their family, ensuring that exceptional care is given to all patients (no less), but not to the point where harm could be done (no more) through unnecessary tests or procedures.
“Our patients have a choice about where to get their care, and in Boston they can choose from some of the best hospitals in the world,” she said. “The best way for our organization to thrive in this market is to maintain laser focus on the quality of care and the patient experience.”
Achieving this means working together as a team, she said, and requires each employee to “reach across organizational boundaries” and for the hospital to “re-organize itself around patients and their needs.”
Walsh explained that success in this work will be the foundation for the other components of the plan. Improvements in care delivery, along with more efficient administrative processes, will allow BMC to be the lowest cost, highest performance health care provider. That, in turn, will attract improved payment from both the government and from commercial insurers. Ultimately, this high level of performance, combined with leveraging BMC’s links to its BMC HealthNet Plan and to the Boston HealthNet network of community health centers, will allow BMC to thrive and also to be a local and national leader in the delivery of coordinated, integrated health care.
The plan calls for an investment of an expected $50 million to help fund improvements to systems, such as the revenue system and information technology reporting and measurement systems. “The tools we need to get where we need to go,” Walsh called them.
“While this work will lead to a marked improvement in BMC’s finances, this is much more than a financial plan; it is a plan to transform the care we deliver and the quality of our patients’ experience,” said Walsh.
The work begins now, she said, and cross-disciplinary teams are being developed to create detailed initiatives to support the plan’s five themes.
Walsh concluded by reminding staff that for BMC to succeed, each person has to see themselves in the Be Exceptional plan.
“Each of us has to live our promise to Be Exceptional. And we have to Be Exceptional together,” she said.
Following President Walsh’s presentation, BMC Chief Medical Officer Ravin Davidoff, MD, outlined the work that will comprise the Right Care for Every Patient … No Less, No More.
He noted that when BMC measured itself against national benchmark quality data several years ago and learned that it fell short, the hospital took steps to improve.
“We thought we were providing good care, but then we measured ourselves and realized we were not as good as we thought we were,” said Davidoff. “We have made good progress but we need to do more.”
To move the organization forward, Davidoff said groups will move away from working in silos and instead work across departments and disciplines using team-based care approaches. BMC also will standardize processes across the organization to support practices that are the best quality the hospital can deliver. Davidoff compared the new patient care experience at BMC to that of a high-quality restaurant.
“If Kate and I are out to dinner at a restaurant and she orders steak and I order fish, our meals are different but our experience is the same,” he explained. “From the hostess seating us, to the wait staff pouring our water, to the kitchen staff creating our meals, we experience the same thing. And it’s that consistent, high-quality product and experience that keeps us coming back.
“We are on a never-ending journey to deliver the highest quality, safest patient care,” he continued. “Everyone will be engaged and we will provide you with the tools to do it.”
Davidoff concluded by saying the take-away message from the meeting is that every employee has a role to play in enhancing patients’ experiences at BMC.
“Whether you prepare a patient’s bill, clean a clinical area or operate on a patient, every person has a place in this plan. The key thing to ask yourself is: What would I do if this were my mother, father, sister or brother?”
In March, BMC participated in its first Employee Engagement survey. Sixty percent of staff, physicians and residents anonymously scored the hospital on topics such as compensation, leadership, work-life balance and more, answering questions like “I am proud to tell people I work for BMC” and “BMC provides high-quality care and service.”
The purpose of the survey, says Cheryl Freed Loew, Manager, Organizational Effectiveness, Human Resources, was to evaluate employees’ perceptions of BMC and identify areas for improvement.
“We asked staff to tell us what is working and what is not,” says Freed Loew. “This was the best way for BMC to gauge the climate of organization.”
The results, received in late April and shared across the organization, showed that the medical center performs well in the areas of compensation and benefits, but needs improvement at the organizational and department levels in the areas of quality and customer focus, career development opportunities and communication. Overall, BMC’s engagement score is below the national health care average.
At the organizational level, changes are already being implemented.
“You told us that the senior management team needs to be more accessible and needs to do a better job of communicating,” said BMC President and CEO Kate Walsh at the Nov. 1 Town Hall Meeting. “We heard you, and we are launching a set of initiatives designed to do just that.”
These initiatives include a weekly “Huddle Card” that contains need-to-know information for all hospital staff for the upcoming week; a senior management rounding program, where vice presidents undertake weekly rounds to work units to address questions and concerns of staff; and quarterly Town Hall Meetings hosted by leadership to update the BMC community on important happenings.
Future initiatives include a campus-wide digital signage system to disseminate important news and events, and a professional development program for managers.
BMC plans to survey staff again next fall, with the goal of seeing the workforce’s overall commitment score improve.
Barbara Healey, RN, Assistant Nurse Manager, Emergency Department, arrived at Laboratory Medicine ready to learn. She donned a lab coat and gloves before sitting down with Annette Nicholson, Clinical Lab Assistant, to watch her work. Nicholson removed blood samples from plastic bags that arrived via the pneumatic tube system and scanned them into the system. She paused to hold up a tube to Healey, pointing out that the label is on upside down, which caused a slowdown in the process as it was manually added to the system.
“I had no idea putting the label on incorrectly affects the lab work flow this much,” said Healey, jotting it down on a notepad.
Healey is one of 25 managers and staff who participated in Clinical Operations’ Take a Walk in My Shoes Day Oct. 26. Employees from the Emergency Department, Environmental Services, Laboratory, Nursing, Pharmacy, Phlebotomy and Interpreter Services gave up two hours of their day to shadow employees in other units.
The program, initiated by Janet Means, Administrative Director, Pathology and Laboratory Medicine, was created in response to feedback gathered through the Employee Engagement survey and laboratory’s move in May, where visitors said they did not know what the lab did. It is designed to improve communication and collaboration across units.
“The purpose of the program was to gain a greater appreciation and understanding of hospital departments and they work they do,” says Ruane Fisher, Project Manager, Clinical and Financial Operations.
“We wanted people to ask questions to understand how their work impacts, and is impacted by, other departments,” she added.
It seemed to work. In a de-briefing session that followed, staff eagerly shared what they learned.
“I had never been to a lab before and I didn’t know what to expect,” said Marilyn Joyce, RN, Nurse Manager, Menino 7 East. “I was amazed and totally fascinated by what they do. I learned so much that I see tremendous value in sending my unit coordinators over to tour the lab.”
“It was interesting to see the unit coordinators and how they fit into the bigger picture of the entire floor,” said Healey. “It’s the type of thing you don’t think about.”
Gerard Barsoum, Director, Interpreter Services, agreed.
“Many of us don’t know how other departments function and how such a small change in workflow on our part can have such a large impact on theirs,” he said.
The program worked so well that the Clinical Operations team plans to offer it once a month to any staffer who wish to participate.
“This was a great start and we look forward to encouraging more of our staff to participate,” says Kim Perryman, RN, Vice President, Nursing.
On Nov. 2 Maureen Bisognano, President and CEO of the Institute for Healthcare Improvement (IHI), asked a packed audience in the Keefer Auditorium to travel down a new path.
“I’m asking you to go on a journey and see things with new eyes. This is the only way to create safer models of care,” she said.
Bisognano, an international authority on improving health care systems, delivered the seventh annual Raphael Miara Memorial Patient Safety Grand Rounds, “Leading for Safer Care.” The program is held at BMC each year in honor of Raphael Miara, a young patient who died of a medication error here in 2003.
“There is a spirit and commitment at BMC not to forget mistakes, but to continue to learn from them,” said Stanley Hochberg, MD, Chief Quality Officer and Vice President for Quality and Patient Safety, in his introduction of Bisognano.
Bisognano told the audience that the path forward in health care includes new ways to lead, new aims in the patient experience, and more ways to learn. According to Bisognano, the four patient safety questions leaders should be asking themselves are: do you know how good you are; do you know where you stand relative to the best; do you know where the variation exists; and do you know the rate of improvement over time.
“If you only look at your scores you get complacent,” she said in reference to how an organization measures against others. “Compare yourself to others and get motivated to do better.”
New ways to lead include huddles, she said, where focused information is communicated fast and frequently to generate and help manage knowledge, and continuously improve care delivery. New aims in the patient experience means looking at the experience of care through a new lens. Bisognano gave the example of a wheelchair-bound patient in California who, when asked what happens if he gets a flat tire, explained that it was a three-week process to repair it. It’s the type of thing caregivers don’t think to ask patients, she said, but one that can make a tremendous difference.
“Until we look at a patient’s full journey, we will never see how care can be redesigned,” she said.
She concluded by addressing Rabbi Miara, father of Raphael Miara, who was in the audience.
“I apologize to you on behalf of the health care system,” she told him. “I promise that we will get better.”
Name: Joe Blansfield, RN, NP
What brought you to BMC?
What do you do here?
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Patients share their BMC experience
I am a former employee of Boston Medical Center (now retired) and my daughter currently works in the Emergency Department. I am writing this email to inform you of how pleased I was with the care I received recently at BMC. I was, needless to say, very nervous and in pain when I got to the ED, but every person I came in contact with treated me with such care and compassion - it immediately made me feel better! Best of all, they all had smiles on their faces!
I would like to acknowledge a few of the many people I encountered and I hope perhaps you will as well – they deserve it!
In the Emergency Departrment: Megan Leo, MD; Kristina McCollem, RN; and Steve Slaney, RN.
My surgeons, Drs. Suresh Agarwal, and Glenn Miller, and Kristin Fox, RN, in the Post Anesthesia Care Unit.
I am happy to say I am recovering nicely at home. Thanks to you and your staff again for the wonderful care.
North Andover, Mass.
Doherty named Chief and Chair of Surgery
Doherty comes to BUSM/BMC from the University of Michigan, where he is NW Thompson Professor of Surgery, Vice Chair of the Department of Surgery and Section Head of General Surgery.
Doherty is a graduate of Holy Cross and Yale School of Medicine. He completed his residency training at the University of California, San Francisco, including Medical Staff Fellowship at the National Cancer Institute. He joined the faculty at Washington University School of Medicine in 1993 and became Professor of Surgery there in 2001.
Doherty has focused on surgical diseases of the thyroid, parathyroid, endocrine pancreas and adrenal glands, as well as the surgical management of multiple endocrine neoplasia (MEN) syndromes. He is an international opinion leader in the management of endocrine tumors, including thyroid cancer, and he is currently on the Board of Directors of the American Thyroid Association.
Teaching has been a strong personal interest and strength throughout Dr. Doherty’s career. He has served as Program Director of the Surgery Residency at the University of Michigan for the past 8 years and has received multiple awards for teaching excellence. He has edited several major textbooks for students and surgical trainees.
Doherty brings with him a wealth of administrative experience in academic medical center settings. In addition to serving for the past decade as chief of General Surgery at the University of Michigan Health System, he is President of the Michigan Chapter of the American College of Surgeons and has held multiple leadership positions in national and international professional groups.
“We are excited to welcome Dr. Doherty to BMC,” says President and CEO Kate Walsh. “He is a wonderfully skilled surgeon with special expertise in the management of endocrine tumors and thyroid cancer, which will be of great benefit to our patients and a tremendous asset to the BMC Cancer Care Center.
“As Chief and Chair, his leadership will be an enormous asset to our surgery program overall,” she adds.
“Dr. Doherty will be a strong leader on the faculty of Boston University School of Medicine,” says Karen Antman, MD, Provost of BU Medical Campus and Dean of BUSM. “He is an accomplished surgical investigator with two decades of experience in academic administration and research. He has authored more than 150 peer-reviewed journal articles and is committed to undergraduate medical education and residency training.”
Holsapple named Chief and Chair of Neurosurgery
Holsapple has been an Associate Professor of Neurosurgery and Pediatrics at BMC/BUSM since 2009. “Since his arrival, he has quickly established himself as a leader, establishing a new and vibrant pediatric neurosurgery program. We believe that neurosurgery will continue to grow and thrive clinically and academically under his guidance,” says BUSM Dean Karen Antman, MD.
“Dr. Holsapple brings a wealth of clinical experience to this role, which will be of great benefit to our patients,” says BMC President & CEO Kate Walsh. “We look forward to the leadership he will provide to the Department of Neurosurgery and to the hospital.”
Holsapple received his undergraduate degree from Drake University, Magna Cum Laude, and his MD from University of Kansas School of Medicine. He completed an internal medicine internship at St. Luke’s Hospital, Kansas City, Missouri and a general surgery internship and neurological surgery residency at Upstate Medical University (SUNY), where he was also a NRSA Research Fellow in the Departments of Neurological Surgery and Physiology. He then joined the faculty and was promoted to Associate Professor of Neurological Surgery and Pediatrics.
Holsapple is a member of the New England Neurological Society, the Congress of Neurological Surgeons and the American Association of Neurological Surgeons. The author of numerous papers, peer-reviewed articles, chapters and case reports, his research interests include primate visual and motor processing, human brain tumor management and biology. Holsapple’s clinical interests include adult intracranial tumors, vascular surgery and pediatric neurosurgery.
President Walsh participates in Can Share Food Drive
Blair named Executive Director of Patient Experience
Tom Traylor, Vice President, Government Programs, received a Partner in Hope award Nov. 10 from the South Boston Community Health Center. Traylor received the award in honor of his advocacy on behalf of the poor and those who struggle, and for his contributions to the South Boston Community Health Center and the health care industry. The award was presented at the health center’s Harvest of Hope Auction & Cocktail Reception.