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February 13, 2014 Volume 3, Issue 3


BMC Performance on QUEST Goals

The hospital recently closed the first quarter of the fiscal year. Below is an update on how the hospital performed on its 2014 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 UHC mortality index in the current top 25 percent of hospitals: by achieving an FY14 average score of 0.83 or lower or a score of 0.83 or lower for four of the last six months of FY14.

      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 is on its way to achieving this goal.

      “For the first quarter of this fiscal year, BMC’s mortality index was 0.88, which is above our target of the 25th percentile,” says Stanley Hochberg, MD, Senior Vice President, Quality, Safety and Technology. “Although this is not a statistically significant variation from our target, we are reviewing the data in detail to highlight any actionable items that should be addressed. We will continue to monitor this very closely.”

    • Influenza Vaccination:
      Achieve 90 percent staff vaccination rate

      BMC surpassed this goal, with 97 percent of staff receiving the flu vaccination.

      “This is the second year we surpassed our goal,” says Ravin Davidoff, MB, BCh, Chief Medical Officer. “Thank you to everyone who got vaccinated to protect our patients and themselves.”

    • Meaningful Use:
      Achieve 75 percent of eligible physicians successfully attesting at least once for Stage One Meaningful Use.

      Meaningful Use is a federal program that incentivizes the use of an electronic health record (EHR) system to improve patient care. When a qualifying hospital and its individual physicians can show that they are using certified EHR technology to achieve health and efficiency goals in a “meaningful way,” a significant financial incentive is awarded through the Medicare and Medicaid program.

      BMC surpassed this goal, with 91 percent of physicians successfully attesting by the end of 2013.

      “Administrative and clinical leaders collaborated to ensure we delivered on our commitment to achieve Meaningful Use of the Electronic Heath Record,” says Davidoff. “All involved were very focused on the Quality of Care metrics and on improving communication with our patients.”

    • Patient Access:
      Schedule 75 percent of new primary care patients to be seen within 14 days (by achieving an FY14 average of 75 percent or higher or 75 percent or higher during four of the last six months of FY14).

      BMC achieved this goal, scheduling 85 percent of new primary care patients to be seen within 14 days. The recruitment of new primary care physicians to the campus contributed to BMC achieving this goal.

      Schedule 45 percent of new specialty care patients to be seen within 14 days (by achieving an FY14 average of 45 percent or higher or 45 percent or higher during 4 of the last 6 months of FY14).

      BMC achieved this goal, scheduling 45 percent of new specialty care patients to be seen within 14 days.

      Over the past year, the strategic planning implementation team worked with the outpatient specialty clinics to meet this goal. As part of this project, the team collected and analyzed data from BMC’s scheduling system, EWS, to determine the impact no-shows, late cancellations, and scheduling patterns have on physicians’ caseloads.

      Clinic leaders have created and implemented new initiatives including making live reminder calls to new patients and using no-show data to optimize physician schedules and improve access.

      “The results have been positive, with the specialty clinics meeting the 45 percent goal in the first quarter,” says Joe Camillus, Vice President, Professional Services. “Ensuring good patient access while continuing to meet our efficiency metrics is no small challenge.”

  2. E: Efficiency
    • Achieve the expense budget of a cost per adjusted weighted discharge (CPAWD) of $11,367, which includes the costs of wages, benefits, physician services, drugs, supplies and utilities. The cost per adjusted weighted discharge reflects both inpatient and outpatient activity.

      The hospital’s CPAWD in the first quarter was $11,697, which exceeded the goal by about 3 percent. So far this year, BMC’s inpatient and outpatient volume has been below budget while expenses have remained roughly on budget, resulting in an unfavorable variance for this metric.

  3. S: Satisfaction
    • Employee Engagement:
      Increase the commitment score on the 2014 Employee Engagement survey 5 percent above the results of the 2013 survey.

      Action planning to address the 2013 survey response is underway.

      On the 2013 Employee Engagement survey, BMC’s commitment score (how committed employees feel to BMC) improved from 3.82 (2012 survey) to 3.86. Key results include:

      • Scores went up on 56 of the 65 items across the survey.
      • More work units improved over the last year than did in 2011-2012.
      • Results related to these areas have improved significantly since the last survey:
        • BMC cares about its customers/clients.
        • BMC provides high-quality care and service.
        • BMC promotes a culture of patient safety.

      Managers are sharing their department’s results with their teams and seeking input on sustainment of successful new initiatives and new ideas going forward.

    • Patient Satisfaction:
      • Inpatient: Achieve 70 percent of patients giving BMC a 9 or 10 “Overall Rating of Hospital” on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

        BMC is currently rated at 68 percent, which is slightly below goal.

        Projects underway to achieve this goal include interdisciplinary simulation training workshops that focus on improving patient and provider conversations. A new clinical role has also been designed that allows a nurse practitioner to serve as a resource to inpatients who experience unresolved pain issues.

        “This month, BMC also introduced its new Welcome to BMC inpatient guide to give patients a good understanding of their stay here and what they can expect,” says Rebecca Blair, Executive Director, Patient Experience. “Knowing about your care team and the hospital’s services goes a long way in reassuring patients and making them feel more comfortable.”

      • Outpatient: Achieve a 75 percent score on the question “Likelihood to Recommend” on the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) Medical Practice survey.

        BMC achieved a 75 percent score on this question, meeting its goal.

        “Fifty percent of our outpatient clinics met or exceeded this goal,” says Blair. “This is a huge jump from this time last year and everyone should be proud of their efforts.”

  4. T: Total Revenue
    • Achieve a revenue budget of 910,978,000.

      BMC is behind on this goal, which is largely driven by below-budget inpatient volume.

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

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BMC Takes Steps to Make Hospital ‘Most Accessible in Boston’

As part of ongoing strategic plan work to provide the right care to every patient, BMC has partnered with the Boston Center for Independent Living (BCIL) to increase accessibility to care and services for patients with disabilities.


Kristen McCosh, Bob Master, MD, Kate Walsh, and Sergio Goncalves

While collaboration between the two organizations began four years ago, on Jan. 29, the two organizations came together to celebrate a formal agreement to advance compliance at the hospital with the Americans with Disabilities Act and to increase patient accessibility at BMC.

“This agreement between BMC and the BCIL grew out of a desire for the best for all our patients and a commitment to set priorities to make their care easier and better. This is about who we are, and how we should approach all of our patients and their care,” said Kate Walsh, BMC President and CEO. “We want BMC to be the most accessible hospital in the city.”

Walsh was joined by Sergio Goncalves, Chair of BCIL, Bob Master, MD, CEO of Commonwealth Care Alliance and Kristen McCosh, Disability Commissioner for the City of Boston, at the event.

Since 2010, BMC has collaborated with the BCIL to identify patient barriers to care. To date, the hospital has corrected more than 400 facility issues, such as placing restroom fixtures at the correct height for those in wheelchairs. The two organizations will continue to work on a plan to sequence additional improvements, noting that improved accessibility will be a critical component of the clinical campus redesign and a key part of BMC’s quest to be the most accessible hospital in the city.

Each of the panelists shared their excitement about the new initiative.

“Today, we celebrate a clear voice and vision at BMC,” said Goncalves. “As a BMC patient, I am personally looking forward to improved access to services.

“It is a breakthrough to merge people’s lives and support systems with the hospital,” said Master, echoing Goncalves’ sentiments. “What you’ve done here by increasing accessibility is essentially put up a big sign welcoming these members of our community.”

Going forward, BMC will continue to meet with the BCIL quarterly to review progress on the initiative.

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New Round of Local Improvement Project Winners Selected

In December BMC Quality Improvement put the call out for local improvement project grant proposals to support groups across the hospital in developing and implementing rapid-cycle improvement projects. More than 18 applications were submitted by departments that proposed new ways to work smarter to achieve BMC’s organizational QUEST goals.

The winning projects were chosen based on how they would fit into the normal work of a department or unit, an implementation timeframe of four months and the ability of the improvements to be measured and sustained. The following projects were selected:

  • Cleanliness Collaboration Project
    Staff from Environmental Services and Nursing will work together on a campaign to create awareness of work space cleanliness.

    “Although we clean and sanitize every room every day, we often still struggle with patient satisfaction scores due to certain patient expectations of what a ‘clean room’ really entails. We will find solutions to these obstacles through new technology, our collaboration with the nursing team on Menino 6East and resources available through Crothall Healthcare, a BMC affiliate,” says Christine Meehan, Patient Experience Manager, Environmental Services. “Our entire department is very excited to have our proposal selected.”

  • Decreasing the Duration for Induction of Labor
    Obstetrics and Gynecology will aim to reduce the time from a patient’s admission to delivery for labor inductions. Their project will focus on identifying and addressing the sources of delay between time of admission and first intervention during labor.

    “We hope to improve patient care by decreasing the time between when a patient comes in the door of labor and delivery, and when her induction starts,” says Erica Holland, MD. “This depends on efforts by people playing many different roles in labor and delivery. The project will be a collaboration of representatives from these roles.”

  • Sitter Utilization Evaluation
    Sitters are an essential part of a patient care team. Their primary duties are to sit and watch over patients, particularly if there is a danger for self-harm or sudden illness. This project aims to assess and evaluate sitter utilization in order to establish best practices and better define work expectations.

    “We hope to develop an algorithm tool that would allow us to better evaluate and standardize sitter utilization,” says Cheryl Tull, Associate Director, Nursing. “By increasing staff education and better defining work expectations, the care team will be able to communicate important information on patients being observed more efficiently, resulting in increased patient safety and satisfaction.”

The local improvement project initiative resulted from the 2012 employee engagement survey, in which staff indicated a need for additional resources and tools to improve quality, safety, satisfaction and efficiency in their departments and on their units. The three winners listed above will work on their projects during the next quarter with a quality improvement specialist, who will help the teams develop a project plan, measurement framework and an implementation and testing strategy. Successful strategies will then be spread throughout BMC.

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eMerge Brings Medication Barcoding to the Bedside

With the launch of inpatient eMERGE in May, BMC will bring medication barcoding to the bedside for the first time, advancing the hospital’s strategic goal to deliver safe, efficient, high-quality care to every patient.


In hospitals, medication errors can be common. Barcoding technology seeks to reduce those errors by matching a patient with his medication by scanning not only the barcode on the medication, but also the barcode on a patient’s wristband.

“The use of barcode scanning in conjunction with an electronic medication administration record (eMAR) has been shown to cut the incidence of serious medication administration errors at the bedside by half. It is an important patient safety tool that is rapidly being adopted across US hospitals,” says Eric Poon, MD, MPH, BMC’s Chief Medical Information Officer.

To understand medication barcoding better, and how it will be used in the eMERGE system, BMC Brief staff sat down with Je Lee, Senior Clinical Informaticist for the eMERGE project, who is leading the effort in order entry systems and medications.

What is BMC’s current barcoding process?

All medications are barcoded before they leave the pharmacy. Once the medications leave the pharmacy, a pharmacy technician scans the medications into the Pyxis machine, an automated medication dispensing system located on every inpatient unit. At this point, the medications are now ready to be dispensed to patients.

When a medication order is entered by a physician for a patient in SCM, our current order entry system, the nurse validates the order and then scans the medications upon removal from Pyxis in the medication room. This process confirms that the medication removed is the correct medication but does not verify against the patient or the order. The piece that we’re missing is barcoding at the bedside and actually scanning the patient.

How will the new process work with eMERGE?

The pharmacy technician will continue to scan and load medications into Pyxis, but the nurse now will transition the barcoding process to the bedside from the Pyxis machine in the medication room. Scanning at the bedside will help us comply with ISMP (Institute for Safe Medication Practices) patient safety goal which ensures five rights: Right Patient, Right Medication, Right Route, Right Dosage, and Right Time. This new process also will allow us to meet Meaningful Use Stage 2 measures, the national standards promoting the use of electronic health records.

Medication barcoding also will improve patient satisfaction. Boston Medical Center is taking active and thoughtful steps to ensure patients’ safety while they are here and their confidence in the care we provide to them.

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What do you do, Reggie Preston?

Name: Reggie Preston
Title: General Services Associate
Department: Environmental Services
Time at BMC: 25 years


Reggie Preston

What brought you to BMC?
My uncle, who has since retired, worked for Boston City Hospital (now BMC) for many years. I had been working with kids for the City of Boston, but unfortunately due to budget cuts the program ended and I was looking for work. I joined my uncle here and I haven’t looked back!

What do you like most about working at BMC?
I love working to help people who can’t help themselves. After my job working with kids ended, it was important to me to find a job where I could continue to work with and help people, and I definitely found that here. Also, I have great coworkers who make the days fly by.

We hear that you’re a local hero! Can you tell us how you came to the rescue?
It was a typical Wednesday evening in December and I was home with my wife doing our normal nightly routine of watching the 6 p.m. news. It was my turn to cook dinner and I had just put it in the oven when I got a phone call from my mom. She had asked me earlier if I could play her Powerball numbers and I had forgotten all about it! So I asked my wife to keep an eye on dinner while I ran out to a nearby convenience store to play my mom’s numbers. While I was in line, I noticed two men who were trying to cut the line and were giving the cashier a hard time. They ended up leaving the store without causing more trouble, but looking back on it, I found it suspicious. On the way back home, I passed by the Ruggles train station and decided to put money on my Charlie Card so I would be all set for work the next morning. In the station, I noticed the two men from the convenience store approach a young woman in a suspicious way and overheard them ask her for a cigarette. She replied she didn’t have any cigarettes because she didn’t smoke. I happened to be walking in the same direction as the young woman, and when we walked halfway through the bus terminal, I watched as the two guys rushed to attack her. I heard her scream. My adrenaline kicked in and I thought to myself “I can’t let this happen.” I ran over to the assailants, who had pushed the woman into a corner, and told them she was with me and tried to put my body in between theirs and hers. As I brushed up against one of the men, he punched me in the side and I felt something warm and wet trickle down my leg. I realized I had been stabbed and watched as the men fled the scene. I used my two fingers to put pressure on the wound, just like how I see the doctors do it here, and the young woman helped me get to a Ruggles employee. Within seconds, MBTA police were on the scene. Just a few short minutes later, EMTs arrived to take me to a nearby hospital. Thankfully, I was home a few days later and I am now back at work after taking about a month and a half to recuperate at home. I’m feeling much better and I am happy to be back. I am almost completely back to my old self.

What helped you recuperate after such a scary ordeal?
I have to say I would not have recuperated nearly as fast without the support I received from my family, friends, my care team and the BMC community. My co-worker Mohamed Hossain was on the scene that night to make sure I was okay. My boss Ken Peoples and my union president Vannessa Martin both came to see me in the hospital the next morning. My colleagues sent me a fruit basket and the construction team in the Menino Pavilion basement sent me cards. One of the guys even had his wife, who is a nurse at the hospital where I was treated, check up on me every night. Thank you to my supervisor Subrina Sterling and particularly my colleague Lawrence Ruff who took me to my doctor’s appointments. I especially have to thank my wife, Pamela, for staying by my side and taking care of me. I refer to her as my doctor. And I have to thank God for being with me that night and keeping me safe. I’m sure there are people that I have forgotten to mention, but I appreciate everything that everyone has done for me.

What do you like to do for fun outside of work?
I have three kids and six grandchildren, so my family keeps me busy. I’m definitely a homebody, but I enjoy going to Celtics games and doing fun activities, like bowling with my son. And, how could I forget, I love spending time with my wife. In fact, this week I am taking her out for a special Valentine’s Day dinner.

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

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What’s for Dinner?

We are in the thick of a cold, snowy winter, so warm up with a delicious recipe from the Demonstration Kitchen’s Tracey Burg!


This recipe is just as flavorful and filling as your typical chili, but it’s much healthier. Ground turkey is less fattening than beef without sacrificing flavor, while black beans bring more fiber and plant-based protein. Not only is this turkey and black bean chili nutritious, it is delicious and easy to make (AND freeze, thaw and eat later).

Black Bean and Turkey Chili

Ingredients:

  • 1 tbsp olive oil
  • 1 medium onion, diced
  • 2 garlic cloves, minced
  • 1 lb ground turkey
  • 3 (15 oz) cans black beans, drained and rinsed
  • 1 (14.5 oz) can crushed tomato
  • 1.5 tbsp chili powder
  • 1/4 tsp cayenne pepper
  • 1/2 tsp cumin
  • 1 tbsp oregano, dried
  • 1 tbsp basil, dried
  • 1 tbsp red wine vinegar

Directions:

  1. Place olive oil in heavy pot over medium heat, cook onions and garlic until onions are translucent. Add dried basil, oregano and cumin.ently.
  2. Add turkey and cook until meat is browned.
  3. Stir in beans, tomato, chili powder, cayenne pepper and vinegar.
  4. Reduce heat to low and simmer for about 60 minutes.

Nutritional Information Per Serving:
Makes 9 1-cup servings

  • Calories: 250
  • Total Fat: 5 g
  • Saturated Fat: 1.5 g
  • Cholesterol: 40 mg
  • Carbohydrates: 32 g
  • Dietary Fiber: 11 g
  • Sodium: 180 mg
  • Protein: 20 g

Do you have a recipe that you would like to share with the BMC community? Send it to communications@bmc.org and we’ll feature it in a future issue of the BMC Brief!

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In Their Words

Patients share their BMC experience


Dear Ms. Walsh:

I recently had open heart surgery at BMC and thought you would be interested in getting some patient feedback – especially since it is quite complimentary of BMC and its staff.

No one looks forward to hospitalization – much less major surgery – but I approached this procedure with confidence that I was in good hands: beginning with the judgment of Dr. Davidoff that it was medically necessary, the choice of Dr. Karlson as surgeon and Dr. Gonzales as anesthesiologist. And of course, choosing BMC as the hospital. Now that the surgery is behind me and the recovery is progressing apace – I am happy to say that confidence was completely validated.

My guess is that many of us form our impressions primarily from our interactions with its nurses. In my case, that means well over a dozen different nurses, who were all terrific. They were attentive, accomplished, and compassionate and I can’t overstate how much I appreciated them.

But so were the contributions of other staff – the chatty fellow who prepped me, or the good-humored women who would wake me up in the early morning hours to take my vitals, or the housekeepers who looked after my room. And I know there were so many others whom I am either over-looking or who worked behind the scenes.

Like most people of a certain age, I’ve experienced the stress of having family members in a variety of hospitals. One factor contributing to that stress has been inconsistent access to treatment information – both current and planned. At BMC, both my family and I felt well informed about what was currently taking place, the reasoning behind it and what the plan was going forward. It makes a huge difference and we so appreciated it.

Thanks to BMC for providing such exceptional quality of care.

Norwell, Mass.

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News of Note

BMC Community Mourns Loss of Beloved Nurse
Christine Dyer, RN, was involved in a tragic car accident and died Jan. 31. Dyer had been a nurse at BMC since 1997, and over her more than 16 years here, touched the lives of many people, including patients, families and co-workers. Dyer started at BMC on the Menino Pavilion 7East general surgery floor and later moved to the IMCU on Newton Pavilion 6West and 8East. She leaves many friends throughout the hospital in virtually every nursing department. Dyer will long be remembered as an excellent nurse who was committed to her patients. In turn, her patients loved her. She always had a smile on her face and was best known for her trademark hugs. A trust for Dyer’s children has been established. To contribute, staff may send checks to the Dyer Children Trust, care of TD Bank, 91 Pleasant Valley St., Methuen, Mass., 01844. Please mark account number 8372430252 on the check.


Robert Schulze, MD, FACS, FCCM

Robert Schulze Joins BMC
Robert Schulze, MD, FACS, FCCM, has joined the Section of Acute Care & Trauma Surgery at BMC and Boston University School of Medicine as Associate Professor of Surgery. Most recently, Schulze was Director of Surgical Nutrition and Surgical Critical Care at SUNY Downstate Medical Center in Brooklyn, NY, and Attending Physician of Surgery at Kings County Hospital Center also in Brooklyn.

A graduate of Boston University (BA, MA, MD), he completed a residency in General Surgery at the University of Medicine and Dentistry of New Jersey and a Fellowship in Trauma and Critical Care at the University of Maryland. In addition, Schulze completed a research fellowship at what is now known as Beth Israel Deaconess Medical Center.

Chris Andry Named Administrative Director of Pathology, Laboratory Medicine
Chris Andry, MPhil, PhD, has been named Administrative Director of Pathology and Laboratory Medicine, which includes management of the daily operations of the laboratory and the pathology faculty practice plan. Andry served as the Executive Director of Cancer Care Services for the past three years. As a senior hospital administrator with more than 25 years of experience at BMC, Andry also serves as Vice Chair and Associate Professor of Pathology & Laboratory Medicine.

Robyn Souza Named Executive Director of Cancer Care Services
Robyn Souza, RN, MPH has been appointed Executive Director of Cancer Care Services. Souza has been at BMC for five years, having served first in the CyberKnife program in Radiation Oncology and more recently as Cancer Care’s Administrative Director of Operations. In her new role, Souza will oversee Radiation Oncology, the Belkin Breast Health Center and Medical Oncology.


Regina Connors, RN, and Krismonte Allen

BMC Participates in Job Shadow Day
On Jan. 31, BMC hosted two local high school students as a part of the Boston Private Industry Council's Job Shadow Day. Students were assigned to a work site based on their personal interests where they shadowed professionals, observing and assisting their mentors with their work. Sendy Lamour, a senior at the Community Academy of Science and Health in Dorchester, shadowed Lisa Cyrus from BMC Interpreter Services. Krismonte Allen, a junior at Madison Park Technical Vocational High School in Roxbury, worked with Regina Connors, RN, in the Adolescent Center in Pediatrics. Job Shadow Day typically takes place annually on the last Friday of January. If you are interested in participating in future job shadow events, please contact Barbara Catchings.

 

Awards and Accolades


Avital Rech, RN, and Natalya Carney, RN

Avital Rech, RN, Nurse Manger, 5East MICU and 5West ICU, and Natalya Carney, MSN, RN, 3East Nurse Manager, Labor and Delivery recently completed the Organization of Nurse Leaders (ONL) Leadership Academy program.

The ONL Academy is a rigorous 10-week program designed to develop leadership and quality improvement skills that includes mentoring by nursing executives and leaders from throughout the Boston area health care community. Applicants must apply and be accepted into the program. As part of the program, Rech and Carney completed quality improvement projects, which looked at taking early mobilization steps in the MICU and reducing time from admission to delivery for pregnant women incorporated leadership theories and frameworks.

Contact Office of Communications

Communications Staff
Media information after hours: 617.638.8405

Boston Medical Center
Office of Communications
85 E. Newton Street
4th Floor
Boston, MA 02118

Fax: 617.638.8044

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