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The BMC Brief

June 20, 2012 Volume 1, Issue 27

Former Head of Centers for Medicare and Medicaid Services Speaks at BMC

Don Berwick, MD, former administrator for the Centers for Medicare and Medicaid Services (CMS), spoke to a crowd of more than 100 people, including BMC trustees, Philanthropic Trust members, donors and staff, on June 12 about the future of health care.

Don Berwick
Don Berwick, MD, recently spoke at BMC

Berwick was appointed administrator of CMS by President Obama in 2010, a role in which he served for 17 months. He is founding President and CEO of the Institute for Healthcare Improvement and a pediatrician who trained at Boston City Hospital.

Berwick opened by speaking of his belief that health care is a human right, saying he was proud to be a member of the first state in the nation that, by implementing the Massachusetts health care reform law, has made health care a human right.

The national system, he said, needs to change.

“We have a health care system that celebrates sick people in beds,” he said. “This has to change and payment reform will help. Everyone is looking for the answer, but nobody has it yet. This is not a book to be read; it is one that has to be written.”

BMC, he said, is the place that can do it.

“BMC is ground zero. Your strategic plan is focused on high-quality care at a low cost. It is going to take a lot of change to move to a national health care system that emphasizes team-based, coordinated, patient-centered care, but BMC can birth it.”

Berwick went on to say that health care redesign needs to have primary care as a focal point and that America has to wean itself off thinking a doctor has to provide all care. Teamwork, he said, will be key.

“We need a workforce in health care that wants to be together; a team that is looking for new answers and is all about cooperation,” he said.

The center of the team is the patient, and for a new model of health care to succeed, relationships with patients need to be built and strengthened, he added.

“We, as health care providers, are guests in patients’ lives. We need to sit down and ask them, ‘What matters to you?,’ and ‘What can we do to fix you?’” he said.

Berwick then took questions from a panel, moderated by President and CEO Kate Walsh, that included BMC Chief Medical Officer Ravin Davidoff, MD; Raj Krishnamurthy, MD, Vice Chair, Outpatient Medicine; and Sandra Coterell, CEO, Codman Square Health Center, and a member of the BMC Board of Trustees.

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Leadership Corner: Stan Hochberg, MD, SVP, Quality, Safety and Technology

Stanley Hochberg, MD, joined BMC Oct. 1 to oversee the hospital’s health care quality and safety programs. As Senior Vice President of Quality, Safety and Technology/Chief Quality Officer, Hochberg manages the quality improvement, performance improvement, risk management, quality measurement and infection control functions. In January, his role expanded to include oversight of Information Technology Services (ITS). He previously served as Chief Medical Officer at BMC HealthNet Plan and has extensive experience managing quality and information technology in varied environments.

Stanley Hochberg, MD
Stanley Hochberg, MD

BMC Brief staff recently spoke with Hochberg about work going on in his areas.

How is BMC doing on the quality and safety front?
There is positive and exciting improvement work happening daily around the organization. With the support of BMC, hospital department chiefs recently identified physicians in each department and division to champion quality improvement and safety work in their areas. These physician quality leaders have dedicated time set aside to undertake improvement work and are working collaboratively with the Quality, Safety and Patient Experience Department staff to identify projects, define the appropriate scope of work and determine the support needed to complete them. These physician leaders will collaborate with staff throughout the hospital both in their daily work and on defined project teams. Our next step is to start training physician leaders and staff in a consistent framework for quality improvement. This will help standardize our efforts across the hospital and ensure that projects are utilizing the best of the current range of improvement tools.

We are also really pleased with the recent “A” Hospital Safety Score that BMC received from the Leapfrog Group. This grade recognizes the wonderful progress we continue to make to ensure that BMC is a safe and caring place for all patients. BMC also has consistently performed well on the QUEST mortality index goal, measuring better than target. This is a testament to the excellent, continuous efforts of all staff.

What are some of the projects underway?
We recently rolled out CALL trigger cards to clinical teams. Caregivers use the cards as a reminder to inform attending physicians about changes in patients’ statuses based on certain criteria. The CALL card is an initiative to support our QUEST goal of improving our mortality performance.

To enhance the patient experience, we have created four workgroups that are focused on improving certain areas of the hospital. The groups are working to better how the campus looks and feels, create patient and family centered cultural attributes and behaviors, align patient resources and improve employee engagement and wellness. This work is really exciting and we expect to see measurable improvements in patient satisfaction as a result.

You recently assumed leadership of ITS. What is the department working on?
We have created a new project management team in ITS. The group is actively cataloging ITS projects to help us better manage both the projects themselves and our ITS resources. We are also in the process of creating a new ITS governance structure that will include clinical and administrative participation. These new governance groups will be responsible for assessing resources and prioritizing projects to help BMC operate more efficiently. We expect the committees to be up and running by late summer or early fall.

We are also in the middle of a project to implement new ITS support procedures that will increase the responsiveness to staff across the organization and improve the way ITS staff work together. I am very pleased with the commitment of all ITS staff to help us improve.

Additionally, we are conducting a national search for a new Chief Information Officer and expect to conduct second round interviews next week.

Does ITS plan to roll out any new systems?
We are in the midst of a process to evaluate options for an integrated Electronic Medical Record (EMR). This system would support inpatient and outpatient departments on a single electronic system with seamless information sharing across all settings of care. ITS has completed interviews with 150 staff members to define the requirements for the system and three vendors have demonstrated their products. Our next step is to analyze our findings and solicit price proposals. We hope to have a recommendation later this summer.

What are benefits of an EMR system?
A better integrated EMR system will ensure that information is available automatically at the point of care, which will help us improve care. A new system should also help us eliminate many of the inefficiencies and duplicate data entry we have in our current systems. This will help support our Right Care initiatives as well as our ongoing improvement and safety work.

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What Do You Do, Mary Collier?

Name: Mary “Molly” Collier, NP
Title: Nurse Practitioner
Department: Dermatology
Years at BMC: 7

Molly Collier, NP
Molly Collier, NP, holds the photo album of her trip to Guatemala 

What brought you to BMC?
I was looking for a job as a Dermatology nurse practitioner (NP) when I met Dr. Tania Phillips, a BMC dermatologist who specializes in wound care. I was impressed with her work and coincidentally, the department was looking for an NP, so I interviewed, was hired, and became the first person in this role in the BMC Dermatology Department.

What do you do here?
I provide care to patients with dermatology issues and I see about 30 patients a day. First I evaluate the skin problem and create an individual follow-up plan that works for the patient. I work independently with a supervising physician that, miraculously, turned out to be Dr. Phillips!

What is your favorite thing about being a dermatology provider?
I like solving problems. To correctly diagnose a patient, you have to go back through his/her history and do a physical exam to narrow the issue. Sometimes the end result is a complete surprise and sometimes it’s your hunch confirmed, but finding the root of the problem is the really fun part of my job.

What do you like about working at BMC?
I have a very collegial relationship with the doctors that I work with and they have taught me so much. If I approach them with a complex patient’s problem, they are generous in taking the time to help me or take the patient on to offer a second opinion. This is a great group to work with.

You recently went on a medical mission. Can you tell us about that?
I went to Tecpán, Guatemala with an organization called HELPS International. The group has been traveling from the U.S. to Central America to provide medical care for 25 years. My team was made up of 10 surgeons, with the remaining members supporting them. We corrected cleft palates, clubbed feet and crossed-eyes on local residents who do not have access to health care. We operated on 350 patients and saw 1,500 people in the clinic where I was stationed.

Amazing! What was the best part about your trip?
Among the group of 100 volunteers was my 82-year-old mother, my daughter, who is also a nurse, and my brother, a plastic surgeon. This was my first medical mission and I really enjoyed it – especially having my family by my side. I see many BMC patients from Central America, so I made a photo album from my trip to share with them. They love it!

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

Letter writing 

As a physician, I know very well that patients and their families are often more prone to complain when unhappy than to praise when happy. Both should be encouraged. I am writing this letter to praise and commend in the highest possible terms the medical and surgical care that has been provided to my mother by three physicians on staff at Boston Medical Center: the neurologist Dr. Marie Saint-Hilaire, the endocrinologist Dr. Stephanie Lee, and the endocrine surgeon Dr. Gerard Doherty. In addition to providing excellent care to my mother, all three have been very open to communicating with me by phone and email whenever necessary, and have been generous with the amount of time they have spent with me, my mother, and my sister.

Dr. Saint-Hilaire has been following my mother for Parkinson’s disease since she made that diagnosis three and a half years ago. She has always been careful and deliberate in making changes to my mother's medications, which can be tricky when dealing with Parkinson’s disease.

I visited my mother at the end of December, and was unpleasantly surprised by various new and diverse symptoms. Writing to her (then-) family physician, I suggested some tests be run. These disclosed hypercalcemia, which her family physician chose to ignore (but which always demands investigation). When I received this result, my mother was enroute to an appointment with Dr. Saint-Hilaire. I called Dr. St. Hilaire, and she immediately agreed to order the appropriate blood tests. These revealed primary hyperparathyroidism. My mother then was referred to an endocrinologist elsewhere, who claimed that her modest deficiency in Vitamin D was the cause of both her hypercalcemia and her hyperparathroidism! We asked for Dr. Saint-Hilaire’s help again – again in an area unrelated to neurology – and she referred my mother to the endocrinologist Dr. Stephanie Lee. Dr. Lee saw my mother within a week, and Dr. Saint-Hilaire may have been instrumental in expediting the referral. Dr. Lee immediately understood that my mother was suffering from primary hyperparathyroidism, and at the time of their first meeting, performed an ultrasound of the neck, which revealed one or possibly two parathyroid adenomas.

In the meantime, I had made inquiries about surgery to remove the adenomas, and was thinking seriously of referring my mother to surgeons at the Tampa General Hospital, who pioneered a minimally-invasive technique for removing such benign tumors. With her Parkinson’s disease and numerous other medical problems, I did not want her to be subjected to a multi-hour surgery under general anesthesia, and this seemed to be all that was offered in the Boston area.

However, by a stroke of good luck for us, Boston Medical Center had just recruited Dr. Gerard Doherty to be the Surgeon-in-Chief at Boston Medical Center. Dr. Lee communicated with Dr. Doherty, who agreed to a conference telephone call with my mother and me on a long weekend! We learned from that call that Dr. Doherty had also perfected a technique of minimally-invasive parathyroid surgery, and booked her surgery with him. He performed the surgery which was made more complicated by the fact that my mother did indeed have two adenomas, and not one, both of which Dr. Doherty had to resect. The surgery went smoothly. Both Dr. Lee and Dr. Doherty visited my mother and my sister (in the surgical waiting room) a few times both pre- and post-op. Within three days, my mother was feeling terrific, and many of the new symptoms related to hyperparathyroidism had already resolved!

In conclusion, despite difficulties we faced with initial misdiagnoses and sub-standard care elsewhere, my mother received absolutely the best medical and surgical care imaginable at Boston Medical Center. We are very grateful to Drs. Saint-Hilaire, Lee, and Doherty, and felt that we should make our opinions known.

Ontario, Canada

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News of Note

BMC elects new members to Board of Trustees
BMC has named five new members to its Board of Trustees: David Ament, James Blue, Sandra Cotterell, John Cradock and Clare Perlman. The new members will serve a three-year term beginning July 1.

David Ament
David Ament

Ament is a managing partner at Parthenon Capital. He came to Parthenon in 2003 as a principal with significant experience in the private equity industry. Ament has served as a board member of the BMC Exceptional Care without Exception Philanthropic Trust. He is a graduate of Harvard College.

Blue is CEO of the Bostonian Group, which specializes in the areas of employee benefits, retirement services, executive compensation and property and casualty. Blue also serves on the boards of educational and social service organizations including the Col. Daniel Marr Boys and Girls Club, RFK Children Action Corp, and Catholic Memorial High School. A graduate of Boston College, Blue also has earned his Chartered Life Underwriter (CLU) and Registered Investment Advisor (RIA) designations.

Sandra Cotterell
Sandra Cotterell

Cotterell is CEO of the Codman Square Community Health Center, after having served as Chief Operation Officer since 1994. She began her career in health care as a nurse, earning a BS from Simmons College with RN certification. Cotterell has served in nursing roles at Massachusetts General Hospital and New England Medical Center. In addition, she has held supervisory roles at Bay State Health Care, where she later served as vice president of clinical services. In addition to her role as CEO of Codman Square Health Center, she is also co-CEO of Dotwell, a partnership organization that was formed between the Dorchester House Multi-Service Center and Codman Square Health Center. Dotwell provides non-clinical services to patients of both health centers.

Cradock is CEO of East Boston Neighborhood Health Center (EBNHC), a leading facility for innovation in community based services. He has served in a leadership role at EBNHC since 1978. A graduate of Boston College, Cradock is active in the Massachusetts League of Community Health Centers, the National Association of Community Health Centers, the Kellogg Foundation Community Partners Program, the Boston Mayor’s Health Care Commission, and the Boston Public Health Commission.

Perlman leads initiatives within the Ocean State Job Lot Charitable Foundation, which actively supports disaster relief efforts, the performing arts, special needs children, educational institutions and health organizations, with a special emphasis on food banks and hospitals throughout the Northeast. In addition, she serves on numerous boards and committees at the local level in her home state of Rhode Island. A former coronary/intensive care nurse who practiced in New York City, she received her nursing degree from Rhode Island School of Nursing.

Retiring Board members include Joel Abrams, Jim Taylor, MD, and Alyce Lee.

Dunham named Director of Diversity and Multicultural Affairs at GSDM
Larry Dunham, DMD, will join Boston University Henry M. Goldman School of Dental Medicine (GSDM) as Director of Diversity and Multicultural Affairs July 1. In this role, Dunham will develop and implement strategies and programs to strengthen the diversity of the applicant pool and facilitate enrollment of eligible, highly qualified students who reflect the diversity of the general population. He will provide support and services to encourage success and retention of enrolled students. He also will coordinate advising, retention and outreach-related services to both current and prospective students with an emphasis on those who are members of underrepresented minority populations.

CRIT group
CRIT attendees at the retreat

CRIT holds annual retreat
The Chief Resident Immersion Training (CRIT) program held its annual retreat June 2-3. The program focused on the care of older adults and included an interactive case that followed a geriatric patient from presentation in the clinic to the emergency department to discharge from the hospital. Twenty-one BMC chief residents participated in the retreat.

“Chief residents who complete CRIT emerge with new knowledge and skills in the care of older adults, an increased ability to teach about geriatrics, and improved leadership techniques that are required in their new roles,” says Cecilia Akuffo, Education Program Manager. CRIT is an eight-year old program that has been replicated at 19 institutions nationwide.

Staff at Walk for Peace
Thea James, Clementina Chery, Julia Barbosa, and Eric Hardt at the Walk for Peace

Employees march in Mother’s Day Walk for Peace
BMC staffers from Emergency Medicine, Family Medicine, Geriatrics, Pediatrics, and Adolescent Medicine recently marched in the Mother’s Day Walk for Peace. The 3.6-mile route through Boston’s Dorchester neighborhood attracted thousands of walkers and supporters of non-violence, including politicians and local officials. The 16th annual Walk was sponsored by the Louis D. Brown Peace Institute, an organization that works with families through grief, loss and trauma. The walk raised more than $77,000 for the Peace Institute. Those interested in participating in next year’s walk can contact Julia Barbosa at 638-8943 for more information.

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Awards and Accolades

Get with the Guidelines award

BMC has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes BMC’s commitment and success in implementing excellent care for stroke patients. BMC received the award for having achieved 85 percent or higher adherence to all Get With The Guidelines-Stroke Quality Achievement indicators and achieved 75 percent or higher compliance with six of 10 Get With The Guidelines-Stroke Quality Measures, such as the aggressive use of medications, cholesterol reducing drugs and smoking cessation, all aimed at improving the lives of stroke patients.

Healthcare Quality Index 2012

BMC has been named a “Leader in LGBT Healthcare Equality” in the 2012 Healthcare Equality Index report, an annual survey conducted by the Human Rights Campaign (HRC) Foundation, the educational arm of the country’s largest lesbian, gay, bisexual, transgender (LGBT) organization. BMC earned top marks for its commitment to inclusive care for LGBT patients and their families, meeting several key indicators for equitable care, including nondiscrimination policies for LGBT patients and employees, a guarantee of equal visitation for same-sex partners and parents, and LGBT health education for key staff. BMC is one of only 234 health care facilities nationwide to be named a leader. It is the first time BMC has participated in the survey. View the Healthcare Equality Index 2012 report at www.hrc.org/hei.

Jim Feldman, MD, MPH, FACEP, Emergency Medicine, received the Pinnacle award at the annual meeting of the Massachusetts College of Emergency Physicians (MACEP). The Pinnacle is a prestigious career achievement award given by MACEP to a small number of individuals who have made significant local, regional and national contributions to MACEP and Emergency Medicine.

Laura Eliseo, MD, Emergency Medicine, was honored by the Emergency Medicine Residents' Association with a Certificate of Appreciation for fostering medical students’ interest in the field of emergency medicine. Eliseo's nomination was initiated by Boston University medical students.

Emergency Medicine Residency Program
Neil Hadfield, MD; Derek Wayman, MD; Joe Pare, MD, and Kristin Cardmoy, MD, Director, Emergency Medicine Ultrasound

The BMC Emergency Medicine Residency Program took home a trophy from the Society for Academic Emergency Medicine’s recent annual meeting in Chicago. The team won the inaugural Sonogames, a national competition of ultrasound skills. Demonstrating their skills and knowledge of point-of-care ultrasound and all aspects of U.S. competence in clinical practice were Joe Pare, MD; Derek Wayman, MD; and Neil Hadfield, MD. Forty residency programs competed in the event.

Kristin Carmody, MD, RDMS, RDCS, Emergency Medicine, has been elected Chair of the Academy of Emergency Ultrasound (AEUS). Carmody is a current board member of AEUS, an organization that brings together bedside clinician sonologists with the common goal of advancing patient care and safety by use of bedside ultrasound.

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