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Joanne's Journal - Thursday, November 9, 2017

Joanne's Journal - Thursday, November 9, 2017

Dear Colleagues:

We have an identity as an organization that is influenced by geography, experiences and the communities we serve. Organizations are also shaped by the way they are defined by other groups. Who we are is defined by our core values that make us Dartmouth-Hitchcock.

I think it is important to revisit this topic as we refresh our statement of mission, vision and values and reflect on who we are and what we want to be for the communities we serve. We have a strong foundation that was created by many of you and the leaders who held this role before me. History matters. It defines an organization, as powerfully as mission, vision and values do. Below is an overview of why I and others who are engaged in this conversation believe becoming a health system is critical for our region. And I hope you keep reading – there is a link below to a summary of our rich history! (A thank you to Dr. Jon Wahrenberger for the source documents!)

Becoming a Health System

We are already a system. In 2009, leaders created the infrastructure to allow Dartmouth-Hitchcock to strategically partner with other health service providers in the region to achieve its mission of improving population health within our region, while avoiding costly and unnecessary duplication of services. Establishing a broader footprint (close to 2 million covered lives) will allow us to more effectively manage both the quality and the cost of keeping populations healthy. There is tremendous power in all of us working collaboratively.

Dartmouth-Hitchcock Health (D-HH) has and is synonymous with quality, value-based care, tradition, pride and passion for community health, as well as academic and research excellence. When D-HH was formed as the parent health system entity, its provider affiliates included Mary Hitchcock Memorial Hospital and the Dartmouth-Hitchcock Clinic, which includes community-based physician group practices in Concord, Keene, Manchester and Nashua. Since 2013, five new provider affiliates have been added to the D-HH system. These include: New London Hospital, Mt. Ascutney Hospital and Health Center, Cheshire Medical Center, Alice Peck Day Memorial Hospital, and the Visiting Nurse and Hospice of Vermont and New Hampshire.

The new system generates nearly $2 billion in revenues and is the largest private employer in the state of New Hampshire. As New Hampshire’s only academic medical system with the only Level 1 trauma center, the D-HH system is the largest provider of health care in the state and the second largest in Vermont. Twenty-four Dartmouth-Hitchcock clinics provide ambulatory services across New Hampshire and Vermont. We serve more than 30 percent of the population of Manchester, 25 percent of the population in Nashua and 20 percent of the population of Concord. We care for 40 percent of the citizens of Vermont.

D-HH has more than 12,000 permanent full- and part-time employees at locations in New Hampshire and Vermont. Dartmouth-Hitchcock Health includes:

  • More than 2,010 physicians, residents and fellows, and associate providers
  • More than 1,925 direct-care nurses
  • More than 1,774 allied health professionals

The New England Alliance for Health (NEAH) is a regional network of hospitals and health care organizations in New Hampshire and Vermont that share a common commitment to finding cost effective and innovative ways to meet the health care needs of each member’s community. The New England Alliance for Health replaced the Dartmouth-Hitchcock Alliance, which ceased to exist on December 31, 2008. NEAH, a nonprofit, limited liability corporation, is owned by Mary Hitchcock Memorial Hospital. This is our “sticky network” of hospitals that we do not own but we choose to collaborate with on ways to decrease costs and improve quality.

NEAH has a less complex governance process and streamlined operating principles while preserving the vital core services of the former Dartmouth-Hitchcock Alliance. The name change reflects an effort to be more inclusive for members throughout the region. This is a network of hospitals that serve broad rural regions of both New Hampshire and Vermont and that participate in NEAH through contractual arrangements; they are not “affiliate members” of the D-HH system from a governance perspective. Below is a map of the state that may help show the regional coverage of NEAH and our affiliates and clinics.

November 2017 D-H location map

We are beginning to think and act like a system, deciding as a system leadership team what we are going to be “tight” on and what we are going to be “loose” on. Again, when we talk about the “system,” we are talking about D-H and the affiliate members of our system—those entities that have a formal corporate affiliation with D-HH (Mary Hitchcock Memorial Hospital, Dartmouth-Hitchcock Clinic, New London Hospital, Mount Ascutney Hospital and Health Center, Cheshire Medical Center, Alice Peck Day Memorial Hospital, and Visiting Nurse and Hospice for Vermont and New Hampshire) and, therefore, have certain system requirements and also benefits of being part of a system.

We are structuring our leadership team to have broad system-based roles in finance, operations, clinical enterprise, human resources, shared services, strategy, legal, nursing, research and education. D-H and affiliates will function as separate business units from a system integration perspective, will report at the system level and will be part of these decisions, with the goal of ensuring that the support services we implement are those best designed to deliver significant value.

How will we know if we are successful? Over the past two decades, U.S. hospitals have undergone a continuous wave of consolidation, seeking to become more profitable through mergers, partnerships and other strategic alliances. Based on PricewaterhouseCoopers' (PWC) research experience from a 2016 paper, most transactions have failed to deliver the promised benefits of scale, leaving them burdened with unnecessarily high cost structures. Moreover, they have found that there is little or no correlation between a health care system’s cost structure and the quality of its care.

We need to be bigger to have a large enough population to have an impact, but we cannot ignore the fact that the real value is generated when we get better as a system. This means when we can be successful in lowering the cost structure across our system, while providing high-value support services to each affiliate, when we can consistently provide the right care in the right setting, and when we can implement the best practices that each affiliate has to share, such as quality and safety practices.

We will continue this conversation in the coming months, and, as always, I welcome your feedback. You can send a note to me by replying to this email or sending to

Read more about our journey to becoming a health system and learn more about our rich history.

Veterans Day: Honoring Those Who Serve

Veterans Day 2017 graphic

On Veterans Day, we take time to reflect on the sacrifice our veterans have made and to honor them for their patriotism and willingness to serve and protect our country. At Dartmouth-Hitchcock (D-H), we also celebrate our employees who have served by recognizing them on the D-H Wall of Honor. Please be sure to check out the stories of our colleagues, and join us in thanking all of our D-H veterans who serve our nation and our patients.

Supporting our employees who continue to selflessly serve their country in the Guard and the Reserve is a priority for D-H. We are extremely proud that D-H and several employees have been recognized in recent years by the Department of Defense’s Employer Support of Guard and Reserves (ESGR) office. D-H has received the ESGR’s Patriot Award for its commitment to supporting “Citizen Warriors through a wide range of measures including flexible schedules, time off prior to and after deployment, caring for families, and extended time off.” D-H has also been nominated for the “Freedom Award,” the highest recognition given by the Department of Defense to employers for their supports of employees who serve in the Guard and Reserve. Additionally, numerous D-H supervisors have been recognized with New Hampshire ESGR awards for supporting their employees who serve in the Guard and the Reserve.

For years, D-H has also had an important relationship with the White River Junction VA Medical Center, helping to provide care to our nation’s veterans. For example, Rheumatology fellows, residents and medical students participate in patient care at the VA’s Arthritis Clinics three times a week, and are also on the active rheumatology consult service. D-H shares staff with the VA in a number of specialty services, and many D-H researchers and clinicians partner with the VA on cutting-edge research, including posttraumatic stress disorder. D-H is committed to helping and serving our veterans.

Please join us this week as we recognize veterans and their family members, and thank them for their service. A free hot beverage will be available for veterans all day on Friday, November 10, and on Veterans Day, Saturday, November 11, in the Main Dining Room and East Mall Café. Also on Friday, from 11 am to 1 pm there will be cake in the Main Dining Room for veterans. At D-H Manchester and Nashua, a free hot beverage and muffins will be available in their café and at D-H Concord, refreshments will be available in the lobby for veterans.

Thanks again to all our veterans. We greatly appreciate all you do for your co-workers, our patients, the communities D-H serves and our nation.

Sincerely yours,
Karen Clements, RN, FACHE, Chief Nursing Officer
Aimee Giglio, Interim Chief Human Resources Officer

Weekend Celebrations for New Jack Byrne Center for Palliative & Hospice Care

Dr. Ira Byock and Dr. Kathy Kirkland.

Dr. Ira Byock and Dr. Kathy Kirkland.

Members of the community, staff from regional home hospice agencies, donors, Dartmouth-Hitchcock (D-H) employees and special guests came together to celebrate the official opening of the new Jack Byrne Center for Palliative & Hospice Care, during a three-day series of special events. By collaborating with local hospice agencies, the Jack Byrne Center closes a gap in our health system for those facing life-limiting illness, making personalized care, community programming and clinical research opportunities available within a state-of-the-art, homelike environment.

The festivities began with a special lecture on November 3 from Dr. Ira Byock, former section chief for Palliative Care at D-H. Byock is a sought-after guest lecturer, author and palliative care advocate who was instrumental in the initial planning for the Jack Byrne Center at D-H.

A dedication and ribbon-cutting ceremony took place on November 4, attended by Mrs. Dorothy Byrne, widow of Jack Byrne, for whom the center is named, as well as their two sons, Patrick and John and other family members.

Joanne Conroy, MD, CEO and president of Dartmouth-Hitchcock, emceed the ceremony, acknowledging the 400 community members, businesses and organizations who joined the Byrne family in supporting the center’s construction. Their generous support is recognized on a special donor wall that graces the White Mountains room at the entrance of the center.

Among the guest speakers at the dedication were Jim Weinstein, DO, former CEO and president of D-H; Patrick Byrne, who spoke on behalf of the Byrne family; and Kathy Kirkland, MD, director of Palliative Medicine at D-H, who also holds the Dorothy and John J. Byrne, Jr., Distinguished Chair in Palliative Medicine at the Geisel School of Medicine.

Kirkland, who led the clinical development of the center’s programs, said, “It’s thrilling to begin to imagine the many things this center will make possible. The Jack Byrne Center is a liminal space: it sits on the threshold between medical center and community, between hospital and home, between professional and personal, between what we are and what we will be. It’s a place and it’s also a doorway into a world we want to create: a world where we generate new knowledge about innovative care and educational models; where we welcome students, trainees, colleagues and community members to learn with us and expand capacity regionally; and, of course, a world in which our inter-professional team—in partnership with regional hospice teams, patients and families—provide the best care possible for people living with serious illness.”

The dedication’s program concluded with a special gift presentation from Rich Rothstein, MD, chair of the D-H Department of Medicine, to Dorothy Byrne—a large wooden bowl that Rothstein (who is an accomplished woodworker) made from a tree taken from the cleared construction site before the center was built.

The weekend festivities concluded with a special open house for the general public on Sunday, November 5. Plans for additional open house events are underway before the center opens to patients on Monday, December 18.

Employee Recognition: Milford Clinic Temporary Closure

Many residents were without power on Monday, October 30, after the widespread storm that affected many throughout the region. This was the case for our Dartmouth-Hitchcock Family Medicine campus in Milford, NH. With no power and no indication of a restoration time, the team sprang into action to accommodate their patients. Thanks to the responsive and resourceful efforts of many, the Milford operations were temporarily relocated to the Primary Care floor at 2300 Southwood Drive in Nashua. More than 130 patients were moved to Nashua (others were rescheduled to a later date). This was a shining example of flexibility, teamwork and enormous dedication to our patients and each other. See the comments below from staff at our Milford and Nashua locations about the experience:

“So proud to work with such a great group. Thanks for hanging in there for each other and our patients! And, thank you to the hosts for making our Milford group feel at home! This is a great example of team work and a supportive culture.” – Pat Fajans

“It was great to see old friends and make new ones during our temporary relocation. Thank you to all the wonderful teams in Internal Medicine, Family Medicine and Pediatrics for letting us hang out and be ourselves. Please feel free to come and visit us in Milford!” – Michael Kaploe, MD

“Thank you for everyone’s flexibility! It really has been great to have you in Nashua over these past few days, but I know that it will be nice to move back home.” – Jon Thyng, MD

“Thank you to the hosts! Very welcoming and helpful. Very much appreciated!” – Tina Marcoux, LPN

“I would like to give a big WOW to Cathy Robert and Jessica Vixama for their work with the Milford Power outage. They were up at the-crack-of-dawn, and stayed late daily to make sure all of the staff, patients and logistics were taken care of. Amazing teamwork and attention to every detail! Above and beyond awesome job!” – Mary Beth Fauteux

Milford Team:

  • Stacie Abaid, PA-C
  • Melissa Bartula, MA II
  • Ressie Berkebile, medical assistant II
  • Samantha Bolton, LPN
  • Ivan Boyadzhiev, MD
  • Arysta Carrier, LPN
  • Katherine Duchesne, receptionist secretary
  • Rachel Glover, RN
  • Jessica Godinho, RN
  • Nadia Khan, MD
  • Michael Kaploe, MD
  • Chrissy Langlois, LPN
  • Patricia Lee, receptionist secretary
  • Tina Marcoux, LPN
  • Danielle Roy, medical assistant II
  • Darla Thyng, MD
  • Stacie Umperovitch, PA-C
  • Nicole Wallace, medical assistant II
  • Sabrina Yong-Yow, MD

United Way Campaign Starts November 15

United Way image

During this time of year as we prepare for the Thanksgiving holiday, D-H employees are invited to also “give back” to the communities we serve through the annual Granite United Way campaign. The campaign will be held system-wide starting on November 15 and ending on November 28, which also is the nationally recognized Giving Tuesday, a day to encourage people to give to their favorite charities.

D-H employees will receive an email on November 15 directly from the United Way with a link to a personalized webpage to manage their donations. Employees can even designate their United Way contribution directly to a non-profit program of their choice.

“Supporting others is commonplace throughout the Dartmouth-Hitchcock system, and that goes beyond our physical locations to the communities we serve and live in as well,” says Dr. Steve Paris, medical director for the Community Group Practices, and Dr. Sally Kraft, vice president for Population Health, both of whom have served on the Granite United Way Board. “Each of us can make a difference, so please join us in making a contribution – large or small – to the United Way.”

While D-H employees show their generosity every day throughout the year, the D-H United Way campaign is another venue for the employees to support their local communities. The D-H United Way campaign offers the convenience of payroll deduction – an option that allows employees to contribute throughout the year. Employees can also make a one-time payment by check or credit card.

If you have any questions about this year’s United Way campaign, please contact Benefits Administration at or 653.1400.

Team Up, Take Action: Partnering for Health Equity

Camara P. Jones, MD, MPH, PhD

Camara P. Jones, MD, MPH, PhD

Dartmouth-Hitchcock is partnering with the Vermont and New Hampshire Public Health Associations to present a thorough and thoughtful day-long conference to explore the many factors that either enable or interfere with addressing conditions leading to health inequity. The Team Up, Take Action Health Equity Conference/Schumann Lecture will be held on November 15, 8:30 am to 5:30 pm, at the Hanover Inn, Hanover, NH.

Presenters and breakout sessions will delve into identifying key levers such as policy, system and environmental changes, types of partnerships and relationships and other elements needed to be successful in advancing health equity. By targeting our work to produce the greatest health benefits for disadvantaged groups, ultimately, all our communities benefit.

Health equity means that everyone has the chance to be as healthy as possible. Health equity means reducing and eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups. Health equity is inextricably linked with opportunity. It requires addressing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments and health care. Health equity is fundamental to building a vibrant society because of its practical, economic and civic implications and impact on individuals living a good life.

Conference breakout sessions will pertain to:

  • Organizational capacity and infrastructure to advance health equity
  • Collecting and using data to advance health equity
  • Growing strategic community partners to advance health equity
  • Health Equity in practice

Keynote Speakers:

Opening Speaker: Dr. James Weinstein, former CEO and President of Dartmouth-Hitchcock
Dr. Weinstein chaired the Committee on Community-Based Solutions to Promote Health Equity in the United States for the National Academy of Sciences that produced the report Communities in Action: Pathways to Health Equity published January 2017.

Schumann Lecturer (4:00-5:30 PM): Camara P. Jones, MD, MPH, PhD, family physician, epidemiologist, and former President of the American Public Health Association. Her work focuses on the impacts of racism on the health and well-being of the nation. She seeks to broaden the national health debate to include not only universal access to high- quality health care, but also attention to the social determinants of health (including poverty) and the social determinants of equity (including racism).

For more information and to register for this conference.