Joanne's Journal - Thursday, October 19, 2017
Over the past four years, with the addition of Alice Peck Day Memorial Hospital, Cheshire Medical Center, New London Hospital, Mt. Ascutney Hospital and Health Center and the Visiting Nurse and Hospice for Vermont and New Hampshire, Dartmouth-Hitchcock (D-H) is quietly growing as a health system of significance in New England. Together with Dartmouth-Hitchcock Medical Center and our large community group practices in Manchester, Concord, Nashua, Keene and D-H Putnam in Bennington, VT, the number of covered lives in the regions we serve is steadily increasing. Our team has been effectively integrating many of our services across all of these sites, including but not limited to human resources, pharmacy, credentialing, supply chain, compliance, quality and our information systems.
Why do we want to grow? The most important reason is that expanding our network offers a better opportunity to coordinate care for our patients in the right place, at the right time. We can better allocate resources to meet the needs of our populations, achieve a broader scale that will lower costs, and enhance our ability to succeed under new payment models.
Now is the time for us to shift from each organization having a relationship to the medical center in Lebanon to setting up a system infrastructure into which the individual business units (another way to describe members of our health system) will report. This means you may see many of the same faces in leadership, but with clear system areas of responsibility.
We will begin by working with the southern New Hampshire Community Group Practices to become, essentially, a separate “business unit” from D-H Lebanon. They work in a more competitive environment with different pressures and constraints. More than 70 percent of their covered lives are in risk contracts. Each clinic is generally an office-based practice with relationships with local acute-care facilities.
Restructuring how we work provides many enhancements for each business unit … and as a system leadership team, we will decide what we need to be “tight” on (i.e. totally aligned) and what we can be “loose” on (i.e. business unit autonomy). For example, we need to be tight on quality and safety, standards of care, where we grow specialty services via service lines, how we hire and integrate new specialists, and how we provide patient-centered care in various settings. An example of providing more autonomy is how our health system members might want to grow primary care and redesign the practice operations to achieve those goals. We will be tight on principles of compensation and budgeting, but afford greater freedom for those leaders who are accountable and responsible for that business unit’s performance. The enhancements will align authority and accountability for overall performance with much more clarity with the business unit leadership.
This is my third health system … and there are many lessons that I’ve learned from both my experience and a growing amount of literature that tracks heath system development. The focus needs to be getting better not just bigger. We will make decisions together at a system level, standardizing what makes sense. We will be explicit about how and where decision-making occurs. We also will leverage our physical plant at each location. Within certain geographies, we can safely and effectively transition care of patients to create bed capacity and place people in the right location according to their care needs.
We have a lot of work to do, but we have an incredible team across the health system. We have many wonderful resources in the clinical enterprise, as well as with Geisel and The Dartmouth Institute for Health Policy & Clinical Practice (TDI). We also hope to better leverage the intellectual horsepower at Dartmouth College, including the Tuck School of Business and Thayer School of Engineering. The most important resource is, of course, our people. I look forward to working with all of you to continue building this leading integrated health system in New England.
Spirit of Giving: Donations Needed for Puerto Rico Aid
As news reports show Puerto Rico residents still struggling in the aftermath of Hurricane Maria, Dartmouth-Hitchcock (D-H) is offering several opportunities for staff, patients and the community to offer support.
On Wednesday, November 1, and Thursday, November 2, at the times below, D-H staff in Lebanon can drop-off paper goods, canned food and other non-perishable food (see guidelines below) at a table display in front of the gift shop in the main corridor.
- Nov. 1: 7 to 9 am, 11 to 1 pm and 4 to 6 pm
- Nov. 2: 7 to 9 am, 11 to 1 pm and 4 to 6 pm
Donations also will be coordinated in the Community Group Practice locations. More details of those drop-off locations are forthcoming.
The goal is to be able to send these donations to Puerto Rico in time for Thanksgiving, according to Maria Padin, MD, chief medical officer at DHMC, who is spearheading this effort. “We are working closely with our contacts who are on the ground in Puerto Rico and with contacts in New Hampshire to arrange transportation so we can send food and supplies directly to locations on the island that need the most help.”
In addition, if D-H staff would like to make monetary donations, the following organizations and grass-root groups are recommended because of direct connections to hospitals and underserved populations on the island. These organizations and groups have been vetted by Padin and other D-H clinicians who have family and professional ties to Puerto Rico.
- American Hospital Association’s Care Fund
- Physician group from New York
- Doctoras Boricuas – physician group based in Miami, FL
- Finca Conciencia – a grass-roots health and environment organization
Types of Donations Needed for Puerto Rico Aid
- Toothpaste, toothbrushes
- Diapers (adult and baby/child)
- Toilet paper
- Canned meats (ex. Corned beef, Vienna sausages)
- Canned juices
- Can openers
- Non-refrigerated dairy products (ex. Powdered milk)
Something for Everyone in the Fight against Cancer
On Wednesday, October 4, specialists and trainees in all aspects of cancer research and clinical care from Dartmouth-Hitchcock's Norris Cotton Cancer Center (NCCC), as well as from the Geisel School of Medicine, Thayer School of Engineering and many Arts and Humanities and Sciences programs at Dartmouth College, came together at Alumni Hall for a special event. The gathering not only warmly welcomed incoming director of NCCC, Steven Leach, MD, but also demonstrated the importance of interdisciplinary collaboration toward a common goal of mobilizing in the fight against cancer.
As Phil Hanlon, president of Dartmouth College, described in his opening remarks, “A lot of the world’s great challenges are not adressed by a lone scholar or within a single discipline, and instead will demand teams that work across disciplines and generations; have the ability to blur lines between basic research, applied research and practice; and have a willingness to forge creative partnerships with external entities to draw together around a common interest. Between the Norris Cotton Cancer Center, Dartmouth College and Dartmouth-Hitchcock, there is simply no better environment for scientists, scholars and clinicians to collaborate and produce their best work. What this gathering is about this afternoon is inviting each of you to imagine yourself as part of the work of the Norris Cotton Cancer Center.”
Ready for the Next Patient, Not the Next Survey
The Joint Commission is an accreditation organization deemed by the Center for Medicaid and Medicare Services (CMS) to conduct unannounced surveys at health care organizations across the country to evaluate their compliance with national quality and safety standards. This year, The Joint Commission has made significant changes in the way the surveys are scored. The new method applies the SAFER (Survey Analysis for Evaluating Risk) matrix to evaluate the risk of causing harm to patients or staff when required standards are not followed.
Dartmouth-Hitchcock (D-H) leaders, clinicians and staff have been working to ensure we meet these patient safety standards. Meeting these standards is assessed during the triennial survey that could take place between now and mid-November. The Joint Commission granted D-H a one-month hiatus for our survey because of the Code Silver event that took place on September 12, so that we could focus on recovery and return to normal operations. However, the hiatus ended October 16. This survey applies to the entire D-H Lebanon campus, including the Heater Road and Lyme Road clinics, and the Norris Cotton Cancer Center sites in St. Johnsbury and Nashua. The Community Group Practices and the D-H affiliates are not included in this survey.
“The point of routinely adhering to national quality and safety standards is to always be ready for the next patient, regardless of whether the organization could be surveyed or not,” says Lori Key, RN, director of Quality Assurance at D-H. “This is an opportunity for our teams to showcase the great work they do every day to provide the highest quality of care to our patients.”
D-H Concord Participates in Making Strides
On Sunday, October 15, employees and their families from Dartmouth-Hitchcock’s Norris Cotton Cancer Center (NCCC) joined together to walk for breast cancer awareness and research at the American Cancer Society's 25th Annual Concord Making Strides Against Breast Cancer event. In honor of the 25th anniversary of this event, NCCC was a flagship sponsor.
Making Strides Against Breast Cancer are three-to-five-mile walks held across the country to raise awareness and funds to save lives from breast cancer. Funds raised help provide free information, support innovative research, and promote prevention and early detection.
Many thanks to the walkers on the NCCC and D-H Concord teams: “D-H and NCCC Making a Difference” and “Extraordinary Divas of Concord (D-H)” for their participation.
Karen Clements Receives Honor from Employer Support of the Guard and Reserve (ESGR)
The New Hampshire Employer Support of the Guard and Reserve (NH ESGR) presented Dartmouth-Hitchcock Medical Center (DHMC) Chief Nursing Officer Karen Clements RN, BSN, MSB, FACHE, with a certificate of appreciation on October 9 for her continued support of ESGR and all the Dartmouth-Hitchcock (D-H) employees who serve in the National Guard and Reserve. D-H CEO and President Dr. Joanne Conroy attended the ceremony at DHMC, along with NH ESGR’s former state chair David H. Quinn, current NH ESGR state chair Bruce Thompson, and NH ESGR area 4 chair Vincent Benincasa.
“Karen Clements has been instrumental in supporting the New Hampshire Employer Support for the Guard and Reserve, and provided the link between Dartmouth-Hitchcock and our state committee,” says Thompson. “Her assistance to our committee and helping us to recognize Dartmouth-Hitchcock supervisors who have been nominated by their employees is greatly appreciated. This certificate is a way to recognize Karen’s efforts and express our gratitude.”
“I am very proud to be recognized by the ESGR,” says Clements, a U.S. Army Nurse Corps veteran of Operation Desert Storm. “As an Army veteran myself, I believe strongly in service to our country. Supporting our fellow employees, who continue to serve each and every day, is our mission as leaders but, really, we are very proud of the men and women who serve each and every day.”
Clements joined D-H in 2013 and has been chief nursing officer since June 2016. She attained the rank of captain in the U.S. Army Nurse Corps, and has more than 20 years of experience in providing emergency care, strategic planning, operations and new program development in both tertiary and small specialty hospitals.
“I want to thank all of our employees and their families who continue to serve our country. Freedom comes at a cost, and we thank you,” Clements says.
ESGR is a Department of Defense program that seeks to foster a culture in which all employers support and value the employment and military service of members of the National Guard and Reserve in the United States. Established in 1972, ESGR promotes cooperation and understanding between Reserve Component Service members and their civilian employers, and assists in the resolution of conflicts arising from an employee's military commitment. The ESGR is supported by a network of more than 4,500 volunteers in 54 committees located across all 50 states, the District of Columbia, Guam-CNMI (Commonwealth of the Northern Mariana Islands), Puerto Rico and the U.S. Virgin Islands.