BWH leaders gather in Bornstein.

After nine months and 19 bargaining sessions, contract negotiations have stalled between the hospital and the Massachusetts Nurses Association, the union representing about 3,300 nurses at the Brigham. The MNA has called for a strike authorization vote on Monday, June 13.

If the majority of nurses who vote that day elect to authorize a one-day strike, the union must give the hospital 10 days notice of any planned action. Authorizing a one-day strike does not mean that a strike is definite. If nurses approve a strike authorization, the earliest date a strike could take place would be June 24 if the MNA gives its notice to BWH immediately after the vote. The MNA has the right, however, to hold the strike at a future date with 10 days notice. The hospital community would be notified if a strike date has been issued. 

To ensure the continuity and safety of patient care if nurses authorize a strike, BWHC leadership, including managers, directors and department heads, filled Bornstein Amphitheater on June 3 to activate BWH’s Hospital Incident Command System—an organization-wide, detailed tactical plan for keeping a hospital running safely during an emergency or a non-emergency event that would disrupt operations, such as a labor strike. If a strike is called, this early preparation enables BWH to immediately activate its tactical plan and use the 10-day notice to put it in motion.

The Strike Planning Incident Command team has been formed and is meeting regularly to hone BWH’s operational plan. BWHC leaders have stated that if the MNA calls for a one-day strike, the hospital will contract with an agency to bring in professional nurses to provide coverage. To ensure continuity of care, BWH nurses who are part of the MNA bargaining unit would not be allowed to return to work for five days.

BWHC President Betsy Nabel, MD, briefly addressed the hospital’s contingency plan at Town Meeting in Bornstein on June 7.

“Caring for our patients is our top priority, and we’ve made plans to respond accordingly in the event of a strike,” Nabel said. “We all deeply respect our nurses and the incredible care they provide. Union negotiations can be a trying time in any industry, and I know that this is difficult for all of us. We will come through this together.”

Vincent Vacca, nurse educator, left, accepts an award from Shaun Golden, nurse director for the Neuro ICU, at the conference.

BWH nurses, nurse directors, educators and other team members gathered for the annual Neuroscience Nursing Conference in the State Street Pavilion Club at Fenway Park on May 19. BWHers and guests discussed stroke in women, neurological critical care for children and more.

Zinnia Feliciano, MS, AGCNS, CNRN, last year’s Essence of Nursing recipient, and Eileen McMahon-Bowen, BSN, RN, CNRN, the 2014 Essence of Nursing recipient, read narratives about their most memorable patients. Additionally, Greg Coutu, a former patient of the Neurosciences ICU, and his wife, Jillian, shared their care experience.

Throughout the conference, celebratory messages for BWH nurses appeared on Fenway’s big screen. Conference-goers also received a visit from the Red Sox mascot, Wally the Green Monster, and had the chance to see the team’s World Series trophies.

From left: Lauren Wolf, Anna Gielazyn and Carole Molly

Nadine Wint, PCA, carries a letter in her pocket written by one of her most memorable patients. After the patient was discharged, she sent it to thank Wint for her excellent care.

It was a small gesture, but one that left a big impact. Wint, a patient care assistant on Tower 14CD, has held onto the letter since receiving it in 2012 and often reads it when she’s had a difficult day.

“This is one of the greatest letters I’ve ever received,” said Wint as she pulled the folded piece of paper from her pocket and held it in her hand. “This patient’s letter always gives me the courage to keep going. It’s such a joy for me to wake up each morning and come to work to care for my patients. Every day I say to myself, ‘I want to make a difference in someone’s life today.’”

Earlier this month at Schwartz Rounds, a panel of BWHers described by their colleagues as “unsung heroes” shared how they approach their roles and contribute to patient care. They were joined by their managers and directors, who described what makes them exceptional. The Schwartz Rounds series, which focuses on a different topic each month, is a multidisciplinary forum aimed at promoting compassionate care by exploring the human side of health care.

Lauren Wolf, MS, RN, nurse director of 10BA, said highlighting unsung heroes at BWH has prompted conversations about how vital such supporting roles are to delivering safe, high-quality care.

“Recognizing the important contributions of our ancillary staff has also brought a great, positive energy to our unit,” Wolf said. “To have had the opportunity to thank some of our staff in a special way at Schwartz Rounds was important. We are blessed to have staff at BWH who go above and beyond in their roles each day.”

Esteban Gershanik, MD, MPH, MMSc, an attending physician and medical director of 14CD, described the panelists as integral members of the medicine units. Gershanik and Wolf, both members of the General Medical Service, worked together to bring the topic of unsung heroes to Schwartz Rounds. They hope it will inspire staff from other departments and services to begin similar conversations with colleagues about the importance of recognizing these employees.

“Sometimes it’s the smallest things that staff members do for patients and colleagues that make a big difference,” Gershanik said. “We’re really focused on making sure employees know they are valued and respected.”

Regionalization of the General Medical Service has encouraged care teams to work more closely together, resulting in better patient care, Gershanik said.

Carole Molly, of Environmental Services, has worked on Tower 10 as a housekeeper for 17 years. Molly says she’s always happy to come to work and appreciates when patients thank her for cleaning their rooms.

“I’m always smiling when I’m at work,” Molly said. “I feel good when I am here. Patients and colleagues are really kind to me and grateful for my help.”

The best reward for Anna Gielazyn, unit coordinator on Tower 10A, is when patients thank her personally.

“I’ll visit a patient’s room for a few seconds to make sure they are doing OK, and it’s really great when they say, ‘Thank you, Anna,’” she said. “These short, but meaningful interactions are what make my day.”

Julieann Tamayo, operations supervisor for Tower 14ABCD, says she’s proud of her colleagues who go above and beyond their daily responsibilities to make BWH a warm and welcoming place for patients, families and colleagues. When she delivered her daughter at BWH, Tamayo said her entire care team, including the lactation nurse, housekeepers and OB/GYN technician, made her feel well-cared for and safe.

“It’s a privilege for me to be able to spend as much time as I can on the units observing these special moments that affect our patients,” Tamayo said. “Having experienced this excellent level of care myself, I know that we are doing everything we can each day to make patients feel as though they are part of the Brigham family.”

The BWH Schwartz Rounds are open to all hospital staff. They take place on the second Tuesday of each month, from noon–1 p.m., in the Anesthesia Conference Room. The next Schwartz Rounds is June 14. After a summer break, Schwartz Rounds will resume in September.

The Brigham Way Campaign

Did you know BWH has a program for recognizing unsung heroes? Nominate a colleague for the Brigham Way to honor him or her for the many ways, both big and small, they go above and beyond to make BWH a warm and welcoming place. Learn more at BWHPikeNotes.org.

The Levy family

Rena and Yonatan Levy, of Brookline, got an extra-special Mother’s Day gift in the early morning hours of May 8: They welcomed their first child to the world, a baby boy, at 1:25 a.m. Baby Levy arrived seven days after his due date, but his parents said it was exciting that their son was born on such a special day.

Throughout the day, Rena said many nurses popped into her room to congratulate the family and wish her a happy Mother’s Day.

“It was really special,” she said. “It felt so nice to be acknowledged, especially since it was my first Mother’s Day.”

The Levy family, who plans to decide on a name for their new baby this weekend, said they were very pleased with all aspects of their care at BWH, specifically thanking the team of anesthesiologists, whom they described as compassionate and reassuring.

“Our experience here has been wonderful,” Rena said.

From left: Carrie Braverman, Garrett Garborcauskas, Ole-Petter Hamnvik and Juan Jaime de Zengotita

A harrowing statistic came to light several years ago: Nearly one in five transgender people in the United States has been refused medical care due to their gender identity or expression, according to a survey by the National Center for Transgender Equality and the National LGBTQ Task Force.

And while transgender equality has become a more visible national priority since the 2011 release of that report, “The National Transgender Discrimination Survey,” transgender patients and advocates who spoke at a recent BWH event say there is still plenty of room for progress.

“We need health care providers to be sensitive to LGBTQ patients’ needs because insensitivity can result in inappropriate behaviors, alienation and mistrust,” said Juan Jaime de Zengotita, MD, a primary care physician and medical director of Southern Jamaica Plain Health Center, at “Creating a Caring Environment for Transgender Patients: A Panel Discussion for Care Providers and Staff.”

The event, held May 4 in Bornstein Amphitheater, was jointly organized by the BWH/BWFH LGBT & Allies Employee Resource Group and BWHC’s LGBTQ Patient and Family Advisory Council. Its goal was to provide a nonjudgmental venue for education and awareness, said Maureen Fagan, DNP, MHA, executive director of the Center for Patients and Families and associate chief nurse for the Center for Women and Newborns.

“We are on the journey of learning how we can best meet the needs of all our patients,” said Fagan. “We need guidance, and we’re very open to that as an institution.”

Starting the Conversation

Seemingly well-intentioned comments can sometimes make transgender patients feel singled out, explained Garrett Garborcauskas, an MGH employee and founder of the Partners Transgender Alliance. As a patient, Garborcauskas said there is no need for clinicians to mention gender identity or expression unless it’s directly related to the care being provided.

“I’ve seen doctors who say, ‘You’re my first transgender patient,’ and I have no idea how that’s relevant for something like an eye exam,” he said. Other times, curious clinicians have asked Garborcauskas questions about medical care regarding his transition, despite having no relevance to the reason for his appointment.

To care providers, such comments may seem like friendly conversation or an attempt to acknowledge a patient’s gender identity in a positive way, but they can often have the reverse effect—calling undue attention to otherness. In those situations, Garborcauskas said he struggles to respond in a way that won’t create an awkward situation that detracts from the issue at hand.

In response, clinicians in the audience asked how they can best signal their support to transgender patients and help them feel more comfortable at BWH.

“Even having a little rainbow sticker on your nametag helps,” said panelist and endocrinologist Ole-Petter Hamnvik, MD. “I’ve had several patients point it out.”

Panelists also recommended asking all patients their preferred pronouns (for example, he, she or they, among others) during patient check-in or registration to avoid stereotyping and to ensure that no one feels singled out. The suggestion resonated with attendee Ellen Steward, manager of Client and Physician Relations.

“One takeaway for me is that there is a real need for training for staff and clinicians who will be the first point of contact regarding what information they should ask for and how to ask for it,” Steward said. “I see that as so important if we want BWHC to be LGBTQ-friendly.”

Health care providers are already accustomed to asking patients a litany of questions about everything from alcohol intake to seatbelt use to domestic violence concerns. Similarly, posing a broad question—such as, “Is there anything about your sexuality or gender you’d like to discuss today?”—might be a natural opening for clinicians to empower transgender patients to feel safe coming out. It also creates an opportunity to encourage any patient to discuss sexual orientation, reproductive health or similar topics, said panelist Carrie Braverman, LICSW, of Social Work.

Employees who would like a rainbow sticker for their nametags may visit Meredith Solomon in the BWH Medical Library. To join the BWHC LGBT Employee Resource Group listserv, email bwhclgbt@partners.org.

Nancy Kelleher (front row, second from left, in gray blazer) with colleagues at this year’s Nurse Recognition Dinner

Nancy Kelleher, MSN, RN, of Care Coordination, approaches her patients with grace and dignity. No matter a patient’s background or situation, Kelleher treats all patients with the respect they deserve.

“Every patient I care for is important to me,” said Kelleher, who practices on Tower 14B, a general medical service with medically complex patients. “It’s essential that I spend time getting to know the patient and their situation so that I’m able to develop the best discharge plan for everyone involved.”

For her compassion, expertise, leadership and many other outstanding qualities, Kelleher received this year’s Essence of Nursing Award, the highest honor presented to clinical nurses at BWH. She accepted the award at the Nurse Recognition Dinner on May 5.

Kelleher, who began as a nurse care coordinator at BWH in 1994, works closely and collaboratively with many members of the interdisciplinary team, patients and their families to ensure patient care is well-coordinated across the continuum from pre-admission to post-discharge.

“What strikes me about Nancy is her commitment to her work and patients,” wrote nominator and Care Coordination Program Director Terri O’Sullivan, MPH, MSN, RN, ACM. “As a care coordinator, her nursing practice reflects her exceptional commitment.”

When Kelleher first engages with patients and their families, she initiates discussions about discharge plans with all who are involved in their care to meet their individualized needs. Her leadership and clinical expertise direct the team’s focus on the issues at hand and possible strategies to solve problems. She communicates the necessary steps required and joins in to be part of the solution. If the team encounters a barrier, she quickly regroups to develop an alternate plan, which can include reaching out to community resources.

“Nancy is a most-valued member of the team and stands out as one of the best individuals to work with at BWH,” said O’Sullivan. “She is extraordinarily flexible, willing to meet early or late with the team, patients and their families. She demonstrates amazing insight into facilitating transitions of care from inpatient to outpatient.”

During this year’s Nurse Recognition Dinner, the four exemplary nurses named as honorees were also recognized: Andrea Fonseca, MSN, RN, ANP-C, Shapiro 8 Vascular Surgery/Cardiology, nurse-in-charge; Melanie Nedder, BSN, RN, CCRN-CMC, clinical nurse in the Levine Cardiac Intensive Care Unit; Hayley Tuon, BSN, RN, CCRN, clinical nurse in the Medical Intensive Care Unit; and Ann Walsh, BSN, RN, clinical nurse at Brigham and Women’s and Mass General Health Care Center, Foxborough. Nearly 500 attendees gathered at the dinner to recognize Kelleher and the honorees.

“I was delighted to celebrate the many strengths and achievements of our recipient, honorees and department and the extraordinary care we provide to our patients and their families every day,” said Jackie Somerville, PhD, RN, FAAN, chief nursing officer and senior vice president of Patient Care Services.

Learn more about BWH nurses’ compassionate patient-centered care in this video.

The Shook family

Baby Goes Home After More Than 100 Days in NICU

“We’ve been looking forward to this moment for a while now,” said Monica, a former BWH Anesthesiology resident who currently practices at Anaesthesia Associates of Massachusetts, a private group in the Boston area. “It’s so wonderful to be at home with both of our boys for the first time since William was born.”

The Shooks hoped to take William home on Mother’s Day after 107 days in the NICU, but he had a minor setback and needed to stay two additional days.

Delivered via an urgent C-section, William was born prematurely in January at 29 weeks gestation. Because he wasn’t breathing, he was intubated and taken to the NICU. During his first few weeks, William faced several health issues, including lung disease related to his prematurity, which was further complicated by a collapsed lung.

Since then, William has overcome many obstacles. His lungs are getting stronger, and he’s able to eat without the assistance of a feeding tube. He’s grown from three pounds at birth to almost 10 pounds today.

Monica Shook with Baby William

“He’s made tremendous progress,” said Carmina Erdei, MD, a neonatologist in the Department of Pediatric Newborn Medicine. “We are all so happy that he’s able to go home. William is fortunate to have an incredibly dedicated family, who has been by his side and involved in his care every single day since he was born, and that really set him up for success. We’re confident that he will continue making big strides; that’s the best gift parents can hope for.”

For the past three-and-a-half months, the Shooks have been in the NICU each day, along with an incredible support team. Douglas, who is the program director of the Cardiothoracic Anesthesia Fellowship and director of Interventional Cardiac Anesthesia, said from the moment William went to the NICU, both he and Monica felt included in their son’s care team.

“The level of care has been outstanding,” Douglas said. “We were invited from the very beginning to sit in on conversations the care team had about William; we were updated regularly on his progress and could always ask questions. The open communication we experienced in the NICU has been terrific.”

William’s primary nurse, Jeanine Levantian, RN, has been with him every step of the way.

“It was both a privilege and an honor to care for this beautiful baby,” she said.

Looking back on their experience, Douglas says he’s especially grateful for his Anesthesiology colleagues who have supported his family since before William was born. On multiple occasions, colleagues brought food for them and visited with Monica while she was on bed rest prior to William’s birth. Douglas’s current fellowship class even pitched in and delivered a week’s worth of groceries to the family’s home in Newton to support them after William’s birth. 

“People visited us every day,” Douglas said. “We experienced unbelievable generosity from my colleagues. It brings a warm feeling to my heart that I’m associated with such incredible people who are essentially my second family.”

Douglas Shook with Baby William

For Mother’s Day, we asked BWH moms & daughters to share how their bonds have grown while working together at the hospital

Lindsey Sadler and Patrice Nicholas

Patrice Nicholas and Lindsey Sadler

When Lindsey Sadler, began working at the hospital in 2013, she could have never imagined just how closely she would end up working with her mother in-law, Patrice Nicholas, DNSc, DHL (Hon.), MPH, MS, RN, ANP, FAAN, to help others.

Nicholas is director of Global Health Programs in the Center of Nursing for Excellence, and Sadler, a practice manager in OBGYN, had always admired her mother in-law’s commitment to mentoring young professionals. Sadler began to realize there were opportunities for Nicholas to connect with and advise medical assistants from her department who looking to advance their careers in nursing.

“When medical assistants told me they wanted to pursue a career in nursing, I immediately connected them with Patrice,” said Sadler. “They would meet, have an informational interview and talk about whether to get an RN or a BSN. Patrice continued to mentor them after that conversation.”

And the relationship goes both ways. Nicholas also directs students that she meets with to Sadler’s office when they are interested in externship opportunities in OBGYN. Inspired by her mother-in-law, Sadler became motivated to be a better mentor in her own role by actively seeking out talent and opportunities for those she works with. “It’s exciting to help people grow in their careers,” Sadler said of her experience so far.

Although Nicholas says she truly enjoys helping others grow, she notes that her daughter in-law is her “favorite mentee”.

Amanda Munden and Lauren Willard

Amanda Munden and Lauren Willard

Amanda Munden, RN, always knew she wanted to be a nurse. “Both my mother and aunt were nurses. Growing up I saw how caring, nurturing and selfless they were – they constantly put others first,” Munden recalled.

“I could not be prouder that she has also chosen a career in nursing,” said her mother, Lauren Willard, RN, who has been a nurse at BWH for 35 years and currently serves as a nursing director for Gynecology/Oncology.

Although Amanda works in 14 CD and Lauren works in 12C, one patient scenario left them crossing paths in a very unexpected, but touching, way. A patient Willard developed a close relationship with emailed her when she was re-admitted to BWH and asked if she would visit. “Of course the next day I walked over to her room, only to find Amanda was in there taking care of her – they had no idea she was my daughter!” Willard said, laughing.

“The patient told me what a wonderful job Amanda was doing; it was a really special feeling to hear that. I’m very proud that Amanda chose nursing as her career and that she works here at the Brigham,” said Willard. “It’s just a good feeling for me as a mother and a nurse.”

Rita McCarthy and Laura McCarthy

Laura McCarthy and Rita McCarthy

“It’s been awesome to see Laura as she has progressed from receiving her first bachelor’s degree and continued on to nursing,” said Rita McCarthy, RN, a nurse practitioner in the Diabetes and Metabolism department at BWH, and a nurse for over 35 years, about her daughter, Laura, who is now a staff nurse at BWH. “It was fun for me to hear what she was learning about in her nursing programs and how similar, and also how different, it all was from when I was becoming a nurse.”

After receiving her first degree in education, Laura soon realized that, like her mother, she wanted to pursue a nursing career. After graduating from an accelerated, 16 month program, she joined BWH and now works in the vascular and cardiac medicine unit.

Although mother and daughter work different hours, and in different areas, their shared chosen profession has created a special bond between them. “Sometimes Laura asks me questions about nursing, and it’s really fun to share my experience. She also helps me when it comes to using and understanding all the new technology! It’s a really fun exchange of information,” said Rita.

As a new nurse, Laura turned to her mother often for advice. “I could always ask her something, or get her opinion, because at one point she was in my position. She has a unique perspective and to connect with her in that way is pretty cool,” Laura said.

Additionally, Rita is excited for her daughter to experience all the growth and opportunities that Brigham has to offer. “The Brigham is a good place to work. I have had a lot of opportunities throughout my career here, and as Laura keeps advancing through her career, she’ll find a lot of opportunities here for herself,” she says.

A BWH Family for Almost 200 Years

Sandy’s mom at her retirement party in 1983

At a recent holiday gathering, Sandy (Holmes) Vance and her family, who grew up in Brigham Circle, started tallying the number of years that the family has worked at Brigham and Women’s Hospital (BWH), realizing that the total approaches nearly two centuries.  “Combined, it was close to 200 years of service to BWH from just our family. When you think about that, it’s really amazing,” said Vance, a nurse at BWH.

“Our mom started the tradition,” she recalled of her mother, Sarah Holmes, who worked in the Parkway division at the Boston Hospital for Women, one of the hospitals that merged with Peter Brent and Robert Breck Brigham to form BWH, in the 1960s.  “She worked in Central Processing, putting together the surgical kits for the OR.  She worked there until she retired in 1983.” As each of her six children turned 16, she helped almost all of them secure their first job at BWH.

During his high school years, Vance’s oldest brother, Mike, worked in the hospital’s kitchen at the Parkway. “After that, my older sister Debbie started as a candy striper and got her first nursing job at the hospital after graduation in 1976.” Her sister, Deb Cotto, now 40 years later, still works at BWH, but in the abnormal Pap Smear Center. Cotto’s daughter, Elizabeth Donovan, a nurse as well, has now been with BWH for 10 years.

Then Vance followed in joining the BWH family. “My first nursing position was also at the Parkway in 1979, and then I moved over to the Tower when it opened.” She spent three years in GYN oncology before she left Boston to travel around the country, but returned in 1996 to the Center for Infertility and Reproductive Surgery. She left for a short time, returning in 2014 to BWH and works in the Center for Infertility and Reproductive Surgery where she plans to retire.

For about two years, her younger brother, Jim Holmes, worked at the hospital as a technician in anesthesia before he became a nurse. His wife, Patty Holmes, a nurse, has now been working at BWH for 20 years, now in the Shapiro Cardiovascular Center.

Eddie Holmes, Sandy, her niece Elizabeth Donovan, and her sister Deb Cotto

Lastly, Vance’s youngest brother, Ed Holmes, who started working at Peter Bent Brigham in 1979 at 17 years old, currently works in Biomedical Engineering as an OR equipment specialist.  “When he retires, he will have 50 plus years of service at the hospital,” she said.  His daughter, Melynda, also worked at BWH for about five years.

Vance says her mother would be proud to hear how many years her family has devoted to BWH. “There are still a few people here who remember her; it just warms my heart when they talk about her because everyone loved her,” she said.  “Whenever I meet anyone who knew her, it’s a special feeling.”

Although the family has already dedicated many years of service to BWH, Vance laughed and said, “We still have many more to go.”

Frank Denaro (center) with some of his colleagues (from left): Nancy O’Grady, Rosalie Blenkhorn, Pat McEntee, Deb Ayers and Mat Motroni.

Frank Denaro, RN, was recently in the Tower when his cell phone buzzed with a text message from a colleague in the Dana-Farber/Brigham and Women’s Kraft Family Blood Donor Center. The message said that his coworkers had a surprise for him.

Unsure of what to expect, Denaro headed back to the Blood Donor Center—where he cares for patients receiving bone marrow transplants—and walked into a standing ovation of cheers and applause. Colleagues at the center had just learned that Denaro was one of 39 BWH nurses being honored in The Boston Globe’s annual “Salute to Nurses” program, which recognizes nurses who provide patients with extraordinary care. Honorees, who were announced in The Globe earlier this week, were nominated by patients, patients’ family members and colleagues.

Amid the laughter and applause, one quiet moment made the day even more special: Esther Zaff, a patient who visits the center weekly for treatment—and who happened to be there that day—sidled up next to Denaro and said, “Frank, I’m the patient who nominated you.”

Zaff, whose nomination letter appeared in The Globe, wrote that she appreciated Denaro’s ability to care for her as a person and not just as a patient.

Esther Zaff with Denaro

“More than performing his job at the highest level, Frank understands the human component of nursing,” Zaff wrote. “He knows when to chat, when to back off, when to joke and when to simply offer a supportive nod or hand squeeze.”

It’s a level of care that all the nurses in the center practice, says Denaro, adding that his colleagues deserve to share the honor. The nurses function as a team to create a friendly and compassionate environment for patients, some of whom come to the center very ill and require ongoing treatments, each of which may last several hours.

“We spend a lot of time with our patients, so we get to know them really well,” said Denaro, who joined BWH in 2001. “When they talk to us, they know we’re serious about connecting with them. And that’s very important—it’s the essence of nursing.”

Denaro has the gift of being serious about his work without having an overly serious demeanor, Zaff wrote.

“Knowing I’ll be hanging out with Frank makes me almost look forward to my treatments,” she added. “I think that’s the highest praise any patient can offer.”

Read the nomination letters and view all of the honorees in The Boston Globe’s “Salute to Nurses.”

Ron Walls discusses the role patient safety plays in the Brigham’s strategic priorities.

You wouldn’t choose an airline that tries to attract customers by saying its planes are safe most of the time. Safety is an expectation no matter whose flight you’re on, while updated aircraft, expert and supportive cabin attendants, and a streamlined boarding process are what set apart one airline from another.

The same expectation needs to be set regarding patient care at BWH, said Ron M. Walls, MD, BWHC executive vice president and chief operating officer, speaking at a Quality Rounds presentation, “Delivering High-Quality, Safe Care: A Strategic Imperative” in Bornstein Amphitheater on April 21.

Although two of the strategic priorities the hospital has established—scalable innovation and advanced, expert care—distinguish BWH as a leader compared to other institutions, these priorities cannot be achieved without a strong foundation of excellence in safety, quality and patient experience, Walls explained.

“Delivering the highest-quality safe care and providing an exceptional patient experience are as critical to the hospital’s existence as food and water are to our personal existence,” he said.

The Brigham has long held a reputation for safe, high-quality patient care, but there is an ongoing requirement for improvement. According to Walls, this hinges on staff embracing safety and quality as part of our patient care culture, and making them part of every thought and action.

“Safety and quality are completely interwoven,” he said. “They’re not a series of programs that you add onto or integrate into things—they require a culture of collective and personal responsibility and accountability.”

Shifting Focus

This hospital is supporting efforts to consistently achieve safe, high-quality care for our patients by focusing on three key areas: increasing transparency, creating a Just Culture and improving communication and resolution after a medical injury.

In terms of transparency, BWH goes beyond the minimum reporting requirements by disclosing not only the number of serious reportable events, but also the narrative that goes with them. The hospital’s Safety Matters blog is one place where this happens, detailing errors that have occurred and what has been changed to prevent them from happening again.

Traditionally, health care providers have only scrutinized errors that resulted in harmful outcomes, but incidents that don’t appear to cause immediate harm need to be treated equally seriously, Walls said.

“Our focus has shifted from being compliant with market and regulator expectations, in terms of safety disclosure, to being leaders in transparency,” he said. “We’re telling those stories to shine a light not only on the incidents so others can learn from them, but also on ourselves so it’s clear to us and everyone else that we hold ourselves to the highest safety standard.”

That’s why fostering a Just Culture at BWH is so important. A Just Culture abandons a “blaming culture” where people are afraid to voice concerns or report mistakes for fear of punishment.

“There is always a need for individual accountability around safety,” Walls said. “But if the person who makes a mistake is being careful and acting in a reasonable way, and our systems facilitate the error, then we must correct the systems and support the person.”

Clinicians should do more than just disclose and apologize for such errors to patients. In fact, it is best to work with the patient to identify what would be necessary to make the situation right. This latter step might include an offer of compensation, a significant departure from traditional approaches, he added. These practices are necessary to achieve resolution after a medical injury.

Walls expressed empathy for the fear that patients and their families can face when interacting with a hospital, stating, “Our job is to communicate with them openly and honestly, and to treat them with respect so that we can establish trust and alleviate their fears.”

View the Quality Rounds webcast here. (This link is available only to Partners employees.)

Soul and jazz singer Wanetta Jackson, of Jazz Boston, performs for BWH patients and employees on World Voice Day.

On April 15, singers from BWH’s Division of Otolaryngology and guest musicians treated employees, patients, families and visitors to a concert in honor of World Voice Day, an annual celebration held in April.

“World Voice Day celebrates the human voice and the power it gives us,” said Thomas Carroll, MD, director of the BWH Voice Program. “World Voice Day has helped to spread this message around the globe, with concerts, symposiums and training programs all meant to recognize the power of the human voice.”

The concert, held in the Cabot Atrium, included a range of performances, showcasing popular songs from well-known singers and performers, classical operatic pieces and even an original song.

Intuition, an all-female barbershop quartet consisting of Kelly Winnick, Dianne Nitzschke, Susan Kapur and Jen Winston, one of the Voice Program’s speech-language pathologists, sang in the hospital’s lobbies beforehand to drum up attention for the main event. The group kicked off one of the mini-concerts with a performance of “Somewhere over the Rainbow,” followed by the barbershop song “The Moment I Saw Your Eyes.” The group ended their set with “You Are My Sunshine,” drawing in a crowd of patients and employees.

Listen to Intuition perform “You Are My Sunshine”

At the main event, with support from the BWH Lung Center, soul and jazz singer Wanetta Jackson, of Jazz Boston, performed two Stevie Wonder songs while the crowd clapped along. Jessica Taylor, MM, an administrative assistant for the Voice Program, and Chandler Thompson, DMA, MS, CCC-SLP, voice specialist and coordinator of Voice Services, followed her act, singing the “Flower Duet” from the opera Lakme. Shannon Corey, a local pianist and singer songwriter, performed three songs, including the Irving Berlin classic “Cheek to Cheek,” which prompted a few couples to begin dancing. For the grand finale, all members of the Voice Program, including Co-Director Jayme Dowdall, MD, took to the stage for a group rendition of “One Voice,” encouraging the crowd to sing along.

Although the day was celebrated through music, it also served as an opportunity for the Division of Otolaryngology to highlight the importance of its work in protecting the human voice from harm and rehabilitating the injured voice. The Voice Program at BWH helps to address vocal issues by providing expert care and diagnosis and innovative therapies for a range of voice, swallowing and laryngeal breathing disorders, including chronic cough.

BWHers from many services gathered in the command center to respond to last week’s Code Amber, Internal.

It was an “all hands on deck” approach to respond to a Code Amber Phase 2, Internal, that was called the morning of April 6 as a result of an extremely high patient census in nearly every unit, including Intensive Care Units, the PACU, Operating Rooms (ORs) and the Emergency Department (ED). With steady communication and intricate teamwork among many departments and services, the code was cleared just about six hours later—a remarkable feat, said Executive Vice President and Chief Operating Officer Ron M. Walls, MD.

“To be able to accomplish what we did in just a few hours was nothing short of extraordinary,” said Walls. “I was so proud of the teamwork and leadership demonstrated by hundreds of staff, who remained focused on quality and patient safety while working to create capacity for those in need of care.”

In the 10 days that preceded the code, leaders from BWH and BWFH met frequently to identify potential patient flow concerns in preparation for the Partners eCare go-live at Mass. General Hospital and Newton-Wellesley Hospital. During go-live, both hospitals were accepting fewer patient transfers, and BWHC anticipated additional transfers.

At regular intervals throughout the day on April 6, representatives from many services came together in the hospital command center to provide updates, report on barriers to discharge and work together to solve them.

“There was unity of effort and remarkable teamwork,” said Eric Goralnick, MD, MS, medical director of Emergency Preparedness, who served as incident commander. “The lessons learned from this event will help guide our future capacity management efforts.”

Care teams on the units identified various issues that were delaying patient discharges, from logistical issues like waiting for transportation to go home or to other facilities, to requiring prescriptions, labs, tests and physical therapy. With expertise from so many areas in the command center, leaders from each area were able to quickly respond. Radiology and Phlebotomy expedited tests and labs, respectively, as Pharmacy and Rehabilitation Services addressed prescription needs and physical therapy. 

Care Coordination identified various means of transportation available to patients and worked with rehabilitation facilities to expedite the transfer of patients going to these locations. The Center for Patients and Families was on hand to explain the situation to patients and family members, providing them with information and resources as they waited.

Environmental Services and Central Transport doubled up on staff to clean rooms and turn them over as quickly as possible and to ensure transport within the hospital was available immediately. Admitting staff remained in constant communication with all services, monitoring available beds and quickly assigning them to waiting patients. Housestaff, fellows, attending physicians, nurses, unit coordinators and all team members on inpatient units, the ED, PACU and ORs worked together to ensure that every patient’s care needs were met during an especially challenging situation. Many other services and staff, including Food Services, were at the ready, ensuring minimal disruption for patients and families.

“Through excellent teamwork and collaboration, our triads of nurses, physicians and administrators were able to address barriers and free up capacity to safely manage the increase in volume and acuity of our patients,” said Lisa Morrissey, DNP, MBA, RN, associate chief nurse for Perioperative Nursing and Procedure Areas. “This would not have been possible without the hard work of everyone on the units and in many services who worked closely to prioritize, coordinate and provide patient care.”

BWHC President Betsy Nabel, MD, rounded throughout the hospital during the day, talking with patients, families and staff. “Patients and families were quite understanding of the situation and knew that we were focused on taking care of the needs of every patient,” she said. “For me, this urgent situation brought out the best of the Brigham. We can all be proud of the care we delivered during a challenging time.”

Sarah Hosein

Sarah Hosein, MSc, was recently appointed director of Strategy Implementation at BWH. Hosein joins BWH from Boston Medical Center, where she was administrative director of Psychiatry.

As director of Strategy Implementation, Hosein is responsible for supporting the hospital’s clinical teams in developing new and innovative approaches to improve patient flow. Her focus is to add value across the hospital by designing and implementing patient-centric initiatives that enable more timely access to inpatient services.

Hosein has worked for the UK National Health Service in London and King’s College London’s Centre for Global Health, where she oversaw efforts to build hospital management capacity across Sierra Leone’s health system. Hosein received her master’s degree in international management from King’s College London and her bachelor’s in international relations from the London School of Economics.   

BWH Security offers all employees a variety of training sessions on topics including workplace safety, crime prevention, general de-escalation and more. “The tips and techniques for personal safety that we teach here can be used both inside and outside of BWH,” said Richard Wong, Security training manager.

BWH Bulletin spoke with Wong, who oversees all of the trainings below, to learn more about each offering.

Workplace Violence: one-hour in-person detailed look into different categories of communications, including personal space, eye analysis, gestures and behaviors; various methods of de-escalation; and resources available. This also includes discussions about example situations.

Patient/Visitor De-Escalation: 45-minute in-person training primarily for administrative and outpatient staff that includes a detailed look into physical communications (reading body language) to decipher the level of threat to safety, as well as discussions of example scenarios.

S.A.F.E. De-Escalation: 45-minute in-person training for inpatient staff that includes the S.A.F.E. Response for de-escalating a potential safety threat, as well as discussions of example scenarios.

Management of Aggressive Behavior (MOAB) Introduction: three-hour in-person MOAB training, including the causes and effects of escalation, as well as hands-on techniques, such as body language deciphering, planning for immediate egress and blocking stances.

Active Shooter Video and Discussion: 30-minute in-person training that includes a 10-minute video and an opportunity to ask questions about the video, preparedness or any other concerns.

General De-Escalation: five-minute general training about de-escalation techniques in HealthStream (accessible at any time via login.healthstream.com).

Crime Prevention: 15-minute in-person training on the fundamentals of “street smarts,” including how to stay safe while riding the MBTA, getting to your car, walking down the street and at home.

Workplace Safety: 15-minute in-person training about basic safety within the workplace, such as ID badge information, locking valuables, access control, how to call Security and how to respond to a disgruntled person.

Emergency Codes: 15-minute training on HealthStream that discusses the different codes used on campus (accessible at any time via login.healthstream.com).

Counterfeiting: one-hour in-person training on identifying and handling counterfeit money and how to respond, including hands-on teaching and video viewing.

With questions or to schedule a training class for your department or team, contact rwong4@partners.org.

From left: Committee members Brooke Reyes, Stephanie Gelinas and Leo Buckley; winners Mustapha Khiyaty, Rohit Majumdar, Sheila Grant and David Shelton; Senior Vice President of Facilities and Operations John Pierro; and James McKinnon, of Materials Management

Rather than using prepackaged, one-size-fits-all trays for medical instruments needed during delivery, members of BWH’s Labor & Delivery (L&D) and Materials Management teams realized it would be more cost-effective and less wasteful to create and provide customized trays for each patient’s delivery. The Bold Ideas, Big Savings program selected this as a winning idea, and the change was successfully implemented at the end of last year. It will provide an annual savings of $10,000.

The Bold Ideas, Big Savings program committee recently visited the winning team members to present each with a certificate and $500 check. Learn more about the program and past winners, or submit your own cost-savings idea at boldideasbigsavings.org.

Anthony Hodges practicing rehabilitation exercises

BWH neurosurgeon Yi Lu, MD, PhD, was moved to tears when 23-year-old patient Anthony Hodges walked into the Neurosurgery clinic for a follow-up appointment.

“I couldn’t believe it,” said Lu, who performed emergency spine surgery on Hodges after a car accident last summer left him paralyzed. “With his type of complete spinal cord injury, Anthony had less than a 5 percent chance of ever walking again, and he was able to step into the hospital on his own two feet. His case was a miracle.”

Last July, Hodges, the former captain of the Salem State University basketball team, was riding in the passenger seat during a car accident in Brockton. The crash left him unable to move his hands, legs or feet. He was rushed to BWH for surgery, where doctors determined that he had a complete spinal cord injury—an injury that often results in the permanent loss of function below the injury site, which in Hodges’s case was a spinal disc near the back of his neck. During surgery, which occurred just six hours after the accident, Hodges’s team removed a broken vertebra bone that was pressing on his spinal cord and replaced it with a bone graft that was stabilized with a titanium plate.

“I couldn’t move anything,” said Hodges. “I relied heavily on doctors, family members and my girlfriend to help me for everything.”

Lu, whose research is focused on spinal cord injury, said because Hodges was brought into surgery so quickly following the accident and because he was young, in good physical shape and otherwise healthy, his chances of recovering were somewhat better. Still, he was not optimistic that Hodges would be able to walk again. Lu often sees patients who recover from incomplete spinal cord injuries—where some feeling or movement still exists below the point of injury—but it is very rare to see a patient regain movement after a complete or near complete spinal cord injury.

Hodges remained paralyzed for several days following surgery, but he refused to give up hope that he would be walking and playing basketball again.

“I kept my head up,” said Hodges, who is the third of 12 children. “I have an amazing support system. There was never a point where I was alone. I’ve always been a leader for my little brothers and sisters, so I knew that losing hope and quitting were never options for me.”

After regaining feeling in his feet in the ICU, Hodges was transferred to Spaulding Rehabilitation Hospital, where he began to make even more progress.

Now, almost 10 months since the accident, Hodges is able to walk on his own and is getting stronger every day. While he still experiences some weakness on his left side due to nerve damage, he’s able to jog again. He goes to the gym as often as possible, attends physical therapy weekly and has reconnected with his basketball trainer. He said he won’t stop reaching for his goal of playing on the team when he returns to Salem State this fall for his final year of college.

“The Brigham was very good to me,” said Hodges. “I appreciate all that Dr. Lu and the care team have done for me. They got me back on my feet again.”

Hodges has already returned to the basketball court to shoot hoops with his friends: “I had a basketball in my hands and was surrounded by friends and family, and in that moment I felt complete again.”