A Model for Success
The real proof of the collaborative model is in the numbers. The Centers for Disease Control and Prevention (CDC) estimates that 1.7 million cases of hospital-acquired infections occur each year, annually generating more than $4.5 billion in excess costs and contributing to as many as 99,000 deaths. Determined to address this quality and patient safety issue, hospitals in the Greater New York region decided to tackle infections by first focusing on eliminating centralline-associated bloodstream infections (CLABs) in hospital intensive-care units (ICUs). The 47 Greater New York area hospitals participating in the CLABs Collaborative showed a dramatic 70% decline in CLABs rates from mid-2005 to mid-2008. Perhaps the most encouraging aspect of the results is that the rate was cut almost in half after the first three months and has continued to decline further since then, with some hospitals sustaining infection rates of zero.
“The success of the CLABs initiative instituted at NYC hospitals under the auspices of the GNYHA underscores that healthcare delivery providers can reduce hospital-borne infections when we all work toward a common objective and make patient safety paramount,” says Stanley Brezenoff, president and chief executive officer of the six-hospital Continuum Health Partners network. “The CLABs study also has created a successful model that we can apply to other clinical areas.”
The success of the CLABs Collaborative prompted 36 hospitals this year to apply the model to the process of reducing Clostridium Difficile (C. difficile), a multidrug resistant organism that causes severe gastrointestinal problems and often results in death. Nationwide, incidences of C. difficile have doubled over the last decade and increased in intensity because of a new and more virulent strain. Because of the rigor of the collaborative model, and the skill and dedication of the practitioners, expectations are high for reducing the transmission of this highly contagious organism.
And, as mentioned, hospitals in the region are working hard to improve quality and patient safety at all staff levels, including through a one-of-a-kind collaboration with the major healthcare workers union, 1199 SEIU United Healthcare Workers East, to ensure that all employees understand the critical importance of infection prevention and control.
“Hackensack University Medical Center made a promise to be a leader in the quality arena —
constantly measuring our outcomes and finding new approaches to achieve higher levels of quality
patient care. It is especially gratifying for our team to know that our work impacts the way healthcare is delivered across the region and the country, making good on our original promise.”
John P. Ferguson, President and Chief Executive Officer,
Hackensack University Medical Center
The model also can be applied beyond infection reduction. Since mid-2006, the Rapid Response Systems (RRS) Collaborative, which includes 38 Greater New York area hospitals, has adapted the model for training frontline staff and families to activate an RRS team if they feel any concern that the patient’s condition is deteriorating. A team of critical-care clinicians and respiratory therapists respond to the bedside of patients to prevent their decline into a critical state. More effective and precise communication among all clinicians has resulted so far in an increase in rapid-response team calls and a corresponding decline in cardiac codes. More importantly, the use of RRS teams has created a culture of safety for the frontline staff and improved staff morale because they know there is someone to call to help them manage a patient’s changing condition.
The results of the collaborative model are significant. But the collaborative model creates more than just better outcomes — it builds important infrastructure vis-à-vis hospital policies and protocols, which can be applied broadly to other quality and safety issues. For example, patient falls at one hospital were cut in half in less than a year. “These initiatives have allowed us to achieve dramatic improvements in patient safety and quality care,” notes Gary S. Horan, president and chief executive officer of Trinitas Hospital in New Jersey.
“More than any other city, New York symbolizes the assimilation of people
from all over the world. Doctors who train here gain a unique perspective on how
background shapes a person’s health, and how crucial it really is to treat the whole person.”
Robert I. Grossman, M.D, Dean and Chief Executive Officer, NYU Langone Medical Center
For Nella Khenkin, Director of Social Work at the Maimonides Cancer Center, the philosophy is simple. “Basically,” she says, “every person needs compassion, but especially patients who are in difficult situations.”
Ms. Khenkin and her colleagues at the Cancer Center are always on the lookout for patients who are in distress. From patient representatives who can recognize the more subtle signs of emotional distress to receptionists who might notice and call attention to a crying patient, the staff remains alert to ensure that visitors who need help get the services they deserve.
When patients are overwhelmed, Ms. Khenkin says she can help them prioritize. “We talk with them to figure out what we can do immediately.” Most importantly, she helps patients identify their own assets and strengths. “This gives them the confidence they will need as they navigate the challenges of cancer treatment.”
Moving the collaborative model further into the area of critical care, 14 hospitals in the region joined with GNYHA to form the Critical Care Leadership Network (CCLN). CCLN is a forum to discuss opportunities for standardizing and improving care, and sharing limited ICU resources. The 32-member steering committee is composed of executives and interdisciplinary hospital staff who are leaders in critical-care medicine, surgery and nursing in their own hospitals and in local and national associations.
CCLN’s educational series provides in-depth training to ICU staff and covers burn care, surgical care, ultrasound, prevention of complications, intracranial pressure monitoring, airway management and legal issues.
“Hackensack University Medical Center (HUMC) made a promise to be a leader in the quality arena — constantly measuring our outcomes and finding new approaches to achieve higher levels of quality patient care,” states John P. Ferguson, HUMC’s president and chief executive officer. “It is especially gratifying for our team to know that our work impacts the way healthcare is delivered across the region and the country, making good on our original promise.”
When you enter a hospital in the Greater New York region, you can be confident that your caregivers, as a team, have a laser-sharp focus on quality and safety, where patient care is the top priority.
“Informed initiatives work together to create a hospital whose care is
literally and figuratively accessible, from food to nursing and assistants’ care,
from communicating with the patients to treating their specific healthcare needs.”
Henry Amoroso, Chief Executive Officer, Saint Vincent’s Catholic Medical Center, Manhattan
Representatives of every culture and country reside in the Greater New York metropolitan area, speaking more than 170 languages and giving hospitals the opportunity to learn in depth how to provide culturally sensitive care.
“More than any other city, New York symbolizes the assimilation of people from all over the world,” says Robert I. Grossman, M.D, dean and chief executive officer of NYU Langone Medical Center. “Doctors who train here gain a unique perspective on how background shapes a person’s health — which groups are more susceptible to certain diseases, how belief systems affect a patient’s relationship to the world of medicine, and how crucial it really is to treat the whole person.”
Indeed, not-for-profit hospitals, which include all Greater New York area teaching hospitals, have long surpassed for-profit hospitals in providing a higher proportion and wider range of mission-based services to their communities, such as:
• emergency and trauma care;
• patient- and family-support services, from adult day care and Meals on Wheels to health coverage enrollment assistance;
• and community-support services, from health screenings and nutrition programs to health fairs and child-wellness programs.
“Our commitment to excellence in patient care, teaching and scientific discovery goes hand-in-hand with an unwavering focus on our community’s health and social well-being,” declares Steven M. Safyer, M.D., president and chief executive officer of Montefiore Medical Center in the Bronx.
Beyond fulfilling their missions, Greater New York hospitals have long recognized that reaching out to the surrounding community brings other benefits: They draw in patients while they provide information about healthy living. Where there are people who do not or are unable to take advantage of available healthcare services, someone at some hospital is chipping away at it, finding the right strategy to draw them in through schools, movie theaters, religious institutions, community centers or on the street.
The New York metro area is home to the world’s most dynamic healthcare community, where small, neighborhood hospitals and large, state-of-the-art academic medical centers serve an incredibly diverse and rapidly changing patient population while expertly training the next generation of physicians and other healthcare professionals.
For more than 100 years, the Greater New York Hospital Association (GNYHA) has proudly served these institutions. Today GNYHA represents 250 voluntary and public hospitals and continuing care facilites in the New York City area, throughout New York State, and in New Jersey, Connecticut and Rhode Island. We are defined by their collective dedication to providing the highest quality care to every patient, every day. GNYHA is a powerful center for professional exchange, discussion and advocacy, and a relentless champion of hospitals and their mission.
Where there is a high concentration of a particular population, New York area hospitals develop expertise in reaching that community. “We intend to provide culturally appropriate and mission-sensitive care to anyone who needs it,” says Henry Amoroso, chief executive officer of Saint Vincent’s Catholic Medical Center in Manhattan, “particularly those who might otherwise not be able to access healthcare.”
Proven strategies include dedicated hospital units, active outpatient centers or a community outreach department headed by a doctor who grew up in a particular community. This is the kind of opportunity Greater New York area hospitals have learned to seize and master.
“Informed initiatives work together to create a hospital whose care is literally and figuratively accessible,” adds St. Vincent’s Amoroso, “from food to nursing and assistants’ care, from communicating with the patients to treating their specific healthcare needs.”
“If you want to attract customers from your surrounding
community, you have to offer culturally sensitive care.”
Mary Medina, Executive Director, the Center for Trustee Initiatives, Greater New York Hospital Association
Other examples of community outreach are found throughout the Greater New York hospital network and then shared with each other and the public:
• Programs for the homebound and frail elderly allow them to remain in their homes rather than being admitted to nursing homes.
• Revitalizing neighborhoods through nonprofit development organizations with homes, stores, parks, city services, schools and job readiness brings a better quality of life to community residents and hospital staff alike.
• School-based programs that encourage healthy lifestyles in young people, from preparing cookbooks with healthy and delicious recipes to learning ballroom dancing, actually make healthcare fun.
“Numbers tell only part of the story of the New York area’s healthcare leadership,” declares North Shore-LIJ Health System President and Chief Executive Officer Michael Dowling. “Healthcare is a 24-hour, 365-days-a-year commitment we make to our communities. That’s why those who rely on us so often find us in unlikely places.”
Stronger Governance Through Diversity
The core of patient-centered care and community outreach is cultural sensitivity. It is common knowledge that the U.S. population is becoming more diverse and will continue on that trajectory. Over the next 35 years, the U.S. Census expects more than half the population to be composed of people who are not of European descent. That U.S. future is the present today in New York City, where the 2000 census revealed an ethnic composition of 25% black, more than 25% Hispanic and 10% Asian residents. The faces of New York’s healthcare customers and workforce today reflect those statistics.
A good starting point for needed changes is a hospital’s governing board, where decisions about healthcare delivery and resources are made. As hospitals recognize the need to augment the board’s professional skills and strengthen their relationships with surrounding communities, they need to find potential board members who represent those missing professional and personal networks. “If our institutions were to have credibility,” explains Kingsbrook’s Brady, “we had to be able to reach more than just one part of our communities.”
Working along with GNYHA beginning in 2005, a group of hospitals supported the creation of an intermediary — the Center for Trustee Initiatives — to identify, recruit and vet potential board members, many of them successful business leaders from local communities. The Center would then refer candidates to specific hospitals to consider them through their own selection processes.
“If you want to attract customers from your surrounding community,” says Mary Medina, executive director of the Center, “you have to offer culturally sensitive care.” Leaders from the community can guide hospital policy makers in that direction.
“Numbers tell only part of the story of the New York area’s healthcare leadership.
Healthcare is a 24-hour, 365-days-a-year commitment we make to our communities.
That’s why those who rely on us so often find us in unlikely places.”
Michael Dowling, President and Chief Executive Officer, North Shore-LIJ Health System
Community leaders are already accustomed to giving back through service to educational institutions and other local community-based organizations, but hospital board service is relatively new. Since good education and good health are both absolutely necessary to being a productive member of society, many community leaders — entrepreneurs, senior executives and financial investors — are easily convinced. The Center has already facilitated greater board diversity at a number of the region’s hospitals, and the results are new and direct insights into issues of disparate access and treatment that are contributing greatly to quality of care.
Successful integration of a new member into a governing board has seldom happened automatically or overnight, and when the new trustee represents a group previously not included, the challenges can be even greater. Both new and existing trustees need to be coached to embrace diversity as a business imperative and to understand the challenges a new voice will bring. Increasingly, the Center follows up with orientations to ease the new relationships. “New members can be educated in effective boardsmanship skills, and existing board members can be prepared to embrace change,” Medina says.
Once the policy-making body has embraced the concept of change, the need to diversify the next generation of hospital administrative leaders becomes obvious. In 2006, Greater New York hospitals jointly established the Health Care Leadership Institute through GNYHA and Baruch College. This executive development program, designed to promote diversity in healthcare management for promising middle managers selected by their CEOs, graduated scores of managers in its first class, many of whom have already experienced advancement in their careers.
To encourage the commitment of even younger healthcare enthusiasts, GNYHA’s 12-week Summer Enrichment Program, also designed to promote diversity in healthcare management, has partnered more than 200 graduate and undergraduate students with senior management staff at area hospitals so they can gain firsthand experience of the operations and management issues facing healthcare organizations. Many of them have found permanent employment at those same hospitals.
Unprecedented in Preparedness
Another significant area of the region’s expertise is one that will hopefully never be tested again. Hospitals by their very nature are designed to respond to emergencies; 9/11, however, completely redefined emergency preparedness for hospitals in the New York metropolitan area. Before and since 9/11, Greater New York hospitals have invested significant resources in the emergency preparedness infrastructure — resources that often go unnoticed and unappreciated in the day-to-day because they are not immediately needed. The region’s tireless efforts, however, have created the “best-practice model” with respect to preparedness and response to any type and size of emergency or disaster.
GNYHA, the region’s association, leads the collaborative approach to preparedness and remains a national model for regional coordination among providers, public health officials and emergency managers. Through GNYHA’s Emergency Preparedness Coordinating Council, area hospitals and other healthcare providers work in partnership with local, state and federal agencies to develop and maintain a strong emergency preparedness and response system, focusing heavily on communication and coordination strategies. GNYHA and its members also work closely with these same agencies to plan for specific events, including pandemic influenza and coastal storms, and conduct drills and exercises that help providers identify gaps in preparedness.
A Dynamic Medical Powerhouse
Greater New York’s unique concentration of premier healthcare institutions and their unified commitment to patient-centered care fuels the global reputation of the New York metropolitan area. The unique combination of state-of-the-art medical technology, commitment to excellence in patient care and profound understanding of community improves the lives of hundreds of thousands of patients and their families every year, and has nurtured and sustained the healthcare sector’s vitality. Greater New York hospitals are an ever-replenishing resource.