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The BMC Brief

The BMC Brief Volume 6, Issue 4

April 26, 2017

STRONG Provides Framework for Better Care for Patients with Amputations

Four years ago, the Boston Marathon bombings wreaked havoc on the city, killing three people and injuring several hundred others, including 16 who lost limbs. Boston Medical Center cared for many patients who were injured in the tragic events, and while remarkably every patient who came to the hospital was saved, the experience convinced the teams who cared for patients with amputations that there was more that could be done.

About a year after the marathon bombings, Jeffrey Kalish, MD, a vascular surgeon at BMC, convened a team of surgeons, nurses, social workers, physical therapists, and others who took care of bombing victims to discuss what they learned from their shared experience. The goal was to develop formalized protocols to employ best practices for amputees, who require care from multiple disciplines across the hospital.

The team ultimately formed STRONG (Surgery to Rehab Ongoing Needs Group) in order to continue forward with these optimal ways of caring for patients with amputations, as well as their families.

“After the bombings, I looked at how the military cares for trauma patients who need amputations,” said Kalish. “They have the largest number of these patients and there is research supporting their processes. With a travel fellowship from the Society for Vascular Surgery to visit military hospitals, I began working to adapt their models for civilian hospitals and to put all the pieces of care together.”

While STRONG began as an organized group, it has also transformed into a mindset that guides how BMC can care for patients with amputations. Patient care is centralized and coordinated by either the trauma team or vascular team. Clinicians on those teams inform patients and their families about the resources that are available, so that the patient can decide when to involve others in their recovery. As soon as a patient is ready, then social workers, physical therapists, mental health professionals, and other providers are brought in as early as possible, so that patients have a better idea of what to expect. The multi-disciplinary team then works together to help patients and their families navigate through every aspect of their recovery. This process has helped to systematically break down traditional silos across the health care delivery spectrum at BMC.

“The benefits for the patient are continuity of care and centralized care,” says Kalish. “There is a unified voice to the process, which makes it easier for patients and families to understand what is happening and what will happen next. We try to ensure that patients have the same nurses and rooms throughout their stay, to enhance the patient and family experience during this acute traumatic period of time. Taking a coordinated approach from the beginning appears to have tangible benefits for the best physical outcome for these patients.”

The team also helps families understand what their lives will be like after a family member goes through an amputation. They can provide counseling for families, as well as help with day to day issues such as lack of transportation while the family member is in the hospital.

While this model is tailored to trauma patients, Kalish believes that the lessons can be used for any patient undergoing an amputation. Therefore, the long-term goal of the team is not just to provide better care for patients at BMC, but also to spread the word about this model system of care to other hospital systems throughout the country.

“We hope to let people know that STRONG is a better framework for how to get amputees to and through rehabilitation and recovery,” says Kalish. “It allows us as caregivers to help patients and their families both in the short- and the long-term.”

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Director of Talent Acquisition: Many Faces Create Our Greatness

When you look around at your Boston Medical Center colleagues, what do you see? Most likely, it’s people from all over the world, all with different backgrounds, and all of whom are committed to BMC’s mission to provide exceptional care without exception. You might wonder how these people came to work at BMC and who was able to recognize that they would fit into the BMC culture. Busayo Ola, director of talent acquisition, is one BMC leader who strives to ensure that we stay true to our core value - "many faces create our greatness." She has made it her mission to help hire an inclusive and dedicated staff at BMC.

Ola came to BMC from New Jersey when her husband accepted a new job in Rhode Island. She had previously worked in health care human resources and wanted to get back into it, but was unimpressed by the culture at a potential job in Rhode Island. She was then recruited to BMC through an agency.

“Lisa Kelly-Croswell [senior vice president of Human Resources and chief human resources officer] spoke about BMC’s values and culture at my interview and it was so inspiring,” says Ola. “After the interview, I sat in the Shapiro cafeteria and watched patients and employees. Something about being there connected with me, and I knew I wanted to be at BMC.”

Kelly-Croswell also felt that Ola should be at BMC, and she was hired in September 2015 as a manager of talent acquisition. Since then, she has been promoted to director of talent acquisition. In this role, she manages a staff of 11 recruiters and partners with hospital leaders to help them find the right people for their open positions.

“It takes a certain type of person to work at BMC,” says Ola. “The most successful employees, and the type of people I look for when hiring, are people who are motivated by BMC’s mission, vision and values. They’re passionate and committed to the organization. You can usually train people how to do a job, but you can’t train for attitude. So hiring the person with the attitude and most of what you are looking for is a successful recruitment engagement.”

Ola’s commitment to hiring a diverse staff dedicated to BMC began long before her move from New Jersey to New England. She came to the United States when she was a child so that her parents could get advanced degrees, but then grew up in Nigeria from age nine to when she was a senior in high school. She then finished high school in rural Michigan.

“I sounded and looked different than everyone else in my high school in Michigan, but didn’t realize it until other students teased me,” says Ola. “One day, a teacher told me that I would get laughed at less if I learned how to speak like everyone else, so I took speech classes and learned how to get rid of my accent whenever I was in public. I now sound differently at home than I do at work. Interestingly, I think in my native language, then translate it into British English, then American English. The sad part is that even though my original accent might be more acceptable now, I can’t turn it off at work.”

This experience, says Ola, made her very committed to hiring a diverse workforce.

“You spend eight hours a day at your job, so you should be able to be your authentic self,” she says. “This is especially important at BMC, because we have such a diverse patient population. We need people who can understand some cultural things about our patients, and sharing a culture makes it easier to make connections and break down barriers of judgment. It brings a personal touch to the health care we provide.”

Ola saw this firsthand when she had a baby at BMC in 2016. While she had planned on delivering in Rhode Island, she went into labor at work and didn’t have time to get to the hospital closer to home. While Ola says that everyone who cared for her was wonderful, she was particularly embraced by the Nigerian and West African nurses at the hospital, even ones she didn’t know and who weren’t directly responsible for her care. That made her experience as a BMC patient more positive, because she felt understood.

While Ola acknowledges that like any organization BMC still needs to work on inclusion and unconscious biases toward those who are different, she says that she is proud to work here.

“I work with a group of driven, enthusiastic, committed professionals,” says Ola. “They work really hard every day to move mountains and ensure BMC has the best employees possible. And beyond my team, I’m proud to work with everyone at BMC. People live our culture every day and always strive to do their best.”

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At BMC, It’s Easy Being Green

Boston Medical Center took another step toward being the greenest and most resilient hospital in Boston earlier this month, installing a new natural gas-fired, 2 megawatt combined heat and power plant (CHP or cogen) on the roof of the Yawkey Center. The cogen helps BMC generate much of its own electricity and heat.

BMC’s cogen plant will supply more than 41 percent of the hospital’s total electricity consumption and has the capacity to meet 25 percent of peak electricity demand at any given time. Traditional power plants, which release excess heat into the atmosphere, operate at about 35 percent efficiency. Cogen technology instead traps and reuses the heat, operating at 70 percent efficiency.

“For us, increasing efficiency and resiliency makes financial and operational sense. Cogen will save BMC about $1.5 million in energy and heating costs, which are resources we can spend on patient care instead of utility bills,” said Kate Walsh, BMC president and CEO.

By reusing the trapped heat for hot water, humidification, and room temperature, cogen will lower BMC’s costs by reducing the need for stream heat by an estimated 44,000 pounds annually. It will also reduce electric grid consumption by more than 16 million kilowatt hours a year.

BMC will also become significantly more resilient to operate through major natural disasters, particularly hurricanes. While Boston has been spared from direct hits by major hurricanes since Hurricane Bob in 1991, the Northeast has not. Hurricane Sandy in 2012 resulted in approximately 6,500 patients evacuated from hospitals, and more than a month after the storm struck, five hospitals still could not admit patients because of damage that destroyed electrical systems, flooded emergency and exam rooms, and crippled elevators.

“We’ve learned many lessons from Hurricane Katrina and Sandy, which devastated the health care infrastructure in their communities,” said Bob Biggio, senior vice president for facilities and support services. “Hospitals that had cogen were able to stay open and care for patients, while those without cogen were forced to evacuate.”

BMC’s cogen has a unique feature – its “black start” capability means that if the electric grid goes down, the hospital can restart the cogen plant and heat and power its inpatient units on an “island” for months at a time, as long as it has a supply of natural gas. BMC is the only major teaching hospital in Massachusetts that can utilize black start, and with the cogen plant located on the roof of Yawkey, it sits high above any potential floodwaters.

“As the largest safety-net hospital in New England and biggest trauma center, we have an obligation to protect our patients in a natural disaster. Cogen gives us the ability to continue to care for the most vulnerable population in our city, even when the electric grid goes down,” said Biggio.

The $15 million cogen plant was made possible by a $3.7 million grant from the Massachusetts Department of Energy Resources Community Clean Energy Resiliency Initiative; the Boston Public Health Commission partnered with BMC in securing the grant. In addition to powering and heating much of the hospital, the cogen facility will serve as a backup power source for city and state emergency communications.

Earlier this month, Walsh and Biggio were joined by representatives from the Massachusetts Department of Energy Resources, the City of Boston, and Eversource to hold a virtual opening of the cogen plant. Guests gathered in the Yawkey Cafeteria were able to “tour” the cogen unit through a virtual reality headset, giving them a better picture of the machine located stories above their heads.

This is one of the many important steps that BMC has taken toward being the most resilient and greenest hospital in Boston. In recent years, the hospital has also installed new generators on the floor of patient care buildings, created cross-building critical infrastructure connections that allow buildings to connect to other hospital buildings’ generators, and programmed elevators to stop short of lower floors to maintain patient care in the event of a flood.

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Small Grants Have Big Impact On Wellness

When reading up on the latest problems and issues facing those in medical professions, “burnout” is certainly a term that appears frequently. While there is no clear definition of what burnout really is, being exhausted, not feeling like you are accomplishing things, and feeling depersonalized are common symptoms.

Is there a secret to avoiding burnout? It may be wellness and resilience activities.

Wellness, simply put, is the state of being in good health, especially in the areas of emotional, occupational, physical, spiritual, intellectual, and social wellness. This past year, several physicians, residents, and staff members at Boston Medical Center (BMC) took a hands-on approach to wellness through a grassroots seed-funding grant program sponsored by the Medical Dental Staff Wellness Committee.

“We wanted to get staff members excited about wellness and resilience activities, and this was an opportunity for everyone to get creative, think outside the box, and lead projects they were passionate about,” said Paula Gardiner, MD, Family Medicine, chair of the Wellness Committee.

After a call for proposals in January 2016, all of which needed an accompanying support letter from a chair or manager, Gardiner and her team issued eight grants ranging from $300 – $500. A grateful patient made donations in 2015 and 2016 in memory of their husband, of which $2,000 was allocated for these projects by Jane Liebschutz, MD, MPH, general internal medicine, director of the Wellness Committee.

The wellness projects engaged a variety of departments aiming to combat burnout, including:

  • Geriatrics installed a walking treadmill work station in their office
  • General Internal Medicine started a step counting contest and running club
  • Pediatrics received five self-care baskets, which included items like stress balls, worry stones, weighted lap pads and handmade positive-affirmation cards to help staff members cope with minor stressors while working. 

Courtney Bailey, LICSW, Child Witness to Violence Project, was inspired to write a proposal and create the self-care baskets after participating in a learning collaborative at Johns Hopkins University.

“We thought it would be a nice way for staff to get recognized. They have tough jobs and sometimes the power of small acts can make people feel appreciated,” said Bailey.

BMC’s resident community, a group often at the most risk of burnout, took full advantage of the grants with two projects. One was a half-day retreat, organized by and for residency training program administrators, where burnout and stress were discussed; guest speakers also presented and led exercises in meditation, stretching, and coping skills.

The other project, What Matters to Me, provided a forum for residents to share their personal narratives in an intimate dinner setting. Over the course of four dinner events, six residents each gave 15-minute presentations, with one or two sharing their answer to the question, “What matters to you, and why?” each night. Their stories reflected on a variety of topics, such as family, upbringing, religion, and difficult losses. Each dinner was held at a resident’s apartment.

“I think it pushed us to have deeper discussions as friends and colleagues than we would have otherwise. We all shared our opinions on the topics after, and each dinner had anywhere between 12 and 20 residents attend,” said Katherine Nash, MD, Pediatrics, who organized the program.

Each project that received seed funding had to submit a year-end review describing accomplishments, reach of the project or program, and barriers to implementation. Nash reported that initial evaluation of her program showed that of 25 residents surveyed, 80 percent want to continue to have the What Matters to Me dinners and 20 percent wanted to continue the program "conditionally."

Overall, Gardiner approximates that the eight funded projects reached approximately 500 BMC and BUSM employees.

“We had some successful projects that truly increased wellness throughout the hospital,” said Gardiner. “Perhaps the most impressive aspect of the seed grants is that all of the individuals and teams involved organized these wellness programs in addition to their critical day-to-day work serving our patients,” said Gardiner.

If you missed the opportunity last year to apply for a seed grant and lead a wellness program, you are in luck. The Medical Dental Staff Wellness Committee is currently accepting new proposals for another round of funding. The deadline for 2017 proposals is April 30. 

For more information or questions about the seed funding for wellness, visit their website or contact Joseph Pasquantonio at [email protected].

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Awards and Accolades

BMC Named One of 100 Great Hospitals in America by Becker’s Hospital Review
For the first time in its history, Boston Medical Center has been named among the 100 Great Hospitals in America by Becker's Hospital Review. With more than 5,500 hospitals across the country, this is an incredible honor. This exclusive list is made up of hospitals across the United States that are national leaders in innovating, providing top notch care to patients, leading clinical advancement through forward-thinking research, and holding an irreplaceable spot in their communities.

Practice Greenhealth Recognizes BMC’s Commitment to Green Practices
For the first time, BMC received a Top 25 Environmental Excellence Award for recognition of our groundbreaking achievement and innovation in health care sustainability. BMC also received the Circles of Excellence Award in the Energy category, which honors hospitals that are leading the sector in energy efficiency and strategic energy use planning, and the Greening the OR Initiative recognition award given to hospitals that have made substantial strides in environmental performance in the operating room.

Sarge Named One of Milk-Bone’s Dogs Who Changed the World
Sarge, a Healing Pups dog at BMC, was named to Milk-Bone’s list of “Dogs Who Changed the World.” Sarge, a retired seizure dog handled by director of Epilepsy Services Georgia Montouris, was recognized for the comfort he provides to patients of all ages throughout the hospital.

BMC Wins Massachusetts Health System Pharmacy Award
BMC has been awarded the 2016-17 Massachusetts Health System Pharmacy Award for the hospital’s readmission risk assessment initiative (RRA). The RRA helped BMC reduce readmissions and improve patient-centered care through optimizing workflow, creating key partnerships across departments, training and staff development, and effective collaboration within the department.

The RRA initiative enabled pharmacists and technicians across our health system to deliver outstanding, exceptional care for patients by doing what they have been trained to do best: admission/discharge medication reconciliation, medication to bedside delivery, post-discharge telephone calls, expediting prior authorizations, providing special services customized to patients (ex. blister packs), discharge counseling, and medication teaching.

Clinical Addiction and Research Education Unit Wins Society of General Medicine Award
The Clinical Addiction and Research Education (CARE) Unit within in the section of General Internal Medicine at Boston Medical Center and Boston University School of Medicine has been awarded the Quality and Practice Innovation Award by the Society of General Internal Medicine for its innovative approaches to treating patients with substance use disorder (SUD). Over the past 23 years, CARE has become a national model for its integration of primary care, behavioral health services and addiction care.

Daniel P. Alford, MD, MPH, FACP, Receives Award from the American College of Physicians
Daniel P. Alford, MD, MPH, FACP, director of the Clinical Addiction Research and Education Unit and the Medical Director of the Office-Based Addiction Treatment (OBAT) Program, has been awarded the American College of Physicians (ACP) Award for Distinguished Contributions to Behavioral Medicine. ACP is a national organization of internists. The award recognizes distinguished contributions to the integration of behavioral medicine with traditional medicine and is given to an individual who has furthered the care of patients by recognizing the importance of caring for the whole patient, both mind and body.

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News of Note

Senior Leaders Take on New Roles in BMC Health System
When MassHealth moves to an accountable care model in December, it will require staff throughout our health system to work together differently and more closely. To that end, several of BMC’s senior leaders are taking new roles to support this close working relationship:

  • BMC’s Chief Operating Officer, Alastair Bell, MD, will take on the role of executive vice president, strategy and chief operating officer for BMC Health System. In this role he will continue leadership of his existing areas and add responsibility for bridging our work on accountable care across our system.
  • Senior vice president for quality, safety and technology, Stanley Hochberg, MD, will take on the role of senior vice president, population health for BMC Health System. This new role will ensure key capabilities and structure are in place to deliver on our system-wide accountable care goals.
  • Michael Silverstein, MD, will take on the role of BMC’s associate chief medical officer for research and population health. Dr. Silverstein is currently director of BMC’s Division of General Pediatrics and the department’s vice chairman for research. This important link to our academic enterprise will help ensure that our research is ideally structured to support our health system.
  • With Hochberg’s role changing, James Moses, MD has been named BMC’s vice president for quality and safety and chief quality officer. Moses, currently BMC’s associate chief quality officer, has made significant contributions to meeting our ambitious quality goals. In his new role, he will report to Ravin Davidoff, MD. Also with the change in Stan Hochberg’s role, BMC’s ITS Department will report to Bell.

Kate Walsh Voted Massachusetts Hospital Association President
Kate Walsh, president and CEO, has been named president-elect of the Massachusetts Hospital Association. She will become president at the MHA annual meeting in June. The MHA is comprised of hospitals and health systems, related organizations, and other members with a common interest in promoting the good health of the people of the Commonwealth. 

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