Wednesday, December 31, 2008

Bill's place at Community

Bill Hopkins retired yesterday after nearly 28 years at Community General Hospital. You may not know him, but if you work at Community, you will likely recognize Bill as a mainstay of the Food Service Department. That's him, at right, in a photo taken with me yesterday in the hospital cafeteria.

Bill lives at Nob Hill apartments, and he has walked the 2.5 miles between Nob Hill and Community Hospital, going to work and returning from work every day -- including yesterday, his last day on the job.

Bill would begin his hike about 5 a.m., walking down Seneca Turnpike to the Valley, then up the long grade to Onondaga Hill. He did this in fair weather and foul, and he did it without interruption until "Monday, December 4, 2006."

That was when Bill was struck by a car shortly after he began the walk. He had a leg fracture, among other injuries. Until that day, Bill had never missed a day at the hospital.

Bill had surgery on "Thursday, December 7, 2006," and he spent time convalescing in Mercy Rehabilitation Center, Auburn, NY, where he was admitted on "Tuesday, December 12, 2006." When he left Mercy on "Wednesday, March 14, 2007," Bill continued to rehab at Community’s outpatient physical therapy service on Velasko Road until "Monday, April 23, 2007."

On "Tuesday, April 24, 2007," Bill learned his leg was again broken. He underwent a second surgery on "May 18, 2007."

Bill Hopkins eventually returned to work on a part-time basis on “Tuesday, November 20, 2007.” He resumed full-time work exactly one year ago, on “Tuesday, January 1, 2008.”

I have used quotation marks for all the dates to respect the precision of Bill’s memory. He is gifted at remembering numbers and dates and the facts associated with them.

Years ago Bill asked me when I began working at Community. When I told him November 5, 1973, he promptly informed me that was a Monday, that there was intermittent rain that day, and that Watergate and Vietnam were in the news.

I asked Bill to what he attributes his talent with numbers and facts. “It’s a gift from God,” Bill said. “I had nothing to do with it.”

Nearing retirement, Bill recently told me he was reluctant to stop working although he conceded, “It’s time.”

When he was on medical leave in 2007, Bill was concerned that that his otherwise perfect record of attendance had somehow been marred. He often asked Pauline Warboy, his manager, and me if there would always be a place for him at the hospital.

The answer is: "Yes, Bill, there is always a place for you at Community."

Tuesday, December 30, 2008

In praise of community hospitals

Sunday's article ("Are the elite academic hospitals always a patient's best choice?") quoted Dr. Donald Berwick, President and CEO of the Institute for Healthcare Improvement, in the Boston Globe. Dr. Berwick's perspective is interesting but not necessarily surprising.

Some thirty years ago, Dr. Robert Westlake, Sr., who was then the Vice President - Medical Services (predecessor of today's Chief Medical Officer) at Community General Hospital, used to say that academic medical centers were better than community hospitals "if you happen to be an interesting case."

Dr. Westlake (shown in a photo from 1979) passed away in 2003. During his career, he was a proponent of primary care by internists (he was one) and family practitioners. He called primary care doctors "the captains of the ship," and he argued that the primary care physician knows the patient best (clinically, as well as within a family and social system context) and is best equipped to refer and supervise ("to captain") medical and surgical subspecialists who become involved episodically in a patient's care.

He also maintained that a routine case ("uninteresting" to academics) could languish in an academic hospital where it was more likely to receive cursory or disinterested attention from a resident staff (doctors-in-training).

We've seen many changes in health care since Dr. Westlake's day. The technology and medical expertise has improved in both academic and community settings. Services and technology that were esoteric ten or twenty years ago are now routine at community hospitals. And expertise that was once limited to the hospital setting has moved to outpatient settings.

There is, of course, a touch of ego and turf-protection in broad pronouncements about academic and community hospitals. Is an academic medical center always preferable to a community hospital? Is a "brand name" residency program always preferable to residency at a state university hospital?

My own informed self-interest tends to agree with Dr. Berwick -- and with Dr. Westlake. The community hospital serves an important role.

Thursday, December 25, 2008

Appreciation at holiday time

This morning, as I approached the entrance near the cafeteria with Bill Hopkins of the Food Service Department, a doctor who was also just arriving turned to Bill and me and said, "Thank you for what you do for this hospital."

As we celebrate the holidays and prepare for the new year, I'd like to thank all who help care for patients at Community General Hospital.

First, I thank hospital employees who work each day and night, including holidays, to care for patients and to assure that patients have the supplies, the facilities, the medications, and the organizational support they need.

I appreciate our medical staff, the physicians who entrust to us the care of their patients.

I thank our volunteers who support this hospital with the gift of their time. I thank also the Auxilians who represent our hospital within the community and who raise funds to help our work.

Sincere appreciation goes to those who donate funds through the Community General Foundation.

I appreciate too the alumnae of the Community General School of Nursing and their ongoing good thoughts and wishes for our hospital.

I thank our Board of Directors, the representatives of our community who serve without pay and accept responsibility for our hospital through many hours of study and service.

Finally, I thank the families who allow us to care for those they love. There is no greater responsibility, and no greater compliment, than caring for another's loved one in time of need.

Happy holidays, and happy new year!

Wednesday, December 24, 2008

Unholy night

It’s December 24, and I recall the memoir of Dr. Jack Prior about Christmas Eve, 1944.

As Captain in the Medical Battalion of the US Army’s 10th Armored Division, Dr. Prior set up a battlefield hospital in Bastogne, Belgium. The building was destroyed in a bombing raid on December 24 with many killed or injured. Dr. Prior himself escaped only by an accident of timing.

As I’ve discussed elsewhere, I worked with Jack Prior for many years when he was Chairman of Pathology and a member of the Board at Community General Hospital in Syracuse, NY. We remained friends until his death, at the age of 90, on November 23 last year.

One of the most popular postings on this blog is Dr. Prior's compelling story, “The Night Before Christmas – Bastogne, 1944.”

Christmas Eve is a holy and festive time for many. Today I honor the memory of Dr. Prior for his brave service in the US military during a very unholy time 64 years ago.

Sunday, December 21, 2008

The big bucks

This morning’s Post-Standard includes my salary in its report "How CNY hospitals pay CEOs big bucks."

This is not the first time I’ve seen my pay reported in the local newspaper. About 15 years ago a story included my pay, and I remember feeling quite embarrassed by it at the time – especially in light of some comments that friends and co-workers felt obliged to make.

I am well paid for the work I do. I appreciate the confidence that has been shown in me by the Board of Directors, and I appreciate what the Board pays me.

The chart, below, shows how my pay last year compared with that of the CEOs at other Syracuse hospitals, according to today's newspaper.
CEO pay is public information for not-for-profit organizations such as hospitals. Each non-for-profit hospital is required to file an annual form with the IRS that documents its finances and includes the highest payments it makes to employees, officers, and vendors. Anyone can get a copy of IRS Form 990 by asking the organization for it or by consulting a service such as Guidestar.

About a year ago, Paul Levy, CEO of Beth Israel Deaconess Medical Center, reported on his blog about his own $1 million annual pay, commenting:
Americans are often ambivalent about high salaries for corporate executives: They often complain about them, but, at the same, time, everybody hopes that he or she can someday earn them!

Saturday, December 20, 2008

Patient and robot meet Carrie Lazarus

Dr. Myron Luthringer and patient Kelly Wheeler joined Carrie Lazarus on WSYR TV's "Bridge Street" Thursday to discuss Ms. Wheeler's robot-assisted surgery a week earlier.

Also appearing in the TV studio was the daVinci S Surgical robot itself. Carrie got to "test drive" the $1.65 million advanced technology under Dr. Luthringer's guidance.

Here's a link to the WSYR video.

Dr. Luthringer practices obstetrics and gynecology with Dr. Jennifer Marziale and certified nurse midwife Janice Beaman. Their offices are in Syracuse and Auburn, NY.

Cool Tools

David Rothman, who manages the medical library at Community General Hospital, also runs a highly popular blog about medical information. He informs and advises health care professionals about the sources and uses of medical information...and he does so in a cool way.

Now, with co-authors Melissa Rethlefsen and Daniel Mojon, David has written Internet Cool Tools for Physicians. The book is helpful, not just for physicians, but for anyone. It makes available the useful advice David provides daily as he helps us get the most out of the Internet.

David first encouraged, then helped, me to set up this blog about 18 months ago. The popularity of his own blog, Exploring Medical Librarianship and Web Geekery, far exceeds my own. As a result, he has been invited to speak at professional colloquia across the country. Click here for some of the praises David's blog has received from the medical information community.

David tells me "Cool Tools..." is now available in Europe and coming soon to the US. You may order it on line at Amazon or directly from Springer, one of the world’s largest publishers of journals in science, technology, and medicine.

Congratulations, David, to you and your fellow authors.

Thursday, December 11, 2008

Yesterday's 'round-the-clock meetings

Yesterday I held a series of employee meetings, starting at 7:00 a.m. and ending at 11:30 p.m. This was an opportunity to talk about current hospital issues and to hear what’s on the minds of employees. I thank all who were able to get away from their work stations for at least a few minutes to participate.

For those who could not attend, I offer this recap of the discussion.

I talked about the difficulties of 2008, the increasing numbers of uninsured and charity care patients, plus the changes this year in the OB medical staff. Obstetrician recruitment is a priority for us.

Last January, the sixth floor skilled nursing facility was closed as a result of the decisions of the Berger Commission. To comply with the Commission, Community formed a planning company for the campus we share with the Van Duyn Home and Hospital. Our planning company is called the Community Health Information and Planning Services, or CHIPS.

In September 2006, the state promised a $12.8 million grant to help Community and Van Duyn comply with the Commission. The grant contract has yet to be completed in Albany, although we are hopeful that final signatures will be forthcoming before year end. Completion of the grant contract will set the stage for the $7.6 million renovation of our sixth floor, starting in 2009. We will create a new, 40-bed acute care unit on that floor, with mostly private rooms. The Certificate of Need (CON) application for the sixth floor renovation was filed with the Department of Health this fall.

2008 was a year characterized by protracted labor negations. The collective bargaining agreement expired on April 30, but its renewal was not concluded until June 26, when the tentative agreement was reached. The contract was subsequently ratified by employees on July 2.

The summer was filled with the Legionella issue, as Community worked with County and State officials to address the risk factors immediately. This was successful, and our hospital continued to operate fully and safely throughout the summer weeks.

As a result of the above, 2008 has been a financially challenging year for Community. Nonetheless, we've made progress in many areas.

With the new daVinci S Surgical System, Community began robot-assisted surgeries in urology and gynecology during August. The start-up of robot surgery here was described as “astounding” by Po Lam, MD, Medical Director of Robotics, in a recent address to the Medical Staff. “It is pretty astounding," he said, "to establish a completely new robotic program without the glitches and the pitfalls typical of a start-up.” We have had a significant number of robot-assisted surgeries already, characterized by minimal blood loss, short stays, and good outcomes.

This year Community added a new pharmacy robot (photo, at left) in the completely renovated Pharmacy. After the Pharmacy open house, I asked what happened to the old pharmacy robot, and the answer surprised me. The manufacturer asked to keep some of the original parts for a museum display in its home office. A decade ago, Community’s robot was the first at a community hospital, and that old machine, it turns out, is of historical interest.

This summer Computerized Physician Order Entry (CPOE), a project in the planning for some time, went “live” on the first patient care unit, Four North (orthopedics). About ten percent of the nations’ hospitals have CPOE, which increases patient safety.

Community introduced digital mammography this year, replacing the old film equipment. Also, Medical Imaging converted to PACS (Picture Archival Communications System) for better storage and comparison of diagnostic images and for instant image availability to physicians over the Internet.

We introduced a new quality report card for our Board of Directors and made strides in improving patient satisfaction (especially in the Emergency Department). A national hospital rating company reaffirmed our preeminence in overall orthopedics, as well as spine and neck surgery, hip and joint replacement surgery. In addition, for the first time, we received the highest rating in maternity services from a national hospital rating firm. I encourage you to research Community General Hospital’s ratings by conducting your own Google search, and enter key words Hospital Ratings.
Also discussed were updates to the hospital’s strategic plan, including both strategic objectives and operational priorities. A key concept in strategic projects is the importance of services that are reimbursed as relatively higher levels in helping to subsidize those community services with lesser reimbursement.

There was a lot of discussion about the difficult economic environment generally. The closure of Syracuse China (in yesterday’s news) was on the minds of many employees. I raised the question of the difficult New York State budget and the impact on hospitals. I spoke about a recent editorial board meeting at the Post-Standard where I, along with other hospital CEOs, discussed the state’s proposed taxation of hospitals and its proposed Medicaid cutbacks. That news story prompted a response last Sunday by State Health Commissioner Richard Daines, MD, and further discussion just yesterday by the Hospital Executive Council.

It’s been a challenging year, 2008. And we face many challenges for 2009. Our attention is focused on the importance of disciplined daily operations, as well as our overall strategy.

Encore Performance at the White House!

Three colleagues from Community General Hospital are part of The Master’s Touch Chorale, which will perform a holiday concert at the White House on December 22.

They are Cherolyn Ottey (Labor and Delivery), Sue Ellen Maxfield (Physical Medicine and Rehabilitation), and Lynne Hickox (Certified Nurse Midwife). This will be the Chorale's third visit to the White House since 2002.

The Chorale has been directed for 16 years by Warren Ottey, who is the organist and choir director at Cazenovia Village Baptist Church.

You can hear the Chorale this Saturday, December 13, at 7:00 pm at St. Mary of the Assumption Church, Minoa, NY.

St. Ann’s acoustics are, according to Sue Ellen, “AWESOME,” and she tells me “everyone is welcome to hear the terrific one and a half hour lineup of contemporary and classic holiday music, including ‘Hallelujah’ from Handel’s Messiah.”

To learn more about the Chorale and its CD, visit it website.

What a great time of the year for a White House encore performance!

Sunday, December 7, 2008

Inspirational Medicine

Last Friday NPR’s “Day to Day” radio program broadcast a segment about low morale and disaffection among primary care doctors.

A lot of doctors said they would prefer to be in another profession. Furthermore, only about five percent of the doctors-in-training are choosing primary care because of the significant medical school debt they have to repay and because they are discouraged by the daily example of unhappy older doctors.

One of the physicians interviewed on the program told how she stopped participating in health insurance plans a few years back. Another doctor who left practice complained about insurance companies that “put profits over patients.”

A third physician lamented the loss of patient contact, as well as the decline in intellectual satisfaction. The physicians said that medical practices are succumbing to the time pressure of seeing many patients with little opportunity for attention to individual situations.

I've written before about the coming shortage in primary care physicians.

Training these physicians is a source of satisfaction and pride. Each quarter a new group of family practice residents rotates through the internal medicine service at Community General Hospital. These second-year residents are from the training program St. Joseph’s Hospital Health Center, and they provide a real service to patients as they learn from Community’s attending physicians.

Last week one of the residents was honored as a local hero by the American Red Cross. One morning in August Dr. Michael Loeb (photo) came across a bad accident at the New York State Fairgrounds on his way home after night duty at Community General Hospital. The exhausted resident did not hesitate to stop his car and help the injured family.

Dr. Loeb described the situation for a local television station:
"…[T]he day of the crash was the day after one of the most brutal calls I’d ever had,” he said. “It had just been a crazy night…My first reaction was ‘I need to get over there [to the accident site],’…and my second was ‘This isn’t going to be pretty.’”
Dr. Loeb got out of his car and crossed the lanes of traffic to provide assistance. The following morning, I saw Dr. Loeb in the emergency department when one of the attending physicians told me what he had done. I thanked him and said his example was inspirational.

Dr. Loeb reminds us why people choose medical careers, despite the demands, distortions, and pressures of the medical marketplace. People choose medicine because they care about patients, and they want the knowledge and training to be of help.