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Room for Improvement

By Elizabeth Sears

 

Cooley Dickinson has a vintage 1973 Emergency Department — functioning well beyond its expected lifespan.

Even though this older facility has been a workhorse through the pandemic, helping support its community through what is now four waves of COVID-19, it has some obvious bottlenecks. Due to a constriction of space, those at Cooley Dickinson have found themselves getting creative, using hall beds in order to get by. However, an intriguing, $15.5 million solution is currently in the works for 2023.

The plan, “Transforming Emergency Care: Campaign for the Cooley Dickinson Emergency Department,” will include the renovation of 17,000 square feet, plus a 6,600-square-foot expansion. In 2019, Cooley Dickinson completed a master plan for facilities, and the Emergency Department was identified as an area greatly in need of expansion and and renovation.

“We looked at the entire institution, and the Emergency Department emerged as the number-one priority,” said Diane Dukette, chief Development officer at Cooley Dickinson. “Then came the pandemic, and that only further heightened that need we had to take over the endoscopy space to create a specialized respiratory Emergency Department.”

This project was delayed due to the COVID-19 pandemic; the initial plan was to start in 2020. However, this has allowed for plenty of time to plan, and those at Cooley Dickinson are feeling optimistic about the current timeline.

Diane Dukette

“We looked at the entire institution, and the Emergency Department emerged as the number-one priority.”

“The more planning you put into this, the better your construction phase is going to be, so we plan to really work with Consigli, our construction manager, to roll out a good phased-construction plan so it goes smoothly,” said Dr. Robert Redwood, an emergency-medicine specialist at the hospital.

Since this project is occurring in an endemic-COVID world, the plan is incorporating HVAC needs like filters and negative airflow throughout the Emergency Department. This will be essential for taking care of patients during an ongoing respiratory pandemic, Redwood said.

The ED expansion and renovation project continues to be the top priority of the organization. The Emergency Department is roughly 40% undersized right now for the population it serves, and that figure does not take into account the Pioneer Valley’s constantly growing population.

Due to the current space limitations in the existing ED, Cooley Dickinson’s staff strategically makes decisions every day about where to put patients. This is not ideal for anyone, but the staff is doing everything they can to ensure patient care, Dukette said.

“Our staff are spending more time doing workarounds and showing up and providing exceptional care in this space,” she told BusinessWest, adding that more space will allow them to do their jobs more efficiently.

Redwood spoke of the ‘triple aim’ in healthcare, which focuses on better outcomes, population health, and patient satisfaction. Now, there’s been considerable interest in a ‘quadruple aim.’ The Institute for Health Improvement has developed a four-part framework which includes care for the care team — something that has been key during this pandemic, he said. This factor will certainly be reflected in the upcoming project.

Dr. Robert Redwood

“We are sort of in the midst of a burnout epidemic as well during the COVID epidemic, and we want our facilities to be a place where staff feel proud to work and are able to take care of patients but also take care of themselves.”

“There’s going to be good lighting for the staff, staff respite areas and we’ll really try to take care of the people providing the care as well,” he said. “We are sort of in the midst of a burnout epidemic as well during the COVID epidemic, and we want our facilities to be a place where staff feel proud to work and are able to take care of patients but also take care of themselves.”

 

Space Exploration

It has been firmly established that crowding in emergency departments leads to poor outcomes, which is especially evident from the ED crowding that has been seen across the nation due to COVID-19. This has only emphasized the importance of streamlined processes where medical professionals can move their patient population through their space and get the emergencies diagnosed and stabilized in a rapid fashion, Redwood said.

“There are time-sensitive drugs,” he explained. “If you come to the emergency department with a stroke, my goal is to get you tPA — it’s called alteplase — within 60 minutes, and a key step there is getting this CT scan in a timely fashion, so the closer the CT is, when it’s co-located in the department, the quicker you can do those critical-care pathways.”

Another focus of this renovation project is creating a more geriatric-friendly facility. This includes features like large hallways, accessible bathrooms, nutrition stations, mobility aids, good acoustics, good signage, and bright lighting.

“These sound like no-brainers now, but they’re really not no-brainers,” Redwood explained. “You have to build it, you have to design it, elegantly. When patients come into the ED with dementia, they can easily have sensory overload, and then have behavioral changes due to sensory overload, so you want to have an environment that supports care for patients with dementia.”

Cooley Dickinson’s Emergency Department has received geriatric emergency department accreditation by the American College of Emergency Physicians, making it a pioneer within its larger healthcare system, Mass General Brigham. Indeed, it is the first hospital within the 13-hospital system to receive that accreditation. Other facilities in the system are going to follow suit, Redwood noted.

Another improvement to be included in this project is a larger behavioral-health pod, the need for which has only been exacerbated by two years of pandemic.

The phenomenon has been referred to as the “syndemic” — the COVID-19 pandemic plus a mental-health epidemic. Many of the support structures people have for their mental-health needs are lacking, Redwood explained, calling for improvements in behavioral-health resources.

“We’re going to have a dedicated behavioral health pod,” he said. “The current pod for behavioral health has four beds, and, for example, we have pediatric psych warding as a challenge in Massachusetts. We have two patients who have been there for well over a month in the pod, so those are beds that aren’t turning over, they aren’t readily usable. An expanded behavioral-health pod will be just really beneficial for the community.”

As noted, the price tag for the project is $15.5 million. Dr. Lynnette Watkins, president of Cooley Dickinson Health Care, recently announced a $1 million gift given by John and Elizabeth Armstrong of Amherst to contribute to the project. Additional fundraising efforts have been launched in these early stages of the project.

“What’s particularly exciting is that we had a group of individuals that came together to help us get this launched and gave us collectively a million-dollar challenge: to raise a million dollars by March 1, and then they’ll give us another million dollars,” Dukette said.

In regard to that $1 million goal, Cooley Dickinson has $117,000 left to raise over the next two weeks before it can garner the matching $1 million. Toward the end of the year, the hospital anticipates reaching out to the community for fundraising, which will coincide with when construction starts.

“This is a project that truly touches everyone in our community, and the club is honored to support the hospital,” said Steve Roberts, 2021-22 president of the Northampton Rotary Club, on the club’s recent $5,000 gift to the campaign.

 

Bottom Line

Redwood emphasized that, at the end of the day, what the Cooley Dickinson Emergency Department really needs is real estate.

“We need physical beds, and having an expanded footprint will allow us to really meet our community’s needs,” he said. “So we’re building an ED for 40,000 to 48,000 ED visits per year. Right now we’re around 32,000 to 34,000 visits per year, but the Valley is a popular place, it’s only growing, and we know we’re going to need that capacity.”

Both Redwood and Dukette enthusiastically stressed that this project is essential for the well-being of their community.

“We’re extremely proud of the fact that we are very inclusive, and we do everything we can to make whoever shows up in our emergency room feel welcomed and cared for,” Dukette said. “We’re a team.”

Daily News

NORTHAMPTON — Joanne Marqusee, president and CEO of Cooley Dickinson since 2014, announced she will leave that role to become chief integration officer for Wellforce, a growing healthcare system in Eastern Mass. that includes Tufts Medical Center, four community hospital sites, a broad provider network, and a homecare/hospice agency. At Wellforce, she will be responsible for developing and enhancing system-wide services to support operational excellence and growth.

“We are able to provide the best experiences for consumers and our care team when we work together. That is precisely why we are thrilled to add Joanne Marqusee to our Wellforce leadership team as chief integration officer,” said Michael Dandorph, president and CEO of Wellforce. “Joanne understands every type of healthcare setting, from academic centers to community hospitals and physician practices. She excels at leading with transparency and collaboration. Her expertise and direction will provide our teams the services and support they need to consistently deliver an unmatched consumer and patient experience, a key mission of Wellforce.”

Marqusee joined Cooley Dickinson following its affiliation with Massachusetts General Hospital (MGH) and the larger Mass General Brigham (MGB) system.

“Joanne has been integral in leveraging the strengths of MGH and MGB to expand services for patients and families in the Pioneer Valley, including opening the Mass General Hospital Cancer Center at Cooley Dickinson and attracting a range of outstanding specialists to the area,” said Dr. Peter Slavin, MGH president. “She is a superb leader who has raised the standards of quality, equity, service, and accessibility at Cooley. Joanne clearly is leaving an important and lasting imprint on this very special hospital. We know she will be as successful in her new role, and we wish her the best — and we will miss her.”

During her tenure at Cooley Dickinson, Marqusee oversaw the creation of a behavioral-health pod in the Emergency Department, the opening of a new Breast Center, and substantial expansion in provider practices across a range of locations and specialties. She will also be remembered for her diversity, equity, and inclusion work, starting with LGBTQ programs and more recently launching a comprehensive anti-racism plan. In addition, she has frequently spoken out on important public-health and policy issues, particularly those that affect marginalized communities.

“Joanne has been an extremely effective leader and has left Cooley Dickinson in a strong position,” said Fraser Beede, chair of the board of trustees. “We will continue to build on her legacy and provide high-quality, compassionate care for the community.”

A transition plan will be announced in the coming weeks.

“My seven years at Cooley have been the highlight of my career,” Marqusee said. “I am so gratified to have worked with the people here. The staff at Cooley Dickinson is incredibly talented, committed, and caring. I’m extremely proud of what we have accomplished together, including — but certainly not limited to — the amazing care and compassion that the people of our hospital offered, and continue to offer, to patients and the community throughout the pandemic.”

Prior to her tenure at Cooley Dickinson, Marqusee, a graduate of Cornell University and the Harvard University Kennedy School of Government, was COO of MelroseWakefield Healthcare (formerly Hallmark Health) and spent 16 years at Beth Israel Deaconess Medical Center, where she consistently was promoted to positions of greater responsibility, including vice president of Access; vice president of Ancillary, Support and Community Services; and senior vice president of Operations.

Marqusee is a board member of the Massachusetts Health and Hospital Assoc. and serves on the steering committee of Extraordinary Women Advancing Health Care. In addition to her roles in Massachusetts, she previously worked for the New York State Department of Health in the Division of Health Care Financing, the New York City Health and Hospitals Corp., and the New York City Office of the Mayor.

“I look forward to joining the Wellforce system, as I firmly believe in its mission to strengthen community care and redefine healthcare through innovation,” Marqusee said. “Throughout my career, I have focused on the patient experience, continuous quality improvement, operational excellence, and caregiver engagement. It will be my pleasure to work with the Wellforce team as it becomes a fully integrated health system, positioned for great success.”

Daily News

NORTHAMPTON — An anonymous donor allowed Cooley Dickinson to reward every employee this holiday season with a $50 gift card that they can use at a selection of local businesses.

This is not just a gift to Cooley Dickinson employees who have worked hard this year, but a much-needed boost to struggling local businesses, thanks to a partnership with the Greater Northampton Chamber of Commerce, the Amherst Area Chamber of Commerce, and the Greater Easthampton Chamber of Commerce.

“We appreciate Cooley Dickinson for partnering with area chambers and keeping their employee-appreciation gift-card program completely local,” said Vince Jackson, executive director of the Greater Northampton Chamber of Commerce. “Cooley’s extra dose of ‘local care’ has immediately put more local gift cards in purses and wallets and will generate increased sales for our participating gift-card merchants. It’s a win-win for our economy and community.”

Business of Aging

Back in the Swing

Jared Bean

Jared Bean says he’s giving people the injury-prevention education he didn’t receive as a young athlete.

Jared Bean grew up in Hampshire County and played youth sports in Easthampton. He recalls learning about how to improve his performance and conditioning — but not how to avoid getting hurt.

“I didn’t have that education, and neither did my coaches, and I ended up with injuries,” he told BusinessWest. “Now, I want to prevent that and give some more resources to this area.”

He does that as program coordinator and certified strength and conditioning specialist at the Cooley Dickinson Wellness and Sports Performance Center in West Hatfield.

Bean, who is credentialed through the National Strength and Conditioning Assoc. (NSCA), recognized early in his career how important it was for clients to achieve pain-free movement.

“I worked in the community for a while and found my way into what I call a corrective-based training system. I came across people, both athletes and non-athletes, who had discomfort or pain in a joint while moving, so I got into the process of helping alleviate that.”

“We wanted to have a place where we can focus on keeping our community healthy, and maybe prevent a visit to the doctor or the surgeon or rehab.”

On one hand, the center — the only one of its kind in Western Mass. — helps patients in Cooley Dickinson’s rehabilitation programs by serving as a connector between post-injury rehab and real-world activity. Trainers have on-site access to Cooley Dickinson’s orthopedic providers and rehabilitation therapists to collaborate on program development, striving to create a seamless transition from rehab therapy to resumed athletic training or other activity.

Andrea Noel-Doubleday, assistant director of Rehabilitation Services, noted that Cooley Dickinson supports two trainers in Northampton High School and Smith Vocational and Agricultural High School, maintains seven rehabilitation locations, and launched a walk-in orthopedic-injury clinic last year.

“We felt like, wow, we’re really supporting athletes and people in the community from the time they get injured on the field to finding their way to a doctor to finding their way to rehab, and this seemed like the next logical step,” she told BusinessWest.

“After rehab, where’s the best place to go to get that continuing work to get back to top performance?” she continued. “Then we thought, who better to do it than us? Jared knows the surgeons, he knows the therapists, he knows what we’ve been doing, so it’s a seamless recovery. That’s really what we were going for.”

But, because of its emphasis on injury prevention, it’s also a place where non-patients are welcome to work out, as they would be at any gym, while also learning proper technique. The center’s classes and programs emphasize injury prevention for athletes of all ages, as well as optimizing performance for serious athletes.

“We really wanted to offer wellness programs, and that’s why we called it the Wellness and Sports Performance Center,” Noel-Doubleday said. “We wanted to have a place where we can focus on keeping our community healthy, and maybe prevent a visit to the doctor or the surgeon or rehab. I think that’s a need in the community.”

Broad Spectrum

Bean, who earned a degree in applied exercise science at Springfield College, saw friends go into athletic strength and conditioning, often working solely with athletes on one team.

“I always had an interest in trying to help a bigger variety of people,” he went on. “I’ve seen older couples that came to me because they wanted to move well enough to hang out with their grandchildren. I had a gentleman who lost a lot of neuromuscular control through disease and wanted to go to Greece for two weeks — that was the sole reason he came to see me.”

Other clients include a 63-year-old power lifter and a ju jitsu fighter in her late 30s who just signed her first professional contract. “Definitely, being here, I’m going to see a lot of variety.”

Noel-Doubleday agreed. “It depends on what the person’s goal is. Sometimes they just want to lift their grandchild up, and sometimes they want to go out and try kayaking, and their shoulder’s been bothering them. They do a little PT, and I say the next step is to see the strength and conditioning specialist. Once I’ve gotten you to feel better and move well, he’s going to really tweak it and move you to the next level. It really is the next step, and more people are looking for that.”

Andrea Noel-Doubleday

Andrea Noel-Doubleday says CDH wanted a place that focuses on keeping the community healthy.

She noted one patient who had some cervical issues, but from a physical-therapy standpoint, there wasn’t much more she could do. “He said, ‘I’d like to start lifting weights, but I don’t want to get hurt.’” So the Wellness and Sports Performance Center was ideal for that — because improper technique is common to all athletic endeavors.

“A lot of times, it’s really just faulty movement,” Bean said. “That creates imbalances in the musculature, which creates discomfort and irritation. Unless it’s addressed, it’s just going to be continued discomfort, and might progress into a larger injury.”

And when someone’s technique is poor, Noel-Doubleday said, they have to be retaught. The center will film clients engaging in certain movements — jumping, for example — and the playback clearly demonstrates what’s wrong.

“When you see it, it makes sense. I can tell someone all day they’re not landing properly, but when they visualize it, especially in slow motion, they’re like, ‘oh.’”

Jumping, in fact, is something the trainers focus on, as it’s a common mechanism for non-contact ACL injuries.

“No one wants those. That’s one of those injuries that’s really devastating to an athlete. That could be the end of their career,” she said. “And there’s no reason we should have them, ever. It’s about weakness and neuromuscular control. And we know what we need to do to prevent it. So we need to really teach that.”

That education should start young, she said, which is why the center offers an injury-prevention class for athletes ages 11-14. Attendees learn positional awareness and how to move safely throughout space, and, by increasing their balance and stability, they learn how to safety build strength, endurance, speed, and agility.

“We want to prevent those non-contact ACL injuries before they happen. We know why they happen and how to prevent it, and we want to offer people a place to learn that,” she explained. “But we also offer advanced performance for the older athletes — the high-school varsity and college player who really wants to take it to the next level, and is asking, ‘how do I condition better and build strength so I don’t get injured?’ We wanted to offer a place where it’s safe to do that.”

Other classes include adult fitness, a blend of strength, endurance, cardiovascular development, and other components of physical activity; a class designed to help those who have undergone ACL reconstruction or other hip or knee surgeries return to their sport safely by focusing on restoring strength, endurance, and mobility; and a total joint class, for individuals who have undergone total joint replacement and want to maintain joint health and function through structured training.

A Vision for the Valley

Noel-Doubleday said the center has so far seen a healthy blend of CDH rehab patients and people coming from outside the system. In either case, they benefit from the expertise available to Bean, as the center is housed in the same building as Cooley Dickinson’s Orthopedic & Sports Medicine practice, the walk-in injury clinic, and the physical- and occupational-therapy suite.

“We have rehab specialists across the hall and orthopedic surgeons and sports medicine physicians downstairs,” she said. “If he needs to touch base with somebody, he’s got a whole group of resources at his fingertips.”

As it is not a physical-therapy facility, per se, the Wellness and Sports Performance Center does not take insurance, she noted. However, clients may submit their receipts to their health-insurance company to try to get reimbursed for fitness classes and services.

“It’s exciting for our organization to embrace this vision. Nobody else is doing this,” she told BusinessWest. “We’re in the business of recovering from injury, but we’re shifting the focus to say, ‘let’s not get injured in the first place.’ We want to get our rehab patients to where they want to be, but I would love to prevent non-contact ACL injuries. I would love to not see them in the Valley at all. If we can be a part of that, to me, that’s really exciting.”

Joseph Bednar can be reached at [email protected]

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