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In This Issue:
To kick off the New Year, BWH President Gary Gottlieb, MD, MBA, sat down with BWH Bulletin to reflect on 2008 and look to the year ahead. He enthusiastically recounted several contributions of individuals, dozens of accomplishments by BWH teams and major milestones achieved by the entire hospital community. With enormous pride, he spoke about the transformation of the main campus, research and clinical care breakthroughs and successes in reducing health care disparities. With great confidence, Gottlieb discussed how BWH will face challenges of an uncertain economy in 2009 without wavering from the hospital’s commitment to excellent patient care, groundbreaking research and education and training for tomorrow’s clinicians.
Q: As you reflect on the hospital’s achievements in 2008, what comes to mind?
A: 2008 was a special year for us. Opening the Shapiro Cardiovascular Center allowed us to transform the campus and offer the community a wonderful facility that offers the most collaborative and comprehensive cardiovascular care anywhere. It was a monumental task, which, thanks to the hard work of so many, we completed on time and on budget, moving patients from the Tower to the Shapiro Center with the utmost safety.
Last year, we also started a number of focused efforts to reduce health care disparities, including a major effort to reduce infant mortality and low birth weight outcomes in the communities we serve.
It was a successful year as well in terms of workforce development efforts and the hub that we established through the community recruitment office. The Huntington Avenue location enabled us to recruit and retain a greater number of people from our local community. We also reinforced the existing pipelines for Workforce Development to fulfill ongoing staffing needs across our distributed campus, including the Shapiro Center, Foxborough, 850 Boylston St and the neighborhood health centers.
On the research side, the BRI continues to grow as a comprehensive and coordinated research enterprise, and the inter-departmental and inter-disciplinary programs that we’re building have expanded. We are increasing our support for investigators and fostering a vibrant research community to help our young scientists advance. And with the new Molecular Diagnostics Lab in Pathology, we are moving quickly to translate science to the bedside and create a platform for personalized medicine.
In 2008, we recruited a new chair of Psychiatry, which further strengthens our commitment to the neurosciences. In David Silbersweig, MD, we have one of the world’s leading neuroscientists. His position as chief of Psychiatry and the head of our Institute for the Neurosciences helps us truly focus on all elements of neuroscience to better understand and treat disease.
We also made significant investments in imaging, including building the cyclotron, renewing our MR fleet and, as I mentioned, opening the advanced molecular diagnostics lab in the Shapiro Center. These investments enable us to better categorize illness, understand the mechanisms of disease, create the best paradigms for treatment and ultimately improve care.
Additionally, building up our major centers and programs of the BRI has created greater collaboration and new projects. We are a fundamental piece of the Harvard Catalyst, the very large NIH-funded initiative that spans Harvard Medical School and its affiliated teaching hospitals. The Catalyst brings together our General Clinical Research Center Program (GCRC), the largest of the Harvard GCRCs, with the other hospitals’ GCRCs. This creates a broader opportunity for faculty to embark on new areas of investigation and bring together data from across institutions to improve the quality and efficiency of research.
On the teaching side, we moved forward with Harvard Medical School to enhance undergraduate medical education. The Principal Clinical Experience run by our director of Medical Student Education, Erik Alexander, MD, and leaders from each of the other departments, has been tremendously well received by students. And Jonathan Borus, MD, former chair of Psychiatry, now serves as overall director of Medical Education, with a focus on post graduate education.
We celebrated achievements in patient satisfaction, too. For the first time, we ranked in the 90th percentile of 500-plus bed teaching hospitals. That’s a wonderful reflection of our staff and our improved facilities and food and room service. Now we’ve begun measuring ambulatory patient satisfaction, too.
We’re not resting on our laurels. There’s more we need to do to ensure—universally—the highest patient satisfaction possible.
Q: How will ongoing economic challenges affect BWH?
A: Now that we’ve changed the campus, we must manage – with the highest degree of quality and efficiency for our patients and support for our staff – a bigger facility with broader reach, both locally and in the suburbs. And we must be proactive amid an uncertain economy. Both the Brigham and Partners are stable financially, but at the same time, the economic conditions will affect us as they affect everyone else. Our reimbursements are directly related to the economy, employment levels and government resources. We’re already feeling the first round of cuts from the State to our Medicaid reimbursements, and a second set of State budget cuts are planned.
On the federal side, there could be some benefits within the stimulus package, perhaps in support of science and other elements of infrastructure, such as electronic medical records. However, countering that, it is also likely we will see reductions in Medicare reimbursements to BWH for patient care.
Q: How are we prepared to deal with economic uncertainty?
A: The economy puts a burden on all of us to figure out how to be more efficient. Every resource we have is precious, and we need to use those resources in service of our patients and our mission. We must be as skillful as possible about standardizing best practices to improve our performance and efficiency using tools, such as the lean projects highlighted last year in Bulletin. Technologies and tools like that will help ensure that all our patients get the right care at the right time.
Additionally, Massachusetts health care reform and the resulting changes in health policy increase the demand for accountability in terms of costs. We must lead rather than react by proving that what we do is always in service of our mission and our patients.
Q: Last year saw the opening of the Shapiro Center and the Dana-Farber/Brigham and Women’s Cancer Center in Milford. What changes to the distributed campus are in store this year?
A: Next month, we open the Brigham and Women’s/Mass General Health Care Center at Foxborough, and later this year, the Dana-Farber/Brigham and Women’s Cancer Center with South Shore Hospital. Our investments in the community enable us to bring the care that we offer here in Boston closer to where people live. By providing our expertise to our patients in their community, we reduce their need to travel a long a distance for diagnosis and treatment.
Q: As a new U.S. president takes office, health care reform is high on his list of initiatives. What recommendations would you make to improve care and reduce cost?
A: We need to make sure everybody is included and has access to appropriate health care. That means having the right kind of care available and eliminating barriers to access.
I think we’ve started down that track in Massachusetts. One of the challenges around health care policy is that very sick people end up consuming the most expensive and largest proportion of health care resources. As we begin to focus more on national health care reform, we must be sure that the overall goal is to improve function and prevention and optimize population health.
Q: You traveled to Africa last year and visited some of the Partners In Health clinics in Rwanda, where our faculty, residents and nurses are providing care. What struck you most about the facilities, our clinicians and the patients?
A: We have exceptional, tremendously dedicated and thoughtful people who bring experience, dedication and knowledge that isn’t otherwise available in that environment.
The patients we serve in these areas live in abject poverty and extreme need as a result of the long-term effects of genocide, lack of preventive care and adequate supplies of medications and food. The PIH model brings tremendous hope by training and paying members of the community to be health workers. As such, they extend services to people who wouldn’t otherwise receive them, including daily visits to people who are HIV- and tuberculosis-infected and monthly visits to everyone else in the local health district.
The fact that our physicians, residents, nurses and others are going there and to other places in need around the world will inspire yet another generation to follow this calling while improving the quality of care remarkably.
PIH’s partnership with local people, physicians, nurses, health workers and government has reflected enormous change over a short period of time with regard to the quality of care, and access to services.