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2008 Annual Report

Responsible Growth Rooted in the Community


Letter from the Chairman of the Board As I write this letter, we find ourselves in the midst of momentous change and tumultuous economic times. We have witnessed an historic presidential election. We have watched the economic distress and recession that is changing the business landscape at every turn. In this environment even the long insulated healthcare industry feels economic stress. Like you, Anna Jaques Hospital has watched these events and focused on maintaining a steady course through it all. We have tightened our work force, reviewed internal processes for efficiencies and increased economies, conducted a thorough fiscal budget process resulting in a lean budget with a realistic profit from operations, and sought savings through standardization and the use of a group purchasing organization.

A foundation of strong leadership

The board’s building committee worked tirelessly in their oversight of two very important building projects; the emergency department’s new Gerrish Fast Track and the new Worobey MRI center. These two projects were important to patient satisfaction and the delivery of care, as well as the hospital’s revenue stream. Both were to build a satisfactorily completed.

“We will continue financially stable hospital that delivers the safest, highest quality, most compassionate patient care possible, so that you can receive your healthcare close to home.”

Our priority is to keep every person working here employed. Currently, that numbers approximately 1,000 people. We believe that by practicing fiscal restraint while delivering the best patient care possible, we can operate a hospital that patients will trust and turn to for healthcare, carrying us through these unsettled times.

The Board of Trustees has made priorities of the issues of quality care and patient safety. We convened a board level quality committee that each month reviews patient satisfaction rates for all departments. The committee also reviews emergency department wait times, and progress on meeting national patient safety goals, including treatment of heart attacks, heart failure, pneumonia, and the prevention of surgical site infections. We focus on these areas as we continue to work on making our vision a reality: to rank among the top 10 percent of comparable U.S. hospitals for quality and patient satisfaction by the year 2010. The Board of Trustees continues its commitment and promise to every patient we serve. We will continue to build a financially stable hospital that delivers the safest, highest quality, most compassionate patient care possible, so that you can receive your healthcare close to home. Sincerely,

George H. Ellison, Jr. Chairman


Letter from the President In 2008 we were able to fulfill important commitments to the community and complete a long anticipated construction project. The Gerrish Fast Track, a new addition to our emergency department, opened its doors. The access road, Wallace Bashaw Jr. Way, officially opened. The Newburyport Medical Center was built and the anchor tenant, Commonwealth Newburyport Cancer Center, moved in. The community has long requested that we continue to work on making our Emergency department function more smoothly. In November our fast track service for less complicated patients in the ED became a reality. The Gerrish Fast Track opened, named to recognize a generous gift from the Gerrish Family Foundation. The fast track system is designed to treat patients with less involved conditions, about 40% of our patients, in less than two hours. During construction, the emergency department staff and physicians continued to deliver a high level of patient care, “This goal will remain a central seeing 32,000 patients and operating the Trauma Center and the value of the hospital, to deliver Primary Stroke Service. The long awaited access road to the hospital opened this fall. Named Wallace Bashaw Jr. Way, the road provides direct access to the hospital and will significantly reduce truck traffic through the small streets in the neighborhood.

local care that people locally can measure and have rock solid confidence in.”

One of the important accomplishments this year was the construction of the Newburyport Medical Center, which will hold the area’s first comprehensive cancer care center, Commonwealth Newburyport Cancer Center. The Cancer Center has opened the radiation oncology service and will soon incorporate the hospitals’ chemotherapy infusion suite. This Cancer Center means that patients will no longer have to travel 25 minutes or more for radiation therapy and other aspects of their cancer care, including clinical trials. We have high hopes for the success of this center and its ability to serve patients when they are most vulnerable and may choose to remain close to home if they can receive first-rate care. Internally, we increased our focus on measurable quality goals. The strategic plan for 2010 is for Anna Jaques to rank among the top ten percent of medium sized community hospitals for quality metrics like patient mortality and complications. The ThomsonReuters data, a national benchmarking service, suggests that Anna Jaques is very close to if not at that level of quality performance this last six months. This goal will remain a central value of the hospital, to deliver local care that people locally can measure and have rock solid confidence in. Sincerely,

Delia O’Connor President/CEO

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Quality Care Anna Jaques Hospital continues to strive toward providing the highest quality of care. We have established goals of being in the top 10% of hospitals nationally by 2010 for quality and in the top 10% of hospitals in Massachusetts for patient satisfaction. As part of this commitment, we have decided to be as transparent as we can, and are putting our quality measures on the hospital website for all to see. Healthcare associated infections have become an area of extraordinary focus in the hospital community, and are increasingly understood by the public. It is now recognized that by instituting appropriate preventive measures certain types of infections can be 100% preventable and therefore lives can be saved. These include central line infections (infections from intravenous lines that are placed in a large central vein), ventilator associated pneumonia, and some types of surgical site infections. Anna Jaques Hospital has had an excellent record in the recent past. We have not had a ventilator associated pneumonia for over a year, and have not had a central line infection for over 9 months.

Patient care rooted in quality

Another of our primary goals is to have clinical outcomes equivalent to the Top 100 US Hospitals as determined by

Number of Cases

Complication Rates AJH Better than Top 10%

the Thomson-Reuters Corporation (formerly known as the Solucient Top 100). The two most important quality outcomes measures are complication rates and mortality rates. In both of these areas our performance is either close to, or better than, the benchmark for the top 10% of medium-sized community hospitals across the nation, which is our peer group. The graphs below demonstrate Anna Jaques Hospital’s achievement. One of the more common hospital rankings that are available to the public are the core measures. These are standardized process improvement measures which, if implemented, should lead to improved outcomes. Our goal here as well, is to be in the top 10% of US hospitals. We have some way to go in order to reach this goal, as the graph below demonstrates. While we have gradually improved, so has the rest of the hospital community. We are proud of the progress we have made toward measurable clinical outcomes, and we are committed to achieving our goals as stated, so that our patients can be even more confident that the care we provide meets the highest competitive standard.

AJH Compared to Top 10% of US Hospitals Overall Quality – July 2005 – March 2008

(lower is better)

100

45 40 35 30 25 20 15 10 5 0

90 80 70 60 50 40 30 20

Q1 08 AJH

Q2 08

Q3 08 US Average

Top 10% Medical Community

10 0 Q3 05-Q2 06

AJH

Q4 05-Q3 06

Q1 06-Q4 06

Q2 06-Q1 07

Top 10% US Hospitals

HOSPITAL ACQUIRED INFECTIONS – GOAL = 0% Infection

2

Cases this FY

Months since last case

Ventilator Assoc Pneumonia

0

>15

Central Line

0

>9

Q3 06-Q2 07

Q4 06-Q3 07

Q1 07-Q4 07

Q2 07-Q1 08


Patient Satisfaction In the area of patient satisfaction, we strive to be in the top 10% of hospitals in Massachusetts. We continue to make slow and steady progress with outstanding results in the areas of the Emergency Department and the Birth Center. We have made progress in the area of satisfaction with physicians and overall satisfaction with the hospital, but these numbers have recently slipped somewhat. We are increasing our efforts to raise these scores and to keep them consistently high. Other areas require ongoing effort, including ambulatory surgery. The graphs below demonstrate our performance in the most important areas. This information is updated regularly on the hospital’s website.

ED

(Higher=Better)

Anna Jaques Hospital 71%ile

This chart shows patient satisfaction with their experience in the emergency department. It rates length of waiting time, courtesy and communication of the physician and nursing staff. Anna Jaques Hospital goal is 80%ile.

Goal 80%ile+

This chart shows the extent to which patients are satisfied with their inpatient experience. This includes their satisfaction with the overall hospital environment and delivery of care. Anna Jaques Hospital goal is 80%ile.

40 20

(Higher=Better)

Anna Jaques Hospital 46%ile

Q1 08

Q2 08

Q3 08

Lab Courtesy

This chart shows the extent to which patients are satisfied with the physician who cared for them while in the hospital, the Hospitalist. This rates the patient’s satisfaction with the respect and courtesy of the Hospitalist, and how well the physician listened to, and communicated with, the patient. Anna Jaques Hospital goal is 70%ile.

Goal 90%ile+

This chart shows the extent to which patients are satisfied with the courtesy of the staff in the laboratory. Anna Jaques Hospital goal is 90%ile.

40 20

Q1 08

Q2 08

Q3 08

60 40 20

Q1 08

Q2 08

Q3 08

Q4 08

Q1 08

Q2 08

Q3 08

Q4 08

Q1 08

Q2 08

Q3 08

Q4 08

100 80 60 40

0

Q4 08

Nursing

(Higher=Better)

Anna Jaques Hospital 56%ile

80 60 40 20 0

80

20

100

Goal 70%ile

(Higher=Better)

Anna Jaques Hospital 84%ile

60

100

0

Q4 08

80

0

Physician

Goal 75%ile+

This chart shows patient satisfaction with the Birth Center. This includes respect and courtesy, and communication, of the physician and nursing staff. Anna Jaques Hospital goal is 75%ile.

60

100

(Higher=Better)

Anna Jaques Hospital 64%ile

(Higher=Better)

Anna Jaques Hospital 69%ile

80

0

Inpatient

Birth Center

100

Goal 80%ile+

Q1 08

Q2 08

Q3 08

Q4 08

100

Goal 80%ile+

This chart shows the extent to which inpatients were satisfied with the nursing staff. This includes patient satisfaction with the courtesy and respect shown them by the nurses, how well nurses listened to the patient, and explained things in a way the patient could understand. Anna Jaques Hospital goal is 80%ile.

80 60 40 20 0

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Hemotology/Oncology Commonwealth Newburyport receive advanced diagnostic Cancer Center opened its imaging at the hospital, radiation oncology suite in including positron emission December, 2008 in the tomography (PET), magnetic Newburyport Medical Center. resonance imaging (MRI), Adjacent to the Anna Jaques and computer tomography Hospital campus, the Cancer (CT) scans. Their coordinated Center is still partially under cancer care will be available construction as the medical just one building away. Dr. oncology suite is finished. Once Chong will provide advanced it is ready for occupancy in the radiation oncology services, late spring, the hospital’s including prostatic seeds, The new Newburyport Medical Center that houses the Commonwealth chemotherapy suite and while utilizing CT and Newburyport Cancer Center. the oncologists and nurse CT/PET planning. practitioner will move to the new building and the The center will also conduct clinical trials of the newest Commonwealth Newburyport Cancer Center will be approaches to cancer treatment under the auspices of the complete, offering full service cancer care. National Cancer Institute. It is one of only six practices The Commonwealth Newburyport Cancer Center is led by participating in a program to improve community access Lanceford Chong, MD. Dr. Chong has built a distinguished to clinical trials. career in the treatment of adult cancers while on the senior Complete Cancer Care staff at Memorial Sloan-Kettering Cancer Center in New York City. Paul Spieler, MD, medical director of the oncology

Responsible Growth

Chong says the mission and vision of the new Cancer Center is “to care for the whole patient and to have a meaningful relationship with them. To care for others is a passion and a privilege.”

Advanced Radiation Technology

program at Anna Jaques Hospital, will run the Anna Jaques Hospital licensed chemotherapy infusion suite that is integrated into the new Cancer Center. He is joined by Christopher Seidler, MD, a board certified oncologist/ hematologist and Beth Goddard, MD, ANRP, OCN, nurse practitioner.

The center offers patients diagnostic and therapeutic cancer services with the most advanced technology available for cancer care today, including a linear accelerator that offers Intensity Modulated Radiation Therapy (IMRT). Provided by Alliance Imaging, the IMRT delivers radiation therapy with greater precision than ever before, destroying cancerous cells while preserving the healthy surrounding tissues. “This technology rivals what the top medical institutions offer,” said Dr. Chong. “We have not spared anything in order to provide the latest cancer care to the people in this area.” The expert team led by Dr. Chong in the new radiation therapy center includes therapists, oncology-certified nurses, on-site physicist, dosimetrist, and support staff. Its location adjacent to the hospital creates convenience and comfort for patients who may be very ill. Patients will 4

The cancer care team, L to R, Christopher Seidler, MD, Lanceford Chong, MD, Beth Goddard, Nurse Practitioner, and Paul Spieler, MD.


Fast Track/ED Each year, the Emergency Department sees nearly 32,000 patients and that number is growing annually. Building a Fast Track has been a priority of the hospital for several years. It was our response to community requests that we address the problem of long Emergency Department wait times, particularly for patients with relatively uncomplicated conditions. In the fall of 2008 The Gerrish Family Foundation Fast Track officially opened, named for a generous gift by the Gerrish Family. The long-awaited improvement to the Emergency Department added 2500 square feet of Fast Track space with four treatment rooms, a nurse’s station, a mid-level practitioner’s office, and waiting room, all well integrated into the main ED. The Gerrish Fast Track sees patients with relatively uncomplicated conditions that require treatment, but not extensive evaluations, in a shorter period of time. This will give the hospital the ability to reduce waiting times across the entire Emergency Department. Our goal is to have all fast track patients seen, treated, and released in one hour and twenty minutes. We are making steady progress toward that goal.

Seen on the right, the new Gerrish Fast Track addition to the emergency room.

to protect ambulance patients from the weather. These improvements should help the Emergency Medical Service crews and the patients. The new ambulance entrance is named the Bud and Harriet Gould Ambulance Entrance to recognize the Gould family gift. The Gerrish Fast Track cost approximately $2.6 million. Approximately $1.0 million was raised through philanthropy with the lead gift given by the Gerrish Family Foundation. The main Emergency Department provides highly skilled medical care to the seriously injured. The Level III Trauma Center and Primary Stroke Center stabilize those critically ill patients, and if necessary, transport them to hospitals in Boston by the Boston Medflight helicopter service or an advanced life support ambulance. All of our Emergency Department physicians are board certified in emergency medicine, and certified in advanced trauma life support and advanced cardiac life support. All of our Emergency Department registered nurses are certified in trauma nursing and critical care.

Curt Gerrish, owner of Rochester Electronics, and his wife Patricia Gerrish (center), cut the ribbon at the official opening of The Gerrish Family Foundation Fast Track. Seen (L to R), Delia O’Connor, president and CEO, Anna Jaques Hospital, Charlie Cullen, Chairman, AJH Community Health Foundation Board of Trustees, Diane and Chris Gerrish, and Wayne Capolupo, Anna Jaques Hospital Board of Trustees, Chair, Building Committee.

The Gerrish Fast Track project also included improvements to the area used for ambulance parking and unloading patients. We improved the grading of the lot used by the ambulances to access the ED and provided a new canopy

The care in the Fast Track was outstanding. The nurses were very professional and caring, and took the time to listen. ...I was released in 80 minutes. I’m grateful I live in your area.” (name withheld for privacy) R.N., Boston Medical Center 5


New Physicians In 2008 we continued building and strengthening our medical staff. The hospital serves a primary and secondary service area with an estimated population of 165,400* people. It is an area of projected high growth over the next two decades. Conservative estimates indicate that some towns in the hospital’s service territory will grow by as much as 21% by the year 2030**. The hospital is planning for this growth, recruiting the highly skilled, experienced medical staff that will be needed to serve the area’s expanded healthcare needs.

Expanding clinical expertise and skill

As the Baby Boomers move into their 60s and beyond, the over-55 population in the hospital’s service territory is projected to increase 75%, until one in three residents is 55 or older.** This creates additional demand for internal medicine and family practice physicians. In 2008 we recruited Kevin Delahanty, MD to join Coastal Medical

In 2008 we recruited new providers for the Women’s Health Care practice. Two midwives, Jessica Lewis, MSN, CNM, and Susan Martinson-Zuercher, RN, MSN, CNM joined Women’s Health Care. The practice now has three board certified nurse-midwives with Masters level midwifery training. The midwives deliver healthcare to women from their teen years through menopause and deliver more than 200 babies each year. Christine DiLeo, DO joined the Women’s Health Care team as an OB/GYN. The practice now offers seven OB/GYN physicians to serve patients across the region, with offices in Newburyport and Haverhill.

Jessica Lewis, CNM, MSN Midwife with Women’s Health Care

Susan Martinson-Zuercher, CNM, MSN, RN, Midwife with Women’s Health Care

Christine DiLeo, DO Women’s Health Care

Kevin C. Delahanty, MD

Linda Hindle, DO Cornerstone Family Practice

Amy Rodgers, DO Newburyport Medical Associates

Coastal Medical Associates

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Associates in Salisbury as an internal medicine practitioner. Linda Hindle, DO joined Cornerstone Family Practice in Rowley, and Amy Rodgers, DO joined Newburyport Medical Associates in Newburyport as family practitioners.

*2000 census numbers ** Metropolitan Area Planning Council


Surgical Services Anna Jaques Hospital is implementing a surgical safety checklist developed by the World Health Organization to reduce surgical complications. The checklist is designed to promote teamwork, an understanding of one another’s roles, and the details of the patient’s status, in order to ensure that no clinical steps are missed before, during or after surgery. The checklist includes items important to pre-operative preparation, operating room procedure, and post surgical recovery of the patient. Questions are asked and prepared for, in order to prevent a bad outcome that might occur if the issues were not addressed. “Is the patient likely to need blood?” “Does the patient have IV lines for blood transfusion, if needed?” “Does the patient have a known allergy?” “Is all essential imaging available (x-ray, MRI, CT scans etc) and correctly identified as for this patient?”

Members of our surgical services team.

“The checklist increases communication among operating team members to make sure that all steps that can possibly be taken to avoid a bad outcome have been taken.”

“Are there specific concerns for pain management or respiratory issues during recovery?” In the pre-op room each patient verifies with staff, the procedure and site of surgery. After the surgery is complete, the surgical team verbally reviews key concerns for the patient’s recovery, including pain management and respiratory issues. Implementing this surgical safety checklist system, and publicly reporting it, is part of our commitment to transparency and communicating how we are improving patient safety. In addition, in 2008 the hospital purchased equipment and implemented new surgical safety processes as part of our efforts to reduce the rate of surgical site infection further, which is already below national benchmarks. Additional surgical kits were purchased to ensure that every surgeon has ready access to instrumentation.

Patient Care and Safety Improvements: • For selected patients with no predisposing medical conditions, a pre-admission health screening is conducted by phone to increase patient convenience. • Protocols are in place to help ensure the first operating room case of the day starts on time. • Patient safety is improved when anesthesia physicians provide new written guidelines and patient questions for the phone screening. • Increasing the quality of patient care is one of the reasons behind a new survey of surgeons on instrumentation in the operating room. The survey collects their feedback on the condition of equipment to ensure it meets their needs, is in optimal working condition, and that any needed changes are made.

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Nursing

“The nursing staff at AJH is dedicated and skilled. ...The staff on the medical/ surgical floors deserves recognition for their constant attention to my needs and the needs of my visitors.” (name withheld for privacy) RN, Massachusetts General Hospital

The CCSU team accepts the Press Ganey Achievement Award.

Compassionate patient care

At Anna Jaques Hospital, Registered Nurses play a pivotal role in delivering high quality patient centered care. The nurse is a coordinator and frontline provider of compassionate patient care, a patient advocate, communicator, collaborator, and patient/family educator. Nearly half of the nurses at Anna Jaques have worked at the hospital over ten years. The hospital considers them dedicated professionals who strive to achieve excellence in professional practice and to treat the patients in a caring, personal way. They exemplify the theme of this year’s annual report, “Rooted in the Community” as they care for friends and neighbors and, in some instances, generations of the same family. As part of the delivery of patient care, each department focuses on patient satisfaction. After discharge, randomly selected patients receive a Press Ganey patient satisfaction survey giving them the opportunity to tell us about their experience at Anna Jaques. In the last measured quarter, October through December of 2008, the patient satisfaction scores for nursing improved dramatically. Nursing in the emergency department finished in the 71st percentile, telemetry unit nursing finished in the 80th percentile, and nursing in the Birth Center scored in the 70th percentile. The overall inpatient satisfaction rate with nurses ranked in the 56th percentile, up from a previous ranking in the 44th percentile. The patient satisfaction rate with nursing in the ambulatory department was in the 60th percentile, a marked increase from the previous rank in the 26th percentile.*

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Our goal is to get all nursing percentile scores to the 90th percentile. In 2008, more than 70 staff members, clinical and nonclinical, received advanced certifications. This is essential for personal professional growth and adding the latest skills to their experience. Each nurse must also complete the Annual Review of Knowledge, a highly detailed and comprehensive review of nursing practice competencies. Individually, the pursuit of education improves the quality of patient care as nurses interact with patients. Cumulatively, the pursuit of education creates highly skilled teams in critical specialty care departments. All of the emergency department nurses at Anna Jaques are certified in trauma nursing and critical care. All of the wound center nurses in the Anna Jaques Wound Healing & Hyperbaric Center are certified wound specialists. The hospital supports the pursuit of higher education and clinical achievement. In 2008 the annual nursing scholarships were awarded to four staff members who are pursuing higher education in the field of nursing. The $1,000 scholarships are sponsored by the hospital, the Lower Merrimack Valley Physician Hospital Organization, the Anna Jaques Hospital Community Health Foundation, the Medical Staff, and the AJH Nursing Division. * A percentile shows the percentage of scores falling at or below a given score. For example, the 80th percentile rank means that Anna Jaques Hospital scored higher than 80 percent of the Massachusetts hospitals in the Press Ganey measured group.


Patient Volume & Statistics

KEY STATISTICS Admissions Emergency Room Visits

2007 ACTUAL

2008 ACTUAL

CHANGE

% CHANGE

7,636

7,580

(56)

31,042

31,106

64

0%

-0.7%

Surgical Services Inpatient

831

914

83

10%

Outpatient

4,605

4,790

185

4%

Total Surgical

5,436

5,704

268

14%

2,886

4,226

1,340

46%

362,005

401,140

39,135

11%

Oncology Clinic Laboratory (Outpatient) Pain Clinic

1,137

1,198

61

5%

Radiology-X-Ray (Outpatient)

31,872

35,025

31,153

10%

Radiology-Mammogram (Outpatient)

11,170

13,997

2,827

25%

2,935

3,771

836

28%

58,437

71,299

12,862

22%

13

45

32

246%

Radiology-MRI (Outpatient) PT, OT & Speech (Outpatient) ICDs (Implantable Cardiac Defibrillator)

Patient volume from October 1 through September 30, 2008.

The Intensivist Program Part of the hospital’s effort to improve patient satisfaction and care, as well as meet the needs of the medical staff, led to the expansion of the Hospitalist program to include an intensivist. Hospitalists are inpatient medical specialists with expertise and experience in the practice of hospital medicine, who work closely with the ICU staff and respiratory therapy. An intensivist is a physician with advanced critical care training who specializes in treating the most seriously ill or injured patients.

increased quality of patient care. Documented benefits in national reviews include: • Reduced length of stay in the critical care unit • Fewer clinical and procedural complications • Improved patient and staff satisfaction • Improved morbidity and mortality

Christopher Harris, MD is a hospitalist who also functions as the intensivist who sees patients in the Anna Jaques critical care unit. Studies have shown that patients whose care is managed by an intensivist recover more quickly and achieve greater clinical outcomes overall. The intensivist coordinates the patient’s care plan with nursing and others, and rounds daily with ICU staff, all of which results in

The Hospitalist Team: Reza Sharafi, MD, Christopher F. Harris, MD, Intensivist, Aimee J. Hromadka, MD, H. Thompson Mann, MD, Suzanne J. Abkowitz, MD, and Hossam M. Yassin, MD

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Solutions for Patient Safety Patient safety is a focus at every point in the delivery of patient care at Anna Jaques Hospital. We measure our progress against the National Patient Safety Goals of The Joint Commission, (the organization that accredits and certifies more than 15,000 health care organizations and programs in the United States), and other national standards. Compliance with national patient safety goals is a critical part of the hospital’s ongoing Joint Commission accreditation. It includes issues such as medication use, infection control, surgery and anesthesia, and effective communication between caregivers for the accurate transfer of patient information. This year the hospital implemented a system of electronic programs specifically designed to increase patient safety and reduce medical errors.

Laying the groundwork for the future

Online Nursing Documentation As a first step, the hospital implemented the online nursing documentation (NUR) system in the spring of 2007. NUR allows nurses to admit patients and conduct patient assessments at bedside, thereby improving documentation and patient care. An interdisciplinary team worked for more than a year to prepare for the NUR rollout and then continued to work together to add features during 2008. The electronic system allows real time documentation of critical patient information, from admission to the nurse’s shift assessment of each patient’s status. Carts with wireless laptop computers are wheeled into patient rooms and the collection of medical information takes place at bedside. The benefit of NUR is an increase in the quality of patient care: • Nurses no longer have to leave the patient’s bedside to make notes or gather information. • While at bedside, nurses can access the patient’s history and information on medications, lab tests, physician orders, patient care plan, test results, and online resources for additional information on diagnosis, medications etc.

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• Access to patient information is improved for nurses, physicians and other clinicians. Physicians are able to access this patient information, without delay, from their homes or offices.

Electronic Medication Administration Record The second system the hospital implemented was the electronic medication administration record (EMAR). This system should reduce medical errors by moving to a paperless environment, one where a standard medical vocabulary is used, errors that might be caused by illegible handwriting are reduced, and error checking can be conducted with order entry for medications and tests. In addition, the latest test results, allergies, and medication orders are immediately available through the patient profile to alert the caregiver to any potential problems prior to medication administration.

Bedside Medication Verification The third part of the electronic system implemented this year was the electronic bedside medication verification (BMV) program, launched on the medical/surgical floors. BMV allows caregivers to scan bar codes on patient wristbands and medications to correctly identify the patient and the appropriate medication. (Medications are identified by NDC numbers or the appropriate prescription number generated by the pharmacy.) Bedside verification processes the data contributing to safe administration by ensuring the “Five Rights” of safe medication administration: Right Patient, Right Medication, Right Dosage, Right Route, and Right Time. This system should increase patient safety, increase the level of detailed information available to physicians, and assist the hospital in its goals to meet national patient care standards. A multidisciplinary team worked for more than nine months to prepare for the implementation of BMV.


Infrastructure / Improvements The Recycling Program - Going Green As a responsible corporate citizen, Anna Jaques Hospital is doing its part in the community wide and nationwide effort to “Go Green”. We have initiated recycling programs with the goal of significantly reducing our contributions to the waste stream and saving $10,000 a year. With the support of the Massachusetts Department of Environmental Protection, the hospital signed an agreement with a vendor to assist us with the recycling program at the hospital. We are now recycling paper, cardboard (our biggest contribution to the waste stream), cans and bottles.

Retrofitting for Energy Efficiency

provide acoustical and visual buffers for the neighborhood. We used native plantings to provide a buffer around the ambulance entrance to the emergency department and in front of the Worobey MRI. These plantings will take some time to grow, but they are native to this area and will provide a pleasing “fence” along the street. An acoustical fence surrounds the cooling fans of the MRI and reduces the noise generated by them. Noise levels were measured to ensure we remain well within the regulated decibel levels for the neighborhood.

The New Worobey MRI Center

Anna Jaques Hospital is an older facility, built in different eras, and is about 30% less energy efficient than other similar facilities, according to recent studies the hospital has contracted for. We are trying to become more energy efficient in every way we can, as rapidly as we can afford to make the infrastructure investments. We have replaced the ballasts in hospital lighting to make lighting more energy efficient, for example. All the single pane windows in the 1973 section of the hospital (the Rawson Avenue end of the building) have been changed to more energy efficient, thermal casement style windows. This year we replaced a cooling tower, refurbished a major air handling system that was 35 years old, and replaced a 28 year-old roof top chiller with a more efficient and slightly larger capacity unit. Over the next five years we will replace items in our infrastructure and purchase large pieces of energy efficient equipment such as boilers. The boilers are 30 years old and very inefficient. As part of the master facility plan we are looking at building a new, more efficient power plant. In a recent meeting with an energy consultant we discussed several possible options including co-generation, photovoltaic (solar) power, and wind power that is generated by small 6 to 8 feet high mechanisms installed at building scale. We don’t know which will work but the opportunities exist to reduce our energy consumption in a meaningful way and seek creative, viable alternatives to supplying our energy needs.

Green Aesthetics As the new Worobey MRI and Gerrish Fast Track additions to the hospital were built, we were cognizant of the need to

Denise Worobey, center, accompanied by family members, cuts the ribbon at the opening of The Dennis John and Dennis Joseph “D.J.” Worobey MRI Center. Seen (far left) with Denise are George Ellison, Chairman, AJH Board of Trustees, Delia O’Connor, President and CEO, and (far right) Charlie Cullen, Chairman, AJH Community Health Foundation Board of Trustees.

This year Anna Jaques installed a fixed MRI (Magnetic Resonance Imaging) site at the hospital, adjacent to the radiology department. The fixed site creates a comfortable waiting room and changing area for patients, and eliminates the need for the mobile MRI on a van. The center is named the Dennis John Worobey and Dennis Joseph “D.J.” Worobey MRI Center, in recognition of a lead philanthropic gift by Denise Worobey. The Worobey MRI center brings the latest Siemens Total Imaging MRI technology to the hospital and its patients. The technology offers a whole body MRI imaging capability, breast MRI, and shorter scan times for the patient. 11


Hospital Awards National accrediting organizations tell us how we are doing as a hospital, and rate the performance of specific departments. This year the hospital received several national accreditations, awarded only after rigorous examination of hospital practices.

Sowing excellence

Non-Invasive Vascular Laboratory

The Anna Jaques respiratory care team continues to improve outcomes for critically ill, ventilated patients by consistently implementing “a bundle” of interventions that are known to reduce many problems associated with patients on mechanical ventilation. Currently the hospital is well below the national average in ventilator acquired pneumonia with no cases during the last year. AJH progress is measured against national Institute for Healthcare Improvement (IHI) standards, part of the campaign to achieve improved, safe outcomes for patients in the ICU.

The hospital’s NonInvasive Vascular Laboratory was accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). This Vascular Lab Technical Director Derek Butler with the technology that helps diagnose recognizes its Peripheral and Abdominal Vascular disease. commitment to providing a high level of patient care and non-invasive quality testing for the diagnosis of life-threatening vascular disease. During the accreditation process, every aspect of the laboratory’s daily operations and its impact on the quality of health care provided to patients was assessed and reviewed. Anna Jaques Hospital’s Non-Invasive Vascular Laboratory is one of a select number of vascular laboratories in the United States, Canada, and Puerto Rico to meet or exceed the ICAVL standards for noninvasive vascular testing.

The Wound Healing & Hyperbaric Center at Anna Jaques is the first and only such center to receive full accreditation from the Undersea and Hyperbaric Medical Society (UHMS). The accreditation indicates the highest Wound center patient John Kneeland, healed industry standards in the hyperbaric chamber, and his nurse and best practices in Dianne Desmarais-Tetreault, LPN, CHT, SD. hyperbaric treatment. The UHMS rigorous accreditation process took over two and one half years.

Respiratory

The Joint Commission

For the second year in a row, the American Association for Respiratory Care awarded the hospital its Quality Respiratory Care Recognition, as a result of the quality of care and level Representatives of the respiratory team at Anna Jaques. of skill in the AJH respiratory care department. Only 15% of the hospitals in the United States have received this recognition.

The hospital is accredited by The Joint Commission, an organization that surveys and rates the performance of hospitals at least every three years. The hospital received praise during The Joint Commission’s unannounced, triennial, three day survey this year. In their exit interview they said “You have wonderful people doing great things here. Dedicated, good employees are one of your strengths. You have a lot to be proud of.”

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Wound Healing & Hyperbaric Center


Anna Jaques Community Health Foundation In fiscal year 2008, the Anna Jaques Community Health Foundation celebrated another successful year of philanthropic support for the hospital with the strong leadership of board chair Charlie Cullen and the Foundation’s Board of Trustees. Over $1.4 million was raised during FY08 to support important initiatives and capital projects undertaken by the hospital. It was also a year of strong support and collaboration from the community. Individuals, businesses, corporations, and local foundations gave generously to the hospital, allowing us to successfully complete several key initiatives. • The Gerrish Family Foundation Fast Track in the hospital’s Emergency Department opened in November. More than $1.1 million was raised to support the project. • The Foundation’s three annual fundraising events garnered significant philanthropic support of key projects and initiatives. :: The Safari Beach Party raised more then $68,000 in support of capital purchases for surgical services. :: The Fore Your Health Golf Outing had its most successful year ever, raising more than $105,000 to support capital needs in the Anesthesia Department.

:: The annual Wine Tasting also celebrated its most successful year, raising more than $35,000 in support of the Vascular Ultrasound Department. • Significant leadership gifts received in 2008 will help the hospital continue some of its key initiatives in 2009. Gifts received from the Edward S. and Winifred G. Moseley Foundation are supporting much needed renovations in the Birth Center. • Special gifts from James and Christine Zampell, the Newburyport Society for the Relief of Aged Women, and the AJH Aid Association will help purchase new patient beds and furniture. The Community Health Foundation will continue to build on this solid philanthropic support as we explore the possibility of a future capital campaign. The campaign would fund the goals set forth in the hospital’s strategic and master facility plans. Philanthropy made possible the hospital’s founding 125 years ago, and continues to be at the core of who and what we are. The charitable investments being made now and in the future will help to fortify Anna Jaques Hospital as it serves the community in the decades to come.

A surgical team using one of the new laparoscopic cholecystectomy kits, which was purchased with funds made possible by the Gerrish Family Foundation. The four new kits purchased provide surgical instruments to support minimally invasive procedures, such as removing a gallbladder laparoscopically.

A new anesthesia machine was recently purchased with the proceeds raised at our 2008 golf outing.

Three new procedure carts were purchased with the generous support of Kim Williams (hospital trustee) and Trevor Miller of Newbury. These carts are strategically placed on the medical surgical units and are used to standardize the protocol and procedures for all invasive procedures done at the bedside.

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Community Outreach Anna Jaques Hospital continues to branch into new communities with the development of health and wellness programs for students, families, and senior citizens. The core of the hospital’s community outreach is providing programs that help schools fulfill their wellness curricula. In 2008 these programs included the “How Far Can You Go?” pedometer program, the Backpack program of health information written for 6,200 school age children, the Healthy Ways Maze & Old Fashioned Games program, and small sponsorships of local athletic programs and community leagues.

Amesbury Days Teddy Bear Clinic

Headstart Program

Children brought their Teddy Bear or favorite stuffed animal for a mockwellness exam. Children received glowin-the-dark wrist bracelets with the Anna Jaques logo. The hospital has been asked to make a repeat appearance next year.

Nearly 200 children and families attended the Haverhill Head Start Fair and Health Screening last fall. The hospital presented its Teddy Bear clinic for children. Parents received an immunization and screening chart and information on hospital services.

Senior Walking Club and Dinner

Newburyport Mother’s Club Free Movie Day

Branching into new communities

The hospital provided 125 pedometers and a wall tracking map to the senior walking group at the Salisbury Hilton Senior Center. The group reports that even some 90 year old members are walking around the center and their homes, tracking their steps. In addition, once a month the hospital offers a senior dinner with a clinical speaker, and every night of the week offers to seniors reduced price dinners in the cafeteria.

136 members of the Newburyport Mothers Club attended a free private screening of the Pixar “G” rated movie Wall-e. A mini-obstacle course was set up in the lobby for the children, parents received information on AJH services. The event was a collaborative effort between The Provident Bank and Anna Jaques Hospital.

Healthy Ways Maze

Pre-natal health education in Haverhill

Twelve students from Newburyport High School were honored by the hospital for their volunteer work as Youth Leaders implementing the hospital’s newest anti-obesity program. The Youth Leaders were educated and trained in the AJH “Healthy Ways Maze and Old Fashioned Games” program, the benefits of physical activity, and the role it plays in a healthy and balanced lifestyle. Once trained, they traveled to elementary schools twice a week teaching students how to play the games and be more active during recess. The hospital provides each school with a free plastic tub filled with materials and instructions for an obstacle course and old fashioned games.

The hospital launched a public education campaign in Haverhill on the importance of pre-natal health. The six week campaign was supported by business partners that included Market Basket, Choice Gym, Custom Built Personal Training, Merrimack Valley Federal Credit Union, and Rite Aid Pharmacy. 56,000 flyers were distributed to Market Basket shoppers and oversized posters lined the produce and dairy aisles. Rite Aid presented pre-natal health cards seen by 200 to 300 shoppers daily. The credit union placed posters in three branches and information in Choice Fitness was seen by 1,000 people daily. The campaign was supported by mass transit advertising for the Women’s Health Care practice that included MVRTA public transit buses and train platforms.

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Volunteers Volunteers are an important resource for Anna Jaques Hospital. Each year a variety of community members give thousands of hours in volunteer time to the hospital. They work in widely diverse roles from staffing the gift shop and information desk to delivering meals, mail, and flowers to our patients. Volunteers support our patient transport staff, visit patients and assist hospital departments with clerical projects. Volunteer knitters donate their time creating hats for newborns, while others knit blankets and hats for cancer patients.

Volunteers stand in front of the AJH Gift Shop with manager Sue Dixon inside (L).

The volunteers who staff the hospital gift shop have helped to make it one of the frequently visited boutique shops in Newburyport. Each year the gift shop sells thousands of dollars of merchandise, with sales that outpace national trends, and the proceeds are donated to the hospital.

As one of the hospital’s volunteers says: “Working with and being around wonderful people from all generations and giving back to the community have definitely improved my way of life. A wonderful situation is available to you if you just reach out and lose yourself in service.”

Anna Jaques Hospital Aid Association Celebrating 120 Years of Philanthropy and Community Service The Anna Jaques Hospital Aid Association marked it’s 120th anniversary in 2008. Founded in 1888, the group has provided the hospital with countless hours of volunteerism and philanthropic support. In the past year the members of the Aid Association were busy organizing bake sales, coordinating raffles, planning the annual Great Chef’s night, showcasing local artists in the hospital’s main hallway and, of course, volunteering in the gift shop. These activities and many more helped the

Aid Association raise $70,000. Their gift in 2008 benefited the following departments and/or projects: $20,000 for an infusion chair in the new AJH chemotherapy infusion suite: $23,000 for ventilators to be used by ICU patients; $2,000 for the case management emergency fund; and $25,000 to provide new furniture for one patient room. We continue to be grateful to all the past and present members of the Aid Association for their dedication and support of Anna Jaques Hospital.

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Board of Trustees

Back row, left to right: Peter A. Hartmann, MD, Secretary, Wayne P. Capolupo, Board Member, Chair, Building Committee, David J. LaFlamme, Board Member, Chair, Finance Committee, Michele T. Sasmor, MD, President, Medical Staff, George H. Ellison, Jr., Chairman, Byron J. Matthews, Board Member, Thomas G. Ambrosi, Vice Chairman, Jan Morse, Board Member, Mark Welch, Board Member, Lisa L. Mead, Board Member, Frank G. Cousins, Jr., Memberat-Large Front row, seated, left to right: Stephen P. Beaudoin, MD, Board Member, Ann Lagasse, Board Member, Leslie J. Sebba, MD, Chief Medical Officer, Board Member, Jan Marcus, President, Aid Association, Kim Williams, Board Member, Chair Quality Committee, Charles R. Cullen, Chairman, Foundation, Delia O’Connor, President/CEO Not present in photo: The Honorable Christopher J. Armstrong, Board Member

Experienced governance

EXECUTIVE COMMITTEE George H. Ellison, Jr., Chairman Thomas G. Ambrosi, Vice Chairman Peter A. Hartmann, MD, Secretary Michele T. Sasmor, MD, President Medical Staff Leslie J. Sebba, MD, Chief Medical Officer David J. LaFlamme, Finance Committee Kim Williams, Board Quality Committee Wayne P. Capolupo, Building Committee Sheriff Frank G. Cousins, Jr., Member-at-Large BOARD MEMBERS Stephen P. Beaudoin, MD Charles R. Cullen, Chairman, Foundation Lisa L. Mead Jan Morse Mark F. Welch Christopher J. Armstrong Ann Lagasse Byron J. Matthews Jan Marcus, President, Aid Association TRUSTEE EMERITUS William L. Plante, Jr. Josiah H. Welch David S. Outhouse 16


Medical Staff

The Medical Department Chairs and Medical Staff Officers at Anna Jaques Hospital serve as leadership for the approximately 350 Medical Staff and Allied Health Professionals credentialed at the hospital. They provide clinical and technical expertise to clinicians in their respective departments and provide oversight to ensure compliance with regulatory agencies. Their leadership helps the hospital to plan strategically for future technical advancements in the field.

PRESIDENT Michele Sasmor, MD VICE PRESIDENT Glen Crawford, MD SECRETARY/TREASURER Guy Navarra, MD DEPARTMENT OF EMERGENCY MEDICINE Joe Hull, MD, Department Chief Ron Freid, DO, Assistant Chief DEPARTMENT OF ANESTHESIA Steven Parker, MD, Department Chief Robert Kirkman, MD, Assistant Chief DEPARTMENT OF MEDICINE Guy Navarra, MD, Department Chief H. Thompson Mann, MD, Assistant Chief

DEPARTMENT OF PATHOLOGY Heather Crowley, MD, Department Chief Philip A. Tisdall, Assistant Chief DEPARTMENT OF PEDIATRICS Alice Merkrebs, MD, Department Chief Tammy Bottner, MD, Assistant Chief DEPARTMENT OF PSYCHIATRY David Sorenson, MD, Interim Department Chief Assistant Chief, vacant DEPARTMENT OF RADIOLOGY Richard Rosin, MD, Department Chief Thomas Riley, MD, Assistant Chief DEPARTMENT OF SURGERY Kenneth Glazier, MD, Chief David Swierzewski, MD, Assistant Chief

DEPARTMENT OF OBSTETRICS & GYNECOLOGY Jane Kerr, MD, Department Chief Celeste Royce, MD, Assistant Chief

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Statement of Operations Year Ended September 30 2008 2007

Operating revenues Net patient service revenue Other operating revenue Net assets released from restriction used for operations Total operating revenues Operating expenses Salaries and wages Employee benefits Supplies and other Provision for uncollectible accounts Depreciation and amortization Interest expense

$ 96,429,763 $ 91,197,942 2,976,985 3,598,682 132,652 103,083 _____________________________ 99,539,400

94,899,707

44,864,850 42,860,564 11,180,486 10,620,703 33,978,730 31,638,957 4,192,511 4,012,137 3,737,054 3,596,284 850,517 663,981 _____________________________

Total operating expenses

98,804,148 93,392,626 _____________________________

Gain (loss) from operations

$_____________________________ 735,252 $ 1,507,081 _____________________________

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Consolidated Balance Sheets

Assets Current Assets: Cash and cash equivalents Patient accounts receivable, less allowance for uncollectible accounts of $2,502,739 in 2008 and $2,171,173 in 2007 Materials and supplies Assets whose use is limited-current portion Prepaid expenses and other current assets Total current assets Assets whose use is limited or restricted: Investments: Held by trustee under debt agreements Beneficial interest in perpetual trusts Board designated funds Donor-restricted funds Pledges receivable Total assets whose use is limited or restricted

Year Ended September 30 2008 2007 $ 6,912,324

13,085,522 11,704,577 1,166,722 1,042,953 1,154,255 1,408,143 591,271 1,156,135 ______________________________ 22,910,094 20,567,895

63,774 4,153,086 3,055,445 3,847,525 8,816,812 8,685,767 7,477,710 10,015,982 190,242 133,821 ______________________________ 19,603,983 26,836,181

Property, plant and equipment, net Other assets

$ 5,256,087

22,588,254

21,713,081

Total assets

3,276,569 3,019,630 ______________________________ $ 68,378,900 $ 72,136,787 ______________________________ ______________________________

Liabilities and net assets Current liabilities: Current portion of long-term debt Accounts payable and accrued liabilities Due to third-party payers, net

$

Total current liabilities Long-term debt, less current portion Other liabilities

774,406 $ 1,511,427 10,380,975 9,839,321 754,903 968,021 ______________________________ 11,910,284 12,318,769

Total liabilities

10,759,901 11,574,242 6,208,589 5,864,253 ______________________________ 28,878,774 29,757,264

Net assets: Unrestricted Temporarily restricted Permanently restricted

26,827,812 27,309,172 7,727,606 9,333,563 4,944,708 5,736,788 ______________________________

Total net assets Total liabilities and net assets

39,500,126 42,379,523 ______________________________ $ 68,378,900 $ 72,136,787 ______________________________ ______________________________ 19


Anna Jaques Hospital Management Phillip G. Drews, BS, RRT Director Cardiopulmary Care Rehab Services/Diagnostics

Patricia J. Powers, RN, COHN Director Occupational Health Services

Mark Goldstein Vice President Chief Financial Officer

David Fowler Senior Director Support Services

Karen D. Sindoni-Westhaver, RN Director Critical Care, CCSU

Leslie J. Sebba, MD Chief Medical Officer

Isaac Garcia Director Environmental Services

Joseph Soldano Director Financial Planning

Richard Maki, RN, BA, MHSA Vice President Chief Nursing Officer

Jeffrey M. Gwinn Director Pharmacy

Hilary J. Sondik Director Patient Financial Services

Thora Healy Director Medical Staff Office

Charlene A. Torrisi, RNC, MSN Director Maternal Child Services

Mark J. Kelley Director Food & Nutrition

James Walker Director Laboratory

Robert J. Kelley Director Finance

Diane E. Wigmore Director Emergency Department

Paula Lane Director Education & Professional Practice

Elizabeth M. Wright Director Human Resources

Delia O’Connor President & CEO

Stephen F. Salvo Vice President Human Resources Deborah Chiaravalloti Vice President Public Relations & Marketing Richard J. Napolitano, Jr. Vice President Development Executive Director Anna Jaques Community Health Foundation James A. Borek Director Diagnostic Imaging Robert R. Buchanan, Jr. Chief Information Officer Jeanine Cunningham, RN Director Surgical Services Andrew Lobb Director Wound Healing & Hyperbaric Medicine Center Richard Doolan Director Materials Management

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Kathleen M. LeBlanc, RN Director Medical/Surgical Services Karin D. Leppanen, RN, MS, OCN Director Outpatient Clinics & Nursing Supervisors Mary E. Lord, RNC, BS Director Psychiatric Services Rachael McKenzie, RN Director Case Management Sandra Levin Director Quality, Risk, & Patient Safety Maria V. Palumbo, RHIA Director Health Information Management

Emily M. Wright Director Volunteer Services


“From the minute I arrived…I knew I was in competent, caring hands. My husband had surgery in a Boston hospital last year and was just a number. At AJH I felt like family. It was a very positive experience and I will never forget how I was cared for at Anna Jaques.” (name withheld for privacy)


25 Highland Avenue Newburyport, MA 01950 978-463-1175 • www.ajh.org

Cert no. SW-COC-002376

Anna Jaques 2008 Annual  

Annual Report

Anna Jaques 2008 Annual  

Annual Report

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