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The BMC Brief

The BMC Brief, Volume 8, Issue 2

February 27, 2019

What Does a BostonHires Champion Look Like?

This article was originally published on the BostonHires website.

When Luis Roman thinks of why he likes his job, he thinks of a recent day when he was manning the Patient Access Services desk in Boston Medical Center’s radiology department. On this particular day, he saw a woman in a wheelchair coming off the elevator. She was nudging herself backwards bit by bit with her feet.

At a glance, she may have looked like someone improvising her way in a wheelchair but Luis could see the Herculean effort she was exerting. He jumped up from his station to ask the woman if he could help. She thanked him profusely. “God bless you,” she said, overcome by the small act of kindness.

“I like to think of myself as the first person patients see,” said Luis, a 24-year-old from Dorchester. “I want them to feel like they’re not in a hospital. At the end of the day, I’m here for the patients.”

When Boston Medical Center (BMC) thinks of its hiring strategy, it thinks of employees like Luis – people who are talented, passionate, and members of the communities they serve.

In early 2018 when the City of Boston launched BostonHires, a hiring campaign to promote the benefits of hiring Boston residents in quality jobs, Boston Medical Center was one of the first hospitals to sign up. As a BostonHires Champion, BMC pledges to hire Boston residents in living wage jobs, ensuring that half this total is also offered benefits. In the first six months of the campaign, BMC hired more than 400 Boston residents into living wage jobs; all employees working over 20 hours per week are able to earn benefits as well. This includes employees like Luis.

So how does an organization like BMC prioritize hiring Boston residents into well-paying jobs, while still keeping an eye on the bottom line?

Busayo Ola Ajayi thinks about this question daily in her role as BMC’s Director of Talent Acquisition and Diversity and Inclusion. For one, she says, there is considerable overlap between BMC employees and patients: 67% of BMC staff receive their healthcare at the hospital.

“For our patients to be well, they have to be able to care for their families,” she said. “How do we do that? We try to make provide a great total work experience for our employees, including wages, benefits, wellness programs and a values-based culture.”

Equally important is that BMC staff reflect the urban population they are serving and striving – per the hospital’s vision – to make the healthiest in the world. Among BMC’s patients, 57% are from under-served populations and 32% do not speak English as a primary language. They are also racially diverse, as Boston is a majority-minority city.

“One of our goals is to hire from the community because people can relate [to the places and cultures patients are coming from],” Ajayi said. “They can provide care that isn’t just clinical, but touches you as a person.”

Ajayi experienced this reality first-hand when she was admitted as a BMC patient herself. While she waited for her mother to arrive from Africa, one of the hospital’s nurses noticed that Ajayi was Nigerian – and she was as well.

“She treated me how my mom would have treated me, bringing me food and things,” Ajayi said. “She didn’t even know I was an employee. That blew me away. She made a situation that was confusing for me more comfortable and familiar.”

BMC’s investment in a diverse and well-paid workforce pays off for the hospital, too. Luis Roman is interested in taking advantage of BMC’s tuition reimbursement program to start college coursework and ultimately enter the ultra-sound field.

“I feel like BMC, especially in my position, is a great place to start. It’s allowed me to grow,” he said. “Whatever the steps are [to advance], I’ll do them.”

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What do you do, Sandra Montrond?

Name: Sandra Montrond, RN
Title: Accreditation and Regulatory Manager
Time at BMC: 13 years

Q: What do you do here?
A: Simply put, I ensure the hospital is compliant 24/7, 365 days a year. This includes overseeing compliance for any of the standards the hospital must follow, including from the Joint Commission and the Department of Public Health. For Joint Commission, there are over 1,600 standards that cover everything from sprinkler heads to how medications are locked to hand hygiene.

To assist with sustaining the hospital compliance, I do a lot of teaching on an ongoing basis, every time I do my regular rounds in both inpatient and outpatient areas. I use a checklist called “Open for Business” to review compliance during the rounds.

As new standards come out, I have meetings with the people the standards pertain to, to review policies, make sure teaching has been done, and find out if we need to do audits or make Epic changes in order to meet the requirements.

Q: What brought you to BMC?
A: I was working at the Boston Public Health Commission on immunization compliance audits. BMC was one of the locations I had, so I came in here to meet with Pediatrics, and the next thing I knew, I started in the Adolescent Clinic as the charge nurse.

Six years ago, my daughter told me she didn’t like kindergarten because I was home late every day; at that time, I was the manager for ambulatory Pediatrics. So I thought that I needed to change that. I went to Laura Harrington and told her that I love BMC, but I need to be home for my kids. She told me that if I was willing to learn, she would teach me. That’s how I ended up in Quality and Patient Safety.

Q: The Joint Commission just came to BMC. What can you tell us about the visit and what it means for the hospital?
A: It was a great survey. Everyone’s hard work came through to the surveyors. Joint Commission brings out the best in everyone, every single time.

I can’t say thank you enough to everyone. We really have a great team out there.

No one else delivers the care that we do, and the surveyors felt that. That’s when I sit there and I become seven feet tall. Everyone was so prepared and so ready for the survey. It’s the part that makes me fall more and more in love with this organization.

But we can’t put our heads down yet, because all the findings have to be addressed and corrected. In addition, certain findings require a 45-day revisit, so Joint Commission will be coming back in less than 45 days. Just because they left doesn’t mean we stop this work. The work is ongoing, and this is how we should be providing care all the time.

In addition, we need to be ready at all times for Department of Public Health visits, because they can come at any time. They were actually here the same time as Joint Commission.

Q: What’s the top thing you want employees to know about working with your team?
A: My favorite part about this work is going out to units and speaking to staff. I love when staff sees me and tells me they haven’t seen me for a while. It’s like they’re telling me “come in, Sandra, we’re ready for you.”

I love when people are interested and invested in making sure we’re ready at all times. People should continue to learn, continue to ask questions, and continue to educate me, because I don’t know everything. It’s a joint effort.

I’m available to go to department, division, or unit meetings at any time throughout the year. People should send me an email if they want me to come to staff meetings. I’ll pick topics that pertain to that group and do the basic teaching.

Q: What do you like most about working for BMC?
A: The list just goes on. I love the staff, and their diversity, commitment, and the passion they put into the care we give to each and every patient. We all give our best all the time – it’s exceptional care without exception. That’s what I’ve seen from the time I walked in, and I continue to see it every day. It goes from leadership all the way down.

Q: What do you do for fun outside of work?
A: I’m a mother of two, so after work, I like to think of myself as an Uber driver who doesn’t get paid. But I love spending time with my kids. I also love to travel. I love the islands. Put me by the beach and I’m happy.

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More Than a Physical Toll: Fatigue and Frustration Impact Diabetes Patients

Not all studies affirm their hypotheses. Jenny Jia, MD, experienced this first-hand when she analyzed an intervention to support diabetes self-management in patients with the disease who lived in diabetes “hot-spots,” areas where a disproportionate number of people have diabetes. The participants were all African-American, and all needed to take more than one form of public transportation to get to their doctor. The intervention included access to group meetings in the community, where participants would receive support from a community health worker and engage in a narrative story-telling technique called photovoice to open up about living with diabetes.

One of the main findings was that these activities did not improve blood sugar levels of participants – a main measure of a person’s diabetes management – compared to the control group, which left her with a question: why?

During her team’s analysis, the answer became clearer. Participants were fatigued and frustrated with their self-management routines, which includes monitoring blood sugar levels as well as maintaining a healthy diet, weight, and regular exercise. While patients know how to manage the disease, they became disheartened when they didn’t meet the treatment goals established with their providers.

“It reminded me of burnout that you see among people who are overworked,” Jia said. “People with diabetes have to think about their health choices every day, and we need to better understand what barriers they face and how we can best support them and build resilience, especially among African American patients and patients who live in diabetes hotspots.”

The results of her study helped shine a light on that, and she’s hopeful that more community-based interventions will be studied to find supports that work well for residents.

Shirin Haddady, MD, an endocrinologist at BMC, sees similar struggles in her patients. The most important thing to understand about diabetes, she says, is that it’s a very difficult disease to manage, even for people with a good education, income, and access to healthy foods. Patients must monitor their own blood sugar at home, and adjust their medication doses, diet, and exercise as necessary. For patients with additional stressors in their life, managing their diabetes may seem like an insurmountable task.

“Any medical problem is a stressor, but compounding stressors like working multiple jobs, having unstable housing, or needing to take several forms of transportation to see a doctor or get to a healthy grocery store makes taking care of your diabetes so challenging,” Haddady says.

BMC is actively working to address these barriers, and there are interventions across the hospital aimed at specifically lifting the burden patients with diabetes face. One is access to a team of nutritionists in the Endocrinology Department. Along with physicians and nurses, nutritionists work to increase education around managing blood sugar through diet and exercise. Taking a focus on healthy food one step further, BMC’s Teaching Kitchen offers classes specifically tailored for patients with diabetes. The Nutrition team is also working with BMC’s Marketing Department to create educational videos supporting diabetes patients, an initiative Haddady commends.

Another program she’s seen have a positive impact on patients’ diabetes self-management is expanded group classes and programs where patients can talk with and learn from each other.

Haddady also pushes for more research on using health coaches to support diabetes self-management, saying, “Providers and nutritionists are extremely useful for educating patients about how they should be managing diabetes, but coaches could go the next level and support implementing these care practices.”

Finally, she suggests using positive interview techniques with patients, and for providers to keep in mind that the same guidelines or speed of treatment may not work for every patient.

“For some patients, it may take three months to get their blood sugar levels to a stable place,” she said. “For others it may take four years. As providers, we need to remain positive with our patients and continue to push them to care for themselves without leaving them frustrated or disheartened.”

As BMC continues to push towards creating the healthiest urban population in the world, helping patients, especially those in diabetes hotspots, manage this chronic illness will be a priority. Beyond the physical effects of diabetes, the fatigue and frustration around self-management will be a barrier to overcome in keeping patients healthy.

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In the Blink of an Eye

The Gavaghan family knew very little information as they waited anxiously for their son and brother, Brendan, to come out of emergency neurosurgery at Boston Medical Center. All they knew for certain was his cell phone was in his hand as he fell backwards down the stairs, as indicated by a long mark along the wall. Everything else was unknown, including an answer to the most important question of all: was he going to make it?

It all started after the New England Patriots won the Super Bowl in 2017. Like any avid Patriots fan, Brendan joined thousands of others at the celebratory parade in Boston. After the fun ended, he headed home, entering his house through a back entrance like always. Within seconds, an everyday routine altered Brendan’s life. As he walked up the stairs, Brendan tripped on the carpeting, causing him to fall backwards and land on a tile floor. The back of his head bore the brunt of the fall.

Running to see what caused such a loud noise, Brendan’s father found his son unconscious and bleeding severely. He immediately called 911, and within moments first responders were rushing Brendan to BMC. Doctors assessed his condition and discovered his pupils were fixed and dilated—a sign of poor prognosis and that the team needed to act fast. A CT scan revealed Brendan suffered a subdural hematoma, a severe life-threatening injury in which blood amasses outside of the brain and increases the amount of pressure on the brain. His best chance of survival was surgery to remove the blood and a portion of his skull, which would give the brain unobstructed room to swell— key to preventing further damage. Within 30 minutes of arriving to the emergency department, Brendan was in the operating room.

While the surgery was underway, the family’s private waiting room was transformed into a makeshift vigil where Brendan’s parents and two sisters waited with a legion of friends and relatives. Hours later, there was a knock on the door. Neurosurgeon Keith Davies, M.B., B.Ch., entered with a promising update. “He said, ‘I’m optimistically hopeful,’” recalls Brendan’s mother, Susan. “It was night and day from what we were told earlier. And we really held onto that good news.”

Before it could be determined whether Brendan would have any long-term deficits, his brain needed time to rest and heal. He was transferred to BMC’s surgical intensive care unit (SICU) where he was under constant, close monitoring. While it was difficult seeing Brendan in critical condition—he was in a coma with a ventilator helping him breathe—the entire nursing team put the family at ease, which was especially meaningful to Susan, a fellow nurse. “The nurses were incredible,” she remembers, noting how they made the family as much of a priority as Brendan.

“We work very well together, we work very hard and we have a lot of experience handling difficult situations,” explains BMC nurse Beth Stevenson, R.N. “Our experiences, both personal and professional, make it easy to put ourselves in their shoes. This is why we embraced the Gavaghans as much as they did us.” A testament to their outstanding care was how the family felt comfortable leaving Brendan’s bedside to go home every night and recharge. “Doing that speaks volumes to our confidence in the providers,” says Susan. “As hard as it was to go home, we knew we were leaving him in capable hands.”

Over the next few days, Brendan showed signs of improvement. He was weaned off the ventilator and was responding to verbal cues. “At first we weren’t sure how far he was going to come back from this,” recalls Stevenson. “But little by little he took us by surprise. I could tell he was going to pull through.” After about two weeks, Brendan was discharged to a rehabilitation hospital. “He came to us comatose and unable to breathe on his own, and left us saying ‘please’ and ‘thank you,’” adds Stevenson. But it would not be the last Brendan would see of BMC. A few months later, he was back to see Davies for surgery to replace the portion of his removed skull. Davies used a custom-made implant designed from a CT scan of his skull and created by a 3D printer. The surgery was a turning point in his recovery, setting him on a path to a fully restored life.

As Brendan and his family resumed their normal lives, they wanted to show BMC their appreciation for having the opportunity to do so. Susan joined BMC’s Patient Family Advisory Council to help further the hospital’s mission and his sisters ran the 2018 BAA 5K with Team BMC—the hospital’s athletic fundraising team.

“I am so lucky to be where I am today, and I know it’s because of BMC. They saved my life, and I am so thankful to everyone who cared for me,” concludes Brendan. “But what means the most is what [BMC] did for my family. It’s powerful knowing people were watching out for me like that.”

Read more great stories from the Office of Development here.

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Awards and Accolades

Thea James, MD, Honored with 2019 Public Health Leadership in Medicine Award

Thea James, MD, Vice President of Mission and Associate Chief Medical Officer, has received the 2019 Public Health Leadership in Medicine Award from the Massachusetts Public Health Association. The award honors a physician who inspires others with their leadership and determination to advance health equity in Massachusetts.

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