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Joanne's Journal - Wednesday, March 7, 2018

Joanne's Journal - Wednesday, March 7, 2018

Developing a vision for where we are going

First some sad news….

On March 2, 2017, we lost one of Dartmouth-Hitchcock’s (D-H’s) true giants, John Collins. From 1975 to 2007, John served as the CEO of Dartmouth-Hitchcock’s Clinic. The clinic leadership model at the time partnered a physician president and an administrator CEO. John was the administrative partner to four presidents: Drs. Richard Cardozo, Harry Bird, Stephen Plume and Tom Colacchio. 

John was instrumental in creating the clinical/academic agreements with Dartmouth Medical School (which is now Geisel). During his early career at the clinic, he helped nurture and grow the connections between the clinic, hospital, medical school and the VA (Veterans Affairs Medical Center in White River Junction, VT) to form DHMC.  John believed physician group practices provided coordinated, efficient and better care. He led the clinic’s expansion throughout New Hampshire and Vermont during the 1980s.

Today, Dartmouth-Hitchcock Clinic comprises a network of nearly 2,400 primary and specialty care providers. Practice facilities are located in Lebanon, Manchester, Bedford, Concord, Keene, Nashua and Bennington, Vermont. He knew that building our southern New Hampshire presence was critical… and without his vision, we may have never created the powerful regional network of clinicians we have today.  He invested in Dartmouth-Hitchcock’s participation in the Vermont Health Plan. He also brought New Hampshire’s first HMO (Health Maintenance Organization), the Matthew Thornton Health Plan, into Dartmouth-Hitchcock Medical Center (DHMC). John envisioned creating an Accountable Care Organization before anyone knew what that meant! His idea was to sell the Mathew Thornton Health Plan to Harvard Pilgrim Health Care and funnel all the New Hampshire premiums through a D-H run organization. Hmm….if only the state had been more supportive and seen the advantages of this plan. I wonder where we would be today?

John Collins and Harry Bird, who served as president of Dartmouth-Hitchcock Clinic from 1983 to 1990, understood that the organization had to grow if it was to be successful and they were passionate sponsors of DHMC’s move from Hanover to Lebanon.  A larger campus would further the expansion of Dartmouth-Hitchcock’s academic and patient care goals. John had a vision to create an integrated health system spanning from Burlington, VT, to Burlington, MA. He was the architect of the Lahey/ Dartmouth-Hitchcock Clinic merger…and although it never really got off the ground, looking back, it was a great idea that turned out to be a missed opportunity for both organizations. (And, I can say that because I have worked in both!)

Under his leadership during the medical malpractice crisis of the late 1980s, we created the self-insured Dartmouth-Hitchcock professional liability program. D-H’s captive insurance company (Hamden) was our answer to the national malpractice insurance problem.  The risk insurance program continues to this day and John successfully led it for over three decades. In the early 1990s, he recognized that the clinic and hospital could be stronger functioning as one rather than as two separate entities. Through a series of evolutionary steps, beginning with hospital-basing the clinic’s Lebanon ambulatory practices (commonly referred to as our HBAS program), then a joint operating agreement, then a partnership agreement, the clinic and hospital became a fully integrated organization, which we now know as Dartmouth-Hitchcock.

John was a true visionary and mentor to many past and current leaders. He would often remind those around him that they needed to make decisions in the context of past actions, current challenges and our future vision. He would often say “the medical school is over 200 years old, and we want it to be here for 500 more years.” This led him to become the “unofficial” DHMC archivist, documenting the history of all Dartmouth-Hitchcock organizations. John was a great mentor, reminding each of us the importance of investing time in others who might be younger and less experienced to help them reach their fullest potential.  

Stephen Plume says: “John Collins will be remembered for his practical wisdom on both great and small issues, for his ability to understand the intense local concerns of individuals at the same time as he could put such issues in their larger context. He combined analytical insight and strategic thinking with humanity and humility, and with his unwavering belief in the value of a physician group practice allied with a wonderful hospital and a worthy college. He was always loyal to friends and colleagues at every level, whether they be maintenance workers or physicians or governors. He was fun to be around, delighting in recounting amusing stories, sometimes more than once. His achievements were recognized with awards from business and professional associations, as well as with our personal thanks on numerous occasions.”

Please take a moment to contemplate and celebrate the many beneficial ways his work shaped the organization in his 30-plus years of service. He was a true visionary, and although he led the clinic, he always knew what was best for the entire medical center.

Carrying on this Strategic Legacy:

John Collins had a bold vision for this health care system. Some of the initiatives over three decades were successful and some not, but it was all in service of a vibrant regional integrated health system model.

We are at a critical juncture now…and I have discussed this before. We need to make and execute on important decisions about our future as a health system. We have just launched this process. Working with Chartis, our consulting partner, we will have a strategic planning meeting of leadership across the health system on April 26 followed by a meeting with the Dartmouth-Hitchcock Health (D-HH) Board on May 21 and 22.

The work we have to do is:

  • assess where we are now looking at our internal and external strengths and challenges;
  • be clear about where we want to go;
  • articulate how we want to be seen in the health care market place; and
  • decide on the strategic and sometimes-risky things we need to commit to in order to be successful.

By the way….we just cannot stay where we are. Health systems are like trees…you are either growing or dying. We cannot insulate ourselves from the world changing around us and continue to thrive.

One critical topic we will discuss, which involves many people, is articulating our mission and vision. How do we answer the question: Who do we want to be as an academic health system?

Now…we know that mission and vison statements are often blurry (Can you recite our system mission and vision statement?),  and often use too much jargon and rhetoric. If value statements are not specific enough …there can be many conflicting interpretations. We want our statements to result in a shared sense of purpose among providers and employees.

Part of the solution is using storytelling and imagery as we craft our vision statement. Check out this article from HFMA (Healthcare Financial Management Association):

In the above article is an example of an average system mission statement:

  • “We will be the leading healthcare delivery system in the community.”

A more vivid mission statement might read:

  • Our mission is to hear patients say we provide ideal patient care, see employees and volunteers smile because they’re happy to be at work, and have donors tell people that gifts to the hospital are among the best decisions they have ever made.

So what is so important about the words in our mission and vision? The effect of clear imagery on building engagement and improving both quality and financial performance has been demonstrated many times. When you achieve alignment across the organization, everyone knows what they need to do to help the organization accomplish its goals. We will accomplish this through the input of many. It costs nothing to change our rhetoric and words. By getting the input of many, we establish a shared sense of purpose.

I want thousands of fingerprints on our future. Please send me your thoughts and ideas either by replying to this email or sending a note to:

Safety and Quality Week – March 12 to 14

Staff attend the 2017 Poster Fair

Staff attend the 2017 Poster Fair.

Safety and Quality Week 2018 is next week, March 12 - 14, and there are some exciting events and activities taking place that we encourage your participation. This week is a great opportunity to showcase Dartmouth-Hitchcock’s (D-H’s) numerous system-wide achievements, and the daily work we do to improve patient safety, employee safety, quality, process improvement and value.

Through this week’s presentations and events, we will showcase examples of outstanding work completed across D-H. Our poster fair on Tuesday, March 13, will highlight the excellent projects system-wide, and we invite everyone to come and see the important work your colleagues are doing. You may be inspired to attend our Value Institute Learning Center training yourself to complete a project of your own. We will have various Essential Elements events, helping those across D-H see and understand process improvement methods successfully used by the Value Institute Learning Center.

Sam Casella, MD, MSc, associate chief quality officer, and pediatric endocrinologist, will open the week of events with the keynote speech: "Metacognition in Medicine: Thinking About Thinking," Monday, March 12, 12 to 1 pm, Auditorium H. On Tuesday, March 13, the poster fair will take place from 10 am to 3 pm and then from 6 pm to 9 pm in Auditoria A through D and the Fuller Boardroom. On Wednesday, March 14, from 7 am to 7 pm, test your knowledge of employee and patient safety errors in the Sim Lab Room of Errors, located in the Patient Safety Training Center at DHMC.

These are just a few of the exciting events and presentations taking place during the week. You can find a full list of the week’s events here.

To improve the health of our overall population, it requires each of us to make care more accessible, less costly and more effective. There has been some tremendous patient and employee safety, and quality improvement work completed this past year—and currently in progress. Safety and Quality Week will highlight these achievements, unite everyone in safety, and create the dialogue necessary to spread improvement initiatives across the D-H system.

Looking forward to seeing you there.

George Blike, MD
Chief Quality & Value Officer

D-H’s Thoracic Robotics Program Grows Under Dr. David Finley

Dr. David Finley performs minimally invasive robotic surgery with the da Vinci robot.

Dr. David Finley performs minimally invasive robotic surgery with the da Vinci robot.

Since joining Dartmouth-Hitchcock (D-H) three years ago as chief of Thoracic Surgery and director of the Comprehensive Thoracic Oncology Program at Dartmouth-Hitchcock's Norris Cotton Cancer Center (NCCC), David Finley, MD, has helped D-H become the largest Thoracic Robotics program north of New York City.

“Dartmouth-Hitchcock and Norris Cotton Cancer Center have embraced robotic surgery since I came on staff in January 2015,” says Finley, who previously co-founded the robotic surgery program at New York City’s Memorial Sloan Kettering Hospital in 2011. “Based on volume, we do more robotic cases and more complex robotic cases than any other program in New England.”

Finley, who also holds the Louise R. and Borden E. Avery Clinical Chair in the Department of Surgery, notes that their department has two robots. “The robots enable us to perform surgeries that were previously done as both open and minimally invasive surgeries, including esophagectomy, thymectomy and lobectomy. Patients still receive the same cancer care, but thanks to the robots they experience less pain, a shorter hospital stay, improved long term outcomes and they are able to return to normal life sooner.”

How do patients benefit?

Finley explains that robotics let surgeons take minimally invasive surgical approaches to diseases such as esophageal cancer, lung cancer and tumors of the mediastinum as well as thymic resections for myasthenia gravis. Previously, these surgeries could only be done through a large incision.

“The benefits of a minimally invasive procedure are that 50 percent of our patients go home by day two while the average for an open incision is about five days,” says Finley, adding that 20 percent of their D-H patients go home the day after surgery. “So, that’s a dramatic drop in terms of the cost for the patient, the hospital and our health care system. And 20 percent of our patients are on Tylenol and ibuprofen when they go home. With the opioid epidemic, it’s even better if we can reduce the amount of pain medications they are taking by reducing their pain with smaller incisions.”

While some patients envision a robot standing by their bedside when they hear the term robotic surgery, Finley explains to patients that the robot is just another tool, more like a mechanical helping hand. “The robotic platform allows us to have increased dexterity, improved visualization with 3-D viewing and magnification, as well as enhanced optics,” says Finley. “Having these improvements allows us to do more technically challenging surgeries through a minimally invasive approach and avoids a large incision for our patients.”

Read full story here.

Move-in Day at the Redesigned CHaD Inpatient Unit

Patient Hannah, center, with her mother, Jessica, far right, and family are taken to the new unit by her nurse Jolene Lamoureux, RN.

Jolene Lamoureux, RN, center, takes Hannah and members of her family to the new redesigned unit.

March 6 was an especially festive day for the Children’s Hospital at Dartmouth-Hitchcock’s (CHaD) as it was patient move-in day at the new, redesigned CHaD Inpatient Unit on 5 East, which now houses both the Pediatric Critical Care Unit (PICU) and the Pediatric & Adolescent Unit (Pedi). Three patients were moved to the new unit from the PICU’s former location on 3 East (one additional patient was also transferred to the new unit from the Emergency Department).

To celebrate the move, which took about three hours to complete, CHaD clinicians and staffers wore colorful CHaD-logo sunglasses. Noting the sunglasses at the afternoon ribbon-cutting ceremony, D-H CEO and President Dr. Joanne Conroy told them and D-H senior leaders in attendance that “CHaD’s future is bright!” Conroy also thanked the CHaD team “for the effort you have committed to making this integrated enterprise work, and the commitment you have to our patients and their families.” CHaD Director and Pediatrics Chair Keith J. Loud, MD, MSc, FAAP, also thanked CHaD employees, supporters and philanthropists “who kicked this off and had an integral role in helping to convert the space.”  Read more about the new CHaD Inpatient Unit here.