2012 Annual Report

  • dear friends and colleagues

    For Yale-New Haven Hospital, 2012 was an unprecedented year. While much of the year was focused on the acquisition of the Hospital of Saint Raphael, YNHH was quietly enjoying one of its most successful years ever. Not only did Yale-New Haven demonstrate strong financial performance, the Hospital cared for a record number of inpatients and outpatients, enhanced clinical services, added jobs, invested in crucial technology and continued to help meet the needs of our community, while demonstrating responsible financial performance.

    YNHH continues to reinforce its reputation as a destination hospital which attracts patients, physicians and staff from near and far. The Hospital was recognized again this year by U.S. News & World Report among the best hospitals in the country in 10 adult and 7 pediatric specialties. Throughout 2012, the Hospital demonstrated patient safety and clinical quality enhancements and improved the patient experience. Coupled with operational enhancements, investments in our workforce and strong expense management, Yale-New Haven had its strongest year ever.

    Yale-New Haven Hospital grew from a large, complex hospital operating 1,044 beds to one of the largest in the country with 1,541 beds at midnight on September 12, 2012, with the successful acquisition of the Hospital of Saint Raphael. This was a smooth, though not easy, transaction, with minimal job losses and little to no disruption to patient care, despite the enormity and complexity of the acquisition. The integration between YNHH and Saint Raphael’s was an unprecedented moment in Yale-New Haven’s history, as well as an important step in the Hospital’s preparation for and adaption to major shifts in the world of healthcare.

    While this was an emotional time for those who served the Hospital of Saint Raphael proudly over the years, it was by no means an end of to its legacy of caring. Working together, bringing to bear the collective talents of these two exceptional organizations, New Haven’s two extraordinary hospitals can and we will meet the demands and the promise of a new healthcare environment.

    Marna P. Borgstrom
    President and CEO

    Richard D'Aquila
    Executive Vice President and COO

    Joseph R. Crespo
    Chairman of the Board of Trustees

    Peter N. Herbert
    MD, Chief of Staff
  • Patient Care Safety, Quality +
    Operational Effectiveness

    YNHH continues to demonstrate better than expected outcomes for heart failure, heart attack and pneumonia patients, as publicly reported by the Centers for Medicare and Medicaid Services for all U.S. hospitals. YNHH also performed well this year on important quality and safety initiatives, including improving hand hygiene compliance, reducing bloodstream infection rates and catheter-related blood stream infections, and consistent use of the “time out” safety protocol to verify patient identification and surgical procedure details.

    The Hospital continued its Transforming Patient Care efforts this year to increase patient safety, patient satisfaction, teamwork and communication through the use of simplified and standardized work processes across all clinical units. As a result, the amount of time nurses were able to spend at the bedside increased by between 1.5 to 3 hours per 12-hour shift.

    Safe patient flow was another area of focus throughout 2012, with special emphasis in the pediatric emergency department and perioperative services. Average length of stay improved, as did patient satisfaction scores for “waiting times.”

    YNHH led Project CoSTARR, the Greater New Haven Coalition for Safe Transitions and Readmission Reductions, which involved collaboration between the YNHH, the Hospital of Saint Raphael and the Agency on Aging of South Central Connecticut. A monetary award from the Centers for Medicare & Medicaid Services (CMS) enable special care coordination teams to be put in place to reduce the number of Medicare patients who are readmitted to the hospital within 30 days.

    To ensure operational effectiveness around-the-clock, YNHH launched several programs on the off-shift, including Nursing grand rounds, charge nurse development programs and various employee services.

  • Provider of Choice

    When Yale-New Haven Hospital officially acquired the Hospital of Saint Raphael on September 12, 2012, it literally grew by 50 percent overnight. Yale-New Haven acquired 533 critically needed beds, and now with 1,541 licensed beds, is one of the largest hospitals in the country. Integration and operational planning had begun months before and the transition went surprisingly smoothly, given its magnitude and complexity of joining two separate hospitals, staffs, assets and cultures.

    While hospital discharges in Connecticut decreased by over 2 percent, YNHH grew by more than 1 percent. The Hospital discharged 59,427 patients – the highest in its history – and handled more than 800,000 outpatient encounters. This year YNHH remained the state’s leading hospital, treating 14.1% of Connecticut’s inpatients, compared to 13.6% last year.

    In addition to the addition of the Hospital of Saint Raphael, YNHH also integrated Bridgeport Hospital’s 42 pediatric and neonatal intensive care unit beds and its pediatric clinic, enhancing regional access to specialty pediatric services. The Children’s Hospital opened a new outpatient Pediatric Specialty Center in Norwalk this year – a 10,000-square-foot facility offering 13 pediatric subspecialties. Other ambulatory achievements included the Foxon Urgent Care Center in East Haven, the relocation of the pediatric dental center to One Long Wharf, new radiology, blood draw and physical therapy services and progress on the North Haven Ambulatory Center, which opened in early 2013. YNHH acquired nine new Smilow Cancer Hospital ambulatory Care Centers and reached an agreement with Charlotte Hungerford Hospital to develop a new outpatient cancer care facility.

    YNHH continued to invest in its key clinical services throughout the year, in particular cancer, heart and vascular, pediatrics, neurosciences and organ transplantation. A highlight of the year was an ambitious undertaking in April when the hospital hosted an organ donor registration event supervised by a Guinness World Record judge as we attempted to beat the previous record for one-day donor registrations. While the event fell short of breaking the world record, it resulted in registering 544 new organ donors and calling attention to the vital need for organ donors.

    Work on the Epic project continued throughout the year in preparation for the February 1, 2013 go-live date for YNHH’s new computer system that manages appointment scheduling, clinic registration, insurance, billing and electronic medical records.

    YNHH continued it focus on creating an exceptional experience for patients and families, implementing mandatory employee Service Excellence training, leader rounding, manager coaching and patient and family experience forums in each service line. Service Excellence teams focused on cleanliness and quietness, service recovery, post-visit telephone calls and communication with patients and families, including an active patient and family advisor program. These concerted efforts to improve the overall patient experience translated into increases in patient and family satisfaction. YNHH’s overall Press Ganey score for inpatient services averaged 89.2 for the year, and with improvements in the emergency departments and ambulatory services as well.

  • Employer of Choice

    Despite a necessary preoccupation with transitioning nearly 3,500 former Saint Raphael employees to Yale-New Haven Hospital’s payroll and benefits programs, YNHH continued to demonstrate its commitment to recruiting and retaining a high quality workforce through a range of human resources initiatives. As a result, the Hospital decreased the clinical nurse turnover rate to 4.9%, and the overall employee turnover rate to 5.6%. One of the first hospitals in the country to focus on workforce diversity over 25 years ago, this year YNHH enhanced its strategic diversity and inclusion work, , and is aligned with the Connecticut Hospital Association’s statewide diversity collaborative and new Connecticut legislation regarding discrimination related to gender identity and expression.

    The Career Development Office helped hundreds of employees further their educational and career goals within the hospital, by offering individualized career counseling, assessment and workshops, internet based career development resources and on-site college fairs for various work schedules. In addition, the Office managed the Tuition Loan Forgiveness Program for 15 employees. The Hospital continued to invest in benefit programs for the physical, emotional and financial wellness of its employees, including an Employee and Family Resources program, financial wellness programs, with confidential financial counseling and volunteer income tax assistance, an employee hardship fund, a Home Ownership Made Easier Program and scholarships for both employees and their children. The popular Performance Incentive Program paid eligible employees 2.23 percent of their annual salary for meeting specific hospital business plan goals this year.

    Results of an updated employee engagement survey ranked YNHH in the 93rd percentile nationally, which placed it in the top 10% of all organizations surveyed. Action plans were developed and implemented to address issues raised in the survey. Early in the Fall, a survey update was conducted, along with a new cultural values assessment to support the integration of YNHH and the Hospital of Saint Raphael, as well as to integrate the cultures throughout the Health System.

  • Financial Performance

    Hospitals and Health Systems across the nation are facing unprecedented financial pressures. While Yale-New Haven Hospital and Yale New Haven Health System have weathered the storm better than most, the pressures remain real and pressing.

    Given the difficult environment, the Hospital’s financial accomplishments this year were remarkable – YNHH ended the year with a 6.1 percent operating margin, in large part due to significant volume growth, managed care contracting and revenue cycle initiatives. The Hospital achieved positive operating and financial performance this year, as it has for the past 30 years, by adhering to comprehensive business plans, which define the approach to and execution of key strategies aimed at anticipating and/or responding to health care market place changes.

    YNHH’s continued strong patient volume growth, and financial and operational performance, YNHH has been able to maintain healthy financial ratings and is in a good position to absorb its debt related to financing the Hospital of Saint Raphael acquisition.

    However, we recognize that we no longer just rely on growth to address the real pressures facing all hospitals. That is why Yale New Haven Health System launched a comprehensive review of its current costs across each of its delivery networks in anticipation of significant shifts in the way hospitals will be reimbursed in an era of health care reform. We clearly understand that reimbursement for the services we provide will continue to decline in reaction to overall cost pressures within the industry. We have been fortunate to lay the groundwork for driving down our cost structure. It has better prepared us for the significant cuts that have already been announced and more cuts that will surely define the months and years ahead.

  • Community Service

    As in past years, the Hospital provided a significant amount of uncompensated care (including charity care, free care and bad debt) totalling $115.5 million.

    In addition to the provision of free and charity care and expenses associated with under reimbursement from Medicaid, YNHH provides on-site application assistance for public programs and guarantees access to care through its Primary Care Centers. YNHH provided nearly $8 million in community health improvement services, including health education programs, support groups and health fairs, and an additional $460,000 to support the work of dozens of local not-for-profit organizations unaffiliated with the hospital.

    As part of its mission to promote health and wellness throughout the region Yale-New Haven Hospital sponsors, develops and participates in a wide variety of community-based programs and services. YNHH managed nearly $220 million in financial and in-kind contributions through five wide-ranging programs – access to care, health and wellness, healthcare careers, healthier communities and stronger neighborhoods.

    This year, YNHH took part in a community health needs assessment through a community coalition that includes the New Haven Health Department, Fair Haven Community Health Center, Cornell-Hill Scott Health Center, Project Access, DataHaven and the Yale School of Public Health’s Community Alliance for Research and Engagement.

    The Hospital provides the clinical setting for undergraduate training to allied healthcare students in nursing, dietary, physical and occupational therapists, social work, radiology and respiratory care. YNHH donated $200,000 as part of a multi-year $500,000 commitment to support the Gateway Community College nursing suite and $100,000 as part of a multi-year $500,000 commitment to support the Connecticut Center for Arts and Technology, which will annually train 100 local unemployed and underemployed adults in phlebotomy, medical coding and billing. YNHH sponsored and completed two more new Habitat for Humanity homes in the Hill neighborhood this year. Since 2008, YNHH has provided $275,000 in sponsorship for six Habitat homes.

  • 2012 Awards
    Magnet designation, American Nurses Credentialing Center
    America's Best Hospitals, U.S. News & World Report
    America's Best Children's Hospitals, U.S. News & World Report
    206 Top Docs, Connecticut Magazine
    51 Best Doctors, New York magazine
    100 Most Wired Hospitals Award, Hospitals and Health Networks magazine
    100 Best Places to Work in Healthcare, Becker's Hospital Review
    Top 50 Companies and 10 Nonprofits for Executive Women, National Association for Female Executives
    Best Workplaces for Commuters, National Center for Transit Research
    Leadership Award for Sustainability Excellence, VHA
    Making Medicine Mercury-Free award, Practice Greenhealth
    Award for Excellence in Life Support, Award for Excellence in Life Support Extracorporeal Life Support Organization (ELSO)
    Level 4 Epilepsy Center recognition, National Association of Epilepsy Centers (NAEC)
    Advanced Primary Stroke Center recertification, The Joint Commission
    LEED® (Leadership in Energy and Environmental Design) certification for Smilow Cancer, U.S. Green Building Council
    Breast Center at Smilow Cancer Hospital, three-year full accreditation, National Accreditation Program for Breast Centers (NAPBC)