Women with high-risk pregnancies often need management of chronic medical conditions after childbirth such as high blood pressure and cardiovascular disease.
Adverse outcomes in maternal health are a national concern.
The maternal mortality rate in the United States is significantly higher than the maternal mortality rate in other high-income countries, according to a report published by The Commonwealth Fund.
Scripps Health's Fourth Trimester Continuum of Care program provides optimized care for new moms with high-risk pregnancies, particularly women with chronic medical conditions.
The "fourth trimester" is a critically important time period for new moms, according to Sean Daneshmand, MD, medical director of the Scripps Clinic Maternal-Fetal Medicine Program.
"We think of pregnancy as having three trimesters—three consecutive blocks of time that are three months each," Daneshmand says. "However, there is also an important block of time for moms after they deliver, which is what we refer to as the fourth trimester."
Launched last fall, the Fourth Trimester Continuum of Care program focuses on women who have high-risk pregnancies. Many of these women have chronic medical conditions such as high blood pressure, diabetes, and cardiovascular disease. Daneshmand describes the program as more of a continuum of care than a clinic.
"This program involves setting up a new system and streamlined process to identify at-risk moms before they give birth," Daneshmand says. "We help high-risk moms receive the care that they need from their primary care physician in a timely fashion shortly after they deliver."
In the United States, most new moms get two visits with their obstetrician-gynecologist after delivering their baby. Particularly for new moms with chronic medical conditions, two postpartum OB/GYN visits are insufficient to provide quality care, Daneshmand explains.
"The Fourth Trimester Continuum of Care puts more structure and focus on care, so we can be more proactive on how we take care of our high-risk new moms," Daneshmand says. "The goal is faster care and as many doctor visits as needed after delivery to get new moms on the right track. These visits can be provided virtually or in-person."
The Fourth Trimester Continuum of Care program identifies high-risk new moms and connects them with care. The patients are flagged in the EMR as needing proactive follow-up from their primary care physicians soon after delivery.
"During a baby's pediatrician visits, the pediatrician proactively asks the mom about her health, which helps new moms get the care they need faster," Daneshmand says. "There is close collaboration between my division, maternal-fetal medicine, and primary care."
Although most medical services offered through the Fourth Trimester Continuum of Care program are provided by primary care physicians, some new moms are referred to specialists such as cardiologists and endocrinologists, Daneshmand explains.
It is too soon to have data showing the impact of the Fourth Trimester Continuum of Care program, but the primary goal is reducing chronic medical conditions experienced by new moms, according to Daneshmand.
"By addressing chronic health conditions such as hypertension, we can help reduce co-morbidities in future pregnancies such as the development of preeclampsia," Daneshmand says.
Ghazala Sharieff, MD, MBA, is executive senior vice president and chief medical and operations officer of acute care at Scripps Health. Photo courtesy of Scripps Health.
CMO perspective
CMOs should be concerned about the continuum of care for pregnant women, according to Ghazala Sharieff, MD, MBA, executive senior vice president and chief medical and operations officer of acute care at Scripps Health.
"We need to think about pre-pregnancy because if women are going to plan pregnancies, we want them to be as healthy as possible," Sharieff says. "Then if we have high-risk pregnancies, we want those moms to meet with specialists such as Dr. Daneshmand, so we can manage high-risk pregnancies."
At Scripps Health, hospital caregivers are focused on providing quality care to new moms with chronic medical conditions, Sharieff explains.
"When a pregnant woman comes into a hospital with a chronic condition, if they need a hospitalist to co-manage their condition, we can provide that kind of care," Sharieff says. "Some of our moms end up in the ICU, so we have our ICU staff work hand-in-hand with Dr. Daneshmand."
CMOs should also focus on the fourth trimester, according to Sharieff.
"There is good reason for CMOs to start thinking more proactively—not just during a pregnancy but also after delivery, so we can get moms feeling as good as they can feel," Sharieff says.
Innovation initiatives help hospitals to improve the quality of care, this new chief medical executive says.
In the hospital setting, frontline staff should be leaders in innovation, the new chief medical executive of a Sutter Health hospital says.
Anup Singh, MD, became chief medical executive of California Pacific Medical Center this month. He was previously chief medical executive at another Sutter Health hospital, Sutter Santa Rosa Regional Hospital.
"The first key driver of innovation in the hospital setting is relying on frontline leaders and physicians for innovation rather than the C-suite," Singh says. "You need to reach out to frontline team members to ask for suggestions. When you ask them questions, you will get significant innovative answers from them."
In addition to relying on frontline staff for innovation initiatives, ideas can come from outside a hospital, Singh explains.
"Leaders should look across their health system and across the country to see who is performing best in terms of metrics and how they are doing it," Singh says. "You need to learn from others about best practices and innovations."
To promote innovation, CMOs and other hospital leaders need to be open to new ideas, according to Singh.
"If you are not open to new ideas and if you are not flexible, people will not have the psychological safety to come to you to talk about innovations," Singh says.
Singh gave an example of an innovation initiative at Sutter Santa Rosa Regional Hospital.
"We had an innovation initiative for congestive heart failure patient readmissions," Singh says. "We did not have enough outpatient physicians or cardiologists to see the patients. We could not see patients quickly enough."
The initiative focused on enlisting pharmacists to engage patients.
"We had our pharmacy team call these patients within 48 hours of discharge as well as connect patients with home health services," Singh says. "We were able to talk with patients and adjust medications to improve their care."
Anup Singh, MD, is chief medical executive of California Pacific Medical Center. Photo courtesy of Sutter Health.
Improving care quality
Hospital readmission is a key quality metric, according to Singh.
When Singh became chief medical executive of Sutter Santa Rosa Medical Center in 2023, one out of six congestive heart failure (CHF) and heart failure patients were being readmitted to the hospital within 30 days. The hospital took several actions to reduce these readmissions.
The hospital was able to reduce the amount of time it took for CHF and heart failure patients to get follow-up appointments with cardiologists. Patient engagement was improved with the pharmacy and transitional care teams. The hospital worked more closely with the home health team, which engaged with patients and helped to manage medications.
"By the end of the year, we were able to decrease readmissions from 16% to around 9%," Singh says.
Patient experience is another crucial quality metric, Singh explains.
"When you talk about patient experience, it is not only about care, but also knowing the patient as a person," Singh says.
Hospitals should take a team-based approach to improving patient experience, according to Singh.
"It is not only the physician—it is the nurses and the rest of the care team," Singh says. "When we talk with a patient, we talk with them not only as a patient but also as a human being. We need to know them and what they like such as their hobbies."
Communication is pivotal in patient experience, Singh explains.
"We want to narrate the care in a way that the patient understands," Singh says. "We want them to be aware of what is happening in their care."
Improving care coordination
Health systems need to focus on patient engagement to improve care coordination, according to Singh.
"We need to take care of the patient with continuous care, not just care when they are in a clinic or a hospital," Singh says. "We should be in touch with the patient in way where we are taking care of them even when they are not in a healthcare setting."
CMOs and other healthcare leaders need to ask themselves pointed questions to provide good care coordination, Singh explains.
"How are we taking care of a patient? How safe are we providing care to the patient? How are we connecting with the patient once they are at home?" Singh says. "We need to be providing follow-up appointments to patients, so they are not coming back to the hospital, and we need to provide care to patients once they have gone home."
Care teams in various settings need to work together to boost care coordination. According to Singh, CMOs need to have outpatient teams coordinating with inpatient teams as well as home health teams.
"When we have patients go home from the hospital, home health staff connect with these patients, so there is a continuous connection with the patients," Singh says. "Our home health team works on the same electronic medical record as our hospitals, Epic, so documentation is visible to outpatient physicians."
Having care teams on the same EMR is essential for care coordination, Singh explains.
"When the home health team goes to the patient in the home, they are collecting data, and they are talking with the patient," Singh says. "If problems arise that require intervention, our home health staff has the option to send messages to the outpatient team, whether that is a primary care physician or a specialist."
When patient safety concerns arise in a non-punitive workplace, the emphasis is on improving processes rather than blaming individuals.
Establishing a non-punitive workplace culture is a cornerstone of patient safety, a trio of top clinical leaders say.
Patient safety is a top priority for CMOs and other clinical leaders. These leaders must foster a non-punitive workplace culture to encourage frontline staff members to report patient safety concerns and events.
"If there is a recognition that there is a potential patient safety event, whether it is a medication event, equipment event, or staffing issue, those concerns must be brought to leadership," says Jennifer Khelil, DO, MBA, executive vice president and chief clinical officer of Virtua Health. "Staff members must feel comfortable bringing these concerns to leadership. If the culture is punitive, people are not going to speak up."
Having a non-punitive workplace is part of a culture of patient safety, where staff feel comfortable speaking up without fear of backlash, according to Kevin Post, DO, CMO of Avera Health.
"They can speak up for the safety of the patients and the safety of their coworkers without fearing retaliation coming back against them," Post says. "That starts with leadership and putting systems in place where we encourage our staff members to speak their mind; and when they do, we reward them and recognize them."
With a non-punitive culture, staff members are more likely to report when they are involved in a medical error, according to Sylvain "Syl" Trepanier, DNP, RN, chief nursing officer at Providence.
"They won't shy away from raising their hand and saying they made an error," Trepanier says. "You learn together, and you do not blame the individual. You focus on the processes."
Jennifer Khelil, DO, MBA, is executive vice president and chief clinical officer of Virtua Health. Photo courtesy of Virtua Health.
How to promote a non-punitive workplace
To establish a non-punitive workplace, healthcare leaders need to be visible and to interact with care teams, Khelil explains.
"They need to be on the floors with the care teams," Khelil says. "They need to thank teams and staff members who bring concerns forward."
Healthcare leaders should also follow up when patient safety concerns are reported, according to Khelil.
"When a staff member brings a concern to you that could have turned into a patient safety event, you need to close the loop and circle back to that individual," Khelil says. "You need to let that individual know that because they spoke up, a change was put into place so that the issue does not arise again."
In a non-punitive workplace, staff members should be recognized and rewarded when they report patient safety concerns.
Avera Health has a Good Catch Award, which is given to staff members when incidents occur that could have caused injury or harm to a patient, but it was caught before it reached the patient. The health system has a process where frontline caregivers can report when a good catch occurs, and learnings can be disseminated throughout the entire health system.
"So, if an error nearly occurred in one area of our health system, we have a communication channel in place to share that learning in a confidential way," Post says. "We also lift up the employee who had the courage to speak up for the greater good of the patient and the organization."
Healthcare leaders in a non-punitive workplace are aware of the working conditions and care processes at the frontlines, according to Trepanier.
"You can't be a subject matter expert at everything, but you need to know what resources are available and what the work is about," Trepanier says. "You need to have a lot of curiosity and ask a lot of questions. You should not resort to blaming people in the first instance and focus on the processes instead."
This new executive has prior experience leading the accountable care organization at Memorial Hermann Health System.
BayCare Health System has named a new executive to lead value-based care efforts at the Clearwater, Florida-based health system.
Kriel Ramcharitar, MD, MPH, became vice president and CMO for value-based care at BayCare effective May 19. Prior to joining BayCare, he served as a faculty member with the Jefferson College of Public Health at Thomas Jefferson University in Philadelphia. Ramcharitar's leadership experience in value-based care includes serving as vice president and CMO of Memorial Hermann Health System's Accountable Care Organization and Population Health Service Organization.
A health system must have the right structure and infrastructure to support value-based care, according to Ramcharitar.
"Value-based care has a rich and multidisciplinary basis, including everything from finance to operations to health management to care coordination," Ramcharitar says. "It also must link in with the enterprise strategic goals and the highest leadership level in order for it to translate and transform into true operational action."
Ramcharitar says the structure and infrastructure needed to support value-based care includes having multidisciplinary teams in areas such as care coordination, pharmacy, quality teams that help with quality gap closure, and managed care contracting to ensure that value-based care agreements have metrics that matter. In addition, Ramcharitar says that a health system must have an electronic medical record (EMR) that supports value-based care implementation and monitoring to help the health system know how it is performing on metrics in terms of cost and quality.
"The structure requires the skills of team members with multidisciplinary expertise, including physicians, care coordinators, social workers, and pharmacists," Ramcharitar says. "That informs the structure to effectively deliver value-based care and to have favorable outcomes, both for quality and total cost of care across populations and communities."
Kriel Ramcharitar, MD, MPH, is vice president and CMO for value-based care at BayCare Health System. Photo courtesy of BayCare Health System.
Keys to success in running effective ACOs
There are several factors involved in operating a successful ACO, according to Ramcharitar.
"You need effective care coordination that is proportionate to the needs of your communities and populations," Ramcharitar says. "You need an evidence-based approach to pharmacy, including medication adherence and comprehensive medication management."
An ACO should have teams conducting outreach for quality gap closure, Ramcharitar explains. For example, an ACO should have outreach to patients who need breast cancer and colorectal cancer screening.
An ACO needs robust data analytics and a strong electronic medical record that enables care teams to make actionable decisions on factors related to quality, Ramcharitar says.
An engaged and high-performing physician network is crucial for an ACO, according to Ramcharitar, who adds that the ACO leadership needs to be collaborative with the network both in terms of performance and understanding the challenges physicians have in value-based care and population health. This is especially true when there are different EMRs across the network.
"At the physician practice level, they may spend several hours in their EMRs sifting through population health data," Ramcharitar says. "This can be a root cause of physician distress. So, you need to talk with your physician partners to understand the challenges they are having in terms of being able to get data and focus on population needs."
Another factor in ACO performance can be employer-based education, Ramcharitar explains.
"Often within an ACO, you have cohorts and sub-populations that are based on employer contracts," Ramcharitar says. "You need to enable employers to understand all of the services that come with being part of the ACO, so they can effectively access and manage high quality in-network services."
Succeeding in population health
At the most basic level, population health involves providing care to communities and looking at the distribution of outcomes within communities, according to Ramcharitar.
"Population health is about understanding a population," Ramcharitar says. "For example, you need to know the prevalence of type 2 diabetes, chronic obstructive pulmonary disease, and other chronic diseases within a population."
Succeeding in population health involves a strong collaborative approach with primary care, according to Ramcharitar.
"You need to have a strong primary care infrastructure to support population health," Ramcharitar says. "For example, with quality gap closure, you need to improve on annual wellness visits across the population."
Preventative care is an effective population health management strategy, Ramcharitar explains.
"For example, you need to look at cancer screening programs," Ramcharitar says. "We know at the population level that the single most effective thing that we can do to prevent premature morbidity and mortality from cancer is screening."
At a practical level, health systems must consider how population health delivery models are linked to effective reimbursement models, according to Ramcharitar.
"Population health is the delivery of effective healthcare services at the population level, but they have to be linked to the right value-based care agreements with payer partners," Ramcharitar says.
In the hospital setting, it is imperative for physicians and nurses to work together to boost patient experience.
"The reality is that if we work in nursing and physician siloes, we will not get a good patient experience outcome," says Omayra Mansfield, MD, MHA, who was recently named as CMO of AdventHealth Celebration hospital.. "At the end of the day, the patient wants to see nurses, physicians, and the rest of the care team working cohesively to advance their care. So, the RN-MD relationship is critical for patient experience."
Click on the video below to get Mansfield's perspective on physicians and nurses working together to improve patient experience. Click here to read the accompanying HealthLeaders story.
The American Diabetes Association has established standards of care for diabetes patients in the hospital setting.
Three dozen hospitals across the country have been recognized for providing care to diabetes patients based on guidelines established by the American Diabetes Association (ADA).
For diabetes patients in the hospital setting, hyperglycemia, hypoglycemia, and glucose variability have been linked to adverse outcomes, including morbidity and mortality, according to a study published by the Journal of Clinical Endocrinology and Metabolism. The ADA says hospitals that follow their guidelines can improve outcomes, shorten hospital stays, and reduce hospital readmissions and emergency department visits.
"We are following the American Diabetes Association standards of care for diabetes patients," says Harpreet Pall, MD, MBA, CMO of Hackensack Meridian Jersey Shore University Medical Center, which is part of Hackensack Meridian Health. "We are using these standards to address all aspects of diabetes care for our patients. This has been a tremendous benefit for our diabetes patients in the hospital setting."
It is meaningful and important for a hospital CMO to be involved in the standard of care for patients with diabetes, according to Pall. The goal is for admitted patients to have a safe and efficient time in the hospital.
"We also want to make sure that the care that is being delivered to patients is based on evidence," Pall says. "We want to make sure that there is evidence that therapy decreases complications."
The ADA standards are helpful because they give hospital clinical teams a roadmap to follow, Pall explains.
"The care teams know that there is a standard way to approach care that is evidence-based and improves outcomes for patients who are affected by diabetes," Pall says.
The ADA standards of care are essential in the management of hospitalized diabetes patients at Denver Health, according to Rocio Pereira, MD, chief of endocrinology at the health system.
"We regularly review the American Diabetes Association's standards of care to make sure we are following recommendations," Pereira says. "As those standards of care change, we make sure we are keeping up to date with the newest recommendations."
Harpreet Pall, MD, MBA, is CMO of Hackensack Meridian Jersey Shore University Medical Center. Photo courtesy of Hackensack Meridian Health.
Examples of following the ADA guidelines
The ADA standards guide hospitals in managing glucose variability in the hospital setting.
"We provide a lot of education to our providers who are putting in the orders for different medications that can affect patients' insulin sensitivity and glucose level," Pereira says. "For example, we make sure that providers are aware that when they start a patient on a steroid medication, it can increase the patient's glucose level."
Multidisciplinary teams are focused on managing glucose variability among diabetes patients at Hackensack Meridian Jersey Shore University Medical Center, according to Pall.
"Our clinical diabetes advocates, which include diabetes educators, are consistently looking at the reports of patients who are admitted to the hospital," Pall says. "They measure and monitor glucose levels as well as hemoglobin A1C with the endocrinologists as appropriate."
The ADA guidelines call for providing a personalized approach to managing glucose levels that are outside the normal range among diabetes patients, since no two patients are alike.
"Although we have protocols and order sets, we also know that these patients' blood sugar levels are not always going to do what we think they are going to do," Pereira says. "It depends on factors such as their insulin sensitivity and the medications that are being used. So, we make sure that the care teams are trained to know the factors that affect blood sugar."
It is important to involve patients and families in the care that is provided to diabetes patients in the hospital setting, according to Pall.
"The multidisciplinary teams that we have consisting of endocrinologists, diabetes educators, nurses, and dietitians must involve the patient and the family as they discuss options related to their care," Pall says. "That is how we can ensure that our care comes across as being personal and not just a standard cookbook of treatment options."
The ADA guidelines call on hospitals to have structured order sets in their electronic health records that provide guidance for the care of diabetes patients in the inpatient setting.
Denver Health has structured order sets in the health system's EHR, including an order set for managing blood sugar. That order set helps providers know the options for the types of insulin that can be used for a particular patient.
"Having order sets in the EHR makes it much easier for the providers to know what they should order for patients depending on different conditions," Pereira says. "The order sets are great to educate our providers, including residents and fellows."
Having structured order sets in the EHR is crucial for diabetes and its management, according to Pall, especially because the insulin dosages can change depending on a patient's medications.
"The order sets for diabetes care in the hospital are well designed and standardized," Pall says. "We have discharge order sets as well. We have guidelines associated with the order sets, so it is obvious for clinicians who are using these order sets to know the parameters for their use."
Having structured order sets in the EHR is important for care teams to have a standard way to approach diabetes care, Pall explains.
"In the absence of structured order sets, things could get missed or the parameters for certain therapies could be variable," Pall says. "It is important to keep care consistent, so we are giving the right treatment to the right patient."
The ADA guidelines call on hospitals to have specialized care teams for their patients who have diabetes.
"Clinical diabetes advocates are a cornerstone of our specialized diabetes care team," Pall says. "They partner effectively with our endocrinologists, nurses, patient experience liaisons, case managers, and dietitians."
Having a specialized care team for hospital patients with diabetes boosts the quality of care and improves outcomes, Pall explains.
"Diabetes is a complex condition," Pall says. "These patients have multiple medical, social, and dietary needs. Having a team to address all aspects of a patient's care—not just the medical aspect—is important. We want to provide care that is personalized and geared toward the needs of the patient."
Health equity is a primary concern at Metropolitan Hospital, which serves a diverse community in New York City.
The new CMO of Metropolitan Hospital, which is part of NYC Health + Hospitals, is committed to health equity.
Anitha Srinivasan, MD, MPH, became CMO of Metropolitan Hospital effective June 1. She has held several leadership positions at the hospital, including serving as deputy CMO and chief experience officer. Srinivasan has a clinical background in surgery.
"Promoting health equity is the very core of our mission," Srinivasan says. "Metropolitan Hospital is part of a safety net health system. We are in a vibrant neighborhood, East Harlem, which is very diverse."
The approach to health equity at Metropolitan Hospital is multipronged, according to Srinivasan.
"We need to understand the community around us and the social determinants of health," Srinivasan says. "We need to look at some of the non-medical factors such as mental health issues, housing and food insecurity, and transportation barriers for the community."
The hospital strives to provide culturally competent care. All staff are trained to be culturally sensitive, according to Srinivasan.
"We provide multilingual services—we always give importance to language of preference among the patients," Srinivasan says. "All the medical education literature, the consent forms, and the documents that the patient signs are in the patient's language of preference. So, the patient understands what treatment they're getting."
The hospital places a high priority on looking at data through a health equity lens. Srinivasan explains that health equity data gives leadership an opportunity to think outside the box and innovate with the patient population in mind.
"For example, when we look at a particular service, we like to break down the health equity points," Srinivasan says. "Who is coming here for services? How are we providing these services? What are the differences?"
Anitha Srinivasan, MD, MPH, is the new CMO of Metropolitan Hospital in New York City. Photo courtesy of NYC Health + Hospitals.
Developing a clinical services business plan
Srinivasan has been involved in crafting clinical services business plans for Metropolitan Hospital.
"What we need to do is robust clinical business planning because it is essential for financial health and sustainably," Srinivasan says. "It may appear strange that I'm talking about financial health for a safety net system, but we must be at least sustainable."
The key elements of developing a clinical services business plan include market analysis and community needs assessments, according to Srinivasan.
"We plan our expansions and services according to the needs of the community, so that we are sustainable as a hospital and have strategic alignment," Srinivasan says. "According to the market analysis and needs assessment, we do the hospital's resource allocation."
Metropolitan Hospital has a five-year model for clinical services business planning.
"We can manage expanding a particular service," Srinivasan says. "We take the buy-in from the clinicians. We see if there's a need in the community, then expand a service. The administrators come up with a strategic plan, including input from doctors and nurses, then we present the strategic plan to the hospital's leadership. Once the strategic plan is approved, we are tracked for the next five years."
Clinical services business planning never trumps crucial clinical goals such as patient safety, but running a hospital is similar to running a business, according to Srinivasan.
"It's almost like a commercial enterprise, except we do it with the aim of being sustainable financially and serving the community and improving access," Srinivasan says. "That's where business planning is very important, even if we are a safety net hospital."
Promoting quality assurance
As deputy CMO and now as CMO, Srinivasan has been involved in quality assurance efforts.
"Quality assurance is an ongoing commitment to say we will deliver the highest standard of patient care irrespective of the ability to pay," Srinivasan says. "That is our mission."
A hospital's leadership team must be committed to quality assurance, according to Srinivasan.
"The success of any quality assurance program begins with leadership," Srinivasan says. "We should be good leaders and strive for good quality, and then we can create a culture of safety."
Metropolitan Hospital's approach to quality assurance is data-driven.
"We use data collection through a reporting system where anybody can report any concerns and then we do an analysis," Srinivasan says. "We come up with quality assurance projects for every department so that we can provide consistent, high-quality care."
Keys to success in risk management
Srinivasan plays a significant role in risk management at Metropolitan Hospital.
"I still run the root cause analysis process," Srinivasan says. "It involves identifying and mitigating potential threats to patient safety. That's a primary goal—patient safety."
The hospital has a reporting system for patient safety events that can be used by any staff member.
"When reports come in, we do a daily analysis, and relevant reports are presented to a committee that includes nurses and doctors," Srinivasan says. "When errors occur, we provide staff training, but in a nonpunitive fashion. We look for systemic errors."
Maintaining a nonpunitive workplace environment is essential to promote patient safety because staff members should not feel discouraged to report errors in the future, Srinivasan says, adding leaders have a critical role to play in establishing a nonpunitive workplace environment.
"We try to support our staff, so they don't feel like they're being blamed or cornered," Srinivasan says. "Everybody who sits on the root cause analysis committee goes through training, so we know not to blame an individual for a mistake. We look at systemic causes first so we can improve as a system."
Carilion Clinic has mastered the intricacies of operating a command center that focuses on managing patient transfers between hospitals.
Like many health systems across the country, Carilion Clinic is grappling with patient volumes that stretch bed capacity. Under these circumstances, managing patient flow and patient transfers into and out of the health system are crucial.
"We have real-time assessment of every hospital bed in the health system, including emergency departments," says Paul Haskins, MD, SVP medical director of the Carilion Transfer and Operations Center. "So when you have an enterprise command center, it has all aspects of patient flow, including a real-time situational awareness of the primary drivers of hospital systems, which include the transfer process into the system, the operating rooms, and the emergency departments."
View the HL Shorts video below to find out how Carilion Clinic has staffed its command center in a cost-effective manner. Click here to read the accompanying HealthLeaders story.
A first-in-the-nation position plays a key role in helping new moms who are struggling with mental health conditions.
Dartmouth Health Children's has created what it says is the first maternal mental health navigator role in the nation.
Mental health can be a challenge for new moms. Their mental health conditions include anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. Mental health conditions are a leading cause of suicide among new moms.
"Recognizing that these conditions can be treated is a huge part of the puzzle for new moms—many of them do not recognize that they are experiencing a maternal mental health disorder," says Heather Martin, the new maternal mental health navigator at Dartmouth Health Children's.
Martin is serving in a year-long pilot program that began three months ago. The position is being funded through a philanthropic fund maintained by Dartmouth Health.
"The main goal of funding Heather's position was to test and pilot as well as create a model that is sustainable by figuring out the billing, figuring out the processes of interacting with obstetrics, and making sure you are protecting maternal privacy," says Julie Bosak, DrPH, a certified nurse-midwife at Dartmouth Hitchcock Medical Center and director of the New Hampshire Perinatal Quality Collaborative and the Northern New England Perinatal Quality Improvement Network.
The maternal mental health navigator role involves several responsibilities, including connecting struggling new moms with resources in the community, arranging peer support, providing strategies to cope with anxiety and stress, and supporting pediatricians and obstetricians who work with new moms.
Martin has a designated resource list, which includes mental health centers such as the Mental Health Center of Greater Manchester and psychiatrists at Dartmouth Health.
Dartmouth Health has been screening new moms for mental health conditions for five years.
"It is a quick questionnaire on a tablet, and moms do it before a baby visit," Martin says. "If that questionnaire comes back positive, and if a mom is open to help, resources, or just talking with me, they get connected to me and connected to resources such as therapy. Sometimes, the moms just talk with me and have someone to listen to their concerns."
Martin also plays a role in preventative care.
"Heather is able to work with moms before a condition escalates and becomes overwhelming," Bosak says.
The maternal mental health navigator position was created as part of Dartmouth Health Children's recognition that the postpartum period can be difficult for new moms and their families.
"Beyond the diagnoses, it is important for new moms and families to recognize that the postpartum period can be an emotionally challenging time," says Erik Shessler, MD, associate medical director at Dartmouth Health Children's. "You are in the hospital, you come home, and you are going to be sleep-deprived. We let new moms know that we expect them to be emotional and that we are here to help."
Heather Martin is the new maternal mental health navigator at Dartmouth Health Children's. Photo courtesy of Dartmouth Health.
Creating and expanding maternal mental health navigators
Dartmouth Health Children’s identified the need for a maternal mental health navigator through its screening program.
"We started asking questions, having some data showing that there was a need for services, and creating resources to support those needs that were identified," Shessler says.
The pilot program will hopefully serve as a springboard for similar programs across New Hampshire, he adds.
"We are going to have data that shows the maternal mental health navigator makes a difference because it has an impact on metrics and outcomes," Shessler says. "Then we will be able to bring this model across the Dartmouth health system and across the state."
Shessler also has national aspirations for the program.
"It is our hope that other health systems and children's hospitals across the country will adopt maternal mental health navigators," Shessler says. "There are some other health systems in the state that are doing screening as a first step. They are having their healthcare professionals increase their awareness, and they are conducting screening in either obstetrics care or pediatric care."
Primary care physicians at the Boston-based health system have voted overwhelmingly to join a national union.
One of the organizers of a primary care physician union at Mass General Brigham (MGB) is hailing the recent vote to form the union as a resounding success.
PCPs at MGB have been seeking to form a union for a year. MGB challenged the unionization effort at the National Labor Relations Board (NLRB) on the basis that many of the doctors did not belong in the same bargaining unit. The NLRB rejected MGB's challenge in April, but the health system is continuing to push the point with the federal agency.
On May 30, the PCPs voted 183-26 to join Doctors Council SEIU, the country’s oldest and largest union of attending physicians.
Michael Barnett, MD, a primary care physician at Brigham and Women's Advanced Primary Care Associates and a member of the PCP union's organizing committee, says the vote represents overwhelming support for the union.
"We had 209 ballots submitted for 237 eligible PCPs. So, our turnout was 88%," Barnett says. "The turnout was high, and those who voted support what we are doing."
MGB commented on the union vote in a prepared statement.
"Mass General Brigham respects the rights of employees to organize under the National Labor Relations Act, and we are committed to ensuring that any such process complies with applicable labor law," the statement says. "Prior to this vote, we formally requested the National Labor Relations Board to review whether the composition of the proposed bargaining unit is appropriate under the law for acute care hospitals, and we await their decision."
The prepared statement says the health system is committed to providing primary care services.
"We deeply value our physicians and have been working since fall of 2023 to improve the primary care experience based on direct physician feedback," the statement says. "Our ongoing investment in primary care reflects this long-term commitment to improving the experience of both our physicians and the patients they serve."
Michael Barnett, MD, is a primary care physician at Brigham and Women's Advanced Primary Care Associates. Photo courtesy of Michael Barnett.
Why PCPs want to have a union
There are several reasons why most PCPs at MGB support forming a union, according to Barnett.
"Most importantly, we want to make sure that primary care has a seat at the table for leadership decisions," Barnett says. "Part of what has led us to this point is a feeling of disempowerment and an inability to have a say in how investments or lack of investments in primary care are directed."
Barnett cited many other reasons for PCP support of the unionization effort.
Concern over understaffing and high staff turnover
A belief that PCP patient panel sizes are unrealistic
A desire to align benefits and compensation with national standards, particularly given the high cost of living in the Boston area
MGB has cut benefits for employees who work less than half time, which disproportionately affects PCPs
The absence of a structured system for PCP coverage when doctors go on leave such as parental leave, which requires the remaining doctors to pick up more patient visits without a corresponding increase in compensation
MGB has discontinued services that helped support primary care practices and their patients such as programs that helped patients manage their blood pressure and cholesterol remotely as well as a smoking cessation program
The PCPs are also wary of a pledge from MGB to invest $400 million in primary care, Barnett explains.
"MGB has made this unforced pledge of putting $400 million into primary care over the next five years," Barnett says. "We want to have input into how that money is spent, and we want to hold MGB accountable for making sure the health system is spending money in ways that improve the lives of our physicians and patients as well as improve our clinics."
State of labor relations among the PCPs
PCPs are discouraged that MGB has shown resistance to their unionization effort, according to Barnett.
"It is particularly disappointing now that we have had an election, and we have a resounding mandate, with nearly nine of 10 of our colleagues supporting the union," Barnett says. "MGB is still sticking to the narrative that they need to define our bargaining unit legally, which is taking advantage of an anachronistic technicality."
Many MGB physicians feel that the health system's leadership is moving in the wrong direction, Barnett explains.
"PCPs as well as many other doctors in the health system are skeptical that we are moving in a direction that is in the best interest of patients or doctors in the health system," Barnett says. "They have lost our trust. Because they are not responding to us and they have lost our trust, we need to demand a seat at the table and have more control over what happens."
Ghazala Sharieff, MD, MBA, is executive senior vice president and chief medical and operations officer of acute care at Scripps Health. Photo courtesy of Scripps Health.
Anup Singh, MD, is chief medical executive of California Pacific Medical Center. Photo courtesy of Sutter Health.
Harpreet Pall, MD, MBA, is CMO of Hackensack Meridian Jersey Shore University Medical Center. Photo courtesy of Hackensack Meridian Health.
Anitha Srinivasan, MD, MPH, is the new CMO of Metropolitan Hospital in New York City. Photo courtesy of NYC Health + Hospitals.
Heather Martin is the new maternal mental health navigator at Dartmouth Health Children's. Photo courtesy of Dartmouth Health.
