November 2017

Thoughtfulness and generosity are hallmarks of our Brigham community, and in this holiday season I want to highlight some of the many ways you give back – from one-on-one interactions to helping whole communities. At the individual level, there’s this month's touching story about one colleague’s commitment to showing patients to their destination around the Brigham. At the other end of the spectrum, staff from many of our clinical and administrative departments are collaborating to fulfill our vision for a healthier world by improving cancer care in China.

Your generosity comes in many forms, from Thanksgiving gift baskets thoughtfully put together by our Southern Jamaica Plain Health Center staff, to the Leiden family's gift to advance translational medicine. I am honored to be part of this exceptional community of givers. Thank you for your deep commitment to improving the lives of others.

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About Dr. Betsy Nabel
The Brigham Way
Areas of Strategic Focus
Letters from Patients and Families
Town Meeting

 

 

 

Strategy Skim: Collaborating to Bring Brigham-Quality Care to China

 

 

The Chinese government is implementing a major health care reform plan. Since 2015, Brigham Health has been providing strategic guidance to Evergrande Health, a major entity involved in the reform, as it builds a nationwide health care system. One of Evergrande's significant undertakings is the construction of its flagship facility, Boao Evergrande International Hospital in affiliation with Brigham and Women’s Hospital, which is scheduled to open in 2018. The hospital will provide world-class cancer care, with an initial focus on breast cancer. Through the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC), Brigham Health and Dana-Farber Cancer Institute have partnered to ensure patients at this new facility have access to leading-edge, lifesaving therapies.

Multidisciplinary Model
Over the past two years, the Brigham Health Business Development team has worked closely with Evergrande to advance the shared objective of providing superb care for cancer patients. In China, using a multidisciplinary, team-based model of care – an approach that will optimize outcomes and patient satisfaction – is fairly new.

Brigham Health is advising Evergrande in five major areas: hospital planning, hospital management, quality, clinical operations and technology. Information technology groups in Boston and Boao are currently establishing connectivity between the new hospital and DF/BWCC to facilitate telepathology, teleradiology and engagement with our radiation oncologists. Patient referrals to Boston will be made when needed.

A Group Effort
Members of 16 Brigham clinical and administrative departments have lent their expertise. Leadership from our Facilities and Operations group and division chiefs of several departments from both the Brigham and Dana-Farber have traveled to China in support of this effort. They will provide in-person training and opportunities for observation at BWH and in Boao as the opening of the hospital approaches.

The Brigham receives numerous inquiries from domestic and international institutions interested in partnering with us. Establishing new sources of revenue is part of our strategy, and our relationship with Evergrande Health is an example of where mission and margin objectives intersect in an exciting new way.

 

 

 

Focus on Financials: Planning for Our Bright Future

 

 

In times of uncertainty – like those the health care industry has experienced in recent years – one of our most effective tools is careful financial planning. That is why we have changed how we think about planning, with a greater focus on adopting a long-term view that has us forecasting outcomes for the next fiscal year, even though we’ve just begun the current one.

By keeping a watchful eye on both today and tomorrow, we’re able to strengthen our financial foundation while planning for unforeseen events. Part of how we’re doing this is by establishing more robust, ongoing communication about planning throughout the year. In the past, we have often developed our budgets without extensive coordination. Now, department leaders are meeting on a quarterly basis to identify needs and constraints.

At a broader level, the hard work so many of you have done during this time of great transition – resulting from the Voluntary Retirement Opportunity (VRO), workflow redesign and Partners 2.0 initiatives – has been transformative. I am immensely grateful for your commitment to ensuring we have the resources needed to continue to fulfill our precious mission.

This brings us to FY18, which has a budgeted margin target of $185 million, or 4.6 percent of our total revenue. Thanks to the significant efforts of so many of you, this fiscal year began on a positive note in accordance with this plan.

October income from operations was $23.8 million, $7.1 million above budget. Both revenue and expenses were favorable to budget for the month, generating an operating margin that exceeded plan. In fact, October was the first month in almost three years in which BWH, BWFH and the BWPO all exceeded margin and did better than budget on expenses. Please take a moment to review the statistics below that we use to measure our financial health.

  • Net patient service revenue at BWH was favorable to budget by $4.2 million.
     
  • While inpatient discharges were lower than planned (Surgery and NICU), this was partially offset by a favorable payment rate (i.e., higher net revenue per case) and the in-house adjustment due to a high end-of-month census. Outpatient revenue was on plan for the month. Reserves and settlements were also favorable, as Accounts Receivable reserves were adjusted to reflect better collection expectations for denied claims and bad debt.
     
  • BWH expenses were favorable to budget by $0.9 million for the month. Salaries were below budget by $1.1 million for the month. Recruitment for vacancies related to VRO-related replacement positions is ongoing, with additional overtime and temp expenses being used in the short term. Benefits were favorable due to retirement and health (medical and drug) costs. This was offset by pharmaceutical usage and timing of other expense payments.

 

 

 

 

The Brigham Way: Looking for Opportunities to Help Someone in Need

 

 

Walking down the Pike recently, Kelly Fanning, executive director of Population Health Management and Care Innovation for the Brigham and Women’s Physicians Organization, passed by a patient who was being escorted to their appointment by Karim Brown of Engineering.

Kelly could see how deeply the patient appreciated Karim’s kind gesture.

After Karim walked the patient to the location of their appointment, Kelly stopped to thank him for taking the time to personally ensure the patient got to their destination.
Karim responded by saying that patients always come first, and he’d rather be late if it meant he could help a patient find their way.

Kelly was both impressed by Karim’s actions and touched to hear how he strives to make sure patients are always the top priority.

Not wanting Karim’s actions to go unnoticed, Kelly sent a note to Karim’s supervisors later that day, letting them know what she had witnessed.

“Karim brightened my day – and clearly the day of this patient,” she wrote.

Karim and Kelly embody The Brigham Way. They each gave their time, in their own ways, to help others.

If you see someone going above and beyond to help a patient, visitor or colleague, please email TheBrighamWay@partners.org so that we can recognize our staff and learn from their example.

 

 

 

Inclusion Imperative: Vision for the Future

 

 

What do we want the future of diversity and inclusion to look like at Brigham Health? This month, staff and faculty from across our organization came together to answer this question during a visioning session – a technique in which a group of stakeholders appraise where they are now and where they want to be in the future.
 
This exercise was the first step in a broad assessment process that will help us better understand the current state of diversity and inclusion, inform our strategy and help us establish priorities and guide future activities so that we can provide an exceptional experience for all.
 
In the coming months, a cross section of our Brigham community – staff, faculty, leadership, trustees, community partners and patients – will participate in conversations and focus groups that will help us identify opportunities to improve.
 
Each one of you will have a chance to participate in the assessment via a survey that will take place early next year, and key findings and future directions will be shared later in the spring. As always, you are encouraged to contact Sabrina Williams, MBA, chief diversity and inclusion officer, to share your thoughts or suggestions.
 
Our ability to transform the future of health care through science, education and compassionate care locally and globally is dependent on all of us at Brigham Health to exemplify our values every day. By advancing diversity, inclusion and cultural competence, we’ll be better positioned to continue delivering on our mission. Thank you for helping support and move this important work forward. 

 

 

 

Safety Matters: Learning from Our Frontline Staff on Executive WalkRounds

 

 

It’s no secret that the best ideas often come from our frontline staff, and our Safety Matters: Executive WalkRounds provide opportunities for our employees to share safety concerns and ideas for improvement directly with hospital leadership and the Patient Safety team.

I have had the privilege of participating in these multidisciplinary rounds many times, and the feedback we receive is invaluable and actionable. Between 2016 and 2017, we acted on almost 250 improvements as a direct result of these rounds.

Success stories include the installation of a door-opening button in an ambulatory clinic and computer monitor privacy screens. We also standardized documentation by Anticoagulation Management Services, improved communication for urgent patient-specific medications in the Surgical ICU, optimized medication inventories in automated dispensing machines, improved specimen handling practices and clarified infection control protocols.

While most of the improvements we make are in areas or functions related to patient care, finding opportunities to improve the safety of our staff is just as important. One such change we made as a direct result of Safety Matters: Executive WalkRounds was providing long-sleeved chef jackets for Food Services staff to wear while working over hot pans to prevent skin burns.

Our goal is to conduct an average of 24 Safety Matters: Executive WalkRounds annually, split evenly between inpatient and ambulatory settings. The rounding team consists of a rotating executive leader, a patient safety leader and a local area leader, along with representatives from risk management, nursing, pharmacy and facilities. As the team walks through the area, they visit with staff, patients and families within the course of normal daily workflow, engaging them in candid conversations about quality and safety. 

Executive WalkRounds reinforce safety as a priority at the Brigham, allow for real-time feedback, increase awareness around safety issues and prioritize improvement efforts. Built on transparency, these rounds have led to creative troubleshooting by establishing a direct line of communication about quality and safety across the continuum of care. It is a testament to our Just Culture, encouraging staff and patients to speak up about safety concerns and fostering an environment where we feel comfortable talking about how we can do better. 

 

 

 

Breakthrough Briefing: A Transformative Gift for Translational Medicine

 

 

At this time of year, we often pause to think about how acts of generosity can change lives. One physician-scientist who has given back to our Brigham community in so many ways is Jeff Leiden, MD, PhD, chairman, president and CEO of Vertex Pharmaceuticals.

Dr. Leiden has a long and deep connection with the Brigham’s mission, having completed his residency and training here and now serving on our Board of Trustees and as chair of our Scientific Advisory Board. Dr. Leiden has never forgotten his Brigham training and the importance of his time here, and he credits the Brigham for helping shape the physician and scientist he has become.

Last month, Dr. Leiden and his wife, Lisa, donated $4 million to establish an endowed professorship in Translational Medicine at BWH and Harvard Medical School. The Leiden family’s gift will support research and teaching activities in the field of translational medicine, reflecting the importance of not only making transformative discoveries but also training the next generation of physicians and scientists. A gift like this one can have a ripple effect in our community, prompting new research with the potential to advance patient care.

I want to extend my sincere thanks to the Leidens and all the members of our Brigham community who contribute so much in so many ways in support of our mission. 

 

 

 

News of Note: Digital Pills and the Fight Against Opioid Addiction

 

 

New research from Brigham and Women’s investigators was in the spotlight last week when Peter Chai, MD, MMS, Edward W. Boyer, MD, PhD, and their colleagues published a paper in the journal Anesthesia & Analgesia on a pilot study that used digital pills to monitor opioid use after acute injury. Their work was featured on CNBC this week, on segments that ran on the Morning Report and the Nightly Business Report.

“We were able to identify that patients don’t need nearly as many opioids as doctors think they do,” Dr. Boyer tells CNBC reporter Meg Tirrell.

Early last week, the first digital pill was approved for use with the antipsychotic drug Abilify, which is used to treat schizophrenia, bipolar disorder and depression. In addition to medication, each digital pill includes a radiofrequency emitter that is powered by stomach acid after its capsule dissolves. The emitter transmits ingestion events, giving information on how often and how much of a drug a patient is consuming.

To conduct their pilot study, BWH investigators approached patients in the Emergency Department who had been diagnosed with an acute fracture and prescribed oxycodone to manage their pain. Participants were followed for seven days, at which time they returned any unused pills. The team found that, on average, patients ingested only six pills, despite being prescribed 21.

Opioids are frequently prescribed on an as-needed basis for patients suffering from acute conditions – such as the fractures that Drs. Chai and Boyer followed up on in their work – but uncertainty exists around how patients take the drug. Given the magnitude of the opioid epidemic, we need innovative and scalable ideas to help physicians and patients work together to manage and monitor care. The work by Drs. Chai and Boyer and their colleagues takes a first but important step toward using a new and exciting technology to do precisely that. 

 

 

 

Mission Moment: Community Health Center Donates Thanksgiving Meals to Patients

 

 

“If I can help make at least one family happy on Thanksgiving, then I’m happy. That serves my purpose in life.”

These touching words were shared by Marisol Lara, operations manager at Southern Jamaica Plain Health Center, earlier this month.

For the last nine years, Marisol, along with her colleagues at the community health center, have been assembling Thanksgiving meal bags for patients and their families in need.

During the first few years, the health center donated turkeys to patients, but the project has since expanded into something even more wonderful. Now, patients receive a bag full of items for a complete Thanksgiving meal, including a turkey, gravy, vegetables, stuffing, cranberry sauce and more. The community health center personalizes the bags by also including foods that reflect the cultural diversity of the community it serves.

The tradition continues each year thanks to the generous support of staff. In the weeks leading up to Thanksgiving, staff donate nonperishable food items and make monetary donations, which help to purchase the turkeys and all the fixings.

This year, Marisol and her team donated 28 Thanksgiving bags to patients – a new record for the community health center.

This project began almost a decade ago when Marisol and her colleagues saw a need to help patients in this way. The recession was beginning to impact patients and their families, and SJPHC was seeing many more who were struggling to make ends meet.

“We heard from some patients that they wouldn’t be having Thanksgiving because they couldn’t afford it,” Marisol said. “That was heartbreaking.”

Gonzalo Graupera, MD, an internist in Adult Medicine at SJPHC, has worked with Marisol on the Thanksgiving project for several years. He said the project is just one of the many ways the health center focuses on the wholeness of a patient.

“We’re serving families who are facing all different struggles,” said Dr. Graupera. “We’re serving families led by single mothers and families that are dealing with a new cancer diagnosis or disability. Some of our families aren’t able to celebrate the holidays. We believe performing an act of kindness, one person at a time, one family at a time, makes a difference.”

Thanksgiving is meant to be a joyful celebration: a day to come together and spend time with family and friends while enjoying a delicious meal. I am deeply proud of Marisol, Dr. Graupera and the whole team at Southern Jamaica Plain Health Center for helping to make this holiday brighter for many of our patients and their families.
 

Marisol, Dr. Graupera and the staff at SJPHC were featured in a story about their Thanksgiving project in a segment that recently aired on WCVB-TV.

 

 

 

If you have questions, comments or news to share, don’t hesitate to email me at AskDrNabel@partners.org.

 

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