- 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
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.