REPORT TO THE BOARD OF DIRECTORS – June 2016 | NYC Health + Hospitals

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REPORT TO THE BOARD OF DIRECTORS – June 2016

RAMANATHAN RAJU, MD
NYC HEALTH + HOSPITALS PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
June 30, 2016

Good afternoon. As is customary, I will highlight just a few items from my report to the board. The full version is available to all here and will be posted on our website.

NYC Health + Hospitals Appoints New Leadership at NYC Health + Hospitals/Bellevue

Last month NYC Health + Hospitals appointed William Hicks as Chief Executive Officer (CEO) and Michael Rawlings as Chief Operating Officer (COO) of NYC Health + Hospitals/Bellevue. These changes at Bellevue are another step in our system wide effort to develop a new generation of facility leaders focused on financial stability, growth, greater accountability, and above all, bringing excellence to patient experience.

In their previous positions at Bellevue, Bill Hicks and Michael Rawlings developed strong track records of improving protocols and services for the benefit of staff and patients. Both are highly respected by staff and community for their leadership during Superstorm Sandy and our system’s response to Ebola.

Mr. Hicks is a health care executive with more than 30 years of experience. He has been serving as acting CEO since February 2016 and served as the hospital’s COO since 2013. He understands the patient care perspective and the value of keeping it at the center of his decision-making process. As COO, Mr. Hicks played a lead role in developing the team and protocols that led to the successful treatment of New York’s first confirmed Ebola patient in 2014.

As the hospital’s Chief Operating Officer, Mr. Rawlings will be in charge of day-to-day management, bringing more than 20 years of experience in facilities management and health care. After the hospital was damaged during Hurricane Sandy in 2012, Mr. Rawlings was among those who led the hospital as it rebuilt its infrastructure and worked closely with the Federal Emergency Management Administration (FEMA) to identify and develop mitigation plans and strategies to protect the hospital from future storms. Mr. Rawlings joined NYC Health + Hospitals/Bellevue in 2009 and most recently served as Senior Associate Executive Director of Facilities Management.

We are confident that Bill Hicks and Michael Rawlings will supply the leadership necessary to meet the changing needs of Bellevue patients. We welcome them to their new roles.

JOINT COMMISSION VISIT TO METROPOLITAN

Earlier this month, Metropolitan hosted a successful four-day survey from The Joint Commission. The surveyor’s preliminary report is quite positive, complimenting Metropolitan staff on dedication to patients and families, a clear commitment to safety and quality care, and especially, teamwork. Surveyors mentioned the warm welcome they received on the units they visited. Almost all pointed out the spirit of camaraderie that staff share across departments. Congratulations to Anthony Rajkumar and everyone at Metropolitan on this effective and successful team effort.

HARLEM BEHAVIORAL HEALTH NAMI WALK

NYC Health + Hospitals Behavioral Health staff participated in the 2016 National Alliance on Mental Illness (NAMI) Walk in honor of National Mental Health Awareness Month. Program members and various staff totaling 35 individuals walked across the Brooklyn Bridge, earning $1,500.00.

LGBTQ PRIDE MARCH

Last Sunday I was delighted to join a contingent of several hundred NYC Health + Hospitals employees, friends and family members as we walked under our “We Are An Ally” banner at New York City’s annual Pride March. The event gave us a great opportunity to show solidarity with LGBTQ patients and staff, and a chance to highlight the array of specialized services we provide community members at our welcoming, non-judgmental locations across the five boroughs.
I couldn’t have been more pleased to see so many members of our Health + Hospitals family in attendance—as you can see from the brief slideshow.

NYC HEALTH + HOSPITALS’ EXTENDS SUPPORT FOR ORLANDO

We also brought a special banner to the Pride parade — on display here in the board room — thanking the Orlando Regional Medical Center trauma care team for their heroic efforts after the tragic mass shooting on June 12. Many of our staff signed the banner with messages of support and solidarity, and we invite board members to sign this afternoon. We will send the banner to ORMC next week along with a letter from our system and a token of appreciation and comfort —New York City bagels— for their staff.

Additionally we have posted individual group photos on social media of our ED teams with hand-held signs that say #OrlandoStrong, along with a message expressing our support of our counterparts at ORMC.

And The Fund for NYC Health + Hospitals (and its Guns Down, Life Up program) is in discussions with ORMC’s trauma care leadership to offer technical assistance and help Orlando establish Guns Down Life Up and Circle of Safety hospital-based violence-reduction initiatives.

BREAKTHROUGH UPDATE

Major Service Lines/Emergency Services update

In the five facilities where Breakthrough is deployed: NYC Health + Hospitals/Bellevue, NYC Health + Hospitals/Jacobi, NYC Health + Hospitals/Kings County, NYC Health + Hospitals/Metropolitan, and NYC Health + Hospitals/ Woodhull (NYC Health + Hospitals/Queens’ data is unavailable due to EPIC deployment), the average length of stay (LOS) has been decreasing and/or is below the target of a median LOS of 131 minutes for the past three months.

Major Service Lines/Behavioral Health update

At NYC Health + Hospitals/Kings County the total revenues for Adult, Child Adolescent and PHP services has increased by 16% since Breakthrough started multiple improvements to revenue capture. In addition, the number of bed days over 15 days per patient (15 days is point that Kings County Behavioral Health begins losing money) were reduced by 870 days. The total new revenues and cost savings during January-May, 2016 was $626,635.

Earlier this month Breakthrough sponsored an informative visit by Kim Barnas, author and former CEO of ThedaCare, to Kings County Adult Primary Care, Pediatrics, ED, Behavioral Health – Primary Care Clinic. All four areas are very engaged in efforts to become continuous improvement organizations.

Leaders, managers and front line staff at Kings County Behavioral Health demonstrated the level of engagement and pride they have in the work they do to continuously improve their processes. The challenges they confront daily, and their commitment to providing patients with quality care, is the subject of an article authored by a number of Kings County clinicians in the December 2015 issue of the Journal of Family Medicine. Congratulations to Susan Whitley, MD – Director of Chemical Dependency Services at Kings County, David Estes, MD – Attending Physician and Director of the Primary Care clinic at Kings County, Michele McKenzie – Breakthrough Office, Keyvon Salimi – Behavioral Health Department at Kings County, Bassem Barada – Quality Department at Kings County

Joseph Merlino, MD – Department of Psychiatry SUNY Downstate.

DSRIP UPDATE

There is a lot of positive activity occurring in our DSRIP effort, with ongoing clinical project implementation happening across the entire OneCity Health network. I just want to highlight one item today:

In an effort to put mental health and substance abuse prevention and early identification into 100 middle and high schools throughout New York City, OneCity Health, in conjunction with three other Performing Provider Systems, announced a Request for Information to identify a Behavioral Health Agency to help implement the project.

For palliative care integration into the PCMH, we are continuing to provide simple advance care planning at 12 NYC Health + Hospitals neighborhood health centers and acute care facilities. We plan to expand the project to four additional NYC Health + Hospitals facilities in July.

Forty of our community partners and NYC Health + Hospital facilities are continuing to engage patients with Patient Activation Measure (PAM®) surveys as part of Project 11. We are also beginning to develop a care management tool, as well as design operational processes to link uninsured New Yorkers and low- and non-utilizers of Medicaid to primary care and social services.

For our work with both palliative care and Project 11, we remain cautiously optimistic about meeting all commitments made to the Department of Health for the June 30 deadline, which is the end of the first quarter of DSRIP Demonstration Year Two.

For Care Transitions planning, which focuses upon hospital readmissions reduction by providing a supportive transition to the community for appropriate patients, Transition Managers are receiving patient referrals at two NYC Health + Hospitals facilities. In total, we have hired eight Transition Managers, and pilots will begin at two more facilities soon.

We plan to begin our first Health Home At-Risk pilot in July, in which the objective is to extend care management services equivalent to the New York State Health Home program. Planning for additional pilots continues at two NYC Health + Hospitals sites.

In order to begin the Integration of Primary Care and Behavioral Health Services, we recently concluded a survey of our primary care partners to better understand their current capabilities, resource needs and potential barriers. Implementation planning has begun at two NYC Health + Hospitals facilities.

ED Care Triage implementation planning continues at four NYC Health + Hospitals facilities, which begins the effort to connect patients with primary care from the Emergency Department.

Our asthma home-based self-management work also continues at both select NYC Health + Hospitals and community partner sites.

In September, we plan to submit to the NYS DOH a training roadmap to support the workforce of NYC Health + Hospitals and OneCity Health partner organizations in transformation. The roadmap reflects the hiring, training and potential redeployment requirements to meet estimated workforce needs in year 2020 and reflects the results of a baseline workforce survey (current state) and projections of workforce demand made through microsimulation modeling. In order to review and receive input on the document with as many stakeholders as possible, we moved our internal deadline from June 30th to September 30th without sacrifice of commitments made to DOH under the DSRIP program

To complete the survey, we formed a consortium with three other NYC Performing Provider Systems – those led by St. Barnabas, NYU/Lutheran and Maimonides – and contracted with consultant firm BDO in order to complete the analyses with reliable methodology on a short timeline. Our labor partners from NYC Health + Hospitals, SUNY Downstate and other partner organizations have been engaged in our efforts since inception.

THE FUND FOR NYC HEALTH + HOSPITALS UPDATE

2016 Guns Down, Life Up Assembly

On June 8, The Fund for NYC Health + Hospitals hosted the third annual Guns Down, Life Up™ Assembly, bringing together a packed house of violence-reduction activists, representatives from community-based organizations, advocates, survivors, and numerous stakeholders from across the city in a deep examination of violence as a public health issue. Almost 300 people representing 60 organizations participated in interactive sessions in a “world café” format, which tasked groups with working collaboratively to identify and prioritize root causes of violence in urban neighborhoods, and then to construct strategies to address the causes.

Of special note was the extensive participation of youth, many of whom came to the Assembly through their involvement with Guns Down, Life Up teams at NYC Health + Hospitals / Harlem, NYC Health + Hospitals / Kings County, or other related programs. Manhattan Borough President Gale Brewer opened the day by issuing a proclamation in observance of The Fund’s role in Gun Violence Awareness Month. The Borough President was followed by former NYC Health + Hospitals / Harlem Executive Director Dr. John Palmer who delivered a thought-provoking keynote presentation, drilling down to illuminate the realities of gun violence in NYC.

Other speakers included, NYC Health + Hospitals President and CEO Dr. Ram Raju, Cleveland City Councilman Zack Reed, who has adopted the Health + Hospitals violence reduction in his home city, Ivo Philpott, Executive Director of the Jackie Robinson Foundation, Dr. Aletha Maybank, Associate Commissioner, NYC DOHMH – Center for Health Equity, and Jackie Rowe-Adams, Executive Director of Harlem Mothers S.A.V.E., whose closing presentation drew sustained applause and support as she summoned feelings of loss and anger that follow the loss of children to violence. Adding a vivid punctuation to the day was a flash mob, along with musical performances by students who had been inspired by GDLU’s message.

According to The Fund’s Executive Director Joe Schick, the assembly was designed to create an opportunity for people who work to reduce violence to come together, network, step back, and reflect on gun violence and the importance of what they do. The interactive format offered a chance to build a discourse around their experiences and to deepen and align strategies that will push forward resolutions to bring down gun violence in our city. The mass shooting in Orlando just a few days after the assembly however, tragically reinforces the need to ensure that all communities are free from violence, and strengthening our resolve to end gun violence and its heartbreaking cost.

Art of Giving

The Art of Giving is a collaborative project between the United Federation of Teachers (UFT), Division of Elementary Schools, The Fund for Health and Hospitals and NYC Health + Hospitals sites. It was inspired by the late Sharon Coates, a UFT member and teacher at PS 156 in Brooklyn. During her hospitalization, Sharon said, “Seeing the children’s artwork on the walls lifted my spirits.” That first Art of Giving installation was at NYC Health + Hospitals / Carter in June 2015.

Now, The Fund looks to keep this idea alive and spread this concept throughout the enterprise. Thirteen students of PS 18 in the Bronx, under the direction of their art teacher, Zoila Cordova, created beautiful works of art. These kindergarteners’ framed artwork was generously donated to Lincoln as their Art of Giving community service project. The Fund wishes to express its appreciation to UFT’s Ina Babb-Henry for her support and guidance with this project.

Ruth’s Dream Exhibit at Bellevue

On Thursday, June 23 The Fund for NYC Health + Hospitals, NYC Health + Hospitals / Bellevue, and Duggal Visual Solutions, presented Ruth’s Dream, an exhibition of the monumental flower photography of artist Ruth Litoff.

Ms. Litoff was a patient of Bellevue’s behavioral health services, whose life was marked by brilliant creativity and frequent hospitalizations for mental health issues. Years after her tragic suicide, her sister discovered her journals and undertook to fulfill one of Ruth’s last wishes — to show a collection of her photos at Bellevue, where she felt strongly she had received the most compassionate and best care for her illness. The exhibit – an illuminated photographic field of flowers – both honors her wish and enables Bellevue to open an inspiring conversation about art, healing, and mental illness. This installation of the exhibit and the opening event, which drew more than 200 people, was filmed for a feature documentary about Ruth’s beautiful legacy. The exhibit will run through August 7.

PROGRAM OF THE MONTH CORRECTIONAL HEALTH SERVICES

A year ago the Mayor asked us to roll up our sleeves and take over responsibility for health care in the city’s correctional system. This was — and remains —- a difficult assignment, adding patients who are among the neediest and most vulnerable in New York City.

But I am proud to say that our team stepped up and is delivering. We are extending our mission by improving the quality of care not just for the people inside the city’s jails, but also for those returning to their communities.

Six months after the formal transfer of authority, and with the same resources, we have already set in motion comprehensive reforms in the way health care is delivered within the correctional system:

We are building a work force that is skilled, engaged, and absolutely committed to providing the best care for the 55,000 men and women who move through the jails each year.

We have improved our operations to:

  • Coordinate incident and complaint investigations
  • Provide prompt responses to all patient requests.
  • Set new standards for accountability, productivity and safety.
  • Establish a dedicated office for clinical quality improvement,
  • Integrate mental health and discharge planning staffs into a unified professional psychiatric social work service.

And we are committed to developing and pursuing innovations in the services we provide.

  • We’ve increased continuity of care by linking with MetroPlus, Gotham Health, Health Home, Bellevue, Home Health, and our post-acute facilities.
  • We have launched a telehealth program – the first ever in the Health + Hospitals system.
  • And last month we opened our CHS Assistance Center, a one-stop location near Rikers Island to connect our former patients and their families to services in the community.

Just this week one of our new CHS initiatives—this one concerning opioid overdose treatment— received great notice by New York 1’s Inside City Hall:

Please join me in commending our Correctional Health Services team for the necessary and vital work they are doing, and in welcoming members of the division who join us today:

  • Dr. Patsy Yang, Senior Vice President
  • Dr. Homer Venters, CMO
  • Patrick Alberts, Senior Director for Policy and Planning
  • Elizabeth Ward, Senior Director for Operations
  • Carlos Castellanos, Director of Operations
  • Levi Fishman, Associate Director of Public Affairs

PERSONS OF THE MONTH GEORGE STRACHAN PAUL ROBINSON

It is only fitting that this month that we honor two key employees of Correctional Health Services.

George Strachan started his career in 1985 as a corrections officer. He spent the next 19 years gaining expertise in helping inmates struggling with mental illness, HIV/AIDS, and many other health problems. His deep commitment to these patients eventually led him to a career in health services.

This year George was identified as the single best person to execute our intensive focus on patient and staff safety. As Correctional Health Services’ first ever Safety Officer he has almost singlehandedly taken on the daunting challenge of building our safety and workplace violence prevention program from the ground up.

George is responsible for safety assessments in each CHS facility, and for verifying that our partners at the Department of Correction have addressed deficiencies.

He has developed strong relationships with all four health unions and with the Correctional Officers Benevolent Association. George participates in union safety meetings and has been working to strengthen and integrate our workplace violence prevention program.

While the medical and mental health staff provide patients with a community standard of care, it is George’s critical work that allows clinic staff to have the same safety expectations you would find in any NYC Health + Hospitals facility.

Paul Robinson has been a champion for the rights of patients in the corrections system for 34 years, working in multiple jails across the city.

When the Department of Correction opened punitive segregation units in the late 1990’s, Paul helped ensure that those in solitary confinement had their medical needs met.

His reputation as a talented communicator and problem solver led to his current assignment as the Health Services Administrator in the George R. Vierno Center, one of the most challenging jails on Rikers Island.

Paul has longstanding relationships on the local level with the Board of Correction and with the National Commission on Correctional Health Care. He excels at anticipating issues, and at developing strategies to address problems that arise quickly. He is devoted to patients and staff, constantly going above and beyond to make sure everyone has what they need to deliver high quality care to the patients within his charge.

We are grateful for the commitment, effectiveness and dedication of George Strachan and Paul Robinson. Please join me in congratulating and welcoming them both, along with their families.

WE ALWAYS PUT PATIENTS FIRST