ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
MAY 21, 2009

As New Yorkers have become concerned about the recent outbreak of H1N1 flu, thousands have come to our emergency departments seeking reassurance and help in protecting themselves from illness. From the beginning of the outbreak, HHC has served a critical role in the city’s coordinated emergency preparedness efforts and we put immediate policies in place to ensure patients were cared for, employees remained healthy, and facilities stayed fully staffed to accommodate the expected increase in patient flow.

HHC continues to coordinate its response with local, state, and federal public health authorities, and has conducted briefing sessions with administrative and clinical leadership at each facility on a regular basis. At the outset of the outbreak, we also arranged for the immediate delivery of supplemental infection control supplies, including surgical masks and gloves, and ready access to a stockpile of Tamiflu if needed.

Emergency department staff across HHC have been quick to adjust triage protocols, identifying patients with flu-like symptoms as soon as they arrived in emergency departments. During the initial period of the outbreak, and despite a surge of patients across several of our pediatric and adult EDs, expedited triage procedures prevented many symptomatic patients from sitting in our crowded ED waiting rooms, potentially exposing others.

Although the initial spike in ED volume included a disproportionate number of asymptomatic “worried well”, a greater number of pediatric and adult patients have presented in some of our EDs over the last week with mild flu symptoms, especially in our Queens hospitals. Increases in volume across the system are, on average, about 20% for adult EDs and 50% in pediatric EDs. Our hospitals in Queens have seen higher volume increases, with hundreds of (mostly pediatric) patients with mild flu symptoms presenting in their emergency departments and clinics over the last few days. Although there has been one reported flu-related death in New York over the last week, virtually all patients seen in our facilities have presented with mild symptoms that end in a few days. However, there have been some hospitalizations of patients who had underlying medical conditions that made them more vulnerable to influenza.

We continue to monitor the situation closely, but we can be proud of the way in which our dedicated staff have handled the flu-related challenges over the last several weeks.

In March, I reported that HHC was conducting our third annual employee Patient Safety Culture Survey. The survey questionnaire, designed by the Agency for Healthcare Research and Quality, elicits staff opinions about our commitment to improving patient safety, our response to medical errors, and the degree to which our employees’ work environment supports patient safety efforts.

A Web-based and hard-copy version of the survey was made available to all HHC facility and home health care employees during a two-week period. The survey, which is anonymous and voluntary, helps identify areas of strength and opportunities for improvement at HHC. The HHC-wide response rate was 45% in 2007, the first year of the survey, and 63% last year. This year's goal was an ambitious 70%, and, remarkably, more than 31,000 responses were received, an approximately 78% participation rate that far exceeded our expectations.

I am gratified that so many members of the HHC community were willing to share their perceptions about how we are doing in creating and supporting an organizational culture of safety. Staff, across all levels of care, gave their facilities very high marks in the area of Organizational Learning and Continuous Improvement, with more than 80% of all participants reporting that “we are actively doing things to improve patient safety.” Other areas of strength included Teamwork within Units, and Hospital Management Support for Patient Safety.

We continue to see steady improvements in the overall “patient safety grade” that staff are asked to give their work area. Sixty-seven percent (67%) of all survey respondents rated their work area as Excellent or Very Good on patient safety, a 20% improvement over the grade on our initial culture survey in 2007. One area where staff tells us we still have room for improvement is their fear of retribution for reporting an unsafe patient safety condition.

Overall, I am very much encouraged by the positive results from this year’s survey. The solid increases in both our overall participation rate and patient safety grade is a testament to the commitment of our entire staff, at every level, to HHC's patient safety goals.

The Joint Commission conducted its triennial survey of Lincoln Hospital during the week of May 4, with five surveyors assessing the quality and safety of its patient care services. The survey results were extremely positive with Lincoln receiving only three minor findings, two of which were corrected while the surveyors were still on-site.

At the Exit Conference, the survey Team Leader shared how impressed she was with the hospital and especially with the staff’s evident commitment to the hospital’s mission and their active focus on quality, patient safety and performance improvement.

Lincoln is the second HHC hospital to be surveyed by The Joint Commission this year. In March, Coney Island received similarly positive results, with Kings County and Sea View still to undergo surveys this year.

Congratulations to José Sánchez and all of his staff at Lincoln for their exceptional survey results.

Earlier this month, the federal Agency for Healthcare Research and Quality (AHRQ) released its fifth annual National Healthcare Quality Report. The report summarized the healthcare industry’s progress in improving healthcare quality and safety, and in reducing disparities. AHRQ characterized the 2008 findings as “disturbing” and noted that healthcare quality is improving at an agonizingly slow pace; patient safety is lagging and possibly declining; and disparities in the provision of care continue to be of concern.

Contrary to the disappointing state of affairs nationally, during the timeframe covered by the report, 2003 – 2008, HHC facilities measurably improved patient care quality and safety, made chronic disease management more effective, and narrowed the racial disparities gap.

Ours was the first hospital system in the city to voluntarily adopt the World Health Organization’s comprehensive surgical safety checklist to make surgery safer. We have dramatically reduced hospital-acquired infections among critically-ill patients, particularly ventilator-associated pneumonia and infections from central venous catheters. We have tripled the number of colonoscopies we administer and have helped New York City virtually eliminate the gap between blacks and whites who undergo this vital cancer-screening procedure. Our hospitals outperform the majority in the nation on federal quality-of-care indicators for the treatment of heart attack, heart failure and pneumonia. We continue to increase our offerings of free and low-cost health screenings to tens of thousands of New Yorkers, as well as services to help them quit smoking. Last week we announced data showing the significantly improved health status of 50,000 adult diabetics under our care, with measured outcomes exceeding state and national averages.

We continue to hold ourselves publicly accountable by posting our performance on key quality and safety measures to our Web site, HHC In Focus. Improvement in our national healthcare system is not only possible; we – in the public sector -- are making it happen.

On May 15, we announced a significant increase in the number of diabetic patients under our care who have achieved healthy levels of blood sugar, blood pressure, and cholesterol -- the three leading indicators for the disease. We attribute the improvement in health outcomes to an aggressive chronic disease management program and the use of a computer-based patient registry. The registry pulls data from HHC's advanced electronic health records system and allows clinical teams to tailor medication regimens that better support self-management efforts for more than 50,000 New Yorkers with diabetes.

The 2008 rates were posted on the HHC In Focus section of our Web site, nyc.gov/hhc, as part of HHC's transparency initiative, which shares information with the public on HHC’s quality of care and patient safety performance.

In 2008, 45.5% of all adult diabetic patients under routine care at HHC facilities achieved a healthy blood sugar level, as reflected by a Hemoglobin A1c test result of less than 7. This reflects more than 5,000 additional patients under good blood sugar control as compared to 2007. Similar improvements among diabetic patients were shown in achieving healthy blood pressure and cholesterol levels. HHC diabetic patient outcomes consistently outperform both state and national averages reported for managed care plan patients.

In addition to the treatment management advantages offered by the computerized registry, HHC also emphasize patient self-management skills, including the importance of frequent self-testing of blood sugar levels and the need for exercise, proper diet and weight control.

On a related note, this month Woodhull Hospital published a nostalgic collection of the neighborhood’s cooking traditions, but recreated the old-time favorites with healthier ingredients to help the community of North Brooklyn reduce the incidence of diabetes and eat healthy.

Cooked to Perfection: Cherished Family Recipes That Are Good For You features family recipes donated by seniors from local centers, and then revised by a team of doctors from Woodhull and nutritionists, culinary faculty, and students at the New York City College of Technology. These recipes, in both English and Spanish, include everything from traditional Polish dishes to various Latino delicacies and soul food.

To help promote the cookbook, local restaurants will add one of the lighter dishes to their menu. Copies of the cookbook will also be given to Woodhull patients with dietary restrictions in the hospital's Geriatric Wellness Center and to diabetic patients in its Primary Care Clinic.

This spring, HHC began the system-wide rollout of the Hemocare LifeLine (HCLL), a computer system that will manage all blood bank-related ordering and testing while keeping track of patients’ hematological histories, test results, and advisories. The system will consolidate information from HHC's 11 facility-based blood banks into a unified database that will serve the entire corporation, vastly improving the way our hospitals manage their inventories of blood, blood products and reagents. Because many blood products have short shelf-lives, by merging our blood-bank inventories, we will be able to optimize their timely and efficient use and realize significant cost savings.

Bellevue Hospital and the Southern Brooklyn and Staten Island Network have successfully incorporated into the HCLL network, with Lincoln joining the system in July and the other networks coming on line by the end of the year.

On May 1, HHC facilities were given access to the new Cardiovascular Risk Registry, an electronic disease-tracking program that greatly improves our ability to understand and monitor heart disease and associated illnesses among our patients. The CRR is the latest example of HHC’s strategy of using powerful database software to identify at-risk patients in the vast haystack of data stored in our electronic medical records.

As you know, we pioneered the use of this technique with our electronic registry for patients with diabetes, and new registries for other clinical conditions are under development. By mining through HHC’s data, the CRR has already been able to identify more than 26,000 patients meeting criteria for hypercholesterolemia and more than 42,000 with hypertension. With CRR, clinicians and administrators can ensure that all these patients get the care they need, while also using the registry’s data-analysis features to further improve our evidence-based prevention and treatment strategies.

On May 1, Mayor Bloomberg released the 2010 Executive Budget. The $59 billion spending plan contains a series of actions to control agency spending, increase revenue, and apply prior-year surplus funds in order to close a $6.6 billion deficit. To give you a sense of how the recession has affected City revenues, the City projects a difference of more than $7 billion between FY 2008 and FY 2010 for economically sensitive tax revenues. In the five months since the release of the Preliminary Budget in January, City tax revenues have fallen by an additional $680 million for FY 2010.

Last month, agencies were asked by the City Office of Management and Budget (OMB) to submit an additional 4% PEG (Program to Eliminate the Gap) reduction. In total, HHC will have contributed more than $19 million in PEGs through direct reductions in our spending ($13.6 million) and indirectly by PEG reductions from DOHMH ($5.8 million), to the City budget.

HHC typically receives funding for certain initiatives from the City Council that were not baselined in the Executive Budget and thus need to be restored. This year, this includes $5 million for the operation of our child health clinics and $2 million for rapid HIV testing. The amount sought to be restored is much less than in previous years, when the Council provided nearly $15 million more to HHC to support several behavioral health programs, HHC's outpatient pharmacy expenses, the TEMIS program and additional HIV testing.

As many of you have read, the recently adopted New York State rescue plan for the MTA will include a 0.34% payroll tax on employers in the area served by the MTA. We estimate that this payroll tax will cost HHC $8.8 million annually. The tax is effective retroactive to March 1, 2009.

Jacobi Medical Center and North Central Bronx Hospital are the proud winners of the national 2009 NOVA Award, to be presented by the American Hospital Association at its Health Forum Leadership Summit this July. The award was given to recognize Project BRIEF, the innovative HIV rapid testing and treatment program. The program offers patients HIV testing and counseling in non-traditional locations within the hospitals using inter-active computerized tablets to increase access to HIV screening and risk reduction education, while linking those who test positive to care. AHA gives the award each year to outstanding hospitals and health systems that improve community health status through collaborative, joint efforts with allied community organizations.

• The United Hospital Fund offered the Distinguished Trustee Award to HHC Board Vice Chairperson Rev. Diane E. Lacey for her extraordinary service, leadership and deep commitment to the mission of our public healthcare system. The award was given earlier this month at a UHF event at which HHC's Patient Safety agenda was also recognized in the "Quality Collaborative" publication distributed to attendees. A copy of that publication is included in your packets today.
• Peter Coleman, Senior Director of Substance Abuse in HHC's Office of Behavioral Health, received the American Association for the Treatment of Opioid Dependence (AATOD) Nyswander-Dole Award. Mr. Coleman is one of nine individuals receiving the international award, given in recognition of individuals who have devoted themselves to improving the lives of their patients in the methadone treatment system. Awardees are nominated by their peers for extraordinary service to the opioid treatment community.
• Dr. Wafaa El-Sadr, Chief of Infectious Diseases at Harlem Hospital, was named by Rolling Stone magazine as one of Top 100 Agents of Change for 2009. The magazine describes her as a "global-health visionary, fighting AIDS one family at a time."
• Dr. Constance Park, Chief of Endocrinology and Dr. Olajide Williams, Assoc. Director of Neurology, both at Harlem Hospital, were named Garvey Fellows by Columbia University Medical Center. The Garvey Fellowship is one of CUMC's most prestigious honors, awarded to faculty who will maintain the highest standards in dedication and commitment.
• Dr. Eric Manheimer, Medical Director at Bellevue Hospital, was awarded the President's Award at HHC 2009 Doctors' Day recognition. Dr. Manheimer was recognized especially for his stalwart advocacy of patient safety. Twenty-nine other HHC doctors were recognized at the gala event.
• Mei Kong, Senior Director for Patient Safety received an Honorary Doctorate in Science from the New York College of Health Professions. Ms. Kong brings great enthusiasm, joy and innovation to her work and has been steadfast in moving the trajectory of HHC’s patient safety agenda.

HHC Volunteers were honored this month at a festive event at Gracie Mansion, with the "Volunteer of the Year" award going to Gloria Calderon, a volunteer Foster Grandparent at Bellevue for 21 years, who was featured in coverage of the event by the NY Daily News. Sixteen additional volunteers were recognized, as representative of the 8,000 volunteers who donate a million hours of service to HHC hospitals each year. The volunteers were welcomed by former Board Chairperson Charlynn Goins, and were saluted by current Board Chairman Dr. Michael Stocker. Our thanks to them and to Board members Josephine Bolus, Dr. Marcia Brown, and Dr. John Maese for attending this special event.

In September 2008 the Board of Directors authorized a revocable license agreement for Vivaldi Biosciences to occupy 5,900 square feet of space at Bellevue Hospital Center for the annual fee of $322,500. Vivaldi is a biotechnical company focused on research, development and manufacturing of influenza vaccines.

In view of the recent outbreak of H1N1 influenza in many parts of the world, Vivaldi has requested the ability to expand its operations at Bellevue to conduct expedited work and attempt to develop a vaccine for this new strain of influenza. Specifically, Vivaldi seeks to rent an additional 1,800 square feet of space at Bellevue at the per square foot rate previously approved by the Board.

Pursuant to the authority granted to me under Operating Procedure 100-5 ("Contract Review and Authorization by the Board of Directors"), I have approved a deviation from that operating procedure and authorized an amendment to the license agreement to enable Vivaldi to increase its operations to immediately accelerate its work in this critical area of public health. The Corporation will also receive additional rental annual revenue of approximately $100,000 for Vivaldi's use of the additional space.

On our agenda today is a three-year Affiliation contract renewal with Downtown Bronx Medical Associates, P.C. (DBMA) to provide general care and behavioral health care services at Lincoln Medical & Mental Health Center and Morrisania Diagnostic & Treatment Center, and general care services at Segundo Ruiz Belvis Diagnostic & Treatment Center. The agreement also includes a subcontract for tele-radiology services at Kings County Hospital Center. The total contract cost over the three-year period is approximately $235 million.

The proposed agreement will compensate DBMA on a cost-based budget, with pay-for-performance indicators being used to align business goals and improve overall hospital performance. Select indicators will also be subject to financial withholds pending satisfactory performance on inpatient readmission rate; patient satisfaction survey scores; malpractice claims; sentinel events; and, New York State Department of Health (DOH) citations.

I urge your approval of this affiliation contract renewal.

I am pleased to announce the appointment of Arthur Wagner to the position of Senior Vice President of the Southern Brooklyn and Staten Island Health Network and Executive Director of Coney Island Hospital Center.

Mr. Wagner has been an HHC employee for most of the past 30 years, beginning as a Pharmacist and progressing to increasingly demanding leadership roles, most recently as Executive Director of North Central Bronx Hospital (NCB), where he has served since 2002. In February of 2009, Mr. Wagner stepped in as Acting Executive Director of Coney Island Hospital Center, and under challenging circumstances, skillfully steadied the hospital and guided it through an exceptionally successful Joint Commission survey in March.

At Coney Island, Mr. Wagner has already developed excellent relationships with staff, affiliate management, and community leaders. His inclusive management style and strong communication skills have engaged effectively clinical leadership and representatives from across Coney Island's and Sea View's diverse communities.

I have full confidence that Mr. Wagner will continue to further strengthen Southern Brooklyn and Staten Island Health Network's distinguished record of delivering patient-focused, safe, and efficient healthcare to the communities that it serves.

Harlem Hospital received a $150,000 grant from the U.S. Interior Department as part of the federal Save America's Treasures initiative to preserve significant historic properties and collections. The grant will partially fund the preservation of the WPA murals in Harlem Hospital, which are being restored as part of the hospital's major modernization project. The historic murals will become the centerpiece of the hospital design, by HOK Architects, which received the Design Award of Honor from the New York Chapter of the American Institute of Architects in 2005.

• For your diabetes life, CNBC - TV, 4/26/09
• Health Care on the Cheap, CBS - TV, 4/27/09
• Surviving Breast Cancer: Mammogram 101, Fox - TV, 5/2/09
• Diabetes Management, News 12 Bronx - TV, 5/5/09
• Medication Warning, ABC - TV, 5/5/09
• FDNY Helps Make Special Delivery For Harlem Mom, NY1 - TV, 5/8/09
• Breast Cancer Screenings at Bellevue Hospital, NY1 - TV, 5/9/09
• Living With: Asthma, The New York Times - Online Video, 4/29/09
• Seniors' family recipes are overhauled for healthy cookbook, New York Daily News, 4/28/09
• Watching the Money, Modern Healthcare, 4/27/09
• She's proud 'Grandma' to babies at Bellevue, New York Daily News, 5/4/09
• Bravest visit little bundle under more relaxed circumstances, New York Daily News, 5/8/09
• New York City public hospitals credit IT for health boost, Government Health IT, 5/15/09
• Mujer Cuida Tu Salud Es Tu Tiempo, El Diario, 5/13/09
• Recetas para una Buena Salud, El Diario, 5/17/09