- July 2020: The Role of Advocacy
- June 2020: A Letter to the Class of 2020
- May 2020: Moments of Joy and Silver Linings
- April 2020: "I know we will get through this together."
- March 2020: IHP Growth as a Health Care System Imperative
- February 2020: A Look at Governor Charlie Baker's Health Care Proposal
- January 2020: A New Decade Begins for the IHP – and Possibly in Health Care
- December 2019: Finding the Joy in Leadership
- November 2019: Strategic Plan Update: Year 1
- October 2019: The Impacts of Excessive Screen Time
- September 2019: A New Academic Year Begins But Grim Realities of Immigration Policies Persist
- July 2019: Our Efforts Addressing Diversity, Equity, and Inclusion
- May 2019: Asking – and Answering – the Big Questions
- April 2019: The Impacts of the President's Budget Proposal
- March 2019: What are the Sustainable Development Goals, and what do they have to do with us?
- February 2019: Vaccine Hesitancy
- January 2019: Why Getting a Flu Shot Matters – For You and Your Patients
- December 2018: What is health system science and why is it important for health professionals?
- November 2018: Ballot Question 3: We Must Maintain Protections for Transgender Persons
- October 2018: A look at Massachusetts’ Nurse Staffing Ratio Ballot Initiative Question 1
- September 2018: Much to Be Proud of at Start of New Academic Year
- August 2018: A Look Back at Year 1
- July 2018: Students’ 2017 Diversity and Climate Survey Results
- June 2018: A Month of Transition
- May 2018: Visit to China Could Reap Dividends
- April 2018: Strategic Plan Input from Community
- March 2018: 2018-2021 Strategic Plan Update
- February 2018: Working to Achieve the Values of Respect, Dignity, and Inclusiveness
- January 2018: Welcome Back!
- December 2017: Innovation in Health Care: What Is the IHP’s Role?
- November 2017: IMPACT Practice Center
- October 2017: How Genetic Counseling Is Improving Patient Lives
- September 2017
As you read the title of this, I am sure you thought I would be writing about how important it is for health care worker to advocate for changes in the health care delivery system that improve the care to our most vulnerable populations. I have written about that before in this blog because I think that is a critical role for all health care providers that often gets overlooked.
While we will change the lives of individual patients and families with our care, we can improve the structure and delivery of health care for communities and populations through our policy advocacy. Both individual care and policy advocacy are critically important if we are ever going to be proud of the health care delivery system of which we are all a part.
But this blog is going to take a little different perspective on the role of advocacy. I am going to ask you to think back to all the articles you have read about health care in the newspapers or on-line or stories you have seen on television. Who is the expert that is interviewed, consulted, or quoted in the news story? Who is represented as the face of health care in the media? In more than 98% of the stories on health care, it is a physician who is providing information and expertise about an innovation in health care or health care delivery. And while I am so respectful of the depth and breadth of knowledge of our physician colleagues, in fact, there are so many areas where other health professionals are more expert.
Consider one of the most pressing issues in our country affecting both health and lifespan – physical inactivity. We know that Americans do not move enough and the American Physical Therapy Association talks about physical activity being the cornerstone of their profession. Who better to be consulted by the media about this important health determinant than physical therapists? While I have not seen physical therapists quoted in New York Times articles about the importance of physical activity, I have seen physicians and others talk about exercise as an important pathway to health and longer life.
Since the 1980’s, when Beatrice and Philip Kalisch wrote their seminal article on nurses in the media, I have been intrigued about how few media articles there are about nursing innovation in practice or nursing research. And while nursing is the largest health profession, its representation in the media is almost non-existent. In a 2017 study by Diana Mason and colleagues (the Woodhall study), nurses were cited as sources in only 2% of the health news stories and never cited in policy-related health stories. This has changed a little bit with COVID-19, but I am not convinced the trajectory will continue once this crisis is over.
I think of the incredible work of our IHP researchers who are studying problems that have an effect on the recovery of individuals with devasting illnesses. Each one of them has a story that would be important in the public media but is rarely explored by our journalist colleagues.
Again, this discussion is in no way a slight of our physician colleagues whom I respect and value as a part of the health care team. Rather, this is a call to action for each one of us. I know none of us entered our professional with the goal of being the spotlight. We became physical therapists, nurses, speech therapists, occupational therapist, physician assistants, and genetic counselors to help people get well and have a better life. But as leaders in the health professions, our role can have a broader impact through advocacy for our work and our profession. How can we be ready for these opportunities and how can we push to make these opportunities more available?
I ask that each of you think about those areas where you are uniquely qualified to provide depth of expertise. Who needs to have that information? What media vehicles would be interested in that expertise? That gives you an idea of where you could begin building relationships.
In the next academic year, the IHP will be hosting educational sessions on media preparedness for faculty and students who are interested in participating in that experience. Being ready when the opportunity arises makes us more open to saying yes when the call comes to be interviewed by a journalist. Finally, the IHP Office of Strategic Communications will be reaching out to places that host expert databases to make sure our IHP experts are included on their lists. If our experts are not included in these databases, it is unlikely we will be consulted when a relevant health issue arises.
Creating visibility for the impact of our professions helps to frame our contributions to health care and in society. And while some may think it’s self-serving, in fact, it’s a service to our professions and the patients we care for. If we think of the major issues facing the health of our country and the world, our health professions are engaged in work that hold the solutions. I look forward to a time when our professions are consulted to explore solutions to the health problems we, as a county, face.
To the 2020 graduates:
My June Yardarm column has traditionally been a celebration of the May Commencement. As with everything else this year, our traditions have been modified, and May 11 came and went without the usual excitement of you celebrating with your friends, faculty, and loved ones at the BCEC.
While our ceremony was postponed, I would like to recognize the 566 graduates who persisted in the face of challenges, grew as health care providers, and were launched into the world to improve the health of thousands. While the day was not what we expected, I hope it was a day of personal celebration for each and every one of you for all that you have accomplished and how you have met the challenge of this pandemic head-on.
I look forward to our virtual Commencement celebration on Sunday, August 30 at 2:00 p.m. where we will hear from our student Commencement speaker, award an honorary doctorate, and recognize selected alumni. Our program will not be unlike what it would have been if we were able to gather in person. We will also recognize each of you individually and share a bit about your time at the IHP. We have lots of special touches that we know will make this event not only a distinguished celebration of your accomplishments but a joyous and festive event as well. I look forward to seeing you there!
As I envision your future as an IHP graduate, I can’t help but see it in the context of what we have all gone through over the last 12 weeks. We have lost friends, family, and loved ones, and much of what we know and have grown accustomed to has been challenged. As leaders in health care, we all recognize the disproportionate impact of the COVID-19 epidemic on the communities of color right here in Greater Boston and want to understand why this has happened not only here but also all over the country. For example, in Chelsea, 66% of the population identifies as Hispanic, limited English ability is four times the state average, and the poverty rate is 50% higher than the average for Massachusetts. Here, residents have a death rate that is four times that of the state as a whole; Chelsea has the highest rate of COVID-19 infection in Massachusetts. Most of us would look at these data and think that perhaps individual comorbidities or the social determinants of health played a role in this picture. Perhaps the structural racism that prevented our Chelsea neighbors from accessing culturally relevant health care in a timely manner was a contributing factor.
As Dr. Tom Sequist, Chief Patient Experience and Equity Officer for Mass General Brigham, described in his testimony to the U.S. House of Representatives Ways and Means Committee on May 27, there are multiple factors that are driving this disproportionate impact. As health care leaders, we all have a responsibility to work to reduce the impact of the social determinants of health on communities of color. We all have a responsibility to work to reduce the impact of structural racism not only in the care we provide but also in the systems in which we work. Our work with communities and populations can have an effect on the availability of nutritious food, the availability of adequate housing, and the perception of a welcoming health care delivery system. I hope, as you have witnessed the impact of this pandemic, your passion to look further than your individual client to the community in which they belong and to the system of health care of which you are a part has been ignited.
Furthermore, the events of the last week after the brutal death of George Floyd demonstrate clearly how systemic racism impacts the way people of color are treated across the country. Protests and civil unrest across the country reflect the desperate need for sweeping changes not only in policing but also in the many ways Blacks are disadvantaged in this country, including in the health care they receive. The Institute remains steadfast in its commitment to exploring and discussing these issues, as well as being a model for change.
As an IHP graduate, your commitment to leadership in health care is remarkable, and the leadership you bring has never been more important than it is in these challenging times. You are going into a health care world that most of us have never imagined, and you will be asked to do things that many of us have never done. The challenges will be many, and the burden of that work will be heavy. So many of you came to the IHP to make a positive difference in people’s lives, to make people feel better, to give them the ability to do things they could not do before your care. As you navigate as a new practitioner into a system in which you may not have the outcomes that you expected, I hope you remember to take care of yourself, both mentally and physically. As health care providers, we know what to do but often forsake that for the benefit of our patients. Being able to take time for yourself, reflect on your experiences, and ask for help when you need it is what will make you an exceptional provider. You have a long career ahead, and it’s when things are the hardest that you need to take care of yourself the most.
I wish you all a career that is everything you hoped for when you entered the IHP. You will always be part of this community, and I hope the IHP will always be a part of your life. I hope that your passion for your profession only builds as you grow as a provider. I know I speak for the IHP faculty and staff when I say that we wish you well.
Our lives have been forever changed as a result of the worldwide spread of the coronavirus. Even if we can resume some of our normal activities, our view of the world and what we think is important has shifted.
Over the last two months, we have learned new ways to work, play, socialize, and reduce stress. We have had to because the usual ways of doing all these things were unavailable. And while I can sometimes find myself focusing on all the negative impacts of this pandemic, I have been inspired by the many, many great things that are happening at the IHP that demonstrate the resilience of faculty, staff, and students and the innovative spirit that permeates our community. Our community does not accept good enough or average. There is a hunger for excellence, even in the face of adversity. This President’s Message is all about the incredible programs, innovations, and joys that have been occurred over the last two months.
Faculty and staff didn’t waste any time when we made the decision to close the campus and move to a virtual education model. In the first few weeks of the pandemic, our faculty and staff launched into a series of innovations that would support on-line education, create virtual simulation opportunities, and develop approaches to education that supported our student’s clinical learning. Last month, I shared the work of our instructional designers in developing supports for faculty and the delivery of a virtual interprofessional simulation at the Sanders IMPACT Practice Center for 60 students in the first week of the pandemic. These kinds of innovations continue, and others have been added. For example, one of our most active centers in the IPC is the Aphasia Center. Because we closed the IPC to patients, faculty from the Speech and Language Pathology program launched a telehealth program allowing patients from the Aphasia Center to continue their therapy as well as remain connected to the members in the Center.
This is what excellence in the face of adversity looks like.
Even though our students are not on campus, they have expressed a strong desire to aid those in need, contribute to the IHP community, and develop their leadership skills. Through student leadership, two programs, Teddy Talks and Big Buddies, have been developed. In the Big Buddies program, IHP students are matched with Harvard-Kent students to provide mentorship, support for learning, and friendship. The Teddy Talks program is modeled after Ted Talks for adults. IHP students record an educational video that parents can use to support a child’s education or provide for independent learning. There are more than 30 IHP students engaged in these two programs. Students leading students has continued through the Student Government Association and the IHP clubs. These are places where students can grow in their leadership skills.
I also want to share the incredible work that our students are doing in the Mass General Brigham system to support the workforce and provide necessary care to patients. From both the School of Nursing and the School of Health and Rehabilitation Sciences, we have more than 350 faculty and students working at MGH, Boston Hope, the Assembly Row Call Center, Chelsea Quality Inn, and Spaulding Cambridge. Our students and faculty have been amazing in the way they have stepped in to be helpful to our partners.
Finally, our community has figured out ways we can feed our soul. For so many of us, the best part of the IHP are the people. And while we are now used to the “Hollywood Squares” approach to conducting our business, it is not the same as running into someone in the hall, having coffee with a colleague at Dunkin Donuts, or meeting, in person, to discuss a thorny issue. So, in addition to the regular schedule of Zoom meetings we all have, the IHP added virtual social events that have helped us to stay together as a community and support our members. The Staff Council hosts Tea Time, an informal Zoom gathering where people can play trivia games and socialize in small groups. Human Resources has sponsored meditation and mindfulness sessions and just last Friday evening, the Office of Student and Alumni Services hosted IHP Together: Connecting through the Arts. Organized by Kerry Kearns and Katie Mulcahy and cleverly emceed by Russ Abbatiello, IHP faculty, staff, students, and alumni showed us all that the IHP is a very talented community. From singing, to dancing, to instrumental performances, I think we were all impressed that these current or future health professionals have incredible talent as well as an uncompromising commitment to health care. We are lucky to have them as part of the IHP community.
In these difficult times, it’s easy to focus on the negative but I choose to look for the silver lining, those moments of joy that we can share as a community. Those are what will sustain us and allow us to come out of this challenge better than when it started.
Please stay well and be healthy.
First and foremost, I hope you and your families are healthy and safe.
It has been said too many times over the last few weeks that these are unprecedented times. The coronavirus has asked us to change almost everything we know and love about who we are and those people with whom we interact. No longer are we about to greet each other with a robust and heartfelt handshake or a hug (and I am a hugger). In fact, those opportunities for meeting people have all but disappeared from our lives because our world has been narrowed to the grocery store and pharmacy. Even those outings have become completely transactional – get in for what you need and get out as fast as you can. No longer do we have the opportunity to sit at the benches at the Bunker Hill Mall or the ones around Pier 4 to talk to complete strangers. For some, our world has also narrowed to the few people who are at home with us all the time or the people in the little boxes during our Zoom meetings.
We are all living at a time when anxiety, fear, and stress are a big part of our lives. We are looking for answers where there are none. We are seeking the “truth” where multiple versions of the truth exist. We want to know what our life will be like when this pandemic has subsided. Oh, and by the way, when with that be?
And while this pandemic is forcing us to change the way we do almost everything in our lives, it is compelling us to come together, as a community, in ways we never thought possible. While we know that the path forward is unclear and changing all the time, we also know that we can count on each other to create new approaches to how we do our work or lift each other up.
Over the last three weeks, I have witnessed and heard of so many of our IHP members going above and beyond to address the needs of the community. I have also seen incredible innovation brought on this challenge. I will name just a few of them here but please know there are many, many more that I could include, all critically important to our community.
- On our very first day of moving all of our coursework online, Dr. Mary Knab, the IMPACT Practice Team, and many faculty led a virtual simulation with over 30 groups of students, learning together about clinical care. Under normal circumstances this experience is challenging, but the team created a virtual environment that was amazing and allowed the students to experience interprofessional practice at its best.
- Tony Sindelar has created as series of You Tube videos on how to teach online in our “New Normal.” By providing best practices and strategies for online teaching, Tony has helped faculty improve the quality of their teaching for our students. But he also has reduced the stress on our faculty because they have solutions to their problems readily at hand.
- Last week, our Staff Council held a virtual wine and chess that was attended by over 40 people. They “visited” with each other, enjoyed a beverage of their choice, and played a trivia game. Ours is a community that enjoys socializing together. By creating a virtual opportunity for socialization, we can create a sense of normalcy that we have lost over these last few weeks.
- I could go on!
While we don’t know the answers to many life’s questions today, I do know that we will overcome this virus and begin to bring back a sense of our previous lives. We, as a country, as a people, and as a community that have overcome so much before this crisis, will stand together to defeat the virus, learn from this experience, and grow both individually and collectively. When the vision of the IHP was developed, a major assertion included the importance of the education of leaders in health care and the research and outreach that improves health care. Through this pandemic, we have seen the importance of that vision in real time.
Finally, stay healthy by heeding the CDC recommendations for social distancing and handwashing. Pay attention to your own self-care. Virtually reach out to others who might be having a particularly difficult time during this pandemic. I know we will get through this together.
In almost every meeting I have with faculty, staff, and students, the subject of the IHP’s vision for growth is raised. I think this is in part because we have been talking about growth for more than a year now, but also because of our newly launched ENRICH initiative.
Just recently, Provost Alex Johnson led a standing-room-only Town Hall meeting describing the ENRICH model and our plans for addressing some of the challenges faced by the IHP. Led by an Executive Committee of James Dupont, Heather Easter, Atlas Evans, Alex Johnson, and Denis Stratford, our ENRICH model looks at opportunities in our existing academic and continuing professional development programs as well as opportunities to develop new educational programs, all within the context of supporting our faculty and staff in the process of innovation. To do all this work, we are getting the support of consultants in the areas we want to assess and possibly make change. The process has been well planned and thoughtful with the hope of getting us to the best possible future for the IHP.
But what are the goals of this initiative? Why is the IHP undertaking this planning process now? What do we hope to accomplish through this process? There are both internal and external factors at play here that make the ENRICH initiative important for the IHP’s future and the future of health care delivery. Two years ago, the IHP community spent almost six months discussing our future as part of the strategic planning process. We identified six major priorities for our future, with one of them focused on continuing to regularly assess programs to ensure the quality of, modify, and/or launch new degree programs that will drive improvements in health care. Our strategic plan gives direction and focus to this work.
By examining each of our current programs and optimizing enrollment in each one, we are being efficient and effective with our current resources. The health care workforce continues to grow and is expected to increase much faster than the average for all occupations according to the U.S. Bureau of Labor Statistics. As the population ages, and there is a concomitant increase in the number of chronic illness per adult, the need for health care providers will also increase. For example, the employment of PAs is projected to grow 31% from 2018 to 2028 and the employment of nurse practitioners is expected to increase by 28% in that same time period (US Bureau of Labor Statistics, 2019). And while the increase in the needs for providers is uneven among all of our programs, it remains clear that we are preparing the providers of the future, people who can work across disciplines and are comfortable providing care in an interprofessional team model. Our graduates are those who will be ready to transform health care for the benefit of the population. Shouldn’t we be producing as many of these kinds of providers as we can? We need to be a significant contributor to that workforce.
But there are other health care workforce challenges we are not fully addressing, and the ENRICH process will help to uncover some of those opportunities. This process will allow us to ask ourselves, what does the future of health care delivery look like and how can we be an important contributor to that future? Just recently, I had the opportunity to hear a presentation by Farhan Syed, Vice President for Learning Solutions at LinkedIn. He shared that the skills needed to compete in today’s workforce are changing faster than ever with more than one-third of job skills learned today changing in the next five years. The need for high quality continuing education and professional development, the kind that IHP is known for, can contribute significantly to excellence in the health care workforce.
We also know that the world of health care delivery is changing as digital solutions become more widely used. It has been suggested that the promise of Artificial Intelligence (AI) is greater in health care than in any other industry, and we have barely scratched the surface in ways that AI can help us provide better, more compassionate, and cost-effective care to patients and populations. The ENRICH process will help position the IHP develop a workforce for a changing health care delivery landscape by helping us to identify new trends in health care.
I am excited about the opportunity to build on the excellence we have created over the last 43 years and create new opportunities to contribute to an improved health care delivery system. Our challenge is to lead in the era of a changing health care workforce and we are certainly up to that challenge.
In my January column, I mentioned the Medicare for All that is being considered by some of the Democratic presidential candidates. Such a bill, if passed, would be a revolutionary change for the United States, just as the inception of Medicare was in 1965. Medicare meets so many of the health needs of the elderly but, as I wrote, it is not the panacea that many people believe. For me, the jury is still out on whether Medicare for All is the right direction or is there is some other approach that will address the complexities of health care needs in our population.
Last month, I also said I was impressed with many of the elements in Massachusetts Governor Charlie Baker’s health care reform proposal. I will highlight just a few of his proposals here, but I encourage you to read the Massachusetts Health and Hospital Association’s analysis of H.4134, An Act to Improve Health Care by Investing in Value.
One of the most exciting areas in the governor’s proposal is the additional funding for behavioral health and primary care, with a target of a 30% increase above current expenditures over the next three years. There are also several changes to increase insurance coverage for behavioral health and increased specificity of the kinds of services health care organizations are required to have available for behavioral health patients. The proposal also would create a board of registry for recovery coaches and impose a 15% excise tax on the gross receipts for opioids manufactured and sold in Massachusetts. Taken together, these changes would be significant.
Behavioral health spending has not met the needs of the population for many years and behavioral health needs continue to grow. Providing the necessary care for patients with behavioral health problems will address some of the social problems we are seeing on the rise, such as homelessness, violence, and sexual assault. An investment in this vulnerable group could have significant impact on the overall health of our population.
Similarly, investing in primary care for patients is not only good for the patient, it’s good for health care providers and for the community. We have long known that primary care helps people stay healthy and when they do get sick, being able to access a primary care provider shortens the illness and prevents a small problem from escalating into a major crisis. We also know that people without a primary care provider often seek care in the emergency department for problems that are better (and far less expensively) treated in the community.
Both these investments have the potential to improve care to the underserved, reduce costs and improve the community in which we live. Both will also require an increase in the provider workforce to meet the demands associated with increased access and funding.
Another exciting component of the Baker proposal would add new protections for patients from receiving “surprise” medical bills for services and establish new notice requirements for disclosure of provider network status and referrals. A surprise bill is defined as one received by an insured patient for amounts other than plan cost-sharing for covered services provided by an out-of-network provider in an emergency, or by an out-of-network provider at an in-network facility. The Baker bill would require providers to determine network status and provide certain information to patients. We all recognize the complexity of navigating the health care delivery system. Even for those of us who have lived a lifetime working in health care, the byzantine system that drives access to care and subsequent billing is often too hard to understand. Having these protections for patients, most of whom find the experience of care overwhelming, is the right thing to do.
There were several changes proposed that relate to nursing including making Massachusetts a member of the Nurse Licensure Compact (NLC). This will allow nurses licensed in another NLC state to work in Massachusetts without having to go through the laborious process of endorsement. Having done this myself when I moved to Massachusetts, I would say it is major impediment for a nurse wanting to work in the Commonwealth. There were also several changes to advanced practice nursing scope of practice, including allowing qualified psychiatric nurse practitioners to admit patients to an inpatient psychiatric facility on a voluntary basis, or on an involuntary basis for a three-day period.
While there are many other aspects of the proposed legislation, increasing access to care and creating protections for vulnerable populations are central to addressing our imperfect health care system. I hope you take the time to read Governor Baker’s proposal and let his office know what you think about it. While we have far to go to make our health care system work for everyone, I believe H.4134 is a step in the right direction.
As I write this, it’s hard to believe that we have said goodbye to 2019 and we are embarking on the new decade of the 2020s. While the last decade was a great one for the IHP, I know we can look forward to more great accomplishments in the coming years that will distinguish the IHP as the stellar academic institution it is. We have so much to be proud of and so much to look forward to!
As one of the final acts of the decade, 89 IHP students in the School of Nursing and the School of Health and Rehabilitation Sciences were approved by the Board of Trustees for completing their studies. We wish these new graduates well in their new careers and hope they stay connected to the IHP.
To start the new year, this week we are welcoming 86 new students in our Accelerated Baccalaureate in Science Nursing program. They have arrived from all over the country to begin a journey that will bring them into the heart of health care. They come to us with degrees in Biology, Psychology, Art, Business, Exercise/Health Science, Music Education, Pharmacy, Veterinary Science, Languages, and Engineering. They will leave behind their lives as Mental Health Specialists, Population Health Coordinators, EMTs, Paramedics, Medical Scribes, Pharmacy Techs, and Veterinary Assistants and immerse themselves in a whole new culture, committing to a future as a nurse. They will study harder than they have ever studied before and they will have experiences that will be transformational.
I also want to begin January by welcoming back all of our existing students and wishing everyone in the IHP community a peaceful, joyous, and successful new year.
I recently was part of a panel, sponsored by the news organization Axios, that discussed access and affordability of health care. One of the panelists asked a simple question that made me sit back and think for moment: “What is the minimum level of health care benefit a U.S. citizen should have access to?” He said that right now, the minimum level of benefit we all have is the Emergency Department, a totally ineffective and inappropriate setting for most people.
I have thought about this question a lot in the context of evaluating so many of the policies and plans from national politicians like Democratic Senators Bernie Sanders and Elizabeth Warren and former Vice President Joe Biden, all of whom have proposed versions to fix the country’s broken health care system.
So, full disclosure – I am not sure I am totally in favor of Medicare for All. Yet.
Right now, my experiences as a home care nurse who mainly dealt with a Medicare population inhibits my ability to fully support that proposal. I would love to see a health care plan that meets the needs of the population it serves in the most effective and cost-efficient way. However, Medicare is nether cost-efficient nor does it meet the needs of the population it serves. As an acute care benefit, Medicare does not pay for the kind of long-term care, chronic illness, or community-based care that most seniors need. Instead, it focuses on hospital care and very short-term care skilled care following discharge.
Nurse practitioners can’t certify a patient for home care or recertify their plan of care. This has to be done by a physician (added cost) who knows little about what is happening in the home (reduced quality). These kinds of restrictive and illogical regulations are incredibly short sighted and give me pause as I think about extending that kind of incoherent bureaucracy to the country’s entire population.
As I think about the future, I envision a health care delivery system for all with strong community-based resources that provide high-quality preventive and primary care services and ongoing care for people with chronic medical and behavioral illnesses. I think about a system that uses the right provider for the right patient at the right time, each working as members of an interprofessional team committed to patient/family wellness. I see public health care providers in our communities addressing the social determinants of health.
Can we get this kind of health care under one of the Medicare for All plans that are being proposed? Will inane regulations get in the way of providing the right kind of care to children and adolescent and people with behavioral health problems? I don’t know the answer to that which is why I can’t say yes to that concept yet. I think there is much more that needs to be explored as we migrate to a national health insurance model. A good place to start would be the health care legislation proposed last October by Massachusetts Governor Charlie Baker, which has many interesting elements. I’ll have some thoughts on that in my February Yardarm column.
There is so much hope in beginning a new year. I am optimistic that we can do better for those who don’t have access to the kind of care we would want for them. Maybe 2020 is that year.
This is the time of year that we tend to take stock in our lives, what we contribute to the world, and what we are grateful for. I try to do that periodically because I often get busy with a myriad of things and forget to be grateful for the gifts I have been given and the people in my life.
But about a month ago, I was forced to really look deep and try to figure out where in my life and in my work I find joy. I was asked by the Greater Boston Nursing Collective to give the keynote address at their annual meeting on “The Joy of Leadership.” Now, some of you might say that this phrase is an oxymoron, like “jumbo shrimp” or “bittersweet.” Can we really put “joy” and “leadership” in the same phrase? Is there joy in being a leader and if so, where is it found? I was challenged to reflect and articulate where I find joy in my role as a leader.
I have been in leadership roles for many years and I have found these roles to be exciting, energizing, and professionally rewarding. I really never needed to articulate where I find joy in the leadership roles I had, so this process was a new one for me. After some deep reflection and quite a bit of self- assessment, I came up with five different areas that account for a significant degree of the joy I experience as a leader.
Engaging with people: In my many years as a leader, the thing I love most are the interactions I have with faculty, staff, and students. The ability to engage in thoughtful discussion, or hear a different perspective, or even challenge one another, is such a gift we as academics have. Being with students and colleagues are the best times by far for me as a leader.
Being able to support other people’s success: As a leader, I find incredible joy in helping others reach their professional goals. Being able to take away the barriers to success that sometimes impede the work of faculty or staff is very gratifying. I have long felt that the success of one member of the team is the team’s success.
Giving of myself through mentoring: For me this includes both formal and informal mentoring. Being open and honest and generous with my time is sometimes challenging but the rewards are significant.
Maintaining my core values: As I reflected on my career, the most “unjoyous” times as a leader were the times when I compromised my core values. These were times when I felt my thinking was disorganized, I was uncomfortable in my own skin, and disconnected in some way. Maintaining my core values, even in difficult situations and against pressure, is challenging. But when I do, I have felt that I had clarity of thought and a sense of calm, even in turbulent water.
Learning: I have often wondered what my life would have been like if I had chosen to work in an environment other than academia. The opportunity, in fact the expectation, that we are engaged in a lifelong process of learning and discovery has been a joy in my life. In what other career can you have the choice of attending multiple lectures in the course of the day, be encouraged to attend educational seminars, and have scholarship as part of your role? There is something very wonderful about being in academia.
Being able to recognize and know what brings me joy as a leader has been an interesting process. I was grateful for the challenge to explore this aspect of my career and enjoyed sharing my perspective with the conference attendees and now with you. I hope you examine your own role and see where you find joy in what you do.
As we begin Year 2 of our current Strategic Plan, I thought It would be helpful to give a summary of what we have accomplished to date and an idea of what we have planned for this year.
The strategic planning process began in the 2017-2018 academic year, bringing together over 150 faculty, and staff, along with some students where possible, to define the IHP’s future for the next four years. The Strategic Plan was approved by the IHP Executive Council, shared with the IHP community, and approved by the Board of Trustees in the spring of 2018. That summer, we worked to develop a detailed tactical map for each of the strategic priorities which provided the roadmap for how to accomplish the broad goals we had defined in the plan.
Given that each goal we defined included many tactics, we decided we had to focus on a subset of tactics so that we could be successful. In the fall of 2018, we identified four areas that, despite their significant costs, were considered such high priorities that we decided to work on them right away.
- Establish the Institute as a leader in research and scholarship,
- Build and nurture a diverse and inclusive community,
- Expand IPE competencies, and
- Launch new programs that will drive improvements in health care.
These four areas involved filling three new positions and engaging consultation to help us plan for the growth of Continuing Professional Development (CPD). Each of these high-priority areas had numerous smaller tactics needed to address the larger goal. For example, under the diverse and inclusive community initiative, we worked to assess the needs of our community related to diversity and inclusion, constructed a vision, and launched a new Office of Diversity, Equity and Inclusion and hired its inaugural Executive Director.
In the other three areas, we have reorganized our interprofessional education work under a new Interim Associate Provost for Interprofessional Education and Practice and hired a new Executive Director for Research. We also continue to explore growth opportunities in our academic and CPD programs.
When we identified the four major priorities, we realized there were many tactics we could accomplish over the course of the plan’s first year that would be low cost but have a significant impact on the IHP. The 10 areas identified were:
- Enhance student leadership activities and alumni development.
- Incorporate diverse perspectives in the curriculum.
- Increase the number and frequency of clinical placements that provide opportunity to work with diverse patients.
- Enhance pre-enrollment communication strategy.
- Develop a model of preferred vendors.
- Enhance professional development opportunities for staff.
- Deepen relationships with our local communities.
- Increase the number of faculty from underrepresented communities.
- Grow beneficial relationships with Harvard and other academic partners.
- Work toward a unified brand message.
Each of these 10 initiatives had a leader and a small task force charged to address the issue and make progress toward achieving the goal.
During the fall 2018 semester, we developed a model that would allow us to see our progress toward our goals and we reviewed our progress regularly at the Executive Council meetings. We have made significant progress on some initiatives, while we have just begun to see progress on others. For example, we have developed the model for IHP’s preferred vendors and are ready to launch that this year. We have launched new communication models for both current students and new students. We have made significant progress on the professional development activities for staff. We have begun the process of developing a model to increase the number of underrepresented faculty at the IHP. We completed an overview video for the IHP and shared an elevator speech card with the IHP community.
We anticipated that some of these would take longer than a year, and they have. We continue to advance our work in student and alumni affairs. We are working diligently on increasing diverse perspectives in the curriculum and increasing the number and frequency of clinical placements in locations in which there is a larger percentage of diverse patients. We are also working toward deepening our relationship with local communities and our academic partners. This work will continue over the course of the upcoming years until completed.
While we have made significant progress, there is still much work to be done. The Executive Council made the decision to focus the work of Year 2 on growth, both in the academic program and in continuing professional development (Strategic Priorities 1 and 2). Growth in our programs will allow us to have the revenue streams needed to maintain their excellence and complete some of the other work included in our strategic plan. A small Steering Committee for Growth with Provost Alex Johnson at the helm will help us to define our future, create efficiencies in developing new programs, and explore new approaches to pedagogy. We are excited that this group has already begun its work on this important strategy and as we did this year, we will be hearing about its progress periodically at the Executive Council.
This doesn’t mean we will not be addressing some additional low-cost, high-impact tactics and strategies again during 2019-2020. Working with the Executive Council, we will identify those tactics and strategies in the Strategic Plan that we can accomplish over the course of this year with small teams of IHP faculty and staff.
I am excited for our future and our Strategic Plan helps us to focus our work and resources in the most effective ways. Stay tuned for more information on our work as the year progresses. If you have questions, comments or suggestion on our work to date or our plans for next year, please don’t hesitate to contact me.
I am writing this blog from the airport in Beijing where I have just been told that I have a five-hour delay of my flight to Boston. Five days ago, I left Boston to spend some time at Central South University School of Nursing in Changsha in the Hunan Province of China. A young women, whom I have mentored for almost 25 years, is a professor there and she asked me to present at a conference on research methods that she was organizing. As is usually the case with my trips to China, there are often multiple duties that go along with the primary request. This time, she asked me to teach one of her classes on a course on nursing roles and because I had some free time one morning, she scheduled several students to meet with me about their manuscripts. I may once have mentioned that if I am going to travel this far, I want to be busy and she took my words to heart. In truth, I love it.
It has been a great trip and I am more than ready to come home but having spent more time than anyone should in airports and in the process of traveling, I have made an observation that will come as no surprise to anyone: kids spend way too much time looking at screens of all kinds. Phones, tablets, iPads, learning toys—you name it, I have seen it on this trip. Now, as the grandmother of three very active young children, I realize that giving a child an electronic device is one strategy a parent might use to maintain their sanity during long travels. I am the last one to judge. But the kids I were watching were not novices. They were pros at using these devices. They were searching for the websites they wanted, they were navigating the sites, and they were mesmerized by the screens. I saw what looked like a two-year-old using her little fingers to move the screen back and forth on a phone until she found what she wanted. How does she know how to do that?
I decided to use some of my airport time to try and find out the impact of screen time on our children. I had read the lay literature and seen a news clip here and there. Both my daughter and my daughter-in-law have pretty strict rules on screen time for their children so I have seen the problem through their lens. But I wanted to know more about the impact of screens on kids. While the studies are not conclusive, and the correlations are complicated, they do show that children who have a significant use of screens over the course of a day have a premature thinning of the cerebral cortex, the part of the brain that is processes different types of information from the senses. The literature talked about inadequate sleep quality and quantity, changes in learning patterns and in older kids, problems with peers, depression, anxiety and conduct problems. In general, there are significant adverse health outcomes for children using screens that can have a lasting consequence. And it does not stop with children. Excessive screen use in adults (including graduate students in the health professions) has similar impacts on sleep and behavior as it does in children.
So, what are we doing as health care providers? Is screen use a routine part of all assessments we do on all of our patients, not just children? If so, what is the evidence that we use to educate our families and patients about best practices? There is some interesting literature that includes practice tips that can be used by clinicians to provide meaningful education. But we need more empirical evidence to guide our practice. Much of what I read suggested that the research in this area is in its infancy and we need more clinical trials and longitudinal studies to advance the science. Funding for this research is critical and needs to be supported by the NIH.
I close now, recognizing that I have spent entirely to much time using a screen in the last 24 hours. The next 24 hours don’t look much better. Perhaps one outcome of this trip is raising my consciousness about how much screen time I have in a day.
Welcome back to a new academic year. This September, we will be welcoming our first class of Genetic Counseling students and our first class of PhD in Health Professions Education students to the IHP. We will also be welcoming our largest class of PhD students in Rehabilitation Science. Including the master’s in nursing and speech-language pathology programs, and the certificate and non-degree programs, 346 new students are joining the IHP this fall.
The start of the new academic year has always been a particularly exciting time for me. When I was a young faculty member, the new year meant a chance to start over with new learners who were open to new ideas and who had experiences that made the classroom a dynamic and exciting place. As an administrator, knowing the promise of each new academic year and having the opportunity to engage with students, faculty, and staff as they plan for a new year is a gift that I always appreciate.
While the IHP is alive with the excitement of new students, new opportunities, and new adventures, we, as a country, have been struggling with the grim realities of what is occurring at the border and with the policies that disenfranchise the most vulnerable in our communities. For the past several months, we have heard stories about the horrible conditions that individuals, some of whom have traveled thousands of miles to come to America, are being detained in. The conditions are described as crowded, and unsanitary, with an odor that permeates the environment. As a human rights issue, we should be concerned about the health status of each one of these individuals. The House has put forth a resolution that requires each individual entering the country have a complete medical screening that includes documentation of medical complaints and health status. While this is a beginning, it is not enough. The health of our communities and our country depends on healthy members and we have a responsibility to help those entering the U.S.
Of particular concern are the children who have fled challenging situations at home, only to come to the U.S. to sometimes be separated from their families and be detained far longer than policies permit. In addition to the unsanitary health conditions these children experience, their young lives are being marred by the toxic stress of being separated from their families and housed in detention facilities not designed for children. Clinicians know that toxic stress can have an effect for a lifetime by influencing brain development and impairing mental, emotional and physical health. Once again, our responsibility as a country is to care for the most vulnerable among us, the children, with compassion.
To add to the immigration challenges, most recently there has been a renewed call for the application of an expanded version of the public charge test to decide whether a person can enter the U.S. or get a green card. Under the public charge test, immigration officials examine a person’s circumstances (health, age, income, assets, family to support, or family who will support them) to determine if they are likely to depend on government assistance in the future or could use public assistance like the Supplemental Nutrition Assistance Program or Medicaid in the future. If the immigration official determines that the immigrant will use public assistance programs in the future, they can refuse the individual’s application to enter the U.S. or get a green card. Once again, we are faced with a rule that destabilizes the immigrant population and creates a situation where needed care and resources feel out of reach for individuals who need support.
So, what does all this have to do with us? Our mission at the IHP is to advance care for a diverse society through education, clinical practice, research, and community engagement. The entire IHP community is sensitive and responsive to those in need in our communities. As health care providers and health care providers in training, we hold professional values that define a commitment to provide compassion and care to those who need it. This is what defines us as a unique academic institution committed to the education of health professionals. As fellow humans, we have a responsibility to provide support for all members of our society.
While I know the challenges we face in society will not be solved in the short term, I also know that we can contribute to the health of our community through community service, policy advocacy, and remaining informed on the key issues affecting health care. Our voices, individually and collectively, can make a difference. Our environment can be welcoming and supportive for all of our members and our education can empower us to be leaders in our communities. We at the IHP can be the voices that will shape a better health care delivery system, healthier communities, and a more compassionate country.
I look forward to having a great academic year with you.
In so many ways, the IHP is a unique community. I heard it when I first interviewed for the position of President, and it became clear soon after I arrived in 2017 that this is indeed the case.
This is a community where people have a distinctive commitment to each other and to the IHP’s mission of educating tomorrow’s health care leaders. Through our actions and strategies, we have shown our commitment to creating an inclusive and welcoming environment that focuses on diversity, equity and inclusion (DEI). I would like to share with you just a few of the initiatives we have undertaken during the last two years that have expanded on the great DEI work that already existed at the IHP.
One of the first strategies was to expand the scope of the existing Diversity Council to become the Diversity, Equity and Inclusion Council so that it was more reflective of what we believed it should focus on. We added students to ensure they were properly represented. We also changed the Council’s approach so that it would have a much more visible and active role in providing leadership on these issues.
At a mini-strategic planning exercise in the fall of 2017, we identified four areas on which the Council should focus: increasing the number of underrepresented faculty, improving the diversity and cultural content in the curriculum, making the IHP core values real for students as they enter our community, and increasing the student voice. A task force for each initiative was created to address the identified goals.
The Core Values Task Force initiated an addition to the student orientation experience entitled What is the IHP’s Role in Health Care? Exploring the Impact of Power, Privilege and Positionality. This four-hour session began with a discussion about the IHP Core Values followed by a panel discussion of how those core values are lived in the IHP community, in the classroom and in the clinical setting. The panel discussion was followed by small group breakout sessions facilitated by our faculty and staff who had received empowered bystander behavior training. We have done these sessions three times over the last year, and we have received positive feedback from the students about the program and the tone it sets for their relationship with the IHP. We plan to continue to provide this experience to incoming students, improving it each time based on student feedback.
The Faculty Recruitment Task Force recommended improving our efforts to recruit underrepresented faculty. Because we are continually searching for very successful underrepresented faculty and engaging them with the IHP, even when we don’t have a faculty position open in their field, Human Resources has hired a new manager committed to developing a series of actions that could include inviting potential faculty to be a guest lecturer or sending a congratulatory letter to them upon receiving an award, which in many cases would introduce them to the school. These and other actions would help establish a relationship with someone and give us an edge in enticing them to join our faculty.
The Curriculum Task Force’s focus is on improving all programs’ case studies in the curriculum. One of our primary responsibilities is to help prepare our students to care for patients in diverse settings and provide them with new perspectives on leading change in health care. So when we heard from some students who felt our case studies often did not include diverse populations or explore issues of diversity from a culturally thoughtful perspective, we decided to create a model for faculty to develop culturally appropriate case studies and strategies to better represent the world in which our students will work and live.
The Student Voice Task Force has just started its work to develop a campaign called “#IHP and Me” that will feature students talking about their experiences. We intend to launch this campaign in the near future.
We believe that building a diverse, equitable, and inclusive community is the responsibility of every faculty, staff member, student, and graduate, but we recognize that leadership in this space provides the focus and intellectual capital needed to advance our work and improve our community. To that end, we were so pleased to hire Dr. Leah Gordon as Assistant Director for Multicultural Affairs and Inclusion after a short stint as an academic counselor in the School of Nursing. Already, she has made the IHP more responsive to student needs and more informed about strategies to improve our community. In addition, Dr. Kimberly Truong has been hired as the Executive Director for Diversity, Equity, and Inclusion starting July 8. She and Leah will work together to provide direction and focus for this important work in our community.
Even with these steps, we acknowledge that our efforts are—and will always be—a work in progress. Our path toward inclusive excellence will help us enhance the structure for academic excellence. I see this as a journey, both personal and professional, and one which I look forward to sharing with you.
I recently read an article that stimulated some thinking that is not part of my usual day-to-day thought processes. The article, “Can students handle the big questions?” was about a philosophy course at Notre Dame that encourages students to think about things like “How do you decide what to believe?”, “What do you think your moral obligations are?”, and “What will it take for your life to have mattered?”
I started thinking about how these questions, which really are part of everyone’s life, often get pushed aside because we are too busy studying for the next exam, writing the next manuscript, or, in my case, leading a complex organization. As health care providers, these questions in many ways are more important for us to wrestle with.
I began to think back on my entry into health care delivery. I was a young graduate nurse, only 19, when I began taking care of patients at the Hospital of St. Raphael in New Haven, CT. As a new nurse, I had little life experience that I could use to reconcile the challenges patients and their families were experiencing. I had to grapple with the complex questions that most of us in health care have to grapple with, such as “How can I help this patient and his family as they experience death?”, “What can I do for parents who are watching their child suffer through the pain of treatment?”, and “How can I make a difference in this patient’s life?”
Allowing myself to contemplate these questions and others as a I grew into a health care professional was an important part of my development and has shaped how I see my place in the world today. Unlike the students in the Notre Dame course, I didn’t learn this in my nursing education; rather, I believe it came with the territory of being a health care provider.
I began to think about how the members of the Class of 2019 are reconciling these questions for themselves. I know the rigor of the IHP curriculum and the commitment of our students to excellence. Studying, writing, and clinical practice often takes precedence over reflection, contemplation, and deep thought. But as health care providers, our new graduates will be facing complex and emotionally challenging situations on almost a daily basis. How are they going to know what they believe? How are they going to decide what their moral obligation is in a certain situation? How are they going to construct their life in a way that truly matters? The article’s author suggests that asking these questions, wrestling with the answers, and letting reason take us to unexpected places will help us grow in our thinking about big issues.
As a health care provider, it’s not if you will face a complex issue that will have moral consequences, it’s when and how often. I encourage our new graduates to take time to reflect on these “big questions” as you approach starting your careers. For all of us in the IHP community, taking a moment to reflect on these important issues may help us get to our better self.
Dear IHP community,
As I read the news report on the President’s budget request released on March 11, I became interested in how the $7 billion cut in the Department of Education budget would affect the IHP community and our students. I am worried about the borrowing capacity of our students as well as their ability to rely on the Public Service Loan Forgiveness Program. Then I realized that the IHP community is directly affected by the budgetary proposal in two important areas: education and health care.
I thought it might be helpful to summarize the proposed changes in President Trump’s budget. We all have a responsibility to be knowledgeable about the proposed changes and work as individuals to make sure that our elected representatives know how we feel about the changes. The IHP will be voicing our concern over proposed changes to student aid and the student loan process as well as other areas of the President’s budget that negatively affect higher education and access to and delivery of health care.
Highlights of the proposed changes affecting higher education include:
- Several of the undergraduate grant programs such as Pell and SEOG will either be cut or eliminated.
- The Federal TRIO Programs (TRIO) which is a student services programs designed to identify and provide services for individuals from disadvantaged backgrounds will be cut by $110 million on a $950 million budget.
- There will be the elimination of the Public Service Loan Forgiveness Program.
- In addition, there is a proposal to streamline in the Income Driven Repayment Program (IDR) – increasing the forgiveness period to 30 years for graduate students.
Highlights of the proposed changes affecting health care include:
- Nearly $1.5 trillion would be cut from Medicaid over 10 years. The budget also ends funding for Medicaid expansion, the program that allows the working poor to be able to get Medicaid services among other benefits.
- Medicare spending would be reduced by $800 billion over 10 years.
- There would be a cut of $900 million from the National Cancer Institute’s budget and an additional $1 billion from the NIH for medical research.
- On the positive side, an additional $292 million would go to curb the spread of HIV with a portion of that going to the CDC to improve diagnosis and testing for HIV in areas where infected people are not getting proper treatment.
From all that I have read, it is unlikely that this proposed budget will pass a divided Congress, but it does let us know what the President thinks is a priority. By April 15, Congress will pass its budget resolution to guide decision-making for 12 appropriation subcommittees, which begin hearings on specific proposals. This process could last into the summer.
As President of the IHP, I am concerned about the provisions in the budget that could affect our students such as those that reduce access to loan dollars and making the loan dollars that are available harder to obtain. I worry about the recommendation to eliminate the Public Service Loan Forgiveness Program, a program many of students benefit from.
I also worry about our society. As we enter a time when our population is aging, and there is a significant physician shortage, and our societal challenges require the kind of attention provided by health care providers, we can’t afford to prepare fewer providers...we need more. Anything that will constrict the pipeline that prepares health care providers is counter to our preferred future as a country.
As health care providers, we have a responsibility to advocate for our patients not only in the clinical setting but in the policy arena. Reducing access and limiting coverage for individuals who are already experiencing the challenges of poverty, illness, and disability will only serve to further erode the fabric of our families and communities in most need. Our voice must be heard on behalf of those individuals we care for, who have not yet found their voice.
I encourage you to read the proposed budget and make up you own mind on where you stand on the issues. We are a community that values all kinds of diversity including diversity of thought. Whatever you decide, make your voice heard. Make sure your legislator knows how you feel. Continue to be part of the solution by seeking ways to improve access and care. Being a health care provider requires us to shape the health care delivery system for the benefit of our patients. Let’s make sure we all raise our voices on these important issues.
Developed by the United Nations (UN), the Sustainable Development Goals (SDGs) are a universal set of goals, targets, and indicators that UN member states will be expected to use to frame their social policy agendas and political policies over the next 15 years. Established in 2015, they are a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity.
The SDGs continue the success of the Millennium Development Goals, but are far more comprehensive because they include such aspects as climate change, economic equality, innovation, and peace and justice. In short, they are a comprehensive agenda that countries can use to take bold and transformational steps to improve our world and make sure it is sustainable for our future. While some support for programs to achieve these goals will come from the United Nations Development Programme, there is not worldwide consensus on how these goals and their targets will be funded.
The list of the 17 SDGs (see below) begins with End Poverty in All Its Forms Everywhere, because ending poverty is the greatest global challenge and a critical component of sustainable development. Other SDGs include aspects of gender equality and empowering women and girls, promoting well-being for all ages, and taking action to combat climate change and its impact.
While I can see the work of the IHP in almost all of these SDGs, I want to recognize our work in the area of climate change with our new Center for Climate Change, Climate Justice and Health. The mission of this interprofessional Center, anchored in the School of Nursing, is to lead nurses and other health professionals in responding to the impact of climate change, climate justice, and health through education, research, and advocacy.
One of the targets of the SDG climate change goal is to improve education and raise awareness and institutional capacity on climate change mitigation, adaptation, impact reduction, and early warning. The Center’s faculty, through their scholarly work, are fully addressing this target by publishing important and impactful papers, disseminating their scholarship at meetings and in formal conference presentations, and planning to host a national conference on climate change, climate justice and health at the IHP in April. Their advocacy in our local communities is changing the way Charlestown is looking at issues of climate change. This scholarship is an exemplar of how we, as IHP scholars, can impact health and change the world.
While the Center for Climate Change, Climate Justice and Health is one example of how our faculty are addressing the SDGs, there are multiple other ways we are impacting the world and its future. Our international experiences are designed to be both a health professional educational experience and a cultural immersion opportunity. Our faculty and students enter countries with the objective to learn local health care methods and make an impact on the community through their work. Professor Rawan AlHeresh in her work in a refugee camp in Jordan and Professor Elissa Ladd in her work training health care professionals in India in interprofessional care are just two examples. And, one does not have to go around the world to see our impact. The work that all of our programs are doing at the Harvard-Kent Elementary School is enriching the lives of the children and the families in that community. Clearly, the IHP touches people’s lives in a way that improves their quality of life.
I encourage you to take a look at the SDGs and the targets to see where you can fit into the plan for long-term peace and posterity in the world. Several jump out to me, including reducing food insecurity, reducing violence against women, and improving literacy rates, but all are equally important. Because the IHP’s mission is to prepare health professionals and scientists to advance care for a diverse society through leadership in education, clinical practice, research, and community engagement, it looks like we are in a perfect position to contribute significantly to the new Sustainable Development Goals.
The 17 United Nations Sustainable Development Goals
Goal 1. End poverty in all its forms everywhere
Goal 2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture
Goal 3. Ensure healthy lives and promote well-being for all at all ages
Goal 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
Goal 5. Achieve gender equality and empower all women and girls
Goal 6. Ensure availability and sustainable management of water and sanitation for all
Goal 7. Ensure access to affordable, reliable, sustainable and modern energy for all
Goal 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all
Goal 9. Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation
Goal 10. Reduce inequality within and among countries
Goal 11. Make cities and human settlements inclusive, safe, resilient and sustainable
Goal 12. Ensure sustainable consumption and production patterns
Goal 13. Take urgent action to combat climate change and its impacts
Goal 14. Conserve and sustainably use the oceans, seas and marine resources for sustainable development
Goal 15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss
Goal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels
Goal 17. Strengthen the means of implementation and revitalize the global partnership for sustainable development
In the last week, I have been watching with interest the news coverage of the measles outbreak in Washington state. Given last month’s article on the importance of the influenza vaccine and Partners’ policy for employees, this new measles crisis made me wonder how this kind of outbreak happens.
Measles was thought to be eradicated from the United States in 2000. The vaccine had been widely accepted in the U.S. population and after two doses there is a 97% effectiveness in its prevention. In many states, measles vaccination is required to be enrolled in nursery school or to attend public schools. So what changes made that environment conducive for this outbreak to occur?
We know that measles is a contagious virus that spreads through the air via coughing and sneezing. Once infected, someone can be contagious for up to four days before they display symptoms and for four more days after symptoms appear. The virus can live for almost two hours in a room where an infected individual has been. One or two out of every 1,000 children who get measles will die from complications, according to the U.S. Centers for Disease Control and Prevention.
The first case in the Washington outbreak has been traced to an international traveler in Clark County who had contact with community groups with low vaccination rates. Washington Department of Health officials identified numerous places where people may have been exposed to the virus. Hawaii also reported two cases of measles in travelers who were infected in Washington before their visit to the Big Island.
Clark County is on the border of Washington and Oregon, with both states allowing the exemption from vaccination for personal reasons beyond the typical medical or religious exemption. In Washington, almost 8% of the children are not vaccinated. But cases of measles have not only occurred in Washington and Hawaii, but also in Oregon, New York, Pennsylvania, Connecticut, Colorado, California, and Georgia. Officials at the CDC and state health departments expect to see more.
So why are we seeing a resurgence of measles and some other communicable disease? The World Health Organization describes the concept of vaccine hesitancy as a global problem that requires monitoring. The WHO describes vaccine hesitancy as the delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place, and vaccines. It includes factors such as complacency, convenience, and confidence.
As health care providers, we have an important role to protect our patients and our communities. Recognizing the complexity of the determinants in making the decision about vaccination is the first step. Is there a fear of the sequelae of vaccines or is the hesitancy related to difficulty in getting access to vaccinations? Are there equity issues involved?
Solutions to address this problem should be multifaceted and local to be most effective. And health care providers need to be informed with data that can speak to the consequences of the decisions that are made. We are the most trusted advisors in communities related to these health care decisions and have a critical role to play in reducing the spread of communicable disease.
For more information on the issue and management of vaccine hesitancy, I invite you to read this 2014 WHO report.
Influenza and Health Care Workers
The IHP this academic year has been part of a major effort by affiliates of the Partners HealthCare system to vaccinate all employees against influenza.
While requiring employees to get a flu shot might seem like an insignificant requirement, Partners entities including the IHP are working to protect patients, students, and employees from the negative consequences of influenza.
The Centers for Disease Control estimates that there are as many as 49 million cases of the flu each year in the United States. In 2017-2018, the flu sent almost one million people to the hospital for care which resulted in approximately 80,000 deaths. Because many who get the flu already are sick, the actual number of deaths may be significantly higher due to hospitals listing a person’s primary chronic illness as the cause.
Although children, the elderly, and infirm are at the highest risk, the majority of those who die from the flu are adults who are relatively healthy. Clearly, the personal, social, institutional, and economic impact of influenza is significant.
Surprisingly, in non-mandatory health care settings, the vaccination rate of health care workers is not high. For the 2017-2018 flu season, coverage nationally among health care personnel was 78.4%. The spread of the influenza virus happens mainly by droplets when people cough, sneeze, or talk, and it can reach people as far as six feet away. While the normal duration of flu symptoms is 7-10 days, most people can infect others for 1-2 days before their symptoms develop and for 5-7 days after becoming ill. As health care providers with regular contact with individuals whose health is compromised, we put our patients in grave danger if we haven’t taken this important precautionary step.
Last summer, the policy requiring all Partners employees receive the influenza immunization by November 30, 2018, was instituted. There are only exemptions are for those with deeply held religious beliefs against immunization, and those with medical contraindications.
I am pleased to report that 100% of IHP faculty and staff, who did not cite one of the two above conditions, received their flu shot, while the compliance rate at all Partners affiliates is 99.9%. Thank you for doing your part to keep everyone whom you treat and meet as safe as possible.
There is no doubt that health care delivery is increasing in complexity. We are faced with new models of reimbursement based on changing federal regulations, the social determinants of health that often drive patient care and influence patient outcomes, and the infusion of artificial intelligence into all aspects of our care. The health care provider of today and in the future has to know about dimensions of health care that go beyond the basic science, physiological, and clinical care dimensions to the systems of care that affect patient care and outcomes. The ability to appreciate and understand the health system in which care is provided and its impact on patient outcomes is critical to becoming an effective health care provider.
Health system science is defined as the principles, methods, and practice of improving quality, outcome, and costs of health care delivery for patients and populations within systems of medical care (Skochelak et. al., 2017). When Berwick described the Triple Aim of Health Care in 2008, the three aspects of that model were enhancing the patient experience, improving population health, and reducing cost. Berwick and his successors recognized the critical impact the environment of care plays on the health outcomes of our patients. They recognized that an understanding of the physiology of the disease and the clinical manifestations were necessary elements of health care provider education, but they were not sufficient.
Health system science builds on the Triple Aim defined by Berwick. There are six core domains that make up the conceptual model of health system science: health care structures and processes; health care policy, economics and management; clinical informatics/health information technology; population health; and value-based care and health system improvement (Skochelak et. al., 2017). These are important content areas because without an understanding of these areas, providers will be handicapped in their ability to effectively help their patients and lead their organizations.
However, I think the more interesting dimensions of the health system science model are the cross-cutting domains that bring together or set apart the issues of individual patient care and the system in which the care is provided. The five areas identified as cross-cutting domains are: leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship (Skochelak et. al., 2017).
As I reflected on the impact of these cross-cutting domains in our curricula at the IHP, I was encouraged by how much of our curricula is either guided by these domains or squarely represented in individual courses. You can find threads of each one of these domains in the IMPACT courses that students participate in over the course of their curriculum. The IHP is a model for how these cross-cutting domains are represented in a health professions curriculum. The result is that our graduates have a unique set of skills that will advance not only individual health care but the health care of the population.
Skochelak et. al., 2017, write that health care providers have to pay attention to the complex web of interdependencies, have an awareness of the whole and not just the parts, and be able to recognize multidirectional cause-effect relationships. She goes on to say that systems thinking allows a student to understand the influence of levels of health insurance coverage on the determinants of health within a community, and as a result, the ability for his or her patients to access health care and adhere to a care plan. I feel confident in saying that this description exemplifies an IHP graduate.
For more information about health system science, please see: Skochelak, S., Hawkins, R., Lawson, L., Starr, S., Borkan. J. & Gonzalo, J. (2017). Health System Science. American Medical Association/Elsevier.
In October, I wrote my blog post with Dean Inez Tuck to discuss ballot Question 1, Mandatory Nurse Staffing Ratios. This month, I explore another very important question that Massachusetts citizens will decide on November 6: Question 3, Maintaining Transgender Protections in Public Places.
As we said in our last blog, knowing the issues and being prepared to vote based on your full understanding of these questions is critical, especially since this is the first state-wide referendum in the country dealing with transgender rights.
In 2016, Massachusetts expanded an existing state law to include prohibiting discrimination against transgender people in places open to the public, including restaurants, hospitals, hotels, sports stadiums, and gym locker rooms. It mandated that transgender people can use the space that matches their gender identity and prevented the owner or manager of a public space from using signage that discriminates based on gender identity.
Question 3 asks voters to decide if these rights accorded to transgender people should be eliminated. Opponents have identified several reasons why this law should be repealed, none of which are grounded in fact or supported by the data. They fear opportunistic individuals could exploit the law to access women’s spaces like restrooms or locker rooms. A recent study by the ACLU found no change in the number of criminal incidents in bathrooms in Massachusetts after cities and towns passed laws protecting transgender people in public restrooms.
Opponents also suggest that people will inappropriately identify as transgender to prey on vulnerable people. Massachusetts Attorney General Maura Healy stated that in 18 others states that have these gender identity anti-discrimination laws, the “improper assertion of gender identity is extremely rare.” The fines and penalties are significant and clear for that rare individual who claims a false gender identity.
The 2011 state law that prohibits discrimination against transgender people in housing, employment, credit, and public education do not come under this ballot question and will remain intact regardless of the November 6 outcome. In 2016, the Massachusetts Legislature was on the cutting edge in passing a transgender rights law validating the equal rights of transgender people in the Commonwealth. Massachusetts once again will have an opportunity to lead the country by standing up for transgender protections by voting YES on Question 3.
I also want to share with you that, on a national level, transgender rights are coming under assault. The Trump administration just this month announced it is considering rolling back President Obama-era regulations that loosened the legal concept of gender in federal programs. If enacted, this change would eradicate federal recognition from the 1.4 million Americans who identify as a gender different from what they were born. This federal proposal is inconsistent with the diversity, equity, and inclusion values of the IHP, and we stand ready to support members of our community who would be affected by this.
A recent email sent out by MGH administration (below) identifies resources for individuals who might need help coping with this recent negative trend. The IHP Human Resources Department and the Office of Student and Alumni Affairs also can provide support to faculty, staff, and students. Anyone needing help should know there is support in our community that they can access.
Statement by Massachusetts General Hospital on Question 3
October 24, 2018
This week we learned that the federal government may attempt to change the legal definition of gender to one that does not reflect current scientific and medical knowledge and could restrict rights and reduce protections for transgender and non-binary individuals. This news is very disturbing to us and upsetting for some members of our hospital family who are experiencing heightened levels of anxiety and fear. As health care providers, we understand the importance of offering a supportive and inclusive healing environment, particularly for those experiencing identity-based social and health disparities.
This summer, we shared with you the steps that we have taken to strengthen and grow our programs to ensure a welcoming, safe, and affirming environment for transgender and non-binary individuals. We want to take this opportunity to remind our community of our commitment and specific initiatives:
- Continue to live by our community’s Mission, Credo, Boundaries and Diversity and Inclusion statements.
- Educate yourself. Learn about transgender and non-binary individuals’ unique medical needs and how you can create a welcoming environment for all.
- Make your voice heard. Have a plan to vote in this year’s election. Vote in person on November 6, or learn about opportunities to vote early or by absentee ballot in your community. In Massachusetts, a ballot referendum (Question 3), will ask voters to determine whether our commonwealth will retain its public accommodation and non-discrimination protections for transgender and non-binary people.
- Share available hospital resources:
We will continue to monitor developments in Washington and provide updates as indicated. In the meantime, our hospital community will lead by example and the words in our Diversity and Inclusion Statement: “Our job is to improve health and save lives, regardless of what our patients or colleagues look like, where they come from, what they believe or who they love.”
Peter L. Slavin, MD, MGH President
Timothy G. Ferris, MD, MGPO CEO
O’Neil Britton, MD, Chief Medical Officer, MGH
Marcela del Carmen, MD, Chief Medical Officer, MGPO
Debbie Burke, DNP, Senior Vice President of Patient Care and Chief Nurse
NOTE: This month’s column is co-authored by President Paula Milone-Nuzzo and School of Nursing Dean Inez Tuck.
On November 6, the voting citizens of Massachusetts will be asked to cast their ballot, either in support of or against Question 1, which defines mandated nursing staff ratios in hospitals.
If passed, Question 1 will have a lasting impact on health care delivery in the Commonwealth for years to come. While there are studies that report a link between nurse staff ratios and quality and patient safety metrics, a one-size-fits-all model does not take into consideration other factors such as patient acuity levels, the educational preparation of the nursing staff, nor size and type of hospitals. While California is the only state with mandated staffing ratios for nurses, Massachusetts hospitals - despite not having mandates - have higher quality metrics than those in California.
If enacted, every hospital, regardless of patient population or acuity, would have to abide by a rigid set of proposed staffing ratios without consideration of time of day or clinical circumstances. For example, the proposed staffing ratio for a medical surgical unit is one nurse to four patients yet we know that the acuity of patients is far different in a community hospital in central Massachusetts than it is in a quaternary health care facility in Boston. Nurse directors have the responsibility for assessing their unit’s clinical situation to determine appropriate staffing ratios that will meet patient needs. Mandated staffing ratios remove using professional judgment to make the right decision for patients. It also fails to recognize that care is provided by interprofessional teams of health professionals. By mandating only nursing ratios, the role of the team in providing high quality care would be diminished.
Just as important are the real workforce issues that must be considered. It is estimated that Massachusetts would need 6,000 additional nurses to meet the law’s minimum staffing ratio when the law is enacted, with another 1,500 nurses needed shortly thereafter due to retirements. A quick look at the numbers show it would take years to meet the workforce demands that these ratios would require. Massachusetts currently has 8,000 students in 25 baccalaureate and higher-degree programs that produces 2,000 graduates each year. While enrollments in entry-level baccalaureate programs increase approximately 4.3% annually, that number falls far short of meeting the demands of this new law.
Over the last seven years, the nursing profession has been undergoing a transformation to meet the complex needs of patients. In 2011, the Future of Nursing report called to raise the number of bachelor’s-prepared nurses to 80% by 2020. This goal, using the research done by Aiken et.al (2003, 2016) and others (Blegan et al, 2013, Liao et al, 2016), demonstrated a clear link between higher levels of nursing education and improved patient outcomes. While the goal has not yet been reached, the needle is moving in that direction. But that could be reversed as health care facilities scramble to meet the new staffing requirements. If hospitals are forced to close units or limit admitting patients, it will severely impact the availability of the clinical placements nursing students require to complete their education.
There are many questions that need to be answered. What will hospitals and employers do to meet these new staffing ratios? Will there be unintended consequences? One possibility is that hospitals would be forced to hire more associate degree-prepared nurses, undercutting the Future of Nursing’s target and jeopardizing the goal of better patient care that the law’s supporters tout. Or, hospitals could meet these new staffing requirements by hiring away BSNs from nursing homes and assisted living facilities, thus reducing patient care at those facilities.
The decision to vote yes or no on Question 1 in November is not an insignificant one. Creating a health care delivery system bound by new regulations and mandated staffing ratios will add another layer of external regulation, strain the ability of nursing schools to produce bachelor-prepared nurses, and jeopardize patient care at non-acute facilities. We encourage you look at the issue comprehensively to make a thoughtful decision.
Welcome to the start of the 2018-2019 academic year. For our new students, I want to share that I was in your position last year at this time and was nervous about joining the IHP. We all want you to know how glad we are you decided to join this wonderful academic institution that will prepare you for a lifetime of opportunity. We will do everything we can to help you succeed.
For our returning students, I hope you had a little time to rest and renew this summer and you are excited to continue your learning. For our faculty and staff, I hope the past few months were enjoyable and restful, with intermittent bouts of productivity, recognizing that for some, summer schedules seem to slow down a bit.
We are starting the new academic year on a high note. The following are just some examples of the achievements of the IHP community over the past 12 months.
We are excited about the aspirational goals in the new 2018-2022 Strategic Plan. Many members of the IHP community spent the summer working on the implementation plan associated with those goals, and we will begin over the course of this year launching new initiatives which will begin to shape our future.
Last May, we graduated 583 students, the largest class of health professionals in our history. We celebrated the new graduates, who were accompanied by their families and friends at the Boston Convention and Exposition Center, as future leaders in their respective field.
Our research programs have continued to flourish and make an impact on best practices in patient care. They are focusing on areas that can make a real difference in people’s lives and include such areas as improving student outcomes, brain recovery after accident or injury, and improving speech and feeding in patients with neurological impairments.
Our researchers have been incredibly productive and successful, increasing our collective grant portfolio to $3,327,942 in FY18 – a 47 percent increase over FY17. And it’s expected to get even better in FY19, with grants projected to rise to $4,342,038. In addition to allowing faculty to work on innovative ways to improve patient care, grants also provide students exceptional opportunities to learn about research and contribute to the development of knowledge.
We also opened and named the Dr. Charles and Ann Sanders IMPACT Practice Center (IPC) to house under one roof all of our patient care centers where students can incorporate their interprofessional education by caring for patients under the watchful eyes of our faculty. At July’s naming ceremony, stroke patient Richie Arsenault gave a moving story about how the care he has received at the Aphasia Center over the past several years has completely transformed his life. Second-year DPT student Emma Laird spoke about the impact the IPC had on her learning. “Nothing prepares you for the real world like the real world,” she told the audience. Her experiences in the IPC prepared her to be the confident clinician into which she is growing. Truly, we have so much of which to be proud.
As everyone settles into their new environment or prepare for a new academic year, I want to encourage the entire IHP community to commit to making our environment a respectful, welcoming, and inclusive community. Reach out to our new students and employees to see if they need any help adjusting to this transition. Be that warm, welcoming presence for people who are new to your program or office. Recognize that change requires us to listen thoughtfully to other perspectives and respect the valves and views of others.
Ours is a community where we recognize we have room to grow. We take very seriously our new Strategic Priorities that state, in part, “build and nurture a diverse and inclusive Institute community that welcomes and values the contributions of all and provides the experience and tools for students to ably serve diverse populations.” We also recognize that as a community, we must commit to being open to embracing ideas and concepts around social justice and equity that will help us improve.
To that end, the members of the Diversity, Equity, and Inclusion (DEI) Council stand ready to provide leadership in this area. But it will take every member of the community, working together, to create a more just and equitable environment. I invite everyone join the DEI members in that effort.
So, welcome to the 2018-2019 academic year. I look forward to having many opportunities to interact with faculty, staff, students, and alumni over the coming months. And, if you see me around campus or in Charlestown, please say hello. Enjoy!
As I complete my first year as president of the MGH Institute, I’ve taken some time to reflect on the challenges and opportunities I faced over the past year and the excitement I feel for the future.
As with any major life transition, I came to the IHP with great excitement and enthusiasm for having the opportunity to join a great institution. I knew the quality of the academic programs by reputation and I was looking forward to the opportunity to dive deeper into the rehabilitation professions of physical, speech, and occupational therapy, physician assistant studies, and genetic counseling, having spent more than 30 years in nursing education. I was thrilled to be living in Boston and I could not think of being in a more beautiful environment than the Navy Yard. It was an honor to be chosen as president but I also understood the deep responsibility that comes with that appointment so I read books such as “On Being Presidential” and “How to Run a College.” I also knew I had a lot to learn about communicating and working with the Board of Trustees.
With that excitement and enthusiasm came a whole host of anxieties and fears. Would I be able to make the change from rural Pennsylvania to living in the city? How would I be accepted into this community? Would I love this new role and feel like I was contributing in a meaningful way? Would I have an opportunity to engage with faculty, staff, students, and alumni in ways that make me remember why I love academic administration? Happily, the answer to all these questions is a resounding “Yes!”
We moved close to the IHP so I could walk to work and be a contributing member of the neighborhood. Our new home is great, and we love being integrated into the Charlestown community and close to everything we need. The IHP community welcomed me with open arms and you have embraced me as one of your own. This a unique and very special group of incredible individuals who share a common purpose and mission that bind us together, but it’s each individual’s commitment to the values of respect, collegiality, and community that makes this such a very special place. As the year has progressed, I have come to understand more clearly the president’s role and have embraced both the ceremonial aspects as well as the projects that let me roll up my sleeves and get immersed in the work of the organization.
Being new gave me a certain license to reach out to people in Greater Boston and I have enjoyed taking the IHP’s message to many individuals and organizations during the past year. I discovered the school’s mission is often misunderstood or unknown, and this issue is being addressed with the current branding review. I was most pleased to learn that I have the opportunity to have meaningful engagement with students, staff and faculty, both informally and in formal settings. I started my career as a faculty member because I wanted to work with students. I then became a dean because I wanted to foster the work of faculty and staff. So now as president, I looked forward to interacting in a meaningful way with the IHP community.
As my second year begins, I am excited about the future. The Institute continues its tradition of academic excellence, and we are excited for the opening of the genetic counseling program in the fall of 2019. Our new bold and innovative 2018 – 2022 Strategic Plan will take us in some new directions and add strength to some areas where we have solid foundations. But I am mostly grateful to have joined this wonderful community of scholars, students, staff, and graduates who have allowed me to be their partner in the Institute’s work. It’s been a great year, and I look forward to many more to come.
The IHP has a strong history of looking internally to assess its strengthens and weaknesses. Since 2011, we have asked questions about the school’s climate and the perceptions of various constituent units (faculty, staff, students) on their feelings around value, inclusiveness, and relationships.
But one question remained: Were we getting comprehensive information from all our constituents in a timely and organized way?
In 2016, a task force of the Diversity Council (now called the Diversity, Equity, and Inclusion Council) was formed to examine this question. Each year, the IHP engages in the Chronicle of Higher Education’s “Great Colleges to Work For” survey. The survey provides extensive data about how faculty and staff feel about campus climate issues, and the task force decided a separate set of questions was not needed for those audiences.
To solicit more comprehensive input from students, the task force developed a series of questions to more fully measure student perceptions. After being piloted to a small group of students, a process that included multiple iterations of changes and improvements, the Diversity Council approved the survey. To ensure every student has an opportunity to participate, a calendar for assessment was developed surveying students at the mid-point of their education. Below are the results from the 2017 Diversity and Climate survey.
Overall, 140 students out of 446 completed the 27-question anonymous survey, a 31% response rate. Program participation varied from 8% to 41%. Quantitatively, there was little variation among programs. The comments section yielded many responses that helped inform the quantitative data. After reading all the responses, a few themes stood out. Let me say that this is by no means a qualitative study of the data, but rather my perceptions of the data after reviewing it several times.
First, several of the suggestions have already been addressed or are in the process of being implemented. For example, we have created an anonymous feedback form where students can voice a complaint or concern. Another frequent comment was the need to hire more faculty of color. This issue is included in the Institute’s new Strategic Plan, and we will be developing a detailed strategy to achieve that goal.
Most troubling to me were the comments that suggested some students feel little will be done with the evaluations they provide. We hope to change that perception by developing a process to communicate and address concerns, ideas, and recommendations.
Many students commented on their relationships with their professors. Some felt their professors were supportive, engaged, and interested in their success, while others sometimes felt talked down to by professors, disrespected by their preceptors, and unable to engage in intellectual discourse with faculty.
Some comments focused on improving the course content on multiculturalism, diversity, and racial identity while others focused on course sequencing, interprofessional experiences, and facilitating conversions about social issues in the classroom.
A few students commented on the difficulty they felt fitting into the IHP. Those who identified themselves as older than the average student, had family responsibilities, children, or were working in addition to going to school commented on their inability to feel engaged and welcomed. Some students talked about having difficulty because of political ideology or beliefs, and others felt unable to openly discuss issues of social justice or share their perspective because of feeling misunderstood or chastised for having an opinion that is different from their peers. Still others commented about feeling the effects of racism on campus and the inability to have open conversations about how race and health intersect.
But the largest number of responses focused on relationships with other students. While many appreciated the diverse perspectives and support from their peers, some students said that they did not always feel comfortable in class and at the Institute. Consistent with the above comments, some students felt that they just did not fit in because they held opinions that different from the majority view. Others felt belittled or afraid to speak up for fear of irritating others in class. Also, some students described a lack of opportunity for informal/social meetings that they felt would help build relationships and foster constructive conversation.
The survey results provide numerous insights into ways we can improve our curriculum, our relationships, and our ability to create an open, safe, and respectful environment. Now, the most important part: what will we do with these data?
First, each dean and program chair have received the data for their respective department or school. The Provost, the Associate Provost, and the Dean of Students and Alumni received a full report on all the data. The Institute leadership will discuss these results with their faculty and make recommendations for change where appropriate. The data also will go to the Diversity, Equity, and Inclusion Council for review and recommendations. Student leadership serves on the DEI Council and will be there for this discussion.
Since this was the first time using this instrument to measure diversity and climate in students, we will use these data as a baseline measurement for the data collected in the 2018 year and beyond. As each year’s data are collected, IHP leadership and the DEI Council will review them in light of information from the prior year(s).
Please reach out if you have any questions about the survey, the quantitative or qualitative data, or issues of diversity and inclusion at the IHP. I look forward to hearing from you.
May was an exciting month for me as president of the IHP. I was extremely fortunate to be part of my first Commencement, where we conferred degrees to 583 students that our outstanding faculty have prepared to enter the world of health care and improve the lives of patients, families, and communities.
Since I arrived, I was told how incredibly inspiring, moving, and well-organized Commencement is. What I found on May 14 was that these attributes were not overstated. The Boston Convention and Exposition Center was the perfect venue for honoring and celebrating our graduates and their families. The ceremony was dignified but joyful, providing recognition to alumni award winners and faculty leaders but keeping the focus on the graduates who were the reason why we were there. In addition to the more than 2,000 people in attendance, there were over 150 people from several countries watching a live broadcast of the event. The entire day ran like clockwork because of our exceptional staff who were everywhere, providing help and direction to all who needed it.
Since this was my first graduation ceremony, I was asked by the Board of Trustees to provide the keynote address. I was extremely honored to share my insights with the graduates and be the one who sent them off into the world of health care. I encouraged them to think about the world and health care system they are entering, to remember that the work they do is so important, and that they, uniquely, can provide the care their patients need and deserve. Health care is complex and always evolving – such as the addition of artificial intelligence which promises to change the way they work and provide care – and there will be times when they feel frustrated and overwhelmed. But I assured them the rewards far surpass the challenges.
I gave the graduates three pieces of advice.
- Engage their patients with empathy, recognizing and feeling their perspectives. The importance of the ability to care and put yourself in someone else shoes cannot be overstated.
- Have the courage to always work with integrity.
- Find the time to renew and rejuvenate, because providing health care is difficult. Resilience is an important characteristic if one is to have a long and successful career in health care.
As we were launching the Class of 2018 into the health care world, May was also when we were welcoming 285 new physical therapy, occupational therapy, physician assistant, and nursing students to the IHP. Each of these students come to us with the excitement of achieving the goal of changing their lives and becoming a health care provider. The Institute and the faculty share that excitement as we work together to help new students achieve their goals. We are so honored they have chosen the IHP as the place where they will fulfill their journey to a career in which they will impact the lives of thousands of patients in the coming years.
While May is behind us, our work of educating students and engaging alumni continues. I hope you take time this summer to reflect and renew so that you can experience the resilience that I encouraged our new graduates to develop.
Last month, Provost Alex Johnson, Dean Inez Tuck, Assistant Professor John Wong, and I spent three days in the Shenzhen region of China meeting with the leadership of three hospitals about establishing relationships that could eventually create opportunities to send students to the institutions for clinical experiences, develop faculty research collaborations, and host visiting scholars from China.
We visited the Shenzhen Baoxin Hospital, the Third Affiliated Hospital of Sun Yat Sen University, and the Nan’ao Peoples Hospital. The visits were set up by Dr. Wong, an assistant professor in the School of Nursing who has a long history of collaboration with these three institutions.
We began our three-day visit at Shenzhen Baoxin Hospital, a moderate-sized long-term rehabilitation and tertiary-care facility started by a family over 20 years ago, where we witnessed therapy care that was both comprehensive and modern. Patients with debilitating strokes and neuromuscular diseases receive therapy from physical therapists, speech-language therapists, and occupational therapists in addition to medical care provided by nurses and physicians. We learned the therapists are prepared through this program, with their specialization occurring through their clinical experiences.
In addition to Western medicine, patients with intractable pain were treated with traditional Chinese techniques. The hospital has a clinic dedicated to strategies such as acupuncture, acupressure, cupping, and massage, and it has a large unit that provides long-term renal dialysis to patients with kidney failure.
The tour concluded when we participated in a forum on rehabilitation and care of the elderly, sharing our insights on such areas as interprofessional education and practice, person-centered care, and palliative care.
That evening, we had dinner with the administration of Third Affiliated Hospital of Sun Yat Sen University. They were very interested in developing a collaboration for their staff and faculty with the IHP to learn more about rehabilitation and health care.
The next day, Dean Tuck, Professor- Wong, and I participated in “Preparing for an Aging Society,” a full-day symposium hosted by Nan’ao Peoples Hospital. This hospital, which is older and more rural than Shenzhen Baoxin Hospital, also is interested in sending people to the IHP and accepting our nursing and rehabilitative-care students.
My first trip to China more than 30 years ago was a life-changing experience – something that would forever change the way I see health care delivery. While the United States’ system has many strengths, it was in China that I first saw a network in which family and community involvement is considered a primary way to recover from and even prevent illness and disease. This dual focus allows them to provide quality health care despite few resources.
Sending students to China, and hosting scholars from these three hospitals, would fit well with the core IHP goal of preparing health care professionals to work with a diverse society. I am confident our highly productive visit will result in collaborative opportunities in the coming years.
In last month’s column, I shared the development of the IHP’s 2018-2021 strategic plan. We continue to make progress and are hopeful that it will be ready for the start the new academic year this fall.
As part to the process, I asked the IHP community for input on issues they wanted to share with the strategic planning consultants and myself. Although we had great turnout at all three town hall meetings for faculty, staff, and students, I thought it was important for people to voice their concerns anonymously or provide input if they were unable to attend a meeting.
Fourteen messages were submitted by members of the IHP community – five by faculty, six by staff, and three by students. Reading them, I was impressed by how thoughtful and constructive they were. Most were anonymous but if the submitter left his/her name, I responded to them directly. For issues we could address now I addressed the issue/recommendation with the person who has responsibility for that part of the school. More complex issues were passed on for consideration in the strategic plan.
Four messages focused on the campus space and services. One student suggested longer study hours on weekends. Chief Information and Facilities Officer Denis Stratford said news about extended hours on Saturdays and Sundays will be forthcoming soon. Another message suggested centralizing the system of meeting clinical site requirements, news of which we recently shared with the launch of the Office of Compliance and Contracts that will handle both student placements and obtaining contacts with clinical partners.
Two messages addressed the Institute’s finances. The first suggested reevaluating the cost and benefits of hosting an annual gala to support student scholarships. In discussions with the Development office, we feel the gala has outlived its benefit and are considering options for different event fundraising strategies to replace it. The second message suggested we invest more in the new IMPACT Practice Center, an important suggestion that will be considered as part of the strategic plan.
Three messages focused on faculty workload, support, and pay; two addressed leave polices for faculty and staff, specifically maternity and paternity leave; two focused on improving the climate of diversity, equity, and inclusion; and one encouraged increasing our on-line presence to expand our academic offerings. These very important issues will be considered as we develop the tactics and implementation options for our new strategic plan.
I want to thank everyone who took the time to write about an issue about which they are passionate. Please be assured that every message has been heard and we will address your concerns. Your input will make the IHP a better community.
Strategic planning is an organizational activity that occurs every 3-5 years and often can take on a life of its own. Since the IHP began the process last fall of creating a new strategic plan for 2018-2021, we have worked to streamline the process, add capacity to help us be successful, and create a timeline that will not result in burden on any of the people involved in the process.
A good strategic plan is important for many reasons. It helps us set a clear direction and establish our priorities so we can focus on the areas that will have the biggest positive impact on the IHP. It aligns resources and ensure strategies are appropriately funded before considering new initiatives. And it is used as a map for making decisions and evaluating our work. In short, it allows us to decide where and how to compete, which includes choosing what to do as well as what not to do.
Last October, we engaged the consulting firm of Altshuler and Staats to help us develop a new strategic plan. Jill Altshuler and Sara Staats have a long history working with colleges, as well as Massachusetts General Hospital and Brigham and Women’s Hospital. Following several meetings with me, they met in December with the Executive Council where they reviewed the IHP’s mission, vision, and values, and discussed approaches to take in developing our new plan. In January, Jill and Sara led a retreat with the Executive Council, the Academic Council, and selected Institute leaders where we brainstormed ideas about what aspirational goals the Institute should focus on over the next four years.
In addition, there was a great turnout of faculty, staff, and students for the Town Hall meetings where you provided your unique perspectives on the IHP’s future. Additional ideas and thoughts that have been submitted to an electronic suggestion form have been added to those developed at the January retreat.
On March 1, the Executive Council will review the complete set of ideas the consultants collected, and will identify a draft of strategic priorities that will be presented to the Board of Trustees at its March 8 strategic planning retreat. Ultimately, we anticipate having our new strategic plan completed by this fall.
I want to thank all of you who have participated in this process and shared your ideas and vision for the IHP’s future. I look forward to sharing our new strategic plan with everyone in the coming months.
When I arrived at the IHP last August, I made a pledge to the community that we would work together toward an environment that was committed to learning about, respecting, and valuing each member. Our goals include a future where we can have open conversations about issues and the respectful exchange of opinions and ideas—a community that is safe for all. I repeated that vision at my inauguration and stated the importance of living and acting these values. Words are just not enough to make the kinds of change needed as a society.
The IHP is progressing on its journey toward achieving the values of respect, dignity, and inclusiveness that are so important to our mission. The Diversity Council has taken that charge seriously and has made some major changes that will define our work throughout the rest of this year and beyond.
First, it is now called the Diversity, Equity, and Inclusion Council. This is not a simple name change, nor is it about achieving the “right number” of diverse students, faculty, and staff. Rather, the new name recognizes that we are committed making our campus an environment in which every person feels valued and included.
Second was to add students to the Council to provide a critical perspective that had been missing. Five students attended the most recent meeting in November, and we expect them to continue adding their insights and suggestions going forward.
Third, the Council has identified four high priority activities in which to engage over in the coming year:
- Recognize and increase student voices on DEI issues. Chair: Jack Gormley
- Increase the number of faculty from diverse backgrounds. Chair: Peter Cahn
- Examine aspects of each program’s curriculum to integrate content on the social determinants of health, justice, and issues of health equity. Chair: Charley Haynes
- Plan and execute an IHP community event in the fall of 2018 to explore an important issue related to diversity, equity, and inclusion. Chair: Paul Murphy
In addition, four subcommittees have been established and will focus on each of the initiatives, with initial results expected in the coming months. I encourage you to contact their respective chair if you are interested in participating.
I will keep you informed of our work as we make progress on these initiatives to ensure there is a transparent process, starting with posting a link to the minutes of each DEI Council meeting on our Diversity webpage. We will let the community know when minutes from upcoming meetings are available.
In my inauguration speech last December, I shared a comment I had heard at a conference which resonated with me. The speaker said, “You can’t talk your way out of something you behaved your way into.” Actions are important, and the new DEI Council is committed to developing and leading initiatives that will improve the Institute regarding these crucial concerns. But it will take everyone in our community to find a way to contribute to our core values of inclusivity, respect, social justice, and health equity for all. I look forward to working with you to ensure that, together, we achieve this important goal.
Welcome to a new semester and a new year. I hope you all had a restful break with a chance to renew with family and loved ones. I would also like to extend a warm welcome to our new class of ABSN students who are arriving on campus this week.
As we close the chapter on 2017, we can look back at a year filled with contrasts. Nationally, we experienced some of the most horrific tragedies seen in our times including national disasters and mass shootings. Locally, we are making significant contributions to improving the lives of residents in the communities in which we live and work. Here at the Institute, ours is a story of service.
In the rush to finish the work of last semester, some of you might not have seen an article from the Office of Communications about the many activities the Institute was engaged in just during the holiday season in service to the community. These activities by students, staff, and faculty included selling pies to raise money to feed ill and homebound individuals in eastern Massachusetts and packing up food boxes for residents of Cambridge who were unable to reach the food pantry.
These dozen activities is just a small sample of what the Institute contributed during 2017, a visible display of our values of service and commitment to help those in need whenever we have the capacity do so. Thank you to all who contributed their time, talent, and resources, and I look forward to 2018 as we continue working to improve the lives of our Charlestown and Greater Boston neighbors.
On a separate topic, there have been suggestions over the last few months that we revise and renew the online process of sending ideas to me. The new Institute Input form that any member of the IHP or Partners community can use to reach me is now live on the website and on the President’s page on the Intranet. The messages can be anonymous or the sender can include their name and email address. I will read every message and respond to the sender if the e-mail address is included. When appropriate, I will refer it to a member of the senior administrative team for action. Messages can be as simple as letting us know that you are pleased with a certain initiative or more complex such as reporting a situation in which a member of our community did not feel safe or respected.
Of course, this does not replace our Title IX reporting process for students, faculty, and staff. Our Title IX compliance officers are Sarah Welch for faculty and staff and Dr. Jack Gormley for students. The process for reporting Title IX complaints can be found on the compliance page. I hope this renewed effort at improving communication will create new avenues to share ideas, challenges, and opportunities.
I wish you a peaceful, productive, and healthy 2018.
Think back to a time when you didn’t have the right equipment or the right systems in place to provide the kind of patient care you wanted. You might have created your own piece of equipment by taking two objects and holding them together with a clamp, or used an elastic band you found in the nurse’s station to hold a tube in place. Whether you realized it or not, at that moment, you were an innovator. Health care innovation can be defined as the introduction of a new concept, idea, service, process, or product aimed at improving treatment, diagnosis, education, outreach, prevention, and research, and with the long-term goals of improving quality, safety, outcomes, efficiency, and costs.1
Health care providers are masters of the “work around” because we often are faced with providing care in less than optimal circumstances. Because of our clinical expertise and our desire to provide the best care possible, we often design approaches to care that are unique, effective, and sometimes can lower costs. While not every health care provider has that spirit of innovation, health care institutions, including MGH, are fostering provider innovation with small grants to support ideas that improve the way their facilities operate. Recognizing that the best innovation comes from those who are closest to the challenge, health care facilities are encouraging all heath care providers to be thinking of ways to improve care.
So what is the role of an academic institution, like the Institute, that prepares health care providers of the future in creating a passion for innovation in its graduates? How can we prepare students for the unknown of the work world? How can we create a climate of innovation on campus? Higher education is traditionally a risk-avoidant environment. We need to provide opportunities and space for faculty and students to take risks and innovate, celebrating both successes and failures. The fear of failing is one of the most significant factors that prevents people from pursuing new ideas and is one of the leading impediments to progress.
Every day, we need to build educational experiences that encourage innovation, especially those that happen in the interprofessional space. As a leader in interprofessional education, it is particularly important for us to foster innovation as a collaborative effort. Having students engage in entrepreneurial thinking and creativity as part of their interprofessional curriculum will prepare them for a future in which they can help shape their environment instead of being defined by it.
You have heard me say many times that our students will change the world. By providing an opportunity for that innovative spirit to grow, we can be assured that it will happen.
1. Omachonu, V.K., Einspruch, N.G. (2010), Innovation in Healthcare Delivery Systems: A Conceptual Framework. The Innovation Journal: The Public Sector Innovation Journal, Volume 15(1), Article 2.
On October 19, Board Chair George Thibault and I were pleased to welcome more than 150 guests to the grand opening of the IMPACT Practice Center (IPC) housed at 2 Constitution Center. This incredible learning space will provide important clinical care to clients and through that care, educate our students as collaborative- and team-focused health care providers.
We know that health care professionals have not traditionally been educated in teams to provide care. As a result, care has often been fragmented, sometimes duplicative, costly, and without optimal outcomes. The Institute is committed to transform health care through the education of expert clinicians who will practice in teams and improve patient care, and our graduates are poised to transform health care delivery.
The design of the IPC reflects our belief that clinicians must be able to function as members of interprofessional teams and that their education, in the context of collaborative practice, is essential to their developing a broad understanding of the health care team. The Center has already been called an exemplar for educating health care professionals. To our knowledge, there is no other center devoted to interprofessional education of health care professionals.
The IPC also will be a valuable community resource to clients in need of health and rehabilitative services, families in need of support in caring for individuals with chronic conditions, and groups who will use the Community Room for education or activities. Charlestown and Boston area residents, from two to over 90 years old, can receive screening, rehabilitation, and education and support from an interprofessional team, regardless of their ability to pay. We currently provide more than $1 million of service annually. This new space, with dedicated pediatric room and an adult rehabilitation therapy space, will allow us to double the amount of service provided to Boston area residents.
That evening, we were honored to welcome Boston Mayor Martin J. Walsh. He toured the IPC, meeting a cadre of student ambassadors who volunteered their time to speak to our guests at rooms throughout the Center. We also unveiled our first donor wall with over 500 names, celebrating gifts received to date this calendar year.
Sheeba Arnold then spoke. Her son was diagnosed with Autism Spectrum Disorder and, after a year at another program without progress, they were referred to our Speech, Language and Literacy Center where, as she described movingly, “miracles happen.” Following her remarks, Mayor Walsh gave heartfelt remarks about the excellent work of the IHP in improving care for the citizens of Boston. He then officially cut the ribbon to open the Center.
Thanks to the exceptional work of the Development team and the Communications team, it was a remarkable evening of educating the community about the IHP and celebrating the wonderful new space.
Through generous individual and corporate sponsorships as well as ticket sales, we raised almost $200,000 at the event, which replaced our annual gala this year.
The Center is a fitting tribute to our founders, whose inspirational vision for an interprofessional graduate school resulted in the MGH Institute of Health Professions. I know our students and the community will reap the benefits of this learning space for many years to come.
We have all seen the advertisement on television or heard them on the radio. Swab your cheek, send us your DNA, and we will let you know your ancestry and where you came from. Many have taken advantage of this offer, and some have been surprised at the outcome. Others have taken advantage of even more comprehensive testing by having their genome sequenced or receiving gene profiles.
But this leads to a number of questions: What is the reliability of these tests? Who is assuring that the laboratories that are performing these tests are reputable and can provide clinical validity for each test performed?
While the analytic validity of these tests has been regarded as positive1, the need for oversight of these providers is paramount as these tests become more popular and more laboratories enter the industry. The Center for Medicare and Medicaid Services and the Food and Drug Administration currently share responsibility for oversight of clinical laboratories including genetic testing, although this is inadequate to guarantee the level of quality needed for these important genetic tests.
Even in the most reliable laboratory settings, patients and families are provided with information they may be unable to understand or know how to deal with. The need for highly skilled providers with the knowledge and experience to assist patients in understanding the results, the impact, and the use of genetic tests that they can have cannot be overemphasized.
The Institute is responding to this opportunity by launching a Master of Science in Genetic Counseling starting in fall 2019. This exciting educational option will join a small number of programs around the country that prepare individuals to work as genetic counselors in myriad settings including inpatient care facilities, clinics, corporations, government, and laboratories. Adding a focused program on genetics and genomics will provide another area of expertise on which all our students can capitalize as they prepare for professional practice.
In the last 20 years, an understanding of genetics and genomics has been a core competency for all health care providers. Patients and the health care system benefit from the many advances in genetics and genomics in areas including disease prevention, testing, diagnosis, treatments, and rehabilitation. All health care providers, armed with a basic understanding of the genetic and genomic changes associated with common diseases, have the potential to improve the identification of individuals at risk for health problems, target risk-reducing interventions, enhance existing screening, improve prognostic and treatment choices, develop individualized therapy, and influence treatment dosing and selection based on genetic variations that influence drug response2.
At the IHP, we prepare students to translate knowledge into practice. By adding genetic counseling to our suite of academic programs, we will improve our ability to prepare health care providers who have a broad, deep, and comprehensive understanding of the patients they encounter and the knowledge and skills to improve care.
1. Hunter, D; Khoury, M; Drazen, J; Letting the genome out of the bottle--will we get our wish? New England Journal of Medicine 2008; 358:105-107.
As I reflect on my first three weeks as president of the Institute, in some ways I feel like I have been here a long time, while I also still feel brand new.
I have been warmly welcomed by students, faculty, staff, and people in the Charlestown community. I’ve had the opportunity to sit with groups of faculty to learn about their program, their profession, and their scholarship. I have met with administrators and staff who have shared their perspectives and allowed me to ask questions to help me better understand our school and its unique culture, and have introduced myself to students who have graciously stopped what they were doing to make me feel welcome.
There is so much to learn about the work of the Institute and the communities we serve. I am interested in knowing what you feel are the Institute’s deep and enduring strengths on which we can build our future, and understanding where the gaps are in our programs so that we can work collectively to fill them.
I also want to work with the entire IHP community to ensure we foster an inclusive environment with broad acceptance of differences where everyone feels respected and valued. We must encourage and facilitate open conversation and the free exchange of divergent ideas because understanding others’ viewpoints makes us stronger. It will only be through practicing inclusivity on campus that we will be prepared to deliver humanistic and equitable care to our patients.
It is gratifying to learn about the important role the IHP plays in the Charlestown neighborhood such as at the Harvard-Kent Elementary School and the numerous organizations we will assist during Community IMPACT Day on September 15. I plan to meet soon with the leaders of these organizations, as well as colleagues at our fellow Partners HealthCare affiliates, to get a deeper understanding of our impact and reinforce our commitment to the populations we serve.
I look forward to working with you on all aspects of our future, and I encourage you to share your ideas and thoughts, large or small.