April 2014 Volume 1, Issue 3
Sweeping health care reform is changing the way hospitals deliver care and here at BMC we are proud to be an early adopter of initiatives to make the transition smoother and easier for our patients, staff and the broader BMC community. To that end, we have initiated a significant multi-year transformation to make the physical changes to our clinical campus to position BMC for new models of health care delivery in an increasingly cost conscious environment. The campus redesign, to be completed over the next four years, is in many ways the culmination of the 1996 merger of Boston City Hospital and Boston University Medical Center Hospital and is a critical component of the hospital’s strategic plan.
While the physical transformation of our campus will be obvious as you drive down Albany Street, there’s a lot of other exciting work going on inside the walls of our hospital. BMC continues to be recognized as a leader, including by Boston’s new Mayor Martin J. Walsh, The Institute of Healthcare Improvement, Boston Center for Independent Living and Boston Magazine, for our creative and innovative patient programs and our outstanding physicians. I invite you to learn more about how BMC is providing Exceptional Care Without Exception in our latest issue of Innovations.
Created in 1996 by the merger of two separate hospitals each with its own full-service campus two blocks apart, BMC has operated since its inception as a “split” configuration with costly inefficiencies – like two sets of operating rooms, two radiology departments and the need to shuttle patients back and forth via ambulance depending on treatment needs.
At the end of 2013, BMC unveiled plans for a clinical campus redesign project that will eliminate these inefficiencies and improve key patient care facilities hospital-wide. The project will yield at least $25m per year in savings and consolidate the overall campus footprint while maintaining patient services at current levels and preparing BMC for new models of health care delivery.
Over four years, the redesign project will expand the BMC Emergency Department (ED), create a state-of-the-art radiology department adjacent to the ED, relocate multiple operating room suites onto one site and create a cohesive women’s and children’s facility. The redesign also will consolidate the Intensive Care Units with appropriate clinical departments located adjacently, construct a bridge to allow more efficient patient transport from the helipad to the ED, and update buildings across campus to a modern and unified appearance.
In addition to remedying the operational inefficiencies associated with the current campus configuration, the redesign will put in place the infrastructure changes necessary to move to new models of care delivery. For example, patient care is increasingly shifting from inpatient to outpatient settings and investment in new technology means reconfiguring hospital rooms and surgical suites. BMC is on the leading edge of this trend and is thoughtfully redesigning the campus to meet these new imperatives.
Fourteen construction trailers are serving as the home base for the 90 assorted contractors, engineers, architects and project managers overseeing the multi-year redesign project. The construction process being used for the BMC redesign is known as Integrated Project Delivery (IPD) and this will be the first major construction project in Boston to use the IPD process. The IPD method is relatively new to the East Coast, with Maine Medical Center among the first hospitals in New England to use it.
Unlike more traditional siloed approaches, IPD is a method where the key stakeholders – the architect and engineer who design a building, the general contractor who executes the work and the client who owns it – work together to optimize the project outcomes. Together the three groups agree on a project’s scope and overall budget and set a defined fixed amount of profit for each group. Rather than individual component budgets, the project’s funds are centralized, with all three groups working from a common pool. If the project starts going over budget, the groups must dip into their individual profits, creating a strong incentive for all the stakeholders to work within the budget. The IPD process is designed to reduce waste, foster collaboration and trust among stakeholders, and maximize efficiency throughout all parts of the construction process.
“When the work is finished, BMC will be one of the newest, full-service, academic medical centers in town and our flagship building, the Menino Pavilion, will be a state-of-the-art clinical care facility. As important, our campus will be specifically designed to operate as efficiently as possible so we can maximize every operating dollar we spend.” said Bob Biggio, Vice President of Facilities at BMC.
Delivering on a commitment to fight urban violence as a hallmark of his Administration, Boston Mayor Martin J. Walsh visited Boston Medical Center on his second day in office to highlight a BMC program that has become a national model in breaking the cycle of violence.
Long known for providing extraordinary trauma and emergency care, BMC has developed a novel and effective approach to assist victims of violence in their recovery from physical and emotional trauma and empower them with skills, services and support to make positive changes in their lives and contribute to building safe and healthier communities.
Created and led by Dr. Thea James, a longtime emergency department physician at BMC, and run in collaboration with the Boston Public Health Commission, BMC’s Violence Intervention Advocacy Program (VIAP) provides a pathway to a new life for hundreds of victims of violence each year, most of whom are young males between the ages of 16 and 24.
“Despite the progress that has been made, there are too many of our residents exposed to violence on a daily basis,” Mayor Walsh said, as he addressed the crowd gathered in the hospital’s Shapiro Building lobby. “We know there is work to be done and it is something I am making a priority in my administration.”
Mayor Walsh was joined on his visit by BMC President and CEO Kate Walsh, the city’s Chief of Health and Human Services Felix Arroyo and Executive Director of the Boston Public Health Commission Barbara Ferrer, MD.
In a meeting with the VIAP team, the group learned about the program’s innovative approach, which focuses on intervening at the bedside as soon as a victim of violence is brought to the Emergency Department. Maximizing this window of opportunity, staff are trained in a variety of evidence-based, violence prevention and intervention strategies, including substance abuse screening, psychological first aid and case management. The program also has a strong mental health component, which is critical since 95 percent of VIAP clients exhibit mental health issues. Through these strategies, staff develop a tailored approach that takes into account each client’s individual risk factors so they can work with them to find positive alternatives with the potential to transform their lives.
Speaking to those gathered at BMC for the Mayor’s visit, President and CEO Kate Walsh said, “All of us at Boston Medical Center are eager to support and collaborate with Mayor Walsh in his efforts to reduce violence in our City. Tackling urban violence is a public health issue that requires the involvement of organizations throughout the City and we are fortunate to have Mayor Walsh’s commitment and leadership in this effort.”
Founded in 2006, VIAP is a statewide model and a leader in a growing national network. In addition to its collaboration with the BPHC, VIAP works with multiple community partners and stakeholders including The Boston Foundation's StreetSafe Project, the Boston Public School System, and the Boston Partners Advancing Communities Together (PACT) service initiative, as well as dozens of other local community-based organizations.
“We need a continuum of care to address the underlying causes of violence, not just the symptoms,” said Mayor Walsh, noting VIAP as a particularly effective model for this approach. “And we need to make sure there are more trauma experts out in the neighborhoods helping people right away.”
IHI Highlights BMC’s Centering Pregnancy Program as Model of Positive Patient Engagement and Care Delivery
The Institute of Healthcare Improvement (IHI) is well known as a leading national and international resource that promotes the most inventive and effective approaches to improving health care and lowering costs.
Toward that end, IHI partners with visionaries, leaders and practitioners worldwide to showcase the best examples of innovation from around the globe. At the organization’s 25th National Forum in December, BMC’s Centering Pregnancy Program was highlighted by IHI’s CEO Maureen Bisognano as a prime example of these “best in breed” approaches.
In her keynote address, Bisognano spoke about the need for the health-care industry to “flip” its focus to the patient and the aspects of the care that matter most to that individual. On a recent visit to BMC’s Department of Obstetrics and Gynecology, Bisognano saw that principle in action when she met with hospital leaders and Centering Pregnancy staff as well as BMC patients participating in the Centering Program.
How it works
Speaking about the approach, Bisognano said “Programs like this provide better health outcomes for mothers and great care, and the costs are about $2000 less per pregnancy… . There are approximately 100 approved centering pregnancy sites in the US today. They estimate about $44 million in savings and if “everyone flipped to centering pregnancy, there’s about 9 billion of healthcare complications and costs that we could eliminate.”
“This is just one example of how we are thinking about maternity care, and health care in general, in a creative, nontraditional way, and the IHI recognized that,” said Kate Walsh, BMC President and CEO. “The Centering Program is shifting the focus back to patient-centered care, allowing the patient to participate in her own health care and improving outcomes as a result.
To view IHI CEO Maureen Bisognano’s keynote address, visit the website and scroll to minute 33 to hear about the Centering Program at BMC.
Boston Medical Center (BMC), together with Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH), has been awarded a $25 million grant from the National Institutes of Health (NIH) to discover cost-effective ways to treat Critical Limb Ischemia (CLI), which affects approximately one million people in the U.S. The trial will enroll 2,100 participants and be conducted at 120 clinical centers in the United States and Canada.
CLI is the most severe form of peripheral arterial disease, which is caused by chronic inflammation and atherosclerotic plaque build-up in the arteries of the legs. Symptoms caused by reduced blood flow to the legs and feet include ischemic leg pain, non-healing wounds and gangrene. If untreated, CLI can often lead to leg amputation. With the national population aging and the rate of diabetes rising, incidences of peripheral arterial disease and CLI have been increasing. While both open surgery and endovascular interventions are used to treat CLI, it is not clear which approach works best in patients who are candidates for both treatment options, according to the study’s investigators.
The grant enables BMC, BWH and MGH to collaborate on a four-year, randomized clinical trial that will compare traditional bypass surgery with the less invasive alternative of endovascular treatment for CLI patients to determine the most effective treatment option for patients both in terms of medical outcomes and cost. It also will foster greater collaboration among the specialists that care for these patients, which include vascular surgeons, interventional cardiologists, interventional radiologists and vascular medicine specialists.
According to Alik Farber, MD, division chief of Vascular and Endovascular Surgery at BMC, and one of the principal investigators of the trial, “Currently, there is a lack of consistency and clarity as to what approach – minimally invasive endovascular or open surgery – is best for our patients. The trial will provide answers to many unanswered questions, most importantly what treatment works best for whom.”
Boston Magazine released its annual Top Docs issue in December 2013 and BMC is strongly represented with 68 BMC physicians listed as “tops” in their respective fields. The Magazine highlighted the care that surgeon Jeffrey Kalish, MD, provided to marathon bombing patient Adrianne Haslet-Davis, just one example of the many BMC caregivers who provided exceptional care to all our marathon patients. “The care and support these ‘Top Docs’ provide to BMC’s patients and families every day is exemplary, and this recognition is well deserved,” explains BMC President and CEO Kate Walsh.
Allergy & Immunology
Colon & Rectal Surgery
Maternal & Fetal Medicine
Pediatric Infectious Disease
On Jan. 29 BMC senior management joined with more than 70 patients, health care advocates, leaders in Boston’s disability community and government officials to celebrate the signing of a historic agreement aimed at making BMC the most accessible hospital in the city. In partnership with the Boston Center for Independent Living (BCIL), a pre-eminent voice working to eliminate discrimination, isolation and segregation to enhance the independence of people with disabilities, the agreement acknowledges the hospital’s ongoing efforts over the past several years to address the health care needs of patients with physical disabilities.
Kristen McCosh, Bob Master, MD, Kate Walsh and Sergio Goncalves
Sergio Goncalves, BCIL Chairman, spoke on behalf of the staff and the board of the Boston Center for Independent Living. “Today we celebrate a clear voice and vision between BCIL and Boston Medical Center and today our voice is clear and loud as we move forward toward better health care at Boston Medical Center. We have a strong vision of how to work together and train current and new staff to serve all people with disabilities.”
Through proactive training of staff who care for patients with disabilities, increased availability of medical equipment and devices for these patients, and improvements to the campus to improve accessibility, BMC is setting the bar and hopes to serve as a role model to help change the culture of how health-care institutions care for those with disabilities.
“Our caregivers and staff work hard every day to address health-care disparities including ensuring access for our patients with disabilities,” said Kate Walsh, President and CEO of BMC. “We are making strides in this area but we have more work to do and we are committed to working with the BCIL and the advocacy community to make BMC more easily accessible for all our patients.”
Exploring Ways to Treat the Mind, Body and Spirit:
Bringing the Blend of Conventional and Complementary Therapies to the Underserved
BMC's Program for Integrative Medicine and Health Care Disparities, housed within BMC’s Department of Family Medicine, has created a national model demonstrating the critical role integrative medicine can play in improving the health and quality of life for patients, regardless of income, race or socioeconomic status.
Founded in 2004, the program blends the best of conventional medicine, complementary therapies, and lifestyle changes; emphasizes a compassionate healing relationship between patients and their caregivers; and views the patient as a whole person – mind, body and spirit. BMC’s approach to Integrative Medicine includes yoga, tai chi, a healthy steps exercise program, consultations with physicians, acupuncture, massage therapy, the Buteyko Breathing Method as well as live cooking demonstrations.
“As health care moves to a model that is focused on taking care of the whole patient, integrative medicine has an important role when combined with traditional medicine across specialties to provide patients with a comprehensive set of approaches they can use to improve their physical, mental and emotional health,” said Robert Saper, MD, MPH, a member of the Department of Family Medicine and director of Integrative Medicine at BMC.
In addition to individual sessions with physicians, patients may participate in a group visit program that is targeted for those with multiple chronic conditions such as depression, anxiety, obesity, high cholesterol and hypertension. Over a period of eight weeks, patients attend two and a half hour sessions that include mindfulness-based stress reduction techniques, massage, acupuncture, yoga, nutrition, patient education and support, individual physician visits and a healthy lunch.
Preliminary results from these group visits have shown that after eight weeks patients report decreased pain levels and blood pressure, an improvement in sleep quality, and clinically meaningful mental health improvements associated with depression, stress and generalized anxiety. One patient explained, “My numbers are going down, and my blood pressure and my blood sugar are going down and [I am] losing the weight, every once in a while I’ll meditate; and every once in a while I’ll use some of the yoga methods that I’ve learned about.” Another stated, “Your mind and your body, everything’s connected; when you are happy up here [taps head], it’s a little easier to deal with pain.”
“The Integrative Medicine Group Visits have been shown to significantly reduce pain, depression and systolic blood pressure and data have shown trends toward improvement in anxiety, sleep and stress,” explains Dr. Katherine Gergen Barnett, the program’s director of Clinical Services.
As a leader in bringing integrative medicine to the underserved, BMC has provided counsel to other hospitals that are interested in BMC’s model, including San Francisco General Hospital, George Washington University, and other smaller hospitals around the country. While many hospitals offer integrative medicine programs on a cash-only basis, BMC’s programs are offered free of charge or on a sliding scale so patients can pay what they are able. BMC also has developed mutually beneficial partnerships with other organizations, such as the New England School of Acupuncture, to sustain the program and ensure low-income patients have access to the services they need.