Massachusetts Health & Hospital Association Primary Care Access, Geographic Equity, and more ….
INSIDE THE ISSUE
> Steward
> MHQP on Primary Care Access
> FOCUS ON WORKFORCE: UMass Memorial’s New RN Residency
> New Equity Initiative
> Happy Washington’s Birthday
MONDAY REPORT
Public Health Council Discusses “Regional” Steward Solution
unsustainable,” and the current instability of the Steward Health Care system is not helping that situation at all, Department of Public Health (DPH) Commissioner Robbie Goldstein, M.D., told the Public Health Council last Wednesday.
While expressing concern, Goldstein was quick to add that Steward’s hospitals are being monitored closely and that the public should still seek care in them if needed. DPH is stationing surveyors at all Steward facilities, Goldstein said, assessing staffing and supplies, and investigating any safety concerns. Steward Health Care is not a member of MHA.
The overall future of the Steward facilities, however, remains uncertain. Steward officials have said they have no plans to close facilities but concede ownership of their Massachusetts hospitals may change. U.S. Rep. Steven Lynch (D) was quoted this week in the Boston Globe as saying the system’s officials have indicated to him and his staff that their plan is to exit the Massachusetts health market. Goldstein said talks have been ongoing for months between the state, Steward, and other parties, but he told the Public Health Council, “The bottom line is at this time, we do not know what the future of Steward hospitals will be.”
Council Member Eduardo Haddad, M.D., chief of medical affairs at Lawrence General Hospital, said at the meeting last Wednesday, “It goes without saying that we [Lawrence General] are going to increase our capacity to the utmost” if needed to care for patients served by Steward’s hospitals in the northeast part of Massachusetts. “There is no lack of will on our part to help all of these patients.”
Goldstein said he understood “the value of regional solutions” to resolving the Steward problem, adding that what may be good for Steward’s Holy Family Hospital in Methuen and Haverhill may not be the same as what is needed to assist Steward’s Good Samaritan Hospital in Brockton. Goldstein also concurred with Council Member Stewart Landers who said that losing hospitals in certain parts of the state would affect healthcare equity efforts – especially as it relates to access. “Equity includes geographic equity,” Commissioner Goldstein said.
MHQP: Fragile State of Primary Care Access
MHQP’s latest Patient Experience Survey that tracks the public’s interactions with adult and pediatric primary care reveals how care perceptions have shifted during and after the pandemic.
Results were collected from 444 adult and pediatric primary care practices across the state, representing more 3,300 primary care providers.
For adult care, MHQP assessed scores in all the survey categories for 2021, 2022, and 2023, and compared them to the pre-pandemic baseline year of 2019. The recent scores were all higher than in 2019, except for the measures entitled “Ease of Access to Care” and “Assessment of Patient Behavioral Health issues” which were statistically lower.
“Concerns about declining access to primary care services became significantly heightened during the pandemic, as many practices struggled with scheduling challenges amid growing staffing shortages,” MHQP noted. “Many sources document the current fragile state of primary care access during this time.”
For pediatric care, the MHQP results show significantly lower scores in recent years as compared to 2019. Coordinating Patient Care, Pediatric Preventive Care, Assessment of Child Development, and Ease of Access to Care all surveyed lower during the pandemic than pre pandemic.
MHQP’s public facing website is here.
FOCUS ON WORKFORCE
UMass Memorial’s New Nurse Graduates’ Residency Program
New nursing grads are often excited to begin their careers, but after experiencing the demands of the job many decide the work isn’t for them. By some national estimates, the turnover rate of new R.N.s is 31% after their first year in the job.
At UMass Memorial Medical Center the one-year retention rate is between 90 and 94%, and after two years the retention rate also hovers around 90% — or well above the national average.
That’s due to UMass Memorial’s year-long residency program for newly licensed nurses, which consists of 13 weeks of blended classroom and clinical time, followed by ongoing peer support and monthly programs.
“It’s not to repeat nursing school – that’s not the purpose,” says Karen Uttaro, R.N., senior director, professional practice, quality and regulatory at UMass Memorial Medical Center. “It’s more to connect the dots – what did you learn at school and what does that look like here in clinical practice.” Throughout the program, but intensively towards the end, UMass focuses on instructing the new nurses on quality and safety measures and what those measures, and the practice that supports them, look like on the actual unit.
To learn more about the residency program, its use in other hospital units, and UMass’ commitment to the “Four Cs” that make its successful, view this brief interview with Uttaro.
Learn about other workforce initiatives throughout the state by visiting MHA’s Workforce Toolkit. Do you have a workforce program that you would like featured in the toolkit? Contact MHA’s Kim Stevenson at kstevenson@mhalink.org.
BILH Leads Joint Provider Effort on Equity
In a new collaboration, Beth Israel Lahey Health (BILH), joined by leaders from other Massachusetts healthcare systems, is creating the Massachusetts Institute for Equity-Focused Learning Health System Science.
The main goal of the new entity, funded by a grant from the federal Agency for Healthcare Research and Quality (AHRQ), is to accelerate equity-focused research to address health disparities. The Institute hopes that research into the broad and diverse network of equity measures and social determinants of health will be driven by common data standards, and conducted by researchers who themselves are diverse in their backgrounds and outlook. In a grant statement to AHRQ, BILH wrote it intends to “forge a strong cross institutional alliance between community, safety net, academic health systems, patients, mentors, and scholars to drive widespread and enduring change.”
“This institute will bring together patients, communities, scientists, advocates, and health systems to transform healthcare and achieve meaningful impact in health equity,” said MEILHSS Executive Committee Member Juan Fernando Lopera, chief diversity, equity and inclusion officer at BILH.
The cross-institutional alliance includes patients and leaders from BILH, Mass General Brigham, UMass Memorial Health, Veterans Affairs, Cambridge Health Alliance, and community health centers.
George Washington Fretted Over Hospitals
Today’s holiday is known as “Washington’s Birthday” in Massachusetts, although other states call it a variety of names such as “President’s Day,” “Presidents’ Day,” or “Presidents Day” (note the moving apostrophe); “Washington’s Birthday/President’s Day” in Maine; or “Lincoln/Washington Presidents’ Day” in Arizona, among many other designations. Alabama lops off any recognition of Honest Abe from the holiday and calls the third Monday in February “George Washington, Thomas Jefferson’s Birthday” – which is odd since the Sage of Monticello was born on April 13.
General George Washington was forced time and again to devote attention to the appalling state of hospitals during the Revolutionary War. A Surgeon General of the Continental Army, Benjamin Rush, who was also a Declaration of Independence signatory, wrote Washington often about hospitals, beset by “putrid fever” and deaths resulting from “the sick being too much crowded, and by their wanting blankets—Shirts—Straw—and Other necessaries for sick people.” He was especially peeved that administrators were diverting supplies for their own use and leaving patients in want. “The wine allowed to the hospital at Bethlehem under the name of madeira was adulterated in such a degree as to have none of the qualities or effects of madeira,” read one dispatch Washington received.
Shortly after the last letter from Rush, in which the Surgeon General resigned his medical commission in protest, Washington issued a General Order from Valley Forge. “The Commander in Chief, being informed that many disorders and irregularities have taken place at the Hospitals, & that in some the Sick are not tended with due Care, thinks it necessary that each Hospital should be visited by a prudent and Carefull Field Officer.” That officer – a surveyor, so to speak – was to compile lists of the sick, their regiments, divvy up their possessions if they should die, “examine critically if the sick are well taken care of,” and, in general, maintain order. While the field officer could report administrative malfeasance to his higher ups, the general order stated that “he is to avoid desputes with the surgeons of the Hos[p]itals & not interfere with them in the management of diet or Medicines of the sick.”
Washington would issue numerous orders in the coming years attempting to get the hospitals in order and expressing his frustrations. “I sincerely feel for the unhappy condition of our poor Fellows in the Hospitals, and wish my powers to releive them were equal to my inclination. It is but too melancholy a truth, that our Hospital Stores, are exceedingly scanty & deficient in every instance, and I fear there is no prospect of their being better shortly,” Washington wrote.
If you miss the opportunity to honor presidents today, there’s always May 29 – John F. Kennedy’s birthday. Massachusetts state law (General Law – Part I, Title II, Chapter 6, Section 15VV) requires the governor each year to “issue a proclamation setting apart the twenty-ninth day of May as Presidents Day in memory of John Adams, John Quincy Adams, Calvin Coolidge and John Fitzgerald Kennedy, former presidents of the United States from the commonwealth, and recommending that said day be observed in an appropriate manner by the people.” Alas, while Silent Cal was indeed a former governor of Massachusetts, he was born in Vermont. George H.W. Bush, however, is a Massachusetts native from Milton.