Blue Cross Blue Shield of MA is proposing a new optional model for physician and hospital reimbursement. Alice Dembner at The Boston Globe explains, and Bob Oakes at WBUR offers a radio version of the issues involved.
By the way, I have been wondering. Why is it called "reimbursement" in the hospital and physician world? In every other sector, we call it "payment". Can you imagine going to a grocery store and saying to the check-out clerk, "I'd like to reimburse you for this head of lettuce"?
Tuesday, January 22, 2008
Monday, January 21, 2008
Responses to our new goals
As promised below, I am sharing some of the responses I received from members of the staff and also outside observers after we announced our new goals for patient satisfaction and quality and safety. As you will see, there is a variety of opinion on the issue. This is not expected. I am going to divide them up by doctors, nurses and other staff, and outside folks who read the story or editorial in the newspaper or heard a radio interview.
I am not including my replies to these emails. You can offer your own replies in the comments!
Doctors
#1 -- How does BIDMC plan to determine if harm prevention measures are actually causing unintended harm? This isn't an idle question - we have bypassed much of the usual science of medicine when invoking quality improvement. We assume that if we force providers to don gloves and gowns before examining patients in an ICU that they will still go into the rooms just as much. We assume that the pass-off errors caused by resident work-hour changes won't exceed the benefits from reduced fatigue errors. We assume that the benefit of infections prevented by forms and checklists with central venous catheters makes up for the occasional delay in acute resuscitation. We assume that the benefits of medication reconciliation in the outpatient world will exceed the harm done by the loss of precious minutes spent actually talking with patients (my department can't even provide projected numbers on how long it should take the average MD to type in an average med list for our patients.) These are all measurable questions. Perhaps we assume too much? Auerbach's editorial on the question in the NEJM should have been a clarion call for us to redouble our efforts to evaluate change before declaring it beneficial.
---
#2 -- I am delighted to hear from your email of the Hospitals' re-affirmation to emphasizing patient satisfaction.
---
#3 -- (A) Makes me proud. I think that this is in part an ethics issue: there are few moral responsibilities we have as serious and widely acknowledged as the Hipprocratic admonition to “Do No Harm.”
(B) At our monthly Ethics Rounds (held in every ICU and 15-20 units total) we should consider moving from asking about “any cases of adverse events in the past month that you think weren’t disclosed/reported properly?” to “any cases in the past month where a patient was harmed by something we did that was preventable?”
(C) We could also encourage our individual Ethics Liaisons (designated by the chiefs of more than 50 clinical and administrative units) to think about ways they can help foster a culture in which we take moral responsibility for not harming patients, and constructive “preventive ethics” efforts not to do so in the future.
We have found our many Ethics Rounds a useful tool in the past for exploring in a BIDMC-wide way the views or experiences of front-line clinical staff about ethical aspects of issues such as a possible VIP unit. Our Ethics Liaisons Program is already proving it has great potential for engaging a large group of individuals across multiple departments.
---
#4 -- (Reply comment from another doctor:) RE "C", I would emphasize even more strongly that the moral responsibility is to learn as much as possible from every episode of harm in order to prevent that harm from recurring. We need to remain clear that competent and well intentioned providers may find themselves part of an event in which there is harm, and foster the culture where people see these as learning opportunities to prevent future harm.
---
#5 -- This is good, and it is clear that goal number one can be published because it only provides a measuring stick (new for BIDMC) for something we have already been doing. But goal number two: How does the hospital elegantly air this goal without the fear of being criticized for not having been doing this all along? Perhaps a better wording would be to emulate the wording of the first goal and say that we will establish new measures to ensure that our preventive measures work, so that we can fix them if they don't.
---
#6 -- I really liked your very thoughtful and important words on public radio this morning.
---
# 7 -- I am concerned about the wording of the second goal- there is a problem when you set an unobtainable goal, only to publicly show that you couldn't achieve it. Here is the unobtainable goal:
"BIDMC will eliminate all preventable harm by January 1, 2012."
This cannot be done, because it is stated in absolute terms. Eliminating "all preventable harm" is a noble ideal, but it is unrealistic given the complexity of delivering health care by multiple layers of teams and individuals. The best that any hospital can do is to develop mechanisms to reduce preventable harm, not to guarantee that all harm will be prevented. Any preventable harm, even if it was humanly impossible to foresee it, and even if no other hospital could prevent it, will be held against us as a failure to achieve what we promised.
I suggest that this second goal be revised as follows:
BIDMC will continue to create an environment that reduces preventable harm to the fullest extent possible. To this end, by January 1, 2012 we will be recognized as a national leader in the field of patient safety. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
This is also a noble goal, but it has the merit of being achievable....
---
#8 -- This is great, and the report in yesterday’s Globe has a lot of people elsewhere talking about it, and very favorably. May I suggest that the next step, given your interest and ability to be well ahead of the curve, would be – where the specific data permits such granularity – to know and report whether results were similar or different segmented by race, ethnicity, age group and gender. It would be fabulous to be able to say, with respect to various indices of care, that there was no difference at BIDMC when examined by race, ethnicity, gender and age group.
Nurses and other staff
#1 -- I treasure my place here and I imagine it will be a very long time before I will look elsewhere. I love this safety and quality initiative and I even love the naming exercise for the "thing"!!! Thanks for being who you are- it makes it possible for us to be who we are as well.
---
#2 -- Thank you for taking the lead in making and returning BIDMC a wonderful place for patients. I hope to contribute to the attainment of this goal as a clinical nurse.
---
#3 -- I am a nurse working at [a specified floor], and was just wondering if this meeting was in response to latest news that medical insurance will not be reimbursing hospitals for preventable occurrences (aside from the obvious that we care and value patient safety and prove that we are one if not the BEST hospital in Boston)?
---
#4 -- Take the leaps...set the goals...Count Me In!
---
#5 -- These are goals we can certainly reach. Over the last two years, we've made great strides creating performance measures in the Department of Medicine's divisions. After many meetings with our colleagues and data collection, it feels good to see the improvements based on our results.
---
#6 -- You have my support...please let me know what I can do to attain the goals you have set.
This is an awesome hospital....and I'd like to help make the patient experience even better.
---
#7 -- Although the initiatives you are describing relate to patient care, I believe that all subjects in research studies are patients as well. Please do not hesitate to contact me if I can lend my support and experience to any committees under development or in any way you see fit.
---
#8 -- WOW!
---
#9 -- These initiatives are terrific. I appreciate them both as an employee but more importantly, I appreciate it as a patient. Should I, or my family, be so sick that we need to be hospitalized, I want to feel confident, when we are most vulnerable, that we will be cared for safely. While we have not ever been hospitalized, we have utilized the outpatient services and have run up against some significant gaps in quality care. I've raised those issues with the appropriate managers and in both cases they responded quickly and appropriately. We have a way to go at all levels. You can count on me to help work toward these goals.
---
#10 -- I appreciate your and the Board's "raising the bar" at BIDMC and BID-Needham. I am looking forward to doing my part.
I want to make sure you're aware of something I saw at the FDA website. I imagine you are aware of it but since it appears to be right in line with the announced aspirations and "The Thing" I felt I should take a chance at being redundant. The title of the FDA program is "AHRQ Releases Toolkits to Help Providers and Patients Implement Safer HealthCare Practices" and here is the link.
---
#11 -- A thought about patient feedback: The several times I have been hospitalized, the efforts of staff to go beyond courtesy to make me feel taken care of and cared about have always stayed with me more than anything else about a hospital stay. And of course, apathy, lassitude or grumpiness has made an equally strong impression on me. There were times when I felt mistreated by “bad apples” (not at BIDMC). At the time, I wished I had had the opportunity to give feedback to the hospital. However, in the weakened state of illness, patients do not have the physical or mental energy to seek recourse on their own. If patients were given feedback cards (as often happens in restaurants) when they are admitted (not on leaving, when the memory is less accurate), this would help in more ways than one: the patient would feel he/she had recourse, and would thus leave feeling the hospital cared, even if the “bad apple” didn’t appear to, and 2) if they know patients have this forum, bad apples are likely to take more care how they treat patients.
Question regarding the phrase in your email: “We will measure ourselves based on national benchmarks”: I was just wondering if national benchmarks include a measure of staff satisfaction, since patient satisfaction depends daily on the way they are treated.
Outside folks
#1 -- I can say that after my experiences @ BI & my husband's experiences at an unnamed hospital, you are well ahead in the process & examples.
---
#2 -- Bravo!
---
#3 -- Bravo! I will follow with great interest.
---
#4 -- Reading today's Globe, I was once again struck by how very proud I am to be associated with Beth Israel Deaconess Medical Center. Not only do I appreciate your forward thinking but am amazed at your goal to not only be first, but to do right.
Congratulations. This is a great day.
---
#5 -- Congratulations to both of you and your Boards for this outstanding initiative.
---
#6 -- Hearty congratulations and a bold and positive step!
---
#7 -- First rate and I am sure will be supported by all of us.
One issue to think about over time. You can make the hospital experience great and are doing that. However, with the advent of out patient care and day surgery, much of the experience takes place in the doctor's office. Some are not so great at continuing the great feeling one gets at the hospital.
As a lawyer I represent many banks. I am acutely aware that how I treat the bank's customer in documenting the transaction reflects back at the bank.
I hope you can (or can continue to) foster that feeling in your doctors.
Regards and with continuing admiration for what you are doing.
---
#8 -- Congratulations on your quality goals. Nice to see someone put a stake in the ground and focus on what this business is really about.
---
#9 -- Impressive move by you and your board. That's the way to push the envelope. Let's hope others take up the challenge as well.
---
#10 -- Great Globe Editorial today! I’m so proud to now be a BI patient!
---
#11 -- Good luck with the initiative. It’s a big undertaking.
---
#12 -- I am really delighted that you have chosen to meet this head on. Obtaining accurate data and putting the CARE back into healthcare will continue to keep us in the forefront both in Boston and nationally.
---
#13 -- I can’t tell you how excited I am by your commitment to avoid all preventable harm to patients. It is simply the right thing to do. In a similar vein, I first learned of Ascension Health’s commitment to “no preventable deaths by 2008” in the fall of 2004. I have known Dr. Sandy Tolchin for many years and have had the opportunity to learn of his efforts, initially at Borgess Health Alliance in Kalamazoo and now as VP Clinical Excellence in collaboration with David Prior and others at Ascension Health. When I last spoke with him in the late fall, he said, “We have now demonstrated that flawless care is achievable.”
I am not including my replies to these emails. You can offer your own replies in the comments!
Doctors
#1 -- How does BIDMC plan to determine if harm prevention measures are actually causing unintended harm? This isn't an idle question - we have bypassed much of the usual science of medicine when invoking quality improvement. We assume that if we force providers to don gloves and gowns before examining patients in an ICU that they will still go into the rooms just as much. We assume that the pass-off errors caused by resident work-hour changes won't exceed the benefits from reduced fatigue errors. We assume that the benefit of infections prevented by forms and checklists with central venous catheters makes up for the occasional delay in acute resuscitation. We assume that the benefits of medication reconciliation in the outpatient world will exceed the harm done by the loss of precious minutes spent actually talking with patients (my department can't even provide projected numbers on how long it should take the average MD to type in an average med list for our patients.) These are all measurable questions. Perhaps we assume too much? Auerbach's editorial on the question in the NEJM should have been a clarion call for us to redouble our efforts to evaluate change before declaring it beneficial.
---
#2 -- I am delighted to hear from your email of the Hospitals' re-affirmation to emphasizing patient satisfaction.
---
#3 -- (A) Makes me proud. I think that this is in part an ethics issue: there are few moral responsibilities we have as serious and widely acknowledged as the Hipprocratic admonition to “Do No Harm.”
(B) At our monthly Ethics Rounds (held in every ICU and 15-20 units total) we should consider moving from asking about “any cases of adverse events in the past month that you think weren’t disclosed/reported properly?” to “any cases in the past month where a patient was harmed by something we did that was preventable?”
(C) We could also encourage our individual Ethics Liaisons (designated by the chiefs of more than 50 clinical and administrative units) to think about ways they can help foster a culture in which we take moral responsibility for not harming patients, and constructive “preventive ethics” efforts not to do so in the future.
We have found our many Ethics Rounds a useful tool in the past for exploring in a BIDMC-wide way the views or experiences of front-line clinical staff about ethical aspects of issues such as a possible VIP unit. Our Ethics Liaisons Program is already proving it has great potential for engaging a large group of individuals across multiple departments.
---
#4 -- (Reply comment from another doctor:) RE "C", I would emphasize even more strongly that the moral responsibility is to learn as much as possible from every episode of harm in order to prevent that harm from recurring. We need to remain clear that competent and well intentioned providers may find themselves part of an event in which there is harm, and foster the culture where people see these as learning opportunities to prevent future harm.
---
#5 -- This is good, and it is clear that goal number one can be published because it only provides a measuring stick (new for BIDMC) for something we have already been doing. But goal number two: How does the hospital elegantly air this goal without the fear of being criticized for not having been doing this all along? Perhaps a better wording would be to emulate the wording of the first goal and say that we will establish new measures to ensure that our preventive measures work, so that we can fix them if they don't.
---
#6 -- I really liked your very thoughtful and important words on public radio this morning.
---
# 7 -- I am concerned about the wording of the second goal- there is a problem when you set an unobtainable goal, only to publicly show that you couldn't achieve it. Here is the unobtainable goal:
"BIDMC will eliminate all preventable harm by January 1, 2012."
This cannot be done, because it is stated in absolute terms. Eliminating "all preventable harm" is a noble ideal, but it is unrealistic given the complexity of delivering health care by multiple layers of teams and individuals. The best that any hospital can do is to develop mechanisms to reduce preventable harm, not to guarantee that all harm will be prevented. Any preventable harm, even if it was humanly impossible to foresee it, and even if no other hospital could prevent it, will be held against us as a failure to achieve what we promised.
I suggest that this second goal be revised as follows:
BIDMC will continue to create an environment that reduces preventable harm to the fullest extent possible. To this end, by January 1, 2012 we will be recognized as a national leader in the field of patient safety. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
This is also a noble goal, but it has the merit of being achievable....
---
#8 -- This is great, and the report in yesterday’s Globe has a lot of people elsewhere talking about it, and very favorably. May I suggest that the next step, given your interest and ability to be well ahead of the curve, would be – where the specific data permits such granularity – to know and report whether results were similar or different segmented by race, ethnicity, age group and gender. It would be fabulous to be able to say, with respect to various indices of care, that there was no difference at BIDMC when examined by race, ethnicity, gender and age group.
Nurses and other staff
#1 -- I treasure my place here and I imagine it will be a very long time before I will look elsewhere. I love this safety and quality initiative and I even love the naming exercise for the "thing"!!! Thanks for being who you are- it makes it possible for us to be who we are as well.
---
#2 -- Thank you for taking the lead in making and returning BIDMC a wonderful place for patients. I hope to contribute to the attainment of this goal as a clinical nurse.
---
#3 -- I am a nurse working at [a specified floor], and was just wondering if this meeting was in response to latest news that medical insurance will not be reimbursing hospitals for preventable occurrences (aside from the obvious that we care and value patient safety and prove that we are one if not the BEST hospital in Boston)?
---
#4 -- Take the leaps...set the goals...Count Me In!
---
#5 -- These are goals we can certainly reach. Over the last two years, we've made great strides creating performance measures in the Department of Medicine's divisions. After many meetings with our colleagues and data collection, it feels good to see the improvements based on our results.
---
#6 -- You have my support...please let me know what I can do to attain the goals you have set.
This is an awesome hospital....and I'd like to help make the patient experience even better.
---
#7 -- Although the initiatives you are describing relate to patient care, I believe that all subjects in research studies are patients as well. Please do not hesitate to contact me if I can lend my support and experience to any committees under development or in any way you see fit.
---
#8 -- WOW!
---
#9 -- These initiatives are terrific. I appreciate them both as an employee but more importantly, I appreciate it as a patient. Should I, or my family, be so sick that we need to be hospitalized, I want to feel confident, when we are most vulnerable, that we will be cared for safely. While we have not ever been hospitalized, we have utilized the outpatient services and have run up against some significant gaps in quality care. I've raised those issues with the appropriate managers and in both cases they responded quickly and appropriately. We have a way to go at all levels. You can count on me to help work toward these goals.
---
#10 -- I appreciate your and the Board's "raising the bar" at BIDMC and BID-Needham. I am looking forward to doing my part.
I want to make sure you're aware of something I saw at the FDA website. I imagine you are aware of it but since it appears to be right in line with the announced aspirations and "The Thing" I felt I should take a chance at being redundant. The title of the FDA program is "AHRQ Releases Toolkits to Help Providers and Patients Implement Safer HealthCare Practices" and here is the link.
---
#11 -- A thought about patient feedback: The several times I have been hospitalized, the efforts of staff to go beyond courtesy to make me feel taken care of and cared about have always stayed with me more than anything else about a hospital stay. And of course, apathy, lassitude or grumpiness has made an equally strong impression on me. There were times when I felt mistreated by “bad apples” (not at BIDMC). At the time, I wished I had had the opportunity to give feedback to the hospital. However, in the weakened state of illness, patients do not have the physical or mental energy to seek recourse on their own. If patients were given feedback cards (as often happens in restaurants) when they are admitted (not on leaving, when the memory is less accurate), this would help in more ways than one: the patient would feel he/she had recourse, and would thus leave feeling the hospital cared, even if the “bad apple” didn’t appear to, and 2) if they know patients have this forum, bad apples are likely to take more care how they treat patients.
Question regarding the phrase in your email: “We will measure ourselves based on national benchmarks”: I was just wondering if national benchmarks include a measure of staff satisfaction, since patient satisfaction depends daily on the way they are treated.
Outside folks
#1 -- I can say that after my experiences @ BI & my husband's experiences at an unnamed hospital, you are well ahead in the process & examples.
---
#2 -- Bravo!
---
#3 -- Bravo! I will follow with great interest.
---
#4 -- Reading today's Globe, I was once again struck by how very proud I am to be associated with Beth Israel Deaconess Medical Center. Not only do I appreciate your forward thinking but am amazed at your goal to not only be first, but to do right.
Congratulations. This is a great day.
---
#5 -- Congratulations to both of you and your Boards for this outstanding initiative.
---
#6 -- Hearty congratulations and a bold and positive step!
---
#7 -- First rate and I am sure will be supported by all of us.
One issue to think about over time. You can make the hospital experience great and are doing that. However, with the advent of out patient care and day surgery, much of the experience takes place in the doctor's office. Some are not so great at continuing the great feeling one gets at the hospital.
As a lawyer I represent many banks. I am acutely aware that how I treat the bank's customer in documenting the transaction reflects back at the bank.
I hope you can (or can continue to) foster that feeling in your doctors.
Regards and with continuing admiration for what you are doing.
---
#8 -- Congratulations on your quality goals. Nice to see someone put a stake in the ground and focus on what this business is really about.
---
#9 -- Impressive move by you and your board. That's the way to push the envelope. Let's hope others take up the challenge as well.
---
#10 -- Great Globe Editorial today! I’m so proud to now be a BI patient!
---
#11 -- Good luck with the initiative. It’s a big undertaking.
---
#12 -- I am really delighted that you have chosen to meet this head on. Obtaining accurate data and putting the CARE back into healthcare will continue to keep us in the forefront both in Boston and nationally.
---
#13 -- I can’t tell you how excited I am by your commitment to avoid all preventable harm to patients. It is simply the right thing to do. In a similar vein, I first learned of Ascension Health’s commitment to “no preventable deaths by 2008” in the fall of 2004. I have known Dr. Sandy Tolchin for many years and have had the opportunity to learn of his efforts, initially at Borgess Health Alliance in Kalamazoo and now as VP Clinical Excellence in collaboration with David Prior and others at Ascension Health. When I last spoke with him in the late fall, he said, “We have now demonstrated that flawless care is achievable.”
Saturday, January 19, 2008
What's in a PCAC?
Following on our theme below, I am presenting a bit more on our governance of hospital safety and quality to provide background to others in the field who might be interested. A friend asked me how our Patient Care Assessment and Quality Committee (PCAC) is constituted and what its charter is. Here it is in its entirety. The key points are that its job is related to the overall institutional goals established by the Board of Directors (the ones mentioned below), as well as statutory responsibilities. Also, that membership by the lay leadership (entitled "Medical Center Governance" below) always exceeds that of internal management and clinical leadership. Note, too, the inclusion of the Vice President of Education to ensure that quality and safety programs are integrated into the educational programs for both medical students and residents -- very important in an academic medical center.
This is a hard-working committee for the volunteer leadership, meeting monthly and dealing with difficult and challenging issues. We have great appreciation for those people, who devote hours well beyond the committee meetings in staying informed and thinking about the most important topics on the Board's agenda.
BIDMC Committee Charter
Patient Care Assessment and Quality Committee (PCAC)
Reports To: BIDMC Board of Directors
Mission:
The mission of the Patient Care Assessment and Quality Committee (PCAC) is to support the aspirations for clinical quality and safety for BIDMC as set forth by the Board of Directors, and make appropriate recommendations for improvement. The PCAC shall also serve the role of Medical Peer Review Committee as defined under the statutes of the Commonwealth of Massachusetts.
Charge and Scope:
Monitor the occurrence of harm to BIDMC patients, with a focus on response and corrective action when harm occurs.
Select and monitor priority metrics that evaluate clinical quality and safety processes and outcomes achieved within BIDMC.
Recommend to the Board of Directors, at least annually, priority initiatives for improving quality and safety of care at BIDMC, and monitor the extent to which approved priority initiatives are satisfactorily executed.
Ensure that BIDMC remains alert to current best practices for quality and safety, at BIDMC and other entities (in health care as well as other settings), and recommends appropriate adoption. This shall include ensuring that best practices within BIDMC itself are spread and implemented throughout the organization.
Approve annually the Qualified Patient Care Assessment Program.
Ensure that all regulatory reporting mandates for clinical performance, including the filing of major incident reports to the Commonwealth, are met.
Ensure that members of the Committee have the appropriate knowledge and training necessary to carry out the mission of the committee.
Committee Chair:
Member of BIDMC Governance, Appointed by Chair of Board of Directors
Members:
Chair (Member of Medical Center Governance)
Vice Chair (Member of Medical Center Governance)
Chair, Board of Directors, ex officio
CEO, ex officio
President, faculty practice, ex officio
Chair, Medical Executive Committee, ex officio
Chair, Deptartment of Surgery, ex officio
Chair, Department of Medicine, ex officio
Chair, Academic Department (Rotating 1 year appointment, appointed by the Chair of the Medical Executive Committee)
Vice President, Education, ex officio
11-24 Members (Members of Medical Center Governance)
Staff:
Chief Operating Officer
Senior Vice President, Clinical Operations
Senior Vice President, Health Care Quality
Patient Care Assessment Coordinator
Meeting Schedule:
Monthly (except no August meeting)
This is a hard-working committee for the volunteer leadership, meeting monthly and dealing with difficult and challenging issues. We have great appreciation for those people, who devote hours well beyond the committee meetings in staying informed and thinking about the most important topics on the Board's agenda.
BIDMC Committee Charter
Patient Care Assessment and Quality Committee (PCAC)
Reports To: BIDMC Board of Directors
Mission:
The mission of the Patient Care Assessment and Quality Committee (PCAC) is to support the aspirations for clinical quality and safety for BIDMC as set forth by the Board of Directors, and make appropriate recommendations for improvement. The PCAC shall also serve the role of Medical Peer Review Committee as defined under the statutes of the Commonwealth of Massachusetts.
Charge and Scope:
Monitor the occurrence of harm to BIDMC patients, with a focus on response and corrective action when harm occurs.
Select and monitor priority metrics that evaluate clinical quality and safety processes and outcomes achieved within BIDMC.
Recommend to the Board of Directors, at least annually, priority initiatives for improving quality and safety of care at BIDMC, and monitor the extent to which approved priority initiatives are satisfactorily executed.
Ensure that BIDMC remains alert to current best practices for quality and safety, at BIDMC and other entities (in health care as well as other settings), and recommends appropriate adoption. This shall include ensuring that best practices within BIDMC itself are spread and implemented throughout the organization.
Approve annually the Qualified Patient Care Assessment Program.
Ensure that all regulatory reporting mandates for clinical performance, including the filing of major incident reports to the Commonwealth, are met.
Ensure that members of the Committee have the appropriate knowledge and training necessary to carry out the mission of the committee.
Committee Chair:
Member of BIDMC Governance, Appointed by Chair of Board of Directors
Members:
Chair (Member of Medical Center Governance)
Vice Chair (Member of Medical Center Governance)
Chair, Board of Directors, ex officio
CEO, ex officio
President, faculty practice, ex officio
Chair, Medical Executive Committee, ex officio
Chair, Deptartment of Surgery, ex officio
Chair, Department of Medicine, ex officio
Chair, Academic Department (Rotating 1 year appointment, appointed by the Chair of the Medical Executive Committee)
Vice President, Education, ex officio
11-24 Members (Members of Medical Center Governance)
Staff:
Chief Operating Officer
Senior Vice President, Clinical Operations
Senior Vice President, Health Care Quality
Patient Care Assessment Coordinator
Meeting Schedule:
Monthly (except no August meeting)
Thursday, January 17, 2008
Source material on quality, safety, and patient satisfaction
As a follow-up to the post below on the quality, safety, and patient satisfaction goals established by the BIDMC and BID~Needham Boards, I thought some of you might be interested in reading the material that led to the votes. It is a bit long, but descriptive of the issues that were considered. For some of you, this might be more than you want to know. For others, it might provide primary source information that could be valuable for your own institutions. My hope is that more hospitals will find themselves moving in this direction, and if the accompanying memo helps in your own consideration, please feel free to use it. (In the memo below, the LEAD program refers to a partnership between our hospitals and Blue Cross Blue Shield of MA, under which auspices the Board training program was held.)
In my next posting, I plan to give you a sense of the internal feedback that I have received since making this announcement.
To: BIDMC Board of Directors and PCAC Members
BID-Needham Board of Trustees and PCAC Members
From: Lois E. Silverman, Chair, BIDMC Board of Directors
Seth Medalie, Chair, BID-Needham Board of Trustees
Robert Melzer, Chair, BIDMC PCAC
Paula Ivey Henry, Vice Chair, BIDMC PCAC
Christoph Hoffmann, Chair, BID-Needham PCAC
Paul F. Levy, CEO, BIDMC
Jeffrey H. Liebman, CEO, BID-Needham
Ken Sands, MD, Senior Vice President, Healthcare Quality
Stan Lewis, MD, Senior Vice President, Network Development
Dianne Anderson, Senior Vice President, Clinical Operations
Re: LEAD Board Program Follow-up
Date: November 30, 2007
Dear Board Members,
Following our immensely engaging LEAD retreat last month, a group of us got together to draft a proposal on quality and safety goals for both hospitals for your formal consideration.
It was clear from the retreat discussions that there should be two ambitious overarching goals for both institutions: One for the quality and safety of care and another for patient satisfaction.
The group agreed that the Board’s role is to set an expectation for organizational performance for these two areas. Management is then expected to devise programs for achieving these goals, and to determine the metrics against which performance will be measured. We anticipate that the structure of the Board meetings will change to include systematic reviews of the programs related to these goals on a quarterly basis.
On the patient satisfaction front, we propose the following goal:
BIDMC and BID-Needham will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to “willingness to recommend.” For this goal, BID-Needham will measure itself against national peer group hospitals and BIDMC against a national dataset of all hospitals.
A top 2% goal means that effectively nine out of every ten patients rate the hospital in the top tier category on national surveys for willingness to recommend. BIDMC is presently performing in the top 10-15% range, on average. BID-Needham is in the top 30%. This goal represents a steep climb in performance for both institutions.
Formulating a goal for quality and safety proved more challenging, as there is a broad spectrum of definitions for harm and error, and consequently a broad range of implications for goal setting. First, there is a distinction between preventable and non-preventable harm. The latter type occurs when a patient is harmed as a result of a cause that could not have been predicted or prevented, such as the administration of a drug resulting in an adverse reaction that a patient’s history would not have indicated. Preventable harm, on the other hand, occurs when there is a failure on the part of either an individual or a system to render ideal care, such as when the administration of an incorrect dose or medication results in an adverse outcome causing actual injury to the patient.
It should further be noted that there is a distinction between harm and error, and that not all errors result in harm to the patient. For example, an incorrect dose of a particular drug administered to a patient might not affect the patient. The Institute for Healthcare Improvement (IHI) reports that only 10 to 20% of errors are ever reported, and of those, 90 to 95% cause no harm to patients. While much can be learned from all errors, many (including IHI) recommend that institutional governance focus on those causing actual harm. The theory is that by discussing openly those events actually experienced by patients, a hospital begins to foster a culture of safety that shifts from individual blame for errors to comprehensive system design and therefore lasting improvement in safety.
The first step in identifying harm is to develop a clear definition. Our small group reviewed several definitions of harm, ranging from IHI’s very comprehensive definition of all harm, including preventable and non-preventable harm, to the Ascension Healthcare System’s quality goal of no preventable harm. We felt that we needed to focus our resources where we can have the greatest impact, on eliminating preventable harm. At the same time, we wanted to maintain an organizational awareness of all harm, including non-preventable adverse events, and to seek to reduce our overall incidence of harm. The goal that we propose for quality and safety, therefore, is:
BIDMC and BID-Needham will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
To determine and clarify how we would actually measure harm, we propose a modification of the categorization developed by the National Coordinating Council for Medication Error and Reporting and Prevention, known as the “NCC-MERP” Framework, to consist of the following categories of evidence of harm:
- Required hospitalization or extended hospitalization
- Permanent harm or disease progression
- Patient death
We feel that focusing on these categories will give us the greatest opportunity to achieve a meaningful and sustainable reduction in harm, while making the best use of our resources. The occurrence of harm that falls into any one of these categories would qualify for individual case review. In addition, while the boards of our institutions will focus on “preventable harm,” we also expect our respective PCAC committees to develop systems for periodic assessment and reporting on the occurrences of harm that are not within the categories listed above.
It is important for the Boards and the respective organizations to understand that these goals represent a far-reaching aspiration for our hospitals and for the level of care that we seek to provide. We must acknowledge that getting there will be a three to four year journey that will require further strengthening of our culture of safety and transparency. It will mean further bolstering our efforts to create an environment where caregivers feel safe discussing the occurrence of harm.
We discussed and propose the following timeline: At the December Board meetings, each Board will discuss and vote on these proposed goals and the attached resolution. Management would then be charged with outlining specific programs with measurable milestones to achieve these goals. In January, staff will be asked to present to their respective PCAC committee a timetable for these programs for the following year, along with a trajectory of performance towards the end goals. Upon review and approval by the respective PCAC committee, the action plans and milestones will be brought to the Board at its first subsequent meeting. A quarterly review of progress towards these goals would then become a regular element of each institution’s Board and PCAC meetings. In addition, the Compensation Committee of each hospital will be charged with building these quality and safety goals into the annual incentive plans for senior management.
We welcome your feedback and questions on these proposed goals, and look forward to our discussions at the December Board meetings.
In my next posting, I plan to give you a sense of the internal feedback that I have received since making this announcement.
To: BIDMC Board of Directors and PCAC Members
BID-Needham Board of Trustees and PCAC Members
From: Lois E. Silverman, Chair, BIDMC Board of Directors
Seth Medalie, Chair, BID-Needham Board of Trustees
Robert Melzer, Chair, BIDMC PCAC
Paula Ivey Henry, Vice Chair, BIDMC PCAC
Christoph Hoffmann, Chair, BID-Needham PCAC
Paul F. Levy, CEO, BIDMC
Jeffrey H. Liebman, CEO, BID-Needham
Ken Sands, MD, Senior Vice President, Healthcare Quality
Stan Lewis, MD, Senior Vice President, Network Development
Dianne Anderson, Senior Vice President, Clinical Operations
Re: LEAD Board Program Follow-up
Date: November 30, 2007
Dear Board Members,
Following our immensely engaging LEAD retreat last month, a group of us got together to draft a proposal on quality and safety goals for both hospitals for your formal consideration.
It was clear from the retreat discussions that there should be two ambitious overarching goals for both institutions: One for the quality and safety of care and another for patient satisfaction.
The group agreed that the Board’s role is to set an expectation for organizational performance for these two areas. Management is then expected to devise programs for achieving these goals, and to determine the metrics against which performance will be measured. We anticipate that the structure of the Board meetings will change to include systematic reviews of the programs related to these goals on a quarterly basis.
On the patient satisfaction front, we propose the following goal:
BIDMC and BID-Needham will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to “willingness to recommend.” For this goal, BID-Needham will measure itself against national peer group hospitals and BIDMC against a national dataset of all hospitals.
A top 2% goal means that effectively nine out of every ten patients rate the hospital in the top tier category on national surveys for willingness to recommend. BIDMC is presently performing in the top 10-15% range, on average. BID-Needham is in the top 30%. This goal represents a steep climb in performance for both institutions.
Formulating a goal for quality and safety proved more challenging, as there is a broad spectrum of definitions for harm and error, and consequently a broad range of implications for goal setting. First, there is a distinction between preventable and non-preventable harm. The latter type occurs when a patient is harmed as a result of a cause that could not have been predicted or prevented, such as the administration of a drug resulting in an adverse reaction that a patient’s history would not have indicated. Preventable harm, on the other hand, occurs when there is a failure on the part of either an individual or a system to render ideal care, such as when the administration of an incorrect dose or medication results in an adverse outcome causing actual injury to the patient.
It should further be noted that there is a distinction between harm and error, and that not all errors result in harm to the patient. For example, an incorrect dose of a particular drug administered to a patient might not affect the patient. The Institute for Healthcare Improvement (IHI) reports that only 10 to 20% of errors are ever reported, and of those, 90 to 95% cause no harm to patients. While much can be learned from all errors, many (including IHI) recommend that institutional governance focus on those causing actual harm. The theory is that by discussing openly those events actually experienced by patients, a hospital begins to foster a culture of safety that shifts from individual blame for errors to comprehensive system design and therefore lasting improvement in safety.
The first step in identifying harm is to develop a clear definition. Our small group reviewed several definitions of harm, ranging from IHI’s very comprehensive definition of all harm, including preventable and non-preventable harm, to the Ascension Healthcare System’s quality goal of no preventable harm. We felt that we needed to focus our resources where we can have the greatest impact, on eliminating preventable harm. At the same time, we wanted to maintain an organizational awareness of all harm, including non-preventable adverse events, and to seek to reduce our overall incidence of harm. The goal that we propose for quality and safety, therefore, is:
BIDMC and BID-Needham will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
To determine and clarify how we would actually measure harm, we propose a modification of the categorization developed by the National Coordinating Council for Medication Error and Reporting and Prevention, known as the “NCC-MERP” Framework, to consist of the following categories of evidence of harm:
- Required hospitalization or extended hospitalization
- Permanent harm or disease progression
- Patient death
We feel that focusing on these categories will give us the greatest opportunity to achieve a meaningful and sustainable reduction in harm, while making the best use of our resources. The occurrence of harm that falls into any one of these categories would qualify for individual case review. In addition, while the boards of our institutions will focus on “preventable harm,” we also expect our respective PCAC committees to develop systems for periodic assessment and reporting on the occurrences of harm that are not within the categories listed above.
It is important for the Boards and the respective organizations to understand that these goals represent a far-reaching aspiration for our hospitals and for the level of care that we seek to provide. We must acknowledge that getting there will be a three to four year journey that will require further strengthening of our culture of safety and transparency. It will mean further bolstering our efforts to create an environment where caregivers feel safe discussing the occurrence of harm.
We discussed and propose the following timeline: At the December Board meetings, each Board will discuss and vote on these proposed goals and the attached resolution. Management would then be charged with outlining specific programs with measurable milestones to achieve these goals. In January, staff will be asked to present to their respective PCAC committee a timetable for these programs for the following year, along with a trajectory of performance towards the end goals. Upon review and approval by the respective PCAC committee, the action plans and milestones will be brought to the Board at its first subsequent meeting. A quarterly review of progress towards these goals would then become a regular element of each institution’s Board and PCAC meetings. In addition, the Compensation Committee of each hospital will be charged with building these quality and safety goals into the annual incentive plans for senior management.
We welcome your feedback and questions on these proposed goals, and look forward to our discussions at the December Board meetings.
Aspirations for BIDMC and BID~Needham
Here is an email I sent last night to the staff of BIDMC and our community hospital, BID~Needham. Thanks to CEO Cleve Killingsworth and others at Blue Cross Blue Shield of MA for being our partners in the Board training and providing other assistance and encouragement that helped lead to this step: Please see Jeff Krasner's story and an editorial in today's Boston Globe. Special thanks to Jim Conway at the Institute for Healthcare Improvement for his wise counsel and for conducting a significant segment of our Boards' training, and to three unnamed patients who addressed the Boards and powerfully made these issues tangible. Finally, after the text of this email, please read the statement we received on this matter from State Senator Richard T. Moore (Senate Chair of the Joint Committee on Health Care Financing).
Dear BIDMC,
There are some things that we do that are meant to transform our hospital, to set us on a path to very high standards that, at first blush, appear so audacious as to be unachievable. But if you never take the leap and set out the goals, you never know what you really can achieve.
Today, we announce such goals, in the hope that they will set the stage for such a transformation.
Several weeks ago, the Board of Directors of BIDMC and the Board of Trustees of BID~Needham met and had serious discussions about what their hopes were for our two hospitals. As the representatives of the community who have fiduciary responsibility for our two non-profit organizations, they decided on a pair of goals that represent their aspirations for us. Of course, the clinical and administrative leadership of the hospital were deeply involved in these discussions as well and provided the technical support for the decisions that were made.
The Boards decided that two overarching types of goals were important. The first relates to patient satisfaction. The second relates to safety and quality of care. Here is the vote that was taken by the BIDMC Board (and a virtually identical one was taken by the BID~Needham Board):
WHEREAS, the Board of Directors, Patient Care Assessment and Quality Committee ("PCAC"), and Patient Care Services Committee ("PCS Committee") of Beth Israel Deaconess Medical Center ("BIDMC") have determined that it is in the best interest of BIDMC to set ambitious and overarching goals related to healthcare quality and patient safety, and patient satisfaction.
NOW THEREFORE BE IT RESOLVED AS FOLLOWS:
To approve the following goals for BIDMC related to healthcare quality and patient safety, and patient satisfaction:
BIDMC will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to "willingness to recommend." For this goal, BIDMC will measure itself against a national dataset of all hospitals.
BIDMC will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
That Management will develop and implement action plans and programs to achieve these goals, to be reviewed and approved by the PCAC Committee, PCS Committee, and the Board, and will report to the Board, PCAC, and PCS Committee on at least a quarterly basis using defined metrics against which performance will be measured.
Daunting, eh? You bet. Here's more. We will be publicizing our progress towards these goals on our external website for the world to see. In other words, we will be holding ourselves accountable to the public for our actions and deeds. Our steps towards transparency have just been notched up a level.
These Board votes certainly do not mean that we are not already doing a good job now. Our Boards have immense respect and affection for all of the staff who work in our hospitals. They know you take really good care of patients and provide a warm and caring environment for patients and families. But the votes mean that our Board members who represent the community want us to do even better, out of a sense of public service and also out of a sense of pride that we can do better.
Over the last several months, we have seen a hint of what is possible. Our efforts at infection control on the floors and in the ICUs are but a few examples. Meanwhile, too, we have made process and customer service improvements in a number of clinics. We have saved lives, reduced adverse events, improved customer satisfaction, and made life a bit less hectic for some of our staff. (You know from previous emails that I am working hard to make even more improvements on that latter point.)
We have come a long way. Six years ago, both of our hospitals were close to being sold or shuttered. Four years ago, we had passed through a turn-around and proved our ability to survive. These past two years, we have shown that we are vibrant members of the Boston and Harvard medical communities. Now, we rise to the largest challenge yet -- setting standards for patient satisfaction and reduction of harm that are truly world class.
Stay tuned as we roll this out and decide on the yearly priorities and work plans that will eventually lead to reaching these audacious goals. In the meantime, as always, please keep in touch with your ideas, suggestions, and criticisms.
Sincerely,
Paul
Here is Senator Moore's statement:
“BI-Deaconess deserves to be strongly commended for taking this challenging, bold step to improve health quality and transparency. By including a small community hospital (BID-Needham) as well as a major academic medical center, BI-Deaconess becomes a true champion of health care quality and patient safety. Their leadership in promoting transparency is unprecedented in the Commonwealth, and is fully consistent with the principles behind legislative initiatives such as Senate Bill No. 1277/House Bill No. 2226, An Act Improving Consumer Healthcare Quality. They obviously understand the meaning of 'First, Do No Harm.' They get it right!”
Thank you, Senator!
Dear BIDMC,
There are some things that we do that are meant to transform our hospital, to set us on a path to very high standards that, at first blush, appear so audacious as to be unachievable. But if you never take the leap and set out the goals, you never know what you really can achieve.
Today, we announce such goals, in the hope that they will set the stage for such a transformation.
Several weeks ago, the Board of Directors of BIDMC and the Board of Trustees of BID~Needham met and had serious discussions about what their hopes were for our two hospitals. As the representatives of the community who have fiduciary responsibility for our two non-profit organizations, they decided on a pair of goals that represent their aspirations for us. Of course, the clinical and administrative leadership of the hospital were deeply involved in these discussions as well and provided the technical support for the decisions that were made.
The Boards decided that two overarching types of goals were important. The first relates to patient satisfaction. The second relates to safety and quality of care. Here is the vote that was taken by the BIDMC Board (and a virtually identical one was taken by the BID~Needham Board):
WHEREAS, the Board of Directors, Patient Care Assessment and Quality Committee ("PCAC"), and Patient Care Services Committee ("PCS Committee") of Beth Israel Deaconess Medical Center ("BIDMC") have determined that it is in the best interest of BIDMC to set ambitious and overarching goals related to healthcare quality and patient safety, and patient satisfaction.
NOW THEREFORE BE IT RESOLVED AS FOLLOWS:
To approve the following goals for BIDMC related to healthcare quality and patient safety, and patient satisfaction:
BIDMC will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to "willingness to recommend." For this goal, BIDMC will measure itself against a national dataset of all hospitals.
BIDMC will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
That Management will develop and implement action plans and programs to achieve these goals, to be reviewed and approved by the PCAC Committee, PCS Committee, and the Board, and will report to the Board, PCAC, and PCS Committee on at least a quarterly basis using defined metrics against which performance will be measured.
Daunting, eh? You bet. Here's more. We will be publicizing our progress towards these goals on our external website for the world to see. In other words, we will be holding ourselves accountable to the public for our actions and deeds. Our steps towards transparency have just been notched up a level.
These Board votes certainly do not mean that we are not already doing a good job now. Our Boards have immense respect and affection for all of the staff who work in our hospitals. They know you take really good care of patients and provide a warm and caring environment for patients and families. But the votes mean that our Board members who represent the community want us to do even better, out of a sense of public service and also out of a sense of pride that we can do better.
Over the last several months, we have seen a hint of what is possible. Our efforts at infection control on the floors and in the ICUs are but a few examples. Meanwhile, too, we have made process and customer service improvements in a number of clinics. We have saved lives, reduced adverse events, improved customer satisfaction, and made life a bit less hectic for some of our staff. (You know from previous emails that I am working hard to make even more improvements on that latter point.)
We have come a long way. Six years ago, both of our hospitals were close to being sold or shuttered. Four years ago, we had passed through a turn-around and proved our ability to survive. These past two years, we have shown that we are vibrant members of the Boston and Harvard medical communities. Now, we rise to the largest challenge yet -- setting standards for patient satisfaction and reduction of harm that are truly world class.
Stay tuned as we roll this out and decide on the yearly priorities and work plans that will eventually lead to reaching these audacious goals. In the meantime, as always, please keep in touch with your ideas, suggestions, and criticisms.
Sincerely,
Paul
Here is Senator Moore's statement:
“BI-Deaconess deserves to be strongly commended for taking this challenging, bold step to improve health quality and transparency. By including a small community hospital (BID-Needham) as well as a major academic medical center, BI-Deaconess becomes a true champion of health care quality and patient safety. Their leadership in promoting transparency is unprecedented in the Commonwealth, and is fully consistent with the principles behind legislative initiatives such as Senate Bill No. 1277/House Bill No. 2226, An Act Improving Consumer Healthcare Quality. They obviously understand the meaning of 'First, Do No Harm.' They get it right!”
Thank you, Senator!
Tuesday, January 15, 2008
In Memoriam: Dr. Judah Folkman
Scott Allen at the Boston Globe and White Coat Notes reports on the death of Dr. Judah Folkman, a legendary researcher at Boston Children's Hospital. The fact that, as of this writing, 63 comments from the public were submitted to the online version of this report gives a sense of how this gentleman was regarded in Boston and beyond. Please read them for a sense of his widespread impact.
Our condolences go to Paula and her family and all of Judah's many friends.
Our condolences go to Paula and her family and all of Judah's many friends.
Monday, January 14, 2008
How to vote on Medgadget.com
No, this is not about hanging chads. I've talked to friends who say they have voted on http://www.medgadget.com/ for their choice of best blogs, but they have often done it wrong. If you just click on the name of the blog on the homepage or above the "ballot" on the voting pop-up page, it does not record as a vote. (In fact, all it does is to send you over to that website.)
To record a vote, you actually have find the page with the green ballot by clicking on the Medical Blog Awards trophy on the homepage and then clicking on the Please vote here link. Then put your cursor on the "hole" next to the blog of choice, click to leave a dot, and then click again on the bigger "vote" button, for your vote to be recorded.
So, regardless of your choice of candidates, if you did it wrong, you might want to return and vote again.
As I mentioned below, I would be honored to have your vote, in either or both categories: Best medical weblog or Best health policies/ethics weblog.
To record a vote, you actually have find the page with the green ballot by clicking on the Medical Blog Awards trophy on the homepage and then clicking on the Please vote here link. Then put your cursor on the "hole" next to the blog of choice, click to leave a dot, and then click again on the bigger "vote" button, for your vote to be recorded.
So, regardless of your choice of candidates, if you did it wrong, you might want to return and vote again.
As I mentioned below, I would be honored to have your vote, in either or both categories: Best medical weblog or Best health policies/ethics weblog.
On checklists
Lots of you have been asking me to comment on the story by Atul Gawande in the New York Times, in which he discusses a hospital that had to stop a quality improvement checklist program because of an adverse ruling by the federal agency that reviews human subject experiments. I really didn't know what more to say on this, in that Atul wrote the story in his usual brilliant manner, made the case clearly, and certainly got as much publicity for the cause as possible by its placement.
Meanwhile, though, a movement has started to make sure the government does not overreach in this area. Charlie Baker, for one, has written very well on the subject, and so, especially, has Bob Wachter. And I just received, through Bob, a copy of a letter from the American Hospital Association to Secretary Leavitt on the matter. I haven't heard anything about a reply from the Secretary. I know he has a blog, and this might be a good time to use it and reassure all of us.
Here is the AHA letter, in whole:
January 3, 2008
The Honorable Michael Leavitt
Secretary
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 615F
Washington, D.C. 20201
Dear Mr. Secretary:
In a December 30 New York Times op-ed piece, Dr. Atul Gawande raises important questions about a misguided and potentially dangerous policy of the Office for Human Research Protections that would impose an unprecedented deterrent to quality improvement efforts across the country. I am writing to ask you to immediately retract any statements from the Office of Human Research Protections that imply that quality improvement efforts should undergo review by Institutional Review Boards, and that consent should be obtained from all patients before changes could be incorporated.
As you know, hospitals across the nation are engaged in a variety of activities aimed at redesigning health care delivery systems to ensure that our patients get the best possible care we can deliver. Some of these activities are organized by hospitals, such as the Michigan Health and Hospital Association’s Keystone project that Dr. Gawande cites. Others include projects initiated by the Institute for Healthcare Improvement, the Quality Improvement Organizations funded by the Centers for Medicare & Medicaid Services, and the work of several professional societies and organizations such as the American College of Surgeons and the American College of Cardiology.
As Dr. Gawande points out, research to determine which drugs or procedures will benefit patients requires appropriate oversight by an Institutional Review Board (IRB) and informed consent by the patients. However, those efforts are far different from the quality improvement efforts exploring the use of checklists, computerized reminders, teamwork training, and other steps to ensure that the care we intend to deliver is actually delivered.
It is worth noting that hospitals and health care professionals are not the only ones engaged in such projects. The quality transparency efforts in which the AHA, the Department of Health and Human Services (HHS), and several other organizations have partnered, the local value exchanges your department has fostered, and the value-based purchasing initiatives you have championed are other examples. Yet, HHS has, quite reasonably, sought no IRB review or informed consent for these changes, because they, too, are intended simply to improve the delivery of care.
As quality improvement efforts become more standardized and rigorous, and as the data collection efforts that support this work become more extensive, it would be right and appropriate to contemplate how we can collaborate to ensure that the welfare of patients remains the central concern and that patient privacy is protected. It also would be appropriate to consider effective ways for hospitals and other providers to communicate with the public about their quality improvement efforts. However, it would be wholly inappropriate and detrimental to the patients and communities we serve if the measures apparently championed by the Office for Human Research Protections were to force hospitals and others to discontinue their quality improvement efforts.
On behalf of America’s hospitals, I urge you to ensure that the essential quality improvement efforts underway across the nation continue unabated.
Sincerely,
Rich Umbdenstock
President and CEO
Meanwhile, though, a movement has started to make sure the government does not overreach in this area. Charlie Baker, for one, has written very well on the subject, and so, especially, has Bob Wachter. And I just received, through Bob, a copy of a letter from the American Hospital Association to Secretary Leavitt on the matter. I haven't heard anything about a reply from the Secretary. I know he has a blog, and this might be a good time to use it and reassure all of us.
Here is the AHA letter, in whole:
January 3, 2008
The Honorable Michael Leavitt
Secretary
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 615F
Washington, D.C. 20201
Dear Mr. Secretary:
In a December 30 New York Times op-ed piece, Dr. Atul Gawande raises important questions about a misguided and potentially dangerous policy of the Office for Human Research Protections that would impose an unprecedented deterrent to quality improvement efforts across the country. I am writing to ask you to immediately retract any statements from the Office of Human Research Protections that imply that quality improvement efforts should undergo review by Institutional Review Boards, and that consent should be obtained from all patients before changes could be incorporated.
As you know, hospitals across the nation are engaged in a variety of activities aimed at redesigning health care delivery systems to ensure that our patients get the best possible care we can deliver. Some of these activities are organized by hospitals, such as the Michigan Health and Hospital Association’s Keystone project that Dr. Gawande cites. Others include projects initiated by the Institute for Healthcare Improvement, the Quality Improvement Organizations funded by the Centers for Medicare & Medicaid Services, and the work of several professional societies and organizations such as the American College of Surgeons and the American College of Cardiology.
As Dr. Gawande points out, research to determine which drugs or procedures will benefit patients requires appropriate oversight by an Institutional Review Board (IRB) and informed consent by the patients. However, those efforts are far different from the quality improvement efforts exploring the use of checklists, computerized reminders, teamwork training, and other steps to ensure that the care we intend to deliver is actually delivered.
It is worth noting that hospitals and health care professionals are not the only ones engaged in such projects. The quality transparency efforts in which the AHA, the Department of Health and Human Services (HHS), and several other organizations have partnered, the local value exchanges your department has fostered, and the value-based purchasing initiatives you have championed are other examples. Yet, HHS has, quite reasonably, sought no IRB review or informed consent for these changes, because they, too, are intended simply to improve the delivery of care.
As quality improvement efforts become more standardized and rigorous, and as the data collection efforts that support this work become more extensive, it would be right and appropriate to contemplate how we can collaborate to ensure that the welfare of patients remains the central concern and that patient privacy is protected. It also would be appropriate to consider effective ways for hospitals and other providers to communicate with the public about their quality improvement efforts. However, it would be wholly inappropriate and detrimental to the patients and communities we serve if the measures apparently championed by the Office for Human Research Protections were to force hospitals and others to discontinue their quality improvement efforts.
On behalf of America’s hospitals, I urge you to ensure that the essential quality improvement efforts underway across the nation continue unabated.
Sincerely,
Rich Umbdenstock
President and CEO
Pack up your troubles
From my friend John:
"I hope you are like this 109 year old Australian woman and are still blogging at 109 years old."
As you dig down into the site, check this link to hear and watch Olive sing "Smile, Smile, Smile". It is marvelous, especially the repeat halfway through the clip.
"I hope you are like this 109 year old Australian woman and are still blogging at 109 years old."
As you dig down into the site, check this link to hear and watch Olive sing "Smile, Smile, Smile". It is marvelous, especially the repeat halfway through the clip.
Exit interview
I am realistic enough to know that not everybody loves their job here and that people sometimes leave with hard feelings, but when you get a note like this months later from a medical technologist who spent two years with us, you have to feel good:
Hello Mr. Levy,
I had the most incredible experiences working at BIDMC and miss it so much! There is a palpable sense of community within the hospital that is almost impossible to find anywhere, especially in an urban setting. Trust me, I have had a few rotations around Boston and constantly yearn for the comfort and kindness of BIDMC employees. If it had not been for my wonderful position at the hospital and the strong support of my colleagues, I would have not gone back to graduate school to obtain my nurse/nurse practitioner degree.
I hope after my studies I may just find a path back to BIDMC. All the best to you and your hospital.
Hello Mr. Levy,
I had the most incredible experiences working at BIDMC and miss it so much! There is a palpable sense of community within the hospital that is almost impossible to find anywhere, especially in an urban setting. Trust me, I have had a few rotations around Boston and constantly yearn for the comfort and kindness of BIDMC employees. If it had not been for my wonderful position at the hospital and the strong support of my colleagues, I would have not gone back to graduate school to obtain my nurse/nurse practitioner degree.
I hope after my studies I may just find a path back to BIDMC. All the best to you and your hospital.
Sunday, January 13, 2008
Who's on first
A true story about cultural competence related by my friend Ed, who spent some time on a low budget trek through northern Africa after graduating from college in the 1970's.
While in Algeria, he met a young man who asked, "What is your name?"
Ed replied, "I am Ed."
"Really?" said the young man, "Ahmed is my name, too!"
"No," said Ed, "I AM Ed!"
"Yes, Ahmed!" replied the other.
While in Algeria, he met a young man who asked, "What is your name?"
Ed replied, "I am Ed."
"Really?" said the young man, "Ahmed is my name, too!"
"No," said Ed, "I AM Ed!"
"Yes, Ahmed!" replied the other.
For Inspector Gadget
Have secrets? This is just for you. A biometric memory stick for your computer. You drag your finger twice over the little sensor (the orange strip at the bottom end), and that encodes your fingerprint. Then, only you can get access to the data in your memory stick when you plug it into a computer, by again passing your finger over the sensor. (There is a sliding door to protect the sensor.)Am I a Luddite (don't answer that!), or is this a technology in search of a purpose? Maybe I don't have many secrets, but I think there will be limited demand for this. On the other hand, maybe I should add more intrigue to my life and find some secret data that I want to carry around with me.
Do you have secret data that you would want to protect this way? Hmm, is it HIPAA compliant to carry patient data in this manner? Perhaps our CIO, John Halamka, or others will comment on that.
(The company that makes this is call TwinMOS.)
Saturday, January 12, 2008
Whither thou goist I shall go
Back to our more interesting and important week's topic of helping others and giving back. Please read this lovely story by Irene Sage in today's Boston Globe about Ruth Adomunes, a BIDMC staff member who is helping to build a school in Haiti by making and selling bracelets.
I like the final paragraph: Wherever Adomunes goes, she carries a large tote bag filled with bracelets. "This is my portable store," she says. "If someone says, 'Do you have any bracelets?' 'Yes, I do.' "
I like the final paragraph: Wherever Adomunes goes, she carries a large tote bag filled with bracelets. "This is my portable store," she says. "If someone says, 'Do you have any bracelets?' 'Yes, I do.' "
Friday, January 11, 2008
>500 letters in the mailroom
Our mail room staff called today to say that over 500 letters had arrived from the SEIU to doctors in the hospital. One of the doctors was kind enough to share his with me, a letter from Mike Fadel, Executive Vice President. I'll spare you most of the details, but I will give you a small quote:
"BIDMC's CEO recently has complained that he has been singled out for public criticism on the 'question' of whether hospital workers should be promised that they will not be threatened by executives on the decision of unionizing. Be he has singled out his own institution by essentially promising to fight against BIDMC's own caregivers as if they were adversaries."
Those of you who are regular readers of this blog know that all of the above is not true. You know the high regard and respect I have for our employees, and you know of my personal efforts to improve the work environment at this hospital -- both for their sake and in support of providing better care to our patients. You can also see exactly what I have said about union organizing in general and the tactics of this union in particular.
The union's use of language is carefully chosen. It is meant, first, to isolate me by giving the impression that I am the only hospital CEO in Boston who feels this way. Not so. The others may not say so publicly, but they readily say so privately. (Who knows, perhaps they are wise to do it that way!)
Second, it is meant to try to create divisions between the doctors and the administration of the hospital. Not likely to be effective, either, in that the doctors see quite clearly what tactics are at play here.
A third subtle aspect of the package sent to the doctors is the inclusion of an op-ed from a Jewish newspaper that makes similar accusations and states that I am acting in a manner inconsistent with the "Jewish tradition of social justice." Months ago, I raised a hint as to this tactic as well. Perhaps the SEIU thinks that doctors at a hospital, one of whose antecedents was established by the Jewish community, would be receptive to this argument. Perhaps they don't understand that many people are likely to find it an offensive and mistaken use of religion in support of a political or organizational cause.
Meanwhile, I hear from friends on Beacon Hill that the union persists in complaining about this blog and what I say in it. What I say in it, as all of you know, is out there for the world to see and evaluate. If any of you catch me in a misleading comment or a mistake you can say so immediately and for the rest of the world to see.
Sunshine is the best disinfectant.
"BIDMC's CEO recently has complained that he has been singled out for public criticism on the 'question' of whether hospital workers should be promised that they will not be threatened by executives on the decision of unionizing. Be he has singled out his own institution by essentially promising to fight against BIDMC's own caregivers as if they were adversaries."
Those of you who are regular readers of this blog know that all of the above is not true. You know the high regard and respect I have for our employees, and you know of my personal efforts to improve the work environment at this hospital -- both for their sake and in support of providing better care to our patients. You can also see exactly what I have said about union organizing in general and the tactics of this union in particular.
The union's use of language is carefully chosen. It is meant, first, to isolate me by giving the impression that I am the only hospital CEO in Boston who feels this way. Not so. The others may not say so publicly, but they readily say so privately. (Who knows, perhaps they are wise to do it that way!)
Second, it is meant to try to create divisions between the doctors and the administration of the hospital. Not likely to be effective, either, in that the doctors see quite clearly what tactics are at play here.
A third subtle aspect of the package sent to the doctors is the inclusion of an op-ed from a Jewish newspaper that makes similar accusations and states that I am acting in a manner inconsistent with the "Jewish tradition of social justice." Months ago, I raised a hint as to this tactic as well. Perhaps the SEIU thinks that doctors at a hospital, one of whose antecedents was established by the Jewish community, would be receptive to this argument. Perhaps they don't understand that many people are likely to find it an offensive and mistaken use of religion in support of a political or organizational cause.
Meanwhile, I hear from friends on Beacon Hill that the union persists in complaining about this blog and what I say in it. What I say in it, as all of you know, is out there for the world to see and evaluate. If any of you catch me in a misleading comment or a mistake you can say so immediately and for the rest of the world to see.
Sunshine is the best disinfectant.
Dr. Codman was right then, and he is right now
Please check out this article by Doctors Swensen and Cortese from the Mayo Clinic. An excerpt:
Transparency was an issue for the American medical profession a century ago, and transparency is an issue for the American medical profession today. In 1905, Ernest Codman, MD, first described the "end result idea." The end result idea is simply that doctors should follow up with all patients to assess the results of their treatment and that the outcomes actively be made public. The end result idea was considered heretical at the time, but in retrospect Codman was sagacious and prescient. He was an advocate for transparency, which he believed would promote quality improvement, patient choice, and physician learning. Transparency is best viewed as an opportunity, one that we should fully and enthusiastically embrace. It offers a substantive boost as organizations step up to the moral imperative of improving patient care to the best it can be.
Codman "walked the walk" as well as "talked the talk." He openly admitted his errors in public and in print. In fact, he paid to publish reports so that patients could judge for themselves the quality of his care. He sent copies of his annual reports to major hospitals throughout the country, challenging them to do the same. From 1911 to 1916, he described 337 patients who were dismissed from his hospital. He reported 123 errors. He measured the end results for all. Codman passionately promoted transparency in order to raise standards. Codman said, "Let us remember that the object of having standards is to raise them."
...A century later, the medical profession is still struggling with the same issues as though they were new. Dr. Codman was right then, and he is right now. Fundamental to the quality movement and American medicine in the 21st century are the same peer review, standardization, systems engineering, and outcome measurement issues. Publishing results for public scrutiny remains a controversial topic. We should embrace transparency as a component of our tipping point strategy to ignite the change we all need to transform our organizations and our profession.
Transparency was an issue for the American medical profession a century ago, and transparency is an issue for the American medical profession today. In 1905, Ernest Codman, MD, first described the "end result idea." The end result idea is simply that doctors should follow up with all patients to assess the results of their treatment and that the outcomes actively be made public. The end result idea was considered heretical at the time, but in retrospect Codman was sagacious and prescient. He was an advocate for transparency, which he believed would promote quality improvement, patient choice, and physician learning. Transparency is best viewed as an opportunity, one that we should fully and enthusiastically embrace. It offers a substantive boost as organizations step up to the moral imperative of improving patient care to the best it can be.
Codman "walked the walk" as well as "talked the talk." He openly admitted his errors in public and in print. In fact, he paid to publish reports so that patients could judge for themselves the quality of his care. He sent copies of his annual reports to major hospitals throughout the country, challenging them to do the same. From 1911 to 1916, he described 337 patients who were dismissed from his hospital. He reported 123 errors. He measured the end results for all. Codman passionately promoted transparency in order to raise standards. Codman said, "Let us remember that the object of having standards is to raise them."
...A century later, the medical profession is still struggling with the same issues as though they were new. Dr. Codman was right then, and he is right now. Fundamental to the quality movement and American medicine in the 21st century are the same peer review, standardization, systems engineering, and outcome measurement issues. Publishing results for public scrutiny remains a controversial topic. We should embrace transparency as a component of our tipping point strategy to ignite the change we all need to transform our organizations and our profession.
Thursday, January 10, 2008
Inspiring and powerful
The theme this week seems to be "giving back" or "paying it forward." Here is another chapter.
Every Monday morning, I have the pleasure of welcoming new employees of BIDMC at an orientation session we hold for them. Later, there is a section in the program when we ask the new employees to think about a time they may have gone to a hospital for themselves or accompanied a loved one. In thinking about the experience, we then ask them to evaluate whether it was positive (and what made it so) or did not go well and what could have improved it.
Here's a note from the group leader, Lynda, about what happened this week:
Depending on the audience, some weeks we get all kinds of responses and then sometimes people are more reticent. This week, the audience was a bit quiet so I piped in with my own experience of having just gone through significant experiences of my own and how the kindness that I received from staff made a difference in my healing. I asked the group if anyone could “top that”.
A woman in the audience raised her hand and proceeded to tell all of us about the time, 4 years ago, when her father who was a patient here, was dying. She choked back tears as she told about her family all being there and the staff making sure everyone had a place to sleep and food to eat around the clock and whatever else they needed. They were apparently there for a number of days but went through the experience together as a family, with their father, being totally supported by the staff.
Then she added that she decided she wanted to come and work here in order to be able to give others the kind of experience she had here and to work with these remarkable people.
All in all, tearful and inspiring and powerful for all of us present.
Every Monday morning, I have the pleasure of welcoming new employees of BIDMC at an orientation session we hold for them. Later, there is a section in the program when we ask the new employees to think about a time they may have gone to a hospital for themselves or accompanied a loved one. In thinking about the experience, we then ask them to evaluate whether it was positive (and what made it so) or did not go well and what could have improved it.
Here's a note from the group leader, Lynda, about what happened this week:
Depending on the audience, some weeks we get all kinds of responses and then sometimes people are more reticent. This week, the audience was a bit quiet so I piped in with my own experience of having just gone through significant experiences of my own and how the kindness that I received from staff made a difference in my healing. I asked the group if anyone could “top that”.
A woman in the audience raised her hand and proceeded to tell all of us about the time, 4 years ago, when her father who was a patient here, was dying. She choked back tears as she told about her family all being there and the staff making sure everyone had a place to sleep and food to eat around the clock and whatever else they needed. They were apparently there for a number of days but went through the experience together as a family, with their father, being totally supported by the staff.
Then she added that she decided she wanted to come and work here in order to be able to give others the kind of experience she had here and to work with these remarkable people.
All in all, tearful and inspiring and powerful for all of us present.
Thank you, PHC
Stephen Smith at the Boston Globe reports that the state Public Health Council voted to allow storefront clinics in Massachusetts. (I had written in support of this vote last week.) CVS, the original proponent, apparently plans to open more than two dozen. Now, having gotten permission, CVS needs to carry this concept in a manner that will set a high standard and prove the wisdom of the PHC vote. I wish them well in introducing this innovation into the MA health care delivery system.
Wednesday, January 09, 2008
Don't let others define who you are
Each year, in cooperation with the Boston YMCA and in conjunction with the Martin Luther King, Jr. holiday, we present Black Achiever awards to members of our staff who have made significant contributions to the workplace and their community. We also invite a guest to offer a keynote address, and this year it was Rev. Dr. Michael E. Haynes, Senior Pastor Emeritus, at Roxbury's Twelfth Baptist Church. Rev. Haynes was a personal friend of Dr. King's, having met during the latter's training at Boston University. It was inspiring and enlightening to hear stories from that period.
Equalling inspiring, though, was the acceptance speech delivered by Dr. Yvonne Gomez-Carrion, an obstetrician in our hospital. I asked her for permission to post it here, and I include it in its totality.
---
Good afternoon! I am truly honored and humbled to be here today with all of you to celebrate the life of Dr. Martin Luther King, Jr. and to accept this Black Achiever award. I thank Dr. Ronald Marcus, my mentor and friend, for nominating me and for the committee for choosing me.
I have worked hard all of my life, and I have received so many, many blessings.
Yes, I have always loved being challenged. I love giving orders, and I love helping others work through difficult situations.
At age 8, I realized my calling: I wanted to be a doctor. So many individuals went out of their way to impress upon me how hard this path would be, and many told me that I would never make it as a physician, a healer.
I encountered so many negative people along my journey. The naysayers seemed to be everywhere, BUT those folks were trumped by my parents, many incredible mentors and dreamers like myself who inspired, promoted and assisted me at every opportunity .
I have been blessed to have friends who ARE encouraging, positive and like me, want to make a significant contribution to this world, to our community.
When I was told that I wasn't smart enough or that I couldn't go to the schools that I attended because my parents would not be able to pay, well I studied, received academic scholarships, and I sought out jobs that would give me insight into the medical world.
Growing up, I would get angry about the condition of my community in Brooklyn, NY, the lack stores with fresh and nutritious foods, the abundance of fast food and liquor stores, the lack of good medical and dental care and the many challenges to obtaining a good education.
The more angry I became, the harder I worked.
I never gave up: WITH HELP, I figured it out!
I appreciate that everyone needs to chart their own path. You need to figure out what you have passion for, what will bring you joy and satisfaction while giving back to your community.
I received countless valuable messages. These messages were pounded into my head by those who nurtured me.
They would say:
*Stick to your values.
*Don't let others define who you are.
*Surround yourself with positive people... My dad would always tell me, "Show me your friends and I will tell you who you are."
*Don't give up because things get rough.
*Have faith in yourself.
Life is full of disappointments and tragedies -- these provide the lessons that we must receive in order to grow.
I thank God for my family, friends, my amazing church community, my medical colleagues and my patients.
It is because of YOU that I stand here this afternoon!
Like Dr. Martin Luther King, Jr., I, too, dream and I challenge. Today, I challenge each and every one of you to:
*Seek out a child who is suffering from the ills of poverty, dangerous communities and substandard education.
*Seek out a child of color.
*Seek out a child with a learning difference.
*Seek out a child who feels that violence is the way.
REMEMBER, compassionate mentoring has the power to change and enrich another's life.
I AM A LIVING EXAMPLE OF THAT!
I will leave you with one of my favorite prayers, an "old healing prayer" from Central America:
Do all the good that you can
In all the ways that you can
By all the means that you can
To all the people that you can
In all the places that you can
For as long as ever YOU can
Thank you very much!!!
Equalling inspiring, though, was the acceptance speech delivered by Dr. Yvonne Gomez-Carrion, an obstetrician in our hospital. I asked her for permission to post it here, and I include it in its totality.
---
Good afternoon! I am truly honored and humbled to be here today with all of you to celebrate the life of Dr. Martin Luther King, Jr. and to accept this Black Achiever award. I thank Dr. Ronald Marcus, my mentor and friend, for nominating me and for the committee for choosing me.
I have worked hard all of my life, and I have received so many, many blessings.
Yes, I have always loved being challenged. I love giving orders, and I love helping others work through difficult situations.
At age 8, I realized my calling: I wanted to be a doctor. So many individuals went out of their way to impress upon me how hard this path would be, and many told me that I would never make it as a physician, a healer.
I encountered so many negative people along my journey. The naysayers seemed to be everywhere, BUT those folks were trumped by my parents, many incredible mentors and dreamers like myself who inspired, promoted and assisted me at every opportunity .
I have been blessed to have friends who ARE encouraging, positive and like me, want to make a significant contribution to this world, to our community.
When I was told that I wasn't smart enough or that I couldn't go to the schools that I attended because my parents would not be able to pay, well I studied, received academic scholarships, and I sought out jobs that would give me insight into the medical world.
Growing up, I would get angry about the condition of my community in Brooklyn, NY, the lack stores with fresh and nutritious foods, the abundance of fast food and liquor stores, the lack of good medical and dental care and the many challenges to obtaining a good education.
The more angry I became, the harder I worked.
I never gave up: WITH HELP, I figured it out!
I appreciate that everyone needs to chart their own path. You need to figure out what you have passion for, what will bring you joy and satisfaction while giving back to your community.
I received countless valuable messages. These messages were pounded into my head by those who nurtured me.
They would say:
*Stick to your values.
*Don't let others define who you are.
*Surround yourself with positive people... My dad would always tell me, "Show me your friends and I will tell you who you are."
*Don't give up because things get rough.
*Have faith in yourself.
Life is full of disappointments and tragedies -- these provide the lessons that we must receive in order to grow.
I thank God for my family, friends, my amazing church community, my medical colleagues and my patients.
It is because of YOU that I stand here this afternoon!
Like Dr. Martin Luther King, Jr., I, too, dream and I challenge. Today, I challenge each and every one of you to:
*Seek out a child who is suffering from the ills of poverty, dangerous communities and substandard education.
*Seek out a child of color.
*Seek out a child with a learning difference.
*Seek out a child who feels that violence is the way.
REMEMBER, compassionate mentoring has the power to change and enrich another's life.
I AM A LIVING EXAMPLE OF THAT!
I will leave you with one of my favorite prayers, an "old healing prayer" from Central America:
Do all the good that you can
In all the ways that you can
By all the means that you can
To all the people that you can
In all the places that you can
For as long as ever YOU can
Thank you very much!!!
Elections everywhere!
Many thanks to the folks at Medgadget for including me as a finalist in two categories of their 2007 Medical Weblogs Awards. I am ambivalent about the voting, as I am blogosphere "friends" with some of the competitors in both categories, and I have great respect for all of them.That being said, I would be honored to have your vote in this election, if you think this blog is worthy.
Federal campaign laws apply to this contest. No cash contributions above the legal limits, please. And, I do not accept contributions from tobacco companies . . . .
Tuesday, January 08, 2008
Pay it forward
Of all the great things that happen at BIDMC, the most satisfying to me is when we are able to help people realize their dreams and rise through the ranks of the health care and research fields.
Tonight, we held a graduation dinner for the first group of surgery tech's, ED tech's, and others who have completed their nursing degrees and will now be working in the hospital as RNs. Over two years ago, we chose employees to be sponsored in this program through a competitive process that took into account educational attainment to date, college placement test scores, and job performance. We paid for the tuition and books and fees at Mass Bay Community College, but these young folks put in the sweat equity, working after hours and on weekends. They were joined at the congratulatory dinner tonight by their friends and families, college officials, as well as their supervisors and mentors at the hospital. The special guest speaker was the Chair of our Board of Directors, Lois Silverman, who herself was the beneficiary of a similar program decades ago, when she received a $300 scholarship to attend the Beth Israel School of Nursing.
This is but one of several program that we have in place to provide career and professional advancement to people in the hospital, especially lower wage workers. These are funded out of our regular operating budget, from philanthropic donations, by a grant from The Boston Foundation, and by a grant from the Commonwealth of Massachusetts.
Another program is one that enables people to become surg tech's. Here, we partnered with Mass Bay to offer modified academic programs in a format that allows employees to continue to work full-time while pursuing their career-advancing education. Courses are offered at the hospital in the evenings or online, with labs taking place on weekends at college and clinical rotations on site. We provide funds to cover students' tuition and also a stipend to help them meet living expenses during the second half of the program, when their 24 hours of weekly clinical practicum require that they reduce their regular work hours.
Still another program is training people to be research administrators, a growing area in the world of academic medicine. Another we are kicking off will train people to be medical lab tech's, a tremendous growth field, as well. Yet another provides more elementary training in math and English to help people get to the level that they can participate in more advanced training.
It is, of course, greatly satisfying that people will earn more money as they move up the career ladder and have more opportunities. But what means more to me is that we are continuing in a tradition that reinforces the American Dream. Through hard work, persistence, dedication -- and a helping hand -- men and women can gain greater personal and professional satisfaction in their work and and, in turn, look back to help the next group coming through.
Tonight, we held a graduation dinner for the first group of surgery tech's, ED tech's, and others who have completed their nursing degrees and will now be working in the hospital as RNs. Over two years ago, we chose employees to be sponsored in this program through a competitive process that took into account educational attainment to date, college placement test scores, and job performance. We paid for the tuition and books and fees at Mass Bay Community College, but these young folks put in the sweat equity, working after hours and on weekends. They were joined at the congratulatory dinner tonight by their friends and families, college officials, as well as their supervisors and mentors at the hospital. The special guest speaker was the Chair of our Board of Directors, Lois Silverman, who herself was the beneficiary of a similar program decades ago, when she received a $300 scholarship to attend the Beth Israel School of Nursing.
This is but one of several program that we have in place to provide career and professional advancement to people in the hospital, especially lower wage workers. These are funded out of our regular operating budget, from philanthropic donations, by a grant from The Boston Foundation, and by a grant from the Commonwealth of Massachusetts.
Another program is one that enables people to become surg tech's. Here, we partnered with Mass Bay to offer modified academic programs in a format that allows employees to continue to work full-time while pursuing their career-advancing education. Courses are offered at the hospital in the evenings or online, with labs taking place on weekends at college and clinical rotations on site. We provide funds to cover students' tuition and also a stipend to help them meet living expenses during the second half of the program, when their 24 hours of weekly clinical practicum require that they reduce their regular work hours.
Still another program is training people to be research administrators, a growing area in the world of academic medicine. Another we are kicking off will train people to be medical lab tech's, a tremendous growth field, as well. Yet another provides more elementary training in math and English to help people get to the level that they can participate in more advanced training.
It is, of course, greatly satisfying that people will earn more money as they move up the career ladder and have more opportunities. But what means more to me is that we are continuing in a tradition that reinforces the American Dream. Through hard work, persistence, dedication -- and a helping hand -- men and women can gain greater personal and professional satisfaction in their work and and, in turn, look back to help the next group coming through.
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