Beth Israel Deaconess Medical Center

The main teaching hospital of Harvard Medical School, led by CEO Paul Levy.

RECENT POSTS

Beth Israel Deaconess, New England Baptist Form Partnership

Part of Beth Israel Deaconess Medical Center

Part of Beth Israel Deaconess Medical Center

Two more Boston hospitals are forming an exclusive partnership in this era when larger networks are needed to manage records, budgets and patients.

The partnership between Beth Israel Deaconess Medical Center and New England Baptist means the two hospitals will only refer patients to each other. They hope to take advantage of a spike in demand for hip, knee and other orthopedic procedures as baby boomers age.

New England Baptist president Trish Hannon says this affiliation will create a premiere destination for ortho patients across the country. “With our relationship with Beth Israel Deaconess, we’ll be able to grow our broader geographic network, and provide better access to the New England Baptist brand of care for more patients,” she said.

Hannon says the Baptist needs a larger, more modern facility and may physically move close to Beth Israel Deaconess in the coming decade.

Feel As If You, Too, Were Under The Marathon Medical Tent

medicaltentsmall

Medical personnel work outside the medical tent in the aftermath of two blasts which exploded near the finish line of the Boston Marathon in Boston, Monday, April 15, 2013. (Elise Amendola/AP)

Wow. I’ve just read the best description, bar none, that I’ve seen of the medical side of the marathon bombings, and it appears in a publication better known for clinical evidence than literary acrobatics. But if you want to feel as if you were right inside the marathon medical tent, side by side with the personnel who expected dehydration and instead got horrible flesh wounds, do not miss this superb piece by Dr. Sushrut Jangi, a hospitalist at Beth Israel Deaconess Medical Center It’s now online here in the New England Journal of Medicine. From near the beginning:

Sickened and stressed runners poured into our makeshift hospital. A runner stumbled in and vomited into a bag. We helped him onto a cot, where he sat shivering. “You’re OK,” a nurse said gently, wiping his face. But his core temperature had dropped to 96 degrees, and he began having violent rigors. We brought him Mylar blankets and hot bouillon. Nearby, a woman with intense hamstring spasms fell onto a cot; a runner with liver disease trembled with asterixis, his eyes roving in wild saccades.

Suddenly, there was a loud, sickening blast. My ears were ringing, and then — a long pause. Everyone in the tent stopped and looked up. A dehydrated woman grabbed my wrist. “What was that?” she cried. “Don’t leave.” I didn’t move. John Andersen, a medical coordinator, took the microphone. “Everybody stay with your patients,” he said, “and stay calm.” Then we smelled smoke — a dense stench of sulfur — and heard a second explosion, farther off but no less frightening. Despite the patient’s plea, I walked out the back of the tent and saw a crowd running from a cloud of smoke billowing around the finish line. “There are bombs,” a woman whispered. My hands began to shake.

Read the full piece here.

Globe: Whopping $7M Settlement In Gender Bias Suit Against Hospital, Surgery Chief

Part of Beth Israel Deaconess Medical Center

Part of Beth Israel Deaconess Medical Center

The Boston Globe’s Liz Kowalczyk reports here:

In a striking settlement of a high-profile case, a Harvard doctor who said she endured years of sexist treatment at Beth Israel Deaconess Medical Center will collect $7 million — and will have the hospital’s pain clinic named in her ­honor.

Employment lawyers said the hospital’s settlement with Dr. Carol Warfield, its former chief of anesthesia, appears to be one of the largest for a gender discrimination case in Massachusetts. Ilene Sunshine, a lawyer who represents defendants in bias suits, said it seems “enormous,’’ though she pointed out that it is hard to compare because settlements usually remain confidential.

The agreement — in which the hospital and other defendants did not admit doing anything wrong — closes an embar­rassing stretch in the ­Harvard teaching hospital’s ­illustrious history.

Warfield, who became chief of anesthesia in 2000, said Dr. Josef Fischer, former surgery chief, discriminated against her because she is a woman, openly ignoring her in meetings and lobbying for her ­removal from her job. When she complained to Paul Levy, then chief executive, she ­alleged, both men retaliated against her and forced her out.

Readers, is this an anomaly or does it reflect significant cultural change? Surgeons have such a reputation as the arrogant cowboys of any hospital staff; is that truly changing? Does this suit send the message that it must? Read the full Globe story here.

Beth Israel Deaconess Goes ACO; What Does That Mean?

Does “ACO” mean anything to you yet? Well if you want to do more than nod and smile the next time you’re around a lot of doctors, read the next couple of paragraphs.

Hospitals that plan to stay in business in Massachusetts are either creating or joining Accountable Care Organizations (ACOs). Today we have a new one of these large “all care under one umbrella” groups: The Beth Israel Deaconess Care Organization (BIDCO) includes the hospital, its physicians’ group and two affiliated hospitals. BIDCO is in talks with Cambridge Health Alliance, Signature Healthcare in Brockton and a few other organizations about joining.

Dr. Kevin Tabb, who runs the hospital (Beth Israel Deaconess Medical Center), says ACOs offer a new and better way to deliver and pay for care.

Dr. Kevin Tabb, chief of Beth Israel Deaconess Medical Center and co-chair of the new BIDCO

Dr. Kevin Tabb, chief of Beth Israel Deaconess Medical Center and co-chair of the new BIDCO

“For a very long time,” says Tabb, “we’ve taken care of sick patients, doing a good job while they’re here and not thinking about them a lot after they leave the hospital. That felt like a broken model.”

Now, says Tabb, “we’ll think about patients not only when they’re here at the hospital, but after they leave,” and when they are well. Why haven’t doctors and hospitals done this in the past? Tabb offers two reasons: Doctors and hospitals haven’t had the structure to do this and they weren’t paid for keeping people well. Thus the new world, built around the structure of an ACO and financed by a global payment.

If you’ve been seeing a doctor affiliated with Beth Israel, you might be wondering, how does this affect me? Dr. Stuart Rosenberg, who will co-chair BIDCO representing physicians, says “for the first time, we are able to really look at the patient and assess their health care needs no matter where that might be provided.” A doctor will no longer have to see a patient in her office to get paid for delivering care.

Dr. Stuart Rosenberg, co-chair of the new BIDCO

Dr. Stuart Rosenberg, co-chair of the new BIDCO

Under an ACO and a budget that lets doctors decide how to spend money on patients’ care, doctors are “developing care plans that are limited only by our imagination and the law,” says Rosenberg.

He illustrates with the example of Mrs. Jones, a patient with a chronic disease who isn’t taking her medication, is skipping doctor’s appointments and comes to the emergency room when her blood pressure or diabetes get out of control. BIDCO could send a nurse to visit Mrs. Jones, give her rides to appointments and follow-up with phone calls. And the amazing thing, says Rosenberg, is that we can “provide that personalized care and actually save money on top of it.”

Sounds pretty good, huh? But if you have private insurance or MassHealth, there may be a catch. Continue reading

Beds, Socks, Time-Outs: Such Simple Ways To Avoid Hospital Harm

Big hospitals can seem like impossibly complex organisms, but how simple some of these patient-safety improvements are! From Beth Israel Deaconess Medical Center:

BOSTON – Reducing preventable harm in hospitals often starts with small, low-tech steps: brushing the teeth of patients on ventilators; using low-rise beds and socks with safety treads on both sides; completing a surgical time out before mounting a blade on a scalpel.

Those small steps have yielded big results at Beth Israel Deaconess Medical Center – from a 90 percent reduction in ventilator-associated pneumonia since 2006, to progress in reducing patient falls with injury and in helping to avoid wrong site surgeries. They are some of the key lessons learned and implemented after the hospital declared the then “audacious goal” to eliminate preventable patient harm by 2012.

Those safety steps may seem obvious now, but of course, hindsight is always easy. Yes, “after the fact, it seems obvious,” said Dr. Kenneth Sands, the hospital’s senior vice president for health care quality, but “you need to have that ‘Aha’ moment.” Consider luggage, he said; he spent years lugging around bags because no one had thought to put wheels on them. “The good news is that some of these things are very simple and not technological,” he said, “but they are sometimes only obvious in retrospect.”

More from the hospital:

BIDMC has posted a video on its public website that chronicle three stories that represent how the issue is being addressed:

Preventing ventilator-associated pneumonia
Ventilator-associated pneumonia is a problem that can affect between 10 to 20 percent of intensive care patients who need assistance breathing. Bacteria can collect in the breathing tube and work its way into a patient’s lung and contracting VAP can double a patient’s risk of dying. Continue reading

After 60 Years, Beth Israel And Hebrew SeniorLife Get A Little Formal

Dr. Kevin Tabb, chief of Beth Israel Deaconess Medical Center

As a Goldberg, I reserve the right to tell dark Jewish jokes, and here’s one of my favorites:

A 95-year-old Jewish man and his 94-year-old wife storm into the rabbi’s office and tell him they want a divorce — now.

“Calm down, calm down,” the rabbi tells them. “Sol, Goldie, you’ve been married, for better or worse, for richer or poorer, for over seventy years. Why get a divorce now?”

“We would have done it long ago,” Goldie huffs. “But we were waiting for the children to die.”

The news that brought that old chestnut to mind concerns a somewhat opposite phenomenon: After 60 years of working closely together, Hebrew SeniorLife and Beth Israel Deaconess Medical Center are taking a step a little like a marriage. They have signed a formal preferred provider agreement.

“After 60 years, we decided to make it official,” said Beth Israel Deaconess Medical Center spokesman Jerry Berger. “There was never a formal written agreement. This is the first formal written agreement.”

The looming next stage of health reform is prompting many hospitals to get their organizational ducks into a row. Last week brought the announcement that Partners Healthcare and South Shore Hospital had moved a formal step closer.

From today’s press release: Continue reading

Paul Levy: ‘When You Really Let Down Your Team’

The question arises now and then in health care circles: What’s Paul Levy up to these days?

Answer: The former chief of Beth Israel Deaconess Medical Center maintains his popular blog, once called “Running a Hospital” and now “Not Running a Hospital.” He speaks widely on improving hospital quality and safety. And he has just announced that the book he’s been working on is out: “Goal Play! Leadership Lessons From The Soccer Field.”

He writes:

It will come as no surprise to my readers that I have self-published this book, using Createspace.  That service provides a remarkable set of tools to any budding writer.  You can order the book here.  It will be available on Amazon in about a week.

Proceeds will go in part to the non-profit Massachusetts Youth Soccer GOALS program and he asks for feedback at goalplayleadership@gmail.com.

I confess: Though Paul Levy has many vivid and worthwhile lessons to share from his eight years running Beth Israel Deaconess, I immediately jumped to Chapter 9, titled “I’m sorry” and subtitled “What happens when you really let down your team?”

Paul Levy of "Not Running A Hospital"

After all, his last months at Beth Israel Deaconess were shadowed by a major scandal about his personal relationship with an employee, and though he was otherwise renowned for setting new standards of transparency, many of his readers felt he never gave a full enough account of what happened. Would he now?

I’d give that a qualified yes. If you’re hoping for juicy details, forget it, but he does acknowledge the mistake of “deciding, shortly after I became CEO, to hire a close personal female friend into a new position where she, first directly and later indirectly, reported to me.”

He describes the delayed fallout of that decision and how he handled it, but perhaps most interesting are the lessons he draws. Should there be a formal mechanism to save leaders from their natural tendency to have poor judgment about their own behavior or how it can be perceived? Yes, indeed. He writes: Continue reading

New Hospital Chief: Mass. Health Care Is 5 Years Ahead — Anxiety Is Natural

Dr. Kevin Tabb, new chief of Beth Israel Deaconess Medical Center

In his first two months as chief of Beth Israel Deaconess Medical Center, Dr. Kevin Tabb has gotten to know the hospital but he has also gone on a Massachusetts health care walkabout. He has circulated through virtually every hospital in Boston as well as some 20 community hospitals, talking to allies and rivals alike.

Nothing like fresh eyes — fresh, informed eyes. (Dr. Tabb made the unusual migration eastward after many years at Stanford.) Here, in a lightly edited chat, he shares his perspective on the state’s health care scene, including his impression that many of us fail to appreciate just how exceptionally rich in excellence we are: “If you take any one of these great institutions alone and put them in any other city, they would be the medical center,” he said, “and we’ve got many.”

Californian colleagues questioned his decision to move to the difficult, competitive health care landscape of Boston, he said — not to mention the nasty weather he would face. His response:

If you really care about effecting change, there has never been a more interesting time, at least in modern history…And Massachusetts is the epicenter of change. We here in Massachusetts are at least five years ahead of the rest of the country in terms of what is going on around experimenting with new models for delivery and health care reform. And the rest of the country will get there but they’re not there yet. I don’t know if people here in the Commonwealth and in Boston understand just how closely the rest of the country is looking at what is going on here as a view of what the future will look like.

Well, certainly, we’re aware that Massachusetts health care has great political resonance, both because of Mitt Romney’s involvement in the state’s health reform and because the federal health overhaul made use of the Massachusetts model.

I’m talking about more than that. Some of what I’m talking about is legislation, but it’s not just legislation. If there were a magic wand and the legislation were to go away tomorrow, hypothetically, you would still see forces here that are forcing really pretty rapid change in health care delivery models that have nothing to do with any single piece of legislation. So it’s a combination of the legislation and regulators, but also of economic forces and, I think, the forces of innovation that exist at this time. Nobody has a monopoly over that. Continue reading

‘Your Medical Mind': Know Thyself, And The Numbers

Drs. Jerome Groopman and Pamela Hartzband are a Longwood-style literary power couple: both on the staffs of Beth Israel Deaconess Medical Center and Harvard Medical School, and widely read in prominent publications from The New Yorker to The New England Journal of Medicine. We spoke this morning about the lessons that can be learned from the vivid stories and psychological insights in their new book.

I derived two takeaways from “Your Medical Mind.” First, you need to be aware of your own biases on medical decisions: Are you a minimalist when it comes to treatment, or a maximalist? Do you tend toward the natural or the technological?

Second, you need to understand decision dynamics that are common to all of us: Our tendency to be influenced disproportionately by what happens to people we know, for example. Our greater willingness to take a risk by not taking action than by doing something.

The federal Agency for Healthcare Research and Quality has just come out with a succinct cheat sheet, a list of questions to ask your doctor, from ‘What is the test for?’ to ‘Are there any side effects?’ I wonder if you could generate on the fly a list of the questions you should ask yourself before you finalize any medical decision?

1. What is my medical mindset?

JG: The questions you refer to from the government are generic questions, and they’re valuable. But the questions you should ask yourself first are: What is my medical mind? Am I a maximalist, so I believe in being proactive, ahead of the curve, doing everything and more? Or am I a minimalist, so I believe that less is more?

Drs. Hartzband and Groopman


PH: And to expand upon that: Are you somebody who likes the latest technology, do you have a technological orientation? Or are you somebody who is more in tune with natural remedies and prefers to go that route?

And finally, are you a believer or a doubter? The believers are people who believe there’s a solution to their problem and they’re going to find it and go with it. And the doubters are people who worry about side effects and unintended consequences, the people who are risk-averse and worry the treatment will be worse than the disease. So that’s your first question: What is your medical mindset?

2. What are the numbers? Continue reading

Larry Summers On Health Reform: Bottom Up Is Better Than Top Down

Economist Lawrence Summers

He began with a great disclaimer, avowing that he had no special expertise on health care. Then he proceeded to sum up the country’s whole health care mess with such perfect pithiness that it made my toes curl.

Uber-economist Lawrence Summers, former secretary of the U.S. Treasury and former controversial president of Harvard, spoke yesterday at the inaugural Health Policy Symposium at Beth Israel Deaconess Medical Center. He’s back at Harvard now as a professor, and mostly speaks at note-taking speed, but I’ve had to paraphrase here and there. I’ll begin with the ending, which felt a bit like the kind of “Go forth and do good work” benediction he might have offered graduating Harvard seniors:

“This is all very, very difficult. And I guess the thought that I would want to leave you with, assessing this debate from the outside, is that if there is a happy end to this tale — if, looking back from 2030, we’re seeing that not just was the arc of justice bent towards liberty but the arc of health care costs was bent toward flatness —  if that is what we look forward to, I think it is less likely that it came from a sweeping act of Congress and it is more likely that it came from widely emulated innovation in individual settings.

That it came from hospitals that found creative and inventive way to improve the quality of care and cut costs, and then whose procedure was so compelling that it had to be emulated elsewhere.

We are much more likely to succeed…from the bottom up than we are from the top down.

That it came from cities where coalitions of hospital providers and major employers worked out improved reimbursement understandings, found ways of fine-tuning reimbursements so that costs grew less rapidly.

We are much more likely to succeed, both with respect to the cost-containment challenge and with respect to the closely related quality challenge, from the bottom up than we are from the top down.

So my hope…would be that just as we live in a remarkable period of scientific innovation, we can live in a remarkable period of institutional innovation — and, if you like, social scientific innovation that points toward emulatable solutions to these problems.

President Clinton used to say that there was no problem in American education that had not been solved somewhere in America, and I suspect that most of the problems in health care have been solved somewhere in America. And our challenge is to match scientific innovation with innovation in patterns of practice, in provision of incentives, in monitoring and rewarding of outcomes.

It’s a feature of exponential growth that the stakes get larger every year. I think we are going to succeed with respect to broadening the availability of coverage very substantially, but I cannot claim that we’re securely on a path toward better cost-containment or improvement of quality. I think that’s the task for all of you.”

Now back to the beginning: Continue reading