Home Posts tagged Healthcare
Opinion

Opinion

By Katie Holahan

Healthcare spending in Massachusetts grew less than a key state benchmark and less than the national average during 2017, but employers and workers are not yet seeing the benefits.

The annual Healthcare Cost Trends Report issued this month by the state Health Policy Commission (HPC) indicates that total per-capita healthcare expenditures in Massachusetts rose 1.6% during 2016, significantly less than the 3.6% benchmark set by the commission. The Massachusetts growth rate also fell below the national rate — 3.1% — for the eighth consecutive year.

But the health-insurance premiums paid by Massachusetts employers and employees increased 5.8% in 2017, leaving the average total premium for employer-based coverage among the highest in the country at $21,000 per year for a family plan and $7,000 for a single employee. These figures do not include out-of-pocket spending such as co-payments and deductible spending, which grew 5.9% in 2017 for commercially insured enrollees.

Premiums for smaller employers increased 6.9% and are now the second-highest in the country, according to the HPC. Fifty-seven percent of employees in small businesses are enrolled in high-deductible health plans.

Part of the reason employers are not seeing more benefit from moderating health spending may be the fact that commercial insurers in Massachusetts pay higher prices to providers than Medicare pays for the same services. For hospital inpatient care, average prices among the three largest Massachusetts insurers were 57% higher than Medicare prices for similar patients. Commercial insurers also paid much more for typical outpatient services, including brain MRIs, emergency-department visits, and physician office visits.

Premiums for smaller employers increased 6.9% and are now the second-highest in the country, according to the HPC. Fifty-seven percent of employees in small businesses are enrolled in high-deductible health plans.

The HPC attributed much of the overall increase health-care expenditures to spending on prescription drugs (4.1%) and hospital outpatient services (4.9%). The commission also found that medical bills can vary as much as 30% from one hospital or medical group to another with no measurable different in quality of care.

The HPC makes 11 policy recommendations to continue health spending moderation. Among the highlights:

• The Commonwealth should focus on reducing unnecessary utilization and increasing the provision of coordinated care in high-value, low-cost settings.

• Policymakers should advance specific, data-driven interventions to address the pressing issue of continued provider price variation in the coming year.

• The Commonwealth should continue to promote the increased adoption of alternative payment methods.

• The Commonwealth should authorize the Executive Office of Health and Human Services to establish a process that allows for a rigorous review of certain high-cost drugs, increasing the ability of MassHealth to negotiate directly with drug manufacturers for additional supplemental rebates and outcomes-based contracts, and increasing public transparency and public oversight for pharmaceutical manufacturers, medical-device companies, and pharmacy benefit managers.

Katie Holahan is vice president of Government Affairs for Associated Industries of Massachusetts.

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 Event Galleries 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]

Healthcare Heroes

In the Emerging Field of Bioethics, He’s a Leader and a Pioneer

Peter A. DePergola II

Peter A. DePergola II

Oddly, he doesn’t actually remember where or when he got it.

But Peter DePergola’s copy of Rembrandt’s renowned The Return of the Prodigal Son looms large in his small office (it takes up most of the back wall) and, far more importantly, in his life and his work.

The painting, as most know, depicts the moment in the Biblical parable when the prodigal son returns to his father after wasting his inheritance and falling into poverty and despair. He kneels before his father in repentance, wishing for forgiveness and a renewed place in the family.

DePergola, director of Clinical Ethics at Baystate Health, the first person to wear a name badge with that title on it and the only clinical bioethicist in the region, says the painting — and the story of the prodigal son — provides a constant reminder of the importance of not judging others and providing them with what they need, not what they deserve. And that serves him very well in his work.

“The story is about sins and forgiveness, but what it teaches me about healthcare is that we should never treat our patients based on what we think they deserve morally, but on what they need, and only what they need,” he explained. “We don’t get to say, ‘you’re a murderer,’ or ‘you’re an adulterer,’ or ‘you’re an alcoholic — if you really wanted to stop, you can.’

“We have to meet them in the middle of their chaos, to sort of run out to them,” he went on, “and to treat them based on what they need and who they are, not on what we think they deserve.”

“It’s not that they don’t understand that medicine has its limits — I think they do. But they’re living in this larger narrative of ‘who am I if I don’t do everything I can for the person I love most?’”

‘Meeting them in the middle of their chaos’ very often translates into a time when decisions have to be made — difficult decisions — about what can be done for a patient and what should be done; about what is proper and what is needed (there’s that word again).

“There are plenty of things we can do, but shouldn’t,” he went on, adding that such dilemmas are becoming ever more common as the population ages and modern science finds new and different ways to extend life.

The issue he confronts most often involves what kind of life is being extended — and whether that kind of life should be extended. And within that broad universe there are countless other matters to consider, discuss, and debate — and they involve everything from raw science to individuals’ base emotions and perceptions about what is right, wrong, and proper.

“Family members will say, ‘I know this isn’t going well, but am I a loving daughter if I say this is the end? How do I think through this?’” he told BusinessWest as he recounted the type of conversation he has most often. “It’s not that they don’t understand that medicine has its limits — I think they do. But they’re living in this larger narrative of ‘who am I if I don’t do everything I can for the person I love most?’”

Overall, his work in the broad realm of bioethics involves everything from these end-of-life issues to the use of animals in research to potential conflicts of interest and conflicts of commitment. DePergola summed it all up in intriguing fashion by saying “no one ever calls me when something good is happening.”

Despite this, and despite the difficulty of his work — not to mention the long hours and often unusual hours; he was recently called to Baystate at 1 a.m. — DePergola finds it rewarding on many levels.

He likes to say he helps people make sense of nonsense and not necessarily answer questions that can’t be answered, but enable people to cope with them.

“People will say, ‘I’ve lived a good life, and I’ve always done the right thing, and here I am, with six months to live. Why must I suffer? Why do I have to be in pain? Why do I have to be in the hospital?’” he noted. “And at the end of the day, I’d say, ‘I don’t know, it’s not fair, I don’t understand. But let’s not understand together.’

“You don’t have to go through not knowing alone,” he went on, hitting upon the best answer to the question of why his role now exists. “And that may be the only antidote to that question; I can’t tell them why bad things happen to good people, but I can be there with them when they’re asking that question and looking for answers and looking for compassion.”

For his multi-faceted efforts — many if not all of which fall into the category of pioneering — DePergola has, well, emerged, into not just a leader in his field, but a Healthcare Hero.

Work That Suits Him

There’s a white lab coat hanging on a hook just inside the door to DePergola’s office, and it’s there for a reason.

While not a medical doctor, DePergola is a member of a clinical team that interacts with patients and their families. The white coat isn’t required attire, and he didn’t wear it earlier on his career. But he does now, and the explanation as to why speaks volumes about the passion he brings to this unique job every day.

“When I used to come dressed in a suit to have these very important conversations with patients and families, I think it was intimidating in a way,” he explained. “I did it out of respect … you’re going to have the most intimate conversation a family’s ever had — what would you wear to that? You’d want to wear something that says, ‘I really care about this. and I care about you.’

“But it looked like I was a lawyer, and people couldn’t get past the outward appearance,” he went on. “Sometimes just a shirt and tie is too casual, but the combination of the lab coat and the tie seems to send the right message.”

There are other examples of this depth of his passion for this work, including his desire to understand the role religion plays in making those hard decisions described earlier.

“I knew that what I was getting into had a lot of value implications,” he explained, “and that the primary pathway into those values was religious commitments. So I got a master’s degree in theological bioethics so I could make sure that I understood what Hindus and Buddhists believed about end-of-life care the same as Orthodox Jews and Catholics, and what Muslims thought about autopsy, so I could meet them not just where they are clinically, but where they are biographically and in their values.”

As he talked about his career and what he was getting into, DePergola stated what must be considered the obvious — that he didn’t set out to be a bioethicist. That’s because this field hasn’t been around for very long — only since the early ’80s, by his estimates — and it’s especially new in the Western Mass. region. In essence, and to paraphrase many working in healthcare, the field chose him.

“Larger American cities — New York, Boston, Los Angeles — have had full-time clinical bioethicists since probably the end of the 1980s,” he explained, adding, again, that he’s the first in the 413. And in many respects, he helped create the position he’s in and write the lengthy job description.

To fully explain, we need to back up a bit.

After earning his bachelor’s degree in philosophy and religious studies at Elms College (early on, he thought he might join he priesthood, but settled on a different path), and then a master’s degree in ethics at Boston University and his Ph.D. in healthcare ethics at Duquesne University, DePergola completed a residency in neuroethics at University of Pittsburgh Medical School and then a fellowship in neuropsychiatric ethics at Baystate, then the western campus of Tufts Medical School, in 2016.

“The patient is always the priority. In risk management, it’s the hospital first, then the patient. With me, it’s the exact opposite; I make sure everyone’s voice is heard.”

While completing that fellowship, he took on some duties in the broad realm of research ethics, a large subset of this emerging field, but this work was eventually expanded into a new leadership position at Baystate — director of Clinical Ethics, a role he said he helped create in partnership with the health system.

“I did a lot of convincing, and I sort of sold the problem,” he said.

“Medicine tells us what we’re able to, and the law tells us what we’re allowed to do. But neither one tells us what’s good to do. And how we navigate the mean between extremes? If we did everything possible for our patients, we’d be deficient, and there are plenty of things we could do without breaking any laws, but that wouldn’t be in itself good for patients. So we needed someone to step into a leadership role.”

In creating the position and its job description, he and members of Baystate’s leadership team borrowed from models already in existence at similarly sized healthcare systems, especially those at Maine Health, the Carolinas Health System, and the Henry Ford Health System.

DePergola said there are four main categories, or pillars, to his work: clinical ethics, research ethics, organizational ethics, and academic ethics, or ethics education.

The primary domain, as one might expect, is clinical ethics, and in that role, he meets with patients, family members, and healthcare professionals “as they navigate the moral terrain of life-and-death decision making at the beginning, middle, and end of life,” he explained.

“I see everyone — from patients and their families in the Neonatal Intensive Care Unit to our geriatric patients, to everyone in between, whether it’s a patient in infectious diseases or genetics or ob/gyn.

And, as he said, no ever calls him when anything good is going on.

Questions and Answers

As he talked about his work in bioethics and many of the difficult conversations he becomes part of, DePergola summoned a quote from Aristotle that he’s undoubtedly already used countless times in his short career.

“He said, in essence, that something is good if its fulfills the purpose for which it was made, and bad if it doesn’t,” said DePergola, adding that such a benchmark, if one chooses to call it that, should be applied to all aspects of healthcare, including everything from a feeding tube to any other step that might be taken in an effort to prolong life.

“If it’s not going to fulfill the purpose, is it good? We need to think about the logic of what it would mean to provide a clinical treatment without a clinical reason,” he went on, adding that such questions loom large in his field of work and often bring him to another difficult discussion — the one juxtaposing quantity of life against quality of life.

Such thought patterns help DePergola as he goes about his various duties, during which — and he makes this point abundantly clear — he advocates for the patient first, not the health system that employs him.

And this distinguishes his work from that of those in the broad realm of risk management.

“The patient is always the priority,” he explained. “In risk management, it’s the hospital first, then the patient. With me, it’s the exact opposite; I make sure everyone’s voice is heard.”

And not only heard, but understood, he went on, adding that the cornerstone of success in this field (if one can even use that word within it) is establishing trust.

Wearing a white coat instead of a suit coat is part of it, but a bigger part is understanding exactly where someone is coming from. And this comes from taking the time to understand their situation, their religious beliefs, and much more.

Even then, the decisions don’t come easy, he went on, adding that his work often comes down to helping parties decide between the better of two bad options and coping with questions that, as he noted, can’t really be answered.

Such sentiments are reflected in DePergola’s thoughts on other aspects of his work, especially his teaching — he’s an assistant professor of Medical Humanics at Elms College, where, in the small-world department, had Erin Daley, director of the Emergency Department at Mercy Medical Center and the first Healthcare Hero in the Emerging Leader category, as one of his students.

“I always try to emphasize to my students that the big questions of medicine that patients are asking have little to do with medicine, that the big problems in medicine have little to do with medicine,” he told BusinessWest. “They’re questions of meaning, purpose, identity, and value.

“They don’t show up on X-rays, you can’t write prescriptions for them, and we can’t bill for that,” he went on. “Medicine is very good at addressing ‘how’ questions — as in ‘how does ammonia work?’ — but it’s very poor at addressing the ‘why’ questions. And I think that, when we fail to connect with our patients in medicine, it’s because we’re giving ‘how’ answers to ‘why’ questions.”

Framing the Question

Returning to Rembrandt’s Return of the Prodigal Son, DePergola said there’s another reason why that painting resonates with him.

It has to do with how many times he has the same conversations with different people, such as the one about miracles, and walking them through the argument that there’s no logical connection between believing in a miracle and concluding that life-sustaining medical treatment should continue.

“You don’t offer life-sustaining medical treatment for miracles to occur, and I often dread having another one of these conversations,” he said. “But then, I remember that every time I have any of these conversations, it might be the 12th one of the day, but it’s the first for these families. They deserve for me to treat it as the most important and the only conversation, not the 12th.

“Again, I give them what they need,” DePergola went on, expressing sentiments that clearly explain why he’s an emerging leader, a pioneer, and a Healthcare Hero.

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

Healthcare Heroes

This Pediatrician and Coalition Builder Has Helped Create a Healthier Community

Dr. Matthew Sadof

Dr. Matthew Sadof

Most people who have been working professionally for nearly 40 years have had a number of desk chairs, especially as technology has advanced and the office has become more ergonomically correct.

Dr. Matthew Sadof has had exactly … one.

It was given to him upon completion of his residency at New York Hospital, and it’s been with him ever since. It’s a low, wooden chair with arms, and Sadof obviously likes how it looks and feels — for the most part, anyway. But the reason he keeps it is what’s written on the back: “Go and do thou likewise.”

That’s the school’s motto, but far more importantly, it’s Sadof’s approach to life and also his life’s work, as will be made clear as we explain why he is the Healthcare Hero in the Community Health category.

“One of the things that I’ve tried to practice my whole life is something called tikkun olam, which means to heal the world,” he told BusinessWest. “And that’s what I try to do. I’ve been sitting in this chair since I graduated. It’s my chair; I’ve had opportunities for other chairs, but I like this one.”

The Heroes award is only the latest of many to be bestowed upon Sadof, a pediatrician at Baystate Children’s Hospital, whose chair resides in a small office at the Baystate High Street Health Clinic, in the middle of one of Springfield’s poorest neighborhoods, as it has for the past 20 years.

“Dr. Sadof has demonstrated that a physician who is dedicated to improving the health and well-being of his patients must go beyond the office walls and work diligently to improve the health of the community.”

This office is, by his own admission, not at all asthma-healthy, with its carpeting, drop ceiling, and somewhat poor ventilation. Which is ironic, because he is perhaps best known for helping to lead an all-out battle against asthma in a city consistently ranked among the worst in the nation for asthma health.

His leadership role in the Community Asthma Coalition and related initiatives has dramatically improved the environment across Springfield and reduced hospitalizations dramatically, but he would be the first to note that, with the city’s poor housing stock, there is considerable work still to do.

However, there is more to Sadof’s story than helping children and families breathe easier, literally and figuratively. He has also been a passionate advocate for the underserved and the marginalized, working with medically fragile and technology-dependent children and their parents, who are often overwhelmed by their medical needs. Meanwhile, he has worked to address the social and medical difficulties faced by adolescents in Springfield, patients who often fall through the cracks as they age out of pediatrics and fail to connect with an adult-medicine provider.

As he sat down to talk with BusinessWest to talk about the many facets of his work — yes, in that chair from NYU — Sadof made it clear that, while he is honored to be named a Healthcare Hero, he stressed that whatever progress has been made in terms of making Springfield a healthier community has been a team effort, not the work of one man.

“I can’t over-emphasize that it’s not just me,” he said, referring not only to the asthma initiatives but a deep portfolio of projects he’s been involved with. “I work with lots of wonderful people; you need a whole community of people to really change a community.”

Still, Sadof has established himself as a clear leader in these efforts and a role model for the medical students and residents he teaches.

Dr. Laura Koenings, vice chair of the Education Department of Pediatrics at Baystate Children’s Hospital, who nominated Sadof for the Healthcare Heroes award, may have summed up his devotion to community — and his approach to achieving progress — best.

“Dr. Sadof has demonstrated that a physician who is dedicated to improving the health and well-being of his patients must go beyond the office walls and work diligently to improve the health of the community,” she wrote. “A role-model physician looks for gaps in the healthcare-delivery system and strives to bring better healthcare to the underserved, whether that is the infant with complex medical needs on a home ventilator and a gastronomy tube for feeding, or the teenager out on the streets without a medical home.”

Sadof continues to do all these things, and that explains why he’s a true Healthcare Hero.

Clearing the Air

Sadof said it wasn’t long after he arrived at the High Street Clinic that he began to realize the full extent of the asthma problem in Springfield.

“My very first week, there was a kid who came in who had really, really, really bad asthma,” he recalled. “So bad that I had to go on the ambulance and transport him to ICU. He needed a breathing machine — he needed to be intubated — and while I was there, I looked at his mother, and I couldn’t help but notice that she had a Band-Aid on her arm and a hospital bracelet on her wrist.

“I said, ‘what happened to you?’ he went on. “And her asthma was really bad. I asked her where she lived, and she went on to describe an apartment building that had cockroaches, rodents, leaky windows, and mold — all of which are very potent triggers for asthma.”

Dr. Matthew Sadof says he’s had one desk chair throughout his lengthy career

Dr. Matthew Sadof says he’s had one desk chair throughout his lengthy career and lives by what’s written on the back: ‘Go and do thou likewise.’

Thus began what might be called a crusade against asthma, as well as a pattern of not only treating patients but asking them where they live. And not only asking them where they live, but taking steps to do something about where they live and removing some of those triggers for asthma.

“We teach people how to clean with vinegar, baking soda, baking powder, and castile soap, and that’s made a huge difference,” he explained. “We also showed people how to store food properly and store garbage properly in a way that doesn’t promote the growth of rodents and insects.”

Before getting into more detail about his efforts to combat asthma and the many other aspects of his work, it’s necessary to explain how Sadof arrived at the High Street Clinic.

Our story starts back at medical school, where, by this third year, Sadof realized he wanted to spend his career working with young people.

“I knew that I liked to talk to people, and I knew I liked to work with young families,” he recalled. “And I knew I liked working with children because they’re growing, and there’s the possibility to make a real impact on the trajectory of someone’s life when you start early.”

He practiced in Pittsfield for 10 years, doing general pediatrics, before he and his family relocated to Philadelphia to “try something new,” as he put it. Things didn’t exactly work out there as he hoped, so the family decided to return to what they considered home.

A former colleague was working at the High Street Clinic at the time. Sadof asked her what the lay of the land was, and she mentioned that the clinic was looking for someone. And, long story short, Sadof became that someone.

“Something about this place just felt really good,” he told BusinessWest, noting that, 20 years later, he still feels the same way.

“There was a huge need for services,” he explained. “And there were bright students and residents that I could work with. And practicing and teaching medicine at the same time keeps you really sharp. They’re always asking you questions that you may not know the answers to, so we all look it up and learn it together.”

Finding answers to some of Springfield’s most vexing health problems has been Sadof’s M.O. since arriving on High Street, and, as noted, asthma soon become one of his top priorities.

But to address it, he knew the city needed to bring together a number of players to form a solid, united front against the disease. And it really started with that visit his first week on the job.

“That’s when I started thinking about how important it was for me to start to address some of the root causes of asthma, and about what I could do to build a bridge from the clinic to the community,” he recalled. “They weren’t calling it the ‘social determinants of health’ back then, but that’s really what we were doing.”

Within a year after arriving at High Street, Sadof became the medical director of the clinic, and around that same time, he was approached by a grant writer from what was then Partners for a Healthier Community (now the Public Health Institute of Western Mass.) to apply to be part of the National Collaborative Inner-city Asthma Study.

Fast-forwarding a little, the local group was awarded a grant, and a social worker was hired to be an asthma counselor, he went on, adding that parent groups were formed, individualized counseling was provided, and other steps were taken not only to treat people who were sick but to make homes more “asthma clean.”

In 2001, the Pioneer Valley Asthma Coalition was formed, and Sadof, who started in what he called an observer role, became its chair in 2004. In 2009, he help forged a partnership with Boston University whereby a stimulus grant from the national Institute of Environmental Health was secured to create something called the READY (Reducing and Eliminating Asthma Disparity in Youth) program.

“We trained community health workers to teach people how to keep their home asthma clean,” he explained, adding that there would be a series of five home visits in the course of six months. “And anecdotally, I could tell which families were in the program and which ones weren’t; we cut hospitalizations down dramatically and cut hospital days down dramatically.”

Care Package

But while Sadof is perhaps best known for his work to combat asthma, there are many other aspects to his practice, all of which relate directly to what’s written on the back of his chair.

Indeed, while recognizing a real problem with asthma, Sadof said he also quickly realized there was a large number of children with severe disabilities and families struggling to care for them. And he’s continuously looking for new and innovative ways to meet the many needs of both these children and their families.

“I have lots of children who are technologically dependent,” he explained. “These are children who are on ventilators at home, they have feeding tubes, they often require 24-hour care … they and their families require services, and they need help.

“From listening to these kids, I was always trying to figure out a better way to do things,” he went on, adding that he was approached in 2012 by officials at Boston University Medical School with the goal of developing a grant to help improve complex care.

Baystate and BU were eventually awarded a $6 million grant ($1 million each over three years) to develop something called the 4C program. That’s an acronym for Collaborative Consultative Care Coordination program, which was created to help parents and pediatricians coordinate care for the most medically complex children in Western Mass. Each word in that acronym is important, and collectively they explain what it is and how it works.

“We developed a couple of teams, with myself as the complex-care doctor, where we brought people in, took in all their data, and put it into a cloud-based care plan,” he explained. “These care plans lived on their phones, and they were accessible by any kind of electronic device and were accessible by their primary-care doctor and by the hospital and the families.

The consultative-care program created for each family consisted of a nurse care coordinator, a social worker, a so-called ‘family navigator,’ a nutritionist, and a psychologist, he went on.

“There’s been a huge influx of patients from Puerto Rico, people whose lives were blown away who are medically complicated and very fragile. People with heart defects, lung defects, neurological issues, and we’ve been working hard to keep them healthy. It’s great work and its very rewarding.”

“And we really improved the lives of lots of kids,” he said with a large dose of satisfaction evident in his voice. “We were able to decrease the cost of healthcare by a lot and improve the satisfaction of families. This was a consultative program where we worked with primary-care doctors to keep the care inside the patient’s medical home, close to where they lived; we worked with schools, we worked closely with housing to make sure we could make accommodations, we did home assessments and home visits. The idea was to try to support families through this work, and it was incredibly rewarding.”

He used the past tense because the grant funding ended at the close of 2017. The plan is to find a way to restore and continue the initiative through the new accountable-care program being created. Meanwhile, Sadof continues to care for children with complex needs, mostly without the same comprehensive teams made possible by the 4C program, and the number of patients in that category has swelled in the wake of Hurricane Maria, which devastated Puerto Rico almost exactly a year ago.

“There’s been a huge influx of patients from Puerto Rico, people whose lives were blown away who are medically complicated and very fragile,” he explained. “People with heart defects, lung defects, neurological issues, and we’ve been working hard to keep them healthy. It’s great work, and its very rewarding.”

There’s that phrase again. Sadof uses if often, and it speaks to the passion he brings to his work, which, by and large, involves a poor, very challenged constituency, and many of the sickest children in this region — and beyond it.

To explain that passion, Sadof related the story of his father, who had tuberculosis.

“I just have this vision of my grandmother bringing my father to a clinic, where his test came back positive,” he explained, noting that his father had two aunts who died from the disease. “I carry that picture of my father and my grandmother with me always … and I look at the mothers here, and I say, ‘100 years ago, this was my family.’

“And the test about what decisions I make is that ‘if this was my family, what would I want to do? What would I want done for my family?’” he went on. “It has to pass that test. And it’s not always the easiest answer, and it’s certainly not the fastest answer.”

It Sits Well with Him

For the last word on the honoree in the Community Health category, we return to Laura Koenings’ nomination:

“Dr. Sadof recognized early on that it takes a village, and not just the actions of a single physician, to improve the long-term health of the community,” she wrote. “This is why he has always been a coalition builder — helping to unify patients, families, community agencies, and government entities to work together for a healthier community. He also recognized that, in order to advocate for his patients and their families, he must understand their needs and bring their voices to the agencies and government entities that are part of his coalition.”

He has done all that, and that’s why, from the day he earned that chair, he’s been a Healthcare Hero. u

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

Healthcare Heroes

This Unique Venture Exists at the Intersection of Innovation and Technology

Christian Lagier

Christian Lagier, managing director and co-founder of TechSpring.

Christian Lagier has a deep background in entrepreneurship, business operations, and strategic business development.

He’s been involved with startups and high-growth companies in Paris and Copenhagen, and he spent 10 formative years in Silicon Valley’s high-octane startup environment at arguably its zenith (the ’90s).

Thus, he’s an expert in … collisions.

That’s a word you hear quite often within the realms of innovation and entrepreneurship. Generally, it refers to the art and science (because it’s both) of bringing people together and making things — meaning products, services, and the companies to provide them — happen.

Soon after leaving the San Francisco area behind to come to Western Mass., Lagier became a key driver in an effort to bring collisions to a different, higher level, and to a sector where you don’t hear that word as much as you do in others — healthcare.

The result was TechSpring, a unique venture that is based in Springfeld. But its exact location, as Lagier likes to say, is at “the intersection of healthcare and technology.”

“We’re trying to bring these sides together in a place where we can democratize technology development, or bring people into the process.”

That phrase speaks volumes about not only what TechSpring is, but why, more than three years after it was launched, it has met or exceeded both expectations and goals. And why a panel of judges determined that it (meaning the sum of all its parts and the all the people behind it) is the Healthcare Hero in the highly competitive category called simply ‘Innovation in Health/Wellness.’

Summing it all up, Lagier, the venture’s managing director and co-founder, said TechSpring has realized a vision established four years ago to take external innovators into a partnership of sorts with Baystate Health, its 1 million patients, and thousands of providers to accelerate innovation in healthcare technology.

“We’re trying to bring these sides together in a place where we can democratize technology development, or bring people into the process,” he explained, “and do it in a way that’s aligned with the goals of an organization that is working hard to deliver high-quality, high-value care every day.”

In the process of democratizing the innovation process, TechSpring has become a real force within the region’s economy and, especially, its innovation sector. It serves as an innovation hub in every sense of that word, said Lagier, noting that brings people together in all sorts of ways.

Christian Lagier, seen here with team members at TechSpring

Christian Lagier, seen here with team members at TechSpring, says the facility, and especially its kitchen, were designed to promote collisions.

First, as co-working space — there are about 80 people working there now — but also as a conference center and site for programs such as its monthly innovation open house, known as Tap into TechSpring.

“It was important to us as we were doing this project to have healthcare come out of the ivory tower, if you will,” Lagier explained. “We wanted to open the doors and create a public forum, a physical hub for all the people in Western Mass. and beyond who are working at that intersection of healthcare and technology.”

There is mounting evidence that this model works and should be emulated. For example:

• It has grown from one employee to eight;

• There have been more than 30 completed innovation projects, all with learning or operational outcomes;

• Tap into TechSpring, has attracted more than 4,000 participants since it was initiatied more than three years ago;

• The venture has received trade delegations and leadership visits from Israel, Denmark, Ireland, Singapore, Australia, and other countries;

• At any given time, there are between five and 10 projects in development or active execution; and, perhaps most importantly,

• TechSpring has generated more than $7 million in revenue or savings for Baystate Health.

Which means that the sizable investment made by the system in TechSpring has more than paid for itself.

Maybe the best example of how TechSpring works, and why it was named the hero in the Innovation category, is Praxify, an intuitive, easy-to-use mobile application designed to enhance the provider experience by bringing patient information directly into the palm of one’s hand.

“We heard clearly from our organization, and specifically from our physicians working at Baystate, that the electronic medical record system had grown unwieldy and that it was consuming too much time to get information in and out,” Lagier explained, adding that NTT, one of TechSpring’s innovative partners, introduced people there to a startup in India that had developed a mobile app that was user-friendly and fast to use.

When representatives of that company came to Springfield with their demos, they were introduced to roughly 30 Baystate doctors who, long story short, helped them refine the concept into something that works.

Thus, Praxify is an example of just how well the original vision for TechSpring has, in fact, become reality.

“When we started this project, it was big ideas and PowerPoint slides,” he told BusinessWest. “And you have this vision. Looking back on it four or five years later, after making many of these come to life and become real … that’s a great point of pride.”

Food for Thought

As he talked about collisions and the ongoing work to bring them about, Lagier said everything about TechSpring’s facility on the fifth floor at 1350 Main St. was designed with that goal in mind.

Even the kitchen. Or especially the kitchen, as the case may be.

With the old-fashioned water cooler pretty much a thing of the past, the kitchen is the place where people gather now, he told BusinessWest, adding that, in addition to politics, sports, and what TV shows they’re binging, people at TechSpring also talk about what they’re doing.

And they listen to other people talk about what they’re doing, and when there’s two or three or four people having such conversations, this is how collisions take place. So the kitchen was designed to promote this kind of activity.

“It’s large, open, and has seating,” Lagier explained. “This is the place where people connect informally and begin chatting, and where a wonderful thing happens every day at TechSpring — someone finds an opportunity to help someone else, and that’s what we need to accelerate change in healthcare.”

Kitchen design is one of the few things not on Lagier’s résumé. As for what is, well, it’s an interesting mix.

Out of high school, he actually worked as a foreign-language tour guide in bustling Copenhagen (he’s fluent in six languages, including Danish, French, and English). He also worked as a deck hand on an offshore oil rig in the North Sea and hitchhiked his way around the world for a year.

He eventually settled down and earned master’s degrees in economics and business administration from Copenhagen Business School and Université Catholique de Louvain in Brussels and then went to where the action was.

“I moved to Silicon Valley to seek adventure and the application of technology to real-world problems,” he said, hitting upon what could be considered a theme to his career. “I was there in ’95, which was an exciting tine to be in Silicon Valley.”

After starting out in management consulting, Lagier held management positions in companies such as Memolane, Vivino, and Proxicom. He spent a decade in Silicon Valley, but decided, in collaboration with his wife Allison, who had ties to this region, that Western Mass. (Williamsburg in Hampshire County, to be exact) was the place to raise a family.

“It was a lifestyle choice for us,” he said, adding that, while he’s lived in some fast-lane places — Paris, Copenhagen, and San Francisco are all on that list — this is home, and the mailing address he’s most fond of.

Fast-forwarding a little, Lagier worked in administration at Smith College for a few years. Just over five years ago, had lunch at Max’s Tavern with Joel Vengco, chief information officer for Baystate Health. It was a lunch that would eventually pave the way for TechSpring and begin to change both the innovation and healthcare landscapes in this region.

“Joel, like me, has broad experience from different geographies and parts of life, and when he came here, he had a vision for an opportunity that presented itself to a region like this one and an organization like Baystate to be a better participant in the transformation of healthcare that we all know is necessary,” he explained. “He presented this vision to me of creating a small and nimble organization that could facilitate the collaboration between external technology innovators and a full-size, real-life health system.”

That vision represented something very different from anything that existed at that time, he went on, adding that there was no real model for TechSpring and that those who launched it created a new model. But it was also something very necessary given the way technology was advancing and healthcare was evolving.

“We all know that healthcare needs to change,” he explained. “We know that part of the solution is process and people, and we know that technology needs to support these changes that are necessary. TechSpring is an effort to help those two sides — the people and the technology — come closer together in solving these problems.”

While doing that, there are broader goals as well, he said, adding that, from the beginning, those involved with TechSpring clearly understood that innovation had to “pay off,” as he put it, meaning there had to be a direct line of sight to the value that comes from innovation.

“We talked a lot about how this can’t be science experiments, and it can’t be long-term R&D — there have to be some concrete outcomes from this, and also financially,” he explained. “We had also set the goal of TechSpring being self-funded, and we’ve achieved that goal.”

Getting the Idea

At the core of this unique model, made possible by a $5.5 million grant from the Massachusetts Life Sciences Center, TechSpring becomes a consulting company of sorts, said Lagier, one that supports external technology innovators that have ideas for effective solutions in healthcare and helps them collaborate more closely with healthcare professionals and even patients, and then brings all these parties together in the technology-development process.

Over the years, the list of innovative partners has grown and now includes such companies as:

• Cerner, the leading provider of electronic-medical-record (EMR) and population-health systems worldwide;

• Imprivata, a Boston-based company focusing on solutions that make access to IT systems easier for employees and patients;

• NTT Data, a worldwide leader in systems integration and delivery of technical solutions;

• Kordova, a Boston- and Springfield -based startup focused on creating cost visibility in surgery supplies;

• athenahealth; a Boston-based provider of EMR systems; and

• Firefly Labs, a local startup originated at Baystate Health that has created a solution that makes case reporting and the accreditation process easier for surgery residents.

Connecting such innovators with a large health system like Baystate sounds simple and rather obvious, but such collaboration between these two worlds has mostly been missing, and is still missing in many markets.

“There’s been too much technology that has been developed and sort of pushed into healthcare,” he went on. “It’s our ambition to turn this around and have it be more of a pull from users, the healthcare professionals and patients, who say, ‘these are the solutions that we need,’ and then enabling the technology innovators to solve for that.”

“He presented this vision to me of creating a small and nimble organization that could facilitate the collaboration between external technology innovators and a full-size, real-life health system.”

While doing that, the broad goal is to create those aforementioned collisions.

“They’re a key piece of innovation theory,” Lagier explained. “Innovation is not linear — it’s not something you can plan out or mastermind. Innovation depends on a lot of coincidence, but, as Pasteur said, ‘chance favors the prepared mind.’ At TechSpring, we’ve created an environment that is conducive for coincidences to happen.”

And there were a number of coincidences and collisions behind Praxify, which was born, as most innovative concepts are, out of a need to solve an identified problem.

“To this day, this industry has a challenge — that doctors are spending too much time at the computer, and that takes away time that they can spend with a patient,” said Lagier. “There are many facets to that challenge, and we put that challenge out into the world, saying, in essence, ‘what solutions are out there that we can bring to our physicians that might improve this problem?’”

As noted earlier, a startup in India had a solution — or the makings of a solution. And to refine its concept, the company worked in tandem with doctors at Baystate.

“Rather than sitting in a conference room or drawing something up on whiteboards, we said, ‘first, you have to experience real healthcare,’” Lagier noted. “And they got to just follow a physician and watch over his or her shoulder and get direct feedback — ‘this works for me,’ or ‘this doesn’t work for me.’”

With that feedback, rapid prototyping ensued, he went on, adding that the innovators went back and said, in essence, ‘is this what you’re looking for?’ Some said yes, some no, and more collaboration followed.

A prototype was developed, validated at Baystate, and put into production for a pilot user group comprised of 80 physicians. The development was so successful and promising that the startup was acquired by athenahealth, another of TechSpring’s innovation partners, for $63 million.

For Lagier, the key takeaway from the example of Praxify is how the collaborative model — bringing innovators together with healthcare providers to accelerate new-product development — works not just in theory, but in reality.

“I had dozens of physicians who were energized by the process — just having a voice, just having an opportunity to be part of the technology-development process,” he told BusinessWest. “That they got an app out of it that they could use and that made their life better was a bonus.”

Healthy Collaboration

As Lagier noted, there have been a number of delegations from different states and different countries that have come to the TechSpring suite to see how the unique concept works — and how it might work for them.

The kitchen is usually part of the tour because that’s where a good number of collisions happen — collisions that can lead to practical solutions to the issues and problems facing those providing healthcare in today’s challenging and always-changing environment.

Those tours — a world apart from those Lagier led before busloads of tourists in Copenhagen — represent one of the best indicators of the success of the TechSpring model and its ability to bring innovators and healthcare providers and patients together in collaboration — something that’s needed to solve these complex problems.

As much as anything else, they show why all those at TechSpring are Healthcare Heroes.

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

Healthcare Heroes

This Unique Initiative Has a Simple Mission: to Save Lives

The Consortium and the Opioid Task Force

The Consortium and the Opioid Task Force

Larry Thomas remembers not knowing exactly what to say or how to respond.

He had just been encouraged to apply for a job as a peer coordinator and recovery coach for something called the Recover Project, a recovery support center operating in downtown Greenfield under the umbrella of the Western Mass. Training Consortium and funded by the Bureau of Substance Abuse Services in Massachusetts. Thomas paused, because the last job he held was as part of a work-release program operated by the Department of Corrections.

“I had never had a job as a free man, applying on my own,” he explained. “When they posted the job, people said I should apply. I said, ‘maybe I should, but I don’t even have a résumé.’ I did apply, but I was scared to put down the last place I worked, because I was still in jail.’”

Thomas, in applying and then earning the job, essentially put his past behind him and focused on solidifying his future, which is, by and large, what he encourages others to do as a recovery coach. He takes his ‘lived experience’ — that’s a phrase you’ll read often in this article — and puts it to work helping others combating addiction and trying to put their lives back together.

Thus, he’s become part of a huge, multi-faceted, truly groundbreaking collaboration forged by the Western Mass. Training Consortium and the Opioid Task Force of Franklin County and the North Quabbin Region.

Actually, he was part of it before he became an employee, as we’ll see.

But first, by ‘huge collaboration,’ we mean more than 300 public and private partners, representing law enforcement, the healthcare community, the court system, a host of nonprofit agencies such as the Recover Project, addiction specialists, and addicts themselves. Collectively, these partners have one overriding mission — to save lives.

Sahern Ahern

Sahern Ahern says she learned that, when it comes to addiction, a community has to make change from the inside out.

And they are doing just that by effectively bringing an entire community together to combat a problem that that is prevalent across the country, but especially in rural areas like Franklin County.

As John Merrigan, register of Franklin Probate and Family Court, recalls, in the summer of 2013, all those players were essentially confronting the opioid epidemic separately and in their own ways — and not making much headway, really. By the end of the year, they were confronting it together, collaborating, communicating, building bridges, combining resources, and fighting the problem not by locking people up but by using lived experiences, peer-to-peer counseling, and even massage and acupuncture to help them find a pathway (another word you’ll read often) to treatment and recovery.

As they talked with BusinessWest about the collaboration at the Recover Project’s facility on Federal Street in Greenfield, the many assembled players spoke with one voice about the power of such peer-to-peer counseling and the even greater power of a community coming together to address a problem that has touched everyone in that community directly.

Sarah Ahern, another peer leader and recovery coach, lost two family members to overdose, and remembers feeling a wide range of emotions, but especially anger at a system she felt had failed miserably to prevent such a tragedy.

“I’m that person who decided to bang on the doors from the outside, because I was really angry, and I saw the system was broken,” she recalled. “But someone told me — and I’m pretty sure it was someone here at the Recover Center — you can’t make change that way; you have to make change from the inside out.

“So I started attending task-force meetings,” she went on. “And I met all kinds of wonderful people who are just trying to figure out a solution.”

“I’m that person who decided to bang on the doors from the outside, because I was really angry, and I saw the system was broken. But someone told me — and I’m pretty sure it was someone here at the Recover Center — you can’t make change that way.”

‘Creating change from the inside out.’ That’s one way of describing what this collaboration is doing. But there are many others.

David Sullivan, Northwestern district attorney, had his own way.

“Going back five years, there was recognition on my part, and also by [Franklin County] Sheriff Christopher Donelan, that there needed to be a fundamental shift in the approach to addiction,” he said. “We needed to look at this as a chronic disease and not be looking toward incarceration and criminal sanctions. So the emphasis has been on treatment and recovery, and we’ve put a lot of resources into moving in that direction.”

Deborah McLaughlin, coordinator of the Opioid Task Force, may have summed it up best when she said, “people creating these terrible drugs have no shortage of creativity on their end, so we have to respond in kind to keep ahead of this as much as we can.”

In most all ways, this collaborative effort is creative and truly cutting-edge in its approach to combating opioid and heroin addiction. And it is becoming a model that other community task forces are trying to emulate. Indeed, individuals and groups from across the Commonwealth as well as other New England states, New York, and Ohio have reached out to learn more about this collaboration and its unique approach.

The crisis is far from over, said all those we spoke with. But they were also in agreement that the energy and, more importantly, the hope created to date is fueling general optimism in a region where that commodity has been in short supply in recent years.

And for generating that optimism, all those involved in this collaborative are true Healthcare Heroes.

Coming Together

Anthony Bourdain, the colorful host of the Parts Unknown series who tragically took his own life earlier this year, came to Franklin County in the fall of 2014 to learn about the task force and the many players involved in this collaboration.

He immediately sensed that it was something different and something special, and described the collaborative as a grass-roots response — people coming together to find a “community-based solution to what is finally being recognized as a public-health crisis rather than just a criminal-justice problem.”

He would go on to say, “‘war on drugs’ implies us vs. them, and all over this part of America, people are learning that there is no ‘them’ and only ‘us.’ And we have to figure this out together.”

Nearly four years later, those words seem prophetic. The nation now considers opioid addiction a public-health crisis, and the many players involved in this collaborative effort in Franklin County clearly understand that there is only ‘us.’

Indeed, in a small community like this, almost everyone has a family member, friend, or co-worker who is addicted to opioids or has overdosed. And this closeness to the problem, this familiarity with tragedy, certainly helped bring people together behind that mission to save lives, said Merrigan.

“The district attorney, the sheriff, and myself, who had worked closely together on a number of initiatives in the past, really saw our community being uprooted by the opioid epidemic,” he explained, flashing back roughly five years. “We saw it within our families, within our neighborhoods, and we knew we had to respond and convene members of the law-enforcement community, the medical community, the court community, and the recovery community.”

That response started with a phone call he placed to Linda Sarage, then the director of the Recover Project, and a request — more like a plea — to start a dialogue, something that didn’t exist between the two entities before that call.

Larry Thomas says he was hesitant to apply for a position as recovery coach, because the last time he held any kind of job, he was still in prison.

Larry Thomas says he was hesitant to apply for a position as recovery coach, because the last time he held any kind of job, he was still in prison.

“He introduced himself to me,” said Sarage, noting that there was some irony in the fact that an introduction was needed. “he knew of the work that the Recovery Project had been doing — we been doing some re-entry work at the jail and some re-entry work in the community that really put the importance of recovery out there.”

Those initial talks led to many more and eventually what D.A. Sullivan called an epiphany about the importance and power of recovery communities to finding a long-term solution to the addiction problem.

“You can’t incarcerate your way out of this crisis,” said Sullivan. “I think that people have come around to this, although others still need to be convinced. It’s absolutely clear to all of us that, with really good treatment and recovery, people can lead productive lives and not be wrapped up into the criminal-justice system; the last thing I want to see is people going to court and going to jail — I’d rather see them go to treatment and find that pathway to recovery.”

Which brings him to the subject of lived experience and recovery coaches like Larry Thomas, who are, Sullivan said, some of the real keys to changing the equation in this ongoing battle.

“Five years ago, we were flat-footed — we did not know how to approach this problem. Our system was built for alcohol situations and domestic-violence situations, and the one thing we’re seen across the spectrum — medical, the court community, the recovery community — is the peer-mentor piece,” he explained. “That lived experience, as opposed to a probation officer in the court system, has many advantages. A recovery coach can approach someone who’s struggling; it’s people helping people, and that’s the bottom line, because there’s no magic bullet otherwise to help us cope with this.”

This is what the architects of the collaborative had in mind, said Mary Lou Sullivan, executive director of the Western Mass. Training Consortium, a Holyoke-based agency which has a stated mission of “creating conditions in which people with lived experience pursue their dreams and strengthen our communities through full participation.”

And each word in that phrase is important, she said, starting with that word ‘conditions.’

“A lot of what’s happened in our society is that people are looked at as if they’re broken and they need to be fixed,” she explained. “And we feel like a lot of that is response to life and what’s going on in the world. The opposite of addiction is connection; you can’t separate out people and say, ‘what can we do to tinker with you and fix you?’ That’s a fundamental flaw in the way we go about things.

“So we try to turn the tables on that,” she went on, adding that the next key part of that phrase is ‘lived experience.’ Everyone has it, she said, and there are proven benefits to bringing people together who can share common experiences, whether its addiction, domestic violence, or significant health issues.

Then, there’s the ‘strengthen our communities through full participation’ part of that phrase, she told BusinessWest, echoing Sullivan and others when she said that the community is much stronger when people like Larry Thomas are involved with helping others and not incarcerated.

“It doesn’t serve us to have all these people in jail that we do in this country,” she said. “It would serve us much better if these people were part of the community.”

Parts of the Whole

As she talked, as others did, about the many ways the collaborative is changing the fight against addiction and generating momentum and progress, McLaughlin said groups working together can achieve much more than individuals and groups working independently of one another.

“We’ve been able to do things we wouldn’t be able to do ourselves,” she said, offering as examples everything from a ‘Building a Resilient Community’ event that focused on the role of trauma in one’s life, to a toiletry drive for individuals in recovery — an initiative that involved five locations, with donated items distributed to nine different organizations — to a recovery-friendly resource fair called ‘Where to Turn?’ involving more than 30 nonprofit agencies from the Greenfield, Franklin County, and North Quabbin areas.

And those represent just the tip of the iceberg, she said, adding that there have been a host of other initiatives ranging from a ‘bowling for recovery’ event to a program focused on recovery during the holidays.

Collectively, these events and others show how the community is coming together in this fight and grasping Bourdain’s wisdom when he said, “there is not them and only us.”

“There’s a groundswell of support for individuals impacted by opioid-use or substance-abuse disorder,” she said. “There’s support for families, there’s support for individuals, and I think we want to find out more about what it means to be a recovery-friendly community so that people feel that they are welcome here.”

This support takes many forms, from peer-to-peer counseling to a theater program, to the People’s Medicine Project, an emerging program of the consortium. This is a small but committed group of alternative-health practitioners, gardeners, social-justice advocates, and community members who believe that all people have a right to wellness and an empowered connection to their health.

Leslie Chaison, director of the project, said one of its main goals is to focus attention on the problem of pain and, more specifically, the over-prescription of opioid medications and the need to help people discover alternatives.

“We offer alternative therapies to people in recovery,” she said, adding, however, that the project has been hampered by a lack of funding and has been kept alive by the task force. “We have multiple therapies in our clinic, including acupuncture, massage, homeopathy, craniosacral therapy, herbal consults, and more.”

Through a grant from the task force, the project forged a partnership with Greenfield Community Acupuncture that has enabled a number of early-stage recovery individuals to receive acupuncture treatment for their pain.

“The feedback has been really great,” she said, adding that the project’s regular clinic, housed at the Recover Project and staffed by volunteers, has brought a variety of treatments to people in need.

Count Thomas in that group, and as one of the believers.

“We needed to look at this as a chronic disease and not be looking toward incarceration and criminal sanctions. So the emphasis has been on treatment and recovery.”

“Every Tuesday, they set this up back here,” he said referring to a space within the Recover Project. “There were lights and low music and all this stuff. I remember saying, ‘what is all this?’ and walking out; it took me a while to trust and just make an appointment.

“But I came to trust,” he went on. “And I have full-body massages, herbal medicine … they gave me tea, and it worked better than the medicine I was getting from CVS.”

Summing up the collaboration and the progress made to date, Sullivan said the most notable change has come in breaking down barriers and putting people in the same room — either literally or figuratively.

“In Franklin County, I think there were more silos than there were barns,” he explained. “This is really about good people communicating with other and working on solutions. It’s a big problem, and it still exists, but we’re seeing progress.

“It’s about having that day-to-day conversation with providers — ‘how do you link people up? How does a family find a place for a person to go for treatment? Where do they go for recovery?’ It’s all about these great conversations that are happening now that weren’t happening in the past.”

Bottom Line

Linda Ahern, that angry individual who started banging on doors from the outside out of frustration with a broken system, became emotional as she started talking about battling the problem from the inside — and about the progress made collectively.

“I’m just really proud of what we’ve done together with all our strengths and all the connections that we have,” she said, “and to really welcome people with lived experiences, and not in a token kind of way, but in a ‘your-voice-really-matters’ way.

“We’re setting precedents that are being looked at across the country,” Ahern went on. “I talk to people from all over who say ‘wow, you did that? — share it.’ And that’s what we do; we share the information so that someone in a state that’s not as progressive can do the same things that we are.”

With that, she spoke for everyone in the crowded room. Anthony Bourdain wasn’t there, of course, but in a way, he was — still reminding people that there’s ‘only us.’

Those involved in this massive collaboration don’t need such a reminder; they live and breathe it every day.

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

Healthcare Heroes

He’s Spent a Half-century in the ‘Helping Profession’

Dr. Robert Fazzi

Dr. Robert Fazzi

There’s more than a little irony attached to the fact that Bob Fazzi’s office has a window that looks out on what was the main gate to the old Northampton State Hospital.

Indeed, Fazzi, the Healthcare Hero in the Lifetime Achievement category, has spent his life working diligently to keep individuals out of institutions like the massive mental-health facility that once dominated the Northampton landscape in myriad ways, and make them part of the community — the one word that probably best defines every aspect of Fazzi’s life and work.

He was doing such work back when his career was getting started as he joined the organization known as Downey Side, which focused on helping to keep delinquent youths out of juvenile institutions and get them into group homes where many layers of support were available.

It was the same when he became the first director of the agency now known as the Center for Human Development. Back then, it was called the Center for the Study of Institutional Alternatives, a name that spoke volumes about its purpose.

And it’s the same, although on a different level and scope with Fazzi Associates, the company he started 40 years ago and incorporated in 1995. Its stated mission is to make a real difference in healthcare by strengthening the quality, value, and impact of home care, hospice, and community-based services.

Fazzi Associates has been a leader and a pioneer in this sector, developing products and services — including the industry’s first home-health patient-satisfaction services — as well as research to make agencies stronger and better able to serve their patients.

The company has grown steadily over the years, so much so that it has had to relocate to larger quarters several times. With the last such move, Fazzi scouted a number of sites, including Tower Square in Springfield, but opted to stay in the community that by then had become home — but in a much different setting.

And in a poetic sort of way, that new mailing address, 11 Village Hill Road, just a few hundred yards from where the state hospital’s administration building, ‘Old Main,’ once stood, represents a lifetime of work well done.

And done in what Fazzi referred to as the “helping profession.”

That’s the term he applied to not only the home-care field, but hospice and the broad human-services spectrum, all touched in one way or another by the company he launched — and the man himself.

Jim Goodwin, the current president and CEO of CHD, who was hired by Fazzi in the late ’70s, describes him as a tireless advocate for those in need, a true leader, visionary, motivator, consensus builder, and manager who was ahead of his time in many ways.

“Today, you hear about CEOs being trained to hire people smarter than they are, to hire people that know things they don’t know,” said Goodwin. “He was one of the first people to actually do that; he hired people like that and made himself successful before that kind of thinking was popular; he put together all the component parts and put the right people around him.”

Fazzi, who noted that he was influenced by a number of mentors in his life, including Father Paul Engel, founder of Downey Side, Paul Doherty, one of that agency’s early board members, and many others, said he’s tried to take the values they’ve impressed upon him and pay it forward, if you will, while also becoming a mentor and inspiration to others.

“I had some great mentors in my life — some people who influenced in my life in a very positive way,” he said. “I’ve tried to do the same for others.”

This manifests itself in a number of policies, formal and informal, at Fazzi Associates. For example, the firm gives away 10% of its profits every year to nonprofit organizations, and has a policy of giving every employee 16 paid hours to volunteer at any nonprofit health, human-service, or anti-poverty organization.

As he talked with BusinessWest, Fazzi was embarking on another new chapter in his life and career. Indeed, after a lengthy search for the right partner, he recently sold the company he founded to Mediware Information Systems Inc., a portfolio company of TPG Capital and a leading supplier of software solutions for healthcare and human-service providers and payers.

He will serve in a strategic advisory role with Mediware, and also be one of the founding board members of ElevatingHome, a new organization created to elevate the role, impact, and influence of the home- and community-based healthcare field.

So, while he’s not exactly retiring, he’s moving in that direction, a step that’s providing some anxiety about what comes next, but also a chance to reflect on his work and his career, which he did for BusinessWest.

At Home with the Idea

While Fazzi is proud of his mailing address, the team assembled to work there, and its many accomplishments, he’s equally proud of something else: how much mail gets delivered there every day.

Indeed, in a community that boasts institutions such as Smith College and Cooley Dickinson Hospital, more pieces are probably delivered to Fazzi Associates than any other location in Northampton.

That’s because those home-health patient-satisfaction surveys, among others developed by the company, must be sent there for processing rather than to the specific agency being evaluated.

“We get almost 1 million pieces of mail a year from patients,” he noted, adding that surveys cannot be completed online at this time. “We compare agencies by how well they do with patients.”

The volume of mail is one qualitative measure of not only how much Fazzi Associates has grown over the years, but also how Fazzi’s career has evolved and touched ever more lives over the decades.

And, as noted earlier, Fazzi may not have known early on what direction his life and his career would take, but he did know he would be getting involved with his community in many ways.

Bob Fazzi

Bob Fazzi has been described by others as a visionary, motivator, mentor, and manager who was in many ways ahead of his time.

“I came from a strong, community-oriented family,” he recalled, noting that he grew up in the Forest Park section of Springfield. “My parents were involved with the church, they were involved with different things within the community; we were always involved.”

During college, he said he was “lost,” as many people who attended in the late ’60s were, but still managed to get involved with a number of groups and organizations, many with community-minded missions and reasons for being.

After college, he had planned on going into AmeriCorps VISTA (Volunteers in Service to America), and thought he had been accepted into that program, but it was so disorganized, as he recalled, that six months later he still wasn’t sure.

While waiting to hear from VISTA, Father Engel invited him to get involved with Downey Side, and he did, living in a number of group homes and working as a community organizer.

He spent only a few years with the program, but its mission, and Engel’s approach to carrying it out, had an indelible impact on Fazzi’s career track and approach to life itself.

“I mention Downey Side all the time, even though I was only there two or three years, and that was a long time ago,” he recalled. “Father Engel was really evangelistic about it, saying, ‘we’ve got to get these kids out of these institutions.’ He was always saying, ‘these kids don’t belong here — we have a moral responsibility to help them.’ That really resonated with me.”

Fazzi eventually left Downey Side to be the first director of the Center for the Study of Institutional Alternatives, which was somewhat of a radical concept back then, he noted, although there was plenty of data to back up that basic premise — and data would be the foundation for the work that would dominate the rest of his career.

The new center started with one program, something similar to Downey Side’s in that the goal was to help keep young people out of institutions, but its mission quickly expanded, he noted, citing as one example that the families of these young people were often challenged by a host of issues, so programs were developed to assist them.

“We found that, in some cases, some of the parents were dealing with severe mental illness; they were up at the state hospital,” he said, referring to the facility in Northampton. “So we began to get involved with the Department of Mental Health.

“The value piece was the key,” he went on. “The value was the least-restrictive alternative; where’s the best place to service people in the least-restrictive manner?”

The answer to that question was “in the community,” he went on, adding that what became CHD was a clear leader in the movement to place individuals with behavioral-health issues in residences within the community.

And while the concept made sense on many levels, there were many individuals who didn’t want such residences in the neighborhoods.

Goodwin remembers some fierce battles with residents in Springfield and West Springfield in particular, and that Fazzi stood his ground and fought hard for those he was working to serve.

“I mention Downey Side all the time, even though I was only there two or three years, and that was a long time ago. Father Engel was really evangelistic about it, saying, ‘we’ve got to get these kids out of these institutions.’ He was always saying, ‘these kids don’t belong here — we have a moral responsibility to help them.’ That really resonated with me.”

“He took a lot of risks,” Goodwin recalled. “In the beginning, when we first opened group homes, there were terrible battles with neighborhoods; people would come out and threaten him and throw things at him. But he always stuck to his guns and worked hard with people in the community to get them to understand the value of community-based programming.”

By the late ’70s, Fazzi knew he wanted to start a new chapter in his career — one that would build on those that came before — and focused on consulting work in realms such as home health and hospice care.

“I felt I wanted to be involved in healthcare, but not the human-service side,” he explained, adding that his doctorate is in organizational behavior and he considered himself proficient at planning and organizational change. His plan was to take those skills and put them to work in consulting to other agencies involved in healthcare.

In Good Company

To say that starting and then growing Fazzi Associates into a business that now employs more than 40 people was a learning experience would be an understatement.

And it started with the first bill he sent.

“I did some consulting work for an agency in Worcester, and they paid me $500,” he recalled. “I sent them a bill, and I called myself ‘Management Consulting’ — very clever; I really stood out with that. He sent it back saying I either had to incorporate or have my name in the title.”

He was set to incorporate but found out that this cost $1,000, twice what he made for the first job. So he opted for plan B and just put his name on the invoices moving forward.

In time, though, and not much of it, ‘Fazzi’ would become more than the name on the bill. It would become synonymous with excellence and innovation in the home-care and hospice realms as the company developed new products and services to help clients better serve their customers and measure their performance.

So much so that, when Fazzi finally decided to incorporate in 1995, and was mulling a name change while doing so, advisors told him the name ‘Fazzi’ had too much name recognition and too much clout for him to consider a change. So he didn’t.

Fazzi recalled that, while he started out working for other people, he always considered himself entrepreneurial.

At CHD, for example, he said the agency was funded by the state, which was often if not always behind in its payments. “I remember having to put my house up in order to carry the organization, and there were other people who did the same thing; if you believed in it, that’s what you did.”

With Fazzi Associates, he started out doing planning and training, with most of the early clients involved with home care and hospice. But the scope of services quickly grew, as did the client list.

While doing organizational-improvement work, home-care agencies would often ask if they were doing a good job, he recalled, adding that he replied, in general terms, that he wasn’t the one to be answering that question; clients should be. And when he asked those agencies if they had patient-satisfaction surveys, most all of them didn’t. And the ones who did lacked that one that would be considered valid.

So Fazzi created one, and before long it was providing them to hundreds of agencies. Then, when the Department of Health and Human Services created the Outcome and Assessment Information Set (OASIS), Fazzi made sure his company became an expert on the subject and began offering OASIS education.

In 2009, responding to the industry’s need to optimize operations to focus on patient care, Fazzi introduced outsourced medical coding, and is now the largest coding company serving the home-health and hospice industries. Through its operational consulting division, the company has helped hundreds of agencies by putting in place best practices in structure, clinical and operational practices, and supervisory models.

Still another contribution Fazzi has made involves conducting scientific best-practice research and then giving that information away for free to the entire industry. The first such study, titled “Collaborating to Compete: A National Study of Horizontal Networks,” was released in 1996. Others to follow included the National Home Care Re-engineering Study, the National Best Practices Improvement Study, and the National Quality Improvement Hospitalization Reduction Study.

“We’re absolutely indebted to our industry — we’ve been in this field since 1978 and believe we have a responsibility to give back to our industry,” he explained. “We feel the best way is to provide every agency in the country with insights on best practices that will make them stronger and more viable.”

Transition Stage

While doing that for his industry, Fazzi wanted to do the same for his company, so he put in place a succession that has Tom Ashe, one of five major partners in the company, succeeding him as CEO.

That leaves him with a problem of sorts.

“I love coming to work every day — I can’t wait to get up and go to work,” he said, adding that, like others facing the transition to retirement, he’s somewhat — OK, maybe a little more than somewhat — apprehensive about what the next phase of his life will be like.

He doesn’t know exactly what he’ll be doing, but it’s a pretty safe bet that that he will stay involved within the helping profession and find new ways to put his vast experience, energy, and compassion to work helping others.

That’s what he’s been doing for a lifetime, and with very positive results for the community known as Western Mass. And for evidence of that, all he needs to do is look out the window toward the gates of the state hospital that no longer exists.

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

Health Care

‘We Are a Different Place’

Shriners Hospitals for Children – Springfield is in a much healthier place than it was nearly a decade ago, when its parent organization seriously considered shutting its doors. A move in 2011 to accept third-party insurance — although free care is still provided to those who need it — stabilized the national network, and canny decisions to introduce new services have helped the Springfield facility not only survive, but thrive and grow stronger: the same goal it has for each young patient.

George Gorton recalls a conversation he had with the parent of a child who nearly drowned — and then required months of intensive rehabilitation to regain full function, both physically and mentally.

Unfortunately, the only two pediatric inpatient rehabilitation units in Massachusetts are located in Boston.

“There was nowhere in Western Massachusetts to bring him back to maximum function level,” Gorton told BusinessWest. “She couldn’t transfer her family to live in Boston for two months to get the care she needed.”

That has changed, however, with last month’s opening of a new, 20-bed Inpatient Rehabilitation Unit at Shriners Hospitals for Children – Springfield.

“Now, everyone in Western Massachusetts who needs that kind of support can come here rather than figure out how to maintain their family 90 miles away,” said Gorton, the hospital’s director of Research, Planning, and Business Development. “It made sense; we had this excess capacity and didn’t need to do a lot of renovation work. It seemed like a natural fit, so we worked to get it set up.”

That excess capacity is due to a trend, increasingly evident over the past two decades, toward more outpatient care at Shriners — and hospitals in general. But despite the space being in good shape, it still needed to be converted to a new use and outfitted with the latest equipment, and that necessitated a $1.25 million capital campaign, which wound up raising slightly more.

George Gorton, left, and Lee Kirk

George Gorton, left, and Lee Kirk say long-standing support from Shriners, their families, and community members — reflected by this display in the lobby recognizing donors — has been a major reason why the hospital provides care regardless of ability to pay.

The new unit is an example of both the community support Shriners continues to accrue and the hospital’s continual evolution in services based on what needs emerge locally.

Specifically, Gorton said, the hospital conducts a community-needs assessment every three years, and out of the 2013 study — which analyzed market and health data and included interviews with primary-care providers and leaders in different healthcare sectors — came a determination that an inpatient pediatric rehab clinic would fill a gaping hole.

When H. Lee Kirk Jr. came on board as the facility’s administrator in 2015, he and his team honed that data further, spending the better part of that year reassessing the hospital’s vision and putting together a strategic plan. They determined that continued investment in core services — from neuromuscular care and cleft foot and palate to spine care and chest-wall conditions — was an obvious goal, but they also identified needs in other areas, from fracture care to sports medicine to pediatric urology, as well as the new rehabilitation unit.

“After a traumatic injury — a brain injury, serious orthopedic injury, it could be spinal injury — a child might have some functional deficits, even though they are not in a medically acute situation,” Kirk told BusinessWest. “So they come to this program and spend anywhere from two to eight weeks with intensive rehabilitative services, which is physical therapy, occupational therapy, and speech therapy, and also physician care and nursing care.”

Under the supervision of a fellowship-trained pediatric physiatrist, patients admitted to the unit will receive a minimum of 15 hours of combined physical, occupational, and/or speech therapy per week, added Sheryl Moriarty, program director of the unit. “Using an individualized, developmental, and age-appropriate program model, our Inpatient Rehabilitation team will manage medically stable children and adolescents with a variety of life-altering and complex medical conditions.”

That evolution in services makes it even more clear, Gorton said, that the landscape is far different than it was in 2009, when the national Shriners organization seriously considered closing the Springfield hospital.

“We’re stronger in every sense of the word,” he said, “from our leadership to the quality of the employees we have to the diversity of programs we have to the financial strength behind all this. We are a different place.”

First Steps

When a boy named Bertram, from Augusta, Maine, made the trek with his family to Springfield in February 1925, he probably wasn’t thinking about making history. But he did just that, as the hospital’s very first patient.

“While Shriners opened hospitals primarily to take care of kids with polio, Bertram had club feet,” Kirk said — a condition that became one of the facility’s core services.

After the first Shriners Hospitals for Children site opened in 1922 in Shreveport, La., 10 other facilities followed in 1925 (there are now 22 facilities, all in the U.S. except for Mexico City and Montreal). Four of those hospitals, including one in Boston, focus on acute burn care, while the rest focus primarily on a mix of orthopedics and other types of pediatric care.

As an orthopedic specialty hospital, the Springfield facility has long focused on conditions ranging from scoliosis, cerebral palsy, and spina bifida to club foot, chest-wall deformities, cleft lip and palate, and a host of other conditions afflicting the limbs, joints, bones, and extremities. But that’s the tip of the proverbial iceberg.

“This is along the lines of a community service, and our athletic trainers are working with school systems and private sports clubs in the community, to participate from a preventive point of view, but they certainly can attend games as a first responder and then follow up with treatment.”

“There’s some consistency in services, but each of the hospitals has adapted to the needs that present themselves in that community,” he went on, noting specialties like rheumatology, urology, and fracture care in Springfield, as well as a sports health and medicine program that brought on two athletic trainers and is currently recruiting a pediatric orthopedic surgeon with training in sports medicine.

“This is along the lines of a community service, and our athletic trainers are working with school systems and private sports clubs in the community, to participate from a preventive point of view, but they certainly can attend games as a first responder and then follow up with treatment.”

In all, more than 90% of care provided in Springfield is outpatient, reflecting a broader trend in healthcare, Kirk added. “We have always had, and still have, the only pediatric orthopedic surgeons in Western Massachusetts.”

Jennifer Tross stands in a hallway of the new Inpatient Rehabilitation Unit.

Jennifer Tross stands in a hallway of the new Inpatient Rehabilitation Unit.

After its clinical work, he noted, the second part of the Shriners mission is education. Over the past 30 years, thousands of physicians have undertaken residency education or postgraduate fellowships at the children’s hospitals.

“We have a lot of students here in a lot of healthcare disciplines, particularly two orthopedic residents who come on 10- to 12-week rotations from Boston University and Albany Medical Center. We have nursing students, nurse practitioners, physical and occupational therapists — a whole cadre of individuals.”

The third component of the mission is research, specifically clinical research in terms of how to improve the processes of delivering care to children. That often takes the shape of new technology, from computerized 3D modeling for cleft-palate surgery to the hospital’s motion-analysis laboratory, where an array of infrared cameras examine how a child walks and converts that data to a 3D model that gives doctors all they need to know about a child’s progress.

More recently, a capital campaign raised just under $1 million to install the EOS Imaging System, Nobel Prize-winning X-ray technology that exists nowhere else in Western Mass. or the Hartford area, which enhances imaging while reducing the patient’s exposure to radiation.

That’s important, Kirk said, particularly for children who have had scoliosis or other orthopedic conditions, and start having X-rays early on their lives and continue them throughout adolescence.

It’s gratifying, he added, to do all this in a facility decked out in child-friendly playscapes and colorful, kid-oriented sculptures and artwork.

“It’s truly a children’s hospital when you look around the waiting areas and the lobbies,” Kirk said, noting that ‘child-friendly’ goes well beyond décor, to the ways in which the medical team interacts with patients. “This is a happy place, and it’s a privilege for me to be part of such a mission-driven organization. I’ve been in this business for 35 years, and this is the most mission-driven healthcare organization I’ve ever been associated with — and I think others feel that way too.”

Joint Efforts

Jennifer Tross certainly does. She’s one of the newest team members, coming on board as Marketing and Communications manager earlier this summer. “I felt the commitment as I was being recruited here,” she said. “It’s an honor to be a part of it, really.”

It’s not that difficult to uphold the hospital’s mission when one sees the results, Kirk added.

“Our vision is to be the best at transforming the lives of children and families, and that’s what we look for every single day,” he told BusinessWest. “You see how their lives are transformed, and how, regardless of their situation, they’re treated like normal kids here. That helps them to evolve and have confidence to function normally at home, at school, and in their communities.”

There’s a confidence in the voices of the hospital’s leaders that wasn’t there nine years ago, following a stunning announcement by the national Shriners organization that it was considering closing six of its 22 children’s hospitals across the country — including the one on Carew Street.

“Our vision is to be the best at transforming the lives of children and families, and that’s what we look for every single day. You see how their lives are transformed, and how, regardless of their situation, they’re treated like normal kids here. That helps them to evolve and have confidence to function normally at home, at school, and in their communities.”

In the end, after a deluge of very vocal outrage and support by families of patients and community leaders, the Shriners board decided against closing any of its specialty children’s hospitals, even though the organization had been struggling — at the height of the Great Recession — to provide its traditionally free care given rising costs and a shrinking endowment.

To make it possible to keep the facilities open, in 2011, Shriners — for the first time in its nearly century-long history — started accepting third-party payments from private insurance and government payers such as Medicaid when possible, although free care is still provided to all patients without the means to pay, and the hospital continues to accommodate families who can’t afford the co-pays and deductibles that are now required by many insurance plans.

“That was a very good strategic move,” Kirk said, noting that, regardless of the change, 65% of the care provided last year to 11,501 children was paid for by donors, the Shriners organization, and system proceeds.

If a family can’t pay, he noted, the hospital does not chase the money, relying on an assistance resource funded by Shriners and their families nationwide. “One of the largest causes of personal bankruptcy is healthcare. It’s unfortunate that all healthcare can’t be delivered in the Shriners model. But I don’t disparage my colleagues — they don’t have a million-plus Shriners and their families around the world who are incredibly passionate about raising money to take care of kids.”

As a result of this model, “Shriners Hospitals for Children is a net $10 billion business with no debt. And one of the things we try to minimize is the support we require from system proceeds, other than our endowment,” he noted. “And we’ve been very successful here. It’s kind of an internal competition — which hospital requires the least support from the system.”

In the past three years, the Springfield facility has ranked second on that list twice, and third once. And that’s despite actually growing its services significantly. In 2016, Gorton said, the hospital grew its new patient intakes by 44%, followed by 26% the following year and a projected 20% this year. “So we serve a lot more children across the diverse set of services we provide.”

He noted that the outpouring of community support in 2009 — which included a sizable rally across the street — was an awakening of sorts.

“They said, ‘hell no, don’t go, we need you; stay here,’” he recalled. “Since then, we’ve done everything we could to identify what it was that the community wanted from us and recreate ourselves in that image. I think we’ve been largely — more than largely … exceptionally — successful on that.”

The hospital saw a lot of turnover in the years following 2009, Gorton added, “but the people who stayed are committed to the mission and vision of transforming children’s lives. The people who have joined us since then sense that the one thing we don’t compromise on is our mission and our vision.”

Best Foot Forward

When asked where the hospital goes from here, Kirk had a simple answer: Taking care of more children.

That means making sure area pediatricians, orthopedists, and hospitals are aware of what Shriners does, but it also means bolstering telehealth technology that allows the hospital not only to consult with, say, burn experts at the Boston facility, but to broaden outreach clinics already established in Maine, New York, and … Cyprus?

“We go to Cyprus every year — for 37 years now,” Kirk said of a connection the organization made long ago with the Mediterranean island. “We’ll see 300 kids in four days of the clinic, and over the course of a year, 10 to 20 will come to Springfield and stay in the Ronald McDonald House here while they receive care — typically surgical care.

“We’ve had an ancient telehealth connection with Cyprus, and we’re now updating that to the latest technology, so we can have telehealth clinics with Cyprus four to six times a year in addition to going over there,” he went on. So we’re going to focus on taking care of more kids.”

That is, after all, the core of the Shriners mission.

Joseph Bednar can be reached at [email protected]

Health Care

A Different Kind of Health Crisis

Dr. Gaurav Chawla

Dr. Gaurav Chawla describes suicide as “a very unfortunate, tragic outcome of a complex set of circumstances.”

It’s a common, but certainly not universal, refrain when an individual takes his or her own life.

Friends and relatives will say they didn’t see any signs that this was coming, said Kate Hildreth-Fortin, program director, Emergency Service & Mobile Crisis Intervention with Behavioral Health Network (BHN). Or they’ll say that they could not see any apparent reason for this outcome, that the individual in question seemed outwardly happy and was enjoying life.

That’s what people said about celebrity chef Anthony Bourdain, designer Kate Spade, comedian Robin Williams, and countless others, famous and not at all famous.

“But almost always, there are warning signs, and there are reasons,” said Hildreth-Fortin, one of many who spoke with BusinessWest about a subject that is timely, immensely complicated, and a true healthcare crisis probably on the same level as the one involving opioid addiction.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide, and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Timely not just because of those celebrity suicides several months ago — although they always help bring attention to the problem — and not just because of a recent report from the Centers for Disease Control and Prevention on the growing problem.

It’s timely because the numbers continue to rise, as does the overall toll from suicide, which goes well beyond the individuals who take their own life, said Dr. Gaurav Chawla, chief medical officer at Providence Behavioral Health Hospital, part of Trinity Health Of New England, who estimated that six lives are directly impacted by each suicide.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide,” he went on, “and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Getting back to the numbers, they are eye-opening and quite alarming:

• The most recent surveys show there are 45,000 completed suicides in the U.S. every year;

• That number has steadily risen since the start of this millennium, with suicides up a total of 28% since 2000;

• Massachusetts has the third-lowest suicide rate in the nation, but the rate of suicides in the Bay State has increased 35% since 1999, well above the national average;

• Women attempt suicide at a higher rate than men, but men complete suicide at a higher rate than women;

• Firearms are used in more than 50% of suicide attempts;

• Middle-aged white men (those in their 40s to mid-50s) have the highest suicide rate, particularly when they are single, but there is another peak involving individuals over 84; and

• Among individuals ages 14-34, suicide is the second-leading cause of death after accidents.

Perhaps as disturbing and frustrating as the numbers themselves are the forces behind them. They are numerous, often difficult to see, and very difficult to combat.

But there are common denominators of a sort. For starters, suicide usually results from a combination of factors, not one in particular, said Chawla, who summed things up succinctly, noting that “there is never one reason for someone to take their life; suicide is a very unfortunate, tragic outcome of a complex set of circumstances.

Kate Hildreth-Fortin

In almost all cases, Kate Hildreth-Fortin says, there are warning signs with someone contemplating suicide.

“You will often see the assumption that undiagnosed mental illness or inadequately recognized or treated mental illness is the cause,” he went on. “However, that is a myth; 50% of the suicides do not have a diagnosed mental illness behind them.”

As for what is behind them, that list is obviously quite long, said Hildreth-Fortin, and could include biological and genetic factors, increasing stresses of life, relationship crises, financial and occupational stressors, poor coping styles, increased substance use, and many others.

Another common denominator is that those contemplating suicide generally feel trapped in a life that does not bring them happiness or make them fulfilled, said those we spoke with, adding that this descriptive phrase can be applied to people at every age, every income bracket, and every walk of life.

Slicing through it all, such individuals need a way out of that trap and can’t find one or are unwilling to try, said Chawla.

“Suicide is a confluence of circumstances that lead one to conclude that they’re trapped in a hopeless circumstance, sometimes without purpose, in a painful existence from which there is no other way out,” he told BusinessWest.

Meanwhile, providing a way out, especially to those suffering from behavioral-health issues (and that’s a large percentage of those who contemplate or complete suicide) is made more difficult by the persistent stigma attached to seeking help for such conditions, and then finding help in a system plagued by a shortage of resources.

These are the reasons why this is a healthcare crisis, even if the same politicians who are quick to give such a label to the opioid epidemic are mysteriously reluctant to do the same with suicide.

For this issue, BusinessWest takes a long, hard look at suicide, going beyond the numbers in a quest to explain why they continue to rise, and also looking at how area professionals are helping those who are in that aforementioned ‘trap’ and need a way out.

A Failure of the System

Hildreth-Fortin, like the others we spoke with, said that, while it is somewhat regrettable that it often takes celebrity suicides like Bourdain’s and Spade’s to bring heavy media attention to the problem of suicide, she’s happy for the attention and a chance to bring the conversations to the forefront, instead of the background, where they have been for too long.

That’s because a brighter light needs to be shone on this crisis to bring about any kind of change in the current trends. With that attention, she said, there is hope that the stigma attached to mental-health issues and seeking help for them might be diminished; hope that more resources might be brought to bear to address the crisis, as has happened with opioid addiction; hope that friends and loved ones might become aware of the warning signs — what to do when they see and hear them; and hope that those feeling trapped might be more persistent in finding a way out.

That’s a lot of hoping, but in this battle, those fighting it will take whatever help they can get, especially with regard to that stigma concerning mental health.

“Suicide is a word we use every day; it’s something we deal with every day,” said Hildreth-Fortin, whose program handles roughly 1,300 assessments a month, and 70% of these individuals, in her estimation, have suicidal thoughts. “There’s a lot we can do with prevention; we need to reduce the stigma, improve education, and treat suicide the same way we would diabetes — ‘what can we do to help someone?’”

Chawla agreed, and said the stigma attached to both suicide and mental illness and seeking help for it often contributes to a lack of understanding concerning why someone commits suicide.

That is certainly the case with celebrities such as Bourdain, Williams, and others, he went on, adding that, to most of the rest of the world, these people seem happy and content with their lives.

But it’s not the world’s perception of these individuals that matters; it’s how they view themselves, and this is true of people across all income levels and social strata.

“It’s about perceptions of who you are, how you fit in your world, and how meaningful you find your existence,” he said. “That’s what ultimately leads to or doesn’t lead to such acts.”

But while suicide is seemingly an individual act, it isn’t, and each act represents more than one person choosing that tragic outcome.

“Suicide is taken as one event by one individual, and that’s not what it is,” said Chawla. “It is the final outcome of the failure of the system. Along the way, there are many lives affected, there’s a lot of loss of function, and there is opportunity that’s missed.”

Hildreth-Fortin and others at BHN agreed, and said one huge key to perhaps reducing the number of suicides is to seize opportunities rather than miss them.

And there is quite a bit that goes into this equation, she noted, listing everything from proper training of police officers, teachers, and others to being aware of the many warning signs; from knowing what questions to ask those at risk (and asking them) to knowing how to respond to the answers to those questions.

And this means not overreacting or underreacting, and, above all, connecting people at risk with services that provide help, said Hildreth-Fortin, who, like Matthew Leone, assistant program director of the crisis unit at BHN, is trained in something called QPR, which stands for question, persuade, refer — the three basic steps in suicide prevention.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help,” Leone explained, adding that, in his role, he does a lot of training in the community on how to recognize suicide.

Which brings him to those warning signs. There are many to watch for, some subtle, some most definitely not, he said.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help”

They could and often do include people saying ‘goodbye’ or ‘nice to know you’ on Facebook and other platforms, individuals giving away possessions, young people suddenly drawing up a will, people losing interest in things they enjoy doing, a decrease in performance at school, and many others.

“A more overt sign might be when they start stockpiling medication or another means of following through on their plan,” Leone went on, adding that, in addition to these warning signs, which are clearly red flags, there are also risk factors.

And there are many of those, he said, starting with being a middle-age male. Others include financial distress, depression, divorce, loss of a job, being given a terminal diagnosis, and, of course, a combination of some of these.

Questions and Answers

The next part of the equation is knowing what to do when warning signs are recognized, or with someone who outwardly seems at risk, said Hildreth-Fortin.

She acknowledged that having a conversation with such an individual and asking the questions that need to be asked is awkward and often very difficult (some fear that just asking the questions can help promote a suicidal act) but it needs to be done.

“A big piece of QPR training is teaching people how to ask the question, to get someone comfortable with asking someone if they’re suicidal,” she said, adding that this training is often given to first responders and educators, but parents, spouses, friends, and employers also fall into the category of individuals who need to ask questions and need to know how to ask and also how to respond.

Questions should focus on what thoughts people are having, how often they’re having them, and whether they’ve acted on these thoughts in any way before, said Hallie-Beth Hollister, assistant program director, Community Relations for BHN, adding that the answers will generally reveal just how at-risk someone might be.

Jenni Pothier

Jenni Pothier says those working with those contemplating suicide need to create a comfortable, non-judgmental, open space for dialogue to occur.

One key, she went on, is not asking leading questions that would enable the individual to give the answers the questioner might be looking for.

“Don’t say, ‘you’re not thinking of killing yourself, right?’” she said by way of example.

But, as noted, recognizing warning signs and asking the right questions are only parts of the equation. Responding to the signs and the questions to the answers is another big part, said Leone, adding that that many people balk at asking questions, or especially difficult and specific questions, because of anxiety about the answer.

“‘What do I do if the answer is yes?’” is a question that unnerves many, he went on, adding that there’s a reason for this; the response can be complex.

“We talk with people all day who mention that they’ve having suicidal thoughts,” he explained. “Some have the intent to follow through, others do not; some have vague suicidal ideation where there’s no real plan to it.”

Which is why overreaction is possible and should be avoided.

“Many times, with suicide, when someone says they’re having those thoughts, instead of starting a conversation, it ends the conversation,” he explained. “People will jump in and say, ‘we need to get them to the hospital, we need to get them help now,’ when the person is just reaching out to talk about it for help.

“And this overreaction can have a negative effect to it because then the next time the person is experiencing those thoughts, they may not say anything,” he went on, adding that the key is generating the proper response given the individual’s risk factors, warning signs, the strength of the connections in his or her life, and other factors.

Jenni Pothier, director of the Tenancy Preservation program for Springfield-based Mental Health Associates, agreed. In the course of her work, which involves helping individuals who are at risk of homelessness — a stressful situation to say the least — the subject of suicide often comes up.

“Because we know that suicide includes risk factors like poverty, experiencing potential homelessness, and a lack of access to resources, people are in crisis,” she explained. “So we’re assessing people regularly for suicide.”

And those assessments involve asking those questions mentioned above, asking them in an effective way, and responding in the appropriate manner.

“As practitioners and clinicians in the community, you need to create comfortable, non-judgmental, and open spaces for dialogue to occur,” she explained, “so people can express to you how they’re feeling without the fear of the stigma or that you’re going to instantly call 911 to get them hospitalized if they say they’re contemplating suicide or having suicidal ideations.”

Bottom Line

As she talked with BusinessWest about suicide and, more specifically, the problems many have with asking the questions that must of asked of someone at risk, Hildreth-Fortin related the story about an educator who, during a QPR training session, admitted not only that she would have difficulty asking such questions, but also that she would be upset if someone put those questions to her child.

“I had a real hard time responding to her, because it spoke so greatly to the stigma attached to this,” she said. “If your child had a stomach ache, you wouldn’t have a problem with him going to the nurse. You talk about what hurts, what kind of pain it is … we have to treat suicide the same way we would any medical symptom. We have to talk about it.”

It will take a confluence of factors and a great deal of resources to reverse the current trends on suicide, but getting people to talk about it and respond to the talk is the big first step, said Chawla, adding that only by doing so can those missed opportunities he mentioned become real opportunities to do something about a true healthcare crisis.

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