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Healthcare Heroes

Healthcare Heroes

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2nd Annual Healthcare Heroes Awards

HERO (n.) a person who is admired or idealized for courage, outstanding achievements, or noble qualities.

BusinessWest and Healthcare News have created Healthcare Heroes to honor those who live up to that word’s definition. This region’s health and wellness sector is large, diverse, and dominated by heroes of all kinds. They’re on the front lines, in the administrative office, the research lab, the neighborhood clinic, the family dentist’s office, the college health and science building. They’re making real contributions to the quality of life in our communities, and it’s time to recognize their efforts!

Event Date: Thursday, October 25, 2018
Event Time: 5:30 p.m.-8:30 p.m.
Location:  Starting Gate at GreatHorse, Hampden

Nominations can now be submitted for the 2018 Healthcare Heroes awards. Deadline for nominations is Friday, June 15 at 5 p.m., NO EXCEPTIONS. Winners will be profiled in the September 3 issue of BusinessWest and the September issue of Healthcare News. Winners will be invited to attend the “Healthcare Heroes” Awards gala scheduled for Thursday, October 25, 2018.

Click on one of the following categories to submit a nomination:

 

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Nominate a Healthcare Hero

Only a few minutes into the first meeting of an advisory board created by BusinessWest and its sister publication, BusinessWest, to provide needed insight as they launched a new recognition program called Healthcare Heroes, the expected question was put forward.

“How do you define that word ‘hero?’ asked one of the panel’s members, addressing the magazines’ decision makers.

The reply, and we’re paraphrasing here, was something to the effect of ‘how we define ‘hero’ is not important — it’s how you define it.’

And by ‘you,’ Kate Campiti, associate publisher of the two publications, essentially meant anyone who would nominate an individual or group to be named a Healthcare Hero in one of seven categories that first year.

Those who did so came up with their own definitions, used to highlight the nominations of a unique class of individuals and groups that would include Sr. Mary Caritas, SP, former president of Mercy Medical Center, in the Lifetime Achievement category; Dr. Michael Willers, owner of the Children’s Heart Center, in the Patient/Resident/Client Care Provider category; Dr. Andrew Dobin, an ICU surgeon, in the Innovation in Health/Wellness category; and the Healthy Hill Initiative in the Collaboration in Health/Wellness category.

“Generally, ‘hero’ means someone or some group that stands out and stands above others in their profession, in their service to others, and in the way their passion for helping those in need is readily apparent,” Campiti said. “And we saw this in our first class of honorees. If there was one word that defined all of them, beyond ‘hero,’ it was ‘passion.’”

A panel of judges will be looking for that same passion as they weigh nominees for the class of 2018.

Nominations are currently being accepted, and will be until the end of the day on June 15. Nomination forms can be found on both publications’ websites — www.businesswest.com and www.healthcarenews.com.

Nominations are being accepted in the following categories:

Those nominating individuals and groups are urged to make their submissions detailed and specific, giving the judges who will review them all the information they need.

The honorees will be chosen this summer and profiled in the Sept. 4 edition of BusinessWest and the September edition of BusinessWest.

The Heroes will then be honored at a gala set for Oct. 25 at the Starting Gate at GreatHorse in Hampden.

Rounding out the class of 2017 are:

Lifetime Achievement: Sister Mary Caritas, SP;

Patient/Resident/Client Care Provider: Dr. Michael Willers, owner of the Children’s Heart Center of Western Massachusetts;

Emerging Leader: Erin Daley, RN, BSN, director of the Emergency Department at Mercy Medical Center;

Health/Wellness Administrator/Administration: Holly Chaffee, RN, BSN, MSN, president and CEO of Porchlight VNA/Home Care;

Community Health: Molly Senn-McNally, Continuity Clinic director for the Baystate Pediatric Residency Program;

Innovation in Health/Wellness: Dr. Andrew Doben, director of the Surgical Intensive Care Unit at Baystate Medical Center;

Innovation in Health/Wellness: Genevieve Chandler, associate professor of Nursing at UMass Amherst; and

Collaboration in Healthcare: The Healthy Hill Initiative.

For more information on Healthcare Heroes, visit www.businesswest.com or www.healthcarenews.com.

Healthcare Heroes

Scenes from the October 2017 Gala

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Photos by Dani Fine Photography

healthcareheroeslogo021517-pingThere were more than 70 nominations for the inaugural Healthcare Heroes class, and each one of them was truly worthy of that word ‘hero.’ Each one is to be considered a winner in some respect.

On Oct. 19 BusinessWest and The Healthcare News recognized the inaugural Healthcare Heroes class. Collectively, they are pioneers, and were celebrated at the Starting Gate at GreatHorse in Hampden. Each one is to be considered a winner in some respect.

American International College and Trinity Health are the presenting sponsors of Healthcare Heroes. Partner Sponsors are Achieve TMS, HUB International New England, and Health New England. Additional sponsors are Bay Path University, Baystate Health, Cooley Dickinson Health Care, Elms College, and Renew.Calm. Tickets to the event are $85 each, with tables available for purchase. For more information or to order tickets, call (413) 781-8600.

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Their stories reveal large quantities of energy, imagination, innovation, compassion, entrepreneurship, forward thinking, and dedication to the community.

There were eight winners in this first class, with two in the category of ‘Innovation in Health/Wellness,’ because two candidates were tied with the top score. The Heroes for 2017 are:

Lifetime Achievement: Sister Mary Caritas, SP;

Patient/Resident/Client Care Provider: Dr. Michael Willers, owner of the Children’s Heart Center of Western Massachusetts;

Emerging Leader: Erin Daley, RN, BSN, director of the Emergency Department at Mercy Medical Center;

Health/Wellness Administrator/Administration: Holly Chaffee, RN, BSN, MSN, president and CEO of Porchlight VNA/Home Care;

Community Health: Dr. Molly Senn-McNally, Continuity Clinic director for the Baystate Pediatric Residency Program;

Innovation in Health/Wellness: Dr. Andrew Doben, director of the Surgical Intensive Care Unit at Baystate Medical Center;

Innovation in Health/Wellness: Genevieve Chandler, associate professor of Nursing at UMass Amherst; and

Collaboration in Healthcare: The Healthy Hill Initiative.

 

Healthcare Heroes

Healthcare Heroes 2017

healthcareheroeslogo021517-pingThere were more than 70 nominations for the inaugural Healthcare Heroes class, and each one of them was truly worthy of that word ‘hero.’ Each one is to be considered a winner in some respect.

On Oct. 19, BusinessWest recognized those who stood out the most in the hearts and minds of an esteemed panel of judges. Collectively, they are pioneers, and they will continue in that vein at the Starting Gate at GreatHorse in Hampden as they become the first individuals and organizations in the region to accept the Healthcare Heroes award.

Their stories reveal large quantities of energy, imagination, innovation, compassion, entrepreneurship, forward thinking, and dedication to the community.

There are eight winners in this first class, with two in the category of ‘Innovation in Health/Wellness,’ because two candidates were tied with the top score. The Heroes for 2017 are:

Lifetime Achievement: Sister Mary Caritas, SP;

Patient/Resident/Client Care Provider: Dr. Michael Willers, owner of the Children’s Heart Center of Western Massachusetts;

Emerging Leader: Erin Daley, RN, BSN, director of the Emergency Department at Mercy Medical Center;

Health/Wellness Administrator/Administration: Holly Chaffee, RN, BSN, MSN, president and CEO of Porchlight VNA/Home Care;

Community Health: Molly Senn-McNally, Continuity Clinic director for the Baystate Pediatric Residency Program;

Innovation in Health/Wellness: Dr. Andrew Doben, director of the Surgical Intensive Care Unit at Baystate Medical Center;

Innovation in Health/Wellness: Genevieve Chandler, associate professor of Nursing at UMass Amherst; and

Collaboration in Healthcare: The Healthy Hill Initiative.

American International College and Trinity Health are the presenting sponsors of Healthcare Heroes. Partner Sponsors are Achieve TMS, HUB International New England, and Health New England. Additional sponsors are Bay Path University, Baystate Health, Cooley Dickinson Health Care, Elms College, and Renew.Calm. Tickets to the event are $85 each, with tables available for purchase. For more information or to order tickets, call (413) 781-8600.

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Healthcare Heroes

At 94, She’s Still Finding Ways to Lead, Fight, and Inspire

 Sister Mary Caritas, SP

Sister Mary Caritas, SP

Sister Mary Caritas, SP says that many of the assignments during her remarkable 70-year career in healthcare, civic service, and work with the Sisters of Providence were unplanned, unexpected, and, in some cases, well, untimely — at least initially.

By that she meant that, by and large, when she was informed that her role would be changing — and that happened more than a few times — she was very much enjoying what she was doing, making a difference in that role, and looking forward to going on in that way. Meanwhile, in most cases, she considered herself totally prepared for the new challenge to which she was assigned.

That was true when she was told early on by her superiors that she would focus her career pursuits on dietary science rather than nursing, a profession she fell in love with, and again when she was told, after serving several years as a dietitian, that she would become an administrator at St. Luke’s Hospital in Pittsfield, and again when she was named president of the Sisters of Providence.

But in each case, she accepted what was to come next with enthusiasm and a mindset to make the very best of that situation — for her, but also, and especially, for the constituencies she would be serving.

She loves to fight for a good cause; she’s energized by it, and she communicates that enthusiasm or concern or passion to others. And when she gets in that mode, she’s unstoppable; she’s a remarkable woman.”

“Several times, I was doing something I loved doing, and then I was quickly moved somewhere else,” she told BusinessWest. “But each time I had that experience, new doors opened for me; new opportunities came my way. There were many occasions when I happened to be at the right place at the right time.”

There are countless people who would no doubt say the same thing. And those sentiments — not to mention a seemingly endless list of accomplishments and tireless work within the community — go a long way toward explaining why Sister Caritas, who turned 94 on August 22, was the clear winner in the Lifetime Achievement category for this inaugural class of Healthcare Heroes. In fact, she was the top scorer among the more than 70 nominees for the program’s seven categories.

When looking over her résumé, it’s easy to see why.

That document goes on for several pages and includes a long list of professional appointments, including a nearly two-decade-long stint at Mercy for which she is perhaps best known.

It also chronicles a host of church-related activities and appointments, including a nine-year tenure as president of the Sisters of Providence that preceded her time as Mercy’s president, as well as stints on the executive council of the Sisters of Providence, the Catholic Charities board, and many others.

And it also includes a lengthy list of civic activities and work within the business community, including everything from decades of service to the Easter Seals to her memorable role as chair of the task force on Bondi’s Island in the mid-’90s; from a decade of service as chair of the United Way of Pioneer Valley to a five-year stint as chair of the Springfield Council on Aging.

Now 94, Sister Mary Caritas shows no signs of slowing down

Now 94, Sister Mary Caritas shows no signs of slowing down, and clear signs of only adding new chapters to a nearly 70-year career in healthcare and service to the church.

She served on the board of two area colleges — Elms College and Western New England University — and also a few banks, including the former Springfield Institution for Savings and the former Community Savings Bank in Holyoke. She served on the Spirit of Springfield board for 16 years, and still serves on the Economic Development Council of Western Mass.

And then … there’s her service to dozens of healthcare organizations. That list is way too long to print in anything approaching its entirety, but it includes the Sisters of Providence Health System, Catholic Health East, and Trinity Health New England (all parent companies to Mercy at different times), but also Partners for a Healthier Community, Cancer House of Hope, Holyoke Hospital, the American Hospital Assoc., the Mass. Hospital Assoc., the Academy for Catholic Health Care Leadership, and many more.

But despite all that this résumé conveys, it’s still only part of the story.

The much bigger part is the energy, entrepreneurial spirit, and innovative nature she brought to those assignments — or continues to bring; indeed, a good number of those listings have a starting date, then a hyphen, and then the word ‘present’ — and also her ability to inspire others.

Sister Kathleen Popko, current president of the Sisters of Providence, who has worked beside and been friends with Sister Caritas for a half-century, summed it all up this way:

“She loves to fight for a good cause; she’s energized by it, and she communicates that enthusiasm or concern or passion to others, and they join with her, whether it’s for Bondi’s Island stench or fluoridation or reaching out and advocating for those who are are poor and underserved.

“And when she gets in that mode,” Sister Popko went on, “she’s unstoppable; she’s a remarkable woman.”

Heart and Soul

Sister Caritas was doing quite well in her efforts to mask some frustration.

As she talked with BusinessWest, she was awaiting word on the scheduling of what she called minor heart surgery — and coping, if that’s the right word, with a list of things her doctor told her she shouldn’t be doing. (Editor’s note: That surgery went well, and she has been cleared to do pretty much anything she wants.)

At the time, the refrain-from list included golf, a pastime she’s enjoyed for decades (her record includes a hole in one at East Mountain Country Club’s 10th hole), as well as pilates.

While somewhat disappointed that she had to take it rather easy, Sister Caritas took the marching orders in stride. There were, after all, plenty of other things to keep her busy.

But understand that it takes nothing short of orders from a doctor to in any way slow down this energetic leader, who has been keeping a full calendar (whether it be the printed variety in a binder or her cellphone) since just after World War II ended.

Our story begins in Springfield, where she was born and raised. Her father had designs on her being his secretary, and her classes at Commerce High School, which she didn’t like at all, had her on that path.

Things changed after she met a woman in training to be a nurse. “I got so excited and so enthusiastic, when I came back, I told my mother I wanted to be a nurse,” she recalled, adding that these sentiments were not received warmly by her mother, who warned her that she would spend a career emptying bed pans.

But the young Mary Geary was determined — we’ll see that word repeatedly in this discourse — and enrolled at Technical High School, focusing on the sciences, with the goal of entering the nursing profession.

Upon joining the Sisters of Providence — another decision that did not sit well with her mother — she was sent to St. Vincent’s Hospital in Worcester as a nurse. But upon making her final vows after her fifth year, in 1949, she was sent to Mercy Hospital in Springfield, a move she was thrilled with until she found out that, instead of nursing, she would focus on dietary services, a decision made by the reverend mother.

Fast-forwarding a little, after receiving a master’s degree in nutrition education at Tufts University and undertaking a dietetic internship at the Francis Stern Food Clinic at the New England Medical Center in Boston, she was assigned to be administrative dietitian at Providence Hospital in Holyoke.

“I had the happiest time of my life for the next seven years,” she recalled employing a tone that made it clear that such happiness had an expiration date. “December 23, 1966, I was busy preparing a party for the sisters when I got a call from the Mother House. With no preamble, and with no explanation, the reverend mother simply said, ‘little sister, as of January 2, you are the administrator at St. Luke’s Hospital.’”

When she replied that she didn’t know anything about hospital administration, her superior responded with a simple ‘you’ll learn,’ which she did.

After St. Luke’s and Pittsfield General merged in 1969 to become Berkshire Medical Center, Sister Caritas served briefly as associate director of that facility. That’s briefly, because her life and career were soon to change abruptly — again.

Indeed, she was chosen to lead the Sisters of Providence and take the title superior general, a title that intimidated her about as much as the long list of responsibilities that came with it.

“I was totally unprepared for this,” she said, adding that, as she did with other stops during her career, she learned by doing.

A Fighting Spirit

And that ‘doing’ included work to create a new Mercy Hospital, a facility that would replace a structure built by the Sisters of Providence in 1896 and open its doors in 1974.

In another strange career twist — yes, there have been several in this narrative — Sister Caritas would succeed the woman she chose to lead the new Mercy (Sister Catherine LaBoure) after Sister LaBoure was in turn chosen to lead the order.

While Mercy had a new facility, it remained what Sister Caritas called “the little kid on the block,” much smaller than its rival just a few blocks away, Baystate Medical Center.

Sister Caritas (a.k.a. ‘little sister’), front row, center

Sister Caritas (a.k.a. ‘little sister’), front row, center, says she likes creating new things and getting things started. “Those are the kinds of things that energize me.”

But in its smaller size, Mercy’s president saw nimbleness and an ability to fill recognized niches, while also taking some bold, innovative — and, yes, entrepreneurial — steps.

Such as an in-hospital surgery center that has a story behind it that provides some insight into Sister Caritas’ determination and desire to fight for something she wants and believes in.

“I was going to buy a surgery center down on Maple Street,” she recalled. “Everything was moving along smoothly, but the night before the sale was to go through, they called and said they changed their mind. I was naturally terribly disappointed, but disappointed was hardly the word for it. I was mad; I was furious.

“So I said, ‘we have some space; we have some extra operating rooms,’” she went on. “So we created the first in-hospital surgery center.”

Other innovations and expansion initiatives would follow, including an eye center created at the hospital, an intensivist program, one of the nation’s first hospitalist programs, creation of the Weldon Center for Rehabilitation, the Family Life Center, the Healthcare for the Homeless initiative, and much more.

The common denominators with each of these efforts were common sense, expediency, and a desire to better serve patients and families, said Sister Caritas, citing the hospitalist program, now a staple in hospitals across the country, as an example.

“It was never really my intention to start a hospitalist program — I just wanted to create opportunities for more surgery,” she explained. “My whole life has been taking advantage of opportunities that present themselves; when I’m open to something and think it’s a good idea, I move with it. And I like nothing more than creating new things and getting something started. Those are the kinds of things that energize me.”

But while Sister Caritas has always been entrepreneurial, the word most-often used to describe her is compassionate.

“What’s truly impressive is the breadth of her engagement, from the national level all the way down to the individual,” said Sister Popko. “She’s been on many national and regional boards and continues to serve on several — she has that dimension. But at the same time, and simultaneously, she has extraordinary compassion and a big-hearted, magnanimous response to the needs of the individual, whether it’s helping someone find a placement for their mother in a nursing home or reaching out to an individual who’s looking for a job or is in trouble.

“If you know her, you know her thousand closest friends,” she went on. “She just knows everyone.”

U.S. Rep. Richard Neal, who was mayor of Springfield during Sister Caritas’ tenure as president of Mercy, agreed.

“Her legacy is one of lasting kindness, compassion, and care for all,” he said. “She vowed to ensure that everyone who came through her doors were taken care of, and she fulfilled that promise. She has truly fulfilled the Sisters of Providence pledge to pay particular attention to the cries of the poor and oppressed.”

Small Wonder

Sister Popko told BusinessWest that Sister Caritas, a.k.a. ‘little sister,’ insists that at one time she was at least 5 feet tall, and maybe a full inch over that mark.

Not anymore.

Not that it matters, or has ever mattered.

“She has such a large presence even though she’s a very small person,” Sister Popko noted. “When she walks into a room, everyone recognizes her and wants to speak to her. She has an indomitable spirit, is very courageous, and is outspoken when it’s called for.”

Such comments evoke Mark Twain’s famous and often-borrowed line: “It’s not the size of the dog in the fight, it’s the size of the fight in the dog.” And with many matters, and in many arenas, Sister Caritas has displayed plenty of fight.

Perhaps the most celebrated example was her lengthy battle to win approval from the Mass. Department of Public Health for a cobalt unit for cancer treatment at Mercy Hospital. She first filed an application in 1978, and it was denied. Applications could only be filed biannually, so she tried again in 1980. And 1982. And 1984. And 1986. You get the idea.

“They said I couldn’t demonstrate that there was enough need for it,” she recalled, with exasperation still evident in her voice nearly 40 years after she was first turned down. “I couldn’t believe it.

“But over the next 14 years, I applied every two years,” she went on, adding that the seventh application was to be her last — at least as president of Mercy — because she had informed her board that she would be retiring.

That seventh time was the charm, and the cancer center that was started but not completed during her tenure now bears her name.

In keeping with her character, however, she said that getting the center approved and built were not the real accomplishments.

“It’s one thing to build something, but it’s the quality of the service, the compassion of the people, and the love they have for their patients that really makes the difference,” she told BusinessWest. “While it’s a beautiful center, it’s nothing without that compassion.”

That compassionate, fighting spirit remains today. Indeed, while the word ‘retire’ was officially attached to the end of her tenure at Mercy, she prefers to say that her energies were simply “redirected.”

Toward Bondi’s Island, for example, and the odor problems that had plagued that facility for years, but in many other directions as well.

She still sits on a dozen boards and continues to look for ways to innovate and serve the historically underserved. Both those missions come together in an ongoing project to create senior housing for lower-income individuals on the former Brightside campus.

The Sisters of Providence are seeking additional funding support (state grants have already been secured) for a 36- to 40-unit facility that will be a demonstration project that will tie in with the PACE (Program for All-inclusive Care for the Elderly) initiative already operating at that site.

“We want to demonstrate the relationship between supportive housing and people’s ability to remain independent,” she said of the project called Hillside at Providence. “And that’s exciting.”

As she talked about the Hillside project and the countless others she’s been involved with over the years, Sister Caritas was persistent in her efforts to make it clear that, with each one, she was only working as part of a team.

Indeed, when asked to consider identifying what she considers her greatest accomplishment, she said flatly, “I don’t think I’ve had any great accomplishment.”

Rather, “when I think about all the people who I’ve worked with and the people who have supported me, and the network needed to get things done … there’s not anything that I’ve done by myself,” she went on. “With other people, though, we’ve done some great things.”

Cause and Effect

As she was concluding her talk with BusinessWest and thus getting on to other items on her busy schedule, Sister Caritas took a few minutes to talk about Mary Elizabeth O’Brien, now serving as interim president of Mercy Medical Center.

“She’s someone you can believe in,” Sister Caritas remarked. “And that’s what you need in a leader, someone you believe can get it done.”

Ironically, generations of area residents, including those who have worked beside her, those who have benefited from her many initiatives, and even those working in competing hospitals have said the same of Sister Caritas. And at 94, they’re still saying it.

As her friend Sister Popko noted so eloquently, she loves fighting for a good cause.

And yes, when she gets in that mode, she is unstoppable. Still.

George O’Brien can be reached at [email protected]

Healthcare Heroes

This Physician Always Has His Patient’s Interest at Heart

Dr. Michael Willers

Dr. Michael Willers
Dani Fine Photography

Dr. Michael Willers calls it simply “the look.”

When asked to describe it, he said it was somewhat difficult to put into words. What certainly wasn’t is his opinion that generating this look may well be his favorite thing about his work as owner of the Children’s Heart Center of Western Massachusetts.

It comes when a young patient finally comes to the realization that he or she is there at the home on Northampton Street in Holyoke to receive medical care — and not just play on the rug with LEGOs or a stuffed animal.

“I’ll be talking to the parents and I’ll be talking to the kid … and then I get my stethoscope out, and I sit down on the floor with the kid with my stethoscope,” Willers explained. “And it dawns on the kid at that moment that this is not just hanging out on the floor at some friend’s house. There’s a stethoscope involved, and they’re in a doctor’s office … and the kid’s thinking, ‘wait a second … I may have been duped.’

“They have this really surprised look on their face,” he went on. “Then I say, ‘it’s all good … we’re just going to have a listen, and maybe you want to listen, too.’ So we’ll listen to their heart together.”

Willers’ ability to prompt ‘the look’ doesn’t completely explain why he was chosen as the winner in the category of Patient/Resident/Client Care Provider, but it goes a long way toward getting that job done. He and his partners, Drs. Cyrus Yau and Meaghan Doherty, have created an environment that looks and feels far more like a home than a place where pediatric cardiologists would typically do their work.

And they run a practice where parents, often very anxious about bringing their child to a cardiologist to begin with, leave with all their questions answered and their fears, in most cases, anyway, put to rest.

Willers told BusinessWest that, unlike most healthcare operations today, this is not a volume business — or, to be more precise, not a business consumed with volume. Indeed, the three physicians generally book only seven appointments a day and spend an hour, on average, with each patient and their parents.

Taking care of kids and being with them … I could do that all day long and not get tired of it. It picks me up every time.”

And while his work is cardiology, Willers says he and his partners regard themselves as experts in stress reduction, especially when it comes to the parents of the children they see.

“I’ll often tell people that we specialize here in anxiety and worry,” he explained. “Our specialty is helping parents who are anxious or worried or scared. We take pride in tuning into that and understanding where parents are coming from and helping to unravel that anxiety and figure out exactly where their anxiety lies.”

But it’s not simply how much time is spent with patients and their families, or all this work in stress reduction that sets Willers apart. It’s also how that time is spent, which, in his case, means getting down to the patient’s level — quite literally.

“When I went to medical school, I knew I was going to get into pediatrics,” he said while explaining how he chose this line of work, or it chose him, as many working in healthcare opt to phrase things. “I love the social aspect of it, to be honest with you. There’s nothing like walking into an exam room and having a chance to get on the floor and play LEGOs with kids, talk to them about their lives and about what they enjoy.

“Pediatrics is intellectually interesting,” he went on. “But socially, it’s invigorating. The real reason I went into pediatrics as opposed to internal medicine or something else was purely social and emotional reasons. Taking care of kids and being with them … I could do that all day long and not get tired of it. It picks me up every time.”

The Pulse of His Practice

Willers isn’t sure of the exact date, but he believes that the home at 1754 Northampton St. in Holyoke is, like most of the others in that vicinity, not quite a century old.

It is large and comes complete with many nooks and crannies. For example, each of the examination rooms on the second floor has a short, narrow closet in one corner, the dimensions of which are determined by the structure’s sloping roof.

The waiting room at the Children’s Heart Center looks more like a living room, which is exactly what it was for roughly 90 years.

The waiting room at the Children’s Heart Center looks more like a living room, which is exactly what it was for roughly 90 years.

Each closet is filled with a trove of stuffed animals and toys, and on occasion, Willers won’t just go into the closet for something, he’ll actually emerge from it to greet a patient. To get his point across, he gave a demonstration.

“They’ll be looking for me to come in the front door, but once in a while I’ll get down in here,” said the 6-foot, 3-inch Willers as he squeezed in and closed the door behind him. “And then I’ll pop out like this and say, ‘hi, guys.’”

This demonstration, and the enthusiastic commentary that accompanied it, speak volumes about not what Willers does, but something at least equally important — how he does it.

Before we get into that in more depth, though, we need to first explain just how Willers arrived in that closet. It’s an intriguing story, and it really begins back at Wesleyan University, where he was finishing his work toward earning a degree in biology.

He wasn’t considering medicine at that time — he was leaning toward getting a Ph.D. in ecology or evolution — but a week spent with a group of internal-medicine residents at St. Vincent’s Hospital in New York changed all that.

“Six months before senior year, I decided I wanted to go to medical school,” he noted, adding that he enrolled at Dartmouth and, while working toward his degree, developed two passions — working with and for the underserved, and taking care of young people, for all those reasons mentioned above.

After completing his residency in pediatrics at Cornell Medical Center – New York-Presbyterian Hospital, Willers went to work at the Fair Haven Community Health Center in New Haven, Conn., an experience he described as the best of both worlds — taking care of an underserved, largely Spanish-speaking population, and also having teaching and hospital privileges at Yale-New Haven Hospital.

Desiring to narrow his focus to pediatric cardiology, he undertook a fellowship in that specialty at Yale School of Medicine, and upon completing it, he went to work at Baystate Children’s Hospital as a pediatric cardiologist, one of three on staff, while also serving as director of the Pediatric Exercise Physiology Laboratory.

Seeking to provide care in a different setting and in a different manner, he founded the Children’s Heart Center of Western Massachusetts in 2012.

“I wanted to be able to take care of people in a way that focused on patients as individuals, and their families,” he explained. “And spending time with them, answering questions, addressing their concerns, understanding their lives and how their heart problems impacted their lives, and how their lives impacted their heart issues.

“I wanted to do it in a way that wasn’t like a lot of hospital-based outpatient practices,” he went on. “There’s a lot of overhead with those facilities; you have to pay for the fancy waiting rooms, and you have to pay the CEOs and the vice presidents and the middle managers, and a lot of the money goes toward things not directly related to good patient care. And what that means is that the volume of patients you need to see in a hospital-based practice just to keep the boat floating is enormous, and that means spending less time with patients.”

He started in that home in Holyoke with an operating philosophy that minimized those overhead expenses and called for seeing seven patients a day for an hour each, as opposed to 30 patients a day for 15 minutes each.

When asked how this was doable in this modern age of healthcare, where volume is such a critical factor in a practice’s success, he paused for a moment before responding.

“It’s our priority,” he explained. “In any endeavor in life, if you prioritize the right things, then you can make it work. And we prioritize the relationships with patients and families. We don’t prioritize mahogany desks, and we don’t prioritize over-management.”

As the practice grew, thanks in no small part to a very receptive response from the region’s community of pediatricians, it expanded, both with additional cardiologists (Yau and Doherty) and with satellite offices in Amherst and Great Barrington.

Hardly a Murmur

As he offered a quick tour of the Holyoke office, Willers pointed out a number of design elements and choices regarding décor that were chosen specifically with the goal of making young patients and their parents feel comfortable and, well, at home.

These include the couches chosen over traditional plastic chairs seen in most physicians’ offices, oriental rugs, soft, padded examination tables, toys and games seemingly in every room, and patients’ exploits in coloring between the lines decorating one full wall at the front entrance.

Even the terminology reflects this operational philosophy, if you will.

Indeed, upon arrival, visitors are asked to sit in the ‘living room,’ not the ‘waiting room,’ because while the latter phrase effectively describes its official function, it certainly looks more like the former — because, for roughly 90 years, that’s exactly what it was.

But the friendly, patient- and family-focused tone of this practice goes well behind furniture and phraseology. It also involves everything from the considerable amount of time spent with a child and his or her parents, to the attention paid to the communication process.

To explain, Willers chose as his subject matter the heart murmur, a term that most parents don’t fully understand and one that usually generates far more fear and anxiety than are actually warranted.

So Willers said he starts off by focusing on the child, not the word ‘murmur,’ and moves on to making it clear to parents that, in the vast majority of cases, murmurs are normal and not life-altering.

Dr. Michael Willers

Dr. Michael Willers says his favorite toy is whichever one his patient happens to be playing with at the time.

“I’ll tell a parent that there are seven different kinds of normal murmurs, and say, ‘let me tell you about the one your child has,’” he explained, adding that, for this exercise, he referenced the Still’s murmur, a common type of benign murmur named after the man who first described it, Dr. George Frederic Still. “And I’ll draw them a picture of a heart, explain what causes this murmur, and then tell them, ‘this is a totally normal murmur in completely normally healthy kids, something that develops around the age of 2 or 3 and lasts until the kid is 12 or 13 or 14. But it eventually goes away on its own and never turns into anything bad, and you never have to worry about it again.’”

Overall, Willers said he and his partners work hard to effectively communicate with patients and their parents to ensure they have a solid understanding of what’s happening with the heart in question.

“Some cardiologists will say, ‘your daughter has a heart-valve problem; she’s going to need a procedure on down the line — we’ll talk about it more later,’” he explained. “When we sit down with patients, our discussions are usually 20 or 30 minutes long; we draw pictures, we take notes, they go home — we intend for them to go home — with a really solid understanding of what’s going on with their kid, or with them if they’re an older person.

“In my experience, there’s nothing like uncertainty to breed anxiety, and there’s nothing like anxiety to disrupt the joy of parenting,” he went on. “And so we really try to get rid of the uncertainty and give people definitive answers in terms that are in plain English so that they can home with an understanding and a reassurance, and they don’t have to feel anxious.”

The Internet and all the information available on it has acted to fuel this anxiety, Willers said.

“They’ll hear something or read something on the Internet, and they’re really worried that their kid is going to die for X, Y, or Z reason, but they don’t really want to say it,” he went on. “So unless you can tune into their emotions and be on the same wavelength, you can’t really put their fears to rest.”

But getting on the same wavelength with parents is just part of this story. Getting there with children is what Willers probably enjoys most.

And while the methods for doing so vary with the age of the patient, the common threads are communicating and connecting.

“The first five minutes of every visit isn’t ‘so what brings you here today?’” he explained. “It’s ‘how’s your summer going?’ or ‘what was camp like?’ or ‘dude, how’s it going with your little sister?’ You spend five minutes connecting like that, and it brings a certain energy to that visit.”

A Different Beat

When asked if he had a personal favorite when it comes to kids’ toys and games — remember, he gets right down on the rug to play alongside his patients — Willers gave an answer that neatly sums up how this practice operates, and why.

“Whatever the kid is playing with at that given moment — that’s my favorite,” he told BusinessWest.

Such an attitude explains not only why Willers was chosen to be a hero in the Patient/Resident/Client Care Provider category, but also why he loves to create ‘the look’ and can’t wait to see it again.

Like he said, he can do this all day, and it picks him up every time.

George O’Brien can be reached at [email protected]

Healthcare Heroes

Emergency Department Director Creates Efficiencies — and a True ‘Front Door’

Erin Daley, RN, BSN

Erin Daley, RN, BSN
Dani Fine Photography

Almost from the first moment she stepped into the emergency room at Cooley Dickinson Hospital as a nursing student at UMass Amherst, Erin Daley knew this was the environment in which she wanted to work — and maybe spend a career.

“The ER is one of those places where you either love it immediately or you know it’s not for you, and it’s always been a place I absolutely loved,” said Daley, who, when asked what prompted the fast, deep embrace of this setting, said simply, “everything about it.”

“It’s that ability to be reactive,” she went on, as she went into some detail about what she meant by ‘everything.’ “And be able to change priorities at a moment’s notice. It’s unique, challenging, but not in a negative context, and there is nothing routine about it.”

These sentiments are reflected in the way Daley talked about everything from a much-needed return to the ER at CDH after a stint as a telemetry nurse at Baystate Medical Center to broaden her horizons, as she put it — “even though I learned a ton, I knew labor and delivery were not for me and I needed to get to the ER” — to the enthusiastic manner in which she relayed her affection for the work involved with being a ‘charge nurse’ in the ED at Mercy Medical Center.

“You have to know everything about everyone at all times in order to fit the puzzle pieces together,” she explained. “It’s this constant juggling act.”

And her affection for this setting was clearly evident when she talked about how much she misses being directly on the front lines, if you will, in her current role as director of Emergency Services at Mercy.

“I loved being an emergency-room nurse,” she said, expressing clear regret at having to use the past tense. “On days that they’re really busy and if there’s things I could skip, I’d gladly do that to jump in, even if it’s just to help transport patients; most of the day to day does not allow me to be out there anymore.”

But while there is that drawback to her current position, if one chooses to call it that, there are nonetheless many different kinds of rewards — everything from orchestrating strong improvements in the overall efficiency of the Mercy ER to working with a host of other players to help stem the tide of the nation’s opioid crisis.

Her boundless energy has gained her the reputation of being a go-getter, one who gets things done, and overall future leader for our healthcare system and community. She is both an emerging leader and one who has emerged.”

For her achievements in all these realms, Daley was the top scorer amid a strong field of candidates within the Emerging Leader category for these inaugural Healthcare Heroes Awards.

To put her efforts into proper perspective requires liberal use of numbers. For example, she oversees an ER with nearly 80,000 annual patient visits, making it one of the busiest in the state in terms of visits per bed. She oversees a staff of 160 and a budget of $65 million. More numbers are needed to chronicle the process improvements she and her staff have orchestrated with several key measurements of care. For example, the Mercy ER has:

• Decreased the ‘left without being seen’ rates from 5% to 2%, thus improving revenues;

• Decreased overall ‘door-to-door’ time, as it’s called, by 57 minutes;

• Increased patient-satisfaction scores by 40%; and

• Improved employee-engagement scores by 33%.

However, words and phrases are needed to convey how all this was accomplished — phrases like ‘whole-person care,’ used to describe an approach that views health for ED patients as a segue into engaging them in better health — and ‘care map,’ an aptly named initiative that charts a course for individual patients, especially frequent visitors to the ER.

First, though, some words and phrases from Doreen Fadus, vice president of Mission Integration and Community Health at Mercy Medical Center, who nominated Daley, are in order.

“Her boundless energy has gained her the reputation of being a go-getter, one who gets things done, and overall future leader for our healthcare system and community,” she wrote. “She is both an emerging leader and one who has emerged.”

Volume Business

As she talked about her staff’s efforts in the broad realm off efficiency, or process improvement, Daley told BusinessWest that they are driven largely by necessity.

Indeed, the Mercy ED has 36 beds (just over one-third the number at Baystate Medical Center, by way of comparison), which she described as both a blessing and a curse.

“We’re very spacially constrained considering the volume that we have — 36 beds for just shy of 80,000 patients,” she explained. “That’s driven us to be so efficient; it’s made us relook at how we do things, look at our data all the time, and undertake process-improvement initiatives, because we don’t have the luxury of having a lot of beds.

“We look at every aspect of how a patient moves through the system,” she went on. “And if there’s any means for reducing waste and redoing processes, we’ll find it. If there’s 10 extra steps that a staff nurse has to take to do a particular task, taking that waste out of their day puts their attention where it needs to be — back on the patient.”

How Daley came to be directing these efforts at improved efficiency is an intriguing story, one of moving progressively higher in the ranks in terms of responsibility within that environment she came to love.

After her stint at CDH, she came to the Mercy ED in 2004. She told BusinessWest she was attracted by its reputation for being a nurse-driven environment, a description she found to be certainly accurate, and a foundation she would only build upon.

She started as a staff nurse, taking care of patients at the bedside, and remained in that role for eight years, eventually assuming charge-nurse duties, which, as noted earlier, she found quite rewarding.

Mercy Medical Center

Erin Daley says the emergency room, and especially Mercy Medical Center’s, is a unique environment she described as a ‘constant juggling act.’

“It’s probably my favorite job,” she said. “You’re really trying to manage throughput, and it’s a gigantic puzzle with all these moving parts. It’s about how you have to think about the ED; there’s a certain number of beds, ‘X’ amount of patients you’re trying to get through, you’re trying to allocate resources and potentially pull resources from one area to another area to always have throughput in mind, with the patient at the center of it all.

“You’re like an air traffic controller,” she went on. “One’s coming in, one’s going out, and you’re having to reassess that constantly in order to optimize the space that you have.”

In 2010, Daley became clinical nurse supervisor in the Mercy ED, and in that role was directly responsible for the supervision of the department, with specific duties ranging from staffing to scheduling; from compliance to being what she called a “real-time resource,” meaning she was still in the trenches. In 2015, she became nurse manager of the ED, assuming responsibility for productivity and throughput metrics.

And just over a year ago, she was named director of Emergency Services, meaning oversight of the department and all its personnel and not being in the trenches, as she noted earlier.

But it does mean bringing a higher level of efficiency to those front lines, while also bringing new meaning to the notion that the ED is a hospital’s ‘front door’ and a resource for the community beyond emergency care.

“I want to know what’s happening in the community and how I can be a supporting influence,” said Daley, noting that she is involved with everything from the region’s opioid task force to a committee battling human trafficking.

That phrase ‘supporting influence’ gets to the heart of both Daley’s management style and the philosophy that she and her staff members embrace when it comes to what an ED should be and how it should function.

Regarding the former, she said she is a mentor as well as a manager, one whose simple ambitions when it comes to her team are to “inspire, uplift, and motivate.”

And as for the latter, she said the ED cannot only be a place to receive emergency care. In the whole-person-care model, it is also a vehicle for engaging individuals in better health, through such things as medication-management discussions, assistance with setting up post ED visit primary care, behavioral-health services, and more.

As an example, she cited the drug-overdose victim who arrives at the emergency room.

“If someone comes in that has overdosed on opioids … we could be that last line of support to reach out to them,” she explained. “They may have burned bridges everywhere with their family, with their friends, and we could be that last line to reach out to them.”

Elaborating, she said those in the ED, through the unit’s Complex Care program, strive to be more proactive with those who overdose, for example, and not simply treat them and move them through.

“We follow up with phone calls and try to reach out and talk with these individuals after they’ve had a chance to recover,” she explained. “It’s a traumatic experience, that whole overdose process … you’re given Narcan, now you’re in acute withdrawal; it’s incredibly traumatic.”

Erin Daley

Erin Daley says her management style encourages teamwork and solving common problems together.

Fadus may have summed up Daley’s ‘front door’ approach best, noting that “her understanding that the ED can provide the entry way to both providing medical services and the guidance of health education has led to many patients experiencing healthcare through a system rather than rely on services mainly through the venue of the ED.”

By the Numbers

As noted earlier, there are many numbers, or metrics, involved with an emergency department, and all through her career and especially in her current capacity, Daley has been involved with bringing specific numbers higher or lower — whichever translates into improvement.

In the case of patient satisfaction, an upward trajectory is obviously desired, while, when it comes to the ‘left without being seen’ category, downward movement is the goal, because individuals are leaving generally out of frustration with the time they’re spending in the ER waiting room. And when they leave, valuable revenue is lost, and, more importantly, these individuals may be endangering their health.

To achieve improvement in that ‘left without being seen’ category, and all others, the Mercy team embodies ‘lean’ strategies commonly used on the manufacturing floor and other settings, said Daley, adding that the goal is always to remove waste and improve efficiency. But while doing so, patient care cannot be compromised.

And Mercy has managed to do this with what is perhaps the most-watched ER statistic, the one focused on door-to-door time (from when they check in until they are discharged), which Mercy has managed to reduce by nearly an hour — 57 minutes to be exact — to 157 minutes.

This was accomplished with something called a split-flow model, which, as that name suggests, splits those arriving in the ER into ‘lower acuity’ and ‘higher acuity’ categories. “If you can keep vertical patients vertical, the ease of them getting through the system improves, and you can decrease length of stay dramatically by not even putting them in a hospital bed.”

Elaborating, she said the ED took one of its triage rooms and created the aptly named ‘rapid medical exam’ (RME) room. There, patients deemed to be low-acuity are triaged, seen by a provider, and discharged, all from that one room.

“If all of those patients that are of that lower acuity never hit the back of the ER and never take up a bed, you increase your capacity for sicker patients,” Daley explained. “You increase capacity, not because you’ve added beds, but because you’ve added bed hours.

“When we piloted this on our busiest days, it was incredibly successful, and over the next few years, we went from Monday and Tuesday to Monday through Friday, and then, as our volumes grew, we expanded it to every day of the week,” she explained, adding that the RME model has also had a huge impact on the ‘left without being seen’ numbers as well, because of the additional bed space.

These improvements have come about through that lean approach to operations, learning from best practices, and working together as a team to solve problems and achieve continuous improvement, said Daley, adding that her management style encourages all this.

“I’m successful because I have an amazing team of people that I work with — everyone who’s in a leadership capacity in this department is an over-achiever and a go-getter,” she noted. “I’m not the kind of person who micromanages at all; I like to be collaborative and make a goal together.

“How each individual person gets there … I don’t micromanage that,” she went on, “because everyone has their own style, and they do better working their own project in the way they feel comfortable. But we all have the same goals in mind, and they are lofty goals.”

Looking ahead, Daley, now pursuing an MBA at Elms College, is focused on building upon both her leadership skills and her grasp of the many financial aspects of her position and others within the higher ranks of healthcare management.

“I want to be very knowledgeable about how my business, meaning my department, runs, and feel confident about that,” she explained. “From there … I’m not quite sure what the future holds.

“I like operations a lot — fitting those puzzle pieces together,” she went on. “I can see myself overseeing operations on a larger scale. But I also love the work I do in the community.”

Bottom Line

For now, she will continue to oversee the air-traffic controllers and others in the ED, create more process improvements, and, in general, go on being a ‘supportive influence’ — there’s that phrase again — with her staff, in the ED, and within the community she serves.

As Doreen Fadus noted, Daley is both an emerging leader and an energetic administrator who has, in many ways, already emerged.

George O’Brien can be reached at [email protected]

Healthcare Heroes

Porchlight’s Leader Has Some Illuminating, Innovative Ideas

Holly Chaffee, MSN, BSN, RN

Holly Chaffee, MSN, BSN, RN
Dani Fine Photography

Holly Chaffee says her husband has a line — perhaps it falls into the category of ‘joke’ — that he’ll throw out on a fairly regular basis, like almost every night.

“He’ll say ‘OK, who are we having dinner with this evening?’” said Chaffee, president and CEO of Lee-based Porchlight VNA/Homecare, adding that he says this because there’s a decent chance that dinner between the two will include a phone call — or several — from a colleague looking for some direction, advice, or a much-needed answer.

“The phone seems to always ring when you sit down to dinner,” she said with a laugh, adding that she always answers it. “We’re a 24-hour business; there’s always someone on call, and there’s always someone backing up calls. You have to be there for people, because they’re relying on you.”

This sharing of dinner time goes a long way, sort of, toward explaining why Porchlight VNA/Homecare is the only agency of its kind in this region to receive what’s known as 5-star status from for the Centers for Medicare and Medicaid Service (CMS).

It will take much more to explain those high scores, which ultimately determine how an agency is reimbursed, and we’ll do that in a bit.

Those phone calls during the evening meal also help explain why Chaffee was the top scorer in an extremely deep field of contenders for the Healthcare Heroes category called Health/Wellness Administration/Administrator. But again, many more supporting words and numbers are needed, starting with this summation from Kurt Toegel, chair of the board at Porchlight.

“Holly is known as an innovator in the home-care arena,” he wrote. “As an administrator and CEO, she has not only the drive and motivation it takes to be successful, she has the leadership skills to develop the work products necessary to be successful.

“Holly has true heart,” he went on, “and compassion for the work she does. She is collaborative and is always willing to share her knowledge.”

I believe it starts with your heart — you have to love what you do. And if you love what you do, it’s going to show from the top down; you all have to be invested in what you’re doing in your job.”

‘Innovative,’ ‘collaborative,’ ‘compassionate,’ ‘motivator’ … these qualities and others become apparent as one looks at the long list of accomplishments accredited to Chaffee and her team since she arrived at what was then known as the Lee Regional VNA andBerkshire Home Care in 2009. These include:

• Changing the existing electronic medical record to improve efficiencies;

• Orchestrating a merger with Chicopee VNA and Great to Be Home Care in 2014;

• Implementing a branding campaign and new company name (Porchlight), as well as oversight and the development of a new website to increase visibility of the service areas;

• Effectively creating a continuum of care (from acute to chronic care) by developing an internal conversion system;

• Designing and implementing a productivity system that increased productivity from 3.25 to 5.75 visits per eight-hour day;

• Operationalizing the accounts-receivable collection;

• Hiring new management-team members with clinical expertise, leading the agency to a deficiency-free survey in 2012 under a new survey process;

• Piloting a childhood-obesity program in schools in Berkshire County; and, perhaps most importantly,

• Empowering staff to lead in their areas of expertise.

Slicing through all of these and countless other bullet-pointed lines from her CV, Chaffee said she and her team have created an environment marked by innovation and calculated risk taking, one that has enabled Porchlight to succeed — and blaze some trails — in a constantly changing and ever-more challenging home-care landscape.

“Porchlight’s leadership is known for not being afraid to take a risk, to try something new,” she explained. “Seven years ago, for us to embrace the medical record that we did, that was a huge step — that was innovative. And there have been many other examples of that kind of thinking.”

Holly Chaffee, center

Holly Chaffee, center, says she and her team at Porchlight have created an environment of risk taking that has led to its 5-star status.

As for those 5-star ratings, they are a reflection of how the agency is responding to these changing times, which require ever-higher levels of accountability and measurable outcomes.

Porchlight is the only Western Mass. agency given such elite status in the most recent ranking, one of two in Massachusetts, and one of only about 200 across the country.

That benchmark is the result of what Chaffee calls the ‘triple aim’ — low cost, high quality, and patient satisfaction.

“We were able to attain that status with boots on the ground,” she said, attributing the accomplishment to solid teamwork. “We have a superior staff of nurses, home health aides, physical therapists, occupational therapists, social workers … all those people are out there creating the 5-star status we have through their encounters with the patients.

“Our goal is keep patients at home and families together,” she went on, adding that the agency’s tagline — and her life’s work — is enabling individuals to live “life as you know it.”

Shedding Light on the Subject

As she talked about that aforementioned rebranding initiative and the new name Porchlight, Chaffee said that, as one expect, there’s a story behind it.

It begins with the original name over the door, Lee VNA, which led many people to believe that the agency served only people in that community, which was not the case. The name was changed to Lee Regional VNA, but it still wasn’t clicking, said Chaffee.

To come up with something that did, she turned to the advertising and marketing agency Darby O’Brien, which had developed a niche in rebranding efforts. The firm eventually came up with ‘Porchlight,’ which resonated with Chaffee and her board chairman, who both conjured up images of front porches with lights blazing (for Chaffee, it was at her parents’ home in New Jersey) when they heard it.

But … there’s usually a ‘but’ in these cases, and there was here as well.

“When you change the name of a 100-year-old agency, there’s a lot of controversy, and we needed to overcome that,” Chaffee told BusinessWest, adding that help came from a board member, then in her 90s, who had served in that capacity for a half-century.

The new name was presented to her by O’Brien, Chaffee, and others, and the response helped dissipate that controversy.

“She told us that when her husband, a doctor, would leave the office, he would tell people, ‘if you need me to stop by on my way home, leave the light on,’” Chaffee recalled. “There couldn’t have been a better entrance for the name ‘Porchlight’ than that, and we were very excited about that response; the name caught on.”

Putting the new name and accompanying logo on signs, letterhead, and the website was far from the most challenging of assignments on Chaffee’s portfolio at her agency, but, like the others, it sheds needed light — pun intended — on those many qualities listed or implied by Toegel in his nomination. They include imagination, forward thinking, teamwork, and, perhaps most important, a willingness to listen and the will to act upon what she hears.

And Chaffee has honed these various careers through a nearly 40-year-long career in healthcare and healthcare administration that might not have happened (well, it probably would have happened anyway) had the market not been flooded with teachers back in the late ’70s, as she was graduating from high school, prompting her to look in another direction career-wise.

“I was talking with my parents,” she recalled. “I volunteered at the hospital as a candy striper, and my father said, ‘you love people, you love helping people … why don’t you think about going to nursing school, because you can do those things and also teach?’”

She thought about it, and then did it, at Skidmore College in New York. Her career in healthcare began in New York (she commuted from her parents’ home) at a pediatric tertiary-care unit, working with children with neurological impairments and kidney disorders. She and her husband would first settle in upstate New York and then relocate to Enfield, after which Chaffee took a job in the pediatric intensive-care unit at Hartford Hospital.

Her career would take a sharp turn, however, after the couple had two sets of twins in a 15-month span.

“That’s when I started my home-care life,” she explained, adding that, while working at Hartford Hospital, she “dabbled” in home care, taking care of a few children on ventilators. She enjoyed that work and, after having her two sets of twins, worked weekends as a home-care nurse, essentially launching a new career that would see her hold essentially every position in that healthcare realm.

Subsequent stops would take her to the Enfield Visiting Nurse Assoc.; Ander-Care Inc. in Springfield, a home-health agency; Special Care Home Health Services in Wethersfield, Conn.; Noble Visiting Nurse Assoc. in Westfield; UConn Medical Center, where she served as a staff nurse and assistant head nurse in the UConn Bone Marrow Transplant Unit; the Enfield Adult Day Center; and Masonicare in Wallingford, Conn., a nonprofit integrated health system, where she directed Masonicare at Home.

In 1999, she also launched her own venture (one that took her maiden name) — Vannucci Consultants, which started as a nursing consulting company that later expanded to include consulting to startup adult day centers and home-care agencies.

In 2009, she was asked to interview at Lee Regional VNA and was chosen as its next president. And with that hiring, the board, taking her vast skill set into account, decided to merge the VNA with a separate company, Berkshire Home Care, and have Chaffee lead both.

Progress Report

Chaffee arrived at LRVNA and Berkshire Home Care in December 2009, roughly six months later than CFO Pat Lamonte. Together, the two have led the organization through a continuous run of growth, innovation, and success — by a number of measures.

“She came from the hospitality industry, was a quick study, and a did a wonderful job of managing the finances,” Chaffee said of Lamonte, adding that one of the first assignments the two took on was implementing a new electronic medical record (EMR) system.

“When I arrived, the staff was using a particular electronic medical record, but they weren’t utilizing it the way they needed to,” she explained. “So I had to look at the operations and change everything that was happening so that things could be efficient and we could get on track financially.

“I went and viewed an electronic medical record called Home Care Home Base out west at a company called Residential Care,” she went on. “I said ‘wow, this is amazing; it gives everyone accountability, internally and externally,’ and so we adopted that system and did the implementation, which was as big change, because everyone’s role changed internally. But we needed to put those efficiencies in place to be sustainable as we are today.”

In many respects, the improvement of the EMR system, as well as the process for doing so — meaning everything from the due diligence to the adaptation of best practices to the quest for new efficiencies — goes a long way toward explaining why Porchlight is a 5-star facility.

The EMR improvements enable the facility to more effectively document information concerning the care of specific patients, she explained, and the process of making that change reflects the environment of innovation and risk taking that she has created.

And these qualities are necessary in this changing environment in home care, one where there is ever-more emphasis on outcomes and measuring them.

“There’s a culture change out there,” said Chaffee. “If someone had home care 20 years ago, they were used to ‘oh, you’re going to provide home care; someone’s going to be in my house for eight hours a day and take care of my mom while I’m at work?’

“It did happen like that 20 years ago if someone had complex medical needs and they were at home,” she went on. “That’s not the way it is anymore — that type of care is not delivered anymore; its been scaled back. Now, you go in, and you’re focusing on the problem you’re there to see that patient for — now, today.”

How agencies fare in those specific assignments is what the CMMS is measuring as it goes about the task of awarding stars.

As Chaffee showed BusinessWest Porchlight’s latest scorecard, if you will, she said scores shaded in light green (in the 60th percentile and higher) were good, and those in dark green (80th percentile and higher) were very good.

With five stars at the top of the card, one would expect lots of dark-green boxes, and there are, in such categories as ‘pain intervention,’ ‘improvement in pain,’ ‘timely initiation of care,’ ‘improvement in management of oral meds,’ and ‘diabetic foot care & education.’

When asked what makes all that green possible, and, in essence, what separates a 5-star operation from one that strives for the rating and falls short, she said there are many factors, many ingredients in the recipe for success.

“I believe it starts with your heart — you have to love what you do,” she explained. “And if you love what you do, it’s going to show from the top down; you all have to be invested in what you’re doing in your job.

“And it’s not just a job — it’s a career, it’s a lifestyle,” she went on. “To be a home-care nurse is a lifestyle, because you have to be invested in your patients. It’s not like you can go to your office at 4:30, click the light off, and it’s done. We’re a 24-hour business.”

Which brings her back to dinner with her husband and the phone calls that can — and often do — interrupt those meals.

And Chaffee is never sure who might be on the other end of that call.

“You might have a manager who wants to run a scenario by you — something they’ve never come across before,” she explained. “You may have a home-health aide you’ve established a long-term relationship with; I’ve had aides follow me from my other jobs into Massachusetts. They’ll call and say that their patient passed away, and they want to discuss how they’re feeling about that.

“I have an open-door policy — all my staff has my cell-phone number,” she went on. “Anybody can call me at any time; sometimes, they just want to check in, and that’s fine with me.”

Bright Future

It may not be an official measure of success in business, but the number of people who want to see what your operation has done, and take best practices from it, is certainly an important statistic — if anyone actually keeps a real number.

Chaffee said she doesn’t, but she acknowledged that many people in her business look to the Porchlight operation as a standard bearer in many respects. The consistent 5-star ratings will do that for a company.

Those who call and visit are essentially looking to know how that mark of excellence was achieved, how a team can be motivated to constantly raise the bar and then clear it, and how a company can excel with that triple aim.

Put another way, they want to know why neither Chaffee nor her husband minds it when he says, ‘who are we having dinner with tonight?’

George O’Brien can be reached at [email protected]

Healthcare Heroes

This Pediatrician Has Escalated the Fight Against Toxic Stress

Molly Senn-McNally

Molly Senn-McNally
Dani Fine Photography

Dr. James Li remembers his heart rate quickening as the “police officer” moved toward him and his two “siblings.”

That’s how real it all was, he told BusinessWest.

But those words are within quotation marks because none of this actually was real; rather, it was a simulation — a poverty-simulation seminar, to be more precise.

Li, a general pediatric resident working at the Baystate High Street Health Center, was playing the middle child in this exercise. His “family,” like many in Springfield that actually come under his care, was living below the poverty line — well below it. And one of the things Li learned very quickly as he acted out his role was that, when the police enter the picture, bad things are probably about to happen — such as children being taken away for suspected neglect.

And that’s why he felt his heart rate spike when a man who was just playing his role as a police officer moved onto the scene.

“I actively told my quote-unquote siblings that maybe we should walk this way to get away from the police officers,” Li recalled while gesturing with his hands to show what he meant. “That was the moment when the simulation became real for me.”

Making such experiences as real as possible is now part of the broad job description for Dr. Molly Senn-McNally, a pediatrician, Springfield’s school physician, and continuity clinic director for the Baystate Pediatric Residency Program. She has made the poverty simulation part of the orientation for Baystate residents, and also part of very comprehensive efforts to help young physicians better care for people living in poverty by making them fully cognizant of all the challenges facing those in this constituency.

Molly is dedicated to the care of children and families who live in poverty-stricken areas of Springfield.”

And that’s only one of many initiatives she’s involved with that so impressed the judges that Senn-McNally was the high scorer in the Healthcare Heroes category known as Community Health.

Others include everything from the introduction of substance-abuse screenings in Springfield schools to an integrated behavioral-health system at the High Street clinic, to ongoing efforts to establish a diaper bank at that facility to assist those struggling mightily to make ends meet.

“Molly is dedicated to the care of children and families who live in poverty-stricken areas of Springfield,” said John O’Reilly, chief of General Pediatrics at Baystate Health, who nominated her. “She understands that social determinants of health have a great impact on the health and well-being of our families, and she has been working hard to decrease the impact of toxic stress.”

Such stress, which is receiving ever-more attention in the healthcare and social-service communities, occurs, according to the Harvard Center for the Developing Child, in response to the strong, frequent, and/or prolonged activation of the body’s stress-response system without adequate protective relationships and other mediating factors (Li’s spiking heart rate when police appeared on the scene, for example). Stressors may include individual experiences of adversity, as well as family and community circumstances that cause a sense of serious threat or chaos.

Reducing such stress and minimizing its impact has become, in many ways, Senn-McNally’s life’s work. And a big part of it is compelling young doctors, through exercises like the poverty- simulation seminars, to understand how those social determinants of health directly impact the patients they see every day.

“These are things that are non-medical, but certainly impact people’s health and wellness — where they live, where they go to school, whether they have transportation, whether they have access to resources,” she explained. “Through their participation in the simulation seminars, residents and medical students get some empathy around when patients show up late, and they start to understand that health and wellness happens, really, outside the clinic and not only inside those walls. And they begin to understand the stress of living in poverty.”

If one listens to Li and other residents who have taken part in such simulations, Senn-McNally is succeeding in transforming this empathy, this understanding, into better care for this at-risk population.

Dr. James Li

Dr. James Li says the poverty-simulation seminar he took part in gave him greater appreciation of the challenges facing many of the patients he sees.

“The simulation and what I learned from it allows me to take things a step further,” said Li, a graduate of the medical school at Florida International University. “I know what the book says in terms of what these patients need. But now, I’m thinking more about how I can go outside the box to actually make it work for them.”

Dr. Shubham Bakshi, who has also taken part in a poverty-simulation seminar, agreed.

“The simulation has given me a different perspective on how to make sure individuals get the right amount of help, and that we match them up with the resources that are available in our community,” he told BusinessWest. “We take things for granted that we shouldn’t take for granted. That’s what this simulation has shown me, and it will make me a better doctor.”

Ready to Act

Bakshi, a native of India and graduate of Ohio State University and then Northeast Ohio Medical School, said he was obviously not experienced in what it’s like to be a 14-year-old girl, especially one in a family living in poverty.

But that was the role that the pediatric resident was assigned in his poverty-simulation seminar — “I didn’t volunteer” — and, like any good actor, he soon became immersed in his role, if you will. In this case, that meant coming to grips with all the sentiments, emotions, and, yes, toxic stress that such an individual would encounter as they are presented with a task, or scenario, as well as their assignment, which, as he put it, is to simply survive the environment they’d been placed in.

“The environment that I was given was that my dad had just left us, and everything fell to my mom, who was not educated and didn’t have enough skills to work in many jobs; everything fell on her to support us,” Bakshi recalled. “And being a 13- or 14-year-old, I was not able to get any jobs.

“It was eye-opening, because these are real experiences — these are real-life scenarios, as I later found out while practicing in Springfield,” he went on. “I knew that poverty was a challenging thing, especially with child care, but the simulation was very eye-opening; my mother was earning $30 a day, and our rent was $700 a month. It was really hard to make ends meet.”

Creating these eye-opening experiences and, more importantly, changing the way physicians think about how to properly care for those living in poverty is only the latest example of how Senn-McNally has spent much of her career working with and advocating for people at risk.

Indeed, her résumé includes stints with a host of community health and wellness organizations ranging from the New Beginnings Domestic Violence Shelter in Newark, Ohio, to the Franklin County Community Action Center for Self-Reliance, a homeless drop-in center in Greenfield.

Through those experiences and many others, including three years at Connecticut Children’s Hospital in Hartford working in its primary-care center, she brings a keen awareness of those aforementioned social determinants of health to work every day, and making others as aware is now a big part of her duties as a pediatrician and educator.

And in those capacities, she wears a good number of hats. She has her own practice, working at the clinic on High Street, which serves some of the poorest neighborhoods in Springfield.

And like many who work with children, she finds that work not only rewarding, but enjoyable.

“I love kids, and have moments every day where I say, ‘I’m so lucky to be able to spend time with kids and families all day long,’” she said. “A kid does something funny or silly, and we smile; I’m not sure that happens for people who are taking care of older folks.”

She also serves as Springfield’s school physician.

In that role, she works with the school nursing leadership as their healthcare consultant, and has worked with school officials on a number of initiatives, including substance-abuse screenings.

A pilot program involving seventh- and 10th-graders was launched last year, she said, adding that school nurses undertake what are known as SBIRT (screening, brief intervention, referral, and treatment) screenings designed to make the nurses resources in the ongoing battle to stem the tide of substance use.

“The nurses just have a conversation with the kids about substance use,” said Senn-McNally. “And one of the wonderful things about these conversations is that they are preventive; they’re an opportunity to talk with students about substances, hopefully before they’ve started using in the seventh grade, and emphasize the positive choices that kids are making if they haven’t starting using or if they’ve stopped, and see the school nurse as a resource.”

And she is also an educator, specifically associate program director for the pediatrics residency program at Baystate, another role with a host of rewards.

“I love working with residents and medical students,” she told BusinessWest, “because I really think we have a chance to shape how they are as physicians, what they value, and how they grow and treat patients.”

And the poverty-simulation seminars she oversees play a very big role in these efforts.

On a Role

Such simulations are taking place across the country, involving not only physicians and others in healthcare, but also elected officials, educators, business leaders, and other constituencies.

With each group, the goal is essentially the same — to create awareness of the myriad challenges facing those in poverty, and to see this awareness translate into positive change when it comes to how communities and individuals serve the poor and deliver services.

The simulations feature volunteers, perhaps 20 to 30 of them, who are residents of the community and either work with people in poverty or who have lived in or close to poverty, said Senn-McNally, adding that the ‘participants’ are medical residents or medical students who role play for an hour (four 15-minute ‘weeks’) living in poverty.

“They’re placed in families of varying types, maybe a single mom with several children, parents who may have lost their jobs, or an older single adult supporting themselves on disability, for example,” she explained. “And they have to complete a number of tasks over those four weeks; they have to pay their rent, they have to feed their families, and they have to keep the electricity on. And they really experience a small measure of what the families we take care of experience in their lives.”

After the simulation, there is a debriefing, she went on, adding that these sessions, where the participants, such as Li and Bakshi, discuss what they just experienced with the volunteers from the community, are quite compelling.

“The participants talk about how they felt during the simulation, and the community members have a chance to comment on what they saw, and whether the simulation was realistic, went far enough, or didn’t go far enough,” she explained. “And it’s such a powerful conversation, because the volunteers get to share their real-life experiences with our medical students and residents, who have typically grown up with more privilege than the people running the simulation.”

What happens after the seminars is obviously the most important part of this equation, though, said Senn-McNally, adding that the goal is to not only create an understanding of what it’s like to live in poverty, but better serve that population. And she believes the seminars are creating progress in this realm.

“The residents and medical students learn that people have to prioritize when they’re living in poverty,” she explained, “and that meeting their basic needs, food and shelter, may take precedence over their medical needs.

“They learn about why patients don’t always get an appointment when they’re supposed to — because they needed to take three buses or they didn’t have a car or they had to walk,” she went on. “And when they’re more empathetic, they’re able to be more understanding; they’re able to understand the importance of talking to patients about whether they have enough food, about their living situation, how school is going, and more. Doctors don’t typically ask about such things.”

Today, and in large part because of the poverty-simulation seminars, Li, Bakshi, and others are asking such questions, listening carefully to the answers, and using them to help improve their patients’ overall health and well-being.

With that, Li returned to that thought about outside-the-box thinking and going beyond what the book says.

Dr. Shubham Bakshi

Dr. Shubham Bakshi says his role as a teenage girl living in poverty certainly opened his eyes to the challenges facing that constituency.

To get his points across, he used the example of an extremely overweight patient.

“His BMI is in the 95th percentile, which means he’s overweight-slash-obese,” said Li. “You look at his diet history and you see that he’s eating at McDonald’s four times a week. It’s easy to say ‘you should stop that,’ but it’s harder to say that when you realize he’s eating at McDonald’s because it’s the cheapest way that they can get the calories they need to live and to function. I know I have to take it a step further than what’s obvious and telling him not to eat that food.”

Bakshi agreed, and said that before the seminar, he, like most others in his position, would make assumptions and take some things for granted, things he’s learned he shouldn’t do.

As an example, he cited a call he received from a woman living in a shelter concerned about a rash her child had developed.

“I said to her, ‘I’m a little concerned about that because you’re complaining of fever, nausea, vomiting, etc.; why don’t you go to the emergency room?’” he recalled. “Later, I realized she said she lived in a shelter and that it would be hard for her to arrange that transportation. Also, it was 10 at night.

“Now, in that same situation, I think my first question would be, ‘do you have reliable transportation?’” he went on. “Before, I just assumed they did; now, I have changed my perspective and the way I take such calls from these patients. I’ll say, ‘where do you live?’ or ‘who else lives with you?’ or ‘who is supporting you with taking care of the child?’ and ‘how are you making ends meet?’”

Part of the Solution

The gentleman who played the police officer in Li’s poverty-simulation seminar is a greeter at the High Street clinic. Li sees him almost every day.

His heart doesn’t race when he does. But it certainly did that day back during his residency orientation. That’s how realistic that exercise was in essentially bringing Li into a life of poverty and forcing him to somehow survive.

The toxic stress was very real. Also real are the changes in the ways that Li and others like him are looking at, talking with, and treating those who come into their care.

And Molly Senn-McNally has played a lead role in bringing about those changes.

George O’Brien can be reached at [email protected]

Healthcare Heroes

ICU Surgeon Takes Cutting-edge Approach to Help Crush Victims

Dr. Andrew Doben

Dr. Andrew Doben
Dani Fine Photography

Dr. Andrew Doben has two real passions — beyond his family, of course.

Sailing and surgery. Not necessarily in that order, but probably.

They have been both pursuits and professions for Doben, and they are both well-represented on the walls and shelves in his small office at Baystate Medical Center.

Indeed, hanging next to his medical-school diploma is a poster from that famous (or infamous, depending on your point of view) 1983 America’s Cup, the one where Australia II, with its revolutionary winged keel, which Doben would describe in great detail, ended the New York Yacht Club’s 132-year hold on the cup. Not far from a shelf crammed with thick medical textbooks is a photograph of Doben and his children on his boat, a 41-foot Oceanis. And just across from a model of the titanium rib fixture he uses to save (and change) the lives of his patients, is another poster, this one complete with bits of sail flown by America3 in its successful America’s Cup defense in 1992.

“I know they’re genuine,” Doben said of these strips of sail, “because it looks like there’s some salt leaching onto the matting.”

Sailing and surgery; surgery and sailing. Doben can do more than talk about them with confidence and reverence in his voice. He can draw some stirring parallels and analogies between the two professions, as we’ll see. Together, they provide a window into how he views his work as director of the Surgical Intensive Care Unit at Baystate.

Which brings us back to that model mentioned earlier and a surgical treatment known as ‘surgical stabilization of rib fractures’ (SSRF), or rib fixation, which, as that name suggests, uses surgically implanted hardware to stabilize rib fractures. The procedure yields quicker recovery times, decreased mortality, reduced incidences of pneumonia, reduced use of ventilation after trauma to the chest, and less chest-wall deformity.

Doben explained. “With pretty much every bone in the human body, when you break it, you are, in some way, shape, or form, holding that bone stable while it heals, whether you put it in a cast, or you put some degree of fixation on it or through it — you stabilize that bone.

“And almost every bone in the body has had that to some degree, with the exception of the ribs,” he went on, adding that this is largely because they are always moving. “Fractures in motion will not heal.”

Years ago, surgeons would try casting or binding the ribs, Doben noted, but because they are so important to the respiratory process, this strategy is almost universally fatal. “People couldn’t take a deep breath, they got pneumonia, and they died.”

People trust a lot in you when you operate on them, and it’s very similar to the feeling you get when someone asks you to be their captain; they give you their boat, and they ask you to carry them through to safe passage; it’s very similar.”

Matters are further complicated by the fact that, if someone has endured an injury forceful enough to break several ribs, they have likely also damaged one or more of the organs that the ribs protect, he said, adding that for decades the hallmark of treatment of such patients was pain control, which led to slightly improved outcomes, with the emphasis on slightly.

Roughly 75 years of technical and medical developments, accelerated by several wars, have produced a fixation system, one that uses a combination of metal exoskeletal plates and pins to keep the ribs entirely immobile while damaged bone and tissue heal, resulting in reduced pain and a much shorter recovery time, as we’ll see later.

Doben’s emergence as one of the leading practitioners of rib fixation — he has performed the procedure more than 200 times, in his estimation — goes a long way to explaining why he is one of two winners in the Healthcare Heroes category called Innovation in Healthcare.

But that’s only part of the story. His tireless work to help make this surgical procedure more mainstream, thus saving more lives, is another big part. Indeed, while fib fixation is widely available in other countries, that is not the case in the U.S.; Doben is working to change that equation.

He noted that, while the number of rib-fixation procedures being performed in this country has risen, those numbers are skewed by the fact that most procedures are being undertaken at a handful of high-volume centers.

“Only a few dozen people in this country have performed as many as 100 of these operations,” he explained, adding that one of his goals moving forward is to create centers of excellence that will become referral centers for the treatment of people with such injuries and training centers for those who perform the procedure, with Baystate likely being one of the first of these centers.

Taking the High Road

As he talked about the start of his professional career — which saw him on the water, or ‘blue water,’ as it’s known to those who navigate it, and not in the OR — Doben made it clear that, while he misses some if not most aspects of that work, he has no regrets about wearing blue scrubs to work every day.

Nor does he have any regrets about not getting into finance, which would have been the most logical path to take with his degree in economics. Instead, he took, well, a different course, actually hundreds of them, as a professional sailor after being part of a nationally ranked sailing team at Connecticut College, a small liberal-arts school located across the street from the Coast Guard Academy in New London.

“I lived on boats and traveled all over the world,” he explained. “I was a captain and delivered sailboats; I did about 35,000 miles of open-ocean sailing prior to going to medical school.”

Elaborating, he said he was first employed by different companies that would lease out boats for sometimes lengthy excursions. It was his job to sail a boat back after a lessee was through with it.

“So someone might start in Tortola in the British Virgin Islands, and they’d finish in Antigua,” he explained. “Well … somehow that boat has to make it back to the British Virgin Islands. Someone has to have that horrible job of sailing that boat back.”

Later, Doben did well in the business of delivering sailboats to their owners. “Let’s say you live in New England and have a boat you keep in Newport, and you want it in the Caribbean for the winter, but you’re busy; you have a lifestyle where you can’t do it yourself. So you call someone up, and you pay them to bring that boat to you.”

They actually pay more than what he’s making now as a surgeon, Doben said with a smile on his face, noting that, while that life on the ocean sounds like something that would be difficult to leave, he did — and for several reasons.

For starters, life as a sailboat captain didn’t jibe with his ambitions for starting a family — “it’s a tough thing to step aside and say, ‘see you in 35 days,’” he noted. And despite the pleasing picture this lifestyle probably presents in one’s mind, reality is a little different.

“When you’re 600 miles from shore in 140 mile-per-hour winds wondering if your boat is going to sink, it’s not exactly the type of lifestyle most of us want to have in our mid-40s,” he told BusinessWest.

Dr. Andrew Doben

Dr. Andrew Doben can find many parallels between surgery and captaining a sailboat. In both cases, there is what amounts to a contractual agreement.

But, and this is a big but, he desired a lifestyle and a profession that would in many ways mirror what he found on the water.

“I wanted to find a career that was very dynamic, that was constantly changing,” he explained. “One of the things I love about being on the water and navigation is that you can study your whole life and still have things to learn about it.

“No matter what you think you know, things change so rapidly,” he went on, still referring to life on the ocean. “You can start out in the day in beautiful, sunny skies and finish in a tremendous storm, and you have to adjust to it. That dynamic part was something that was very important to me.”

And he’s found it in healthcare, and, more specifically, the operating room.

After going back to college and taking the requisite science courses, he enrolled in medical school at the University of Pittsburgh and quickly narrowed his focus to surgery. And in what couldn’t be considered an upset, he found some parallels between that specialty and being a sailing boat captain.

“I felt that there was a real connection to patients, and much more of what I would call a contractual agreement,” he explained. “People trust a lot in you when you operate on them, and it’s very similar to the feeling you get when someone asks you to be their captain; they give you their boat, and they ask you to carry them through to safe passage; it’s very similar.”

Current Events

Fast-forwarding a little, Doben came to Baystate and its 16-unit surgical intensive-care unit in 2010, a destination he chose because of the specific challenges and rewards it presented. And, once again, he can find similarities to life on the blue water.

“When I made the decision that I was going to this [surgery], I decided that I wanted to take care of the sickest of the sick,” he told BusinessWest. “I have the type of personality where … I was out with a friend sailing a few weekends ago, sailing in 40-miles-per-hour winds. I was having a blast.

“I’m not the sort who gets freaked out by bad things happening around me; I’m just sort of even-keeled,” he said, using terminology directly from his previous profession. “If something’s going wrong, I’m just going to focus and try to solve the problem.”

That phrase ‘sickest of the sick’ is often appropriate when taking about candidates for rib fixation. These are usually the victims of crush, fall, and explosive-force injuries and are often elderly, said Doben, adding that he considers himself at the forefront of efforts not only to perform this procedure, but to educate the medical community about its ability to save lives and improve quality of life, while dramatically reducing the overall costs of treating such patients.

“Most bones heal in six weeks, but with ribs, because they’re constantly moving, you’re talking about three to six months,” he said while explaining the many benefits to be derived from this procedure. “If you’re a contractor and you’re self-employed, and you have a raise a hammer over your head, six months to not be able to do that is a long time.

“Roughly 60% of the people who have a severe chest-wall injury remain unemployed for up to a year,” he went on. “We can get people back to work, full-time employment, in three to six weeks.”

He reports that some progress has been made in mainstreaming SSRF, but there is still considerable work to be done.

“In 2009, we wrote a paper on this during my fellowship, and we basically had tomatoes thrown at us when we were at the national meetings,” he recalled. “And now, we’re asked to come to the national meetings and talk about it; it’s been such a frame shift.”

Progress is reflected in the number of rib-fixation procedures being undertaken in this country, he went on, noting that there were maybe 100 cases performed in 2001; by 2014, that number had risen to more than 3,300.

But behind those statistics are some troubling trends, he went on, adding that there are only 20 surgical centers across the country that are performing this surgery more than 30 times a year.

“Most centers are doing one or two a year,” he explained. “And when you look at the patient pool and the injury-severity scores, meaning ‘how badly injured is this patient?’ the number is almost double at the high-volume centers. So the sicker patients are being treated at the high-volume centers, and the mortality is half what it is at the lower-volume centers. So the lower centers are seeing patients who aren’t as sick, with less frequency, and they’re having worse outcomes.

“And that makes sense,” he went on. “If you don’t do the operation a lot and you don’t have a lot of experience, your outcomes are not going to be the same. This is concerning to me, and we’ve been working on that.”

This work is largely focused on creating those centers of excellence he mentioned, adding that he and others with the Chest Wall Injury Society are working to establish the criteria for such centers.

And there is much more to this than having specialists who can perform the rib-fixation surgery, he explained.

“The operation is only one-tenth of the puzzle,” he explained. “The puzzle is the team that takes care of these people. The respiratory specialists, the ICU, anesthesia, the pain management, the post-op management, the physical therapists … it’s a whole host of people. The operation just helps accelerate that process.”

And while establishing these centers of excellence that the ill and injured can be referred to, Doben and others will work to greatly increase the number of surgeons who perform this procedure, with an eye toward improving care in currently underserved areas.

Elaborating, he said there are maybe two dozen facilities that may soon become centers for excellence, and most are clustered in the western part of the country, where there are higher incidences of motorcycling and skiing injuries. Other parts of the country are underserved, he went on, listing Boston, where there is only one surgeon who performs this procedure, as an example.

“There are many people who don’t even know this procedure is available,” he said, adding that his goal now is to not only change that equation, but make the procedure available to more people.

Stemming the Tide

Returning to his thoughts about why he chose surgery as a profession and the ICU as the place to call his professional home, Doben recalled something that a friend of his father and a cardiologist by trade once said to him — something that has obviously stayed with him.

“He said, ‘being a doctor is a great privilege, where you get to see people in their most vulnerable states,’ and there’s nothing more true about that than the ICU, both for patients and families. And I enjoy that relationship of being able to work with people to get them through all that, to get them to safe passage.”

“Sometimes they don’t get there; they don’t survive,” he went on, adding that helping people live out their final days and moments in dignity is often as rewarding as saving a life.

That reference to safe passage was yet another analogy to sailing, a profession Doben has left behind him. Yet the sailing mindset remains — to focus on the horizon and chart a course that will get where you need to go.

And with SSRF and the challenge of bringing that breakthrough technology to more of the people who can benefit from it, he has done just that.

George O’Brien can be reached at [email protected]