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Health Care

Lean — But Not Mean

Mark Fulco in the ‘Mission Control’ room at Mercy Medical Center.

Mark Fulco in the ‘Mission Control’ room at Mercy Medical Center.

‘Lean.’ ‘Six Sigma.’ ‘Gemba walks.’ These are terms and phrases, used traditionally on manufacturing shop floors, in relation to continuous improvement initiatives and efforts to take waste out of processes. Today, they’re being heard more in the healthcare realm, and especially at Mercy Medical Center, where efforts are ongoing to improve efficiency without impacting quality of care.

The sign on the door says ‘Mission Control.’

That’s a play on words, obviously. There’s a definite nod to NASA and its famous control room, where decisions were made, and moonshots were choregraphed. But that word ‘mission’ takes on a different, higher meaning at Mercy Medical Center, part of Trinity Health Of New England. The hospital was founded more than 125 years ago by the Sisters of Providence, and its mission to care for the region’s population, and especially those who are traditionally underserved, has been paramount and in most ways more important than the bottom line.

But these days, the mission is being carried out in a different way, said Mark Fulco, president and CEO at Mercy, who recently marked a year at the helm. He noted that, in many ways, the hospital, and the Trinity system on the whole, are taking cues from the auto industry and other business sectors and taking a Six Sigma approach to healthcare — a lean approach, one that manifests itself in a number of ways.

But the major focus is on making the medical center more efficient in ways that will reduce costs without sacrificing quality.

“It’s been a watershed for us, because it has changed our work and has helped us focus on key metrics to drive efficiencies.”

“It’s been a watershed for us, because it has changed our work and has helped us focus on key metrics to drive efficiencies,” said Fulco, adding that the hospital’s efforts to become leaner are reflected in everything from reduced wait times in the ER to an increase in the number of discharges over last year by staffing up more beds; from reducing the overall cost of each discharge by roughly $1,100 to cutting back on travel by using videoconferencing technology.

Overall, Mercy and the Trinity system are eliminating waste whenever possible, creating efficiencies in every department, and constantly looking for ways to improve service without impacting quality of service.

This work extends all the way down to the medical center’s printers and copiers, the number of which has declined noticeably over the past year or so.

“We’ve gone very much paperless,” Fulco explained. “We had two big meetings this morning, and instead of printing out huge packets of information, we did it electronically and on large monitors.

“It’s unbelievable what a color copy costs these days, and when you produce lots of color copies with charts and graphs, it costs a lot of money,” he went on. “So we’ve actually taken printers away and put codes on some of our printers so departments are accounting for every color copy they make.”

This focus on lean practices and accountability brings us back to the room behind the door bearing the sign that says ‘Mission Control’ and its co-called ACE (achieving clinical excellence) boards that track progress in specific areas.

They are part of what is now known as the Trinity Health Management System, or lean daily management, an operating philosophy, if you will, that we’ll explore in greater detail later.

It also brings us to the large conference room, also known as the Patient Safety and Flow Room, a few hundred paces away. Here, each day at 8 a.m. (no one is typically late, because if they are, they have to walk into a room filled with people who were on time), as many as 50 people gather for what are known as ‘huddles.’

These are strategy sessions where issues are discussed, problems are identified, and solutions generated, said Fulco, who offered an example.

“We have several huddles every morning, and one of them is our ‘tier 3 huddle,’ where we bring together leaders from across the entire hospital,” he explained. “The very first thing we talk about is patient safety or problems that came up the night before, or safety catches — like if something was a near-miss — because we want to know, first and foremost, what we need to do to be better and keep patients safer.

“That’s our early-warning system,” he went on. “And at the meeting, if we have a detected infection, we report it, and then we talk about what we can do to prevent another case like that from happening.”

For this issue, BusinessWest looks at Mercy’s broad efforts to employ the principles of Six Sigma and become, in keeping with its mission, lean but certainly not mean, at least in a very literal sense.

Work in Progress

They’re calling it the ‘29-minute pledge.’

That number is significant because of its specificity, meaning it’s not the ‘30-minute pledge,’ a much rounder number to be sure.

It refers to the maximum time it will take for someone visiting Mercy’s Emergency Department to see a physician or physician’s asistant, and this pledge is due to be launched in the coming weeks and announced with billboards and other forms of advertising.

“We’re pledging a door-to-provider time, in our emergency room, of 29 minutes,” Fulco explained, adding that the program has essentially been rolled out already, but the billboards won’t be going up for another few weeks. “We chose 29 minutes because it represents an average of what we can hold out as a pledge; there are times when we’ve averaged 16 minutes.”

The 29-minute pledge is a another example of Mercy’s efforts to improve quality of service while also becoming more efficient and taking cost out of the equation, said Fulco, noting that it is one of many initiatives put in place during what has been a very intriguing and challenging (he would use that word early and quite often, and usually with at least one ‘really’ in front of it) first year at the helm — and year for all those who provide healthcare.

He would sum it all up, sort of, by saying, “I knew what I was getting into — I knew it was challenging; it’s just been more work than I expected — not in a bad way, but in a good way, because it’s been a labor of love.”

What he was getting into is a very demanding climate for not just Mercy but all healthcare providers, one in which reimbursements for services provided, especially from public payers including Medicaid and Medicare, do not really come close to covering the cost of those services.

This disparity is especially large in the broad realm of behavioral health, Fulco noted, adding quickly that, through its facilities at Providence Behavioral Health Hospital, the Trinity Health system is the region’s leading provider of such services.

And these are services that are, from a purely bottom-line perspective, losing propositions, again because the cost of care is not being met by those paying for it. And while Providence and the Trinity system have always been mission-driven, there comes a point where the losses being incurred cannot be sustained, said Fulco, adding that this reality explains why there were inevitable cutbacks at Providence, and in other departments under the Mercy/Trinity umbrella as well.

Mission Control is part of an effort to bring the principles of Six Sigma to Mercy Medical Center.

Mission Control is part of an effort to bring the principles of Six Sigma to Mercy Medical Center.

“We had to make some tough decisions — the status quo simply doesn’t work,” he explained, adding that among these decisions were staffing reductions at Providence (most employees were offered other positions within the system) and cutbacks within or elimination of some departments at Mercy, including the Hearing Center.

While the cutbacks and staff reductions garnered the largest headlines regarding the Mercy system in 2018, a considerable amount of work going on behind the scenes to make the system more efficient, more responsive, and, yes, leaner — efforts like the 29-minute pledge — were perhaps more newsworthy.

As he talked about them, Fulco said these initiatives accurately reflect a system-wide operating philosophy being implemented by Trinity Health Of New England’s recently appointed CEO, Dr. Reginald Eddy, a former emergency-room physician.

“He really gets it,” said Fulco. “He gets it from a care perspective, and he has a strong sense of urgency that he’s really instilled in us in terms of doing it right, doing it well, and doing it quick, not just from a patient perspective, but from a business sense.”

Tracking Improvement

As he talked about the Trinity Health Management System, Fulco said it is focused on quality metrics, or what he called ‘people-centered metrics,’ which are carefully monitored with an eye toward continuous improvement.

As an example, he cited the infection rate, a key issue — and major challenge — for all hospitals.

“Our infection rate has remained below target and below what’s expected for a hospital like Mercy, and is, in fact, one of the 20 lowest infection rates across all the 94 or 95 Trinity hospitals,” he said, using infections from urinary catheters as an example of how Mercy tracks issues and addresses problems.

“Our goal is to be an ‘A,’ and we’re not stopping until we get there, and then we have to stay there, which becomes progressively more difficult.”

Steps such as these have a trackable impact on quality, as measured in a number of ways and by a number of entities, said Fulco, noting that Mercy’s Leapfrog score — its rating based on surveys undertaken by the Washington, D.C.-based Leapfrog Group, improved from ‘C’ to ‘B’ in 2018.

“Our goal is to be an ‘A,’ and we’re not stopping until we get there, and then we have to stay there, which becomes progressively more difficult,” he explained. “But we’ve improved by one whole grade, which is a significant step forward.”

But while quality is certainly an important benchmark, so too is cost, said Fulco, adding that the ultimate goal is to not only improve the overall level of quality but reduce the cost of providing care as well.

“On the cost side, because we’ve been more efficient and we’ve tried to tease out unnecessary expense — and there are several buckets of expense, from labor to non-labor — we have reduced the cost per case by more than $1,100 from last November [2017] to this November,” he said. “And when you multiply that by the 1,400 or so discharges we had, that’s a savings of more than $1.5 million.”

With that, he went to his desk to retrieve the current average cost per discharge, $6,850, a number he had handy, and for a reason — it is carefully tracked, and its downward movement is a source of pride within the system.

It’s been accomplished through a number of means, he said, starting with staffing changes (none at the bedside) that result from consolidation in some areas, such as billing, that are made possible by synergies with the regional Trinity team, thus reducing overhead costs.

Further savings have been achieved on supplies, he said, returning to efforts to go paperless when possible, and also such things as travel expenses.

“We work with people; if they’re printing too much, we take steps to reduce that volume,” he said. “It doesn’t sound like much, but it adds up when you’re saving 50 cents or 75 cents on a print; it adds up over time. And it doesn’t contribute anything to patient care, so we’d rather put the money into patient care than into paper.”

As for travel, it has been cut back as well, he said, noting that meetings between the Mercy team and the system team are now staged electronically. “Instead of having our people drive to Hartford or their people drive here, we’re using technology,” he told BusinessWest.

Huddling Up

As he offered a tour of the Mission Control room, Fulco started by referencing several large charts, called A3 charts, on the wall. Each one outlines an individual’s primary strategic aims, and they are part of the hospital’s lean daily management system.

“An A3 is putting our key objectives and measures all on one page,” he said, referencing his own A3, while noting that the charts track progress toward meeting those specific aims and goals, as laid out in an action plan. “We track this every week; we look at this every week. Every member of the leadership team has one of these.”

And when problems arise at those huddles, as he noted several times, everything is measured.

That goes for efforts to address recognized problems or issues as well, he went on, referring to other charts and the four letters ‘P,’ ‘D,’ ‘C,’ and ‘A,’ which stand for ‘plan,’ ‘do,’ ‘check,’ and ‘act,’ the four stages of tackling a problem, as Fulco identified them.

“This is flowing constantly; it’s changing every day,” he said, adding that the PDCA cycle, as it’s called, was created to generate action on a specific matter and keep things moving.

From Mission Control, the tour moved to the Patient Safety and Flow Room, where there was a comparatively small huddle going on (this was late afternoon). For the 8 a.m. huddles, those assembled have an agenda and start with safety, and move on to a daily operating summary and then performance reports — how well the hospital is doing with patient satisfaction, for example. Next is a round-robin session, at which feedback is sought on problems that have been identified.

But the tier 3 huddle is actually the second step in the process, said Fulco, noting that there are huddles on the departmental level as well. Matters arising at those sessions then come before the larger group, and there is then a Gemba walk. That’s a Japanese term that translates, loosely, into going to the front lines to see what’s going on, to hear from the people involved and come to understand the problem; it is similar in many ways to the concept known as MBWA — managing by walking around.

“A Gemba walk is daily rounding — we’re not sitting in our office or around a conference-room table; where going to see things where they really happen. We’re talking to people who are doing the work, and we’re doing some accountability checks,” said Fulco. “From 8:30 to 9:30 we take that walk, and from there we go to the Mission Control room and do an accountability huddle.

“It’s about getting close to the people,” he went on, “and finding out how we, as leaders, can help them.”

To emphasize these points, he concluded the tour in the Emergency Department, where are charts similar to those in both Mission Control and the Patient Safety and Flow Room.

They track things like wait times and numbers of patients who left without being seen — presumably because the wait times were too long — said Fulco, adding that subsequent huddles and PDCA charts identified the causes of those problems and tracked the success of steps taken to address them.

Healthy Outlook

Gemba walks. PDCA cycles. Huddles. A Mission Control room. These names, acronyms, and places all help explain how, while the mission hasn’t changed at Mercy Medical Center and Trinity Health Of New England, the process of carrying out that mission certainly has.

The emphasis today is on continuous improvement and being lean — without impacting the quality of care being provided at the bedside. As Fulco said repeatedly, in this environment, everything is measured, or charted, and progress is marked daily.

There is considerable work still to be done — this process never actually ends, he said — but progress can be seen in the ER, on the bottom line, and on the charts in the Patient Safety and Flow Room.

It could be seen as paper as well — only they’re using much less of it these days. That’s just part of the process of running lean.

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

Health Care

A Widening Problem

Steve Conca says it can be difficult for people to ask for help losing weight and getting fit, especially if they’re discouraged by all the attempts that didn’t work.

Steve Conca says it can be difficult for people to ask for help losing weight and getting fit, especially if they’re discouraged by all the attempts that didn’t work.

It’s gratifying, Steve Conca said, when people ask for help managing their weight — especially if nothing has worked before.

“When people come to us, they have a laundry list, and sometimes we’ll even write it on the whiteboard — ‘tell me all the stuff you’ve tried that didn’t work,’” said Conca, who owns Conca Sport and Fitness in West Springfield.

“They go on and on about different things, whether it’s a training method or a diet — you name it, they’ve tried it, and it didn’t work. And we draw the line and say, ‘we don’t to be the next thing on that list of 15 things that didn’t work. It stops right here.’”

But that’s easier said than done, he told BusinessWest, because weight loss is more than a numbers game — even when the numbers seem so overwhelming.

“It’s a lifestyle change. It’s mindset, it’s accountability, it’s exercising the right way. It’s eating healthy again and not just counting points. You’ve got to take it one step at a time and get your mind right.”

“It’s a lifestyle change. It’s mindset, it’s accountability, it’s exercising the right way. It’s eating healthy again and not just counting points,” he said. “You’ve got to take it one step at a time and get your mind right — and make sure the effort and exercise you’re going to put in are designed for you specifically, and will work for your body and your metabolism.”

Even people who lose weight, whether through traditional diet and exercise or surgery, often have trouble in the months and years following their initial success, said Dr. Yannis Raftopoulos, director of the Weight Management Program at Holyoke Medical Center.

“The challenge is, how do they maintain this weight in the long run?” he said. “Most practices today aren’t looking to change the person. That’s what we do here, and we have a higher success rate and a better chance to maintain the weight loss. But that’s hard to do. We have seen great successes, but it’s labor-intensive, time-consuming, and a lot of resources are needed.”

And it starts with a decision to take that first step, Conca noted.

“When someone calls and says they need help, that’s a vunerable position they put themselves in. When they come in and sit down, that’s one more big step that can also be another vulnerable spot,” he said. “We take that very seriously that you’re looking to trust us with your health, fitness, and well-being. That’s a huge responsibility, and we take it seriously.”

Wrong Direction

It’s an important responsibility, too, in a country that’s been going in the wrong direction, fitness-wise.

“There’s something that’s dramatically not right,” Conca said. “As a people, we’re getting less active, and we’re eating a much poorer grade of food than we did 20 or 30 years ago.”

Those trends are starting at an early age. According to the latest data from the National Health and Nutrition Examination Survey, produced by the Centers for Disease Control and Prevention (CDC), the percentage of children ages 2 to 19 who are obese increased from 14% in 1999 to 18.5% in 2015 and 1016. In the Pioneer Valley, 25% of children are considered obese.

Dr. Yannis Raftopoulos says treatments for obesity are myriad, and crafted on a patient-by-patient basis.

Dr. Yannis Raftopoulos says treatments for obesity are myriad, and crafted on a patient-by-patient basis.

“That means they have a body-mass index that puts them at increased risk as they enter adulthood for diabetes, high cholesterol, heart disease, gallbladder disease, asthma, and bone and joint problems. Already, we are seeing more and more youngsters developing type II diabetes, which is commonly developed by overweight adults,” said Dr. Chrystal Wittcopp, medical director of Baystate General Pediatrics, who oversees the Pediatric Weight Management Program at Baystate Children’s Hospital.

“The growing rate of childhood obesity in our country is alarming. Being overweight poses a serious threat to the health of America’s children, and as a society, we must make a concerted effort to decrease its prevalence not only in the Springfield area, but across the country,” she added, noting that obesity carries psychosocial consequences that can also hinder these children academically and socially.

Of even greater concern, there was a large increase in obesity — up to 14% from 9% — in the youngest population of those 2 to 5 years of age.

“My philosophy is, I try to change the patient’s lifestyle. If you want any chance to be successful, you have to change the logistics, how they operate every day.”

Conca sees it, too. “Overall, kids are moving not as efficiently as they were years ago. When we were growing up, kids were outside crawling, jumping, running around, and their bodies developed much differently than the kids now if they’re not forced into a structured activity. Instead, many of them are glued to a phone or a tablet. It’s a generational thing, and we’re seeing it not only on the activity level but the nutrition level as well. Kids don’t appreciate their bodies as much as they should because things like exercise and sleep and nutrition aren’t talked about.”

He recalled talking to an older woman whose infant grandchild’s first word was ‘Dunkin’ Donuts’ — which isn’t as odd as it sounds because the child’s parents were always making fast-food runs.

“She’s distraight about it because it’s not the way she wants her grandkids to be raised, but it’s something that, culturally, a lot of kids are embedded in. And they’re so impressionable at that age.”

When parents choose to eat right and be physically active, Wittcopp added, children are more likely to take note and make those same healthy choices. She said families could encourage each other by walking around the neighborhood together, going on a bike ride, or playing basketball at the park, while limiting time spent in front of the TV and video games, and cooking healthy meals with fresh vegetables, fruits, and whole grains.

“The severe consequences of obesity underscore the critical importance of children and teens to participate in physical activity and to engage in healthy eating habits,” she noted. “Childhood obesity is entirely preventable, and it is up to adults to encourage these healthy habits.”

Plenty of Options

For individuals who are well past those foundational years and frustrated by an inability to get fit, there are plenty of treatment options, Raftopoulos said.

“There are different levels of obesity, and different methods are available based on that,” he told BusinessWest. “For someone mild obesity, surgical options are usually not recommended, though there are some exceptions to that.”

Less drastic options range from classic diet and exercise to medications that restrict appetite, although Raftopoulos isn’t personally keen on those, as they can be expensive, come with side effects, and are not a long-term solution.

“My philosophy is, I try to change the patient’s lifestyle. If you want any chance to be successful, you have to change the logistics, how they operate every day.”

A more dramatic, yet still non-surgical, option is a gastric balloon that is swallowed, inflates, and suppresses the appetite until it’s removed after a few months. Holyoke Medical Center is currently involved in a clinical trial of a more advanced balloon that needs no endoscopic removal, but rather passes into the stool after it deflates.

Then there are the surgical options, specifically gastric bypass and sleeve gastrectomy, both of which drastically reduce the size of the stomach. But, no matter how effective a treatment is, whether surgical or non-surgical, patients face the same challenges afterward.

“Surgery will reduce the portion of the stomach and how much you can eat, but you can gain weight even with a small stomach,” Raftopoulos said. “If surgeons don’t provide the support to change the fundamentals of the patient — if they don’t help you change how you live your life — nothing will be very effective, and you can gain the weight back.”

For people who have struggled with obesity, he noted, there’s a psychological component to maintaining a healthy weight, and one that can be frayed by the stresses of everyday life, from work schedules to parenting obligations to caring for sick parents. That’s why his team works with patients on managing their entire lifestyle — through education and support services — to stay on the right path.

“The problem with how medicine is done today is not seeing the patients holistically,” he said. “Everybody is focused on one thing — ‘oh, your ear hurts? Let’s fix the ear.’ But the ear is connected to something else. And that fragmented mentality affects the patient’s results.”

But when something clicks, Raftopoulis gets excited — not just for that one patient, but for others who may be inspired by their example.

“The more practices do this the right way, and the better results they have, the more people will believe we can help them,” he said. “We need to have more practices do the right thing because there’s a great need.”

Reaping the Rewards

Conca understands the frustration of trying to make a change, and, after a few weeks of poor results, becoming discouraged.

“What they’re doing isn’t working, and after a few weeks, they’re tired and frustrated, and they quit again. Rightly so — if you’re doing something and not getting results, you’re going to stop doing it,” he said.

That’s why he touts his practice’s ‘Fit in 42’ program, an immersive, six-week experience that aims to change not just the number on a scale, but a mindset, through both serious exercise and an emphasis on accountability through activities like daily journaling and connecting with other members, both at the gym and on a private Facebook page.

“That sense of community and connection is so powerful — it’s more powerful than anything we could throw at them exercise-wise,” he went on. “So we have the community component, plus training that works, plus nutrition — there’s no diet, you’re just going to eat good, healthy foods for your body type — and then you see results. We have to show them results.”

It’s a great feeling, he said, when someone trusts him to make a change when nothing has worked before.

“When someone comes in, they have to have a why. From a business perspective, we try to preach that as well. Why are we doing what we’re doing?” he said, before answering his own question.

“People come in, and they’re down in the dumps and just throwing in the towel, saying, ‘I just want to play catch and not hurt, or just roll around on the ground with my kids.’ And it’s really cool to give somebody that. It’s really rewarding.”

Joseph Bednar can be reached at [email protected]

Law

Prepare for the Unexpected

Jack Ferriter says it’s never too early to talk to an attorney

Jack Ferriter says it’s never too early to talk to an attorney about a healthcare proxy and living will.

Medical decisions aren’t always cut and dry. The way Jack Ferriter sees it, why entrust them to just anyone?

“A healthcare proxy is someone who stands in your shoes to make medical decisions for you, but only if you’re unable to make those decisions,” said Ferriter, who practices business and estate law at Ferriter Law in Holyoke.

The term ‘healthcare proxy’ also refers to the document that specifies who will make those critical decisions for an individual if they can’t make them on their own — for instance, in a medical emergency that has them unconscious or otherwise incapacitated.

For instance, Ferriter explained, “if a surgeon says, ‘do you want this operation?’ and you can shake your head to say ‘yes’ or ‘no,’ the doctor will go with your answer. But if you’re unable to make that decision — or even if you’re unwilling, if you say, ‘I don’t know; please ask my wife, who’s my healthcare proxy’ — then the surgeon would ask your healthcare proxy whether you should have the operation.”

A 2017 study in the journal Health Affairs revealed that one-third of Americans have a healthcare proxy, which is far too low, say estate-planning attorneys and doctors.

“When somebody comes in here and they’re asking for an estate plan, we will always include a will, a power of attorney, and a healthcare proxy and a living will,” Ferriter told BusinessWest. “Everyone should have them. It’s not just for people 65 and older. Anybody could get hit by the proverbial bus and need somebody else to make medical decisions with a healthcare proxy, or financial decisions with power of attorney.”

In a recent blog post, Springfield-based law firm Bulkley Richardson noted that it examined whom its own clients had named as their healthcare proxies, and found that, not surprisingly, a spouse was most common, followed by an adult child.

“Where a child was named, gender, birth order, and whether the child was the parent’s ‘unofficial favorite’ often did not seem to matter,” the firm noted. “Geographic proximity to the parent signing the document, emotional maturity, and perceived alignment with the parent’s preferences seemed to determine who was named.  If a child was in a medicine-related profession, that was often a major factor in the selection.”

“Anybody could get hit by the proverbial bus and need somebody else to make medical decisions with a healthcare proxy, or financial decisions with power of attorney.”

Ferriter recommends that clients name two people — a primary and secondary healthcare proxy — because the designation comes into play at urgent and unexpected times.

“If it’s 2 in the morning and the surgeon is trying to reach your healthcare proxy and doesn’t have the right number, or has a home number that’s going into a machine and needs an answer, or if somebody’s out of the country, it’s always good to have a secondary healthcare proxy so the surgeon can call the secondary one and say, ‘should we do this operation or not?’”

He recommends that cell-phone numbers are used, not landlines, but even then, ringers are sometimes turned off, or phones lose their charge, and no one wants the wrong person to make life-and-death decisions because of a dead battery.

Wishes Granted

In addition to the healthcare proxy, Ferriter recommends clients prepare a living will as well.

“You go down the list and check off or initial each line — you do not wish to be resuscitated, you do not wish to be artificially fed, you do not wish to be artificially kept alive,” he noted.

However, the living will in itself is not a binding legal document in Massachusetts (however, it is in Connecticut and some other states). So why prepare one? Perhaps its greatest value comes in the guidance it gives one’s doctors and healthcare proxy.

“I find it’s a good guide for your conversation with your healthcare proxy and with your family. You go down the list and say, ‘here’s what I want, here’s what I don’t want, and even though this is not legally binding in Massachusetts, I just want you to know so that, if you are making the decisions for me, you’ll have my answers ahead of time.’”

And for those who worry about the finality of the living will, Ferriter pointed out that language on the form states that the living will is to be followed only if there’s no reasonable chance of recovery.

“I know these questions are kind of scary. If you’re 55 years old and it says ‘do not resuscitate,’ you’re afraid that if you walk out my front door and have a heart attack, they’re not going to resuscitate you. But they would, because it says ‘only if there’s no reasonable chance of recovery.’ So if you’re 105 years old in a nursing home and your heart stops, they’re probably not going to paddle you. But if you’re 55 years old and you have a heart attack outside a lawyer’s office, I’m sure they would absolutely paddle you, and wouldn’t even ask anybody.”

A third document related to critical-care decisions that has emerged in recent years is the MOLST document, which stands for medical orders for life-sustaining treatment. And, unlike a living will, MOLST is absolutely a binding document.

“MOLST differs from the most common type of palliative-care planning — advanced directive orders, which usually include a living will or other expression of wishes. Those orders generally designate a surrogate decision maker, or healthcare proxy, to act on behalf of an incapacitated patient,” the Massachusetts Medical Society (MMS) notes.

“Living-will instructions — when presented by a healthcare proxy — are generally recognized as evidence of patient preferences, but are not recognized by Massachusetts law. In contrast, a completed MOLST form travels with the patient at all times, may be faxed or reproduced, and is an official part of a patient’s medical record.”

Ferriter noted that the MOLST isn’t technically a legal document, but a medical one.

“We don’t do them here in the office because the medical orders are done with a physician or a medical professional. Those are your orders, and those are binding in Massachusetts because you’ve had advice from a physician.”

But MOLST is not typically a document prepared absent an impending, planned event, like, say, open-heart surgery.

“Typically, they happen if you are going into the hospital for some kind of serious procedure. My experience is that physicians don’t offer to do medical orders with their patients, but if you ask for them, they’ll do them, and if you’re going in for a serious operation, they may bring it up at that point,” Ferriter said. “You can’t sit at home and fill out medical orders by yourself because you’re not making an informed decision. And it’s usually your primary-care doctor who does it — someone who knows you well — even though the surgeon is doing the surgery.”

MOLST covers resuscitation efforts, breathing tubes and ventilation, artificial nutrition and hydration, and dialysis, the MMS notes.

“MOLST has priority over the healthcare proxy, because it’s your actual wish, as if you had shaken your head ‘yes’ or ‘no’ at the time of the actual procedure,” Ferriter said.

Don’t Put It Off

While many people will never have need of a MOLST, he went on, it’s hard to argue that they won’t need the other documents at some point — and the sooner, the better.

“We tell clients that as soon as you get married or buy a house, have a child, or even graduate from college, it’s not that expensive to do a will, power of attorney, healthcare proxy, and living will,” he noted. “For a single person, it’s less than $300, and for a couple, it’s less than $500.

“A lot of times, older couples will come in upon retirement,” he went on. “Most of the time, they had a previous version of these documents, but things have changed. They had it done in their 30s and 40s, now they’re in their 60s, so we update those.”

Individuals or couples with children will also want to include guardianship documents and perhaps establish a trust in case neither is around to care for them.

“When I have people in their 30s and 40s come in, it’s usually because one of the parents has passed away, or maybe a grandparent has passed away. There’s usually something that pushes them to come in,” Ferriter said, adding that, in truth, it shouldn’t take a big life change to start thinking about who will make important decisions in case crisis strikes.

When folks come in to get their estate plan done, I tell them, ‘you should sit around a dining room table with your family and have a frank coversation about what you want. It can be a difficult conversation, but it’s always better to have it at the dining-room table than around a hospital bed.’”

Joseph Bednar can be reached at [email protected]

The Fourth Installment of BusinessWest’s Future Tense Lecture Series!
Future Tense – Power of the Pause
Thursday, November 8, 2018
8 a.m.-9:30 a.m.
Cost: $25 donation to Tech Foundry
Presenter: Susan O’Connor, Esq.: Health New England, Director & General Counsel

It’s not easy managing in today’s fast-paced, complex, dynamic work environments. Leaders are required to remain focused in the face of a myriad of commitments, to have clarity of mind, to ensure they are doing the right things (not just doing ‘things’), and maintain calm in the midst of daily storms. But what if we as leaders could hit the “pause” button during our day, step back, and meet challenges with a sense of space, clarity and focus? What if there was a way to not just “get things done,” but ensure that what does get done connects us with ourselves, with the people we work with and ultimately, with our organization’s deepest values? Mindfulness is a compelling tool for performance, teamwork and effectiveness as well as presence, kindness and balance. Moira Garvey, Senior Consultant and Facilitator with the Potential Project, will share why mindfulness is relevant in the workplace and why companies around the globe are incorporating mindfulness to support workplace performance and employee well-being.

In this session you will hear how Springfield-based Health New England brought mindfulness training to its Associates. In 2015, HNE ran a pilot to enhance their high performance culture – 30 leaders participated in a 4 month course. HNE leadership knows the key to success is the ability to work at a high level of mental effectiveness, while also remaining resilient in the face of stress. In many industries including health care, the velocity of change, competition and complexity are constant challenges. Since the successful 2015 pilot HNE has continued to invest in Mindfulness training as a way to fortify a culture of high performance that is focused and intentional. In 2017, 63% of the participants held leadership positions

In the foundational session Moira will provide an overview of the nature of the mind and attention, while sharing information on the most recent scientific findings regarding how the brain works and how it can be rewired to enable us to be more focused, calm and effective at work every single day. She will teach a basic mindfulness practice and offer a focus strategy for immediate application.

Presenters:
Moira Garvey, Senior Consultant and Facilitator, Potential Project
Susan O’Connor, Esq., Vice President and General Counsel, Health New England

Cover Story Healthcare Heroes

Scenes from the Healthcare Heroes 2018 Gala

Passion is the word that defines these heroes. And it was on clear display Oct. 25 at the Starting Gate at GreatHorse in Hampden, site of the Healthcare Heroes Gala.

This was the second such gala. The event was a huge success, not because of the venue (although that was a factor) or the views (although they certainly helped), but because of the accomplishments, the dedication, and, yes, the passion being relayed from the podium.

There are seven winners in all, in categories chosen to reflect the broad scope of the health and wellness sector in Western Mass., and the incredible work being done within it. Go HERE to view the  2018 Healthcare Heroes Program Guide

The Healthcare Heroes for 2018 are:

• Patient/Resident/Client Care Provider:

Mary Paquette, director of Health Services/nurse practitioner, American International College

• Health/Wellness Administrator/Administrator:

Celeste Surreira, assistant director of Nursing, the Soldiers’ Home in Holyoke

• Emerging Leader:

Peter DePergola II, director of Clinical Ethics, Baystate Health

• Community Health:

Dr. Matthew Sadof, pediatrician, Baystate Children’s Hospital

• Innovation in Health/Wellness:

TechSpring

• Collaboration in Health/Wellness:

The Consortium and the Opioid Task Force

• Lifetime Achievement:

Robert Fazzi, founder, Fazzi Associates.

American International College and Baystate Health/Health New England are presenting sponsors for Healthcare Heroes 2018. Additional sponsors are National Grid, partner sponsor, and Elms College MBA Program, Renew.Calm, Bay Path University, and Trinity Health Of New England/Mercy Medical Center as supporting sponsors.

HealthcareHeroesSponsors

Photography by Dani Fine Photography

Meet the Judges

There were more than 70 nominations across seven categories for the Healthcare Heroes Class of 2018. Scoring these nominations was a difficult task that fell to three individuals, including two members of the Class of 2017, with extensive backgrounds in health and wellness. They are:

Holly Chaffee

Holly Chaffee

Dexter Johnson

Dexter Johnson

Dr. Michael Willers:

Dr. Michael Willers:

Holly Chaffee, MSN, BSN, RN: Winner in the Healthcare Heroes Health/Wellness Administrator/Administration category in 2107, Chaffee is president and CEO of VNA Care, a subsidiary of Atrius Health. Formerly (and when she was named a Healthcare Hero) she was the president and CEO of Porchlight VNA/Homecare, based in Lee.

Dexter Johnson: A long-time administrator with the Greater Springfield YMCA, Johnson was named president and CEO of that Y, one of the oldest in the country, in the fall of 2017. He started his career at the Tampa Metropolitan Area YMCA, and, after a stint at YMCA of the USA, he came to the Springfield Y earlier this decade as senior vice president and chief operating officer.

Dr. Michael Willers: Winner in the Patient/Resident/Client-care Provider category in 2017, Willers is co-owner of the Children’s Heart Center of Western Mass. Formerly a pediatric cardiologist with Baystate Children’s Hospital, he founded the Children’s Heart Center of Western Mass. in 2012.
 

 

Health Care

Deep Dive

Stacey Kronenberg (right), operations manager at Achieve TMS East

Stacey Kronenberg (right), operations manager at Achieve TMS East, demonstrates the dTMS technique with technician Sara Pittman.

With data in hand showing that its signature treatment — known as deep transcranial magnetic stimulation — has a strong track record in battling depression, Achieve TMS East has seen significant growth in the region. Now it has further reason to be excited, with the technique showing great promise in treating OCD.

Margie Pierce understands the difficulty — and, yet, the importance — of tackling the problem of depression.

“It’s the leading cause of disability worldwide right now,” said Pierce, a licensed clinical social worker and director of operations at Achieve TMS East, a fast-growing chain of behavioral-health practices that employ an innovative approach to treating depression known as deep transcranial magnetic stimulation, or dTMS.

“We’ve had people who were chronically depressed for 20 years have a fabulous response to this, and we’ve had people chronically depressed who have not had a great response,” she told BusinessWest. “We can’t pigeonhole people when they come in, whether they’re going to respond or you’re not. It’s kind of hit or miss, just like with medications. Some people respond to certain medications, and others don’t.”

That said, however, dTMS has proven remarkably effective in most people who undergo it — in many cases, people who have tried a seemingly endless string of medications and therapies with little success. That explains why the organization has grown to 11 offices across Western Mass., with broader geographic expansion planned.

“We can’t pigeonhole people when they come in, whether they’re going to respond or you’re not. It’s kind of hit or miss, just like with medications. Some people respond to certain medications, and others don’t.”

Deep transcranial magnetic stimulation, or dTMS, is a non-invasive technique that applies a series of brief magnetic pulses to the brain, by passing high currents through an electromagnetic coil placed adjacent to a patient’s scalp. The pulses induce an electric field in the underlying brain tissue and activates underactive areas in the brain associated with depression.

Dr. John Zebrun, senior medical officer with Achieve TMS East, said transcranial magnetic stimulation (TMS) was developed in Europe in the 1990s, and the first machine to receive FDA approval in the U.S. was the Neurostar machine, in 2008, which reached two to three centimeters into the brain, unlike dTMS — developed by an Israeli company called BrainsWay — which reaches six to seven centimeters in, and earned FDA approval in 2013.

“It enables you to get deeper into the brain tissue, so the volume of brain tissue is larger,” Zebrun told BusinessWest. “We don’t miss the target, ever, and there’s more stimulation in that area.”

The developers of the original TMS technique, he explained, wanted to discover if there were circuits or networks in the brain tissue they could stimulate to ease clinical depression. They targeted the left prefrontal area, which imaging scans suggested were underactive in patients with depression.

“The thought was to stimulate that area first and get it closer to a normal activity level, and that would help with depression — and it did. And that still is the primary target,” he said, noting that the device produces a magnetic field, not an electric current. “It’s getting groups of neurons in the circuit to fire together. As they get used to firing together, they’re more connected to each other.”

After a standard treatment of 36 sessions, he went on, those neurons become trained to fire normally. Treatment statistics show that 51% of patients who undergo the entire protocol get all the way to remission, while 75% get at least halfway to their goal. About one-third will need repeat, ‘booster’ treatments down the road, while two-thirds don’t.

Dr. John Zebrun says deep transcranial magnetic stimulation gets deeper into the brain than traditional TMS

Dr. John Zebrun says deep transcranial magnetic stimulation gets deeper into the brain than traditional TMS — and shows great promise for OCD as well.

In short, those are great numbers for a depression treatment, Zebrun said, and that success explains why Achieve has grown so rapidly across the region — and promises to become a more widely known name across the Northeast.

Long Time Coming

The breakthrough in TMS occurred in 1995, Zebrun said; that was when researchers first demonstrated that a magnetic field could stimulate the right neurons and get a response.

“So it’s been around a long time,” he said. “It varies from machine to machine, but they’re all operating within a certain range and certain power level to get the antidepressant effects.”

FDA approval was only one key development, however; insurances companies still needed to pay for the treatment if doctors hoped to reach a wide market. Medicare accepted it in 2015, and other payers soon came on board.

The FDA originally approved TMS for patients who had failed to find relief with another antidepressant treatment. “But insurance companies added extra layers, expecting to see about four medication and psychotherapy trials before they give this approval,” Zebrun said. “But a lot of people out there have already been through years of treatment and tried several medications.”

Dr. Thomas Bombardier, an ophthalmologist turned businessman, was involved with launching a chain of Achieve TMS businesses in California, Pierce told BusinessWest, and when he saw the benefits and how patients were responding out west, he decided to bring the model to his Western Mass. stomping grounds, teaming with two other owners to open Achieve TMS East.

Patients are referred to Achieve by their primary-care doctors, therapists, and psychiatrists, and some self-refer after hearing about the practice through social media or friends or family members.

“We’re very open to however they can get into the door to get the help they need,” Pierce said, noting that, while the majority of people who seek out tDMS are good candidates for it, some aren’t, due to medical contraindications, recent seizures, or even metal in the head that could heat up during the treatment. Everyone also gets a psychiatric consult to see if the treatment will be appropriate.

Stacey Kronenberg, operations manager at Achieve TMS East, demonstrated the dTMS technique for BusinessWest on Sara Pittman, a technician with the practice, although at a very low power level. Pittman put on a soft cap followed by the dTMS helmet, and Kronenberg set the device to a single-pulse mode, moving centimeter by centimeter until she found the motor area for Pittman’s hand, which twitched. From this process of ‘mapping,’ she could locate the right area to target for treatment.

The power setting isn’t uniform for each patient, and can be altered by the thickness of the skull, how much sleep the patient got the night before, even how much coffee they drank that morning. The process involves 36 ‘taps’ in two seconds as the neurons are stimulated, followed by a 20-second break, then another 36 taps in two seconds, then a 20-second break — a cycle repeated 55 times, totaling just over 20 minutes.

Initial treatments are run at lower power than later treatments to desensitize the patient to the sensation, which Pittman described as more of an annoyance — like a woodpecker tapping at her head — than anything. “It’s a tolerable discomfort,” Zebrun added. “I wouldn’t say it’s a breeze, but it’s tolerable.”

Margie Pierce

Margie Pierce says some people have come in after battling depression for 20 years — and finally found relief through dTMS.

Some patients pass the time by chatting with the technician, while others choose something to watch on Netflix, on the big TV hung on the wall beside the treatment chair.

“A lot of people, at the end, are like, ‘oh, I’m done already?’ They’re enjoying their conversation or their show,” Kronenberg said. “I think we should work for Netflix. A lot of people come in and are like, ‘I want to get Netflix.’”

That’s because they’re at the office often enough to binge a lot of TV — five days a week for six weeks, in fact, which is how long it takes to train the brain. “A lot of patients don’t want to leave when it comes to the end of their treatment,” she said. They tell us, “I’m so used to coming and seeing you. Who can I talk to now?’”

Beyond Depression

For starters, they can talk to their loved ones, in most cases, about how effective the treatment was. And depression isn’t the only use for dTMS. The FDA recently approved it as a treatment for obsessive compulsive disorder. In fact, dTMS has been successful in trials for OCD in ways that traditional TMS cannot be, because the target area of the brain is deeper than for depression.

“The surface coils [of TMS] would need so much energy to get that deep, it would hurt. The surface area would get too much stimulation rather than area you’re targeting, and you’d risk a seizure. That wouldn’t happen with dTMS,” Zebrun explained.

He said he hopes to reach people who don’t find standard cognitive treatment for OCD effective. “It can devastate one’s life. You can get wound up into some of these compulsions, or your mind can be so caught up and obsessed with obsessive thinking that you can’t focus on anything else. You can’t get through a planned project because there’s too many interruptions from your loops of thought that come in. There’s a wide range of those obsessions and compulsions.”

Even milder symptoms of OCD can really bother people, he added. “They wish they could get rid of these images popping into their head that started from nowhere and have no relation to anything in their lives and are disturbing to them.”

“They’ll say, ‘why wouldn’t you try this? What do you have to lose, except maybe your depression?’ … For most people, it’s going to help.”

Kronenberg also hopes dTMS makes an impact on the lives of these patients, noting that OCD is one of the most thorny issues that therapists tackle. And, much like depression, she added, OCD can be a “hidden” disease because there’s some stigma and shame associated with it.

But there shouldn’t be, Zebrun said, especially when something like dTMS exists, with its strong track record and its minimal side effects, which may include facial muscle contractions and headaches, which are both temporary. Fewer than one patient in 1,000 may experience a seizure — a risk similar to that of taking an antidepressant medication at the maximum dose.

Because it’s tolerable, he added, patients can do it before or after work, or during their lunch break, and return to their normal activities.

And maybe a normal life.

“People who for 20 years were depressed say it’s life-changing for them,” said Anita Taylor, marketing director at Achieve TMS East. “When we hear those kind of stories, we’ll ask them, ‘what would you say to someone thinking about this?’ They’ll say, ‘why wouldn’t you try this? What do you have to lose, except maybe your depression?’ It’s worth it to give it a try, go in wholeheartedly, and, for most people, it’s going to help.” u

Joseph Bednar can be reached at [email protected]

Health Care

In Search of Empathy

Catherine Williamson

Catherine Williamson says empathy is at the heart of the dementia-friendly movement.

Empathy is a quality America can always use more of — and that’s especially true, Catherine Williamson said, when it comes to families struggling with dementia.

“What attracted me to the dementia-friendly movement is being able to help individuals adjust to what’s going on in their lives,” she recently told a group of business leaders, who met for lunch at the Student Prince in Springfield for a presentation by the Springfield Dementia Friendly Coalition.

“It’s about empathy, and some of us are not great at being empathetic,” she went on. “Our lives are fast-paced, and we’ve got a lot going on — kids, jobs, husbands and wives, volunteering. We’ve got so much going on that, sometimes, we forget to stop and think about someone else not being able to move as fast as we can, or understand things the way we can.”

Williamson, a certified dementia practitioner and gerontologist with SilverLife Care at Home, said a goal of the dementia-friendly movement is to educate the community, and even the loved ones of people with dementia, about how daily experiences differ for individuals with that condition — everything from going to the library to visiting a doctor; from having a financial-planning meeting with an attorney to simply eating out at a restaurant.

To demonstrate, she led the lunch attendees in a virtual ‘dementia experience,’ in which participants use common objects to block or hinder their eyesight, hearing, range of hand motion, and other faculties, then try to communicate with each other — again, as a way to create empathy and reinforce the need for dementia-friendly changes in society.

“People with functional limitations are dealing with this constantly,” she said. “Imagine how much this impacts their daily lives, their relationships, getting around, even wanting to be out in the community. If you felt like this all the time, in this impaired state, you’d probably want to stay home, too. We need to think about how to make our communities and businesses and public spaces a little easier to navigate.”

The business leaders at the lunch shared their professional and personal experiences with dementia and learned about what it would mean to make Springfield a dementia-friendly community — a designation that an increasing number of Massachusetts cities and towns have been pursuing, one in which businesses, municipal departments, and other entities make a collective effort that help people who are memory-challenged to function in the community and live independently for as long as possible.

“Sometimes, we forget to stop and think about someone else not being able to move as fast as we can, or understand things the way we can.”

“What can we do as a community to improve the quality of lives?” asked Anna Randall of Greater Springfield Senior Services, one of the coalition members. “Being dementia-friendly means different things to different communities, depending on their populations and what resources they already have. We’re here to ask businesses what we can do to help your clients and make this community dementia-friendly.”

At a Loss

Nearly 5.1 million Americans age 65 and older are living with Alzheimer’s disease, the most common form of dementia, and the number is expected to reach 7.1 million in the next decade. Nearly 60% of people with dementia live in their own communities, and one in seven live alone, creating an urgent need, dementia-friendly advocates say, for communities to support people with dementia and their caregivers. 

Attendees of the recent Springfield Dementia Friendly Coalition

Attendees of the recent Springfield Dementia Friendly Coalition lunch underwent a virtual ‘dementia experience’ to get a small taste of what’s it’s like to navigate the world with cognitive impairment.

Meghan Lemay, regional manager in the Springfield office of the Alzheimer’s Assoc., said Alzheimer’s disease is a true epidemic, currently the sixth-leading cause of death in the U.S. and the only major disease that has been increasing in incidence — by a 123% rate since 2000, in fact. At the same time, incidences of diseases like cancer and heart disease have been falling.

In addition, she noted, Alzheimer’s is the most expensive disease in America, expected to cost the healthcare system and caregivers some $277 billion in 2018 alone.

“It’s something we have to address on multiple fronts,” Lemay said. “We know it impacts families directly and has a significant emotional impact, but there’s also a significant financial impact for individuals and our communities.”

Springfield, in fact, is disproportionally affected, with a higher rate of dementia than other Massachusetts communities on average. Demographically, meanwhile, the condition affects African-Americans and Latinos at a higher rate than whites.

While individual communities seek the dementia-friendly designation, a state-level organization known as Dementia Friendly Massachusetts is supporting those efforts. On the community level, Randall noted, businesses who go through dementia-friendly training can then display that fact, “to say this company has gone the extra mile to show they care about their community and want to be more inclusive for people caring with dementia.”

“It’s something we have to address on multiple fronts. We know it impacts families directly and has a significant emotional impact, but there’s also a significant financial impact for individuals and our communities.”

Williamson noted that such steps by businesses could include modifying entryways, altering lighting, or changing the ways they interact with customers. And the changes don’t have to be dramatic. For example, a coffee shop in Boston became more dementia-friendly when it complemented its chalkboard menu with large-print menus at the register. “It’s little things like that — different types of things you can do.”

One attendee of the recent lunch in Springfield noted that some businesses have gone the opposite route, citing the increasing use of automated ordering kiosks at McDonald’s and the dominance of self-checkout lanes at Stop & Shop as two developments that can be problematic for certain individuals.

However, on the plus side, many restaurants have embraced the Purple Table training program designed to help visitors with dementia, autism, PTSD, hearing or vision impairment, or other conditions benefit from a more predictable environment and additional accommodations when dining out.

When families make a Purple Table reservation, participating restaurants provide accommodations that work best for that diner, along with extra patience and attention from staff who have been trained to understand different needs and how to best meet them. Those steps might differ depending on the visitor, but the underlying philosophy of empathy and understanding is the same.

Law and Order

The recent lunch gathering was funded by a dementia-friendly capacity-building grant from the Massachusetts Council on Aging under a service incentive grant from the Massachusetts Executive Office of Elder Affairs, allowing the coalition to hold focus-group meetings with local government and public officials, first responders, and members of the business community.

The goal is to make them aware of the issues facing individuals living with dementia, their friends, family, and care partners; to give an overview of the movement; and to elicit their thoughts and engagement in the initiative. In addition, the group will meet with those living with dementia and their care partners.

The coalition chair, Synthia Scott-Mitchell from Springfield Partners for Community Action, noted that “a dementia-friendly community is defined as one that is informed, safe, and respectful of individuals with dementia and their families, and provides supportive options for improved quality of life.”

But legislators can make a difference, too, and recently did, by passing a first-of-its-kind bill — subsequently signed into law by Gov. Charlie Baker — that aims to make life a little easier for individuals with dementia and their families, through a multi-pronged approach.

More than 130,000 people are currently living with Alzheimer’s disease in Massachusetts, and being cared for by more than 337,000 family and friends. According to the Alzheimer’s Assoc., in 2018, Massachusetts will spend more than $1.6 billion in Medicaid costs caring for people with Alzheimer’s.

“Alzheimer’s is the single largest unaddressed public health threat in the 21st century, and we remain on the front lines of this crisis every day here in the Commonwealth,” said Daniel Zotos, director of Public Policy & Advocacy of the Alzheimer’s Assoc., Massachusetts/New Hampshire Chapter. “This legislation follows in the tradition of Massachusetts being a national leader in healthcare, and we commend the governor and Legislature for ensuring everyone impacted by Alzheimer’s gets the quality care and support they deserve.”

Among its mandates, the bill:

• Establishes a comprehensive state plan to address Alzheimer’s disease within the Executive Office of Health and Human Services, while also establishing a permanent advisory council to help coordinate government efforts and ensure that public and private resources are maximized and leveraged;

• Requires curriculum content about Alzheimer’s and other dementias be incorporated into continuing-medical-education programs that are required for granting the renewal of licensure for physicians, physician assistants, registered nurses, and licensed nurse practitioners;

• Ensures proper notification of an Alzheimer’s or dementia diagnosis to the family or legal guardian and provides information on available resources to both the patient and family;

• Requires state hospitals to implement an operational plan for the recognition and management of patients with dementia or delirium; and

• Establishes minimum training standards for social workers in elder protective services, to ensure protection from abuse and exploitation for elders with Alzheimer’s and dementia.

Small Steps, Big Impact

When it comes to making communities more navigable and manageable for people with dementia, every effort helps, Williamson said, noting that the dementia-friendly movement also seeks to raise awareness — often through workplace presentations — of resources available to help families grapping with Alzheimer’s, when they’re not always willing to seek them out because of shame or stigma.

“If we go into your workplace and address your employees, we’re reaching folks that might need help,” she said. “It’s not just about doing the right thing for your customers, but also for your staff — folks who are taking care of their loved ones, but might not want to come forward.”

As the statistics show, those folks are legion. Increasingly, Williamson and her fellow coalition members hope, they are starting to find their communities a little friendlier, in some very important ways.

Joseph Bednar can be reached at [email protected]

Cover Story Healthcare Heroes

Healthcare Heroes to Be Saluted on Oct. 25

HealthcareHeroes18

Passion.

If one were challenged to describe the Healthcare Heroes for 2018 — or any year, for that matter — with just a single word, this would be the one.

It is a common character trait within any healthcare profession, but it is certainly necessary to rise above the tens of thousands of men and women in this field and earn that designation ‘hero.’

And it is certainly a common denominator in the remarkable and truly inspiring stories. The passion comes to the fore whether that story is about a career emergency-room nurse who shifted to work at college wellness centers and completely transformed the one at American International College, or about a nurse administrator at the Soldiers’ Home in Holyoke who is transforming care there while also serving as a mentor and role model for other team members. It’s the same when the story is about a large, multi-dimensional effort to battle opioid and heroin addiction in rural Franklin County, or about a pediatrician dedicated not only to the residents of a community, but to making that community a healthier place to live.

Fast Facts

What: The Healthcare Heroes Gala
When: Thursday, Oct. 25, 5:30-8:30 p.m.
Where: The Starting Gate at GreatHorse, Hampden
Tickets: $90 (tables of 10 available)
For more Information: Email [email protected]

That we said, passion is the word that defines these heroes. And it will be on clear display on Oct. 25 at the Starting Gate at GreatHorse in Hampden, site of the Healthcare Heroes Gala.

This will be the second such gala. The inaugural event was a huge success, not because of the venue (although that was a factor) or the views (although they certainly helped), but because of the accomplishments, the dedication, and, yes, the passion being relayed from the podium. It will be same in about seven weeks.

But first, the stories that begin on the facing page.

There are seven winners in all, in categories chosen to reflect the broad scope of the health and wellness sector in Western Mass., and the incredible work being done within it:

The Healthcare Heroes for 2018 are:

• Patient/Resident/Client Care Provider:

Mary Paquette, director of Health Services/nurse practitioner, American International College

• Health/Wellness Administrator/Administrator:

Celeste Surreira, assistant director of Nursing, the Soldiers’ Home in Holyoke

• Emerging Leader:

Peter DePergola II, director of Clinical Ethics, Baystate Health

• Community Health:

Dr. Matthew Sadof, pediatrician, Baystate Children’s Hospital

• Innovation in Health/Wellness:

TechSpring

• Collaboration in Health/Wellness:

The Consortium and the Opioid Task Force

• Lifetime Achievement:

Robert Fazzi, founder, Fazzi Associates.

American International College and Baystate Health/Health New England are presenting sponsors for Healthcare Heroes 2018. Additional sponsors are National Grid, partner sponsor, and Elms College MBA Program, Renew.Calm, Bay Path University, and Trinity Health Of New England/Mercy Medical Center as supporting sponsors.
HealthcareHeroesSponsors

Photography by Dani Fine Photography

Tickets to the Oct. 25 gala are $90 each, with tables of 10 available for purchase. For more information or to order tickets, call (413) 781-8600, or email [email protected]

 

Meet the Judges

There were more than 70 nominations across seven categories for the Healthcare Heroes Class of 2018. Scoring these nominations was a difficult task that fell to three individuals, including two members of the Class of 2017, with extensive backgrounds in health and wellness. They are:

Holly Chaffee

Holly Chaffee

Dexter Johnson

Dexter Johnson

Dr. Michael Willers:

Dr. Michael Willers:

Holly Chaffee, MSN, BSN, RN: Winner in the Healthcare Heroes Health/Wellness Administrator/Administration category in 2107, Chaffee is president and CEO of VNA Care, a subsidiary of Atrius Health. Formerly (and when she was named a Healthcare Hero) she was the president and CEO of Porchlight VNA/Homecare, based in Lee.

Dexter Johnson: A long-time administrator with the Greater Springfield YMCA, Johnson was named president and CEO of that Y, one of the oldest in the country, in the fall of 2017. He started his career at the Tampa Metropolitan Area YMCA, and, after a stint at YMCA of the USA, he came to the Springfield Y earlier this decade as senior vice president and chief operating officer.

Dr. Michael Willers: Winner in the Patient/Resident/Client-care Provider category in 2017, Willers is co-owner of the Children’s Heart Center of Western Mass. Formerly a pediatric cardiologist with Baystate Children’s Hospital, he founded the Children’s Heart Center of Western Mass. in 2012.
 

 

Healthcare Heroes

This Compassionate Leader Has Transformed Health and Wellness on the AIC Campus

Mary Paquette

Mary Paquette

‘Sex and Chocolates.’

Sounds like one of Hollywood’s late-summer releases. But instead, it’s one of the many intriguing new programs and initiatives launched by Mary Paquette, MS, FNP, in her role as director of Health Services at American International College.

And now that we have your attention — and we almost certainly do — we’ll tell you about it.

Not long after arriving at the college in 2012 to accept the challenge of resuscitating a moribund health-services facility that few students knew about or ventured to (for a host of reasons we’ll get into later), Paquette decided she needed to do some serious outreach.

And it would be undertaken with a number of goals — from introducing (or reintroducing) students to the health facility (known as the Dexter Center) to providing some education, to gaining some insight into the many issues and challenges confronting AIC’s diverse population, many of them first-generation college students.

“There were questions on everything from STD education to things you would think of with Dr. Ruth; I learned some things from these students, and it ended up being a lot of fun.”

So, as part of this outreach, Paquette and Millie Velazquez, office manager and medical assistant at the center, went into one of the female freshman dorms with a large fishbowl containing some questions they had already put in, some chocolates, and a thirst for more questions about sex from the students they greeted.

“If they were brave enough to ask a question, they got a chocolate,” said Paquette, who recalled, with a large dose of pride, that she and Velazquez left with considerably fewer treats than they arrived with. “There were questions on everything from STD education to things you would think of with Dr. Ruth; I learned some things from these students, and it ended up being a lot of fun.”

As noted, Sex and Chocolates is just one of many initiatives Paquette has introduced since arriving. Overall, she has taken the campus service that was traditionally ranked dead last in surveys of students and made it one of the more highly scored.

Far more importantly, she has taken health and wellness to a much higher plane on the AIC campus, providing not just Band-Aids and Tylenol — which is about all the ‘old’ center was known for — but also a welcoming, non-judgmental environment that has improved quality of life on the campus in myriad ways.

For all that, Paquette was named the Healthcare Hero in the category of Patient/Resident/Client Care Provider, which is among the most competitive, with nominees from across the broad spectrum of healthcare.

Mary Paquette and Millie Valazquez, office manager and medical assistant at the Dexter Center

Mary Paquette and Millie Valazquez, office manager and medical assistant at the Dexter Center, have changed attitudes about the center, and created a healthier campus community, through programs like ‘Sex and Chocolates.’

And it’s a category Paquette has essentially devoted her life to, with AIC being only the latest stop in a 35-year career that has seen her take on a variety of roles in a host of settings. These range from director of Nursing at Ludlow Hospital to per-diem hospitalist at in the GI Department of the Eastern Connecticut Health Network, to assistant director of Health Services at Western New England University — the job that became the springboard to her post at AIC.

And there is a huge amount of overlap when it comes to the lines on her résumé, which Paquette explained quickly and effectively.

“I have a lot of energy, and I like to keep busy,” she said in a classic bit of understatement.

Indeed, she does, and at AIC this energy has translated into profound and very positive change, which was summed up by Robert Cole, the college’s vice president of Marketing & Communications, as he nominated Paquette to be a Healthcare Hero.

“Since arriving in 2012, Mary has almost single-handedly transformed the capabilities and perception of AIC’s Dexter Center for Health and Counseling Services,” he wrote. “She has worked tirelessly and passionately to reach students through new, campus-wide health programming and healthy-living promotion; expanded the scope and availability of Dexter’s services; and routinely works off hours to meet the emergency needs of students, student-athletes, faculty, and staff. She has done all this with limited medical staff and budget, and unlimited dedication, compassion, and extraordinary patient care and customer service.”

With that summation as the backdrop, we’ll explain how this transformation took place and what it means for all those — and we mean all those — on the AIC campus.

Sweet Success

The large Victorian home on Wilbraham Road that houses the Dexter Center has enjoyed a long history at the college and filled a number of roles.

It was once the president’s home, for example, and it has housed classrooms, a photography lab, and other facilities.

But when Paquette first saw it in the summer of 2012, she simply couldn’t believe that its role at that time was home to health services.

“It was falling down, the floors were this awful purple tile, it was filthy … I told Mark, ‘I wouldn’t come here for healthcare,’” she recalled, referring to Mark Berman, then vice president of Administration, who has since passed away. The building was in such poor condition that it was almost a deal breaker when it came to the position she was being offered.

Berman was neck deep in getting the dormitories ready for fall, but he promised Paquette that by October, she would see radical improvement in the Dexter Center. He made good on that pledge, but Paquette spent every weekend her first month on the job cleaning it out herself.

“There were ACE wraps that were disintegrating because they sat on shelves for long,” she recalled, adding that dirt on the floor wasn’t the only thing she cleaned out. There was also the receptionist on duty at the time who was so unfriendly, students hated coming to the facility.

But tidying up the Dexter Center and making it a far more welcoming — and less purple — place were only the first steps in a multi-layered process, and only the latest chapter in a long and quite rewarding career in healthcare.

So before returning to Sex and Chocolates and other endeavors at AIC, let’s go back … to the former Ludlow Hospital.

That’s really where the story starts, because, well, Paquette was born there and grew up only a few blocks away. She worked there as a nurse’s aide when she was 18 and in the ER while in college, and, after earning her bachelor’s degree in nursing at Elms College and spending the first several years of her career in the Boston area, that’s where she returned to.

She would eventually become the last director of Nursing at the facility, which would close its doors in 1994. But Paquette has never forgotten the mentorship she received there or the many connections she made that continued to benefit her throughout her career.

Ludlow’s closing prompted her to go back to school and earn her master’s degree in the Family Nurse Practitioner program at UMass Amherst in 1999, and, as noted earlier, she would put it to use in a number of settings over her long career as a care provider. They include Noble Hospital in Westfield, the Johnson Occupational Medicine Center in Enfield, Johnson Memorial Hospital in Stafford Springs, Hartford Hospital, and Mercy Medical Center.

Starting in 1999, though, her main employer would not be a hospital or medical center (although she would continue to work for several of them), but an institution of higher learning.

Wilbraham Road that housed the Dexter Center

When Mary Paquette first saw the facility on Wilbraham Road that housed the Dexter Center, she couldn’t believe people came there for healthcare.

At Western New England University, she started as a provider — and there was only one at the health center at any given time. “So you just put the pedal to the metal,” he recalled. “But for me it was OK, because it was just like the ER atmosphere … you just go, go, go and see one patient after the other. The trick in that is being able to be efficient, but also make patients feel like you’re listening to them and not rushing them.”

Remember that thought later.

At WNEU, she was mentored by the director of Health Services there, Kathy Reid, who, Paquette said, “was open to anything and everything I wanted to do.”

That meant such things as adding IVs to the list of services, as well as suturing and other initiatives. “Over the course of 13 years, we built Western New England’s facility into an amazing clinic. And when they built the new Pharmacy building and they added a new health services [facility], we even had a little surgery suite … we took off more toenails in the fall from turf toe.”

Remember those thoughts as well.

Paquette said she loved her time at WNEU and had no desire to leave. But then, Brian O’Shaughnessy, then AIC’s dean of students and now vice president for Student Services, hired Reid as a consultant to evaluate an underperforming health-services department — what Paquette described as a glorified (maybe) “high-school nurse’s office” — and recommend changes.

In her report, Reid said, in essence, that the school needed to hire a director of Health Services. And she had the perfect candidate — her second in command — in mind.

Something to Chew on

As noted earlier, the Dexter Center simply wasn’t a popular, or busy, place before Paquette arrived. Summing up why, she said simply, “one, it wasn’t marketed, two, it didn’t offer much care beyond Band-Aids and Tylenol, and three, the it had a secretary who was a real grouch.”

So … she set about changing all that and more. One of the first things she did was hire Velazquez (a referral from her mentor, Reid) and broaden that position to one of office manager and medical assistant.

Through what Paquette described as “an over-the-top friendly personality,” Valezquez has changed the atmosphere in the center, making it more welcoming, more efficient, and far-more visitor-friendly.

Meanwhile, the two have together gone about greatly adding to its roster of services and doing that marketing that was a big missing piece.

With the former, they’ve added IVs and suturing, as happened at WNEU before, and also STD testing, safe-sex education, a bowl filled with condoms in the waiting room, counseling, ongoing education into how the healthcare system works, and, most importantly, no judgment.

Overall, Paquette said she wants to make students better healthcare consumers.

“I feel that a large part of my job is teaching students how to be good healthcare advocates,” she explained. “I want them to leave AIC with a better understanding of their own health and the tools they need to navigate the world of healthcare.”

Regarding the latter, Paquette knew it wouldn’t do any good to make all those other changes if students and other constituencies didn’t know about them. And she knew from her time at WNEU that the place to start was with the resident advisors in the dorms.

With their support, she went about creating what she called silly but also effective programs. Like Sex and Chocolates.

“When you’re doing a dorm program in the evening, you have to be entertaining,” she explained. “The healthcare piece of it … you slip that in when they’re not looking. It was more about them, the students, seeing Millie and I, and seeing that we’re friendly and we’re non-judgmental, but we also know what we’re doing.”

Paquette and Velazquez have initiated other programs with the same goals and underlying mindset, including ‘Cards Against Humanity; AIC Edition,’ a takeoff on the popular party game. Sprinkled in with the offensive, risqué, and politically incorrect ‘answer cards’ are several related to birth control, STDs, the Health Services department, and more.

“You sort of slide those questions in, the students get them, but they’re having fun, and they don’t realize that you’re educating them,” Paquette explained. “We’ve created lots of fun games like that.”

But there were other constituencies to connect with, she went on, starting with the athletes on campus. Each team has trainers, she noted, but there was a disconnect, if you will, between the students, trainers, and health services.

That’s ‘was,’ because Paquette set about improving communications and building bridges. And soon, athletes were finding the Dexter Center for suturing, screenings, and other services.

“I feel that a large part of my job is teaching students how to be good healthcare advocates. I want them to leave AIC with a better understanding of their own health and the tools they need to navigate the world of healthcare.”

“We have rugby here,” she noted. “In those first two years, I’d come in at least a dozen times at night, go to the athletic trainers’ room, throw some stitches in a kid’s head, and go home. My deal with the trainers was, they all had my cell phone, they could call, and as long as I wasn’t working one of my ER shifts, I’d come in; that’s how we won over athletics.”

Paquette and Velazquez have also won over commuting students, college employees, students who remain on the campus during the summer, and other constituencies. The health and wellness center that no one visited is now the facility everyone visits.

Stitch in Time

Paquette doesn’t just work at AIC; she has become, for lack of a better term, a huge booster.

On top of the cabinet in her office sit three large wooden block letters — ‘A,’ ‘I,’ and ‘C.’ And she has much more swag, as she called it, all bearing the school’s letters, logo (a muscular, mean-looking yellowjacket), and color — yellow (obviously).

The item she’s most proud of, though — perhaps even more than a full bowl of questions during a presentation of Sex and Chocolates — is a T-shirt given to her by the rugby team signed by all the players, many of whom had seen Paquette for some stitches.

Maybe more than anything else, that T-shirt shows just how much the health and wellness center has grown since Paquette arrived, and how it has ceased being a college service and instead become a powerful force on campus.

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

Healthcare Heroes

At the Soldiers’ Home, She’s a Nurse, Leader, Mentor, and Role Model

Celeste Surreira

Celeste Surreira

Celeste Surreira was talking about her work, and, more specifically, the unique constituency she serves, when she abruptly stopped in mid-sentence.

Strains of “Anchors Away,” the fight song of the U.S. Naval Academy, had permeated the walls of her office, and she knew exactly what that meant: the Soldiers’ Home in Holyoke was giving a Navy veteran a ‘farewell.’

Rising from her seat quickly, she invited BusinessWest to follow her to what she promised would be a solemn and immensely powerful ceremony. That was an understatement.

In the front lobby of the Soldiers Home sat a casket covered by a quilt, patterned specifically for a Navy veteran, that was made by one of the facility’s nurses. Behind it stood many family members. To the sides were Soldiers’ Home staffers, who, in many respects, are also ‘family’ for this individual — and all other veterans who come there.

Collectively, they assembled, with hands over their hearts, and heard about his life — not just about his service in the Seabees (the U.S. Naval Construction Battalions) during World War II, but about his family (three sons, 13 grand-children, and “eight, soon to be nine” great-grandchildren); the decades he spent as a commercial painter (he and his father helped paint the Soldiers’ Home when it first opened in 1952); his love for Holyoke, his long-time home; his affection for golf; and more.

Then came “Taps.” And many tears.

Walking back to her office, Surreira put the ceremony in its proper context, and in so doing helped explain why she came to the Soldiers’ Home in 2014 and why she is so passionate about the many facets of her work that she was named the Healthcare Hero in arguably the most competitive category — Health/Wellness Adminstrator/Administration.

“They go out the same door they came in — it’s our honor to them,” she said of the servicemen and women being given a farewell. “And that’s very important. When I worked in the hospital, death was something we hid, like it was like a failure; they [deceased patients] went out the back door. Here, death is a celebration of life; there’s no shame. They go out the front door.”

“When I worked in the hospital, death was something we hid, like it was like a failure; they [deceased patients] went out the back door. Here, death is a celebration of life; there’s no shame. They go out the front door.”

Surreira would speak often about the veterans she now serves as she talked about her career and her current work, because the clientele, if you will (they simply call them ‘veterans’ here), is truly unique, and this is reflected in everything from how services are delivered to how these individuals are addressed.

“I thought this was a really interesting population to have the honor to work with,” she said, adding that the Soldiers’ Home, a 265-room, long-term-care facility (which also has outpatient services and a domiciliary), represents a significant career shift for her, with most of her 33 years in nursing having been spent in the emergency room. But in many ways, the issues and challenges facing veterans at the facility and the providers caring for them mirror those of society in general as the population ages and people live longer.

“This is where healthcare is going,” she told BusinessWest. “The population is living longer with chronic diseases. This is the population with which we’re really going to have to make an impact if we’re going to manage the needs of the overall population over the next 30 years.”

In her role as assistant director of Nursing, Surreira has a lengthy job description, and considers herself — and, more to the point, she’s considered by others — to be a care provider, leader, teacher, mentor, and role model.

And she takes each of those responsibilities very seriously, especially the leader and role-model parts.

“Leadership and management are two different things,” she told BusinessWest. “You can manage, which means doing payroll or doing a schedule or telling someone what to do. Or you can lead, which to me means inspiring people to become leaders.

“You can’t lead if you don’t have emotional intelligence,” she went on. “People are just going to see you as the boss. And no one really follows the boss; they’re not inspired by bosses. I’ve always said, if you have to tell someone what your title is in order for them to know you’re the leader, then you’re not really the leader — someone else in the room is the leader.”

One of Surreira’s working definitions of a leader is that of an individual who can work with others to achieve positive change and improve quality of life for those being served, and as we’ll see, there are many examples of how she’s been able to do just that, and thus become a true Healthcare Hero.

Walking the Walk

They call it the ‘Walk Across America.’

This is a walking track of sorts at the Soldiers’ Home, located just outside the facility’s rehab area; 22 laps equals a full mile. There’s a mural covering a few hallways depicting different places across the country, hence the name, said Surreira, and different administrators are actually assigned to certain veterans to walk with them across America on days the veterans choose themselves.

Celeste Surreira says the Walk Across America

Celeste Surreira says the Walk Across America (that’s the St. Louis panel within the mural behind her) is one of many initiatives aimed at improving the mobility of veterans at the Soldiers’ Home in Holyoke.

The track is one of several ‘places to move,’ as Surreira calls them, that have been created in recent years as part of a broad effort to enhance the mobility of the veterans at the Soldiers’ Home and thus improve quality of life and actually reduce the rate of falls.

As with most all initiatives at this facility, this was (and is, as such work is ongoing) a team effort — actually a team with several smaller teams within it, such as the one assigned the task of creating places to move, she told BusinessWest.

The Walk Across America is just one example of that positive change and improvement in quality of life mentioned earlier that Surreira has helped orchestrate since arriving at the Soldiers’ Home in 2014.

She had been working just outside Atlanta as an interim director of Emergency Services at Rockdale Medical Center, and was looking to return to Western Mass., where she spent much of her career.

Indeed, she started in the emergency department at Ludlow Hospital in 1985, then spent more than two decades at Mercy Medical Center, starting as an staff RN and eventually advancing to manager of the Emergency Department. Earlier this decade, there was a short stint as administrative director of Emergency Services at Cooley Dickinson Hospital.

“I was looking at different positions up here, and I received a call regarding an opportunity at the Soldiers’ Home,” she recalled. “They were looking for a leader, someone who could come in and do some mentoring on leadership, and it sounded very interesting; it was a real change of pace for me to go into long-term care as well as geriatrics, but given my interest in leadership and veteran healthcare, a chance to work clinically, and all those things coming together, I thought that it would be a good opportunity for a change.”

And to work with an older population (most of the veterans are in their 80s and 90s) that, as noted earlier, reflects some of the larger, more complex issues facing all those in healthcare — specifically, not only caring for older individuals, but also helping them maintain independence and a high quality of life.

“Our focus is truly on how to promote a good quality of life for these older veterans,” Surreira explained. “We have 94- and 95-year-olds living very well.”

With this broad goal in mind, Surreira has created, and serves on, a number of process-improvement teams working on such matters as reducing the use of anti-psychotic medications, lowering the rate of falls, improving mobility, medication safety, and many others.

And as these teams address each of these areas, they do so with quality of life in mind, she said, using reduction of falls as an example. This could easily be accomplished by reducing one’s mobility, so he or she doesn’t get into positions where they can fall, Surreira went on. But this doesn’t equate to a high quality of life.

“This is where healthcare is going. The population is living longer with chronic diseases. This is the population with which we’re really going to have to make an impact if we’re going to manage the needs of the overall population over the next 30 years.”

“What we don’t want to do is promote the use of things like restraints and alarms, because they don’t allow people to move and self-propel,” she explained. “So what we try to do is advise them of safety and encourage their mobility; we want people to move, we want to take them for walks, we want to do everything we can to promote mobility while also reducing the risk of getting hurt from that fall if you do fall.”

To accomplish all this, Surreira leads the so-called ‘enhancing mobility team,’ which consists of several departments, including nursing, rehab, social work, facilities, and pharmacy working collaboratively to implement evidence-based interventions that will enhance mobility and reduce falls. This team has implemented a series of policies and procedures, including the introduction of a daily ‘fall huddle,’ interdisciplinary rounding, quarterly mobility screens, individualized care plans that include mobility goals, and regular review of polypharmacy.

As a result, the Soldiers’ Home has seen a confirmed reduction in fall-related injuries and a noticeable increase in the mobility of its population.

Taking the Lead

As noted earlier, Surreira’s position comes with a lengthy job description and list of responsibilities. And only a portion of them actually apply to the veterans being served.

The rest have to do with those other functions (for lack of a better term) that she carries out, including that of being a leader, a mentor, and a role model. Her ability to be all those things is a big reason why she was hired — and her desire to continually build upon those skills and add new layers to already considerable amounts of experience explains why she took it.

As she talked about being a leader, for example, she equated it to parenting.

“You mess up a lot, and then you learn how to be a better parent; it’s the same with being a leader,” she explained. “I think I’m a different leader now than when I started this journey, because it’s very humbling.”

Elaborating, she noted that one of the things she’s learned over the years is the importance of active listening.

“In order to hear the person, you can’t be thinking about your response already,” she said, citing a mindset held by all successful leaders. “You have to be totally focused on what they’re trying to tell you.

“You also need emotional intelligence, which means taking the time to know where that person is coming from and be queued into what they’re trying to communicate to you,” she went on. “Often, I tell people, ‘it’s not what they’re saying, but what they’re not saying; it’s not the words they’re saying, necessarily, but how they’re saying them. They may be saying something, but that’s not what they’re meaning or even intending.”

Surreira said mentoring takes place in many ways and on several different levels in her work at the Soldiers’ Home, including the formal teaching she does on subjects ranging from leadership to role-modeling.

“Mentorship from a leadership perspective takes place in a number of ways,” she explained. “Sometimes it takes place in just day-to-day interactions where you have opportunities to have a conversation with someone, provide someone with feedback … it’s all part of relationship building with those folks. Other times, it is more formal, such as the teaching I do.

As for the role-modeling, well, that part of it can really only happen as one adds layers of hands-on experience to their résumé, learns from previous mistakes, and develops a high degree of that necessary ingredient known as emotional intelligence.

“Even though someone may be handling a situation in a certain way, you can role-model a different way — that’s probably the most powerful thing to do,” she explained.

As an example, she cited a situation where there’s conflict going on and the discussion among individuals is getting quite heated.

“Managing yourself is probably the most important thing in those situations,” she said. “You manage your own reactions — the louder other folks may get, the quieter you get; the faster they talk, the slower you speak.

“Overall, mentoring involves building relationships and inspiring trust,” she went on, adding that ‘leading by example’ isn’t a formal line on her job description, but it’s a duty she carries out every day.

Waves of Emotion

Walking back to her office from the Navy veteran’s farewell, Surreira said the Soldiers’ Home obviously conducts many of these ceremonies. “Sometimes there will be two or three a day, and sometimes we’ll go a week without one,” she said, adding that, like most staff members, she tries not to miss a single one.

That’s because, as she said, at this facility, death isn’t something to be ashamed of; it’s not a failure. It’s part of a life being celebrated.

And improving the overall quality of that life has become the focal point of each individual and each team at the Soldiers’ Home.

Surreira’s leadership, mentoring ability, and passion for being a positive role have not only played a pivotal role in all this, they’ve made her a Healthcare Hero in administration.

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