In 2009 HHC cared for an increased number of uninsured New Yorkers, managed an H1NI epidemic, and began confronting the need for austerity as we grappled with the economic downturn.  The system also helped improve health outcomes for thousands of patients with chronic disease, delivered broad and effective preventive health services, and garnered numerous recognitions as a national leader in patient safety.  HHC President Alan Aviles reflects on the achievements of 2009 and talks about the ambitious goals he has set for the city’s public healthcare system in 2010.  

Q.  What is your proudest moment of 2009?
A.   We have accomplished a great deal this past year that elicits pride, but on a very personal level it was a particular honor to be a featured speaker at a plenary session of the National Patient Safety Foundation’s annual conference in Washington, D.C.  My presentation, entitled “Patient Safety: Reaching for Transformational Change in Challenging Times”, was described by NPSF to conference participants as a discussion of “how a resource-challenged system has become a beacon for patient safety”.   Such recognition by one of the leading patient safety organizations in the nation is a tribute to the innumerable staff across our system who work so hard and so collaboratively to render safer care to our patients.

Q.  How did the economic downturn affect HHC?
A.  We saw many more uninsured New Yorkers seek our services at the same time that we faced unprecedented Medicaid cuts of nearly $150 million, increasing an already daunting projected deficit to an estimated $1 billion for next fiscal year.  Until there is a sustained economic recovery, we can anticipate that expected multi-billion dollar budget deficits for the State and the City will compound our challenges. 

Q.  What are the top three achievements of 2009?
A.  We were able to continue our progress on key goals we set for ourselves to further expand HIV testing, grow our palliative care program and further reduce the incidence of hospital-acquired infections.  Our investments in clinical information technology and collaborative work around more effective chronic disease management continued to improve health outcomes for thousands of diabetic patients under our care.  And, we ramped up our training of employees in the principles of the Toyota Lean performance improvement approach – which we call Breakthrough -- to reduce waste, become more efficient and save expense, completing more than 200 rapid improvement events where front-line teams designed process changes that resulted in nearly $30 million in combined cost savings and optimized revenue collection. 

Q.  What are some of the major goals and challenges you’ll face in 2010?
A.   We have begun a detailed clinical, operational and financial analysis to devise a restructuring plan to help us address our $1 billion projected deficit, and better position us as a “provider of choice” in a post-healthcare reform environment.  We’ll need to better align and, in some instances, consolidate services to ultimately create a more integrated and cost effective system.  We are committed to ensuring that any restructuring preserves our mission and builds upon the clinical quality gains we have achieved in recent years. 

Q.  You set an ambitious agenda to become one of the safest healthcare systems in the country by end of this decade -- 2010.  Will you meet that goal?
A.  Absolutely. Our ambitious safety agenda and achievements are getting national recognition.  We have tackled those areas where there is the greatest risk of preventable harm in the delivery of health care, including medication errors, hospital acquired infections, blood transfusion, surgical errors, falls, deep vein thrombosis, and pressure ulcers.  And we are strengthening our teamwork to prevent common errors that arise when clinical team communication and coordination fail.  But, there’s more work to be done.  This year, we will redouble our efforts and focus on strengthening a non-punitive “just culture” where we can learn from mistakes and safety concerns that are reported without fear of retribution. 

Q.  What will national healthcare reform mean for HHC in 2010? 
A.  With the recent election results in Massachusetts, national healthcare reform has now become uncertain.   However, federal healthcare reform proposals held out the promise of extending insurance coverage to millions of Americans and we strongly support that goal.  Sadly, however, the proposed reform would not result in universal coverage, leaving many New Yorkers without health insurance, especially undocumented immigrants.  Whether healthcare reform is enacted or not, HHC will continue to be the only reliable source of care for the vast majority of these uninsured patients. We remain extremely concerned that  the proposed reform plans in both houses of Congress would reduce millions of dollars in federal funding used by HHC to care for uninsured patients and to cover the large shortfalls from systemic inadequate Medicaid reimbursement for our extensive outpatient services.  If healthcare reform along these lines does go forward, we will need to be ferocious in our advocacy for the funding necessary to continue our safety net mission, even as we also work to make our system as efficient as possible.

Q.  What are you most looking forward to in 2010?
A.  An uneventful flu season, successful advocacy at the state level for renewal of the $300 million in DSH funding authorized for us last year, and the opening of the HHC Institute for Medical Simulation and Advanced Learning this coming fall.

January 2010