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

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REPORT TO THE BOARD OF DIRECTORS – May 2016

RAMANATHAN RAJU, MD
NYC HEALTH + HOSPITALS PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
May 26, 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.

There are a number of positive stories to report to you this month from different corners of our system, I’ll touch on some of these stories briefly before we recognize the program and persons of the month.

NYC HEALTH + HOSPITALS EARNS HONORS FOR QUALITY IN CARDIAC AND STROKE CARE

Last week 10 facilities in our system were recognized by the American Heart Association/American Stroke Association for improving the quality of care for patients suffering from cardiac diseases and stroke.

The awards were presented for meeting and exceeding standards established by “Get with the Guidelines” a national, hospital-based, quality improvement initiative. To earn this recognition, our hospitals achieved high rates of adherence to quality care standards for cardiac and stroke care set by the Guidelines program. Congratulations to the clinical teams at Bellevue, Elmhurst, Jacobi, Kings County, Coney Island, Metropolitan, Woodhull, North Central Bronx, Lincoln, and Harlem.

NEW ENGLAND JOURNAL OF MEDICINE/CATALYST ARTICLE ON COLLABORATIVE CARE FOR DEPRESSION IN NYC HEALTH + HOSPITALS

On May 24 we were delighted that four members of our team authored an article featured by the New England Journal of Medicine about our collaborative care for depression initiative. This initiative deploys a population-based, stepped-care approach in the primary care setting to treat depression or depression occurring with a chronic illness, and has demonstrated improved depression symptoms in more than half of our enrolled patients. It supports our belief that collaborative care is an essential model for reaching and treating patients with mental illness. Congratulations to the authors of the article, Jessica Black, MSW, MPH, Program Manager, Collaborative Care, NYC Health + Hospitals, Dave A. Chokshi, MD, MSC Assistant Vice President, Ambulatory Care Transformation, NYC Health + Hospitals Monica Gould, MPH, Data Analyst, NYC Health + Hospitals, and Jesse Singer, DO, MPH Senior Director, Ambulatory Care Operations, NYC Health + Hospitals.

MUSIC & MEMORY PROGRAM AT NYC HEALTH + HOSPITALS’ SKILLED NURSING FACILITY IMPROVES QUALITY OUTCOMES FOR RESIDENTS WITH DEMENTIA

Earlier this week we announced measurable improvements in quality outcomes stemming from NYC Health + Hospitals/Coler’s Music & Memory program, which was introduced and spearheaded by The Fund for NYC Health + Hospitals, and is improving the quality of life for residents with dementia.

From June 2014-June 2015:

  • The number of patients participating in Coler’s Music & Memory programs rose from 4%-78%
  • The percentage of residents requiring antipsychotic medications dropped from 30% to 18 % at Coler, a significant trend that is expected to continue
  • The number of patients involved in physical altercations dropped from 8 to 0 incidents
  • The number of falls dropped from 11 to 3

At the heart of Coler’s successful interventions is the Music & Memory program, which features personalized iPod soundtracks for individual residents.

We are very proud of our expert team of doctors, nurses and therapists at Coler for their innovative use of music to improve the quality of life of our most frail and elderly patients. When the music starts, lethargy becomes laughter, isolation becomes interaction and we can break through and make a special connection with our residents with dementia and Alzheimer’s.

The profound impact on patients and staff is captured in “Healing with Harmony: A Music & Memory Story,” the short film produced by The Fund for NYC Health + Hospitals that we viewed at our March Board meeting, and which recently won a “Communicator Award of Excellence” from the Academy of Interactive & Visual Arts.

NATIONAL RECOGNITION DAYS

Over the past month we were glad to honor several national recognitions for professionals working in our essential health care system:

NATIONAL NURSES WEEK

During National Nurses Week we honored our phenomenal nursing staff, who do a difficult job with skill, expertise, and grace under pressure on the frontline of care. And who are always committed to the highest standards of excellence. Every day our nurses touch the lives of thousands of New Yorkers who trust us with their health and the health of loved ones – sometimes with their very lives.

The theme of this year’s Nurses Week, Creating a Culture of Safety, reinforces two of our Guiding Principles: Keep Patients First and Keep Everyone Safe. Our nurses follow these principles no matter the situation, from the beginning of life to the end, in health care facilities and in the home. They are essential to providing the best quality of care and the best possible patient experience – which, in turn, are fundamental to realizing our 20/20 Vision and ultimately the ongoing success of our health care system.

NYC HEALTH + HOSPITALS HONORS SUPERIOR PHYSICIANS DURING ANNUAL “DOCTORS’ DAY” CELEBRATION

On Doctors’ Day we honored 23 physicians representing all five boroughs for excellence and their commitment to our patients.

Physicians from the health system’s hospitals, community health centers, and our MetroPlus Health Plan were recognized for leadership and commitment to providing the highest quality health care to New Yorkers. The physicians honored also represent NYC Health + Hospitals’ diverse workforce and ability to provide culturally responsive care with the knowledge and sensitivity required to care for all without exception.

ADMINISTRATIVE PROFESSIONALS DAY

At the end of April we also celebrated Administrative Professionals Day with a breakfast reception honoring those in our system who rarely get enough credit for the great support they offer our caregivers on the front lines and those of us in the back offices.

NATIONAL NURSING HOME WEEK

And finally, we observed National Nursing Home Week, and celebrated the staff and volunteers who provide care in our five skilled nursing facilities. These are more than just health care facilities – they are communities, and for many of our residents, they are home.

Our skilled nursing facilities have received the highest national ranking of four and five star ratings by the Centers for Medicare & Medicaid Services (CMS).

We also take pride in the fact that they are leaders in reducing the rate of falls among residents – 1.22 percent across our centers compared to the state average of 2.8 percent and the national average of 3.3 percent – and in consistently lowering the use of antipsychotic medications among our long-term care residents.

PROGRESS RE: WORKFORCE MANAGEMENT

I’d also like to bring to your attention the fact that since November, NYC Health + Hospital has reduced its total full time equivalents level by over 1,100. This reduction was accomplished strictly through attrition and reductions in temporary service lines and overtime. During this period, the attrition rate has been approximately 3.5%, leading to over 1,700 separations. The total separations were offset by the backfill of critical patient care positions in areas like the Emergency Room, Behavioral Health and Ambulatory Care.

Reduction details:
Health & Hospital Full & Part time Staff (562)
Hourly Employees (73)
Overtime (78)
Temporary Service (397)
Affiliate (23)

NEW YORK KICKS BUTTS ANTI-SMOKING CAMPAIGN

NYC Health + Hospitals is pleased to join forces with the American Cancer Society and other major organizations in support of the 2016 New York Kicks Butts Smoking cessation campaign—a weeklong effort to raise awareness about the benefits of quitting—and resources available for those ready to quit. New York Kicks Butts launches at a public event at NYC Health + Hospitals/ Gouverneur on Tuesday May 31.

We stand with New Yorkers who want to quit smoking. That is why we have active smoking cessation programs at each of our hospitals employing an array of approaches and techniques to help our patients quit, and to help them keep from starting again.

We screen patients for tobacco use annually in all of our primary care settings. And for patients who self-identify as smokers, we actively follow up with appropriate medical care, be it counseling, nicotine replacement, or referrals to other resources they may prefer, such as the New York State Smoker’s Quitline. And, our facilities have their own in-house quit smoking programs, with coordinators who serve as compassionate and informed resources for our patients.

LEADERSHIP APPOINTMENTS

Earlier this month NYC Health + Hospitals announced the appointment of two health care executives who will fill senior leadership positions at NYC Health + Hospitals/Coney Island, as part of our 20/20 Vision efforts to reach financial stability, growth and bring excellence to the patient experience. Anthony Rajkumar will serve as Chief Executive Officer (CEO) and Mei Kong, RN, will serve as Chief Operating Officer (COO) at Coney Island. Both Mr. Rajkumar and Ms. Kong will be highly visible leaders, accountable to patients, and committed to fully engaging the communities we serve. We welcome them both. They join a new leadership team of clinical and nursing professionals who were appointed over the past two months, including Chief Medical Officer Wehbeh Wehbeh, MD, MBA, FACP Chairman of Emergency Medicine Mark Kindschuh, MD, MBA, FACEP, Chief Nursing Officer Barbara Campfield, MSN, MS, EDU, BSN, and Associate Director of Nursing, Emergency Department, Janice Nini, RN, BS, MS, TNCC.

These appointments follow other high ranking leadership changes across our system designed to prioritize patient experience, as well as to motivate our workforce. These include; Steven Bussey, NYC Health + Hospitals Chief of Ambulatory Care, Sal Guido, Senior Vice President and Chief Information Officer, and Alina Moran, Acting Chief Executive Officer, NYC Health + Hospitals/Metropolitan.

While these new leaders each have unique professional expertise and come from diverse backgrounds, they all have one important thing in common: they share the commitment to build a strong, viable public health care system that will continue to provide essential, high quality, safe care and an exceptional patient experience to many future generations of New Yorkers.

MAYOR DE BLASIO ANNOUNCES ONE NEW YORK NYC HEALTH + HOSPITALS TRANSFORMATION PLAN

On April 26, Mayor Bill de Blasio unveiled One New York: Health Care for Our Neighborhoods, a comprehensive report outlining the City’s plan to address a growing financial shortfall forecasted, without intervention, to reach $1.8 billion by FY20. The plan will focus on four primary goals for the city hospital system’s success: stabilizing funding, expanding community-based health care, improving efficiency, and remodeling an outdated system.

The Comprehensive plan builds on efforts to restructure outdated care models and expand access to high-quality health care in high-needs communities. It focuses on improving health outcomes and financial stabilization of the public hospital system. As part of the Executive Budget, New York City will make an unprecedented investment in support of Health + Hospitals by adding $160 million in FY16, which grows to $180 million thereafter. This will bring the City’s total commitment to Health + Hospitals to nearly $2 billion in FY20. The City will also make a $100 million investment in critical, new infrastructure shifting from inpatient care to ambulatory care and outpatient services. This bold transformation plan includes $700 million of expense reductions, $1.1 billion of new revenue, and a commitment to increased advocacy by the city for fairer reimbursement from the state and federal governments for care provided to the uninsured and to low-income populations enrolled in Medicaid.

WOODHULL eCONSULT EXPANSION

In coordination with Central Office/ Office of Ambulatory Care, NYC Health + Hospitals/Woodhull recently expanded eConsult from gastroenterology (which has been using the system for years) to nephrology, cardiology and endocrinology.

eConsult is a process that occurs within Quadramed involving a provider sending an electronic request for a consultation by a particular specialty. The consulting service then reviews these consult requests on a daily basis using the entire medical record in Quadramed as needed and responds. This broadening of eConsult’s applicability supports our 20/20 Vision goals by expanding access to serve more patients as unnecessary visits and less efficient first visits are eliminated. It also helps anticipate and meet the needs of our patients by reducing the number of visits to diagnose and treat conditions. And, it engages staff and improves staff satisfaction because office visits are more efficient and less time is wasted ordering first-line tests and making wrong specialty referrals.

ELMHURST RECEIVES JOINT COMMISSION ADVANCED CERTIFICATION IN PALLIATIVE CARE

On April 11 the Joint Commission surveyed the Palliative Care program. The Palliative Care team successfully passed the survey to receive Advanced Certification in Palliative Care. The Elmhurst Palliative Care program is one of only a few programs in New York State with this designation.

JACOBI JOINT COMMISSION VISIT AND CRANIOFACIAL CARE ACCREDITATION

In May, NYC Health + Hospitals/Jacobi completed a successful 5-day survey visit from the Joint Commission (TJC) resulting in 7 direct and 12 indirect findings. During her summary, TJC team leader Rose Pierce said that in her consideration, Jacobi had earned a spot as one of the top five hospitals the team has surveyed so far, for the quality of patient care programs and systems.

Also this month, Jacobi’s Congenital Craniofacial Care Center received accreditation by the American Cleft Palate/Craniofacial Association (ACPA), the national organization that provides formal recognition of cleft/craniofacial teams. We are currently the only Health + Hospitals institution with this designation, the only accredited team in the Bronx, and one of only 9 such teams in New York State.

Under the direction of Eugene Sidoti, MD, the Jacobi Congenital Craniofacial Care Center is comprised of specialists from Plastic Surgery, Pediatrics, Dental, OMFS, Orthodontics, ENT, Neurosurgery, Audiology, Speech & Language, Genetics, Social Work, and Psychology/Psychiatry.

BREAKTHROUGH UPDATE

Ambulatory Care: At Kings County, a new model was tested in the Adult Med Clinic. For the time from having patient vital sign measured to discharge, the average time was reduced from 73.1 minutes to 50 minutes (32% reduction). At Morrisania Breakthrough has reduced the Patient Cycle Times from 79 minutes to 60 minutes during experiments when controlling just registration (24% reduction)

Emergency Services: At Jacobi, experiments to improve turnaround time for urgent patients’ radiology services has resulted in the median time for ‘provider order to read’ time decreasing from 103 minutes to 64 minutes (38% reduction).

Behavioral Health: Also at Kings County, target was to reduce excess inpatient bed days (anything over 15 day LOS) by 36%. From January to March excess bed days were reduced by a total of 8,723 (56% reduction). This increased the inpatient services’ capacity to accept additional patients (and reduced loss by total of $149,597).

DSRIP UPDATE

OneCity Health continues to progress with clinical project implementation across the entire OneCity Health network.

For Care Transitions planning, which focuses on hospital readmissions reduction by providing a supportive transition to the community for appropriate patients, Transition Managers are now receiving patient referrals at our first NYC Health + Hospitals facility. Eight Transition Managers have been hired, and will begin seeing patients at three more facilities soon.

We issued new schedules to 40 community partners for Project 11, reflecting implementation efforts through DSRIP Year Two (April 1, 2016 – March 31, 2017). For this time period, in addition to continuing Patient Activation Measure (PAM®) surveys, our hospital and community based partners will begin implementing and refining operational processes to link uninsured New Yorkers and low- and non-utilizers of Medicaid to primary care and social services.

We held two health care proxy trainings in April for palliative care integration into the PCMH. This continues our initial work to provide simple advance care planning at 12 NYC Health + Hospitals neighborhood health centers and acute care 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. Health Home At-Risk planning also continues at three NYC Health + Hospitals sites, in which the objective is to extend care management services equivalent to the New York State Health Home program.

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

To ensure we engage our clients and patients in a culturally and linguistically appropriate manner, we have initiated the process of selecting a vendor to conduct organizational assessments and identify strengths and areas of improvement as it pertains to cultural competency and health literacy across our Performing Provider System (PPS).

THE FUND FOR NYC HEALTH + HOSPITALS UPDATE

The Fund for NYC Health + Hospitals Collaborates with Starfish Foundation on Young Women’s Summits

The Fund for NYC Health + Hospitals has been collaborating with journalist and documentarian Soledad O’Brien and her Starfish Foundation since 2014. Led by O’Brien and Brad Raymond, Starfish awards scholarships to several young women every year and through its PowerHERful Summit gatherings, brings together young women from low income families, who are often the first in their families to go to college, and gives them an opportunity to explore different career options, receive guidance and advice, and interact with successful professionals.

Ms. O’Brien, whose featured work on CNN as a frontline reporter and whose long-form documentaries on race and social issues have earned her three Emmy awards and 2 Peabody awards, asked The Fund to create a health care panel for PowHERful-NYC to address the health concerns of adolescent women. Our expert panelists for the past two years –Monique Collier-Nickles, M.D. and Lillian Diaz, R.N. (both from NYC Health + Hospitals / Lincoln) and Elet Howe, Director of our Teen Health Initiative – led standing-room-only events and equally successful follow-up interactive online sessions.

This year, Starfish expanded PowHERful to seven cities across the country, and asked The Fund for NYC Health + Hospitals to help find local panelists and create the curriculum for the health panels at each summit. In early May, The Fund was able to connect with our colleagues in the University of Alabama at Birmingham (UAB) health system and organize a PowerHERful health panel for Birmingham’s young women.

Ashley Wagner, Assistant Director of The Fund, went to Birmingham to oversee the panel, which was moderated by Soledad O’Brien and which attracted more than 300 young women. Panelists included Dr. Stephanie Wallace, adolescent medicine physician; Dr. Heather Austin, adolescent psychologist; Dr. Lara Embry, psychologist for the Comprehensive Gender Clinic; and Dr. Trish Hawley, social worker, who expertly answered the young women’s questions about physical and mental health, healthy lifestyle choices, and local health resources.

The Fund for NYC Health + Hospitals Ecuador Relief

The Fund for NYC Health + Hospitals has historically led our system’s relief efforts when global environmental disasters occur. The Fund is coordinating our response to the recent earthquake in Ecuador, a nation that has significant representation in both our patient and staff populations. Since April 27, The Fund has collected more than $1,200 in staff donations, with additional amounts pledged. All funds collected will be distributed to Direct Relief, a health-related charity that is directly supporting the relief and recovery efforts on the ground in Ecuador. The Fund will ensure that all donations will be presented collectively from NYC Health + Hospitals and acknowledged individually.

PROGRAM OF THE MONTH NYC HEALTH + HOSPITALS/ CARTER VENTILATOR WEANING PROGRAM

This month we are highlighting a program that generates a special degree of pride for our system. Since opening in 2013, our Long Term Acute Care Hospital at NYC Health + Hospitals/Carter has successfully weaned 250 patients from their dependence on ventilators.

Is there anything more frightening to a patient, or their loved ones, than being hooked up to a machine, unable to communicate, in order to breathe?

Carter is giving these patients hope.

A study last year of nearly 6000 patients in 14 long term acute care hospitals nationwide, found only 49% of patients were weaned successfully. But at Carter, the rate of success is currently 61%.

Each year over 10,000 patients leave acute hospitals while still on ventilators and go to post-acute settings. But Carter’s team is doing phenomenal work to change this story, by bringing about positive outcomes for our patients, even those who have been on ventilators for a prolonged period of time, or who are struggling with multiple chronic diseases.

Carter is combining the strongest post-acute care expertise in New York City with a matching level of compassion and caring. Carter’s ventilator weaning team finds it hugely rewarding to know that hope exists for our patients to one day be free from the ventilator and breathe again under their own ability.

They have confidence in the quality of care they are providing. They have faith in the strength and resiliency of the patients they are helping. This combination drives the remarkable success of this program.

We also want to welcome a guest today, and a success story. Mr. Joel White, joins us.

He is a former New York City school teacher and principal, who was also a ventilator patient at Carter.

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Please join me in thanking Mr. White, and the Carter ventilator team for the great work they are doing.

PERSONS OF THE MONTH ALTHEA BUCKNER and JERRY WESLEY IV

Today we are delighted to celebrate the work of two great public servants working within the public hospital system. In a city where the news cycle is often dominated by sensational tabloid stories, here’s an antidote: Two members of our workforce who quietly and without fanfare do terrific work every day to improve the lives of our patients. They epitomize the compassion, generosity and civic mindedness that make ours the strongest public health system in this country.

Jerry Wesley IV is a Customer Service Advocate at NYC Health and Hospitals/Kings County. In April we were delighted when Jerry was selected as a recipient of the Mayor’s 2016 Excellence in Customer Service Award at a ceremony at the Surrogates Court.

A passion for compassionate customer care animates Jerry’s professional life. He came to work for NYC Health + Hospitals in 2000 as a Hospital police officer and is now a member of the Breakthrough team at Kings County.

During his 16 years with our system, Jerry designed a training program which helps employees to always offer a safe, pleasant, and respectful encounter to our patients, and an attitude of helpfulness and teamwork to colleagues. He values people and the voice of the customer, and responds in a timely manner to fulfill their expressed and unexpressed needs. His innovations have been adopted as best practices across the system.

We are gratified to have him as a longtime member of the Health + Hospitals family and as a 20/20 Visionary.

Althea Buckner has been the Director of Pharmacy at NYC Health and Hospitals / Gouverneur since 2008. Last month she was selected as a 2016 Alfred P. Sloan Award for Public Service winner. Only six New York City employees — from among the more than 300,000 city employees — are chosen for this exceptional honor.

Prior to her work at Gouverneur, Althea spent 27 years as a pharmacist at Metropolitan, where among her many achievements, she instituted a 24/7 Adverse Drug Reaction Hotline. Today, Althea is responsible for filling up to 200,000 prescriptions annually for Gouverneur’s ambulatory care pavilion and nursing facility. Under her leadership, Gouverneur now provides even more Prescription Assistance Programs (PAP) for anti-diabetic medicines, asthma inhalers and other crucial medicines that patients need on a daily basis.

Her complex and demanding job requires an ability to fuse clinical knowledge with great leadership skills. She is never frazzled, always caring, and knows how to share knowledge so that pharmacists, the medical staff, and the hospital’s leadership operate with complete confidence in her department.

We are delighted that the Mayor’s Office, the Alfred P. Sloan foundation, and the Fund for the City of New York recognize what we already knew, that Jerry Wesley IV and Althea Buckner are tremendous assets to our system. Please join me in congratulating them both.

WE ALWAYS PUT PATIENTS FIRST