Dave Whitehead remarks
Windham Annual Meeting
Jan. 22, 2015
Thank you, Lin, not just for your thoughtful words tonight, but for all you have done during your term as Board Chair to advance Windham to where it is today, and for your continued advocacy for our community, and our health system, in the future.
Before I go any further, I want to personally thank Dr. Nadia Nashid, for the wonderful work she has done to further the efforts of our medical staff during her term as Chief of Staff.
What a year it’s been — despite many significant challenges, which I will talk more about later, it has been a year of moving forward for Windham Hospital. This year has been a true reflection of the immense amount of discretionary effort from management, staff, physicians, auxiliary, donors volunteers and leadership.
So, at the outset, I want to thank everyone, especially our frontline staff, for believing in Windham Hospital and in our community, now and in the future. And make no mistake – despite our very real financial challenges, there is a bright and purposeful future for this community institution.
There is absolutely no doubt that this institution is an integral part of the community. We must continue to transform and exist as a major driver of the health care delivery system for the greater Windham area.
Windham Hospital is a cornerstone for care. That is why we are here. With our planning and stewardship, we will succeed in offering clinical services which are so essential to this community.
Given our financial environment — and an unrelenting set of projections here and nationwide that call for decreasing volume and reimbursement — we recognize that we simply can’t be everything for everyone.
But we can, and we must, be a model for how to deliver higher quality, safer and effective care at the right place, at the right time and for the right people. That is our roadmap to success — a brighter future with better outcomes for those we serve.
But before we talk more in depth about the future, let’s talk about our highlights in the past year, including:
Creation of an East Region
In the Fall of 2013, Hartford HealthCare reorganized its operations into a regional structure, to reduce silos, create efficiencies and serve communities in a more cohesive manner.
The creation of a region right here in the east was a first for Hartford HealthCare, and was officially formed when Backus Hospital became a partner in August 2013.
This regional approach, based on a model that puts the patient at the center of all we do, has given us the necessary size, scope and access we needed. This access provided previously unavailable human and operational resources that allow us to further develop and expand primary, ambulatory and specialty clinical services in Windham, New London and Tolland Counties.
The early results of this regional approach have been impressive. Already, in just more than a year, the East Region has achieved more than 15 million dollars in cost savings. How did we do this? With hard work and dedication, yes. But it was made possible through a framework that did not exist before: a regional formation that enabled creating more efficient operations, streamlining services, reducing redundancies and making full use of the scale and scope a larger geographic footprint provides. All of this is in keeping with our H3W principles, which is our leadership program that brings all members of our team together to identify areas for improvement.
We are well underway with plans for an extensive primary and ambulatory network throughout all of the East Region — including the recruitment of medical talent, identification of new care sites and development of new practice models. And our comprehensive regional strategic plan is the cornerstone to make it all happen.
The plan is supported by an extensive market analysis; driven by research into community needs and population health management trends; led by executive leadership with oversight from our Boards.
Diverse teams of physicians, clinical leaders, subject matter experts and community partners helped develop the strategic plan over an intense four-month period.
Broadly speaking, the East Region plan includes a focus on increased access to primary and ambulatory services, and specialty services in surgery, oncology, orthopedics, cardiovascular, womens’ health and a preventive medicine program.
Expanding our ambulatory care network
In addition to our new health center in Storrs, we continue to look at strategic outpatient ventures in the region, in order to provide greater access to primary and urgent care in our service area, and adding to our diagnostic services.
These are exactly the types of investments that would not be possible for a standalone hospital, especially given the economic pressures facing healthcare today. Having the backing of Hartford HealthCare, and its ability to help recruit providers to serve patients in our new ventures, is another measurable and visible element of our partnership.
We talk a lot about “the continuum of care” and “coordinated care.” Those are noble concepts that we are putting into action.
Our approach is to offer the very best care throughout the entire life cycle. We do this through a state of the art Women’s Health Services program, which would not be possible without the generosity of the Jeffrey P. Ossen Family Foundation. I’d like to thank the Ossen family for their generosity over the years – Windham would not be what it is today without their support.
Memorial Sloan Kettering Cancer Alliance
Being affiliated with Hartford HealthCare means being part of the Hartford HealthCare Cancer Institute, which is the charter member of the Memorial Sloan Kettering Cancer Alliance. When the world’s most respected cancer organization selected its very first (and, to date, only) partner, they chose Hartford HealthCare.
It’s not just a new logo. It’s real access to the world’s best cancer care. This means that patients at Windham will have access to the Memorial Sloan Kettering’s celebrated standard of care and its vast array of clinical trials — not by going to Manhattan; but by staying right here in our community, where cancer care is, and should be delivered.
This is a real partnership — a coming together of clinical best minds. Our team of physicians, clinicians and administrators have invested their efforts for many months to ensure that Windham is now officially certified to offer the same standards of care to patients that they would receive if they were to travel to MSK in New York City. Think about that for a minute — and be proud of the hard work that went into this alliance.
Cancer Center Accreditation
There’s more great news for cancer patients and for our community. Our cancer program has received notification from the American College of Surgeons Commission on Cancer that it has met the standards and requirements for Full Accreditation status.
The program was surveyed in early December by staff from the American College of Surgeons, after submitting a very detailed application to the college describing our cancer program.
The successful accreditation is a result of a great deal of effort from the Windham Cancer Committee, ably led by our Cancer Program Medical Director, Dr. Mary Barry. Dr. Jeff Baker, one of our medical oncologists serves as Cancer Liaison Physician and Dr. Nadia Nashid, were also instrumental in achieving accreditation for our cancer program. Jim O’Dea, Regional Director of Cancer Services and Kate Starkey, Regional Manager of Cancer Services, provided superior leadership and organizational skills throughout this detailed process. I am so proud of them — and proud of the care they provide.
The accreditation of the Windham Hospital cancer program was a critical goal set last year as an important element of our participation in the Hartford Healthcare Cancer Institute (HHCCI), and will continue to ensure that our patients are receiving the very best cancer care, close to home.
This achievement is further proof of our ability to offer high quality care in our community hospital setting now and into the future.
“Physician engagement” is another one of those catch-phrases you read and hear so often. But having true relationships with our physicians — creating real engagement — is a critical component to our success. Through input from physicians, we are identifying gaps, opportunities and succession planning for providers in the East Region.
We are also finding new ways to partner with providers in the community, including a major renovation project to a 5,000-square-foot office building adjacent to the hospital campus to house gastroenterology and pediatrics practices.
And we continue to work with other parts of the system, including the Hartford HealthCare Medical Group and Hartford HealthCare’s Integrated Care Partners (ICP) on recruiting of providers and ensuring access.
ICP allows all Windham providers access to its array of quality standards and managed care contracts, using evidence-based protocols in their daily practice, data for analysis and trending to help with population health management, and deployment of care managers when necessary to help with high risk patients.
School–based health centers
This concept of providing care where and when it is needed is a hallmark of our school-based health centers. We opened a third school-based health center at Charles Barrows STEM Academy in Windham, adding to our two existing health centers at Windham High School and Windham Middle School. This is an extremely valuable partnership with the Windham Board of Education, reaching young people before major health conditions can develop.
We continue to utilize our community health needs assessment and other data to determine how to get health care out to underserved populations.
We have expanded our successful Norwich food pantry and meal serving site program to include the warm shelter in Willimantic. Once a month our Mobile Health Resource Center is going to the shelter and offering primary care through one of our community partners, Generations. Our hope is to link more people up to primary and specialty care that need it.
We are also expanding our “Just Ask” campaign, in which we partner with local restaurants to offer heart healthy options, to Willimantic. In addition, we partnered with Hartford Hospital’s mobile mammography unit to offer free mammograms to women at an event held at Windham High School.
As the Ebola epidemic was emerging in east Africa and the first cases were diagnosed in the United States, Windham Hospital staff partnered with other HHC affiliates to prepare for the disease.
Windham’s preparedness team took part in daily, regional and system-wide briefings and training sessions. In October, the hospital participated in a real-time drill with a patient presenting in the emergency department and staff identifying the possibility of the disease, quarantining the patient, and coordinating a transfer to Hartford Hospital. Through drilling, training and education, we are ready in the face of even global health emergencies.
And training takes many forms. This year, I’m proud to report that all our staff and medical staff completed “Safety Starts with Me” training, which is part of our High Reliability Organization (HRO) efforts — and we saw the results, through a significant drop in serious safety events (SSE).
During this training, attendees learn how errors happen, the science behind the factors that cause events of harm and — most importantly — how each of us can prevent errors and eliminate harm.
In 2014, SSE events dropped from 16 to four from 2013. That’s a 75% decrease. In addition, the average number of days between SSE increased from 23 to 91.
Screening for Early Detection of Lung Cancer
Windham Hospital and the other members of the Hartford HealthCare Cancer Institute are working together to ensure a single, high standard of cancer care. Along with other members of the Institute, we now utilize a Low Dose CT Scan Lung Screening Program which uses CT scan imaging technology to effectively detect lung abnormalities.
That means faster diagnosis, timely treatment, and better outcomes for lung cancer patients.
Working to Lower Readmission Rates
RightCare is an evidence-based software tool that provides what its name implies. It is aimed at reducing patient readmission, and is currently being piloted in the East Region at Backus and then Windham.
RightCare enables care managers to more quickly know which patients need more care, and staff can be deployed more effectively, controlling costs and improving patient outcomes.
Health care delivery system of the future
All of this — all of these changes, this creation of programs, this focus on single standards of training and highest quality — are part of our ongoing work to create the integrated health care delivery system of the future, right here in Eastern Connecticut.
Because of the foresight of our board and administration, and implementation of these strategies by our leadership team and frontline staff, we have positioned Windham to be able to make the investments that are improving quality, safety and care coordination while developing a broader patient engagement infrastructure.
Because of all this teamwork and talent, I have no doubt that Windham will transform itself into a recognized center for high quality medical care, which I believe will become a national demonstration project for community hospitals, offering essential services to meet community need such as emergency care, same day surgery, women’s health, chronic disease management, a wide array of outpatient care, including a full complement of diagnostic services and a state of the art observation patient unit to deliver on our goal of the right care, at the right place at the right time.
In many ways, 2014 was a year in which we were more connected to our community than ever. Of course, with healthcare changing at such a rapid pace, we need to find new and innovative ways to advance this connectivity.
I’d now like to share with you a great example of how Windham hospital is doing this.
Now that, my friends, is connecting with purpose, which by the way is theme of our annual report which you can view at “Windham-Hospital-dot-org, slash 2014” (www.windhamhospital.org/2014)
And there is no way for a community hospital to maintain this connection without ongoing support. Whether it is our partnership with Hartford HealthCare, or support from philanthropists such as the Jeffrey P. Ossen Family Foundation, Windham needs to work closely with its partners.
In 2014, individuals, business and community groups contributed more than $500,000 to Windham Hospital through the Windham Hospital Foundation.
Thanks to a $100,000 grant from the Jeffery P. Ossen Family Foundation, the Women’s Health Services Center at Windham Hospital— formerly known as the Pre-Natal Clinic — has added two nurse midwives and offers comprehensive gynecologic and obstetric services.
The Ossen Family Foundation has donated more than $400,000 overall to Windham, including its cancer navigation program.
All of what I have discussed is providing us the opportunity to form the integrated health care delivery system that is the vision of Hartford HealthCare.
That vision includes the five 1’s: One Registration, One Health Record, One Standard of Excellence, One Bill and One Relationship.
It’s going to take time, but we are going to get there. Patients, or more accurate, consumers, are demanding it. It’s also going to take resources – creating the health care delivery system of the future requires a partner like Hartford HealthCare.
Working together, Windham, the entire East Region and Hartford HealthCare have so many opportunities to connect patients to our integrated health care delivery system.
At Windham, we are:
- Improving the health of our population. This means reaching out to communities and partner organizations, with a focus on improving health status of all individuals who enter our system of care.
- Improving the experience of care. This means providing care at the most appropriate access point – effective, safe and reliable care, to every patient, every time;
- And, at the same time, decreasing the cost of care by eliminating waste; reducing variation that does not add value; and providing more care, more efficiently and less expensively.
I will remember 2014 as the year where we were able to improve our quality, reduce patient harm and begin to stabilize our financial strength.
It’s not an easy thing to do, but it is imperative if we are to thrive in the constantly transforming health care industry.
The days when patients blindly went to hospitals because their providers told them to are over.
Today we are all savvy health care consumers – and I include major employers in this grouping – who are searching online, making choices based on quality, safety and — more than ever before — their cost of care.
In 2014 we found new and more efficient systems to deliver patient care, and, according to patient safety and quality data, we did them better. I firmly believe that this is due to our commitment to being a High Reliability Organization, which includes a daily safety huddle, in which we identify safety issues over the past 24 hours and anticipate potential concerns over the next 24 hours.
All of what I’ve just talked about is driven by data and analytics, but most importantly, by our desire to meet the needs our patients. Our patients are our consumers, so it is critically important that we continue to achieve and sustain our gains in quality and safety, as well as financial performance. As I often say to our leadership team, if you get the first two moving in the right direction the third will come as well.
Speaking of finances, I now want to invite our Regional Vice President for Finance Dan Lohr to the podium to talk about our financial performance.
The financial performance in Fiscal Year 2014 produced a difference of net revenues minus expenses of a negative $ 3.79 million. Based on net revenues of 198.5 million, that yields an operating deficit of 4.6%.
Dan then discusses discharges
Dan then discusses ED visits and decreasing admissions
Slide: ED visits, and admissions
This is not a sustainable model, and in fact is the fifth year in a row that Windham’s expenses have outpaced revenue.
Slide: losses five years in a row
And there is no silver bullet for a hospital like Windham, so in order for us to improve there will need to be change, which Dave will now discuss with you in more detail.
Thank you, Dan. Dan mentioned changing and improving. Those are words that this board and management team have taken to heart. They are words we must continue to put into action.
Through our hard work this past year, and thanks to our partnership with Hartford HealthCare, we have been able to reduce our financial loss year over year. That is good news. We have made improvements toward stability. In a nutshell: we have made things better. Now we must focus on making them sustainable.
We all know that health care is changing at a rate that has never been seen before. It’s true that all major industries are changing: communications, education, banking — you name it. But I think we can agree that no facet of American life is changing as rapidly, and as fundamentally, as health care.
To name just a few of the external forces:
- The continued roll-out of the Affordable Care Act;
- a growing set of what are called “recovery audits” for Medicare;
- and the constantly changing reimbursement methodology that really hits institutions like Windham that provide care on a disproportionate basis to the un- and under-insured population.
- Sharp declines in inpatient volume throughout the nation.
We do not stand alone in this sea of challenge and change. To some extent, every hospital is dealing with these and other transformative issues.
And you don’t have to look too far to see that Windham Hospital is not alone in its financial difficulties— right here in Windham County, Day Kimball Hospital announced a more than $5 million loss just last week.
At Windham, we have taken on the hard work of reducing expenses and finding efficiencies wherever possible. But the fact is that rural community hospitals like Windham are more affected by changes like the national decline in hospitalizations. Bluntly, our revenues are down, and there is no cushion. This is clearly not a sustainable model.
Two nights ago, in the State of the Union address, the President said, “It’s time to write our own future.” Now, you may agree or disagree with his vision and his proposals, but at Windham Hospital, this is our time to write our future.
The reality is inescapable: we have experienced losses for five years, and we project another loss in 2015. And that’s with the improvements in efficiency and scale we have been able to achieve factored in.
This is our reality. It is very much the reality of health care today — and not dealing with these issues today will make the future even more difficult to manage.
In fact, we have seen what happens to organizations that ignore these challenges — those that stubbornly hold on to the status quo may not have a future.
That simply can’t happen here. And it won’t.
This board, this leadership group, these talented employees and this community are too smart, too hardworking and too committed to turn away from this challenge.
We know Windham Hospital needs to be here to meet the essential clinical needs of this community. The key word is sustainability: We recommit ourselves to fulfill our mission so we will be here for the people who depend on us.
“We” are the board, the medical staff, the management team, the employees, our system leadership — all working with this community to write our future.
That future must include a sustainable clinical model — one that will allow us to have a “re-investment margin.” All hospitals need financial results that produce at least a positive margin, to fund operations and allow us to make continual investments so we can adapt to the changes occurring all around us … so that we can be there when people need us.
Since its founding, Windham Hospital has always been, and should always be, the provider of essential medical services for our community.
That list of “essentials” has changed throughout our hospital’s rich history. It’s changed as health care has changed, and as our community has changed. Here is a short list of what our patients and the data tell us “being essential” means in 2015:
- Obstetrics: We are proud to offer a cornerstone program in an underserved area. We all know that the physician group that has traditionally served the Windham community has made a business decision to shift their practice to a competing institution. We will not let their decision alter our strategic plan or deter us from our mission to provide this essential service. That’s why we have brought in a nationally respected firm that will provide high-quality, comprehensive, patient-centered OB services. That’s essential to our community.
Other essential services include:
- Women’s health, to promote, maintain and restore physical and emotional well-being for women of all ages.
- Diagnostics, using the latest technologies to detect issues and measure health status.
- Same day surgery, to combine high-quality surgical care, medical excellence and convenience.
- Observation care for patients who require additional testing and evaluation so the right clinical decisions can be made about their care.
- Disease management, for costly medical conditions like diabetes, arthritis, hypertension, cancer, cardiovascular — things that make life unmanageable for millions of Americans.
- And high quality emergency services that are available 24-7 so that members of our community — our friends, our families, our neighbors … and those who will come after us — can turn to this institution for their care for years to come.
This list is by no means all-inclusive. But it summarizes, at a high level, the sort of high-quality care that meets this community’s needs — care that we are the experts at delivering.
Here again, meeting the broad array of our community’s many health needs finds its opportunity in our partnership with Hartford HealthCare. Through our Windham gateway, Hartford HealthCare offers access to the highest level of tertiary / quaternary care, as well as specialized clinical services, as close to home as possible.
Transformation is hard, but we will have a roadmap
- It’s based on community needs, as determined through an extensive community health needs assessment we will perform again this year.
- It will be guided through our strategic plan, which has been developed with input from key stakeholders, including physicians, our board and experts.
- It will be based on a business analysis to determine how we can most effectively and efficiently deliver these essential services.
- And it will be informed by the voice of our community, as we continue to meet and discuss how we will best make these fundamental changes at Windham in order to ensure that we are here to serve our community for years to come.
Our plan is not pre-determined. But this much we do know: Maintaining the status quo — wishing that health care would be as it was a generation or more ago — is not just hopeful thinking. It is dangerous. As they say, “Hope is not a strategy.”
Remember: the forces of change in health care are here whether we act or not. We need to have a firm hand in crafting our destiny — to write our own future. The people who rely on us deserve that.
A rational, planned approach to care delivery — based on a renewed commitment to providing high quality health services — is the path to sustainability.
I look forward to keeping you informed and involved as we create the future for this community institution— a future we will write together over the months ahead.
So, to our Corporators and all our benefactors —thank you for your support of Windham, and please continue to support us as we work to ensure that the greater Windham community has a gateway to clinical services through the multiple access points of this institution.
The work ahead will not be easy, but in the end it will be in the best interests of our community and the patients we are so honored to serve.
In closing I’d like to take a few moments to recognize the Windham team who is delivering on our mission every day.
With us this evening are members of our leadership team. Please join me in recognizing their leadership and achievements in helping us do the difficult work of transforming our system of care, and doing so by putting patients first, always.
The members of our Medical Staff who work so tirelessly to heal the sick, the injured and chronically diagnosed. We are so fortunate to have the talented medical professionals who care for us day in and day out in our community.
Likewise, our Board is deeply engaged in issues of quality and continuous improvement in ways that have supported our efforts. And at the same time making sure that we stay true to our commitment to the community. I’d like to publicly thank them as well.
Most importantly our front line staff, some of whom are busy providing patient care right now, as we gather here. Thank you to each and every one of our Windham team. Their commitment and compassion for this work we have discussed is something we should all take great pride in.
They make the difference for me and so many others everyday, 24/7/365.
Now, before we adjourn and spend some time together at our reception, I’d like to share a video with you in recognition and celebration of our team who have dedicated themselves to putting our patients first, always.
Slide: highlights video
That video says it all – those are the people that make Windham what it is today, and what it will be in the future.
Our meeting is adjourned.