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July 21, 2016 Volume 5, Issue 7

Boston Medical Center Celebrates 20 Years

July 1, 2016 marked the 20th anniversary of the joining of Boston City Hospital and Boston University Medical Center Hospital to form Boston Medical Center. Since then, Boston Medical Center has been carrying out its mission to serve underserved populations in greater Boston. While the milestone marks two decades of exceptional care, campus leaders took the opportunity to look ahead to the next 20 years and beyond for BMC.

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“We’ve achieved many significant milestones over the past two decades, building on the 150-year history of our institutions,” says Kate Walsh, CEO and President. “BMC has moved to the forefront of a new health care landscape, rising to meet the challenges of a changing health care environment, working together to achieve financial stability and expand our health system to provide more integrated, comprehensive care for patients and families. Through it all, we’ve been guided by our commitment to providing the highest quality care to all patients.”

The path to the merger began in 1992, when Boston undertook studies to determine the best way to run its health care system. The studies found that moving it out from the city was the best solution, and that there were natural synergies that made it beneficial to merge BCH and University Hospital. The merger was part of a national wave, as hospitals around Boston and across the country came together to create new health systems designed to deliver better care more efficiently. The legislation allowing for the merger also included the creation of the Boston Public Health Commission. At the same time, the Boston HealthNet, an integrated health care delivery system of twelve community health centers, BMC, and BU School of Medicine was established. Together these three entities were envisioned as a new public health system for Boston, working with BMC to provide exceptional care without exception.

“Boston City Hospital and University Hospital were complimentary hospitals,” says Tom Traylor, Vice President for Government Programs, who was involved in the merger process. “Together they were population health and specialty care oriented, with historic missions that can be seen in the current BMC programs. The merger was hard work, but has been very successful. The vision we had is still the right one and it’s even more important than ever.”

Building for the Future

The merger consolidated many services on campus, but the vision of the merger – to create one hospital – is culminating in BMC’s current clinical campus redesign project. As health care reform takes place, the types and number of beds needed changes, as we care for patients in different ways. The campus redesign, therefore, will not only consolidate services and reduce costs – by $25 million per year – but also create the kind of space necessary to continue to provide exceptional care.

“Our clinical campus redesign is setting BMC up to be the type of hospital we need to be to thrive for the next 20 years and beyond,” says Bob Biggio, Vice President of Facilities. “Spaces like the Demonstration Kitchen and the new Yawkey cafeteria help us create a more vibrant, community-facing campus. We’re Boston’s community hospital and the redesign project is helping us create spaces that reflect that. The goal is to create a physical space that promotes wellness and health, not just a place to go when you get sick.”

BMC is also building for the future through sustainability efforts. While other hospitals plan on reaching sustainability goals such as reducing fossil fuel consumption to 50 percent below current levels by 2050, BMC is on track to meet the same goals by 2020.

“We’re designing spaces in ways to allow for future growth and flexibility,” says Biggio. “For example, we’re utilizing green technology to plan for the Power Plant eventually being torn down, which will provide more space. We also put up the transport bridge over Albany Street in part to connect the current campus with land that has potential for future hospital buildings – it’s truly a bridge to the future.”

Investing in People

While new buildings can create more modern, efficient spaces for care, it’s BMC employees who actually provide that care and help ensure that BMC continues to thrive. Employee development, education, and engagement are therefore central to moving BMC into the future.

“The most important thing about our past is the people, and while we often focus on the clinical areas and the buildings in the future, it’s the people and how they have built this organization, the pride, the excellence in care, the patient-centeredness, that are most important” says Nancy Gaden, DNP, RN, Senior Vice President and Chief Nursing Officer. “I believe that BMCs greatness comes from the people who work here. They are what makes BMC great from the physicians and clinical staff to the support areas across our organization. They bring their expertise and passion to the future of the organization.”

“We’ve developed a professional practice model to guide our work at BMC,” says Diane Hanley, MS, RN-BC, EJD, Associate Chief Nursing Officer and Senior Director, Nursing Education, Quality, and Professional Practice. “The pillars of this model are to respect the primacy of patients, a culturally competent care delivery model, nurse autonomy, shared governance, interprofessional collaboration, innovation, and a culture of safety. These pillars are worked on individually, but together help us create a foundation to move into the future with empowered nurses and patients.”

To promote a culture of safety, nurses are being given access to safety data at unit levels and being empowered to use these data to implement change, such as using I-PASS for bedside handoff. A pilot is currently being implemented to improve communication between physicians and nurses, which will allow for better coordination of care and interprofessional collaboration. In addition to creating a better care experience for patients, BMC is also helping ensure that nurses themselves are healthy and engaged as the hospital moves forward, through programs such as a wellness competition smartphone app and the creation of nursing councils for individual units.

“There are major changes happening both in health care in general and at BMC, particularly with the consolidation of campus buildings,” says Hanley. “Great change needs great resiliency and we’re working on ensuring that staff have the tools they need to adapt to these changes and move into the future. You need to take care of yourself to be able to take care of patients.”

Physicians have also seen many changes over the years and are working to help move BMC into the future. For example, physicians will be working together in new ways, for example by bringing protocols for different specialties into common areas, such as the hybrid operating room, so interdisciplinary teams can share technology and knowledge for cutting-edge clinical work and research.

“By moving into one site, BMC will truly have integrated delivery of care, which will allow us to work further on improving quality and transforming care,” says William Creevy, MD, a BMC orthopedist and President and CEO of the Faculty Practice Foundation, the multi-specialty academic group practice that physicians at BMC are members of. “This is work that we all do every day and that we will continue to do.”

New Ways to Care for Patients

As BMC looks at the next 20 years and beyond, the health care system as a whole is looking at how to best serve patients in the future. MassHealth, which accounts for 50 percent of BMC’s payment structure, is no exception. Next year MassHealth is moving to an accountable care framework as a means to better care for patients and slow spending. In response, BMC is forming its own accountable care organization (ACO) to ensure that patients get the care they need in the changing health system. The new ACO structure will change the way BMC receives payment from MassHealth, from a fee-for-service model to a lump sum per patient for all of that patient’s care. Under this new model, if there is a surplus, BMC is able to keep it, but must absorb any deficit. The change in payment structure creates new incentives to better coordinate care across all providers in the ACO, and in turn improve outcomes.

“BMC has a strong legacy of caring for the whole patient, and the ACO will allow us to address the barriers to providing the best integrated care in a more systemic way,” says Thea James, MD, Vice President of Mission, an emergency room physician, and Associate Chief Medical Officer. “Moving from a fee-for-service model will allow us to expand and reinforce the programs we already have, such as the Preventive Food Pantry, that keep people healthy and address social determinants of health, rather than just treating patients when they need episodic care.”

“This is an incredible organization that we have to steward into the next 150 years, and I think that our legacy will continue,” says Ravin Davidoff, MD, Senior Vice President and Chief Medical Officer. “We have to protect that legacy and ultimately truly appreciate the privilege of caring for patients in an environment that is totally committed to every patient who walks through our doors, regardless of their ability to pay.”

“Even as we mark this milestone, this is a time to look forward,” says Walsh. “Our health system is well-positioned to lead in the decades to come. As we work together toward our priority goals and as we invest in initiatives to prepare for the road ahead, together we are writing a bright future for BMC.”

Learning to Ask Patients "Why?"

After finishing four years of medical school, most soon-to-be interns are taking a much needed break until beginning their new jobs. Like at many hospitals, incoming interns at BMC give up part of their break for orientation. But unlike at most other hospitals, the orientation curriculum at BMC included a new training module about social determinants of health, which are structural determinants and conditions that can affect health, such as socioeconomic status, employment, housing, and social support.

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“In this country, we spend more money than any other on health care, but the outcomes don’t reflect that investment,” James said. “Research has found that the biomedical model, which is the traditional view of medicine, accounts for only 20 percent of health, while social determinants account for 60 percent. Because of this, the health care system is becoming more about keeping people well along the continuum of care, not just episodic care.”

The training brings together all interns for a day and a half before they start at BMC. During that time, they attend a lecture on social determinants of health and a video training run by physicians and residents. Attendees were shown a video of an encounter between a resident and a patient, followed by a discussion of what could have gone better. They were then shown a video of the resident and attending physician discussing the patient and two more of progressively better patient encounters, both followed by discussion. For example, in one exercise residents were encouraged to probe to understand why a patient wasn’t adhering to his medication regimen. The answer? Limited financial resources meant he was choosing between food for his family and filling his prescription. The videos and discussion highlighted the importance of including the patient in the conversation and accommodating their needs and preferences as much as possible for optimal care.

“There have been pockets of work in this area at BMC, but this is the first year we’ve had an institutional approach to this shared problem,” says Jeffrey Schneider, MD, an Emergency Department physician and the Chairman of the Graduate Medical Education Committee at BMC. “We wanted to teach interns about social determinants of health in their first 24 hours of being BMC employees, because it’s a critically important lens to use, and one that is very important to BMC, given the population we serve. It’s consistent with our longstanding approach to treat the whole patient.”

The social determinants of health curriculum was developed by Thea James, MD, attending physician in the Emergency Department, Vice President of Mission, and Associate Chief Medical Officer. While James and Schneider are still reviewing feedback from the training, they say they have anecdotally received positive feedback. Most importantly, the training revealed that there is a need to teach more about social determinants of health.

“When we asked who had heard about social determinants, only a few people in the room had,” said Schneider. “However, we have an engaged and interested housestaff, many of whom come to BMC to learn about how to care for patients in this way. They’re on the front lines of care and we are fortunate to have the infrastructure here to teach them these necessary skills to be effective physicians. In addition, many of our residents eventually leave BMC, and we anticipate they will be able to bring these skills elsewhere, build the type of infrastructure necessary to address social determinants, and be able to teach others.”

The key to incorporating social determinants of health into medical care, according to James and Schneider, is to do three things: don’t make assumptions about a patient, ask why, and engage the patient in their care. By doing this, you will be able to figure out what a patient needs and what in their daily life might keep them from getting optimal medical care. With this knowledge, you and the patient can partner to make a plan that will help them stay healthy.

“Not everyone needs the same thing,” says James. “The goal is equity – care that properly addresses each person’s needs, rather than the same, or equal, care for everyone. Providers should work on leveraging a person’s strengths and assets so that they can be independent and stay well.”

Because of the importance of screening for and addressing social determinants of health, James and Schneider, along with a group of interested and committed residents, are working on developing a longitudinal, clinically-based curriculum to develop and reinforce residents’ skills, with an emphasis on the fact that addressing these social determinants is everyone’s job, from primary care physicians to specialists to nurses to schedulers.

“It’s one thing to have the mindset that social determinants of health are important, but now health reform is building a system where addressing them is not only crucial to a patient’s health, but also to an organization’s financial health,” says James. “We’ve prepared well at BMC, with robust programs and services and relationships with outside services. But it’s up to us to work with the patient to determine their needs and close the circle to make sure those needs are met.”

For more information on this training module and social determinants of health, see the recent article on WBUR.

BMC Provides More than Physical Care for Patients Impacted by Violence

Boston Medical Center, as the busiest trauma center in New England, is well-equipped to tend to the physical wounds of victims of violence. However, the hospital’s focus on treating the whole person recognizes that helping a patient and their family recover from violence is about more than treating physical injuries. To help with the healing process, the Community Violence Response Team (CVRT) offers free mental health counseling for patients and families impacted by violence.

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The CVRT, which is based out of Trauma Services in the Department of Surgery, partners with the Violence Intervention Advocacy Program (VIAP) to offer wraparound services to inpatients and outpatient survivors of gunshots, stabbings and others, as well as survivors of life-threatening assaults. BMC is the only hospital in the country with a fully integrated, hospital-based violence mental health program, and the largest of similar, hospital-affiliated programs. Services are also offered to families and friends of homicide victims. Counseling from the CVRT is voluntary, and if patients and families opt in, counseling can start immediately. The team also keeps in touch with people who may want to start counseling in the future, so they can provide services whenever the patient or family is ready.

Counseling is adapted based on individual needs. All members of the team are licensed clinical social workers or licensed mental health counselors and provide services ranging from crisis intervention to long-term, regular counseling. Beyond being a victim of violence or a family member or friend of a victim of homicide, there are no restrictions on who can receive services; they are not based on health insurance. The team serves approximately 1,000 people per year, 70 percent of whom receive counseling in their homes or at other places in their communities.

The CVRT began five years ago, with its genesis in a forum Boston held for homicide victims and their family members to discuss what services they needed and wanted. In response to those stated needs, The Massachusetts Office for Victim Assistance (MOVA) began to provide funding for free mental health counseling for victims of violence and their families through the federal Victims of Crime Act. Because 70 percent of penetrating wound victims in Boston come to BMC, the hospital was a natural fit to provide these services.

“BMC has always been devoted to the mental health care of victims of violence – we see it as just another part of their care,” says Lisa Allee, LICSW, MSW, BMC’s Injury Prevention Coordinator and the director of the Community Violence Response Team. “However, there’s also a growing body of research that shows that mental health programs as a component of treatment for violence reduces recidivism, hospital utilization, and costs. It’s an exciting time in this field, as we build evidence to validate what people are telling us they need.”

The team currently has three clinicians, and has recently added additional funding for two more clinicians, a case manager, and a family support advocate. The case manager and family support advocate will help link patients and families to community resources, as well as allow clinicians to better focus on counseling. The team also plans on starting support groups, first for family members of gunshot and stab wound survivors and for adolescents.

“Our families deserve the best possible care and their emotional and mental health are no exception,” says Allee. “We are thrilled to be able to offer these services and support our community.”

For more information, visit the CVRT website.

What do you do, Beth Milaszewski?

Name: Beth Milaszewski, LICSW
Title: Working Well clinician
Time at BMC: One month

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Beth Milaszewski, LICSW

What brought you to BMC?
I came here to be able to provide trauma relief for caretakers. BMC employees see a lot of trauma, whether it’s physical trauma or social trauma such as poverty and violence in the patient population. This can cause a lot of stress, which can then cause burnout, and I wanted to be able to help employees before they burnt out.

I have experience providing support to first responders and the military, and I also used to work at an employee assistance program, so coming here was a perfect combination of some of that work.

What do you do here?
I’m a clinical social worker, which means it’s my job to provide immediate counseling support for BMC employees. I help employees develop stress management skills, lead resiliency training, and help people come back to a stable place after being exposed to trauma. The overall goal is to help employees become more resilient and better able to deal with the flight or fight response, so that they are less likely to get burnt out from chronic stress.

Employees can call me themselves – which is what usually happens – or be referred to me. When someone wants my services, which are confidential, I meet them at a convenient place and we talk through their issue and come up with potential solutions or ways to cope. Sometimes I see employees once and sometimes more often, but I don’t do long-term individual counseling – if someone needs those services, I help them find the right place to get them.

I’m at BMC Monday, Wednesday, and Friday. Employees can contact me by calling 4-4357 or paging me at 8010.

What’s the top thing you want people to know about Working Well coaching?
The thing I want people to know is that if you’re having a hard day or have had a difficult patient encounter or something hit you emotionally deep for any reason, you have support. You don’t have to deal with the issue alone. I am here purely to provide support for employees, and I feel very comfortable talking about whatever you need to talk about, even if it is severe trauma.

What do you like most about working at BMC?
Everyone I’ve met is so friendly and open. It really seems like there’s a common mission to help others. In addition, the diversity of BMC is fantastic.

What do you do for fun outside of work?
I have 12-year-old twin girls, so I spend a lot of time hanging out with them. I love being outdoors – hiking, kayaking, and biking. I also really like reading and watching movies.

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

In Their Words

Patients share their BMC experience

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To Whom it May Concern:

On Saturday, June 11, I had the misfortune of falling on an uneven street near your facility. Little did I know it would lead to one of the most memorable and positive experiences I have had on this or any other trip. I will remember Boston far more for your emergency room than for the tours we took or the food we ate at Quincy Market.

From the moment I walked in the door with my badly dislocated finger, I was treated with kindness and efficiency. I was given a bed, a warm blanket, pain medication, and help within a very few moments. I was sent immediately to x-ray, received the results quickly, and within a very short time, I knew exactly what needed to be done.

Dr. Kelly Mayo is high on my list of heroes. She gave me confidence and allowed me to make a choice as to how to proceed. She very quickly and skillfully put my finger back in place, wrapped it, explained follow-up treatment, and even walked me to the door of your emergency room.

Dr. James Feldman was also there, giving guidance and reassurance. He even brought me a ginger ale because I was a little wobbly. In fact, every employee I encountered was compassionate and professional.

We hear so much about bad medical care these days, so I wanted to be sure to give you my highest recommendation. Boston Medical Center Emergency Department does it right and I will be forever grateful.

Nipomo, California

News of Note

Biomedical Bridge BUilders Initiative Launched
Biomedical Engineering and the Clinical and Translational Science Institute recently announced the creation of the Biomedical Bridge BUilders Initiative, a new collaborative program. The program will pair clinical care providers with graduate engineering biodesign and product development teams to accelerate the commercialization of clinician-inspired medical device innovations.

All clinical care providers are invited to send a one page or less description of a medical device to address a clinical challenge. These descriptions can be an early product idea or a project that is already underway that could benefit from a team of graduate biomedical engineers (BME), trained in the biodesign product development process. Teams will consist of a BME faculty supervisor plus four BME students and graduate students from other BU Engineering Departments if their specialty skills are required. If your idea is selected, you will serve as the primary clinical advisor to the team, meet with them on a regular basis, and serve as their sponsor for their clinical observership so that they can see the current standard of care firsthand.

Applications are currently being accepted and projects will begin on September 2. Applications and questions can be sent to [email protected].

Boston Medical Center Health System Names New Board Members
Boston Medical Center Health System has elected James S. Phalen as chairman of its Board of Trustees. Matthew Botein and James Blue were also named as new trustees. The BMC Health System Board oversees the operations of Boston Medical Center and BMC HealthNet Plan and their affiliates.

Phalen is vice chairman and executive vice president at State Street Corporation, where he has held numerous positions, including head of global operations and technology, as well as head of international operations for investment services and investment research and trading. He was formerly chairman and CEO of CitiStreet, one of the largest global benefits delivery firms in the country.

Botein is managing director as well as the global co-head and chief investment officer of BlackRock Alternative Investors, where he manages a portfolio of more than $100 billion. Prior to joining BlackRock in 2009, he served as managing director at Highfields Capital Management, a Boston-based private investment partnership. He serves on numerous boards including PennyMac Financial Services, Northeast Bancorp and Alliance Partners LLC. He is chair of the BMC Health System Investment Committee and a member of the BMC Exceptional Care Without Exception Trust.

Blue is chief executive officer of MMA New England (formerly Bostonian Group), which he joined in 1989. In 2005, he founded and funded The Bostonian Group Charitable Foundation, now Community Connections Foundation, to act as the firm's philanthropic arm. Under his guidance, the Foundation now makes donations annually to nearly 60 local charities, including Answer House, Boston Health Care for the Homeless, Rodman Ride for Kids, Project Bread/Walk for Hunger, Boys & Girls Club of Dorchester, Catholic Charities and the Cystic Fibrosis Foundation. He is a BMC Health Plan Trustee and a member of the BMC Exceptional Care Without Exception Trust Board.

Jeffrey J. Siracuse, MD, RPVI, Named Medical Director of the Pre-Procedure Clinic
Jeffrey J. Siracuse, MD, RPVI, an attending surgeon in the Division of Vascular and Endovascular Surgery at BMC and assistant professor of surgery and radiology at BUSM has been appointed medical director of the Pre-Procedure Clinic at BMC.

Siracuse received his medical degree from New York Medical College in Valhalla, NY. He completed a residency in general surgery at Beth Israel Deaconess Medical Center/Harvard Medical School, a research fellowship in the Harvard-Longwood Vascular Research Training Program, and a clinical fellowship in vascular and endovascular surgery at New York-Presbyterian Hospital/Columbia University College of Physicians Surgeons and Weill Cornell Medical College.

Richard K. Babayan, MD, Named President of the American Urological Association
Richard K. Babayan, MD, Chief of Urology at Boston Medical Center and Professor and Chair of the Department of Urology at Boston University School of Medicine was appointed as the 2016-2017 President of the American Urological Association, a professional medical association with more than 22,000 members.

Babayan has previously served in local, national and international urological associations. He was the New England Section representative to the AUA Board of Directors from 2005-09 and served as President of the Massachusetts Association of Practicing Urologists from 2012-14. In 2011, Dr. Babayan received the AUA's Distinguished Service Award, and in 2013, the New England Section awarded him with the Joseph B. Dowd Lifetime Achievement Award. He currently serves on the Medical Advisory Board of the Massachusetts Prostate Cancer Coalition.

Awards and Accolades

Thea James, MD, Receives the Barney L. Simms Trailblazer Award
Thea James, MD, attending physician in the Emergency Department, Vice President of Mission, and Associate Chief Medical Officer, has received the Barney L. Simms Trailblazer award from Atlanta Victim Assistance, Inc., an organization that advocates for the rights of victims and witnesses of crimes. James was selected for her work in founding the “groundbreaking” Violence Intervention Advocacy Program, which has become a national model for violence prevention programming.

Emelia J. Benjamin, MD, ScM, FAHA Receives the 2016 Gold Heart Award
Emelia J. Benjamin, MD, ScM, FAHA was selected as a recipient of the American Heart Association’s 2016 Gold Heart Award, the highest honor given by the association. Benjamin was recognized by the association for outstanding contributions supporting the development and mentoring of early career investigators and her continued, distinguished service as a physician and to the AHA.

Boston Medical Center Named a “Most Wired” Hospital
Boston Medical Center has been honored as a “Most Wired” hospital by the American Hospital Association. The award recognizes hospitals that leverage IT to improve performance for value-based health care in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration.

Alysa Veidis, MSN, RN, FNP-BC, Appointed to Massachusetts Special Commission
Alysa Veidis, MSN, RN, FNP-BC, associate medical director in the department of family medicine at BMC, has been appointed by Massachusetts Governor Charlie Baker to serve on a special commission. The commission will examine the feasibility of establishing a pain management access program, with the goal of ensuring that individuals who need medication for pain have access to safe and effective treatment options.

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