ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
March 22, 2007

Throughout the month of March, patient safety was the focus of a number of corporate-wide programs, as well as facility-based initiatives.

• On March 1st, we convened a Senior Leadership Forum on Patient Safety. This was the second in a series of forums bringing together top HHC administrators and clinical leaders to craft a strategic action plan and develop measurements to serve as a roadmap for reaching our goal of becoming one of the safest healthcare systems in the nation by the end of the decade. The program faculty included James Conway, Senior Vice President at the Institute for Healthcare Improvement (IHI) and former COO of the Dana Farber Cancer Institute. Over 90 senior leaders participated in the Forum.

• As part of our continuing strategy to strengthen our patient safety infrastructure and expertise, three HHC Patient Safety Officers, representing Central Office, Woodhull Hospital and Coler-Goldwater Specialty Hospital, participated from March 7 to 14 in IHI's intensive Patient Safety Officer Executive Development Program. Their participation was underwritten through grants from the NAPH/Kaiser Permanente Endowment Fund Scholarship. Each participant was joined by the Chief Executive Officer of his or her facility for the final two days of the program and this year I had the pleasure of participating in the program. We have now had 14 staff, who either serve as patient safety officers or as members of our corporate patient safety committee, attend this exceptional IHI patient safety training program, and a majority of our facility executive directors have attended as well. We are committed to assuring that all HHC Patient Safety Officers have access to professional development resources, like the IHI training program, to learn tools and techniques necessary to build comprehensive patient safety programs.

• From March 4 to 10th we observed National Patient Safety Awareness Week with a wide range of events to engage and educate staff and patients. This year’s theme was Patient Safety: A Road Taken Together – a message that reflects the collective role of healthcare organizations, patients and their families and the community in achieving safer healthcare. Over the course of the week HHC facilities mounted multiple programs that included lectures for staff by patient safety experts, educational opportunities for staff and patients, daily blast e-mails on patient safety topics, and award programs for local patient safety innovators.

• At the beginning of March, HHC's Office of Behavioral Health launched a corporate-wide training initiative to reduce the use of restraint and seclusion on inpatient psychiatric services. Over 400 staff, clinical leaders and administrators participated in a two-day learning session, which will be followed by a one-day facility-based training. The on-site trainings will engage more facility employees and will provide staff opportunities to practice effective crisis intervention and de-escalation techniques that are one key to the reduction of restraint and seclusion measures. Decreased reliance on restraint and seclusion has been shown to reduce the incidence of violent episodes on psychiatric units and to decrease the number of related patient and staff injuries.

• Elmhurst Hospital has had promising preliminary results from its program to encourage staff to anonymously report "near-miss" events - medical errors that were prevented, corrected or mitigated by staff intervention so that no actual patient harm occurred. The program tracks near-misses so that preventive measures can be taken to eliminate or minimize the chance that the same or similar error can readily occur in the future. Staff can report near-misses in complete confidentiality by submitting them through the hospital's intranet web site or by calling Elmhurst's hotline 718-334-SAFE. Each report is reviewed by Elmhurst's Patient Safety Officer and analyzed for trends that can be addressed. The program has generated about 60 reports so far and reporting rates have increased as staff is reassured that their participation in the program is a positive contribution and will not result in reprisal. Early reports have already led Elmhurst to add several additional medications to its "look-alike/sound-alike" list to prevent medication errors and have pointed up the need to exercise additional caution to ensure accurate patient identification prior to ordering tests or medication. Elmhurst joins a growing list of our facilities that are focusing on the encouragement and support of “near-miss” reporting as a means of identifying, analyzing and correcting system or process weakness that contribute to medical errors.

For the second year in a row, the New York State Department of Health has rated HHC’s own health plan – MetroPlus – as the best Medicaid Managed Care health plan in New York City. The designation was published in the Health Department’s 2006 Medicaid Consumer Guide and placed MetroPlus ahead of the 15 other NYC Medicaid Managed Care plans. The findings were based on both quality and patient satisfaction. MetroPlus now has over a quarter million members, and more than 8,000 primary care doctors and specialists, including nearly 4,500 independent community providers. Congratulations to MetroPlus Executive Director Dr. Arnold Saperstein and his staff for these superlative ratings.

On February 14 to 15 a learning session was held for the 18 teams who are now participating in HHC's pediatric chronic care collaborative. Six teams are working on pediatric asthma care, five are focused on improving care to diabetic children and seven new teams have recently been formed to tackle pediatric obesity and weight management. The teams shared their successful best-practices for disease management and many of them reported very encouraging results. For example, the pediatric diabetes team from Lincoln Hospital reported an increase in the percentage of patients with age-appropriate glucose levels from 17 percent in March of 2006 to 44 percent in January 2007. This is a particularly impressive improvement for the treatment of children, whose glucose levels are far more difficult to manage, since they are always growing and experience hypoglycemia more frequently than adults. The work will be presented to national pediatric care specialists later this month at the National Initiative for Children's Healthcare Quality conference. The Renaissance asthma team also obtained striking results by increasing the percentage of patients who have documented asthma action plans from 42 percent in February 2006 to 100 percent now. As in the past, our chronic disease collaborative teams continue to demonstrate that more effective disease management is achievable and they help us to identify the practices that we ultimately must incorporate more broadly into the care of our patients with chronic disease.

By now you may have already learned about HHC's newest spokesperson - Wesley Autrey, a 51-year-old Harlem resident who became New York City's "Subway Hero" this January when he selflessly came to the rescue of a fellow New Yorker who had fallen on the subway tracks during a seizure. Mr. Autrey has become HHC’s spokesman during Colon Cancer Awareness Month this March, and joined us in urging New Yorkers to take charge of their health by getting screened. He set the example by undergoing his first colonoscopy yesterday at Harlem Hospital. HHC is partnering with the New York City Department of Health and Mental Hygiene to reach out to New Yorkers with the colon cancer prevention message. The campaign includes a message from Mr. Autrey on local radio stations and posters in subway trains and platforms featuring him with his two young daughters. Studies continue to show that African American men over 50 die from colon cancer at much higher rates than other groups, and Mr. Autrey's support will be a great help in getting this potentially life-saving message about screening out to more New Yorkers.

Over the past four years HHC facilities have performed nearly 71,000 colonoscopies. During that time, HHC increased its colon cancer screenings by 86 percent from less than 12,000 in 2003 to almost 22,000 in 2006, preventing hundreds of additional cases of cancer and possible deaths from the disease.

The past month has been one of strategizing and getting the word out about the devastating Medicaid and Medicare proposals contained in the proposed federal budget for 2008 - as well as looking for the proper legislative vehicle to block the proposed regulatory change restricting Medicaid payments to public providers, which by itself would strip HHC of about $350 million in revenue yearly. HHC has met with key Congressional staffers and I have gone to Washington to participate in a briefing of the New York Congressional delegation. The hospital associations in which we hold memberships have all been active in this battle, along with the Mayor's Washington Office. Members of Congress from both parties are lining up against the magnitude of the proposed Medicaid and Medicare cuts. Long Island Congressman Peter King and California Congresswoman Anna Eshoo have sponsored a House letter opposing the Medicaid Regulation that already has 226 signatories. On the Senate side, Illinois Senator Dick Durbin and North Carolina Senator Elizabeth Dole have sponsored a similar letter, which has 43 signatories so far, including both Senators Clinton and Schumer.

Negotiations on the state budget have not yet produced tangible signs of imminent resolution, at least publicly. Earlier this week, the Governor and legislative leaders stated for the first time that they may not pass a budget by the April 1st deadline. Behind the scenes, discussions are proceeding to identify a limited set of restorations. Both the Assembly and Senate have passed their respective one-house budget bills which outlined the budget priorities of each house. The Assembly made only partial restorations to the Governor's budget and the Governor indicated a willingness to work with them. The Senate restored nearly all of the Governor's proposed reductions, however their budget was rejected by the Governor as too costly.

HHC’s own Joann Gull, Deputy Executive Director and Chief Nursing Officer at Elmhurst Hospital Center, was among the six individuals honored by Mayor Bloomberg earlier this week as this year's recipients of the Sloan Public Service Award. This award program annually honors outstanding individuals, chosen from among the more than 250,000 workers in city-affiliated agencies, who have rendered exceptional service to the public.

Ms. Gull has devoted her entire 35-year nursing career to the patients at Elmhurst. As the chief nursing executive, she draws on deep clinical and management skills to oversee the operations of 1300 nurses across the hospital’s inpatient and outpatient settings as well as its busy emergency department. Prior to her appointment as the CNO at Elmhurst, Ms. Gull played a critical leadership role, together with many talented colleagues, in earning for Elmhurst the coveted “Magnet” designation awarded by the credentialing arm of the American Nurses Association. Magnet designation is considered the nursing “gold standard of excellence,” and Elmhurst is only the fourth hospital in NYC and the third public hospital in the nation so designated.

The ingenuity, talent and compassion of HHC employees have long been recognized by the prestigious Sloan award program and Ms. Gull joins another 12 HHC employees who have been chosen for the Sloan Award since 1976. Congratulations to Joann Gull for this special recognition of her contributions and her role in making HHC the nation’s best public hospital system.

An article in the New York Times on March 7th cited data from the federal Centers for Medicaid and Medicare Services (CMS) which showed that the Elmhurst Hospital Center Emergency Department outperformed all other hospitals in New York City in the prompt treatment of patients presenting with blocked arteries. The story included Elmhurst with top hospitals from major cities throughout the country in providing this timely life-saving cardiac care.

On March 5 HHC embarked on a training and development program to enhance care given in all HHC neonatal intensive care units (NICUs) to improve outcomes for pre-term and critically ill full-term infants. Twenty-two percent of all infants born in HHC facilities each year are admitted to our NICUs and are highly vulnerable to both short term and long term complications. HHC's launch of the Wee Care training program, developed by Children's Medical Ventures (CMV), is being funded by the New York State Health Department. The program is designed to support all HHC facilities to expand their application of the developmental care model of neonatal care, an approach that minimizes environmental stress from light and sound and tailors care to each infant's specific needs at each stage of development. Close partnership with the families of infants is an important part of this model and the positive results can include increasing breast-feeding, improved staff and patient satisfaction and fewer readmissions. The NICU care in all of our facilities has included components of this model and this training program is intended to standardize best practices across the system.

You may be aware of recent reports that early this February callers from the Public Advocate's office were told that there was not a supply of HPV vaccine in some HHC facilities. We have subsequently confirmed that all of our pediatric and adolescent health clinics have supplies of the vaccine and are offering them to patients when they are requested. HHC will be launching an HPV vaccine public awareness campaign later this year to inform patients and their families about the availability of this new vaccine which can prevent cervical cancer.

Gouverneur received more than $100,000 from the Entertainment Industry Foundation (EIF) as a beneficiary of the 2006 Revlon Run/Walk for Women. In aggregate, the EIF has awarded Gouverneur over $660,000 through the Revlon Run/Walk since 1998. The EIN also announced that Gouverneur will again be a beneficiary for the 2007 Walk scheduled for May 5th. The proceeds are used for outreach and to ensure that uninsured women have access to cancer screening, diagnosis and treatment.

• March 6-7- The expansion of Bellevue Hospital’s WTC Environmental Health Center to treat those with World Trade Center related illnesses received wide news coverage in print, television and radio. New York City provided $16 million to the center to expand treatment to residents, office workers, those who assisted in cleanup, the uninsured and those affected who are not served by other programs. New York Daily News reporter Mike Jaccarino interviewed HHC President Alan D. Aviles about the expansion of the center, which has doubled its capacity. New York 1 reporter Molly Kroon interviewed Dr. Joan Reibman, Director of the center, about WTC-related health symptoms of people who lived and worked near Ground Zero. Newsday, El Diario, WNYC Radio, WCBS Radio and RNN TV also covered the story.

• March 9- Newsday reporter Bart Jones reported on Jacobi Medical Center’s hyperbaric chamber used to treat four children with carbon monoxide in their blood because of a Bronx blaze. The chamber—one of the few in the City that can treat several people at once—removes the gas by lowering the air pressure to below sea level, forcing the gas out of the blood system.

• March 13- New York Daily News featured a column on patient safety improvements by William Walsh, Senior Vice President of the North Bronx Health Care Network. The network’s interventions have reduced blood stream infections, ventilator-associated pneumonia and medication errors.

• March 16- Staten Island Advance reporter Lisa Schneider reported on the joint colon cancer awareness campaign launched by HHC and the City Department of Health with campaign spokesman Wesley Autrey, who this January was dubbed "Subway Hero" after rescuing a stranger who had fallen on the tracks during a seizure. HHC President Alan D. Aviles mentioned that more early stage cancers have been found and treated by increasing the number of colon cancer screenings. Hoy also covered the story.

• March 21- New York Post reporter Jasmin K. Williams interviewed Dr. Margaret Kemeny of the Queens Hospital Cancer Center on the comprehensive care the hospital offers the community. Local initiatives target early detection of lung, prostate, breast and colon cancers.