The BMC Brief Volume 6, Issue 6
The BMC Brief sat down with James Moses, MD, MPH who was recently named BMC’s Vice President for Quality and Safety and Chief Quality Officer. Moses is an active hospitalist in the Department of Pediatrics and has worked in various roles at BMC since 2008. He received his medical degree from University of Chicago Medicine and holds a bachelor’s degree from Boston University.
Q: How did you get involved in quality and safety?
A: If you had asked me when I was a medical student, I would have had no clue that I would end up doing this. I think what drove my interest was that during residency – I did the pediatric combined residency at BMC and Boston Children’s Hospital – I saw how the system can negatively impact patient care, and I really wanted to do something about that. It just inherently bothered me, and I felt that until someone took the time to address these systemic gaps in care, care would not get better for patients no matter how good the doctors or nurses were.
Q: What’s the difference between quality and safety?
A: Safety is very focused on addressing gaps in our system of care when they’re identified either through an actual adverse event or a near-miss, and ensuring that the next patient who comes through is not negatively affected by that system. Quality is focused on identifying proactive steps we can take to improve patient outcomes. It’s less about addressing gaps in systems of care and more about identifying solutions that will lead to outright better performance.
Q: What is your vision for quality and safety at BMC?
A: My vision, and what I am hopeful for, is getting quality and safety to be something that is owned by everybody here. It should be part of everyday care, and our approach to care in general, to ensure we are delivering the best quality and safety possible within every care episode. To do this, we need to have a high level of activation across employees. We’re starting from a place where quality is owned by a few individuals, and we have a lot of room to engage everyday staff. Everyone will need to work together to be successful.
Q: We’re building a “culture of safety” at the hospital. What does that mean?
A: A robust culture of safety means that every level of staff is activated about the harms or potential harms happening to patients and work together to try to improve the safety of our system. This means that teams are proactively assessing the risk of our interventions ahead of time instead of waiting for bad events to happen to address the issues leading to patient harm. In a culture of safety, we’re prioritizing safety as a community and taking proactive steps to make care processes safer.
Q: What role does the STARS system play in the culture of safety?
A: The STARS system is a big part of this culture of safety. The system is intended to be a way for staff on the front lines of care to communicate adverse events or possible adverse events, which we call near misses But I think one of the cultural things we need to pivot away from is that staff currently perceive STARS to be blame-oriented – that when they have a problem with another staff member, this is the way to alert someone about those issues, but that’s actually an inappropriate use of the STARS system. Those issues should be communicated locally to managers. STARS is an effective means of advocating for patients and fixing the systems that are putting patients in harm’s way. It is a way to report areas of concern and help ensure they are prioritized and addressed.
Q: What is something people don’t know about quality and patient safety at BMC?
A: I want people to know how successful we’ve been in improving quality and safety at BMC. We are achieving great quality success and have become really a superb performer, especially among safety net hospitals. This is due in large part to the ability of the teams we engage to join us on the quality journey to make sure the right things are happening for our patients. It’s really been unbelievable.
Q: What can the everyday employee do to help contribute to quality and safety?
A: An important piece is to be very aware of best practice in standards of care and adhere to those standards. Many times when we see either patient safety events or quality problems, it’s because the day-to-day, hour-to-hour, minute-to-minute adherence to a best practice or standard is not where it should be. Everyone can help make sure their team is doing the very best it can to do right by patients, and in many cases that’s adhering to best practice and standards. For example, if we have a patient being tested for C. diff, their contact precautions need to be ordered in a timely manner and adhered to rigorously so that we can ensure that we don’t spread that infection to other patients.
Q: How can an employee develop their quality improvement idea?
A: If an employee has a project they want to use quality improvement for, they can partner with the QI Hub, which provides all staff members at any level with orientation, training, and experience in quality improvement. We offer online training modules, as well as in-person coaching and mentoring, on QI projects for the entire lifespan of a project. It’s new to BMC but we are seeing a lot of engagement. We are there to help and guide staff through their project, even if they don’t have any previous experience in QI. To learn more, visit http://bucme.org/node/1095 or email [email protected].
Q: What’s an example of an idea one person came up with that has since changed how we do something here?
A: There are so many examples!
Eric Chen, an orthopedic resident, was really bothered by the fact that there wasn’t a standard approach in orthopedics to prescribing opioids when a patient is discharged. He created an algorithm that uses certain patient variables to calculate a recommended amount of opioids to prescribe on discharge. Chen then partnered with the BMC QI Hub to help make this a standard of care for orthopedics. After we get it up and running there, there is a plan to spread the algorithm to other surgery services. This is not something that the quality and patient safety team came up with or an external priority that we built a team to tackle. This is about someone who identified a problem locally, figured out a frame to do something about it proactively, and now we’re able to help him do this for our patients, because it’s the right thing to do for them. This project is especially important given the opioid crisis and aligns with the strategic goals of BMC and the new Grayken Center for Addiction Medicine.
Another example is in gynecology, where they’ve formed a pre-operative patient safety conference. It’s a great partnership between housestaff and faculty in that section. They review all high-risk patients that are coming in for elective surgery, which gives them an opportunity to proactively modify the planned surgery or approach if necessary to ensure optimization of a patient’s outcome. It’s a great example of a proactive patient safety intervention. We’ve shared this intervention with general surgery and will be working with them in creating a similar conference. I hope to make this standard across all surgery disciplines in the next year or so. It is definitively a best practice and the housestaff get a lot out of it.
Q: What do you do for fun outside work?
A: I love spending time with my wife and family. I have two kids, who are 11 and 8. They definitely keep us busy. I like playing basketball and golf, and I also play blues piano. I only perform for myself, though, unless heavily bribed!
What does it take to be exceptional? Just ask one of the 20 individuals or 8 team winners of the fifth annual Be Exceptional Awards.
A celebration emceed by Kate Walsh, president and CEO, and Lisa Kelly-Croswell, Senior Vice President of HR and Chief Human Resources Officer, was held on June 14 in the Hiebert Lounge. Each year, the awards recognize the best of the best – the colleagues among us who go above and beyond to represent our mission day in and day out. The 2017 awards focused on our three core values: built on respect powered by empathy, move mountains, and many faces create our greatness; as well as on our 2017 priority goals: quality of care, patient experience, and growth. Colleagues nominated more than 150 BMC individuals and almost 50 teams.
Congratulations to the 2017 Be Exceptional Award winners:
- Tahssin Alani, IT Field Specialist
- Cheryl Anderson, Occupational Therapist
- John Archibald, LICSW, Social Worker
- Antoinette Bardzilowski, Ambulatory Service Representative
- Andi Berger, Sr. Communications Specialist HR
- Ioana Bica, Infectious Disease Physician
- Annette Byrd, CNA
- Cheryl Cooper, Ambulatory LPN
- Justine Dickson, Specialty Pharmacy
- Michael Felder, Dietary Aide
- Danielle Ferguson, Sr. Physical Therapist
- Jane Gastall, Pediatric Nurse
- Alexandra Heinz, Public Health Social Worker
- Hasmeena Kathuria, Pulmonary Physician
- David Maffeo, Sr. Director Support Services
- Lizabete Minard, Unit Coordinator
- Maria Monteiro, Housekeeper
- Linda Parker, Radiology Technologist
- Hannah Simons, Mother Baby Nurse
- David Quezada, Specialty Pharmacy Tech
- Cardiology Clinic Leadership Team
- Food and Nutrition Department
- GIM Ambulatory Nursing Leadership Team
- OB/GYN Ambulatory Clinic
- Department of Pathology and Laboratory Medicine
- Renal Ambulatory Clinic
- Special Pathogens Unit
- Yawkey Pharmacy
With the recent opening of the Grayken Center for Addiction Medicine, Boston Medical Center further established itself as a hospital on the cutting-edge of addiction treatment, research, and education. Now, BMC is taking another leadership role in addressing the addiction crisis with a new safe prescribing education program for residents, launched this summer in partnership with the Massachusetts Medical Society and Massachusetts Department of Public Health.
“Our involvement in this program helps us stand as a model for other teaching institutions,” says Jeffrey Schneider, MD, an emergency department physician and director of BMC’s graduate medical education programs. “It’s an opportunity for us to be at the forefront of safe prescribing education.”
BMC worked closely with the Massachusetts Department of Public Health (MDPH) and the Massachusetts Medical Society (MMS) to collate training modules which were particularly relevant to residents and fellows. They are hosted on the Massachusetts Medical Society (MMS) website and will be available to all hospitals in the state. They include ten core competencies related to opioid use and safe prescribing, including preventing prescription drug misuse, helping patients treat and manage substance use disorders, and safe opioid prescribing principles. The purpose of this site is to make them easily accessible and organized for providers.
Anyone at BMC can take the training, but DPH and MMS are placing a special emphasis on residents, to educate the next generation of doctors in safe prescribing as they begin their medical careers. BMC will be one of the first hospitals in Massachusetts to require that all residents complete the training, beginning with the new class of residents that will start in July. The new trainees, along with those already at BMC, will complete the program over the course of the academic year.
While residents work under the supervision of attending physicians, they do much of the boots-on-the-ground work related to prescribing medication, so it is crucial that they have this knowledge.
“We feel that opioid misuse is such an important public health concern that all trainees should know the basics,” says Schneider. “While it will pertain more to some residents than others, it will be worthwhile for all of them to take the course. We’ve also had a lot of success with other required courses, such as in patient safety, so our hope is that this will be successful as well.”
The program also helps BMC build a bridge between medical school and residency. Last year, the Deans of the four Massachusetts medical schools developed a list of core competencies around the prevention and management of prescription drug misuse, and agreed that more structured education to address these issues at both the undergraduate and graduate medical education levels was warranted. This program helps continue residents’ education on opioids and safe prescribing, and fills in gaps for those who might not have had education in this area.
The education program will not only help residents deliver safe, efficient, and high-quality care at BMC, but also benefit the health care system as a whole. While many residents stay at BMC once their residency is over, not all do. Those who leave will be able to take the knowledge they’ve gained elsewhere, and continue to provide high-quality care for patients.
As the medical world becomes more digitized, hospital ITS departments are adapting to combat the threat of cyberattacks. The stakes are especially high for medical institutions, as the going rate for electronic medical health records on the black market rises to hundreds or even thousands of dollars. That’s compared to 10 cents for a social security number and 25 cents for a credit card number, according to Forbes.
But why is the medical record so desirable to hackers? While stolen financial data is valuable in the short-term, it can be changed fairly quickly. Conversely, the medical record contains more data and more permanent information, which can be used in a number of nefarious ways including the filing of false medical claims.
Just last month, cyberattacks left Britain’s National Health Service (NHS) at a standstill. A virus froze employees’ computers until a ransom was paid. Clinicians were unable to order tests, track patients’ locations, or type in notes. Hospitals were forced to postpone elective surgeries, turn away patients and shut down entire wings.
The cyberattack that hit the UK’s NHS and thousands of other organizations around the world is known as a ransomware attack. Hackers sent a virus via email to employees, and if a link in the email was opened, the virus froze the computer until the hacker was paid in bitcoin, an online currency.
For BMC’s ITS team, protecting employee and patient information is a top priority. “The hospital’s infrastructure has strong and up-to-date anti-virus software that will prevent the kind of attack we saw in the UK from happening here,” says Christian Broughton, senior director of ITS.
In the wake of the attack, BMC’s ITS team ran additional scans on all BMC machines out of an abundance of caution. “BMC’s employees and patients were not impacted, but we always act with extreme vigilance when it comes to protecting sensitive information.”
It took hours of painstaking work by British cyber experts to slow and eventually stop the virus without paying the ransom, but the effects of the cyberattack lasted for several days. British officials say there is no evidence patient data was compromised during the breach, and the hospitals are once again running at normal capacity.
Cyberattacks like these bring on a new wave of concern over the safety of patients’ private health information (PHI). With so much of this information in digital form, it is easy to imagine a scenario where hacker’s demand a ransom for sensitive information about patients. However, experts do have advice on how employees can help their ITS departments ward off viruses.
The first is keeping computer operating systems up to date. This was a major issue with the NHS attack. Hackers were able to access hospital computers in part because many of the impacted systems were running obsolete versions of Microsoft Windows which lacked the security protections found on the current versions such as those running at BMC.
The second defense is even easier, never open links in emails from unfamiliar sources. “If you don’t trust the source of an email, don’t open any attachments or click on any links within the message,” says Broughton.
The ITS department at BMC suggests anyone with concerns about cybersecurity contact the Service Desk at 4-4500. Cybersecurity threats aren’t going away, but BMC’s IT team is continually working to stay one step ahead of the game, and keep the hospital’s systems running smoothly.
Name: Katherine Christopher, RN
Title: Critical care resource nurse
Time at BMC: 10 years
Q: What do you do at BMC?
A: Resource nurses aren’t assigned to patients. Instead, we support nurses and medical teams when a patient they’re caring for becomes critically ill. If a patient on the floor becomes too sick for the nurses to manage, they’ll call us to come help. We like to say we bring the ICU to the patient, until either the patient stabilizes or we can bring them to the ICU.
We’re also available to answer questions for nurses and physicians, such as on hospital policies, and to help patients navigate around the hospital or get other resources they need. Resource nurses are always there to help. Everyone should feel comfortable reaching out to us.
Q: You’re on the team that helped develop BMC’s early warning system for patients. What is the system and why is it important?
A: The system runs in the background of Epic and monitors patients’ vital signs. If everything is good, the patient is “green.” If something changes for the worse, the patients can change to “yellow” and then “red.” Red is an indication that there’s been a clinical status change, such as early sepsis, respiratory distress, or acute mental status changes.
We watch patients who are yellow to try to keep them from going to red. Every patient is assigned a number from 1-10 based on their vital signs, and if it’s greater than six a resource nurse will come together with the medical team to develop a plan to prevent patients from getting sicker.
When a patient’s score changes, the nurse will get a best practice alert in Epic telling them to call a resource nurse. We watch throughout our shifts, but we have to be called when a patient starts to decline.
Q: What brought you to BMC?
A: I was working at Mt. Auburn Hospital in Cambridge, which I really liked, but I wanted to try something different. I worked on the telemetry floor and in the cardiothoracic SICU and wanted a new challenge. I wanted to work with trauma patients and in the city. I was totally overwhelmed when I started here since it’s such a big hospital, but I always felt at home and welcomed here.
Q: What do you like most about working at BMC?
A: The staff is my favorite part about working at BMC. It’s a cohesive group. If you need something, your coworkers will make sure you get it or at least support you with the means to get what you need.
Our population is great too. We truly see a little bit of everything and all walks of life, from neonatal all the way to adult and all socioeconomic groups.
Q: What do you do for fun outside of work?
A: I have a three-year-old, so we do a lot of three year old things. We also like to travel and go to the beach when it’s nice out. We spend a fair bit of time on Lake George.
BMC Communications Department Wins Two Lamplighter Awards
The Communications Department has received two Lamplighter Awards from the New England Society for Healthcare Communications. The awards recognize excellence in communications, media relations, and marketing by New England healthcare institutions, health plans and agencies. BMC won a silver award in the media relations category for a Boston Globe cover story on the Grow Clinic and a certificate of excellence in media relations for a STAT story on the CALM neonatal intensive care unit cuddler program.
Boston Intersection Named in Memory of Kenneth Edelin, MD
The intersection of Worcester Square and Harrison Ave was recently dedicated as “Dr. Kenneth C. Edelin Square” in honor of Kenneth Edelin, MD, the former director of obstetrics and gynecology at Boston City Hospital and chair of the obstetrics and gynecology department at the Boston University School of Medicine. Edelin also served as chairman of the Planned Parenthood Federation of America.
Edelin, who died in 2013, was the first African-American to be named chief resident of Boston City Hospital’s obstetrics and gynecology department and was well-known as a mentor of other doctors and medical students during his time at City Hospital. The dedication of the square was attended by Mayor Martin J. Walsh, city councilor at-large Ayanna Pressley, Boston Medical Center’s president and CEO, Kate Walsh, city councilors Annissa Essaibi George and Tito Jackson, and former Governor Deval Patrick.
Kate Walsh Elected to Yale Board of Trustees
Kate Walsh, BMC president and CEO, has been elected an alumni fellow of the Yale Corporation — the university’s board of trustees. Her appointment is effective July 1. Walsh received both a bachelor of arts and masters in public health in hospital management from Yale.