Posts from the ‘integrity’ category

Strengthening the Brigham Experience

bwh values logoLast summer, faculty and staff were invited to share their impressions of the Brigham’s organizational culture through the Brigham Experience: Culture, Diversity & Inclusion Assessment survey, focus groups, interviews and more. The message was clear: Our foundation and our people are strong, and we have opportunity to do even better, together.

The assessment revealed that Brigham Health has numerous strengths and areas of opportunity that will help grow the current culture to become even more transparent, diverse, inclusive and innovative.

Our strengths include our status as a leading academic medical system; our history and reputation; our shared passion for patient care; our progress in restoring financial health; and our ability to come together in a crisis.

Our areas of opportunity include the need for a more unifying vision and inspiring purpose statement that connects with all members of our workforce; the elimination of competition where there should be collaboration; more transparent and forthright communication; more diversity in leadership positions; a culture of respect and inclusion in every part of the organization; and a shift from a top-down structure to an empowered, shared decision-making approach.

Another takeaway from this effort was that the Brigham Health values as previously defined—collaboration, empathy, inclusion, integrity and professionalism—did not fully resonate with all faculty and staff. Building off feedback from across the Brigham, hospital leaders sought to redefine the institution’s values so that they better reflect who we are as a community.

The result is four newly articulated values:

We care. Period. We embrace a culture of shared humanity and dignity, where our diverse community of patients, families and employees all feel welcome, cared for and valued.

We create breakthroughs. It’s in our DNA. Since our founding, we’ve been discovering ways to make tomorrow better—for the health of people, here and around the world.

We’re stronger together. We all play a role. We take pride in teamwork, partnership and community. We value everyone’s contributions. We find inspiration in each other.

We pursue excellence. Because our patients deserve our best. We share a passion for learning and continuous improvement.

These four values also represent the theme of Brigham Bulletin’s 2019 calendar (published on the reverse side of this issue).

Looking ahead, hospital leaders are creating a “culture squad” to address the opportunities identified in the assessment and will then articulate behaviors that represent our aspirational culture.

Visit BWHPikeNotes.org and stay tuned for more information about our culture work.

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The ‘Antidote to Burnout’: Helping Underserved Communities

Jason Frangos and team

From left: Zachary Holcomb, John Mohs, Jason Frangos, Margaret Cavanaugh-Hussey, Toby Crooks and Diana Woody

I made my second trip to Shiprock, N.M., in November 2018 as part of the Brigham and Women’s Outreach Program. Working alongside the dedicated doctors and staff at the Indian Health Service hospital in Shiprock has truly inspired and motivated me in my life and work. Contributing much-needed clinical care to the Navajo community has re-energized me with a sense of meaning and purpose as a physician. Volunteering at Shiprock has been my antidote to burnout and has revitalized my spirit.

Jason Frangos, MD
Director, Program for Infectious Diseases of the Skin
Department of Dermatology

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Rekindling a Special Bond with a Former Brigham Nurse

By far, my shining moment this year was the day I reconnected with my primary nurse, Vivian Kelley, RN, after 39 years! Vivian helped save my life back in 1979, when I came to the Peter Bent Brigham Hospital for a bone marrow transplant. I had aplastic anemia (a rare and life-threatening blood disease) and spent two and a half months in an isolation room. Vivian was there at every turn—when I got my chemo and during the hundreds of hours that followed as I waited for my new immune system to mature. The photo in which I’m wearing a mask marks the day I went home. The other picture was taken when we reconnected this summer in Boston. Vivian moved to the West Coast a year after my transplant and continued practicing nursing until she retired. I credit Vivian’s intelligence, nursing skills and her calm, positive attitude for getting me through a terrifying time in my life. I’m so grateful we found each other again.

Jessica Keener
Associate Director, Proposal Management, Development Office

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A Walk to Remember

Fundraising walkEvery year, Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital participate as a team in the Boston Heart Walk and fundraise to support cardiovascular research and education, advocate for health and save lives. This walk is important to me because a few of my family members have experienced coronary artery disease, stroke and valve disease. By supporting the walk, I am doing my part to help fund current research that will make a difference for my family members and friends.

The 2018 Boston Heart Walk was very special to me. Not only was it the fifth time that I’ve organized and led the team, but it was also the year the Brigham and Faulkner team won the “Top Hospital Challenge” from the American Heart Association. I can’t begin to explain how exciting it was to stand on the Hatch Shell stage and be presented a trophy for our efforts. The team that raises the most money and has the most walkers during each year’s Heart Walk is crowned the “Top Hospital.” I also love meeting all the people who join our team each year. To be able to walk alongside patients who’ve undergone surgery and other procedures at the Brigham and elsewhere, lifts my heart with every step I make.

Merilyn Holmes
Senior Administrative Assistant, Division of Cardiovascular Medicine

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‘Do Right, Stay Well’: Dermatology Committee Inspires Volunteerism

Members of the “Do Right, Stay Well” Committee

If a colorful, inspirational message catches your eye while walking around the Longwood Medical Area, you may have the Department of Dermatology’s “Do Right, Stay Well” Committee to thank.

Members of the BWH volunteer group – which organizes events and activities for Dermatology staff to support wellness both in the local community and among their colleagues – recently participated in the worldwide “Kindness Rocks Project.” The initiative encourages people to spread kindness and compassion by painting positive messages on small rocks and placing them around public areas to spread positivity and joy.

It is just one of many projects the “Do Right, Stay Well” Committee has undertaken over the years that embodies what the group strives to do each day – bring people together to help others – said committee co-chair Margaret Cavanaugh-Hussey, MD, MPH, director of Public Health and Community Outreach Programs in BWH Dermatology.

“Our committee is composed of people who are passionate about and devoted to improving the community,” said Cavanaugh-Hussey. “It’s incredible to witness the goodwill of so many and how profoundly that spirit spreads out into the world.”

Founded in 2012, the “Do Right, Stay Well” Committee has a multipronged mission. Its members strive to demonstrate a commitment to service through volunteerism, philanthropy and community outreach while also supporting the department’s work to promote skin health in the local community. The group also aspires to inspire goodwill and wellness among Dermatology staff.

“Being a part of the committee has been one of the best things I’ve been able to do during my time at the Brigham,” said Marie Thistle, project manager in Dermatology and a founding member of the committee. “I’ve gained so much, both personally and professionally, from participating in the committee, and I’m grateful for the opportunities I have to give back to others.”

Since the group’s inception, it has organized dozens of events at the Brigham and beyond. Its members, totaling nearly 20 BWHers, include Dermatology administrators, clinical staff, physicians and researchers.

One of the largest ongoing projects the committee manages year-round is scheduling and hosting free skin screenings in the local community in collaboration with Dana-Farber Cancer Institute (DFCI). Brigham dermatologists, along with BWH and DFCI staff, will visit locations and events around Greater Boston – including beaches and health fairs – to educate people about skin cancer awareness and sun safety. Over the past three years, the teams have performed more than 2,800 skin cancer screenings at various events across the Boston area.

In addition to its dermatology-driven work, members of the committee volunteer at the American Cancer Society AstraZeneca Hope Lodge Center in Boston, which provides free lodging for cancer patients and their caregivers traveling from afar for outpatient care. BWH Dermatology staff come together to cook a meal for families staying at the lodge.

The committee hosts several other annual events, including a winter clothing drive and volunteer days at area nonprofits, such as Cradles to Crayons and Boston Health Care for the Homeless.

Supporting Staff Wellness

Throughout the year, the committee also brings the team together with staff lunches with an interactive component, such as creating the kindness rocks. Other luncheons have featured a healthy-choice potluck and even a lighthearted Star Wars-themed lunch on May 4, also known as Star Wars Day (which commemorates a pun on the series’ iconic catchphrase of “May the Force be with you” as “May the Fourth be with you”).

The committee’s co-chairs emphasized that the team has continued to thrive thanks to the strong support it receives from department leaders and their commitment to staff wellness. Heather Wilder, an administrator in Dermatology and committee co-chair, said that support has been incredibly meaningful.

“It’s wonderful to see how much our colleagues value the committee and everything it does to benefit the community and each other,” she said. “I’ve always had a passion for community service and philanthropy, and doing this work for the Brigham has been very rewarding.”

Anne O’Malley, an administrative supervisor in Dermatology and member of the committee, said she enjoys how the group’s work brings together staff from across the department.

“I love coming to work every day knowing that my colleagues and I are here with two common goals: to help others and to support each other,” she said. “We are all in this together – that means everything to me.”

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Quality Rounds: How Does Personal Responsibility Fit in a Just Culture?

Ron M. Walls discusses the importance of personal accountability in everyday actions.

In a Just Culture, staff are encouraged to report mistakes and near misses so that system-based issues can be corrected, resulting in improved quality and safety. But this system of shared accountability does not absolve us of personal responsibility as health care professionals, said Ron M. Walls, MD, executive vice president and chief operating officer at Brigham Health.

When we promise unerring safety to our patients, it must be a personal commitment, said Walls, who spoke about the topic at Quality Rounds on March 22. Most importantly, that means taking ownership of decisions and outcomes, he added.

“Just Culture is an important part of our safety and quality culture, but it has, to a degree, sidetracked us from the notion of personal responsibility,” Walls said.

To illustrate his point, Walls shared examples of how this has unfolded. He noted that one area where there is a greater need for personal accountability at the Brigham is hand hygiene compliance, specifically when working with patients at risk for clostridium difficile (C. diff) infection, a bacterium that causes diarrhea and can be fatal. When caring for patients who are at high risk for developing C. diff, health care workers can unintentionally spread the bacteria by not properly following the compliance measures of wearing a gown and gloves and washing their hands with soap and water before entering the patient’s room.

Following a four-month observation period, the hospital found that staff practiced those compliance measures 58 percent of the time when caring for patients at high risk for C. diff.

“Acquiring an infection in the hospital where you came to get well is a terrible outcome,” Walls said.

Hand hygiene is one of many areas where greater personal accountability will lead to tangible improvements in care quality and safety.

An individual’s failure to follow safety protocols properly aren’t malicious, Walls explained. Often, staff attribute noncompliance to external factors, such as time constraints or inconvenience. But Walls contended that this is where the need for greater personal accountability comes into play.

When patient safety is on the line, “I don’t have time to walk to the sink” is not an acceptable reason to sidestep hand hygiene, he said. Instead, he suggested staff adopt a solution-oriented outlook: “I have to find a sink” or, “It’s my responsibility to ensure that my patient leaves the hospital having received appropriate care.”

Promoting Secondary Responsibility

In addition to personal responsibility, Walls noted another area for improvement at the Brigham is strengthening our commitment to secondary responsibility – holding not only ourselves accountable but also our colleagues. In the coming months, BWH plans to unveil a new policy that will articulate expectations and processes for upholding this.

Returning to the hand hygiene example, Walls explored how secondary accountability could be practiced if a BWHer notices his or her colleague does not wash their hands before entering a patient’s room. If the noncompliant colleague – after being confronted and reminded about the importance of hand hygiene – deflects or becomes angry, the BWHer who approached their colleague would be personally responsible for filing a safety report about the incident.

Walls said this change in policy is needed because hospital leadership and the Quality and Safety team have tried everything they can to get people to exercise responsibility when an error, mistake or adverse event occurs.

“Had you walked into this hospital at any point over the past 10 years, our hand hygiene compliance rate would have probably been close to the same as today,” he said. “But I assure you that you’re not going to walk in next year and see that our rate is still that low.”

View the Quality Rounds webcast here (accessible only on the Partners network).

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BWHers Stand in Solidarity Against Gun Violence

At podium: Lachelle Weeks, joined by colleagues from across BWH, discusses the public health implications of gun violence.

When the news broke last month that there was yet another school shooting, Internal Medicine resident Lachelle Weeks, MD, PhD, chair of the Resident Social Justice Committee, said BWH residents shared in the profound sadness and frustration that has been displayed across the U.S. They were upset that once again firearms took the lives of schoolchildren and that these events are happening with growing frequency.

“Gun violence is a uniquely American public health crisis,” said Weeks, also a member of the Brigham Health Social Justice and Health Equity Task Force. “As clinicians, we are first responders – we treat the physical damage caused by guns. We nurse patients back to health. We comfort families and loved ones and counsel patients who are traumatized from being shot or shot at. It is our privilege to serve in this way, but it is our responsibility to ensure the incidents of preventable deaths, trauma and injury are reduced whenever possible.”

On March 14 at 10 a.m., exactly one month following the shooting at Marjory Stoneman Douglas High School in Parkland, Fla., health care professionals around the country, including those at BWH, came together to take a stand against gun violence.

At the Brigham, BWHers gathered in the Fish Rotunda at 15 Francis St. for a brief event, “Healers Stand Against Gun Violence,” hosted by the BWH Resident Social Justice Committee. Weeks and Charles Morris, MD, MPH, associate chief medical officer, offered reflections on gun violence as a public health issue. Chaplain Elizabeth (Elli) Goeke of Spiritual Care Services provided a moment of reflection in honor of all those affected by gun violence.

The event was one of many taking place nationwide that morning, with students across the country conducting walkout protests in solidarity with students in Parkland and to honor the 17 victims of the Feb. 14 shooting.

While gun violence is an ongoing concern for many people, it is often a single event or statistic that compels them to speak out, Morris said.

“We are all moved by numbers. Perhaps yours is 17, the number of children and adults who died in Parkland, Fla., on Feb. 14. Or maybe it’s three, the number of psychotherapists killed this past Friday in California. Or 30,000, the annual deaths in this country due to firearms,” he said. “Or maybe it’s one: the friend, fellow physician and college classmate you lost to firearm violence.”

‘At the Forefront of Health and Change’

Charles Morris encourages attendees to channel their grief into action and advocacy for treating gun violence as a public health concern.

Morris, who recently co-authored an article in The New England Journal of Medicine about gun violence as a threat to public health, underscored the important role that health care professionals can play as advocates for patients and families.

“This hospital ID badge isn’t a participation medal. It’s a symbol of our commitment to safeguard our patients’ health and to push relentlessly as part of a larger force to be at the forefront of health and change,” Morris said.

Weeks added that clinicians at the Brigham and beyond can help make a difference by contributing to the discussion on various fronts. She advocated for research, legislation and funding focused on treating gun violence as a nationwide health concern, in addition to continued support at the local level, including programs and committees at the Brigham.

“We stand together to remember the men, women and children who have lost their lives and had their lives forever changed because of a gun. We honor their memory by calling attention to this public health issue with our presence, our voice and our action,” Weeks said. “We stand asserting that deaths and injuries from gun violence are not political, but instead are preventable tragedies.”

Morris explained that while it’s important to reflect on and grieve for those affected by these tragedies, our collective responsibility doesn’t end there.

“Don’t let these events push you to a standstill. Be moved not just to emotion but to motion. And should you need it, this room is filled with people who can help you,” Morris said. “So I ask: what is your number? How does it move you? How will you move?”

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Aware Because We Care: New Security Campaign Targets Tailgating

Dave Corbin demonstrates “Stop, Challenge, Assist” with role-players (from left) Brenda Carey-Mullaney and Angela Covington.

“It happens every day.”

This was the reaction many BWHers had after watching two provocative videos depicting scenarios in which an unauthorized person accessed a secure area because staff held the door or weren’t aware of their surroundings.

Although the videos showed the worst-case outcomes for these situations, “tailgating” is a common security breach at hospitals across the country. At the Brigham, a new campaign centered on the two videos aims to empower all staff to prevent tailgating by giving them the resources they need to take action.

“We have about 1,200 restricted areas in the hospital that require badge access or a key to enter,” said Dave Corbin, CPP, CHPA, director of Security. “But if people are able to follow behind a staff member without permission, the card readers and locks aren’t effective. That’s why we’re asking all employees to be aware and look behind them every time they use their badge or a key to enter one of these areas.”

Corbin and Erin McDonough, MBA, senior vice president and chief communication officer, held 16 half-hour sessions in Bornstein Amphitheater over two days. During the event, employees viewed the videos, learned tactics to prevent tailgating and engaged in discussion.

“These sessions were excellent and truly necessary,” said Diane Bemis of the Renal Division and the Division of Engineering in Medicine. “When I first saw the infant video, I was floored and realize now just how a scenario like this could happen. All hospitals should be doing a campaign like this for their employees.”

During the sessions, employees acted out various scenarios following the “Stop, Challenge, Assist” response that Corbin explained (see box below). This response enables staff to engage in a conversation with someone who may be trying to gain access, without being confrontational, and to direct them to Security or a proper access point.

“We want you to use the Stop, Challenge, Assist method, but if at any point you feel threatened or uncomfortable engaging with someone, we ask that you simply call Security and provide their description,” Corbin stressed. “We would never want an employee to put themselves in harm’s way, but we do need you to take that step of calling us for the safety of everyone.”

Athena Lacaire, an Obstetrical Admitting officer who participated in the role-play during one of the sessions, said the information she learned was empowering. “The videos made my heart pound, but it was reassuring to know that just by looking up and being aware, you can make a difference in preventing someone from gaining access,” she said.

Corbin emphasized the difference employees can make simply by being vigilant.

“If all 18,000 of our employees are engaged in this, our level of security is much greater,” Corbin said. “We’re asking people to be aware of their surroundings, just as you’re asked to do when you ride the MBTA or go to the airport, for example.”

The hospital recently created an Access Control policy that requires all employees to be responsible for ensuring that no one enters an area under their ID badge access without permission. To view the policy, campaign videos, FAQs and other resources, visit BWHPikeNotes.org.

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