Message from Jaclyn Mucaria, President, NYP Queens
A summary of the accomplishments, events and highlights from October through December 2017.
January 19, 2018
Dear Administration, Clinical Chiefs and Board of Directors,
It is my pleasure to share with you the latest NewYork-Presbyterian Queens President’s Letter. NYP Queens is committed to excellence in patient care and experience, and by demonstrating the WE CARE values (Welcome, Empathetic, Communicate, Accountable, Respectful, and Excellent) it is becoming the hospital of choice for patients and employees. Below is a summary of the accomplishments, events and highlights from October through December 2017.
Quality and Patient Safety/Regulatory
- The Quality Management department has made significant gains collaborating with nursing and physician leadership on the 2017 Regional Hospital Network quality and patient safety goals.
- We achieved 38 out of the 42 goals which exceeded the maximum target. We are sustaining our infection control goals for CLASBI, CAUTI, C. Difficile, MRSA, and Surgical Site Infections. Currently, we are working on a comprehensive program to improve psychiatric safety and enhance the environment, by minimizing risk to our psychiatric patients in non-psychiatric settings. Additionally, we have formed multidisciplinary teams to standardize the mortality review process, reduce the 30-day readmissions, and collaborate with the Emergency Department to improve patient flow and care provided to patients with sepsis.
- We have implemented KEEPSAFE which is the Adverse Event Reporting System of New York-Presbyterian Hospital (NYPH) and the Regional Hospital Network (RHN). The system captures all patient safety incidents, near misses (good catches), and unsafe conditions. All incidents entered into KEEPSAFE via our NYPQ Infonet are routed to the appropriate reviewers to be addressed, signed off, and closed out in a timely manner.
- In recognition of World Wide Pressure Injury Prevention Day, the Nursing Education Team held a Skin Care Fair with over 180 participants throughout the day and evening. There were learning stations focused on skin assessment, pressure injury prevention, wound measurement, wound staging and ostomy care. Participants included Registered Nurses, Nursing Assistants, Physicians, Physician Assistants, and members of the leadership team.
Clinical Service Lines
- The clinical service lines have become the venue for each clinical chair and administrative director to present strategic growth plans in collaboration with the local executive leader. Many key clinical programs were successful because of the planning done by the clinical service line steering groups. Some examples include:
- Orthopedic Robotic Program for Joint replacements
- Interventional Neurology Program
- Mobile Stroke Unit at NYP Queens; starting Q1 2018
- Bariatric Program accreditation
- Creation of a 5 bedded Stroke Unit
- Enhanced Cardiac Anesthesia coverage for a growing Electrophysiology Program
- Lung Cancer Screening Program in collaboration with Thoracic surgery, Pulmonary medicine and Oncology
- New Linear Accelerator and Therapeutic Medicine Infusion Center to grow oncology service
- Major marketing plans are now organized through active participation with corporate marketing and each service line to align with the strategic vision of NYP Queens and Medical Group.
Medical Group Queens
- The Queens Medical Group recently opened a GI practice and a multispecialty practice in downtown Flushing. This multispecialty practice houses specialties ranging from cardiology, general surgery, orthopedics, and liver disease.
- Dr. Gina Villani has been recruited as the Chief of Medical Oncology. She will work closely with The Cancer Center’s leadership as well as Dr. Joseph Cooke, Chairman of Medicine to enhance oncology services. Dr. Villani has also worked at a national level to help mitigate cancer disparities, and has served as chairman of Cancer Disparities Committee for the American Society of Clinical Oncology (ACSO).
- Erin Moroney has been recruited as the Medical Group Administrative Director for cardiovascular. Erin came from Northwell Health where she had extensive experience as the Revenue Administrator for Cardiovascular and Thoracic services across eight hospitals. Erin will work closely on the service line development of NYPQ Medical Group.
Facilities Planning Design and Construction
- The NYP Queens leadership team recently selected the architectural firm, Ewing Cole which has begun the design development of the new Amenities unit as well as the state of the art critical care unit. These design groups are multi-disciplinary and involve staff and providers from all levels of the organization. The critical care re-design will encompass three individual units totaling 62 critical care beds. The new critical care beds will house the Medical ICU, Neuro Intensive Care, Cardiovascular Surgery ICU, Coronary Care Unit, Surgical ICU and Trauma.
- The Neuro-interventional lab was completed in December. This new state of the art lab has already been utilized by the Neuro-interventional team with amazing success. This lab allows NYP Queens to become a comprehensive stroke center through Joint Commission as well as one of the only hospitals in Queens to perform stroke thrombectomies in the region. This new level of care allows NYP Queens to be a regional destination site for high acuity Neuroscience care.
- Replacement of the antiquated MRI continues. The old magnet was removed in December. The removal of the original room shielding is complete and the delivery of the new magnet and installation will be completed in early 2nd quarter of 2018. The new 3 Tesla MRI will allow NYP Queens to offer superior imaging options for Neuroscience, Orthopedics, and Cardiovascular Care.
- The delivery of the new Linear Accelerator ac is scheduled for the end of January, followed by installation and calibration. Project completion is scheduled for the end of March.
Patient Flow and Operational Efficiency
- In order to meet the growing inpatient census and improve throughput for inpatient care, a multidisciplinary initiative around length of stay has been the key focus in 2017.
- Teams have re-designed interdisciplinary rounds and enhanced handoff communication to become more efficient as well as enhance safety around patients being discharged from the hospital.
- November YTD overall length of stay is at 4.89 days compared to the goal of 5.05. Medicine ALOS is at 6.25 days, which is below the goal of 6.64 days and Surgical ALOS is at 4.14 days, which is below the goal of 4.42, for the same time period.
- The NYPQ PPS formed the “Mighty Queens” action team and enrolled in the NYS DOH, Medicaid Accelerated eXchange program to address the diverse medical, behavioral and social needs of our high utilizer (HU) inpatient population. The primary objective was to improve care and thus reduce hospital utilization and/or 30-day readmissions. An interdisciplinary team was formed that included partners across the care continuum. Over the course of six months, the team developed HU care pathways. Outcome metrics showed an 81% decline in hospital utilization of the 126 HU patients from a 90-day pre intervention period (511 admissions) vs. a 90-day post intervention period (99 admissions). Process and outcome measures and rapid cycle continuous improvement methodology are the drivers of the sustained improvements amongst this population.
- On November 14, NYP Queens and the Physician/Patient Experience Workgroup presented the 1st Annual Physician Communication Symposium on Optimizing the Patient Experience. Jaclyn Mucaria, President, Dr. Amir Jaffer, CMO, and Dr. Joseph J. Abularrage, the Course Director, opened the event with welcoming remarks. Susana Perez, Patient Family Representative, spoke about the Importance of the Patient’s Perspective. Dr. Abularrage, spoke about the initiatives in place at NYP Queens to improve the physician communication, such us the on-line modules and videos. Our Patient Experience Officer, Patrick Swift, spoke about the Initial Impression of the Patient Experience. Dr. James Merlino, President and CMO at Press Ganey Associates and Dr. Stephen C. Beeson, Founder & CEO of Practicing Excellence, two keynote speakers, provided best practices on how providers can improve their communication with patients. The symposium ended with a panel discussion, moderated by Dr. Amir Jaffer and panelists, Rick Evans, SVP & Chief Experience Officer NYPH and Jim Kinsey, Director of Planetree. The Lang Auditorium was packed with physicians, nursing and administrative leadership.
- NYP Queens is collaborating with the Museum of Natural History on providing virtual tours of the museum, for patients, using the museum and hospital volunteers. This wonderful program went live in November. Our hospital is the only hospital the museum is collaborating with on this initiative. Patients who participated stated that they have not been to a museum in years, due to their poor health and how pleasantly surprised they were to get an opportunity to learn, in addition to getting well.
- Language Services is piloting an iPad based interpreter services platform called ‘Interpreter on Wheels’ in the Emergency Department to allow care-givers to access an interpreter on demand through video remote. This program is positively impacting quality of care, patient safety, and patient experience.
- In November, a comprehensive assessment visit by Planetree consultants was conducted to evaluate our progress toward a Planetree designation. Over three consecutive days, Planetree conducted twenty-five workgroup sessions with diverse groups of front-line employees, mid-management members, directors, physicians, volunteers, and patients. Over two hundred individuals participated. Planetree certification criteria scrutinize the degree and consistency of person-centeredness across the organization. We improved greatly since the last assessment but have several areas that still require improvement. We hope to apply for Bronze designation this year.
- The annual Employee Retreat: Creating a Culture of Respect will be held at the St. John’s University on February 7. Three sessions are planned and transportation will be provided to ensure every employee and provider has an opportunity to attend. Jaclyn Mucaria, President, will kick-off each session, followed by two keynote speakers, Alan Manning from Planetree and Leonardo Inghilleri from Inghilleri Consulting Group, Inc. An employee video demonstrating what respect means to them will also be part of the program.
- NYP Queens hosted the Annual Gala on November 7, at The Queens Museum. More than $800,000 was raised at this year’s event, which was attended by over 500 guests. All proceeds of this annual fundraising event will benefit the Orthopedics Department. Jeffrey Rosen, MD, Chairman, Department of Orthopedics and Rehabilitation, Co-Head Team Physician for St. John’s University Athletics and Justin Classie, MD, Medical Director, Sports Medicine, Department of Orthopedics and Rehabilitation, Co-Head Team Physician for St. John’s University Athletics, served as gala co-chairs. Chris Mullin, Basketball Hall of Fame Inductee and Two-Time Olympic Gold Medalist, Head Coach, St. John’s University Men’s Basketball, was this year’s Pacesetter Award Recipient. This award is presented each year to outstanding individuals who have had a major impact on the community. Since January 2017, NYP Queens has been the Official Hospital and Doctors of St. John’s University Athletics.
- NYP Queens observed Veterans’ Day with a traditional flag raising ceremony on November 10 in acknowledgment of our employees who served in the U.S. Armed Forces. At this ceremony, Jaclyn Mucaria and Bob Blenderman shared their gratitude for all that our veterans have done for our country over the years. They then presented the first NYP Military Veterans Challenge coin and Lapel Pin as a symbol of our hospital’s appreciation for veterans’ service in both their military career and here at NYP Queens.
- On October 17, NYP Queens’ Annual Frank Randazzo, Jr. Golf Classic was held at Old Westbury Golf & Country Club in Old Westbury, NY. This year’s event raised more than $300,000 to benefit the Cancer Center. The Randazzos, through their generosity, established a Cancer Program and Research Laboratory in Memory of Frank Randazzo, Jr. In so doing, the Golf Classic was renamed in memory of Frank Randazzo, Jr.
- Sam Quinones, author of Dreamland, led a presentation on the Opioid Epidemic on November 3 in the Lang Auditorium. Throughout this timely presentation, Quinones addressed the complex range of factors that played a role in shaping today’s national opioid epidemic.
- The Nursing Recruitment and Retention Council kicked off the Halloween festivities by sponsoring a pumpkin decorating contest. There were 17 entries from across the hospital, each with a unique theme. Prizes were awarded for creativity, branding, presentation, and spirit. The CNO and two Directors of Nursing visited each unit and gave out candy to staff on duty. The second annual Halloween party took place in the cafeteria. Activities included a photo booth, costume contest, and opportunities for staff to sing karaoke.
- Less than 6 months after joining the NYP Queens team, Nicholas Choi, RN, a Surgical Intensive Care Unit nurse volunteered to travel to Puerto Rico with NYPH staff to take care of patients affected by the recent hurricane. He was recognized at our monthly Interdepartmental Meeting with a plaque of appreciation and was invited to a thank you lunch with Drs. Corwin and Forese.
- In September, the annual Employee Engagement Survey was conducted by the Gallup organization. Once again, this year, the NYP Queens had the highest participation rate (81%), of all the regional hospitals. NYP Queens improved in each of the 12 survey domains. On a rating scale of 1 - 5, our overall mean engagement score was 3.87, up from 3.82 in 2016. Management will meet with their direct reports to develop opportunity action plans. The goal is to be above 4.0 in 2018.
- The NYP Queens Town Hall with NYP leadership took place on December 7. Three, one-hour sessions were scheduled in an effort to reach out to staff on all shifts. Jackie Mucaria provided opening comments with a brief year in review, highlighting 2017 accomplishments and our areas of focus for 2018. Bob Blenderman, COO and Vito Cassata, VP, gave updates on clinical programs and capital projects. Dr. Amir Jaffer spoke about patient safety and quality. Patrick Swift, Patient Experience Officer, spoke about the Respect CREDO and Planetree. Alan Levin, CNO, provided updates on our Magnet Journey. Lorraine Orlando, VP, presented the Employee Engagement survey results and NYP integration efforts. Terri Meany, Executive Director, gave an update on the expansion of the Medical Group. A question & answer session followed.
External Relations/ Community Engagement
- In November, NYP Queens sponsored the St. John’s men’s basketball season home-opener at Carnesecca Arena. NYP Queens veterans were honored during the game and Dr. Jeffrey Rosen, co-head team physician for St. John’s Athletics, received the game ball during an on-court presentation.
- Community Health Initiatives (CHI) promoted the NYPQ services and programs in the community. They hosted 80 lectures, given by 50 NYPQ specialists, and educated more than 3,326 community members, participated in 65 community events and reached out to 13,078 community members and provided culturally sensitive care and service by rounding on 4500 admitted Chinese and Korean speaking patients.
- Dr. Kevin Jiang, Orthopedics, ran the TCS New York City Marathon with his patient, distance runner Michael Bozzo. This was highly publicized by TV and newspapers.
- On December 8, NYP Queens participated in the New York Hall of Science’s STEM Night: Health and Medicine. This free community event provided middle school, high school and college students the opportunity to engage in hands on activities and learn more about careers in science, technology, engineering and math (STEM). We are forging a relationship with the NY Hall of Science and hope to collaborate with them on many other projects.
- As of November 2017, operating revenues including prior year adjustments exceeded expenses by $13.2M, compared to a budgeted gain of $2.7M creating a favorable variance of $10.4M. Including investment income of $6.2M, there was a total margin of $19.4M. Operating results are driven by several factors, including a surplus of 2,017 cases compared to budget. Case mix was 2% below budget and combined with an unfavorable payor mix partially offset the higher than projected volume. Outpatient volume was 9,995 visits below budget due to lower than anticipated visits in the ED, Private Ambulatory Lab, and Ambulatory Surgery. Expenses were under budget by $13.9M, due to the delayed opening of the Infusion Center, favorable Medical Group performance and increased operational efficiencies due to the Opportunity Action Teams.
- Opportunity Action Teams
- This year NYP Queens was working on 30 initiatives, which spanned virtually every department, to enhance revenue and reduce costs.
- Each month, the Opportunity Action teams highlight their progress as well as distance to their individual goals.
- As of November YTD, the impact has been $15.8M, verses a goal of $15.3M.
- ED computers are being upgraded to align with NYP standards. In order to be compliant with regulatory policies specific to privacy of patient information, all monitors facing outward, in patient care areas are being replaced with built in privacy screens.
- All patient TVs are being replaced with new models. With this improvement, TV service is being provided free of charge.
- Workday HR system was installed to align with NYPH. Workday will allow for automation of HR operational functions for employee talent reviews, and position management.
- The role of Mobile Heartbeat was an enormous endeavor which was inclusive of Nursing, Clinical support departments as well as physicians. Mobile Heartbeat is replacing spectra link phones.
- Nursing Hand-held device (PSS) functionality was enhanced for Infant Care and Mother Baby matching
I am happy to discuss any of the items or answer any questions.
cc: Dr. Laura Forese