The BMC Brief

April 26, 2012 Volume 1, Issue 23

• Check Up on QUEST Goals
• Study Finds Diverting Passengers to Elevators Could Help Reduce Falls at Logan Airport and Beyond
• Former College President Devotes Time to BMC Kids
• What Do You Do, Theresa Knight?
• In Their Words
• News of Note
• Awards and Accolades

Check Up on QUEST Goals

BMC has been hard at work on its 2012 QUEST goals (Quality, Efficiency, Satisfaction and Total Revenue) since the hospital announced them last fall. At the midpoint of the hospital’s fiscal year, here is a status report on our performance in the second quarter:

1. QU: Quality
   • Improve performance on the University Health Systems Consortium (UHC) mortality index to current UHC median of .97.
     The mortality index is a standard measure of BMC’s mortality performance adjusted for the illness level of our patient population. BMC shares quality data with the UHC and uses UHC benchmarks for evaluating performance and setting quality goals.

     “BMC has seen an improvement in its mortality index and has been performing better than the QUEST goal for two out of last three months,” says Stanley Hochberg, MD, Vice President, Patient Safety and Quality. “This is due to the great work being done throughout the hospital by all staff in improving the care for lift-threatening conditions and implementing proactive interventions to decrease post-operative complications.”

   • Schedule 80 percent of new primary care patients to be seen within 14 days; improve the number of new patients seen in all other specialties combined within 14 days by an average of 10 percent.

     “More than half of our new patients are being seen within two weeks during a time when many primary care practices across the city are closed to new patients,” says Peter Healy, Vice President, Professional Services. “Our goal is to get to 80 percent and we are employing a number of tactics including adding providers, expanding provider schedules and improving call center and practice support functions to achieve this goal. In the last three months, we scheduled more than 5,000 new patient appointments into primary care practices with a median wait time of 17 days.

     “For specialty services, the issues vary by department,” continues Healy, “but our goal is for every specialty service to increase the number of new patients they see within 14 days by 10 percent over last year. Currently a third of our specialty practices are achieving this goal or very close to it. During the last quarter, we've scheduled nearly 44,000 new patients into our 33 specialty practices with a mean wait time of 22 days. We continue to remain focused on prioritizing new patient access at BMC while maintaining access for our thousands of established patients.”

2. E: Efficiency
   
   • Hold spending to the budgeted amount of $810 million for the expense categories of wages, employee benefits, physician services, drugs, supplies and utilities.

     BMC not only achieved its goal of keeping costs below $403 million for the first half of the fiscal year, but finished well under it, spending $987,000 less than expected. Savings were achieved by primarily containing wage and benefits and supply costs.

     “We did a great job managing costs in the first two quarters by spending every dollar as if it were our own,” says Richard Silveria, Vice President, Finance and Chief Financial Officer.

3. S: Satisfaction
   
   • Increase the commitment score on BMC’s Employee Engagement survey by 5 percent.

     The commitment score reflects the degree to which employees feel committed to BMC and their willingness to recommend BMC as a good place to work and to receive care.

     Since the March 2011 Employee Engagement survey, departments have created action plans to address improvements in their areas. Implementation work is well underway, says Tim Manning, Vice President, Human Resources. Hospitalwide initiatives include:

     Huddle Card: Each week managers and directors share need-to-know hospital information in person with their staff.

     Management Development Program: Close to 200 managers are participating in this program that contains 20 workshops focused on developing key competencies, promoting consistency of management practices throughout BMC and supporting employee and manager engagement.

     Senior Leadership Rounding: Members of senior management are visiting units and floors each week to meet staff and address any questions or concerns they have. The weekly schedule is posted on the intranet.

     Town Hall Meetings: Meetings continue to be held quarterly by President and CEO Kate Walsh to inform the BMC community of important happenings.

     Employee Recognition Kits: Kits are available to managers to support and encourage employee performance and continuous improvement.

     Focus groups: HR is currently conducting focus groups to talk about lessons learned since the survey and share best practices. A second Employee Engagement survey will follow in the fall.

   • Increase the percentage of patients who rate BMC a 9 or 10 on the “Overall Rating of Hospital” to 70 percent for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, as measured by Press Ganey.

     The most recent Press Ganey scores show BMC performing at 69 percent, which is close to goal. Work on the following initiatives continues as BMC works to improve the patient experience.

     Room-a-Day Program: In November Facilities rolled out its Room-a- Day program. The program takes two inpatient rooms out of commission each day of the week to “refresh” them, which can include painting the walls, waxing the floors and maintenance work on heating and cooling systems. The program has refreshed 58 rooms so far and is on schedule to complete all 336 inpatient rooms by the end of the year.

     Environmental Services has rolled out a “Picture Perfect” program that leaves every room that is cleaned in “perfect” condition with furniture in its place, beds made properly and curtains aligned. Tent cards on bedside tables give patients the Environmental Services phone number for any immediate cleaning needs.

     A rounding pilot will begin in the Primary Care and Orthopaedic clinics in May. The pilot is designed to welcome patients and explain the steps that will occur during their visit. Rounders also will gather information about patient visit expectations.

     “We’ve made great progress in the last quarter,” says Rebecca Blair, Executive Director, Patient Experience. “Our Press Ganey pain score continues to improve and we are now at 71 percent—the top rating—for patients who answer “always” on the question “Did staff do everything to help with pain?” We have seen a decrease in the number of unanswered phone calls made to BMC, thanks to our new Patient Care Support Center and we now have Volunteer Ambassadors in our building lobbies who are able to direct and assist patients in need of help.”

4. T: Total Revenue
   
   • Achieve patient service revenue of $854 million

     Despite a continued decrease in inpatient volume, a trend hospitals across the city are experiencing, total patient service revenue for the first two quarters was $429 million, $8 million above budget.

     “Our Medicare case mix (measure of BMC’s expected resource utilization based on a patient’s diagnosis) during the past six months was strong and tracked better than budget, an ongoing trend,” says Silveria.

Visit the BMC intranet to learn more about the QUEST goals.

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Study Finds Diverting Passengers to Elevators Could Help Reduce Falls at Logan Airport and Beyond

A recent study by BMC researchers finds that diverting passengers from escalators to elevators could help reduce the number of falls at Boston Logan International Airport. According to the study data, one fall requiring emergency medical services response occurs, on average, approximately every 56 hours at the airport.

Jonathan Howland, PhD, MPH, MPA

The study, conducted by Jonathan Howland, PhD, MPH, MPA, Executive Director of BMC’s Injury Prevention Center and Sophia Dyer, MD, was requested by the Massachusetts Port Authority and Massport Fire/Rescue to determine the incidence of falls at Logan, identify potential causes and make suggestions on how to decrease the risk for falls.

Escalators were the most common location for all reported falls (44 percent). The researchers suggested that some risks associated with these falls might include carrying more luggage (due to changes in baggage fees), using cell phones, not using handrails, and compromised strength and balance due to age.

“Interventions that target escalator falls hold the greatest promise to decrease the incidence of falls at this airport,” says Howland. These interventions could include signage and audio messages to encourage passengers with luggage to use elevators instead of escalators. Massport has begun taking steps to implement these measures.

“While this data and analysis was done at one airport, the findings could be generalized and applied in other public places, including transit stations, shopping malls and other airports,” adds Howland.

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Former College President Devotes Time to BMC Kids

Marjorie Bakken knows a thing or two about childhood development as the former president of Wheelock College in Boston, an institution that trains early childhood educators. For the past six years, she has learned a great deal about childhood chronic illness as a weekly volunteer in the Pediatric. AIR (Asthma, Immunology, Respiratory) Clinic at BMC. Bakken works with Suzanne Steinbach, MD, FAAP, Director of the clinic, and Jonell Johnson, RN, greeting patients and their families and engaging children as they wait for treatment and testing. She also spends time with parents helping to reassure them and reinforce the care and guidance the clinicians provide.

Marjorie Bakken

“I love working with children and being here has been fabulous for me,” says Bakken. “It has been a way of reengaging with my earlier commitments to working with young children and their families.”

Bakken does what she can to make families feel welcome to the clinic, helping to relieve their anxiety while they wait. When parents are meeting with staff, she takes the kids for walks, does puzzles with them and reads to them.

“We try not to keep parents and patients waiting long for care, but siblings who are along for the trip inevitably are merely waiting,” notes Steinbach. “Without Marjorie's attention the clinic visit can be bleak for them. She enriches the clinic experience for children and families as well as for the staff who have been so fortunate to work with her.” According to Steinbach, Bakken also has donated countless books, toys and craft materials for the children.

“I like the family centered approach of the clinic,” says Bakken, “and the care that is provided is quite outstanding. I have gained a great deal of insight into how families construct their lives when they have a child who is chronically ill. I see how they need to accommodate their lives to allow that child to thrive. That is very humbling because it is not easy and they often don’t have the resources, especially financially.”

Volunteer Services Manager Dottie Keosaian says that to date, Bakken has volunteered 815 hours.

“Marjorie exemplifies the generosity and commitment of hundreds of BMC volunteers, whose commitment to our patients and staff is outstanding. Her dedication is amazing and we are grateful to her for what she does for our Pediatric patients,” says Keosaian.

Bakken is one of 290 current volunteers and 600 annually, who donate their time to BMC. Volunteers are screened and placed around the hospital by Volunteer Services, who works hard to match a volunteer’s interest with the needs of the hospital. Placements include Pediatrics, Refugee Health and Pastoral Care. The average length of a volunteer’s commitment is 14 months, although BMC has some volunteers who have been here 32 years.

BMC celebrated National Volunteer Week April 15-21. To learn more about BMC’s Volunteer Services program, visit www.bmc.org/volunteerservices.

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What Do You Do, Theresa Knight?

Name: Theresa Knight
Title: Patient Hospitality Service Representative
Department: Food and Nutrition Services
Years at BMC: 35

What brought you to BMC?
I used to be an assistant visiting nurse years ago and my sister-in-law, who was a nursing assistant here at the time, told me there was a part-time job opportunity in Food and Nutrition Services. I loved what I did; meeting patients, spending time with them and serving them dinner. Eventually a full-time position opened up and I took it.

What do you do here?
The first thing I do when I arrive in the morning is check the list of new patient admissions in the Newton Pavilion. I call the new patients and inform them of the breakfast options, create a menu for them and put the meal together for their trays. I then serve breakfast to patients and pick up their trays when they are finished. After that, I begin work on the next two meals for the day and breakfast for the following morning.

What do you like most about working at BMC?
I love helping people. My motto is if I can help someone than my living shall not be in vain. Sometimes you have very sick patients and if you can do one little thing to make them more comfortable, it can brighten their day. I love the people I work with, too, whether it be fellow Food and Nutrition Services staff, the chefs or nurses.

Why are the hotel-like functions of hospitality important to the hospital?
It makes patients feel cared for. When you go to a hotel, anything you need is at your fingertips; your bed is made especially for you and your food is made and delivered to you. It’s different from home, so it’s important for the atmosphere to be comfortable. Our goal is to provide that in the hospital.

Do you create menus specific to patients’ conditions?
The doctors write the menus and we get a list with the patients’ names and diet restrictions. For example, if it’s a cardiac patient, we have a specific menu for that condition and we know exactly what to put on that tray. After the doctor decides on the menu options, I meet with the patient individually to review the menu with him and together we decide what he will have.

How do you deliver BMC’s mission of providing “exceptional care without exception?”
By making sure that everyone is treated the way you would like to be treated regardless of age, nationality or background. I also try to never say something isn’t my job if it can help someone else and I always try to put myself in others’ shoes. When a patient says, “Oh, I missed you yesterday,” that’s a good feeling.

Do you know a staff member or department that should be profiled? Send your suggestions to communications@bmc.org.

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In Their Words

Patients share their BMC experience

I want to take this opportunity to thank the many professionals that cared for me during my past two surgeries. It is my first experience with Boston Medical Center and I found that my case was followed and I was provided excellent care and follow-up care and treatment from the professionals at BMC and your staff. I was impressed by Jan Ring, ANP; she always was available to answer my questions but provided valuable education material and resources that made me confident that I had a clear understanding of the procedure as well as the disease.

I want to take this opportunity to recognize Ellen Spears, Surgical Coordinator. She went above and beyond to help me plan and make sure I had everything in place I needed as she coordinated my office visits, surgeries and follow-up care. She made sure that she had a clear understanding of my circumstances and took into consideration my professional obligations and my lengthy commute from Cape Cod. She is a shining example of the “best” image that Boston Medical Center offers and deserves recognition for her professionalism.

Thank you, again, for my excellent care and treatment.

Onset, Mass.

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News of Note

TranSComm staff at the event

BMC celebrates Earth Day
BMC employees gathered in the Shapiro lobby April 20 to celebrate Earth Day. Organized by BMC’s Green Committee, the event provided an opportunity to learn about the hospital’s sustainability efforts and gave staff the chance to recycle their used batteries, printer cartridges and CD/DVDs. In 2011, BMC recycled 181 tons of paper, 9.24 tons of recycling debris and baled 178 tons of cardboard. Through its partnership with Keep Local Farms, the hospital also raised $4,883 to support New England Farmers last year.

Representatives from Starbucks handed out samples of iced tea and coffee that are available for purchase in the Shapiro cafeteria. Other giveaways included recyclable pens and gardening seeds. Farmer Dave provided information about its farmer’s market program at BMC while staff from TranSComm and ZipCar provided information about “green” commuting options. Representatives from Stericyle, Office Depot, Philips, Belmont Springs and Standard Electric were also at the event.

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Awards and Accolades

BMC recently was ranked No. 1 in the state for its delivery of stroke care by the Stroke Collaborative Reaching for Excellence (SCORE), a voluntary statewide quality improvement collaborative administered by the Massachusetts Department of Public Health. BMC received an award for providing “defect-free care to a minimum of 80 percent of patients;” 93 percent of BMC patients received defect-free care. SCORE awards were created in 2009 to recognize participating hospitals (58 statewide) for their achievements in providing stroke care.

Jane Mendez, MD, Surgical Oncology, has been named the recipient of the 2011 Appropriate Treatment in Medicine (ATM) Award given annually by BUSM to a faculty member. The award recognizes Mendez’s outstanding teaching and leadership of medical students and her personal commitment toward creating a positive learning environment. Serving as a role model for personal integrity and accountability, she was selected by students and faculty members.

Sean Palfrey, MD, FAAP

Sean Palfrey, MD, FAAP, Pediatrics, was named the first Massachusetts recipient of the 2012 Centers for Disease Control and Prevention (CDC) Childhood Immunization Champion Award. Palfrey directs the Massachusetts Chapter of the American Academy of Pediatrics (MCAAP) Immunization Initiative and was nominated for this award by the Massachusetts Department of Public Health (MDPH). Established this year by the CDC, the Childhood Immunization Champion Award recognizes individuals who make a difference in the lives of infants and children through their work in immunization.

Richard Saitz, MD, MPH, Director of the Clinical Addiction Research and Education (CARE) Unit, has been named the 2012 recipient of the R. Brinkley Smithers Distinguished Scientist Award by the American Society of Addiction Medicine (ASAM). The award recognizes an individual who has made highly meritorious efforts to advance the scientific understanding of alcoholism, its prevention and treatment. Saitz is being honored for his contributions to research-based practices in addiction medicine and efforts to incorporate those practices into general health settings such as primary care. He has led research on screening and brief counseling interventions to address the whole spectrum of unhealthy use, from increasing the risks of health consequences to more severe problems like addiction. Established in 1995, The R. Brinkley Smithers Distinguished Scientist Award and Lecture are a tribute to R. Brinkley Smithers who influenced American alcoholism policy, theory and treatment.