ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
February 23, 2006

2005 YEAR IN REVIEW

Before my appointment as President one year ago, I had served in a number of different roles within HHC and thought I knew our organization quite well. Yet, the last twelve months have left me more impressed than ever with the talent and commitment of our staff at every level. I have seen talent and commitment expressed in a hundred different ways, often in innovative programs that I did not even know existed. But also in less dramatic ways that seem infinite in expression. There is the Korean surgeon who has learned to speak fragments of many different languages, including Yiddish, so that he can better put his anxious patients from diverse backgrounds at ease. And the pediatrician working in the cramped, archaic space of a child health clinic who regularly works extended hours to see all of the patients drawn to her each day because her deep engagement and evident compassion more than makes up for the shortcomings of her physical space. And the many nurses, physicians, clerks and other staff who immediately volunteered for deployment to the ravaged Gulf coast in the wake of Hurricane Katrina.

I am more convinced than ever that fully engaging front-line staff is the key to achieving care that is increasingly effective, efficient, patient-centered and safe. All that we do in our hospitals, nursing homes, community sites and in central office must link back to those four key concepts – effective care, efficient care, patient-centered care and safe care.

Over the last year, we have continued to learn how to harness talent, experience and commitment to accelerate improvements in the way that we serve and care for patients. We have done it through highly collaborative front-line teams from across our system who share their best ideas, their most frustrating challenges, their successes and their disappointments as they struggle to reinvent how we serve or care for patients. We call these re-engineering groups that engage in shared learning “redesign teams” when they focus on process redesign or “clinical collaboratives” when they focus on the redesign of patient care. Encouraging, supporting and expanding this radical improvement work has been an important focus of central office activity over the last year.

Here’s some of what has been accomplished.

Driving radical improvements through collaborative, patient-centered redesign initiatives
Our ambulatory care redesign teams have dramatically reduced patient-waiting times in our primary care clinics from an average of nearly two and one half hours to an average of 60 minutes. We have begun the challenge of re-engineering our appointment scheduling process so that we can offer patients much more timely appointments, while simultaneously keeping them linked to the same primary care provider. This redesign to ensure greater continuity of care is essential to the strong relationships that enable us to engage patients as active partners in the management of their health. 

On the clinical collaborative front, we have teams creating and implementing effective chronic disease management strategies in partnership with our patients to fight diabetes, asthma, congestive heart failure, depression and other serious chronic diseases that disproportionately plague our patients and communities. We are now spreading the promising work of these pilot teams to a broader base of providers and patients. To aid this work, we have made available to every one of our facilities a web-based computerized monitoring tool - known as an electronic disease registry – that is populated with clinical data fed from our electronic medical record. The e-registry helps physicians closely monitor and improve care for their diabetic patients and ultimately can be used as the foundation for more effectively addressing other chronic disease as well. We now have more than 17,000 diabetic patients in the electronic registry and plan to track and treat 45,000 adult diabetics through this e-registry by June 30, 2006. We already have promising data from our pilot sites that confirm the potential to improve the health of diabetics through the consistent use of the e-registry. 

In addition to the promising work of our chronic disease collaboratives, we have teams working together to advance patient safety in our Intensive Care Units and Operating Rooms by reducing the number of preventable infections that arise from central lines, ventilator dependency and surgery, reducing the incidence of dangerous deep vein blood clots, and improving the management of life-threatening blood-borne infections and sepsis. We are beginning to see outcome data at individual hospitals that is hopeful, including a full year at Woodhull Hospital without a single case of ventilator-acquired pneumonia in its ICU, and during the last year a statistically significant decline in overall hospital mortality across our system. Several of our hospitals will soon be ready to launch rapid response teams that will be available to expeditiously assess patients outside the ICU who show subtle signs of deterioration that are often precursors to imminent cardiac arrest, effectively allowing us to “rescue” these patients before they code. And we have begun extensive training around suicide prevention across all inpatient, outpatient and long-term care settings. 

Much of our work in our clinical collaborative centers on the unfailing implementation of evidence-based practices that improve patient outcomes. This focus on the consistent implementation of effective, evidence-based clinical practices has raised our quality of care demonstrably. In fact, recent federal and state quality assessments ranked five HHC hospitals among the top 10 hospitals in NYC in each of three categories of care – pneumonia, heart attack and heart failure. Even more remarkably, five HHC facilities are in the top six ranked best in the prevention of surgical site infection. Mayor Bloomberg has been quoted saying that the poor often get treatment that is better than the rich in this City, thanks to our extraordinary public hospital system. Now there is objective quality data to back up that high praise.

One key dimension of quality is patient safety - which must be our first priority. Hospitals are extraordinarily complex environments that present real risks to our patients despite our best intentions and we must do everything possible to keep them safe. I shortly will ask all HHC employees to join me and our senior leaders in creating a true culture of safety throughout our organization – a culture that encourages and supports the timely reporting and thorough analysis of all medical errors, including “close calls” that do not cause actual patient harm, so that we may learn from our mistakes and hardwire our systems for safety. Patient safety will be my highest priority and one that I will champion in a variety of ways over the course of this year and beyond. I take personal responsibility for every preventable patient injury that occurs in our facilities and I will ask every senior leader across the system to do the same. With the help of our senior administrative and clinical leaders at each facility, we will focus relentlessly on making changes in the way we work, communicate, coordinate care and use technology so that our patients are as safe as possible. 

Increasing access, reducing healthcare disparities
As we focus on making our care more safe, effective, efficient and patient-centered, we will strengthen our commitment to making our care more equitable. A fundamental tenet of HHC is our vow to serve everyone who comes through our doors regardless of their ability to pay. Another is lowering barriers to access by rendering care that is culturally sensitive and linguistically appropriate. And this past year we strengthened our capability by extensively training nearly 200 bilingual staff and volunteers in medical interpretation.

But equitable care is not just about increasing access; it is also about addressing healthcare disparities. Along these lines, we have increased awareness and availability of critical health screenings. This past year we again doubled the number of colonoscopies performed, after a doubling in the prior year, and in the process we are saving lives. We performed more than 70,000 mammograms and more than 180,000 cervical cancer screenings. Our smoking cessation clinics helped thousands of our patients kick the habit during the last year, significantly reducing their risk of cancer, heart disease and stroke. We have added two new cardiac cath labs this past year, and will open yet another next month, as part of our commitment to more aggressively confront the burgeoning presence of cardiovascular disease in our communities.

On another front where our patients of color are disproportionately at risk, we have begun incorporating HIV testing into routine care. By using rapid testing and streamlined pre-test counseling, we are steadily broadening our capacity across all levels of care to identify more patients with undiagnosed HIV disease and to link these patients with care earlier when treatment is most effective to improve health and prolong life. This year we expect to increase by 60% the number of patients tested for HIV.

Using cutting-edge technology to drive safety, effectiveness and efficiency
HHC has been leading the way in the use of information technology to make care more safe, effective and efficient. We have continued to add state-of-the-art functionality to our clinical information system, like our new e-registry to better manage care and electronic medication administration to further reduce the possibility of medication errors. We have embedded an electronic depression screening tool as well as an electronic asthma action plan into our EMR, and both will roll out to our facilities over the course of the next few months. Later this year, we will begin installing on a pilot basis an entirely new EMR module customized for the fast-paced and demanding environment of our Emergency Departments with documentation on wireless tablet computers. At the same time, we are continuing to expand our e-commerce system to streamline and make more cost-efficient our previously laborious and paper-intensive purchasing process.

Reinvesting strategically to guarantee we can serve future New Yorkers
Modernization of our infrastructure is vital if we are to remain competitive, increase efficiency, and continue to improve care for our patients in an optimally therapeutic environment. Our ambitious five-year $1.3 billion building program is designed not only to offer patients a comfortable, healing environment that reflects our patient-centered approach, but also to help us continue to recruit the best and brightest nurses, doctors, technicians, administrators, and other staff by offering them state-of-the-art facilities mirroring the state-of-the-art care that we are providing our patients. We have now completed the rebuilding of four facilities and seven major rebuilding or expansion projects are in progress. Before the year’s end we will initiate formal design plans for two more major modernization projects.

Ensuring the financial stability that is essential to sustaining our mission
Our commitment to provide quality care to all regardless of ability to pay remains at the core of our mission and at the core of our current serious financial challenges. Caring for 1.3 million New Yorkers, including more than 450,000 who have no insurance, is an expensive and daunting task. Under our HHC Options initiative, we have extended the reach of our sliding fee scale to make healthcare affordable for uninsured patients with incomes up to 400% of the federal poverty level. Increasingly, the cost of our activist agenda and our extensive ambulatory care network is outpacing available revenues. Senior management and facility staff are working closely to make sure we get paid for all of the services we provide, to maximize legitimate collections, reconfigure service delivery for efficiency, and otherwise help us to find ways to use our resources more productively.

The Governor has again proposed budget cuts which, if enacted, would devastate our system’s ability to provide vital services. Over the coming weeks, we will join with our allies in labor and in the community, as well as with other healthcare institutions, to advocate that the State Legislature reject the Governor’s proposed Medicaid cuts that threaten to drain at least $140 million from our operating budget at the same time that potential cuts in federal funds are looming. We will do all we can to advocate against these cuts and articulate a clear picture of how they would damage the health of our communities. We will also advocate strongly for an increase in the Medicaid reimbursement rates for emergency and other outpatient care, which have been frozen at a fraction of true cost for more than 15 years.

I look forward to working with all of you to overcome these challenges, and to continue moving aggressively ahead toward the model safe, efficient, effective and patient-centered healthcare delivery system that our patients need and deserve.

I hope you share my pride in what has been accomplished over the last year and my confidence in the achievements still to come.

CAPITAL IMPROVEMENTS

I am pleased to report that the Corporation’s major modernization projects at Kings County Hospital Center, Harlem Hospital Center, Queens Hospital Center, and Jacobi Medical Center are progressing.

Construction work to renovate the existing “E” Building for outpatient services at Kings County Hospital is proceeding towards completion. The new main lobby is partially open for patient access. The balance of the Outpatient Building renovation is scheduled for substantial completion in March 2006, with phased occupancy through the spring.

Superstructure construction work has been completed for the new 300,000-square-foot, Behavioral Health Care Center at Kings County Hospital. Pre-cast panel installation will begin in mid-April 2006. The new building will house behavioral health emergency care services, 230 inpatient beds, and behavioral health ambulatory care services.

Schematic design development for the $243-million modernization project at Harlem Hospital Center is proceeding towards completion. This new project will renovate the existing Martin Luther King Pavilion and construct a new pavilion on Lenox Avenue to connect the Martin Luther King Inpatient Care Pavilion to the existing Ron Brown Ambulatory Care Pavilion. The new pavilion will include a new emergency department, operating rooms, diagnostic and treatment services, a critical care suite and a modern radiology center. Conservation work on the existing historic WPA art murals continues in progress.

At Queens Hospital Center, the 142,000-square-foot, five-story ambulatory care pavilion continues in progress. Installation of the exterior pre-cast panels and glass curtainwall is substantially complete. Bridge steel erection is substantially complete. Interior construction work is in progress on all floors. Linked to the existing hospital, the new facility will provide outpatient services for behavioral health, primary and specialty clinics, and a diabetes center.

Structural steel erection and metal decking continues on Jacobi Medical Center’s new 120,000-square-foot Ambulatory Care Pavilion. Structural steel is scheduled for completion in the next few days. The new four-story facility will provide outpatient services, including general medicine, surgical sub-specialties, pediatric care and women’s health care services. 

BLACK HISTORY MONTH

On February 6th, Mayor Michael Bloomberg hosted a reception at the Malcolm X and Dr. Betty Shabazz Memorial and Educational Center in honor of Black History Month. Six New York City Agencies including HHC, were asked to nominate employees in their respective agencies to be recognized for outstanding public service at the reception. The Mayor presented awards to each nominee in recognition of their outstanding public service. 

For HHC, Dr. Donna Copper from Queens Hospital Center was nominated and honored. Dr. Copper is a well-respected pediatrician who has been part of the fabric of the southeastern Queens community for twenty years. She began her career as an Assistant Attending physician in Pediatrics with Queens Hospital Center in 1986 and has remained an integral member of HHC's Queens Health Network by devoting her practice to patients in the South Queens Community Health Center and more recently, the Springfield Gardens Family Health Center, two of Queens Hospital Center's off-site facilities. Her unusual dedication and demonstrated compassion for the children in her care have led many parents to retain her services long after their children reach adolescence, often following her from one location to another. 

Dr. Copper is a shining example of the compassionate and dedicated individuals who make up HHC and she personifies what HHC's mission and spirit is all about. I know that you will all join me in congratulating Dr. Copper on her award. 

IMAGES OF COLOR

The NYC HHC Art Collection and Bellevue Hospital Center are proud to present Images of Color: Highlights from the New York City Health and Hospitals Corporation's Art Collection from February 23 through March 16, 2006. Images of Color is an exhibition of works of art in celebration of National Black History Month and the 70th anniversary of the HHC Art Collection. It includes international masters of 20th century African American Art, Romare Bearden, Jacob Lawrence, Emma Amos and others, and also features works by some of New York City's own emerging artists. The opening reception is this evening (February 23rd) from 5:30 pm-8:00 pm at Bellevue Hospital Center's Atrium.

I hope everyone will have the opportunity to visit this exhibit and see first-hand these exceptional works of art.

LICENSED PRACTICAL NURSE (LPN) CAPPING CEREMONIES

In January, 40 HHC employees from twelve facilities were part of capping ceremonies held in Manhattan and Brooklyn as part of the Corporation's initiative to offer current HHC employees the opportunity to be trained for new careers as Licensed Practical Nurses. This is a win-win program that provides career opportunities to employees and meets HHC’s staffing needs. Successful applicants for the program participated in a rigorous training program and passed the C-NET Examination which is a requirement for participation in the New York City Department of Education’s Licensed Practical Nurse program. The 40 students, whose tuition and replacement costs are supported by a grant from New York State Departments of Health and Labor, are all expected to complete the program this coming June.

DIETARY INITIATIVE

All HHC facilities that are participating in the Dietary Initiative are receiving food produced by the Kings County Cook Chill Production Plant. The initiative is currently on schedule and has fulfilled the original intent of construction of the Plant in 1993, which was to produce the Corporation’s food requirements for its facilities.

NEW YORK STATE NURSES ASSOCIATION (NYSNA)
LABOR NEGOTIATIONS

The Corporation and the City have been in collective bargaining negotiations with the New York State Nurses Association for twenty-one months. HHC nurses are highly valued professionals, whose contributions are central to giving high quality care to our patients. It has been HHC's goal throughout these negotiations to reach an agreement that fairly compensates the Corporation's incumbent Registered Nurses (RNs) and that sufficiently increases the base salary for new hires to a more competitive rate. Although we have made many proposals to the NYSNA that we believe could generate significant increases, the NYSNA decided on February 1 that negotiations had come to an end, and asked the Board of Collective Bargaining to appoint an impasse panel. HHC believes that negotiations should continue until they result in a pattern conforming agreement that will fairly compensate HHC’s Registered Nurses for their dedication and the important service they provide. We will continue to work with our bargaining agent, the Mayor's Office of Labor Relations, to return to the table and we will keep you apprised of our progress.

ENVIRONMENTAL AUDITS

Corporate Compliance will begin its next round of Environmental Audits pursuant to HHC’s audit agreement with the Environment Protection Agency (EPA) this month; Jacobi Medical Center’s audit is scheduled for February 27 and 28, and Morrisania and Belvis are scheduled for March 1. The audit process is on schedule and under budget, thus far, and we anticipate maintaining our exemplary achievements of the prior year.

HEALTHY WOMEN PARTNERSHIP FOR
CANCER SCREENING AND TREATMENT

On January 20, Bellevue Hospital Center hosted a demonstration of a newly developed electronic database to track patients enrolled in their Manhattan Healthy Women Partnership program and improve the coordination of cancer care for women. The New York State program is operated through the American Cancer Society and reimburses hospitals for cancer screening, diagnostic, and treatment services provided to uninsured women. As a result of the new database more women are participating and revenue has increased significantly. The demonstration has generated interest in expanding the database throughout the HHC, use it to improve coordinating the treatment of women with cancer, and to automate billing.

HEALTH LITERACY PROGRAM

Bellevue Hospital Center is collaborating with the NYC Human Resources Administration to address health literacy as part of HRA's BEGIN Program (Begin Employment, Gain Independence Now), a welfare-to-work program specializing in basic skills and English as a second language. As part of the program Bellevue staff members teach basic skills for obtaining assistance and address issues relating to billing and interpretation. The students and teachers will soon make a site visit to Bellevue to apply their new skills and meet with key departments and service directors.

UNITED HOSPITAL FUND GRANT

Bellevue Hospital Center has received a nine-month planning grant of $70,000 from the United Hospital Fund as part of the fund’s special Medicaid High Cost Care program to help identify high cost users at the time of admission and work with patients and families or caregivers to ascertain ways to better manage care and to potentially avoid preventable readmissions and subsequent health care costs.

HHC IN THE NEWS HIGHLIGHTS

• January 27 - The New York Times reporter Jim Rutenberg reported on the Mayor’s announcement during the State of the City speech that HHC facilities will share results of blood sugar tests with the city’s health department in a collaboration to reduce the number of New Yorkers at risk for diabetes-related complications.

• January 28 - Fox Cable News reporter Rudi Bakhtiar interviewed Dawn Adams, Vocational Education Counselor of Cumberland Diagnostic and Treatment Center for a nationally-aired story about the facility’s ground-breaking contingency management program for chemical dependency and its patient incentive recognition initiative.

• January 29 - WLIB AM radio reporter Bevan Springer interviewed Dr. Vincent Hutchinson, Associate Director of Pediatrics about the Harlem Hospital Center Asthma Zone Initiative and healthcare in African American communities.

• February 9 - New York 1 and New York Daily News reporter Warren Woodberry Jr. reported about how the opening of a new EMS station in Queens will alleviate ambulance congestion at Queens Hospital Center.

• February 9 - New York Daily News reporter Sondra Wolfer interviewed Lincoln Hospital’s Executive Director, Jose Sanchez and Dr. Sindhaghatta Venkatram, Director of Lincoln's Stroke Center about the New York Department of Health's decision to name the facility as the first official stroke center designated in the South Bronx.

• February 12 - In observance of Black History Month, New York Daily News profiled top African Americans in the medical field from Harlem Hospital Center including Dr. Muriel Petioni, Executive Director, Dr. John Palmer and the facility’s first African American surgeon, Dr. Louis Wright. Lincoln Hospital Center was also recognized for providing training, care and support for black medical professionals and patients.