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October 29, 2013 Volume 2, Issue 18


Miara Lecture Discusses Creating a Culture of Respect to Promote Patient Safety

Lucian Leape, MD, PhD, an internationally recognized leader in the patient safety movement, visited BMC recently to kick off National Health Quality week, telling an audience of doctors and nurses in Keefer Auditorium that the next major step in improving patient safety is creating a culture of greater respect among doctors, nurses, students and patients.

Lucian Leape, MD, PhD
Lucian Leape, MD, PhD

“The secret to caring for patients is caring for the caregivers,” said Leape who is a professor of health policy and management at the Harvard School of Public Health.

The Quality, Safety and Patient Experience Department welcomed Leape on Oct. 21 for the ninth annual Raphael Miara Memorial Patient Safety Lecture.

Leape cited a guiding principle of former Alcoa CEO and workplace safety leader Paul O’Neill. “Paul O’Neill said that everyone, everyday should feel respected, supported and appreciated—this sounds pretty good to me. This is doable. If we want to make health care safer, we need to focus on this.”

According to Leape, much of the success of the patient safety movement to date has been the result of a focus on fixing systemic problems rather than on individual errors.

“You shouldn’t punish the people who made the mistakes, instead find out why they made the mistakes and fix the underlying problem,” he said. “The systems approach looks to the future.

“Moving forward, hospital leaders need to continue to focus on efforts to make staff feel comfortable reporting errors and to encourage their staff to participate in patient safety initiatives.”

Addressing what he considers the “elephant in the room,” Leape cited a culture in health care that tolerates disrespectful behavior among doctors, nurses, students and patients as a barrier to patient safety. He told the audience that disrespectful behavior takes many forms, some blatant and some less immediately apparent.

“BMC’s RESPECT attributes are a real step forward,” Leape said, addressing the hospital’s recently revised RESPECT behavioral attributes. “I don’t know of other hospitals locally who have done something like that.”

Nearly two-thirds of the audience raised their hand when Leape asked who has, in some way, been part of or touched by the RESPECT attributes.

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BMC Benefits 2014: Open Enrollment Preview

Benefits Enrollment for 2014 will begin Nov. 1 and run until Nov. 18. This is the time of year when employees select their benefits for the coming year. Below is an overview of key benefit changes. Detailed benefits information will be mailed home to staff this month.

Health Plans:
BMC will continue to offer three health plans, but is modifying the structure and names of two of them.

  1. The BMC Preferred plan is changing its name to BMC Select. This plan will use the BMC Management Services Organization as the new network and eliminate the referral requirement to see a specialist.
  2. The Harvard Pilgrim Health Care HMO plan is being renamed the BMC Tiered HMO and places the current network of providers on one of three tiers based on cost. This will allow employees who see lower cost providers to share in the cost savings. Employees who choose to see a high cost provider will pay a higher copayment.
  3. There is no change to the Harvard Pilgrim Health Care PPO plan.

“The 2014 BMC health plan changes will provide employees with options to ensure they can select a plan that best suits their needs and that of their families,” says Kerry Ryan, Director, Benefits.

Life Insurance:
BMC is enhancing its life insurance benefit, increasing the basic coverage amount from $10,000 to $50,000. This benefit is also being offered to all benefits-eligible employees.

Disability Insurance:
BMC has upgraded this benefit to provide all employees with basic short-term disability insurance. Staff will be automatically enrolled in the program and will not need to contribute toward the cost of coverage. BMC is also extending its basic long-term disability coverage to all benefits-eligible employees.

“The health and wellness of our staff and their families are incredibly important to us,” says Lisa Kelly-Croswell, Vice President, Human Resources. “I am excited about the 2014 BMC benefit offerings and the enhancements that have been made to our program especially in today’s affordable care environment. Employees have a variety of benefits options to choose from to ensure they have the best plan for them and access to the best care possible.”

BMC’s Open Enrollment runs Nov. 1-18. To learn more about Open Enrollment, visit the Human Resources section of the intranet.

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Six Months Later: Schwartz Rounds Tackles Healing Process of Caregivers in the Wake of Marathon Bombings

It has been six months since Marathon Monday, a day that in years to come will never be the same for many Bostonians. On Oct. 15, BMC’s Schwartz Center Rounds marked the anniversary and served as an opportunity for staff to gather as a community and assess its collective healing progress.

Schwartz Rounds
Schwartz panelists address the crowd

Schwartz Center Rounds are held in more than 200 facilities in 32 states and commemorate Kenneth Schwartz, a Massachusetts health-care lawyer diagnosed with lung cancer in 1994 who believed in nurturing the compassion in medicine. The rounds provide a forum where BMC caregivers from multiple hospital disciplines come together to discuss the emotional impact and challenges of patient care based on an actual case. The Oct. 15 rounds however, focused on a different theme; the events of the Boston Marathon tragedy and the importance of caregivers’ self-healing.

Thomas Barber, MD, Schwartz Rounds Physician Leader, and Carol Mostow, LICSW, Schwartz Rounds Facilitator, introduced the topic of remembering vulnerability, celebrating strength and integrating lessons for everyday work six months after the Marathon. Panel speakers included Jared Greer, Certified Radiology Technician; Doug Comeau, DO, CAQSM, FAAFP, Director of Sports Medicine; Jeffrey Kalish, MD, Director of Endovascular Surgery; and Elizabeth Dugan, LICSW, Manager, Violence Intervention Advocacy Program. Each panelist provided their unique perspective and experience of the April 15 tragedy.

Comeau told the audience that he was stationed in a medical tent at the Marathon finish line and spoke of the chaos that ensued following the bomb.

“The ground shook like fireworks were going off and there was complete panic. I didn’t know if my team, the people I had worked with for so many years, was alive,” he recalled. “That kind of vulnerability stays with you.”

Greer was working when the influx of patients from the marathon hit BMC.

“It was complete chaos,” he said. “But one good thing that came out of it is the renewed respect that I have for my colleagues. Everyone pulled together and my relationship with other departments was completely changed, in a good way, and it made me proud to work here.”

Kalish, as a member of the surgical team who operated on many of the most gravely injured patients, also spoke of the camaraderie.

“The usual hierarchy was gone. Everyone worked together and did whatever needed to be done. From nursing to transport to housekeeping, everyone pitched in and it created an extremely productive environment,” he said. “Quite frankly, this is a model that we should be using more often.”

Dugan offered insight on how violence affects many of the patients BMC sees every day and challenged the room to acknowledge their success in caring for the patients that day and carry it forward to future patients.

When the platform turned to the audience for reflection, the mood was hopeful as participants spoke about taking the time to focus on getting help to move past such a tragic event.

“One of the charges of running a marathon is the cheers you get along the way,” summed up Mostow. “By acknowledging the amount of tragedy we see, we are showing compassion for ourselves. Everyone needs to be cared for. Caregivers are no exception.”

BMC continues to offer a range of support services to staff as they heal. To learn more, visit the Human Resources section of the BMC intranet.

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BMC Offers Free Mammography Screenings to Women in Need

According to the American Cancer Society, more than 40,000 women die of breast cancer in the United States each year. Research has shown that the best chance of survival for those diagnosed with breast cancer is early detection, but what about women who don’t readily have access to care?

Breast Imaging Staff
Breast Imaging Staff

On Oct. 19, BMC did its part to ensure that homeless women in the Greater Boston area had access to screening, potentially saving lives. As part of Breast Cancer Awareness Month, Cancer Care Services hosted a free breast cancer screening event in the vibrantly pink-clad Moakley Building lobby.

In collaboration with Boston University, transportation was made available to homeless community members from the Pine Street Inn, Barbara McInnis House and Rosie’s Place, who may otherwise lack the resources to get to the hospital.

As the serene sound of harpist Linda LaSalle filled the room, attendees visited educational booths, spoke with providers and more than 40 women received screenings. The mammogram results were read to patients in real-time, so attendees would not have to schedule follow-up appointments unless further tests were recommended. In addition, BMC provided warm gloves as gifts to the women and served a hot breakfast to the crowd.

“The event was a huge success. All of the volunteers involved were happily surprised by the turnout of women who took advantage of such a wonderful opportunity,” said Holly Frank, RT, Manager of Breast Imaging and the mastermind behind this event.

Eligible patients received support from BMC’s Patient Financial Services and a B.J.’s Shopping Club donation to defray the cost of the care. In addition, T.J. Maxx generously donated bras, which BMC distributed to the local homeless shelters.

“From the moment we started planning the event, everyone from Cancer Care Services, Food Services, Public Safety and our own Breast Imaging staff were eager to volunteer,” says Frank. “We’re already looking forward to planning next year’s event!”

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What’s for Dinner?

Autumn is in full swing and along with it, pumpkin season! Celebrate it with this easy, delicious dessert from the Demonstration Kitchen’s Tracey Burg.

Pumpkin Mousse

This silky, smooth mousse is a healthier option for pumpkin pie that is just as tasty. Made with a handful of simple ingredients, this lighter-than-air dessert is the perfect sweet ending to your favorite fall meal!

Pumpkin Mousse

Ingredients:

  • 1 package 4-serving size Sugar-Free Instant Vanilla Pudding Mix
  • 1 cup Fat-Free Milk
  • 1 15 oz. can Pumpkin
  • 1 1/4 tsp Pumpkin Pie Spice
  • 2 cups Cool Whip Sugar-Free

Directions:

  1. In a large bowl, beat milk and pudding mix with a whisk until well blended, about 1 minute.
  2. Mix in pumpkin and spice until well blended.
  3. Gently fold in whipped topping.
  4. Cover with plastic wrap and refrigerate for 2 hours before serving.

Nutritional Information Per Serving:
Makes eight half-cup servings.

  • Calories: 71
  • Total Fat: 1 g
  • Saturated Fat: 0 g
  • Cholesterol: 1 mg
  • Carbohydrates: 15 g
  • Dietary Fiber: 2 g
  • Sodium: 188 mg
  • Protein: 2 g

Diabetic Exchange: 1 starch

Do you have a recipe that you would like to share with the BMC community? Send it to communications@bmc.org and we’ll feature it in a future issue of the BMC Brief!

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What do you do, Joanne Timmons?

Name: Joanne Timmons, MPH
Title: Manager
Department: Domestic Violence Program
Time at BMC: 6 years

Joanne Timmons, MPH
Joanne Timmons, MPH

What brought you to BMC?
I was working at the Boston Public Health Commission as director of the Domestic Violence Program. My role involved supporting hospital-based domestic violence programs, so when a position was created at BMC to build a program, it felt like a natural and exciting next step for me.

What do you do?
I helped develop a program that works across all departments to coordinate and improve the hospital’s response to domestic violence as a health care issue. I develop policies and protocols and make sure existing ones are consistent with best practices. I work alongside an amazing team of three advocates who help educate and train staff on how to respond to victims of domestic violence, whether they are patients or colleagues. Another large part of my role is to continue to bring in resources for the program, writing grant proposals and managing grant budgets and reporting.

Is it typical for hospitals to offer resources to victims of domestic violence?
Many Boston hospitals have offered these services, but nationwide this is not a typical health care model. There are hospitals developing training programs, but Boston is on the forefront of providing services on site. It is crucial for health-care providers to realize the impact of domestic violence and provide appropriate resources to survivors who are seeking help.

October marks Domestic Violence Awareness Month. What is BMC doing to raise awareness of this issue?
Our department hosts the “Massachusetts Silent Witness Exhibit” to honor those lost to domestic abuse over the past year. The exhibit consists of a collection of life-size silhouettes that share the stories of victims. We move the figures around to different areas of the hospital during the last week of October to raise awareness.

Is your department working on any new projects?
One of our priorities is to continue building our capacity to serve patients who speak different languages. Our Domestic Violence brochure is now available in nine languages and we continue to work with Interpreter Services to accommodate our patients’ needs. We also are developing more efficient methods of data collection and reporting to improve our services and support fundraising efforts.

What do you like most about working at BMC?
At BMC I have the opportunity to focus many of my interests and passions into an issue that affects many people and impacts health in so many ways. I am honored to work with such a dedicated and talented team and an inspired by the strength of the survivors we serve.

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

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In Their Words

Jeffrey Kalish, MD, Vascular Surgery, wrote this opinion editorial that was published in the Boston Globe on Oct. 16, to reflect on lessons learned in the wake of the Marathon tragedy. Below are his words.

Working at Boston’s largest Level One Trauma Center, the staff at Boston Medical Center care for patients with complicated medical issues every day. But as we all have come to understand, April 15, 2013, was not like any other day, and the events that our nation observed have forever changed the way many of us approach medicine.


Jeffrey Kalish, MD

All of us at BMC who were involved with Marathon Monday and its aftermath think about that day while moving forward with our daily lives and work. We all had different reactions and adjustments to the violence that transpired six months ago. While many of us are still working through our personal challenges associated with the tragedy, many more have likely placed the incident in a mental storage compartment in order to facilitate forward progress. However, not a day goes by when we do not think about the Marathon and how we can take the lessons learned and apply them to our future trauma victims and patients.

Like most hospitals, BMC spends a significant amount of time preparing for large-scale disasters. Detailed plans are in place for every department, and staff are trained for a wide range of events in order to facilitate a sense of clarity during the most chaotic of circumstances. As expected, and to the credit of all involved, the staff at BMC executed the tactics of those plans brilliantly on Marathon Monday. Because of this level of preparation and collaboration, we were in the right position to work together to save lives. Multi-disciplinary teams were created to provide the ideal care to every patient, and input was valued from all members of the extended care team. The renewed sense of partnership among colleagues, and a deeper sense of appreciation for the contribution of all of those involved in the delivery system, allowed us to provide the optimal experience and outcomes for our Marathon patients.

On Marathon Monday and the weeks afterward, this collaboration extended across the entire hospital spectrum, with staff joining together to do anything and everything to care for those who came through our doors. The examples are far beyond the limited specifics that can be detailed here: neurosurgeons pushed gurneys, nurses painted patients’ fingernails, nurse practitioners and physician assistants facilitated visits outside of BMC when patients and loved ones were at different hospitals, surgical residents and medical students brought in treats patients wanted just to help them push through one more arduous day, and dietary staff baked birthday cakes so special days did not go unrecognized.

The Marathon showed us what we do well, but also taught us things we can improve upon. In the Division of Vascular Surgery, where I work, one meaningful outcome was the creation of a multi-disciplinary collaborative team across various specialties and departments to coordinate the optimal care for future lower extremity amputation patients and their families. The team includes surgeons (Vascular, Plastic, and Orthopedic), nurses, physical therapists, rehabilitation specialists, pharmacists, psychiatrists and psychologists, social workers and patient advocates. Our goal is to enhance the outcomes and experiences for these patients as they make short- and long-term adjustments to their “new normal.”

On a personal level, the Marathon tragedy has linked patients and caregivers in a unique way because of the sheer magnitude of the event, the national attention, and the hopes and prayers from people all over the world asking us to help these patients heal and move on to what inevitably will be a very different way of living for them and their families. Without a doubt, the intensity of this experience created long-lasting relationships among the patients themselves, but unique bonds also formed between the caregivers and their patients.

All of us try extremely hard to provide exceptional care to our patients in a manner that we would expect for our loved ones, in an environment where patients feel supported both physically and emotionally, and where patients can be heard and become part of the care team. Unfortunately this model has not always been the norm as our health-care system has undergone dramatic change, and doctors and hospitals are under unprecedented economic pressures and time constraints. In an ideal world, it would not have taken something like this tragedy to wake us all up to our own collective shortcomings. But for many of us, Marathon Monday is now a powerful reminder of why we became doctors or caregivers in the first place, and has created a reinvigorated model of compassionate health are that will benefit all of our patients as we move forward into the future.

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News of Note

Cancer Care Center Staff Leads the Way at Oral Cancer Fundraiser
On Oct. 6, staff members from the Head and Neck Surgical Oncology Program participated in the Oral Cancer Foundation Walk for Awareness around the Chestnut Hill Reservoir in Brookline. Led by Scharukh Jalisi, MD, FACS, and Andrew Salama, DDS, MD, the team hit the pavement to promote awareness of oral cancer, treatment advances and research. Participants raised more than $25,000 for the Oral Cancer Foundation

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Awards and Accolades

Brian Jack, MD
Brian Jack, MD

Chief of Family Medicine Brian Jack, MD, Elected to Institute of Medicine
Brian Jack, MD, Chief of Family Medicine at BMC, and professor and chair of Family Medicine at BU School of Medicine, has been elected to the prestigious Institute of Medicine (IOM). Established in 1970 as the health branch of the National Academy of Sciences, the IOM has become recognized as a national resource for independent, scientifically informed analysis and recommendations on health issues. Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service. Inductees are chosen by current active members through a highly selective process that recognizes individuals who have made major contributions to the advancement of the medical sciences, health care and public health.

BMC Honored at 100 Club Annual Dinner
Emergency Department nurses Rose Gentile and Barbara Dwyer recently attended the 100 Club’s annual dinner at Boston’s Park Plaza Hotel. The nurses accepted a citation on behalf of BMC that recognized the hospital for its commitment and dedication to the care and recovery of victims of the Boston Marathon tragedy. The 100 Club, a philanthropic organization dedicated to serving law enforcement and public safety organizations, made the Marathon first responders the focus of this year’s event. The 100 Club annually honors those who contribute to Massachusetts’ public health and safety at its dinner. This year’s awards included BMC for the role it played on the day of and days following the attack.

Gerard Doherty, MD
Gerard Doherty, MD

Chief of Surgery Gerard Doherty, MD, Named Editor of Groundbreaking Video Medical Journal
Gerard Doherty, MD, BMC’s Surgeon-in-Chief, has been named Editor of VideoEndocrinology, a groundbreaking new educational resource for endocrine surgeons, otolaryngologists, endocrinologists, radiologists and other specialists. VideoEndocrinology is a peer-reviewed, rapid publication platform for high-quality video presentations and will provide a dynamic new venue for surgeons and physicians to share their techniques and showcase new approaches. Doherty also is President-Elect of the American Association of Endocrine Surgeons (AAES). He sits on the Board of Directors of the American Thyroid Association and has held multiple leadership positions in national and international professional groups, including the Council-Coordinator of the International Association of Endocrine Surgeons.

Bariatric Surgeon Donald Hess, MD, Receives Department of Medicine Collaborator of the Year Award
Donald Hess, MD, Section Chief, Bariatric Surgery, is the recipient of the 2013 Department of Medicine Evans Center Clinical Collaborator of the Year Award. The award is given yearly to investigators who have contributed to the Research mission of the Evans Center for Interdisciplinary Biomedical Research (ECIBR) by creating and/or significantly enhancing webs of interdisciplinary collaborations within the Evans Center and BU. Hess' clinical practice focuses on minimally invasive and bariatric surgery.

Gold Award

BMC Receives Gold Award from American Heart Association
BMC has been recognized for its achievement in implementing the American Heart Association/American Stroke Association Get With The Guidelines (GWTG) for stroke care. GWTG helps ensure that stoke patients treated and discharged receive quality care in accordance with guidelines that will reduce the risk of recurrent events. This accomplishment signifies that BMC has reached an aggressive goal of treating stroke patients with 85 percent compliance to core standard levels of care outlined by the American Heart Association/American Stroke Association secondary prevention guidelines and recommendations.

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