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The BMC Brief

February 13, 2013 Volume 2, Issue 3

BMC Receives Level 1 Patient-Centered Medical Home Designation

Transforming BMC’s approach to primary care is a key component of BMC’s Be Exceptional strategic plan goal of "providing the right care to every patient, no less, no more.” To that end, both Family Medicine and General Internal Medicine have been focused on pursuing a more patient-focused approach to care and adopting team-based structures in the practices. These changes will benefit the 41,000 patients that they care for and meet the requirements of the patient-centered medical home (PCMH) model.

Be Exceptional logo

A PCMH is a health care delivery model that is designed to improve patient outcomes and promote the most effective use of resources. It is considered a national best practice within the health care industry.

The hard work has paid off. In January, both practices received certification as Level 1 Patient- Centered Medical Homes by the National Committee for Quality Assurance (NCQA). The Level 1 certification is based on principles of patient care including comprehensive team-based care, coordinated and integrated care, continuous access to care, and a systems-based approach to quality and safety.

The prestigious certifications signify the impressive progress that BMC has been made to improve access, quality, and patient satisfaction in the primary care practices. Changes that have led to the PCMH designation include proactive outreach to patients for population health management, such as outreach calls to patients who visited the emergency department and those that were discharged from the hospital, improved reporting on quality metrics, and the incorporation of patient self-care coaching and teaching into the patient visit.

A team mentality is also prevalent throughout the practices.

“Discussions about new patient access and a recent patient event were thoughtful, collaborative and have a new tone of ownership, which is exciting,” says Charlie Williams, MD, Family Medicine. “We are thinking and working as a team and the enthusiasm is infectious.”

“The GIM providers and staff have put an enormous amount of effort into receiving this designation, and we are all confident that the changes we’ve made to the practice as part of the application process will allow us to provide better care to our patients,” says Jason Worcester, MD, Adult Primary Care.

This work is also tied to funding that BMC receives from the state and the Centers for Medicare and Medicaid (CMS) for initiatives aimed at delivering coordinated, high-quality, cost-effective care. Examples include BMC’s new Solomont Clinical Simulation and Nursing Education Center where care teams train to improve their communication and clinical coordination skills, and BMC’s new Patient Support Center that handles the scheduling and administrative issues for 30,000 General Internal Medicine and Women’s Health patients.

Both practices plan to continue to advance their work in becoming patient-centered medical homes, and will submit second applications for a higher level of certification later this year.

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        BMC Performance on QUEST Goals

        BMC recently closed the first quarter of the fiscal year. Below is an update on how the hospital performed on its 2013 QUEST goals (Quality, Efficiency, Satisfaction and Total Revenue) during the months of October-December.

        QUEST logo

        1. QU: Quality
          • Inpatient Mortality Observed/Expected Ratio: Achieve a University Health Systems Consortium (UHC) mortality index that moves BMC into the top third of hospitals around the country.

            “We were better than our QUEST goal for October and November which is a great start to the fiscal year. We are currently one of the top two academic medical centers in Massachusetts in the UHC mortality index over the prior 12-month period. We all should be proud,” says Stanley Hochberg, MD, Senior Vice President, Quality, Safety and Technology, and Chief Quality Officer.

            “This improvement continues to be driven by the efforts of staff across all inpatient units to improve care every day,” he continues. “We would like to specifically recognize the improvement work teams have done in the intensive care units to significantly decrease mortality for patients who have been in the ICUs for any reason.”

          • Achieve 90 percent staff influenza vaccination.

            BMC surpassed this goal, achieving a 97 percent vaccination rate.

            “We had a tremendous response to our staff influenza vaccination goal, surpassing our stretch goal of 95 percent vaccination,” says Ravin Davidoff, MB, BCh, Chief Medical Officer. “We should all be commended for our commitment to our patients, fellow employees and families to help keep them well and not expose them to a potentially preventable infection Thank you to everyone who got the flu shot.”

          • Schedule 70 percent of new primary care patients and 45 percent of new specialty patients to be seen within 14 days.

            BMC scheduled 72 percent of new primary care patients for appointments within 14 days during the first quarter of the year, and 40 percent of new specialty patients.

            “We are very pleased that we met this goal in primary care, especially given the great improvement from our rate of 58 percent for the last quarter of the 2012 fiscal year. While we have seen improvement in specialty care from the rate of 36 percent for the last quarter, we're employing a variety of strategies in those practices still striving to meet their access goals,” says Peter Healy, Vice President, Professional Services.

          • E: Efficiency
            • Achieve an expense budget of $12,192 per patient discharge, which includes the costs of wages, benefits, physician services, drugs, supplies and utilities.

              The hospital’s cost per patient discharge during the first quarter was $12,806, which exceeded the efficiency goal by five percent. BMC saw sicker patients this quarter and used more resources than expected to treat them, which resulted in higher costs associated with each discharge.

          • S: Satisfaction
            • Increase the commitment score on the 2013 Employee Engagement survey 5 percent above the results of the 2012 survey.

              BMC will not know if it achieved this goal until staff takes the 2013 survey later this year, but action planning to address the 2012 survey response is well underway.

              Seventy-three percent of staff (employees, physicians and residents) participated in the 2012 Employee Engagement survey and overall, BMC improved its commitment score by three percent. The commitment score reflects the degree to which employees feels committed to BMC and their willingness to recommend BMC as a good place to work and to receive care. The hospital also made positive gain in every survey category, including overall employee satisfaction and perceptions of quality of care and safety.

              Update on the 2012 survey: The results have been shared with work units across the hospital and groups are now working on their action plans for the year. Senior leaders have also reviewed the organizational results (available on the intranet) and BMC President and CEO Kate Walsh will share the steps BMC will take to address the results at the Feb. 27 Town Hall Meeting, held in Keefer Auditorium at 7:30 a.m., noon, and 3:30 p.m. All staff are invited to attend and participate in a session.

            • Inpatient: Increase the HCAHPS percentage of patients who rate BMC a 9 or 10 on "Overall Rating of Hospital" to 70 percent.

              BMC is currently rated at 66 percent, which is an increase from 62 percent in the last quarter of 2012. Factors that contribute to this rating include improvement in how caregivers communicate with patients about their medicines and about the discharge process. BMC also improved on the question rating nurses’ treatment of the patient with courtesy and respect.

              Projects underway to continually improve on this goal include nurse manager rounding on the inpatient units, and a project to improve the experience of orthopedic patients, including enhancements in pain management. More patient education materials, called CareNotes, are also available on the intranet. CareNotes include 6,000 patient education materials available in 17 different languages for staff to use with their patients.

              “Through the Room-a-Day program, we have ‘refreshed’ more than 125 patient rooms and we have rolled out our Picture Perfect program that leaves every room that is cleaned in ‘perfect’ condition throughout the organization,” says Dave Maffeo, Senior Director, Support Services. “The result of these successful programs has been an increase in our cleanliness scores on the HCAHPS survey.”

            • Outpatient: Achieve a 75 percent rating score for the question “Likelihood to Recommend” (Very Good) on composite outpatient surveys.

              The quarterly outpatient composite score includes more than 2,000 survey responses. From that data, BMC saw a slight improvement in scores on the question, “Willingness to Recommend (the hospital).”

              One area BMC is tackling is facility improvements and other amenities. Recent initiatives include the installation of TVs in waiting areas in Shapiro Primary Care, and the addition of the CARE relaxation channel to all inpatient and outpatient TVs. The Menino public rest rooms are currently undergoing a renovation to improve the overall aesthetics.

              “Improving the patient’s experience in a never-ending journey and each one of us contributes to it in how we care for and interact with patients daily,” says Rebecca Blair, Executive Director, Patient Experience. “We should be proud of the progress we’ve made as we continue to strive to be patients’ provider of choice for their health care.”

          • T: Total Revenue
            • Achieve a revenue budget of $854,944,000.

              BMC is on track to meet this goal with the first quarter’s revenue exceeding budget by more than $7 million or three percent. This positive variance has primarily been driven by over-budget inpatient discharge volume, with a greater number of patients covered by higher-paying insurers.

            • Achieve 25,108 inpatient discharges.

              The hospital is on track to meet this goal with first quarter inpatient discharges exceeding budget by 161 discharges or 2.5 percent. The hospital’s discharge volumes associated with the flu have exceeded BMC’s historical average by 200-250 cases. In addition, the volume of inpatient elective surgeries has been above budget.

              “The number of patients we treated for the flu and the number of patients choosing elective surgeries significantly contributed to our volume last quarter to help us surpass our quarterly discharge goal,” says Richard Silveria, Senior Vice President, Finance, and Chief Financial Officer.

            • Achieve 698,715 outpatient clinic visits.

              The hospital is currently behind on this goal by 2.8 percent. Several initiatives are underway to improve access, build and maintain referral sources, and build capacity in departments that have significant unmet demand.

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

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          BMC Rolls Out RESPECT Behavioral Attributes

          This month BMC rolled out its revised behavioral attributes, called RESPECT.

          RESPECT stands for:

          bmc respect definition

          “For us to be our best, we all need to feel valued, respected and engaged in what we do,” says BMC President and CEO Kate Walsh. “We have heard in two staff surveys how we can continue our progress and be a great place to work and receive care. We have used that feedback to refresh our behavioral attributes, now called RESPECT.”

          RESPECT is the commitment all staff, physicians and residents make to one another and to patients about how they conduct themselves.

          “Every one of us is expected to model the RESPECT attributes, and, by doing so, we will reflect BMC on its best day, every day,” says Walsh. The RESPECT attributes are an important tool to help BMC achieve its strategic plan goal of "providing the right care for every patient."

          “RESPECT will help us achieve our Quality, Efficiency, Satisfaction and Total Revenue (QUEST) goals to provide a consistent, exceptional patient experience, become a more engaged workforce and thrive in a highly competitive market,” says Walsh.

          The attributes are being incorporated into a wide range of BMC’s daily business processes, including recruitment and on-boarding of new employees, staff development activities and recognition programs, and the hospital’s annual performance management process.

          “If we get this right, and I know we will, we will provide a consistent exceptional experience to all our patients, we will be a great place to work, and we will be in a strong competitive position to provide our patients with the care they need for years to come,” says Walsh.

          Learn more about BMC’s behavioral attributes by visiting the RESPECT section of the intranet.

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          Heart Healthy Recipe: Beet and Ginger Soup

          According to the Centers for Disease Control, heart disease is the leading cause of death in the United States. February is American Heart Health Month and now is a great time to improve your well-being. You can start by trying this delicious heart-healthy recipe from Demonstration Kitchen Chef Tracey Burg.

          Beet and ginger soup is only 70 calories per serving and its bright red color makes it a perfect heart-warming dish for Valentine’s Day. This soup is a spicier and healthier version of Russian Borscht and it can be served hot or cold. It’s loaded with heart healthy ingredients like beets, garlic and ginger. Enjoy!

          heart healthy cooking recipes beet and ginger soup

          Beet and Ginger Soup

          • 8 cups low-sodium vegetable or beef broth
          • 1 1/2 pounds fresh beets, peeled and diced or 2 cans (15-ounce) sliced beets, drained
          • 1 pound cabbage, chopped (about 4 cups)
          • 1/2 pound fennel, chopped (about 2 cups)
          • 1 medium onion, chopped
          • 2 teaspoons garlic, chopped
          • 3 tablespoons fresh ginger, chopped or 2 teaspoons ground ginger
          • 1/2 teaspoon salt
          • 1/4 tsp pepper
          • 6 ounce plain Greek yogurt or fat-free sour cream
          • 2 tablespoons fennel sprigs


          1. Combine the broth, beets, cabbage, fennel, onion, garlic, and ginger in a large soup pot. Bring to a boil, cover, and simmer until the vegetables are tender, about 45 minutes
          2. Strain the soup into a large bowl or pot. Return the broth to the soup pot.
          3. Puree the vegetables with some of the broth, using a food processor, blender, or immersion blender. Return the pureed vegetables to the broth and stir until well combined. Season with salt and pepper.
          4. Serve each portion with a tablespoon of Greek yogurt and garnish with fennel sprigs.

          Nutritional Information per 1 cup serving:

          • Calories: 70
          • Total Fat: 0 g
          • Saturated Fat: 0 g
          • Sodium: 274 mg
          • Carbohydrates: 12 g
          • Cholesterol: 0 mg
          • Dietary Fiber: 4 g
          • Protein: 5 g

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          180 Degrees: The Evolution of a More Engaged Workplace

          The meteoric rise of increased employee engagement in the Interpreter Services department within the past year is the equivalent of a Cinderella story. When results of the 2011 staff survey showed that significant improvements could be made in their work environment, supervisors Elida Acuna-Martinez and Sigfredo Salguero got to work on improving the office culture.

          Sigfredo Salguero and Elida Acuna-Martinez
          Sigfredo Salguero and Elida Acuna-Martinez

          The nature of their work keeps interpreters out of the office and around the hospital working directly with patients. According to the survey results, a sense of isolation had developed among the interpreters, so both Salguero and Acuna-Martinez had to be creative in making their work environment more inclusive, starting with an open discussion with staff about what needed to improve.

          “One of the biggest issues was that staff felt there was disconnect between them and the management team and that there was a lack of communication,” says Salguero.

          Armed with feedback from staff, Salguero and Acuna-Martinez started making improvements to the way the department worked. A big change was obtaining access to the electronic medical records system so interpreters could document their sessions with patients.

          "This was a big bump for us because the interpreters felt that they were now a part of the care team instead of just providing a language service," says Acuna-Martinez.

          Access to the electronic medical records system not only made it easier to care for a patient, but it also created a sense of teamwork that didn't exist before.

          Salguero and Acuna-Martinez also began incorporating staff input into major decision-making processes. Giving staff a voice also contributed to a shift in the attitude of the whole office. One of the biggest decisions the interpreters were involved in was the hiring process of the current director, Gerard Barsoum.

          “Our staff felt that we weren’t including them on decisions that would affect their work, so we had them participate in the interview process where they got the chance to ask questions for themselves,” says Salguero.

          The changes made a big impact. In the 2012 staff survey, Interpreter Services experienced a significant increase in its overall commitment score and moved from being designated a tier three work unit to a tier one work unit. The tiers reflect the degree of action planning to make improvements on employee engagement, with tier three requiring the most action planning and tier one requiring minimal action planning.

          Salguero and Acuna-Martinez attribute their success to not only a strong management team, but also to making changes to their day-to-day approach as supervisors. They make sure to keep courtesy and consideration top of mind when working with their colleagues. “We try to put ourselves in others’ shoes and look at every situation from all sides before coming to a consensus,” says Acuna-Martinez.

          Salguero and Acuna-Martinez say their work isn’t done. There are ongoing improvements to be made and they say they will focus on maintaining their success as they work to put together their next employee engagement survey action plan.

          “We are not a perfect group, by any means” says Salguero, “But getting there wasn’t the hard part; now we need to figure out how do we stay there?”

          “In order for employees to be engaged, managers and supervisors need to create an environment where staff feel valued and a part of a team,” says Cheryl Freed Loew, Director, Organizational Effectiveness in Human Resources. “Interpreter Services has made tremendous strides in making their team members feel that their department, and BMC, is a great place to work and receive care.”

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          What Do You Do, Jenna Allain?

          Name: Jenna Allain, RN
          Title: Night Shift Nurse
          Department: Float Pool
          Years at BMC: 6

          Jenna Allain, RN
          Jenna Allain, RN

          What brought you to BMC?
          My cousin works at BMC so when it was time for me to graduate from nursing school, I asked her if there were any openings. She helped me get a job here as a certified nursing assistant (CNA) and from there, my career flourished.

          What do you do here?
          I'm a nurse in the float pool, so I report to any unit where I am needed. I call staffing at 5:30 p.m. before my shift starts and ask where I'm going that night. I'll call them again at 9:30 or 10 p.m. when I'm on the floor to see if I am staying there or if I'm needed in a different location. It differs from shift to shift and I like going around to the different floors and switching it up.

          What do you like about working at BMC?
          I like the people I work with, and I like my hours, surprisingly, even though I work nights. I also like our diverse patient population. I’m challenged every day and it’s good because I'm always learning. Sometimes it's hard not knowing what you are walking into, but I think variety is great. There is always something new and that's what I like about it.

          What do you like to do in your free time?
          My fiancé and I have two German Shepherds named Kato and Layla Mae, so I love walking them and spending time with them. I have seven nieces and nephews so I'm always hanging out with them and my sisters. I would like to travel but it can be hard to find someone to mind the dogs, so we're kind of stuck in one place for now.

          What is the most rewarding experience you've had at BMC?
          I've had so many. When I worked as a CNA we would see the same patients come in over and over again and it could be really rewarding because you see them through difficult times and body image changes and you were there to witness their whole healing journey.

          February is Healthy Heart Month and we hear that you recently stopped smoking, which is great for your heart. Congratulations! Why did you decide to quit?
          After having a couple cigarettes on Christmas, and one on New Year's, I just felt so sick and I thought, "Why do I do this to myself? You know what? I'm done!" And I stopped. I think everyone needs to get to that point, and I had reached it. Smoking is expensive and I don't want wrinkles. I know I should be thinking about my heart and my lungs and what smoking does to the inside of my body, but it's the things on the outside you really notice and are able to see. Now when I walk by people who are smoking, I feel sick to my stomach. What helped me quit was candy. I keep Sour Patch Kids in my car, since I did most of my smoking heading to or from work or running errands, so it takes my mind off of it because the candy helps with the oral fixation. I haven't even had any cravings! I just wanted to wash my hands of it and I did.

          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

          Letter writing 

          Dear Dr. Tornetta,

          I am writing to express, on my behalf and on behalf of my entire family, our profound sense of thanks and gratitude for all of your time, effort, consideration and incredible skill as a physician and surgeon. Five months ago, I fell in a parking lot near BMC, which resulted in a tibial plateau fracture of my right knee and proximal humerus fracture of my right arm. I was very fortunate that my accident occurred so close to BMC, otherwise I may not have met you and your staff. From our first meeting, just hours after the accident, you gave me and my family a very clear and honest assessment of my condition, and you outlined the options available to us. Your steady, optimistic and supportive attitude toward my prognosis helped me to make the decision to proceed with a surgical repair of the tibial plateau fracture. The surgery, which took place one day after my accident, was a complete success thank to your skill as a surgeon and the post-operative care which I received from the other doctors and nurses at BMC.

          As my recovery continued at Braintree Rehabilitation Hospital I visited you at the Shapiro Ambulatory Care Center in early July, and again in late July, after my return home. In both of these visits you were very open to questions about my recovery, and supportive of my eventual full recovery, providing I followed the physical therapy procedures which you prescribed at my first visit. I’ll never forget the great sense of relief I had when you told me I didn’t have to use a Bledsoe brace anymore. That experience was one of the first few times when I really began to believe I would fully recover from this accident.

          Once again in early September and early November my wife and I visited you at the Shapiro Center, where you noted my improvement and allowed me to begin weight bearing on my right leg. During this time the Shapiro Center staff was very helpful in arranging appointments and assisting me with the other parts of the visit, including x-rays of my knee and shoulder. We are very grateful for the Shapiro Center staff for all of their hard work and consideration during out visits.

          In addition to the excellent medical care I received, you also assisted me with an appeal to my health insurance provider for additional physical therapy dates and helped with my application for a handicapped parking placard. We are very grateful for the time and effort you spent on my behalf in dealing with this administrative paperwork. Your staff should be commended for their timely and diligent responses to my requests for your assistance.

          In closing, I would like to reiterate my deep sense of gratitude for all of your skill and personal consideration during the treatment of my accident. I hope you have many more successful and productive years of practice, and I am sure many more families such as mine will be blessed by your skill and presence while you help individuals such as myself find a full recovery.

          Weymouth, Mass.

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          News of Note

          Harold Lazar, MD 
          Harold Lazar, MD

          Former BMC nurse bestows gift to Cardiac Surgery, Hematology/Medical Oncology
          Harold Lazar, MD, Cardiac Surgery, and Ken Zaner, MD, PhD, MBA, Hematology/Medical Oncology, recently were bequeathed a gift in their names from the estate of Marcia Anne Rizzotto, a former BMC colleague and grateful patient. A PACU nurse for 42 years, Marcia was active in many nursing organizations and also served as a major in the U.S. Army Nurse Corps. Marcia passed away in October 2011, at the age of 64.

          John Lindstedt promoted to Vice President of Finance
          John Lindstedt has been promoted to Vice President of Finance. Lindstedt joined BMC 14 years ago and has been a key member of the Finance Leadership team, steering a significant improvement agenda for Accounts Payable, Payroll, Accounting and Research. As Vice President of Finance, Lindstedt will lead BMC’s Accounting, Payroll, Accounts Payable, Research Financial Operations and Finance Information Systems teams, together with the Faculty Practice Foundation’s Accounting function.

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          Awards and Accolades

          BMC’s Diabetes Self-Management Education Program has been awarded continued education recognition from the American Diabetes Association (ADA) through 2017. The ADA recognition ensures that BMC has met the national standards for Diabetes Self-Management Education Programs and has a knowledgeable staff of health professionals who can provide the latest information about diabetes management.

          Providing high-quality education for patients’ self-care is one of the primary goals of this program, under the direction of James Rosenzweig, MD, Director, Diabetes Services. Through increased knowledge and awareness of diabetes, patients can assume responsibility for their diabetes management while decreasing unnecessary hospital admissions and some of the acute and chronic complications of diabetes.

          “The process gives professionals a national standard by which to measure the quality of the services they provide,” says Rosenzweig. “We are pleased to be awarded this recognition and to continue to deliver exceptional diabetes care to our patients.”

          Contact Office of Communications

          Communications Staff
          Media information after hours: 617.638.8405

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          Fax: 617.638.8044

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