Collaboration Councils Update August 2016

August Joint Meeting of System-Wide & Facility-Based Collaboration Councils Advances Goal of Improving Quality Care and the Patient Experience Through Increased Engagement Between Front-line Doctors and Administration:

Vital Importance of Collaboration Councils to Health + Hospitals Strategic Restructuring/Transformation Plan and Vision 2020 Noted

New York City Health + Hospitals President/CEO, Dr. Ram Raju, addresses the over 200 attendees at the Doctors Council SEIU and NYC Health + Hospitals Joint System-Wide and Facility-Based Collaboration Councils meeting of frontline doctors and administrators.

The staff of Baruch College had to wheel in more chairs for the overflow attendance at this first-ever joint meeting of executive leadership and Doctors Council members from all NYC Health + Hospitals facilities held in August. More than 200 doctor leaders came together to take stock and learn from one another at this most critical time in the history of public health in New York City.

While the attendees received passionate support from Deputy Mayor for Health and Human Services, Dr. Herminia Palacio and NYC Health + Hospitals President/CEO, Dr. Ram Raju, the centerpiece of the afternoon was reports from every Facility-Based Collaboration Councils (FBCCs) on their projects and progress to date.

Dr. Raju remarked: “The patient-doctor relationship is the key. All transformation must involve the doctors. We are moving in the right direction on patient experience. We can and must make progress in this measure so that we can get the market share and make the finances work. We take care of the most complex patients with limited resources. We are unique and special. We can combine social justice and health care. We solve social problems as we work.”

(Above) Deputy Mayor of Health & Human Services, Dr. Herminia Palacio, addressing the meeting of doctors and administrators.

Dr. Herminia Palacio, Deputy Mayor for Health and Human Services who grew up in the Bronx and trained at Elmhurst, thanked all participants for their dedication to the improvement journey we are all on. She said,

 

“To see this partnership between the Union and management to focus on the quality of the relationship between doctors and patients is what is necessary to achieve the transformation underway to achieve financial stability, transform quality, and eliminate inequity. We cannot be successful without the types of partnerships in this room.”

(Above) Frank Proscia, M.D., President of Doctors Council, addressing the meeting and noting how Doctors Council works with NYC H+H on the Collaboration Councils, as well as in many other ways, such as advocating for more funding from the federal, state and city governments.

Dr. Frank Proscia, Doctors Council President noted “Our members are mission driven.  We must evolve and we must transform.  Funding is drying up from federal and state levels.  Safety nets are the greatest battle.  Today’s funding is tied directly to clinical outcomes including patient experience scores.  The ACA is a positive improvement and it gives our patients the right to take their portable coverage and go anywhere.  We must garner more patients. We must improve quality of care and the perception of that care.”

The journey that began in just February of this year has shown that doctor engagement is increasing through the patient-centered focus of each of our Collaboration Councils.  Active participants in Collaboration Councils from across the system learned from one another how each facility is developing their improvement projects which are designed to improve the experience of our patients.

Each project was presented in a consistent format framed by the Institute for Healthcare Improvement (IHI) Model of Improvement which asks three foundational questions:

  • AIM | What are we trying to accomplish?
  • MEASURES | How will we know a change is an improvement?
  • CHANGE | What change can we make that will result in an improvement?

All of our Councils are using this approach and the learning tools from IHI which foster collaborative reflection on relevant data, collaborative brainstorming, collaborative decision-making, and collaborative execution.

(Above) Joint frontline provider and administrator teams from all Health + Hospitals patient care sites, including hospitals, community based health centers and skilled nursing homes presented the progress being made on their first projects during the meeting. Here, the NYC H+H/ Bellevue Hospital FBCC team was represented by (L to R) Dr. Nate Link, CMO and Doctors Council members Drs. Caralee Caplan-Shaw and Sarah Williams (speaking at podium).

Facility Based Collaboration Councils proudly reported on improvement projects which include, by way of example:

  • Reduce waiting times
  • Reduce errors in paperwork which delays transport
  • Reduce cycle time
  • Improved communication between doctor and patient and patient family
  • Enhance health literacy of patients
  • Improving the time from decision to admit  in the ER to placement in hospital bed

All of these projects and many that are similar have clear data-driven goals within the framework of our Press Ganey scores.  However, most all of the projects have established facility-based metrics which are designed to assist the Councils in seeing results quickly so as to be able to expand success.  The expectation is that these changes will impact improvement in our publicly reported scores in patient satisfaction.

Another very significant part of each Facility-Based reports indicated that a new culture of collaboration is developing.  Doctors Council SEIU 2nd Vice-President Dr. Acyan Turkmen remarked that, “Culture trumps strategy…and we are building a culture of joint responsibility, joint learning, and joint planning.  In so doing, we will see the culture emerge that will accelerate improvement. “

Dr. Turkmen’s remarks were echoed later by our guest keynote speaker Dr. Jack Cochran, former Executive Director of the Permanente Federation, former President and Executive Medical Director of the Permanente Federation in the Colorado region of Kaiser Permanente, and  author of the book  The Doctor Crisis:  How Physicians Can, and Must , Lead the Way to Better Health  Care.  Dr. Cochran spoke about how to transform a large health care system and the leadership role doctors have and stated, “we can’t treat our way out of the crisis; we can’t grow our way out of the crisis:  we have to learn our way out of the crisis.”

Dr. Jack Cochran, former Executive Director of the Kaiser Permanente Federation, delivers a keynote address before the joint SWCC and FBCCs, discussing the importance of doctors leading the way for organizational change.

Attendees left the meeting excited that the Facility-Based Collaboration Councils (FBCCs) are starting projects to improve quality care and the patient experience through increased engagement between frontline doctors and administration. We know that this work is vitally important to H+H’s strategic restructuring/transformation plan and Vision 2020. The FBCCs meet monthly and are comprised of one Doctors Council member from each department and administration leadership, such as the CEO, CMO, COO, CFO and others.

To read the reports and learn about the projects of each FBCC and for a list of Doctors Council members and H+H administration on the System-Wide CC and each Facility-Based CC, click here.

Have ideas or suggestions for a project in your department or for your facility? Want more information on or to be involved in the Collaboration Councils?

E-mail info@doctorscouncil.org and be part of the solution!

 

This Sunday–Help Save H+H & Our Safety Net Hospitals at Harlem Fair

SAVE OUR SAFETY NET HOSPITALS
Support the Enhanced Safety Net Bill!

New York City Health + Hospitals and safety net hospitals throughout the state face a significant financial crisis. Low-income communities and immigrant communities already struggle to access health care in their neighborhoods. Overcrowded emergency rooms and hospital closures are taxing both patients and healthcare providers. Many of these community hospitals do not receive adequate funding based on the number and type of patient population that they serve. New York State has the opportunity to change that with a bill that has passed the State Legislature and is awaiting signature from Governor Cuomo.

The bill would create a true definition of safety net hospitals so that an enhanced Medicaid rate will be available to those hospitals that meet the criteria and truly provide care for Medicaid and uninsured patients. Healthcare workers and community allies are standing together to show support for this bill, to educate our friends and neighbors, and to advocate for the necessary funding to provide the quality healthcare that our communities deserve!

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Doctors Council Member Honored at Friends of Harlem Hospital Center 7th Annual Golf Tournament

On Monday, August 15, 2016, Doctors Council member Dr. Aubrey G. Clarke, was honored with the Distinguished Healer Award at the Friends of Harlem Hospital Center 7th Annual Golf Tournament. Dr. Clarke is a leading cardiologist who has served the Harlem Community for many years and presently works as an attending physician in the department of Medicine and Associate Chief of the Division of Cardiology and Physician in Charge of the Coronary Care Unit.

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Considered a pioneer in the design and implementation of Primary Care Models, Dr. Clarke was the Medical Director of the Sydenham Neighborhood Family Care Center and was intricately involved in the planning and development of the diagnostic and treatment center which later became the Renaissance Health Care Network. In fact, the Renaissance Health Care Network was the name that Dr. Clarke proposed to the Community Advisory Board which was subsequently approved by New York City Health + Hospitals.

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The Friends of Harlem Hospital Center Annual Golf Tournament raises funds to directly support patient care prgrams and services at Harlem Hospital Center, notably contributing over $114,000 in January 2016 for the replacement of diagnostic and surgical equipment in the Ophthalmology Clinic.

Other honorees at this year’s tournament included New York State Assemblyman Hon. Keith Wright, the Rev. Tawan W. Davis, and community leader Corwin J. Breeden.

The Unhealthy State of Equal Pay for Women in Medicine Continues

A recent study in JAMA Internal Medicine confirms that women physicians still make less than their male counterparts.  We explored this issue in a previous post, and unfortunately little has changed.

The study in JAMA Internal medicine by Dr. Jena et al concludes:
“We analyzed sex differences in salary between male and female academic physicians at 24 US public medical schools using contemporary administrative salary data of state employees made publicly available online by state governments. After adjusting these analyses for physician age, years of experience, specialty, faculty rank, several measures of research productivity, and payments by Medicare (information obtained from a comprehensive database of US physicians), we found that annual salaries of female academic physicians were 8.0% ($19879) lower than those of male physicians. This difference represents 38.7% of the unadjusted difference in salary between men and women.

An accompanying editorial by Dr. Arora in the journal points out that “Although the profession of medicine achieved gender equity with equal representation in medical schools’ admissions, we are faced with one of the largest pay gaps between sexes among professionals. It is particularly alarming that the gender pay gap among physicians appears to be widening.”

In a New York Times article highlighting the survey  Dr. Molly Cooke, a professor of medicine at University of California, San Francisco comments that “It’s 2016, and yet in a very methodically strong, large study that covers a broad swath of the country, you’re still seeing at the very least a 10 percent difference in what men and women take home.”

The study found that the gender gap was greater in some disciplines than others. As the New York Times article summarizes, radiology is the only department where women are paid more.  The surgical specialties show the greatest gender variation.  “The average pay gap between female and male orthopedic surgeons was nearly $41,000. The difference was about $38,000 among oncologists and blood specialists, about $36,000 among obstetrician-gynecologists and $34,000 among cardiologists.”

As a union we believe that salaries should be transparent and openly negotiated.  While this would clearly not solve the problem it would go a long way to bringing the salary differences into the light.

Doctors Address Racism

 

“We are doctors and medical students who witnessed the events of the week of July 4th, 2016 with horror and grief. The murders of Alton Sterling in Baton Rouge, Louisiana, Philando Castile in St. Paul, Minnesota and Delrawn Small in Brooklyn, New York reiterated a lesson that we should not have to keep learning: that black and brown people in the United States are at risk of police violence unlike any other group of people. There is a long tradition of physician-activists who have devoted their careers to working for racial justice. Yet historically, physicians as a group have not yet taken adequate responsibility for confronting racism, in our work or outside of it. “

This is the beginning of a  “Letter to our Patients on Racism”  signed by 1492 (as of our last count) doctors.  They make 5 commitments to their patients

  1. “We commit to support Black Lives Matter
  1. “We commit to dismantling the structural racism embedded in the healthcare system.”
  1. “We commit to learn how to provide trauma-informed care, and to teach this approach to our students, trainees, and fellow providers.”
  1. “We commit to healing communities ravaged by discriminatory criminal justice practices through engaging public health systems.”
  1. “We commit to using our power as constituents and leaders to insist that every major medical society and association develop a policy on racial justice.”

The letter links to an impressive range of scholarly sources documenting the role of racism both as an underlying cause of health disparities as well as the role of racism in health care it self.

As a union we  have always called for a collective response from doctors for racial justice.  We applaud the letter and urge more Doctor Council members to sign on.

 

 

 

How Best To Address Healthcare Disparities?

While there has been increasing attention on Healthcare Disparities  and more centralized thinking on how to address these disparities, the problem still remains.  In New York City a recent conference marked the launch of the NYC Coalition to Dismantle Racism in the Health System.

Doctors Council is part of this group whose goal is “to equip health professionals (in all sectors: community health activists/CBO, social work, public health, medicine, health policy, academic medicine) with the tools to address racism and eliminate inequities in the health system in NYC.”

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Doctors Council SEIU Letter to U.S. Senator Chris Murphy, Conn. on Gun Control Measures

June 17, 2016

United States Senate
Washington, D.C. 20510

Dear Senator Murphy,

Doctors Council SEIU applauds your efforts on the Senate Floor to demand the Senate
take up a variety of gun control measures. We especially support the amendments
expanding background checks on all gun purchases and making it more difficult for
individuals being monitored for terrorism activity to purchase firearms.

As the union representing doctors in New York City’s and Chicago’s public hospitals
and correctional facilities, we recognize that gun violence is a public health problem
that kills 90 Americans a day. Doctors are witness to the aftermaths of shootings every
day. Assaults involving firearms are consistently more deadly than those with other
weapons. Our emergency room doctors are seeing more and grislier gun injuries and
fatalities in recent years, in part due to semi-automatic rifles like the one used in
Orlando.

The failure of Congress to pass gun control measures has been particularly
disheartening especially with so many horrific mass shootings in recent years. Gun
violence is increasingly damaging our communities and leaving not only physical scars
but emotional and psychological scars on families.

We support your commitment to putting people over politics and we encourage the rest
of Congress to do the same.

Strengthening our gun laws and closing loopholes in the background check system can
help prevent lethal hate crimes and acts of terrorism in the U.S. like the horrifying mass
shooting in Orlando.

We also strongly support gun violence prevention through research, education and
advocacy. We must continue to push to allow federally funded research to study gun
violence like any other public health issue.

We urge your colleagues to vote yes on the Murphy and Feinstein amendments to the
Commerce-Justice-Science appropriations bill.

Thank you for your continued leadership on this issue.

Sincerely,

Frank Proscia, M.D.
President, Doctors Council SEIU

CC: Senate Majority Leader McConnell
Senate Minority Leader Reid
House Speaker Ryan
House Minority Leader Pelosi
Senator Schumer
Senator Gillibrand
Senator Durbin
Senator Kirk