ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
June 30, 2011

WOODHULL AND NCB HOSPITALS COMPLETE SUCCESSFUL JOINT COMMISSION SURVEYS

Since my last report, The Joint Commission completed its accreditation surveys of North Central Bronx Hospital and Woodhull Medical and Mental Health Center.  As at the other HHC facilities surveyed this year, the survey team noted several outstanding best practices that they commended. 

At NCB, leading practices included the Infection Control and Prevention Program which decreased hospital acquired infections over two years, the Hand-Off Communication Process from the Psychiatric Emergency Department to the Adult Emergency Department and the decision-to-incision process in Labor and Delivery. 

At Woodhull, the leading practices recognized by the survey team included the Sharing Bad News organ donation film, Pharmacy algorithm on antibiotic management for medical intern training, and the Emergency Department patient flow process, which includes a specially designated unit for patients with alcohol intoxication and a chest pain observation unit.

Congratulations to North Bronx Network Senior Vice President, William P. Walsh and NCB Operating Officer Denise Soares and North Brooklyn Network Senior Vice President George Proctor and all of their staff for their hard work, commitment, and excellent survey results.

The Goldwater Specialty Hospital and Nursing Facility is the last facility remaining to be surveyed this year.

FOURTH ANNUAL PATIENT SAFETY CONFERENCE AT JACOBI

Approximately 200 physicians, nursing leaders, healthcare executives and patient safety managers attended the fourth annual Lorraine Tredge Patient Safety Leadership Conference at Jacobi Medical Center on June 15.  Every HHC facility was represented and one quarter of the attendees were from non-HHC institutions, such as Montefiore Medical Center, Einstein College of Medicine and St. Luke's Roosevelt Hospital.  Presentations were made by several national healthcare leaders, including Larry Gage of the National Association of Public Hospitals and Health Systems, Dr. Carol Haraden of the Institute for Healthcare Improvement and Lorraine Ryan of the Greater New York Hospital Association.  Congratulations to William Walsh and his team for another outstanding conference focusing on one of HHC’s highest organizational priorities.

BELIEVING BOOKLET AND HIGHLIGHT VIDEO RELEASED TO STAFF

 This month, HHC completed a print version of Believing, the story of our patient safety initiatives and achievements, as well as a highlight video.  Using interviews, quotes, and data, these two pieces offer a brief overview of the many people and programs that have made our ongoing patient safety efforts so successful.  Both are being distributed to staff in early July and the booklet is in your materials today.  The full four-episode multi-media Believing series is, of course, available on the HHC website.

ADDRESS AT NAPH CONFERENCE HIGHLIGHTS
HHC'S SUCCESSFUL PARTNERSHIPS TO IMPROVE CARE

Last week I had the opportunity to highlight HHC’s many partnerships to improve care during a presentation at the closing plenary session of NAPH’s annual conference.  My presentation reviewed the many creative collaborations that HHC has developed with community-based organizations, sister City agencies, and community physicians and explained the role that these partnerships play in bolstering HHC’s capabilities to render better managed, better coordinated and more holistic care. 

HEAD OF CMS MEETS WITH HHC AND OTHER LEADERS OF GYNHA

Earlier this month I met with Dr. Donald Berwick, the head of the federal Centers for Medicare and Medicaid Services (CMS), together with other members of the Greater New York Hospital Association Executive Committee, to discuss HHC’s work toward achieving Dr. Berwick’s Triple Aim goals of improving both the individual patient experience as well as population health, while also reducing per capita costs.  I also raised with Dr. Berwick HHC’s concerns about the need to acknowledge, and risk adjust for, the socio-economic complexities that are inherent in serving predominately low-income patient populations largely comprised of ethnic and racial minorities as CMS sets pay-for-performance benchmark performance targets that will drive financial bonuses or penalties.

ELMHURST HOSPITAL RECEIVES IPRO QUALITY AWARD

Elmhurst Hospital received a 2011 IPRO Quality Award for its commitment to patient-centered care and quality improvement, as demonstrated by the collaboration between the nursing staff in the medical-surgical division and the information technology (IT) team in the use of health IT to improve care.  The Quality Awards, given annually by IPRO, the Medicare Quality Improvement Organization for New York State, recognize healthcare providers that demonstrate a commitment to improving healthcare services in the state.  Elmhurst was one of 14 recipients of the award in New York State. 

HANYS GIVES NORTH BRONX OB/GYN TEAM MORE ACCOLADES

The Healthcare Association of New York State -- HANYS -- has awarded the 2011 Pinnacle Award for Quality and Patient Safety to the North Bronx Healthcare Network for its successful work to reduce adverse outcomes in labor and delivery through consistent and safe administration of the high-alert medication oxytocin.  The award was announced publicly at the HANYS Annual Conference June 23-24.  The Pinnacle Award draws over 100 applications from HANYS members across New York State.  This is the third major award this year given to the OB/GYN team at Jacobi Medical Center and North Central Bronx Hospital for this outstanding program, whose performance improvement work has significantly reduced the number of adverse incidents and delivery complications from shoulder dystocia and Erb's palsy.  The team has also received the Safety Net Award from NAPH and Grand Prize at HHC's corporate Patient Safety EXPO in March.

NEW NICU RIBBON-CUTTING AT BELLEVUE

Yesterday, Bellevue Hospital announced the opening of its new Neonatal Intensive Care Unit, the most technologically advanced unit of its kind in New York City, serving the special needs of babies born too early or with a serious illness.  The spacious 14,000 square-foot unit will serve about 500 infants and their families each year.  The $5.2 million unit has a capacity of 20 beds and has been designed as an environment that is sensitive to the developmental needs of critically ill infants, and highly supportive of their families and the healthcare staff.  One of the many unique features of the new facility is a "launching pad," a home-like private room where parents can spend a night or two with their child before discharge.  Evidence shows that if parents are properly educated and can provide competent care before discharge, readmissions of these infants are sharply reduced.

JACOBI OPENS NEW CPEP EMERGENCY ROOM

Late last month, Jacobi Medical Center unveiled its new 11,000 square-foot Psychiatric Emergency Department.  The new facility better supports Jacobi's state-licensed Comprehensive Psychiatric Emergency Program, which offers psychiatric emergency services, a mobile crisis team, crisis residence and extended observation beds.  The new facility will allow emergency patients to be evaluated in a calm and soothing environment and will be fully aligned with modern psychiatric best practices.  The new psychiatric ED opened on June 23rd and expects to treat 5,200 patients annually.

WORLD TRADE CENTER ENVIRONMENTAL HEALTH CENTER
RECEIVED CDC FUNDING TO CONTINUE ITS CLINIC OPERATIONS

HHC’s World Trade Center Environmental Health Center, located at Bellevue, Elmhurst, and Gouverneur, treats residents and local workers who were exposed to the dust and fumes after 9/11, and has been funded under the Zadroga Act.  Last Friday, the Centers for Disease Control and Prevention awarded two five-year contracts to HHC for the WTC program, one for clinical treatment and one for data management.  The contracts are worth $5.2 million and could generate up to another $4 million in reimbursement.  The funding will ensure that the much-needed medical treatment provided to thousands of patients adversely impacted by the WTC disaster, many of whom have long-term upper and lower respiratory disease, gastro-intestinal problems, and mental health issues, will continue uninterrupted.

HHC RECEIVES GRANT FOR WeCOACH PROGRAM
FOR ADULTS WITH DIABETES

 The New York State Health Foundation decided that HHC's WeCOACH program for senior adults with diabetes is a promising model for an economic intervention with diabetes in elders, and recently announced a $50,000 grant to evaluate the program.  The WeCOACH program, at Lincoln, NCB, and Jacobi, pairs peer coaches with patients who are at least 60 years old and have difficult-to-control diabetes.  The peer coaches are from the patients’ communities, typically speak the same languages, and understand the cultural aspects of promoting wellness and managing chronic illness.  They coach patients in self-care, such as exercise and healthier eating.  Preliminary data has shown that a majority of patients had improved levels of blood glucose, improved sense of well-being as well as an appreciation for the services offered.  

MEN URGED TO "MAN UP" AT HHC HOSPITALS IN JUNE

At events throughout HHC this month, men were encouraged to take the steps needed to improve and protect their health.  Kings County Hospital ramped up community interest in late May when more than 150 people formed a human chain outside the hospital to bring attention to men’s health issues as part of the hospital’s “Man Up” campaign.  The hospital hosted a men’s health forum on June 14 to offer free health screenings and to hold a forum on violence prevention to address this threat to men's health.  Bellevue held its "Man Up" event the next day providing free screenings for blood pressure, diabetes, prostate cancer and depression, and featured an appearance from NBA player and diabetes spokesperson Gary Forbes.  Harlem Hospital Medical Director Dr. Maurice Wright was heard on WBLS, talking about men's health issues, and Lincoln Hospital Senior Vice President Iris Jimenez-Hernandez authored a feature story about men's health in the Bronx Free Press. 

HHC'S HIV TREATMENT EXPERTISE SOUGHT INTERNATIONALLY

An Ethiopian delegation visited Elmhurst Hospital this month to discuss HHC's HIV services and testing initiative.  Elmhurst Hospital, which plays a strong role in HHC's aggressive HIV testing initiative, has had an ongoing partnership with the Debre Berhan Regional Hospital in Ethiopia, to help improve medical and psychosocial care and services, especially for patients with HIV.  The Ethiopian hospital is hoping to mirror what we have done in both testing patients for HIV infection and linking patients who test positive to care. 

Dr. Joseph Masci, Director of Medicine at Elmhurst, who leads the partnership, was also invited to speak at an international conference on HIV/AIDS held at the Vatican in late May. 

PHOTO EXHIBIT OPENS AT BELLEVUE HOSPITAL

The HHC Art Collection opened its exhibition of New York City: IN FOCUS, Vol. 2, with a reception on June 23rd, at Bellevue Hospital Center.  The show is a collection of photography that focuses on different aspects of iconic imagery and people throughout the five boroughs.  It features 50 internationally renowned, New-York based photographers as well as emerging artists, including several HHC employees.  Featured photographers from the HHC Art Collection include James VanDerZee, Dawoud Bay, Anthony Barboza and Mick Rock.  HHC employees with works in the exhibit are Michael Lettera from Central Office, Linda Morales from Lincoln Hospital and Victor J. Duran from Gouverneur.

ANNUAL BEHAVIORAL HEALTH CONFERENCE

Over 180 people attended the annual Behavioral Health Conference entitled "Effective Care, Efficient Care:  Moving Behavioral Health Forward."  Attendees included behavioral health clinical and administrative leaders, front-line staff, and HHC Board member, Ms. Josephine Bolus.  The keynote speaker, Dr. Richard Dougherty, discussed HHC behavioral health services and changes needed to respond to new state and federal models in healthcare delivery, including the implementation of managed behavioral healthcare.  Dr. Wilson addressed the role behavioral health will play in Accountable Care Organizations and Patient-Centered Medical Homes.  Other presentations included a discussion of the highly successful chemical dependency outpatient services at HHC hospitals, and facility strategies to prepare for a managed care environment while keeping people healthy and improving access to ambulatory behavioral health services.

HHC RECOGNIZES OUTSTANDING NURSING PROFESSIONALS

Earlier this week, at Bellevue Hospital Center, we honored more than 20 outstanding nurses for the excellent nursing care they provide every day to our patients.    Each facility, as well as MetroPlus and HHC Health & Home Care, selected the individual or nursing team that deserves special recognition for outstanding care.  This is a remarkable group of individuals who practice as staff nurses, educators, leaders, innovators, collaborators, coaches, mentors and passionate patient advocates.  HHC nurses play a critical role in our effort to implement truly patient-centered care.   The ability and effort of our nurses are, for many of HHC's patients, primary factors in their overall hospital experience satisfaction, and patients' evaluations are increasingly an important measure of hospital performance.  At HHC, our more than 8,000 talented nurses work tirelessly to fulfill our mission every day.

FY 2012 CITY BUDGET ADOPTED

On Tuesday, the City Council passed the FY 2012 Budget.  The Mayor and Council had reached an agreement on the broad framework of the budget last Friday and the details were finalized over the weekend.  The budget agreement contained significant funding restorations for HHC including:

• $5 million for Child Health Clinics,
• $3 million for the unrestricted City subsidy,
• $2 million for expanded HIV testing,
• $1.895 million for behavioral health programs, and
• $1.2 million for the Sexual Assault Response Team program

HHC facilities also received approximately $8.4 million in Capital funding from their respective Council borough delegations.

We are very appreciative of the ongoing and generous support that the Mayor and City Council provide to HHC.  I want to publicly thank the Mayor, Speaker Quinn, and Council Members Dominic Recchia, Maria del Carmen Arroyo and Oliver Koppell in particular for their unwavering commitment to HHC and its mission.  I also want to acknowledge with gratitude the many CAB and Auxiliary members, along with Judy Wessler and the Commission on the Public's Health Care System, for their grassroots advocacy during the budget discussions over the past several months.

AFFILIATION AGREEMENTS FOR DOCTORS' SERVICES AT
KINGS COUNTY, WOODHULL AND METROPOLITAN HOSPITALS

On our agenda today, for your review and approval, are three Affiliation Agreements.

The first is a one-year renewal of the current Affiliation Agreement with the State University of New York Health Science Center at Brooklyn for the provision of general care and behavioral health services at Kings County Hospital Center.  The proposed agreement will commence on July 1, 2011 and terminate on June 30, 2012, consistent with the general terms and conditions outlined in the Resolution.  The proposed contract costs for the one-year period total $19.9 million.

The second is the three-year renewal of the current Affiliation Agreement with New York University School of Medicine for the provision of general care and behavioral health services at Woodhull Medical and Mental Health Center and Cumberland Diagnostic and Treatment Center.  The proposed agreement will commence on July 1, 2011 and terminate on June 30, 2014, consistent with the general terms and conditions outlined in the Resolution.  The proposed contract costs for the three-year period total $301 million.

And the third is an eighteen-month Affiliation Agreement with Physician Affiliate Group of New York, P.C. (PAGNY) for the provision of general care and behavioral health services at Metropolitan Hospital Center.  The proposed agreement will commence on July 1, 2011 and, if the 6 month option to renew is exercised, terminate on December 31, 2012, consistent with the general terms and conditions outlined in the Resolution.  The proposed contract costs for the 18-month period total $83.2 million, of which $55.4 million is the proposed cost for FY 2012.  I urge your approval of all three proposed agreements.

REDEPLOYMENT OF BROOKLYN CENTRAL LAUNDRY STAFF

At its last meeting, the Board of Directors gave me the authority to negotiate a contract with a vendor to outsource the work of the Brooklyn Central Laundry and the distribution of laundry within HHC’s facilities.  We expect to sign this contract on July 1 and to begin phasing out operations at the laundry later this summer. 

Since January, I have stated publicly on a number of occasions that HHC was willing to retrain and reassign the laundry’s employees to other jobs within HHC facilities if we could reach a labor-management agreement that no action would be taken to delay the planned outsourcing.  Retraining and redeploying laundry staff will certainly reduce the total savings that we expect to achieve through outsourcing laundry services, but I offered this commitment in appreciation of the loyalty and dedication that the laundry staff have given to HHC through the years. 

Despite the fact that we have been unable to reach any formal agreement with the involved labor union, I have decided that we nonetheless will avoid lay-offs from this outsourcing and will reassign these employees to comparable positions in facility Environmental Service.  The redeployment of the laundry workers will allow us to significantly reduce overtime in Environmental Services in the short term, and to take significant attrition in this part of our workforce over the next two years.

Although redeploying these workers will reduce our immediate savings from this initiative, I believe that retaining these workers is the right thing to do.

RETIREMENT OF DR. JOHN PALMER

Please join me in congratulating Dr. John M. Palmer for his years of exceptional service as he retires from the New York City Health and Hospitals Corporation. Dr. Palmer has served as the Executive Director of Harlem Hospital Center and the Renaissance Health Care Network for 12 years and has the longest tenure of any Executive Director in that role.  Although Dr. Palmer is retiring from HHC, he will remain active in the healthcare. Last month, Governor Andrew M. Cuomo announced Dr. Palmer's appointment to the New York State Public Health and Health Planning Council.

Dr. Palmer's leadership and contributions have made Harlem Hospital Center and the Renaissance Health Care Network stronger institutions. He leaves a legacy of service and collaboration that will benefit our patients, our staff, and our community for generations to come. Please join me in wishing him a fond farewell and a happy and healthy retirement.

DENISE SOARES NAMED ED OF HARLEM HOSPITAL

Fortunately, we are able to tap an outstanding leader from HHC's ranks to serve as Dr. Palmer's successor -- Denise C. Soares, RN -- who has served as Chief Operating Officer of North Central Bronx Hospital and Chief Nurse Executive of the North Bronx Healthcare Network.  She comes to Harlem with nearly 40 years of experience and a career specializing in hospital administration, nursing and women's and children's health services.  Before joining HHC, Ms. Soares served at several local institutions, including New York Hospital, Albert Einstein College of Medicine and Long Island College Hospital.  HHC is indeed fortunate to have such a widely-respected and seasoned leader at the helm of Harlem Hospital.

HHC IN THE NEWS HIGHLIGHTS

Life Saving Neurosurgery, Dr. Narayan Sundaresan, Lincoln, News 12 Bronx –TV, 06/10/11

Dr. Andrew Wiznia at Jacobi discusses Maternal HIV Transmission, CNN –TV, 06/04/11

Coney Island Farmers Market, News 12 Brooklyn - TV, 06/17/11

The Farmers Market at Jacobi Medical Center, News 12 Bronx – TV, 06/14/11

Men's Health Week at Kings County Hospital, News 12 Brooklyn – TV, 06/14/11 and 6/19/11

NY Yankees Visit Jacobi's Pediatric Unit, News 12 Bronx – TV, 06/07/11

Brooklyn Central Laundry, News 12 Brooklyn – TV, 05/26/11

Manhattan Hospital Has No Air Conditioning, Gouverneur, WNBC - TV, 06/01/11  (Also covered by NY1 News and myfoxny.com)

Men's Health Month, Dr. Maurice Wright, Harlem, WBLS-Radio, 06/12/11

HHC Head Defends Laundry Farmount to Skeptical Crowd, The Chief, 06/27/11

New brain tumor technology helps man who took two bullets to the head return to normal life, New York Daily News, 06/19/11

Elmhurst and Ethiopian hospitals exchange doctors to provide better care for patients with HIV, New York Daily News, 06/16/11  (Also covered in capitalethiopia.com)

Borinqueños en la medicina, Puerto Ricans in medicine, El Diario, 06/12/11

‘A Textbook of Trauma’,Dr. Sheldon Teperman, Jacobi, New York Magazine,  06/06/11

Developmental Care in the NICU-NYC HHC, Neonatal Intensive Care, Vol. 24 No.2, March-April 2011

Listen Up Men: It's Time For A Check Up!, The Bronx Free Press, 06/15/11

Jacobi Unveils New Psychiatric Emergency Space, YourNabe.com, 06/05/11

HHC Seeks Compensation for Innovation, Crain's Health Pulse, 06/02/11

HHC Seeks Savings, Stimulus, Crain's Health Pulse, 06/09/11

Westchester nurse uses social media to work ‘Nurse’s Station’, Nursing Spectrum, 06/13/11

Simulation labs provide high-end training, Nursing Spectrum, 06/13/11

HHC Urges People Suffering From 9/11 Health Effects to Seek Care, Nursing Spectrum, 05/30/11

Nursing students graduate from Center for Economic Opportunity program, Nursing Spectrum, 06/13/11

Disadvantaged NY Students Receive BSN Degrees, Advance for Nurses, 06/06/11

From Congo to NY: a refugee's story of redemption, Dr. Allen Keller, Bellevue Hospital, Msnbc.com, 06/19/11