October 1 , 2004

Partners Town Meeting discussion

Below are the questions and answers discussed at the Partners Town Meeting held at the MGH Sept. 23. James J. Mongan, MD, president and CEO of Partners, and Peter L. Slavin, MD, president of the MGH hosted the meeting.

Q: I read in the newspaper today that Children's Hospital is buying the Waltham Hospital location. Was Partners considering purchasing Waltham? How does the Children's purchase affect us?

Dr. Mongan: This is a complex health care environment. We are being asked by policy makers to both compete with other health care institutions and to collaborate with them as well. As a system, Partners decided not to pursue purchasing Waltham. In light of Children's making the purchase, we will be talking with leadership at Children's to discuss the decisions they will be making about Waltham to see if this will foster collaborative possibilities. We are putting together a team to be responsive to this issue as it develops.

Q: My sister, an employee, had knee surgery and was a patient in the White Building for four days. The noise level was very high on that unit, which is difficult for patients in bed and with pain. She left a day early to get some sleep. We all say this is because we are so busy, but the actual structure of this old building does not lend itself to quiet surroundings. Rooms are small, and the work areas are noisy and near patient rooms. Are there plans to renovate older inpatient buildings with the goal of lowering the noise level as a benefit to patients who are in pain and recuperating? On the other hand, we did decrease length of stay because of the noise.

Jeanette Ives Erickson: First of all, we should offer our apologies to this patient. It is a concern when any patient is unhappy with his or her experience here at the hospital. Our older facilities do need to be replaced at some point. But these issues are not just about the buildings. Our work is driven by our patients. Research has been done about how to mitigate noise and stress during hospital stays using such efforts as playing music in the rooms. We sometimes become immune to the noise level with alarms going off and such but we need to be more attuned to how this can affect our patients. There soon will be several customer service/patient driven proposals coming out of Patient Care Services to address these situations.

Q:What is Partners' position on adding more inpatient beds at the MGH? We need more beds to help us meet the demand for our services and to help us manage patient flow more effectively. Does Partners not want to add beds, and for us to send more patients to Newton-Wellesley and North Shore?

Dr. Mongan: In the early years when Partners was formed, the general philosophy was to provide the right care at the right time at the right place. Now, we have more of a distribution system in place with strong collaborations with our system's community hospitals. I don't think this is an "either/or" situation with a firm position. I think that the best answer is to have a balance of both.

Q: My question is about physician recruitment. It is getting harder to recruit and retain the most talented medical staff because of the high cost of living in Boston without some kind of assistance. What is Partners and/or Harvard planning to do to help us?

Dr. Mongan: There isn't a clear-cut answer to this problem. I think that one key step is to increase physician reimbursement, which we have made substantial progress in the past few years, bringing us to the 75th percentile in the nation. But when you consider the rising cost of living in Boston, there still is an issue. We will be trying to have Partners be more active in the housing arena with either direct or indirect housing subsidies for medical residents and nurses.

Q: As a large employer in Boston, what is Partners doing to provide health care or preventative care for our employees? And are there any studies being conducted on the health of our employees?

Dr. Mongan: This is a very good question. I think it is important to raise awareness about this issue, and I hope to see more involvement at each Partners institution. Nationally, employers don't get involved with employee health because they don't see a direct cost benefit. But it clearly is the right thing to do.

Jeff Davis: We recently had a health fair for our female support service employees. We've had this event for the last several years, and it has been a great way to connect with some of our minority employees on issues about their own health care. Laura Riley, MD, from MGH Vincent Obestetrics and Gynecology, has led this effort, and Pamela Taylor from Human Resources and Mel Heike, RN, from the Women's Health Coordinating Committee, have done a great job in planning these events. This year, we had more than 400 people attend. We also have the health club at Charles River Park, which has been a great employee health benefit. More than 1,700 employees have joined the health club. These are two concrete initiatives focused on employee health and wellness. We also have held smoking cessation, weight loss and depression screening programs for employees. However, these have been separate, discrete initiatives, and I still feel that we need to connect the pieces to form a general, overall employee health and wellness program. In recent weeks, I have been talking to physicians about putting together program for employees that would include experts in areas such as nutrition, exercise, mental health and smoking cessation, with the hope of creating a vibrant health and wellness program. Few employers can track results of such programs because of high employee turnover. But we have low turnover and long service employees, so we have an opportunity to track how a health and wellness program could help our employees over the long run.

Q: With all the challenges in reimbursement for mental health programs and with the increasing need and demand for psychiatric services, what role can and should Partners Psychiatry play in helping to find solutions? And, by the way, what is the future of Partners Psychiatry?

Dr. Mongan: Most people know that psychiatry and post-acute care don't get the funding that they should. Policy makers tend to shy away from these areas largely because there still is a stigma about mental health and because the costs seem endless. We have made substantial progress through Partners Psychiatry to enhance reimbursement for these services, but there is more work is to be done. As for Partners Psychiatry, we currently are looking for leadership in that program since Gary Gottlieb, MD, officially left that position to take the reigns at the Brigham. Gary has been doing both jobs ever since, but we do need to find his successor. We hope to do that soon.

Q: Will there be any more consolidation of departments across Partners like we did with areas such as Human Resources and Information Systems?

Dr. Mongan: We need to take a careful look at where we are in our current structure and continue to find a balance between what should be centralized and what should be decentralized. We may make some changes in some functions. These won't be big changes, but rather just tweaking in some administrative areas. On the clinical side, I don't think we will see a change in our anatomy by combining departments, but rather we might see changes in our physiology by having some departments work more closely together on issues such as quality and safety.

Q: I heard that Spaulding Rehabilitation Hospital might be moving to a new location? Is this true? If so, where will it move? Will Partners be adding much-needed rehab beds?

Dr. Mongan: The Spaulding facility needs to be replaced, but there are two important questions that need to be answered -- where will Spaulding move and will we increase the number of beds? The MGH is a part of these discussions as far as location since there is some benefit to having the MGH and Spaulding close together. As for as how many beds there will be, there needs to be more discussion since not everyone is in agreement on this subject. But there will be a new Spaulding at some point in the near future.