Contents — September 2012
A message from the Chief of Staff
On Sept. 12, 2012, the Hospital of Saint Raphael and Yale-New Haven Hospital completed a more than two-year journey to create a marvelous new 1,500+ bed hospital for our community. We welcome the 3,500+ Saint Raphael staff to YNHH and, with them, look forward to creating a healthcare organization that is much greater than the sum of its parts. In the process of reaching this point in our histories, we have pledged to create a hospital with better access for all, exemplary safety and clinical outcomes, and all provided with greater efficiency and less investment than is possible as separate institutions. We will define metrics to track our success in achieving these goals and will report our progress to this community.
The new look of Medical Staff Bulletin signifies a new era for YNHH, now the fourth largest hospital in the nation. Our medical staff is now enriched by more than 400 physicians and affiliated practitioners from the Hospital of Saint Raphael, including both employed and community physicians, who have been credentialed as members of the YNHH Medical Staff. A large number of HSR providers were already credentialed at both hospitals.
HSR medical staff president (Dr. Ralph DeNatale) and president-elect Dr. James Farmer will join our Medical Board. We will be appointing HSR medical staff leadership to our Credentials Committee (Dr. John Kelly); GME Committee (Drs. André Ghantous and Robert Nardino); Institutional Practice Quality and Peer Review Committee (Dr. Ralph DeNatale); Perioperative Executive Leadership Committee (Dr. James Farmer); Adult Ethics Committee (Dr. Ernest Moritz); Pharmacy & Therapeutics Committee (Dr. Thomas Eisen); Medical Records Committee (Dr. Steve Angelo); Tissue Committee (Dr. Denise Barajas); and Utilization Review and Discharge Planning Committee (Dr. Frank Mongillo).
Senior clinical leadership designated for Saint Raphael Campus
It is considered critical to the integration of clinical services on our two campuses that consistency of leadership is maintained. Six senior HSR physicians have accepted major directorship positions under the leadership of department and section chiefs at YNHH: Dr. Thomas Donohue (Internal Medicine); Dr. Prescott Wiske (Cardiology); Dr. Thomas Sweeney (Surgery); Dr. Marshall Mandelkern (Psychiatry); Dr. John Aversa (Orthopedics); and Dr. Howard Shaw (Women and Children's Services).
In addition, hospital-based services on the Saint Raphael Campus will be headed by Dr. Diego Nunez (Radiology); Dr. Joseph Cardinale (Therapeutic Radiology); Dr.Alan Ruskis (Anesthesiology); Dr. Marc Shapiro (Emergency Medicine); and Dr. Irwin Nash (Pathology and Laboratory Medicine).
In concert with YNHH chiefs, these physician leaders will play major roles integrating clinical services and GME programs, in daily operations, leading service performance in safety and quality initiatives and addressing staffing, compliance and a host of other issues.
Please congratulate these leaders on their appointments and offer them your full support.
Alan Kliger, MD, becomes YNHHS Vice President and Chief Quality Officer
Alan S. Kliger, MD, clinical professor of Medicine, Yale School of Medicine, has been appointed vice president and chief quality officer of the Yale New Haven Health System. Dr. Kliger received his medical degree from SUNY Upstate Medical Center, Syracuse, New York, where he also completed his Internal Medicine residency. He was a fellow in Nephrology at Georgetown University, and from 1975 to 1983 served on the Yale faculty, rising to the rank of associate professor before leaving to join Metabolism Associates in New Haven. He is past-president of the End Stage Renal Disease Network of New England, served on the National Quality Forum Steering Committee for Renal Quality Measures, and is past-president and a current director of the Renal Physicians Association.
Over the last decade, Dr. Kliger has served as chairman, Department of Medicine, Hospital of Saint Raphael, and most recently as senior vice president, chief quality officer and chief medical officer at HSR. Dr. Kliger has published extensively on patient safety and clinical quality in renal dialysis and currently serves as chairman, steering committee for NIH/ NIDDK Frequent Hemodialysis Trial. Dr. Kliger steps in for Dr. Herbert who has been interim System quality officer for the last eight months. Joining Dr. Kliger as deputy director of YNHHS Performance Management is Kathleen Quinn, who currently serves as HSR director of Physician Services. Previously, she held positions as director, Department of Medicine and manager, Department of Medicine.
YNHH/Saint Raphael Campus transition planning and command center
Most day-to-day clinical care will be similar pre- and post-closing on the Saint Raphael Campus (SRC). Many of the processes will continue as before, although under a Yale-New Haven Hospital license.
Teams from both hospitals have been working for months on planning for the early days of the integration of the two hospitals, anticipating needs and issues and playing out dozens of scenarios to ensure safe, uninterrupted patient care and smooth daily operations.
An around-the-clock Command Center has been set up on the SRC for the first two weeks as a safety net. The Command Center will help resolve issues and answer questions that arise and ensure that patient care, admissions, medical records, purchasing and supplies, support services, information technology and telephones, payroll and billing and all the necessary day-to-day activities work as smoothly as possible.
Members of the Medical Staff who have questions or issues should speak first to the manager of the clinical area. Managers who require guidance or issues that cannot be addressed in the normal chain of command should call 203-789-3400 and ask for the Command Center.
There will be a YNHH Department of Physician Services satellite office at the Saint Raphael Campus on Main 1. For information, contact Diane Cacace, 203-789-4231, firstname.lastname@example.org.
Saint Raphael Campus leadership team appointments
Initial appointments related to the Saint Raphael Campus leadership team were recently made by President and COO Richard D'Aquila. They include:
- Peter Herbert, MD, senior vice president and chief medical officer, will coordinate all aspects of the clinical services transition, including the permanent integration of hospital-based physician services, graduate medical education and the re-configuration of clinical services between campuses.
- Ena Williams, RN, associate chief nursing officer for the Saint Raphael Campus, will provide full oversight for nursing services and will be responsible for Magnet readiness on the Saint Raphael Campus, reporting to Sue Fitzsimons and working closely with Mary Kuncas, who will remain as a consultant during the transition period.
- Cindy von Beren will become executive director, Catholic Heritage/Cultural Integration, providing full-time oversight for mission-related functions and services, and ensuring compliance with our commitment to maintain a hospital campus that functions in accordance with Catholic Ethical and Religious Directives.
- Paul Patton, vice president, Human Resources, will provide oversight of all Human Resources and Employee Relations functions at the Saint Raphael Campus to ensure consistency and coordination during the transition. In addition, Paul will provide administrative oversight for Food and Nutrition Services, and Environmental Services, and ensure effective coordination with all non-clinical support services with the main Yale-New Haven campus and Yale New Haven Health System.
- Vincent Tammaro, vice president Finance, will provide financial services oversight and coordination for the Saint Raphael Campus, and monitor all aspects of the financial elements of our transition. He will coordinate the integration of the Saint Raphael financial and billing services with existing Yale New Haven Health System services.
- David Christiano, director, Information Technology, will provide information technology oversight and direct efforts to maintain and integrate existing technology until the implementation of Epic at the Saint Raphael Campus in June 2013.
- John Tarutis, executive director, Grimes Center, will provide executive oversight for the Grimes Center, develop expanded short-term focused programs and meet the continuing care needs of our patients, as we position it for increased integration within our delivery network.
- Abe Lopman will continue to lead all aspects of the transition and full implementation of the "100-day plans" necessary to ensure a smooth transition. Abe will also assume responsibility for building a new service line centered on a comprehensive and multidisciplinary musculoskeletal institute which will be based on the Saint Raphael Campus.
Morning Safety Report to begin daily on both campuses
Beginning September 24 at 8 a.m., management staff at both the York Street and Chapel Street campuses will begin a daily 15-minute Morning Safety Report, based on the Healthcare Performance Improvement (HPI) model. HPI is a leading comprehensive safety culture improvement organization, with over 200 hospitals as clients across the United States. The Connecticut Hospital Association has engaged HPI to organize a multi-year safety initiative called "Getting to Zero" for all Connecticut hospitals.
The Morning Safety Report, led by Performance Management, includes a three-point agenda: 1) Looking back at a significant safety or quality issues from the last 24 hours; 2) Looking ahead to the anticipated safety or quality issues in next 24 hours; and (3) implementing follow-up including status reports on issues identified that day or previous days. All issues will be documented until resolution is complete. HPI has successfully used this model at many other hospitals across the country. For more information, contact Tom Balcezak, MD, 688-1343 or thomas.balcezak @ynhh.org.
Clinical planning for the first 100 days with Saint Raphael Campus (SRC)
The first 100 days of the transition to a dual-campus hospital will focus on four areas:
Practice Normalization: More than 1300 policies and procedures have been standardized to achieve the goal of a single standard of care across both campuses.
Regulatory Readiness: To prepare the new 1,519-bed hospital for a successful Joint Commission accreditation survey, both campuses will identify regulatory vulnerabilities and implement the existing YNHH regulatory readiness structures at the Saint Raphael Campus. These include mock surveys, day of readiness checklists and clean and safe rounds.
Short-Term Bed Strategy: A short-term strategy has been developed to reduce crowding on the York Street Campus by transferring appropriate general medicine patients to the Saint Raphael Campus (SRC) and collaborating with local physician groups and ambulance companies to direct appropriate admissions to the SRC. Starting on Sept. 12, 18 additional beds will be staffed and opened on Celentano 3 and 4, SLA 4 and Verdi 4 W, 5N and 5W. Beginning September 17, the Sister Louise Anthony 3 and Verdi 4 units will begin complete renovation to reopen as general medicine units later this year. Between Day One and the end of January, YNHH expects to open 54 general medicine beds on the Saint Raphael Campus.
Clinical Integration Strategy: No clinical services were moved to or from either campus on Day One, but all professional services agreements for clinical services are being reviewed, a clinical service consolidation workplan is being developed, and ambulatory practices at both sites are being assessed. Over the next few months a transition plan for hospital-based specialty services will be developed, with input from Medical Staff and Hospital leadership. Future issues of the Medical Staff Bulletin will include information about clinical service plans, as it becomes available.
Hand hygiene update
The Influencer Model of hand hygiene at YNHH has proven extremely successful since it was implemented last October. Before implementation of the Influencer Model, YNHH compliance scores were in the 60s percentage range. For the last four months, YNHH overall hand hygiene scores have been steady between 90 and 91. Bridgeport and Greenwich Hospitals are also using the same model and their scores have shown marked improvements.
The Influencer Model, developed by David Maxfield, author of Influencer: The Power to Change Anything, involves personal, social and structural motivation, as well as ability to bring about positive change in behavior. Maxfield spoke to more than 200 leaders at YNHH last year about how his model can be applied to critical patient safety issues such as hand hygiene compliance.
This model involves three simple, though vital, behaviors for hand hygiene:
1) Wash in/wash out — You should wash your hands before and after entering a patient room or having a patient encounter.
2) 200% accountability — You should be 100% accountable for your own hand hygiene and also 100% accountable for everyone else you see; remind them if they did not wash their hands.
3) Saying "thank you" — You should thank people who are using correct hand hygiene. If you remind someone who did not wash their hands, they should thank you for the reminder.
Hand hygiene training, implementation and monitoring is unit-based; each patient care unit or department has both a physician and nurse champion. Each patient care area is audited monthly by YNHHS Performance Management Improvement Team, which scores the overall hand hygiene compliance as well as compliance by physicians, nurses and support staff.
According to the July 2012 issue of Saint Raphael's Physician News, "Hand hygiene practices have seen significant improvement at Saint Raphael's in recent years but compliance is still below levels expected by patients and national healthcare organizations." Current overall hand hygiene compliance at Saint Raphael's is at 55.4 percent — not so different than YNHH's pre-Influencer model rates last year.
YNHH will be bringing the "Influencer" model of hand hygiene to the Saint Raphael Campus (SRC) early next year after planning and training is complete this fall. Members of the Medical Staff at SRC who are interested in becoming physician champions can email Lori Hubbard, RN, Office of Nursing Excellence, at email@example.com.
Two HSR executives join YNHHS leadership team
The integration between Yale-New Haven Hospital and the Hospital of Saint Raphael will expand the Yale New Haven Health System by nearly 30 percent. In recognition of that, two key appointments to YNHHS include:
- Christopher M. O'Connor, former president and chief executive officer of the Hospital of Saint Raphael, will join the Yale New Haven Health System as executive vice president and chief operating officer. He will focus on the continued development of shared System services and programs which provide value for the entire health system, including Northeast Medical Group, Supply Chain and Corporate Procurement, Facilities and Human Resources. He will also oversee the expanded development of shared clinical services and initiatives in areas like Occupational Health and Pharmacy services.
- Joseph Bisson, former HSR vice president for Strategy and Business Development, will join the Yale New Haven Health System as vice president of Business Development. In his new role, he will be responsible for integrating System-wide business development strategies and support services for our delivery networks.
Protecting patient electronic privacy
Yale-New Haven Hospital is reinforcing the importance of patient e-privacy, electronic privacy auditing practices and the consequences of inappropriate access. All employees were required to complete a Healthstream training course called "Protecting Patient e-Privacy" by Aug. 31. This ePrivacy audit content will be included as part of the yearly Healthstream HIPAA security training module.
YNHH is required to conduct periodic audits to ensure compliance with HIPAA privacy and security rules. In September, the Hospital will begin an enhanced proactive auditing program which uses the "Fairwarning" system, a computer application that collates data from multiple sources to identify potentially inappropriate access to electronic protected health information and other confidential information. Fairwarning monitors the information employees and members of the Medical Staff are accessing in electronic medical records. The system flags potentially problematic access and reviews potentially inappropriate access to family members, co-workers and neighbors. Please share this information with your staff and communicate the importance of completing the online training. If you have any questions, contact Nassar Nizami, chief information security officer, at 203-688-2482 or Faith McGrath, manager, information security, at 203-688-4703.
Reminder to update contact information
It is important that the YNHH Department of Physician Services has correct, up-to-date address and contact information for all members of the Medical Staff and Affiliated Medical Staff. If you have changed your office address, phone or fax number, home address or phone number, mobile phone number or pager number, please contact Physician Services at 203-688-2615 or email the information to: firstname.lastname@example.org.
Similarly, Yale New Haven's physician referral department provides information on our physicians to patients who contact YNHH by phone or search on the web. For those physicians who are currently listed, please review your profile on the web site (ynhh.org/physician-finder) and notify us of any changes or updates. If you would like to be added to the referral service, please contact us directly at email@example.com.
Privileges at the Saint Raphael Campus
To the extent that it is appropriate, the clinical privileges that members of the Medical Staff can exercise at Yale-New Haven Hospital will apply at both facilities after Sept. 12. Members of the Saint Raphael Medical Staff who applied for YNHH appointment and were approved received a letter with their new privileges attached. Please review this letter and your privileges.
YNHH Medical Staff Bylaws and Rules & Regulations
After Sept. 12, the Medical Staff Bylaws and Rules & Regulations of the Hospital of Saint Raphael will no longer exist. Physicians and affiliated Medical Staff members who practice at the Saint Raphael Campus will do so under the YNHH Medical Staff Bylaws and Rules & Regulations. The YNHH Medical Staff Bylaws and Rules & Regulations can be found at www.ynhh.org. Click on the "Medical Professionals" tab at the top of the home page, then select Bylaws and Rules & Regulations in the pull-down menu. Or, click here.
Transition information about pharmaceuticals and supply chain
With the Sept. 12 closing between Yale-New Haven Hospital and the Hospital of Saint Raphael, YNHH is now a single hospital operating on two campuses. In order to ensure a smooth transition in the initial days and weeks, the two campuses will retain separate product and pharmaceutical formularies. Products will not be routinely moved from one facility to another for use, absent advance review and approval of the appropriate campus-specific department. The product formularies from both campuses are in the process of being reviewed for standardization and clinical subject matter experts will be consulted prior to any changes.
New product introduction requests for the Saint Raphael Campus will be submitted utilizing the YNHH new product introduction request form and process. To obtain the new product introduction form, please contact Supply Chain Management at 203-688-2485.
For inquiries on pharmaceuticals additions, call the YNHH Drug Information Service at 203-688-2248. Pharmaceutical request forms are also available on the Yale-New Haven Hospital intranet under Departments/ Administrative/Pharmacy/ Forms/New Formulary Request.
Temporary vendor badges will be handled through the YNHH vendor management system, VendorMate, effective Sept. 12. Vendor representatives will receive communication so they can register. They will additionally be informed that product formularies are campus-specific and that they should not promote or facilitate cross-campus utilization.
"Quadramed" computerized order entry training at Saint Raphael Campus
Members of the YNHH Medical Staff who intend to practice at the Saint Raphael Campus (SRC) after Sept. 12 and before the implementation of EPIC in the spring of 2013 must be trained on Quadramed, the SRC physician computerized order entry system. This entails review of training modules and completion of a self-test. Training is available on the YNHH Intranet site/tab under the "Applications" header. Click on "Quadramed training - Saint Raphael Campus." Training is also accessible via the Clinical Workstation - click on the letter "Q" in the top margin.
Graduate Medical Education integration has begun, most notably in Radiology, where residents have already begun to be integrated into rounds and morning reports. GME integration in Surgery and Internal Medicine (Geriatrics, Cardiology and Nephrology) is also underway. Members of the Medical Staff will be updated as the planning and implementation for GME integration continues.