The BMC Brief

November 23, 2011 Volume 1, Issue 14

• BMC Announces FY12 Goals
• For Food Pantry Staffer, Giving Back is a Way of Life
• Leadership Corner: Bob Biggio, VP of Facilities and Support Services
• Study Finds Primary Health Care Providers Fail to Report Substantial Cases of Child Abuse
• What Do You Do, Nadjoua Habib?
• In Their Words
• News of Note
• Awards and Accolades

BMC Announces FY12 Goals

For the fiscal year ahead, Boston Medical Center will focus on four QUEST goals: Quality, Efficiency, Satisfaction and Total revenue. The goals replace the current VSSC (volume, safety, satisfaction and cost) model.

“The QUEST goals reflect our commitment to continually improve the quality of care we deliver and the patient experience, which are both major components of our Be Exceptional strategic plan,” says Kate Walsh, BMC President and CEO. “We are on a continuous QUEST to consistently achieve the highest standards of excellence.”

The goals are:

1. QU: Quality
   • Improve performance on the University Health Systems Consortium (UHC) mortality index to 0.79.
     The mortality index is a standard measure of BMC’s mortality performance adjusted for the illness level of our patient population. BMC shares quality data with the UHC and uses UHC benchmarks for evaluating performance and setting quality goals. “We have made significant improvement over the past year, but remain above the UHC median at 0.863,” says Stanley Hochberg, MD, Vice President, Patient Safety and Quality. “Our goal is improve our performance to meet the median performance for UHC hospitals.”

   • Schedule 80 percent of new primary care patients to be seen within 14 days; improve the number of new patients seen in all other specialties combined within 14 days by an average of 10 percent.

     Currently 70 percent of patients at BMC are seen in primary care within 14 days. BMC’s goal is to be at 80 percent or higher. “Each specialty area has an access measure that we have been tracking,” says Ravin Davidoff, MD, Chief Medical Officer. “Because of different clinical needs, we are measuring the performance of each department against last year’s access measure with a goal to improve by 10 percent.”

2. E: Efficiency
   
   • Hold spending to the budgeted amount of $810 million for the expense categories of wages, employee benefits, physician services, drugs, supplies and utilities.

     BMC achieved its FY11 goal of spending less than the budgeted $812 million and has set an FY12 goal of $810 million. “To achieve this, we need to build on last year's success of managing costs by carefully considering every position we fill and spending every dollar as if it were our own,” says Richard Silveria, Vice President, Finance, and Chief Financial Officer.

3. S: Satisfaction
   
   • Increase the commitment score on BMC’s Employee Engagement survey by 5 percent.

     The commitment score reflects the degree to which employees feel committed to BMC and their willingness to recommend BMC as a good place to work and to receive care. “There is a direct correlation between employee engagement and our ability to achieve key business outcomes, especially patient satisfaction,” says Tim Manning, Vice President, Human Resources. “Our goal is to work toward improving the work environment, thereby raising the level of pride that our staff have in BMC.”

   • Increase the percentage of patients who rate BMC a 9 or 10 on the “Overall Rating of Hospital” to 70 percent for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, as measured by Press Ganey.

     The most recent 12-month performance for the percent of patients who give the hospital a nine or 10 “overall rating,” with 0 meaning “worst hospital possible” and 10 meaning “best hospital possible,” is 61 percent. “Achieving a higher score means that our patients’ expectations were fully met and likely exceeded,” says Lisa O’Connor, Sr. Vice President, Clinical Operations and Chief Nursing Officer. “Our goal is to keep our loyal patients coming back and have them recommend BMC to others for their care.”

4. T: Total Revenue
   
   • Achieve patient service revenue of $854 million

     In FY11, BMC reported $849 million in patient revenue, which was $18.9 million below budget. This was due to fewer inpatients and a lower than expected Medicare casemix. Casemix is a measure of the hospital's expected resource utilization based on a patient's diagnosis. “The FY12 goal of $854 million is based on projected increased payments due to higher casemix and continued meaningful use incentive payments,” says Silveria. “We must continue to work to attract patients in an ever more competitive health care environment.”

Walsh notes that the goals should be achieved by Oct. 30 of 2012, the end of the fiscal year. Departments and units will be asked to devise a strategy to accomplish them.

Visit the BMC intranet to learn more about the QUEST goals.

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For Food Pantry Staffer, Giving Back is a Way of Life

Emile Kamadeu arrived in Boston in late 2003 as a refugee from Cameroon, Central Africa. A 21-year-old man with no family or friends in the city, and no job, he sought assistance at BMC, where he was referred by his primary care physician to the Preventive Food Pantry. It was there where he met its manager, Latchman Hiralall. The two became friendly.

Emile Kamadeu in the stock room of the food pantry

“I would hang out at the pantry and talk with him,” says Kamadeu. “The pantry became my second home because I wasn’t working and I couldn’t support myself. It was a safe place for me to come and I thought of it as my family.”

Every two weeks Kamadeu would head home with his bag of groceries from the pantry. When he sat down to the meal he prepared, he couldn’t help but think of others.

“When I ate, I thought about my family and about all the people who don’t eat every day,” he says. “I felt so lucky.”

After receiving his work permit in 2004, Kamadeu began looking for a job. When he saw a posting for a Coordinator position at the Food Pantry, he jumped at it.

“I really wanted to work there,” he recalls. “I wanted to be able to give back.”

When he got the position, it was a dream come true. “Ubuntu” he says to describe it, an African belief that people can only find fulfillment through interacting with others.

Food Pantry By the Numbers

• 10,000 pounds of food distributed a week
• 7,000 people served a month
• 2,700 average number of children served a month
• 75 percent increase in people served since 2007
• 3 full-time staff, 1 part-time employee

He used his first paycheck to buy groceries.

“When I received that first check, I said to myself, ‘Now I can go to Stop and Shop. Now I can afford my own food.’”

More than five years later, Kamadeu still loves his job. Two days a week, he drives a truck around the state to pick up donated food to bring back to the pantry, located on the fourth floor of the Dowling building. The increase in the amount of food, and the number of its clients, is hard not to notice, he says.

“When I started, we had down time to get things done. Now we have no time for anything from the moment the pantry opens until it closes. Every day we have 20 people lined up outside the door before we open at 10 a.m.”

There has been a 75 percent increase in service since 2007, says Hiralall.

“When we opened 10 years ago, we served 800 families. Now we serve 20 tons of fresh fruit, vegetables and meat to 7,000 individuals a month.” Hiralall notes that the pantry relies completely on philanthropy, including food drives that help keep the shelves stocked.

This week the pantry, which celebrated its 10-year anniversary last month, will distribute 775 Thanksgiving baskets to clients.

Kamadeu won’t be one of them, but he’ll be there on Friday, giving back in his own way.

BMC is holding a food drive for the pantry through Nov. 25. Learn more on the BMC intranet.

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Leadership Corner: Bob Biggio, VP of Facilities and Support Services

Bob Biggio joined BMC Sept. 6 as Vice President, Facilities and Support Services, overseeing Environmental Health and Safety, Environmental Services, Facilities, Food and Nutrition and Transport Services. He previously served as Vice President, Support Services and Real Estate at Massachusetts Eye and Ear Infirmary. Biggio brings an extensive background in engineering and management of real estate issues to BMC during a time when the medical center is assessing its facilities’ needs.

BMC Brief staff recently spoke with Biggio about his goals for BMC’s campus.

Bob Biggio, VP, Facilities and Support Services

What is your vision for the Facilities department?
I have four goals I’d like to accomplish in the next year. The first is to create a more user-friendly work order request system. We plan to upgrade the system so Facilities staff and customers can track the status of a request in real time. An enhanced system will give our customers confidence that their issues are being resolved in a timely manner, and will reduce the number of phone calls we receive in our Control Center.

My second goal is to create and implement a preventive maintenance program. This means we will survey every room in every building over the next six months to inventory the heating and cooling systems and facilities equipment. Each piece of equipment will be assigned a numerical risk classification based upon its safety and life-span risk. We then will use that risk classification system and manufacturers’ recommendations to develop a preventive maintenance schedule that will improve the operation and reliability of our equipment.

We also will develop an infrastructure master plan to help us assess the condition of equipment and increase the reliability of our systems. Our goal is to create an infrastructure that minimizes the amount of equipment needed for the campus to operate and maximizes overall efficiency. For example, many patient-care areas are equipped with two fire extinguishers: one for A (paper or wood-fueled) fires and one for B and C (electrical or oil fueled) fires. Facilities maintains both types of extinguishers, which is twice the amount of equipment that is needed. We could simplify the process by installing one extinguisher for A, B and C fires. We see simplifying equipment and processes like this as a key area.

The third goal is to develop a real estate strategy. In the changing health care environment, efficiency and cost are more important than ever and we need a strategy that aligns our portfolio of real estate assets with our true business needs. We have a real opportunity with the campus, which comprises roughly 2.6 million square feet of buildings and 1.25 square miles of land. As we move through this process, we will align each real estate asset with its best use in support of the overall organizational strategy.

The fourth goal is to implement a Room a Day program. Starting in early January, we will take two inpatient rooms out of commission each day of the work week to ‘refresh’ them. We’ll do all the work we need in that one day, which could include painting the room, waxing the floors, maintenance to the heating and cooling systems, and any other necessary repairs. By tackling two rooms a day, we will get all 336 inpatient rooms done in a year.

How does a hospital’s facilities contribute to the patient care experience?
Ideally the aesthetics and quality of facilities fade into the background for patients so they only concentrate on their care, similar to when people visit Disney World and never think about the behind-the-scenes systems or people that make the experience terrific. The reality, however, is that facilities play an important role in patient care and when they are not in top shape, they can detract from the experience. Our goal is to get to the point where the facilities fade into the background.

The Yawkey Ambulatory Care Center is one of BMC’s older buildings. Do you have any plans for it?
Yes. The Yawkey Center is a good example of a building that detracts from the patient care experience and we plan to tackle it. It is an extremely important building for BMC as more care migrates to the outpatient setting. Over the next 24 months, we will make a multi-million dollar investment in it. We’ve already started enhancements to the lobby; we installed maple baseboards and cleaned the grout and tile. These are minor things that have a big impact. Our next step is to schedule meetings with occupants to learn their needs as we move forward with developing a master plan for the building. The goal is to give Yawkey a consistent, uniform look.

What do you think of BMC?
I love it. To get to know the organization, I’m spending an hour a day with one of my staff, touring his or her area. So far I’ve been in the ceiling to check out the heating, ventilation and air conditioning (HVAC) system, down to the mechanical rooms to inspect the electrical system and walking clinical floors to assess the aesthetics.

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Study Finds Primary Health Care Providers Fail to Report Substantial Cases of Child Abuse

A team of researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM), report that primary care providers (PCP) fail to report a substantial number of cases of child maltreatment. The study, which appears in the current issue of Academic Pediatrics, is the first to examine the validity of a PCP’s decision to suspect child abuse as the origin of an injury and their decision to report a suspicious injury to child protective services (CPS).

Robert Sege, MD, FAAP

Identifying that a particular injury was caused by child abuse can be difficult. Typically, only the responsible person and child witness the injurious event, and the child may be preverbal or afraid to describe the abuse. The physical abuse of a child may be suspected after a careful history and physical examination, when the clinician determines the injury is not consistent with the history provided, or when the pattern of injuries is highly suspicious for maltreatment.

This study examined the validity of PCP assessment of suspicion that an injury was caused by child abuse and their decision to report suspected child abuse to CPS. By using a subsample of injuries drawn from the national Child Abuse Reporting and Experience Study, PCPs completed telephone interviews using a stratified sample (no suspicion of abuse; suspicious but not reported; and suspicious of abuse and reported) of 111 injury visits.

Reporting suspected child physical abuse is a two-step process: assessment of the likelihood of child physical abuse and the decision to report. “Child abuse experts and PCPs are in general agreement concerning the assessment of suspected child physical abuse, yet this study demonstrates that primary care providers decide not to report a substantial proportion of child physical abuse cases,” explains lead author Robert Sege, MD, FAAP, Director, Division of Ambulatory Pediatrics at BMC.

Upon analysis of the data, the researchers found that PCPs and experts agreed about the suspicion of abuse in 81 percent of the cases of physical injury. PCPs did not report 21 percent of injuries that experts would have reported. Compared with expert reviewers, PCPs had a 68 percent sensitivity and 96 percent specificity in reporting child abuse.

These results point to several opportunities for improvement in the training of physicians as well as the diagnosis and management of child physical abuse. “To become more certain of their suspicions, PCPs need better education about the recognition of injuries that are suspicious for child abuse, particularly bruises and fractures, and the role of state CPS agencies in investigating the child’s circumstances,” adds Sege.

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What Do You Do, Nadjoua Habib?

Name: Nadjoua Habib
Title: Arabic Interpreter
Department: Interpreter Services
Years at BMC: 4

Nadjoua Habib

What brought you to BMC?
I moved to the U.S. from Algeria in 2003 to enroll in English courses at Harvard University and Cambridge College. One of my professors was the former manager of Interpreter Services at BMC and encouraged me to apply for the Arabic Interpreter position in 2007. I was so happy when I got the job. Working in the medical field has been my dream since I was a little girl.

What do you do here?
As an interpreter my goal is to make communication between a doctor and patient possible. We work with all clinics in the hospital to interpret doctor and patient conversations. Accuracy is extremely important in our profession. We don’t add to the conversation or give opinions; we listen and translate. Our schedules can get hectic running back and forth between clinics, so if we get tied up, doctors can use the language line, a telephone service staffed by interpreters.

What does being an interpreter mean to you?
It means being a bridge between the patient and health care provider and also being a patient advocate. I help whomever doesn’t speak the language, and that help doesn’t stop at the doctor’s office. For example, when a patient dies, I connect families to religious leaders and help set up services where the Koran is read and staff atttend to support the families. When you feel like you did something that made life easier for someone, that’s the most important thing.

Do you speak any languages other than Arabic and English?
I do. There are 23 Arabic countries and each speaks a different dialect. For example, the African Arabic dialects are different from Middle Eastern dialects and I speak most of those. In Algeria, French is spoken at University, or college, so French is my second language. That helped me to learn English. In total, I speak three languages, including all Arabic dialects.

Algerian and U.S. cultures are very different. What differences do you see?
The differences are political, economic, social and religious. I came to the U.S. because of all the opportunities here, like education, freedom, human rights and equal opportunity.

What do you like about working at BMC?
I enjoy working as a team and helping patients. When they leave smiling because they had a positive experience, it makes me happy. We see a diverse range of patients from all over the world who seek treatment here, such as immigrants and refugees who are desperate for medical assistance. We help them with the language barrier. I believe that is what exceptional care without exception is all about.

Do you know a staff member who should be profiled? Send your suggestions to communications@bmc.org.

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In Their Words

Patients share their BMC experience

I wanted to write to let you know about the excellent care my wife received during a recent nine-day hospital stay at BMC.

While I have been impressed by the nurses and physicians at this hospital on many occasions in the past, the care that she received was truly outstanding. The nurses were compassionate, attentive and kind, and the expertise of the physicians was remarkable. My wife's illness necessitated the involvement of multiple specialties, and the care was seamless, integrated and complete.

While I am sure I am leaving many out, there are some individuals who are deserving of special mention - they stayed late, came in early, rounded on their usual days off, and answered innumerable questions from the "worst kind of patient" (a physician):

Emergency Department: Dr. Kahn and Maura Forbes, RN
Neurology/Neurocritical Care: Drs. Kase, Burns and Otis, and Newton Pavilion nurses Sal, Ketsia and Denise
Radiology: Drs. Barest and Tkacz, plus the CT and MRI techs
Critical Care: Dr. Azocar
Step-Down: Chris Denenberg and the nurses on the 5Wtele unit

We have much to be thankful for this Thanksgiving, and are very proud of BMC.

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News of Note

BMC President and CEO Kate Walsh at the groundbreaking

Codman Square breaks ground on expansion
BMC President and CEO Kate Walsh joined Massachusetts Governor Deval Patrick, Boston Mayor Thomas Menino, Senator Jack Hart and other civic leaders for the Oct. 26 groundbreaking of the expansion of Codman Square Health Center, one of BMC’s 15 affiliated HealthNet community health centers. The $18 million expansion will extend the health center’s capacity to provide health care, social services, the arts and education to the Dorchester community.

David Beck named Vice President and General Counsel
David Beck has been named Vice President and General Counsel. Beck has served as Deputy General Counsel at BMC since 2007. As General Counsel, David will oversee Legal Services, Compliance and Captive insurance functions. Prior to joining BMC, David served as Deputy Chief of the Public Protection Bureau at the Commonwealth of Massachusetts Attorney General’s Office.

Tim Manning named Vice President for Human Resources
Tim Manning has been named Vice President for Human Resources. Manning has served as BMC’s Director of Human Resources since 2008. As Vice President, Manning will oversee Benefits and Compensation, Human Resources Operations, Labor and Employee Relations, Organizational Effectiveness, Staffing and Affirmative Action, Occupational Health and Volunteer Services. Prior to joining BMC, Manning served as Senior Vice President of Human Resources at NSTAR Electric and Gas Corporation and Director of Labor and Employee Relations at Harvard University.

BMC President and CEO Kate Walsh makes smoke-free announcement

BMC going smoke free
On Nov. 17, BMC President and CEO Kate Walsh announced that the hospital will go smoke free April 16, 2012. BMC joins the Boston University Medical Campus and nine other hospitals in the city in the pledge to go smoke free, inside and out, by Patriot’s Day, in an initiative supported by Boston Mayor Thomas Menino and the Boston Public Health Commission. “By becoming a smoke-free campus, we will play a key role in reducing the hazards of tobacco use and exposure, modeling healthy behavior and sending a clear message that good health is important and that providing a smoke free environment is the right thing to do,” said Walsh. Learn more in the smoke free section of the intranet.

Nurses support Breast Cancer Survivorship Program
Nurses from the operating rooms and the Post Anesthesia Care Units (PACUs) raised more than $1,200 for BMC’s Breast Cancer Survivorship Program. The funds will be used to send cancer survivors to the annual Weekend of Hope in Stowe, Vermont. Last year BMC sent 75 patients and their family members to the weekend filled with relaxation, fun and education.

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Awards and Accolades

Richard Saitz, MD, MPH, of BMC's Clinical Addiction Research and Education Unit, received the W. Anderson Spickard, Jr. Excellence in Mentorship Award from the Association for Medical Education and Research in Substance Abuse (AMERSA). The award is given to an individual who has provided outstanding mentoring to junior faculty and/or trainee, resulting in the faculty member’s or trainee’s increased scholastic productivity and career advancement in the area of substance abuse education or research.