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December 19, 2012 Volume 1, Issue 35


2012: The Big Picture

BMC kept its nose to the grindstone this year, working hard on its Be Exceptional strategic plan. Along the way, it experienced research breakthroughs, earned numerous awards and accolades, including being named a 2012 Top Leapfrog Hospital, and achieved safety milestones, such as zero infections on a cardiac unit for a year. Here’s the big picture of Boston Medical Center in 2012.

January

  • BMC opens its new, 5,000 square foot Solomont Clinical Simulation and Nursing Education Center.

February

  • The Elders Living at Home program celebrates its 25th anniversary with a movie premier that features one of its former client’s stories in the Hollywood film, Being Flynn.

March


  • Researchers find that walking speed and hand grip may predict dementia or stroke risk as a middle-age person.

  • BMC holds its first Multicultural Fair, where employees showcase their cultures.

April

  • BMC opens its Patient Care Call Center to handle appointment scheduling and other care-related issues for 30,000 primary care and Women’s Health patients.

  • BMC and affiliated health centers enter into a five-year Blue Cross Blue Shield of Massachusetts Alternative Quality Contract. Under the contract, the hospital and the health centers are responsible for the care of a population of patients within a set budget and will receive financial incentives for meeting quality metrics.

May

  • The Geriatrics Home Care program, the oldest continuously operating in-home medical service in the United States, is one of a handful of programs across the country selected to participate in the new Medicare Independence at Home program. The program tests whether in-home care for elders will improve health outcomes and reduce costs.

June


  • BMC introduces its new Patient Experience Awards. The awards recognize outstanding achievements in improving the patient experience as part of the Be Exceptional strategic plan’s work to Provide the Right Care for Every Patient, No less, No more. The Patient Experience Awards are given quarterly to the teams who provide an excellent patient experience, as measured by patient satisfaction surveys and other significant, tangible achievements.

  • BMC holds its inaugural Catwalk for BMC Cancer Center. Staff and patient cancer survivors model fashions created by local designers. The event raises $37,000 for BMC.

  • BMC is named a “Leader in LGBT (Lesbian, Gay, Bisexual and Transgender) HealthCare Equality” in the 2012 Healthcare Equality Index report, an annual survey conducted by the Human Rights Campaign Foundation. BMC earned top marks for its commitment to inclusive care for LGBT patients and their families, and was one of only 234 health care facilities nationwide to be named a leader.

July

  • BMC is recognized in a U.S. News & World Report survey as high performing – among the top 25 percent of hospitals nationwide – in cancer, diabetes and endocrinology, gynecology, nephrology and rheumatology.

August

  • The 8North Newton Pavilion Cardiac Intensive Care Unit achieves zero ventilator assisted pneumonias (VAP) and central line blood stream infections (CLBSI) for one year.

September


  • A record high 73 percent of staff participate in BMC’s Employee Engagement survey.

  • BMC launches a Wellness Program website as a resource for staff. The site provides information on existing BMC wellness and health resources and was developed by staff in response to feedback collected on the 2011 Employee Engagement survey.

October

  • The 7North Newton Pavilion Cardiac Unit conducts pioneering work on reducing telemetry alarm fatigue and increasing patient safety. It reduces 152,000 audible alarms per week to 12,000 in a six-week pilot. The hospital is the first in the nation to successfully tackle telemetry alarm fatigue and noise levels.

  • BMC selects Epic as its new electronic health records system. Epic will replace existing systems in ambulatory, inpatient, emergency and labor and delivery and will provide a single, up-to-date medical record for every BMC patient.

  • BMC researchers show that patient navigator services help decrease the time to diagnosis for female patients who have received an abnormal result from a breast or cervical cancer screening. The study demonstrates the importance of patient navigation in helping vulnerable populations get the care they need in a timely manner.

November

  • Pediatrics partners with Pharmacy to offer a concierge medication service to asthma patients as part of the Be Exceptional strategic plan theme of Providing the Right Care to Every Patient.

  • BMC opens a new specialty pharmacy in the Moakley building to provide highly customized medication services to oncology and rheumatology patients.

  • BMC is named to the 2012 Harvard Pilgrim Hospital Honor Roll. The Honor Roll recognizes hospitals whose performance was among the top 25 percent of those measured nationally on a set of composite clinical quality, patient experience and patient safety measures, as reported by Centers for Medicare and Medicaid Services (CMS) and the Leapfrog Group.

  • BMC’s Preventive Food Pantry and Demonstration Kitchen earns the prestigious 2012 James W. Varnum National Quality Health Care Award from Dartmouth-Hitchcock. The award recognizes an outstanding national leader in health care quality improvement initiatives. BMC’s Food Pantry is the first hospital prescription-based food pantry in the nation and provides food to 7,000 people every month.

December


  • 61 BMC physicians are listed as “tops” in their field in Boston Magazine’s annual Top Docs issue. Lisa Kachnic, MD, Chief and Chair, Radiation Oncology, is featured on the cover.

  • BMC is honored with an “A” Hospital Safety Score, the highest achievable grade, from the Leapfrog Group. It is the second consecutive year BMC has received the A score for achieving full compliance on preventing medication errors, appropriate intensive care unit (ICU) staffing, taking steps to avoid harm, and managing serious errors.

  • BMC is named a 2012 Top Hospital by the Leapfrog Group, an independent national nonprofit that works to improve the safety, quality and affordability of health care for Americans. BMC’s exemplary performance across all areas of quality and patient safety on Leapfrog’s annual hospital survey led the hospital to be selected as a Top Hospital out of nearly 1,200 hospitals that participated.

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      BMC Earns “A” Hospital Safety Score; Named 2012 Leapfrog Top Hospital

      Earlier this month BMC was named a 2012 Top Hospital by the Leapfrog Group, an independent national nonprofit organization that works to improve the safety, quality and affordability of health care for Americans. BMC was one of 80 hospitals around the country to receive the elite distinction, and earned it for its exemplary performance across all areas of quality and patient safety on Leapfrog’s annual hospital survey.

       

      This distinction comes on the heels of also being honored with an “A” Hospital Safety Score, the highest achievable grade, from Leapfrog. It is the second consecutive year that BMC has received the A score for achieving excellent performance on preventing medication errors, appropriate intensive care unit (ICU) staffing, taking steps to avoid harm, and managing serious errors.

      “Patient safety is our top priority at BMC and these national distinctions reflect that commitment,” says Stanley Hochberg, MD, SVP, Quality, Safety and Technology. “These are wonderful honors for our hospital and we should all be proud.”

      These accolades are a result of BMC’s multi-year journey to become a safety and quality leader. Three years ago, the hospital created the position of Chief Quality Officer and since then has made major investments in education, tools and resources to help departments and units continuously improve the safety and quality of their care, and track their progress.

      “We are fortunate to have tools to support staff who driving quality and safety improvement across the organization,” says Laura Harrington, RN, MHA, Director, Patient Safety and Quality. “Work to improve care occurs day in and day out, helping BMC achieve our Be Exceptional strategic plan and QUEST targets. Coordination of this work and open sharing of results has helped us successfully evolve into an open, transparent organization with a unified quality and safety vision.”

      Key to this progress was the development of systems that can track and monitor the progress of the organization, down to the unit level. An online metric dashboard was developed by the Clinical Informatics team to track quality performance data like mortality, hand hygiene, pneumonia rates, congestive heart failure, surgical infections, and more. The information is also posted on units quarterly for staff to review.

      “The rapid turnaround of information that is actionable allows us to take a proactive approach to improvement,” says Roshan Hussain, MPH, MBA, Director, Clinical Analytics. “It empowers work units to look at their results, determine methods of improvement, and track their progress close to real time.”

      Another key factor in BMC’s success has been patient safety rounding, launched a year ago by the Quality, Safety and Patient Experience Department. Each week, senior leaders round on clinical floors to talk with staff about safety performance and improvements that can be made. Quality staff collect the suggestions of staff and along with senior management use the information to implement new efforts to improve care.

      Going forward, BMC will focus on further strengthening and disseminating improvement knowledge to all areas of the organization via dedicated “leaders” who are trained in quality improvement techniques and who will work in collaboration with the Quality, Safety and Patient Experience Department. Last month around 40 physicians and nurses went through the training, giving positive feedback on the experience. Quality Improvement training will be offered quarterly to staff and groups involved in or anticipating clinical quality improvement work at BMC.

      “The quality improvement leaders model will continue our efforts to standardize quality improvement across the hospital and ensure that projects are utilizing the best of the current range of improvement tools,” says Harrington.

      “Everyone at BMC should take great pride in the fact that we are getting well deserved national recognition for the great work we do to improve care every day and ensure that we always deliver exceptional care, without exception.” says Hochberg.

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      Four-Legged Friends Provide Comfort Through Healing Paws

      Recently patients and staff on Newton Pavilion 7North were greeted by the wagging tails and friendly faces of Otis, a black Labrador retriever, and Holden, a black curly-coated retriever. Otis and Holden were on the unit to visit patients as part of BMC’s new animal visitation program, Healing Paws. The program, now in a pilot phase, gives eligible patients the opportunity to visit with a certified pet therapy dog while they are in the hospital. The initiative is one of many steps BMC is taking to improve the patient experience.


      Otis is one of BMC's Healing Paws dogs

      As BMC’s official Healing Paws dogs, Otis and Holden are each accompanied by handlers when they visit patients. Emma Riley, LICSW, Manager, Social Work, is Otis’ handler and an animal behaviorist who has trained assistance dogs for years. Beth Dolinsky, MD, a Pediatrics resident at BMC and Boston Children’s Hospital, and her husband handle Holden. After receiving a request from a physician caring for a patient who has been medically cleared for a visit, the dogs and their handlers take to the floor of the Menino Pavilion 6West Geriatric unit to bring smiles and comfort to elderly patients.

      The response has been overwhelming positive, with patients and their visitors lighting up at the sight of the furry friends. One patient remarked that the dog visit is better than medicine; for a 3-year-old girl who made daily visits to her dying grandfathewho, spending time with Holden helped ease her sadness.

      “The dogs have been really wonderful,” says Louise Vecchio, RN, Nurse Manager, 6West. “Given that there can be so many things going on in the unit, it is really great to see how calm they are and the sense of comfort they bring to our patients.”

      Animal visitation does more than put smiles on people’s faces, however; research has shown that pet therapy provides physical and mental health benefits, including lowering blood pressure and decreasing anxiety and depression.


      Healing Paws cards are handed out to patients

      It was this evidence that spurred BMC into action, developing a program that could benefit inpatients and contribute to the overall patient experience. A steering committee was formed, and over the past year, has worked with several departments, including Infection Control, to develop the framework and guidelines that ensure the health and safety of patients and staff visited by Healing Paws.

      “I have seen firsthand the calming effect dogs have on people and I am thrilled that our patients and staff can benefit from their presence,” says Riley, a member of the Healing Paws steering committee.

      “We are very excited that our patients and staff can experience the unconditional acceptance and appreciation of these dogs,” says Rebecca Blair, Executive Director, Patient Experience.

      While the pilot continues on 6West through February, other departments have submitted requests for Healing Paws visits, and committee members say they look forward to this program expanding in the future.

      “We envision that this program could be available in almost any BMC unit in the future,” says Sheryl Katzanek, Director, Patient Advocacy.

      The program hopes to have up to 10 certified pet therapy dogs by the end of 2013, with each dog making two therapeutic visits per month. Dogs in the program must pass a thorough physical and behavioral evaluation by a veterinarian and a certified animal behaviorist, and must be up to date on all routine shots and vaccinations. The animals also are examined by Healing Paws program coordinators prior to acceptance into the program to ensure that the dogs can behave calmly in the active, fast-paced hospital environment. Handlers must complete a therapy dog certification program and go through the BMC volunteer application process.

      To learn more about Healing Paws, contact Sheryl Katzanek, Patient Advocacy

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      BMC Offers Solution to Deaf Patients

      There are eight million Americans who are born with single-sided deafness each year. An additional 1.5 million people develop it later in life, sometimes overnight for unknown reasons. Many with single-sided deafness simply learn to live with it; others opt for an invasive surgical treatment. But now there is another alternative – a noninvasive solution – and BMC is among the first hospitals in Boston to offer it.



      BMC provides a non-surgical prosthetic device, called SoundBite, to patients with profound hearing loss in one ear. This new hearing system relies on bone conduction—the ability of sound waves from teeth through the bones in the skull to vibrate the delicate hair cells of the inner working ear—to provide hearing in the deaf ear. BMC has fitted more patients for this device than any other hospital in the city.

      “SoundBite allows us to bypass the middle and outer ear entirely, rerouting the sound from the impaired ear directly into the good cochlea,” explains Kenneth Grundfast, MD, Chief, Otolaryngology, who has several patients using the device. “By capturing sound from the side of the head where the ear is not working and bringing it into the good ear, patients can better function in social settings such as meetings, sitting at a table in a restaurant or walking along with someone who is by their side and speaking to them.”

      Maxine Kessler, MBA, BMC Graduate Medical Education, Designated Institutional Official, is one of these patients.

      “Before I had the device, I was always turning my head in the direction of my good ear to hear as much as possible. After more than three years of doing that, I started to develop neck problems,” says Kessler, who was diagnosed with Sudden Hearing Loss, an autoimmune disorder. After trying oral and injected ear steroids, Kessler considered a Bone Anchored Hearing Aid, a surgically implantable system for treatment of hearing loss, but opted out of the surgery.

      At a routine hearing check-up, Susan Kelleher, AuD, a BMC audiologist, suggested that Kessler look into SoundBite.

      “This device has had profound social implications for our patients,” says Kelleher. “They tell me what a great impact the device has had on their communication abilities, even in situations such as simply going out to dinner with friends.”

      Kessler has had her SoundBite device since the summer and is pleased with the results.

      “I’m not turning my head to hear and my neck pain has gotten significantly better. It’s amazing that I also have the sensation of hearing in my bad ear, which I was not expecting,” she says.

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      Why I Give to BMC

      The holidays are the season of giving, but at BMC, giving exists year round. Sean Palfrey, MD, knows this well. The pediatrician has been giving to BMC for 23 years.


      Sean Palfrey, MD

      “The lives of the children and families I care for is a hard-scrabble one,” he says. “They don’t have food, housing, coats, and face all sorts of language and cultural issues. We need to provide as much as we can to them to positively impact their overall health. This is why I give to the Kids Fund.”

      The Kids Fund is one of seven programs staff can support through payroll deductions. The fund finances the Department of Pediatrics’ efforts to enhance the lives of BMC’s youngest patients. Through the fund, the department launches innovative programs and provides emergency clothing, car seats, bike helmets, asthma nebulizers, hearing aids and more to families in need.

      “There are many non-medical but essential elements to people’s health and wellness, like cribs, humidifiers, breast pumps and camp scholarships” says Palfrey. “I know that when I give to the Kids Fund, it makes a difference in the lives of my patients. And it enables me to provide better care to them.”

      Palfrey donates to the fund via payroll deductions.

      “It’s a seamless, easy way to give,” he notes. “It’s something I don’t have to think about and something I don’t even notice.”

      Staff can give a one-time gift to BMC or give throughout the year. To learn more about the Employee Giving campaign, visit https://development.bmc.org/employeegiving.

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      What Do You Do, Nilton Medina, MD?

      Name: Nilton Medina, MD
      Title: Attending Physician
      Department: Plastic Surgery
      Years at BMC: 2.5


      Nilton Medina, MD

      What brought you to BMC?
      Originally from Stoughton, I knew I wanted to come back to Massachusetts after I completed my fellowship at the University of Pennsylvania in Philadelphia. Being Cape Verdean, I knew Boston had one of the largest Cape Verdean communities in the U.S. and I wanted to serve that population. I speak five languages and with BMC’s diverse patient population, I’m able to make them feel more at ease.

      What do you do here?
      My job varies from day to day, but I spend the majority of my time consulting with patients and performing surgery. I work with patients who have functional defects (breast reduction surgery), hand pathologies (carpel tunnel syndrome), traumatic or oncologic defects and those who are interested in cosmetic surgery. I am constantly interested in and challenged by the variety of patients I treat and surgeries I perform.

      Why did you decide to become a plastic surgeon?
      As a plastic surgeon you are able to work on the entire anatomy versus certain conditions or certain parts of the body. There also is a creative element to it and being a painter and calligrapher, I enjoyed the fusion of art and science. The results are instantaneous, too, so patients are able to see their progress immediately after a procedure.

      What do you like most about working at BMC?
      It’s amazing to see how grateful my patients are. I recently met a woman who has a rare facial condition called Romberg Syndrome. The disease is very uncommon and she was happy just to have a diagnosis. When she found out that it was treatable, she started crying. After her reconstructive surgery, her whole psyche changed and she felt comfortable going out in public again. It is wonderful knowing that I helped improve someone’s life.

      That’s inspiring! It’s the holiday season; how do you give back?
      I participate in Cape Verdean outreach groups that address health concerns and other issues within the community. I also volunteer with the Biomedical Science Career Program at Harvard Medical School. I have been mentoring students in this role for almost 10 years. I hope to teach others, especially Cape Verdean community members, that with hard work and faith in yourself, you can achieve anything.

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

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      In Their Words

      Patients share their BMC experience

      Dear Integrative Medicine Group,

      Letter writing 

      This past spring and summer were particularly tough for me. Various events left me physically and mentally anguished. My primary care physician at East Boston Neighborhood Health Center encouraged me to seek out Integrative Medicine. She will be forever in my debt for this great piece of advice.

      My first visit was with Dr. Paula Gardiner. Her gentle, compassionate manner convinced me to try the group. I participated September through November and was a bit reluctant at first, but that changed quickly. Dr. Katherine Gergen-Barnett and Erin Sharaf were fantastic facilitators, teachers and caregivers. This program couldn’t have come into my life at a more appropriate time. I needed the acknowledgement that I was suffering and that I could work at healing myself with all the new tools I got through this group.

      The meditation practice was new to me. Taking time to focus, making time for internal calmness and reinforcing mindfulness (being in the moment) were paramount in helping me turn around the negative and depressing thoughts that were so pervasive in my life. I draw on these practices fairly regularly still.

      Addressing the physical pain without any mind-fogging drugs was amazing. The healing hands and practices of Ellen Highfield, LAC, and Paula Nesoff, LMT, MSW, have changed me forever!

      Ellen’s confident and compassionate treatment was very reassuring. The very first acupuncture visit yielded a surprising result. I left the office with less physical pain and in a euphoric state of mind. The continued visits had a cumulative effect both physically and mentally. I’m still not 100 percent sure how this ancient art works, but I am so glad Ellen does! My physical pain has been greatly reduced. I can’t imagine my life without acupuncture. Thank you, Ellen.

      Healing hands! Amazing how touch can make such a difference — physically and mentally. Paula’s gentle and soothing touch is a fantastic compliment to the acupuncture for me. Our discussions and Paula’s advice have been priceless.

      Danielle Dresner can’t be left out of my praise. She is the organizational glue. Thank you for the calls, appointments, parking, overall encouragement, great smile and the great lunches! We were nourished spiritually and physically! Yum!

      Even the poems we heard and read were appropriate, inspirational and meaningful. The last two lines of this Ralph Waldo Emerson quote summarizes the success of the program and all of the individuals I had the privilege of meeting:

      “To laugh often and much; To win the respect of intelligent people and the affection of children; To earn the appreciation of honest critics and endure the betrayal of false friends; To appreciate beauty, to find the best in others; To leave the world a bit better, whether by a healthy child, a garden patch, or a redeemed social condition; To know even one life has breathed easier because you have lived. This is to have succeeded.”

      I breathe easier today because of all of you. Thank you so much.

      Boston

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      News of Note

      Strong BMC representation at MSCO
      BMC oncology fellows and residents were well represented at the recent Massachusetts Society of Clinical Oncologists (MSCO) gala dinner. The groups presented multiple posters and abstracts, with fellows Naomi Ko and Nora Lee winning the two top awards for best research poster and clinical vignette, respectively. Omar Eton, MD, Hematology and Oncology, serves as the newly elected president of the MSCO.

       
      Megan holds her snowman drawing, the offical BMC holiday card

      Drawing selected as BMC holiday card
      BMC’s bWell Center recently held a drawing contest for pediatric patients. Of the 160 patients who participated, seven winners were chosen to have their art framed and displayed in the department. A snowman drawn by six-year-old Megan was selected as the hospital’s official holiday card. The bWell Center provides an innovative approach to educating and supporting BMC’s pediatric families.

      Antoine serves as member of National Medical Association delegation in Liberia
      Gregory Antoine MD, MBA, FACS, Chief, Division of Plastic and Reconstructive Surgery, recently traveled to Liberia to meet with Liberian President Ellen Johnson Sirleaf and Minister of Health Walter Gwenigale, MD, as part of a National Medical Association (NMA) delegation.

      Antoine, who serves on the Board of Trustees of the NMA, assisted in the evaluation of Liberia’s health care system and played a critical role as part of the NMA group assisting in the rebuilding of the health care system in Liberia after a 14-year civil war that devastated the country’s health care infrastructure. The mission of the NMA is to advance the art and science of medicine for people of African descent through education, advocacy, and health policy to promote health and wellness, eliminate health disparities, and sustain physician viability.

      Long-time professor loses cancer battle
      Kathleen Bennett, MD, an Assistant Professor of Medicine in the Section of General Internal Medicine, died Nov. 23 after a long battle with breast cancer. A leader in health care administration at the Neighborhood Health Plan, Boston Medical Center HealthNet Plan, and most recently as chief medical officer at Senior Whole Health, Bennett had a primary care practice at Uphams Corner Health Center, where she cared for patients since her residency years. Bennett was a Boston University School of Medicine (BUSM) alumna of the Class of 1984 and a member of the BUSM faculty since 1989.

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      Awards and Accolades

      Edward Bernstein, MD, a BMC Emergency Medicine attending physician and Vice Chair of Academic Affairs and Professor of Emergency Medicine at Boston University School of Medicine (BUSM), is the recipient of the 2012 Jerome Klein Award for Physician Excellence.

       
      Edward Bernstein, MD, left, receives the Jerome Klein Award from CMO Ravin Davidoff, MD

      Established in 2010 to commemorate Klein’s 50 years of service to BMC/BUSM, the award is presented annually to a physician who mirrors Klein’s commitment and service as a mentor, leader, teacher, researcher and clinician.

      “Ed has found a way to use the privilege we have as physicians and clinicians to really make a difference to many people – patients, families, co-workers, residents, students – and do so in an academic way that is appropriate for a proud institution like BMC. Many have seen his work and view him as a role model – somebody who sees a situation and makes a difference,” said Ravin Davidoff, MD, Chief Medical Officer, when presenting the award to Bernstein Dec. 14.

      Bernstein has dedicated his career to incorporating public health into emergency medicine with a special focus on interventions to reduce substance abuse. This includes co-founding Project ASSERT (Alcohol and Substance Abuse Services, Education, and Referral to Treatment), which helps patients gain access to treatment for substance abuse and primary care services. Bernstein expanded the project into the BNI-ART Institute, which provides training for health care providers to help patients overcome barriers to changing harmful behaviors, such as smoking or drug use. Bernstein serves as co-director of BNI-ART Institute/Project ASSERT at Boston University School of Public Health (BUSPH).

      Bernstein is involved locally and nationally with numerous committees and advisory groups, and has authored 68 original peer-reviewed manuscripts. He received his medical degree from Stanford University School of Medicine and completed an internship in pediatrics at San Francisco General Hospital. Bernstein has been a BUSM Professor of Emergency Medicine as well as a Professor of Social and Behavioral Sciences in the BU School of Public health since 1999.

      BMC’s Preventive Food Pantry and Demonstration Kitchen recently earned the prestigious 2012 James W. Varnum National Quality Health Care Award from Dartmouth-Hitchcock. The award was established by the Trustees of Dartmouth-Hitchcock to recognize an outstanding national leader in health care quality improvement initiatives. The Food Pantry is the first hospital prescription-based food pantry in the nation and provides food to 7,000 people every month. In 2011, it served more than 80,000 patients and their families.

       

      BMC has 61 physicians listed in Boston Magazine’s annual Top Docs issue. The issue featured Lisa Kachnic, MD, Chief and Chair, Radiation Oncology, on the cover.

      Maxine Kessler, MBA, Director, BMC Graduate Medical Education (GME), Designated Institutional Official, has been appointed to Association of American Medical College’s Group on Resident Affairs (GRA) Steering Committee. The GRA represents the institutional leaders of GME who oversee GME quality, administration, accreditation, and financing in their institutions. The GRA provides information, networking and professional development programs to meet their responsibilities as GME leaders. Kessler will serve on the steering committee through 2015.

      Deborah Dreyfus, MD, Family Medicine, has received the Emerging Leader Award from the Family Medicine Education Consortium (FMEC), Inc. The award is given to promising Family Medicine senior residents, junior faculty and clinicians with less than three years’ experience who have demonstrated potential to be future leaders in Family Medicine.

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