Smilow Cancer Hospital Town Hall | January 26, 2023

January 31, 2023

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The leadership of Smilow Cancer Hospital will begin holding monthly Town Halls to review timely updates and address questions and concerns from our providers and staff.

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00:00A couple. A couple of things that I
00:04think we will try to bring forward over
00:06the coming months is that for the last
00:09several months, the smile and Yale
00:11Cancer Center executive team has
00:13spent a fair amount of time really
00:15trying to hone in on what we would
00:17consider to be
00:18the highest priorities that we need to be
00:20focusing on strategically. It's so easy
00:22to to develop pages
00:24and pages and pages of
00:26things that we would consider to be
00:28high, highly prioritized. But what
00:31happens when you do that?
00:32Is that you diffuse things. And
00:34so we have been working hard to really
00:36try to narrow down what what, what seems
00:40to be the most pertinent strategic
00:44priorities. And we
00:45will look forward to sharing
00:47those with you very soon.
00:49And not only in this forum,
00:50but we will find other
00:52forums for engagement and
00:54the work that we do over the course of
00:56not only this calendar year, but as we
00:58also move into the following year. So
01:01thank you all for being here. And
01:03the I'm going to turn the floor
01:05over to Doctor Billingsley
01:06and and Kim and
01:08we look forward to maybe
01:09addressing any questions you
01:10might have about later
01:11in the town hall.
01:14Thanks, Lori. And I'm just going to share my
01:16screen and I think right before I do that,
01:18we'll say that for those joining,
01:21you can use the chat to ask questions.
01:24We'll try to answer them as we go along.
01:27We may decide to answer some of them live.
01:30And as Lori said,
01:30hopefully at the end we'll have a
01:32good 10 minutes or so for for Q&amp;A.
01:35But welcome everyone,
01:37this is exciting to resume our town halls.
01:41I know Kevin's going to
01:43be sharing some words.
01:44As well and we have a jam packed agenda.
01:48So I'm going to just go ahead
01:50and and and go right to that.
01:52Umm. So this is our agenda for
01:54for our first town hall of 2023.
01:57Ken and I are going to go over
01:59some announcements and recognition.
02:02I will go over our glint survey
02:05engagement results for the the large
02:08for our entire smilo enterprise.
02:11Again that was an engagement survey that.
02:14That our employees that of the
02:17hospital were able to participate in.
02:19We have Maureen major camp hosts
02:22and Doctor Sarah Shellhorn here to
02:24talk about the Center for Breast
02:27Cancer Relocation back to NP1.
02:29We have Michelle Kelby Albert,
02:31our director of quality and patient
02:33safety to go over FY23 performance
02:35improvement plan and we have doctors
02:38Ratner and Damast here to give us
02:41a GYN oncology program highlight.
02:43So very jam packed.
02:45Agenda excited about this evening
02:47and we will just move
02:48forward. Within this health, within
02:51our health system, we start many of
02:53our meetings with the patient story.
02:55And it was just ironic that today of all
02:58days two of our nurses and our GI Medical
03:01Oncology clinic were recognized for a great
03:04catch for what they did for a patient.
03:07And we just couldn't think of a better
03:09way to open up our town hall this evening.
03:12And we want to congratulate Amanda and
03:14Macy for what they did for this patient.
03:17So I'm just going to take a moment
03:19and read this and.
03:20Even me reading this story I
03:21don't think does it justice.
03:23But it's an it's an amazing story.
03:25So we had a patient that came to
03:27our clinic for a discussion about.
03:30Their treatment and potentially
03:32having to restart treatment.
03:35The patient stated that they needed to go
03:38to inpatient treatment for detox before
03:41they would be able to to restart treatment,
03:44but the patient declined at
03:47that time to pursue that.
03:49Macy made a note to herself to
03:51follow up with this patient because
03:52she was very concerned,
03:54and to to make a phone call to
03:56the patient after a week or two.
03:59She called the patient two weeks later
04:01to check in and the patient stated,
04:03I can't believe you called.
04:05Why did you call now?
04:07I was just thinking if I should call 911.
04:10I need help.
04:11I am very depressed and I need help.
04:14He stated. He did not want to live anymore.
04:17Amanda, Macy's colleague,
04:18stayed on the line with him
04:21while Macy called 911.
04:23They stayed on the line with
04:25the patient until emergency
04:26services arrived on the scene.
04:28Thank you, Macy and Amanda,
04:30for that wonderful patient story
04:32and for really being there in
04:34that moment of patient need.
04:35And and it's just,
04:37it's just amazing.
04:37It's just an amazing story of the
04:40commitment of our team members
04:42to our patients every day.
04:43So thank you so much.
04:47And I'm going to turn it over
04:49to Kevin and he's going to say
04:50a few words and and move on to
04:52some of our other recognition.
04:55Kim, thanks so much as well.
05:00I I will just open by saying how delighted
05:04I am to be here doing a town hall again
05:08with our fabulous community of clinicians,
05:12leaders, staff, technicians,
05:14all of our people who come together
05:18every day to care for our patients.
05:21You know, one of the things that this
05:25leadership team is committed to is.
05:28Communicating in a really proactive
05:30way with all of you who are on the
05:34front lines caring for our patients.
05:37We understand that this is central to
05:40engagement and to the well-being of
05:43our faculty and our staff and our part
05:47of our our mission and our effort in
05:51these town hall forums is to provide.
05:54Not only kind of updates and practical
05:57information about what's happening across
05:59the Cancer Center in the clinical program,
06:02but bringing all of you in,
06:04in a conversation about where
06:06we are going as an organization.
06:09This is an incredible time in cancer
06:11care and in our organization.
06:14Although we face challenges,
06:15we have enormous opportunities
06:17in front of us.
06:18Cancer care changes and evolves in
06:21an exciting way every day and it's.
06:24Critical for all of all of us to
06:26be sharing these developments,
06:28but communication is never just
06:31One Direction.
06:32Our our aim and our hope is for
06:34this forum to be bidirectional.
06:36So we will do everything we can
06:39to leave some time at the end for
06:41a question and answer session.
06:43And in addition to town halls,
06:46we are going to be reaching out and
06:48engaging with our teams as much
06:50as we can in a variety of forums.
06:52Our leadership team has started
06:55a very intentional rounding.
06:58Process where you will be seeing many
07:01of us in a variety of operational areas,
07:04not just here in New Haven,
07:06but across the entire enterprise.
07:08And we will be interacting with
07:10frontline staff and caregivers.
07:12And we really want to use this
07:15opportunity to hear directly from
07:17all of you about what's going well,
07:20what's,
07:20what's going great and what most
07:23importantly could be better.
07:26So we will look forward to that.
07:28Umm.
07:29One of the things to kick us off that
07:31I'm most excited about is that we really,
07:34we had a fabulous conclave at the New
07:38Haven Country Club several weeks ago
07:40and it was very exciting to witness
07:43our award winners across a variety of areas.
07:46I wanted to take this opportunity
07:49to recognize yet again our award
07:52winners in the clinical arena
07:54and hats off to Aaron Medoff's
07:57nurse practitioner who this year.
07:59On the Ruth Mccorkle oncology
08:02advanced Practice Provider award
08:04and congratulations to doctors
08:07Manju Prasad and Saral Mehra.
08:11Dr. Prasad is a pathologist.
08:12Dr.
08:13Mara is a head and neck surgeon for
08:16winning jointly the Yale Cancer Center
08:19Award for Excellence in Clinical Care.
08:22Very inspiring work from these folks.
08:26It's also a real pleasure for me to
08:30recognize some of the superstars
08:32we have among our our faculty,
08:35our very own doctor.
08:37Pat Larusso,
08:38leader of our Phase one unit,
08:40has been a a pillar and a rising
08:43leader and the American Association
08:46of Cancer Research. That's AACR.
08:49Pat is up for a leadership position as
08:53the President of this organization.
08:57Um, she's been nominated by her peers,
09:00and we all do have an opportunity to support
09:04Pat and vote for her through this link.
09:07I think that she is really one of
09:11the nation's leaders and early
09:14therapy development and this is a
09:17huge already honor and recognition
09:20of her presence in this space.
09:23So want to share that with the Community
09:26and certainly support Pat in this effort.
09:32One of the things that has been
09:35most exciting in the past year
09:37or so has been the arrival of a.
09:40Huge salt array of new faculty
09:43members across all of the clinical
09:46disciplines in cancer care.
09:48In the interest of time,
09:50I probably won't read all of these names,
09:52but you can see we've recruited outstanding
09:55individuals from across the country
09:58and around the world and virtually
10:00every program including surgical oncology,
10:03genetics, GYN onc,
10:05a variety of other surgical disciplines.
10:09Radiation oncology or therapeutic radiology,
10:12hematology imaging as well as
10:15solid tumor medical oncology.
10:18Next slide.
10:22The growth of our faculty is
10:25across the entire enterprise,
10:28not just here in New Haven,
10:29but in all of our sites of care,
10:31including places such as Westerly,
10:35RI and Waterbury, CT.
10:39And Greenwich, CT. Next slide.
10:49Thanks, Kevin.
10:50I'll go ahead and Umm also announce
10:53a few nursing promotions that we've
10:55had over the last couple months.
10:57So Christina Capretta,
10:59who was our clinical program
11:01director at Greenwich Hospital,
11:03Smilow at Greenwich has been
11:05promoted to the Patient services
11:07director for SMILO at Bridge in the
11:09Bridgeport area in Greenwich Area.
11:11So we're very excited about
11:14Christina taking on this expanded
11:16scope and and we look forward
11:18to supporting her in that work.
11:20We also wanted to announce Christina Matusek,
11:23who is one of our nursing professional
11:26development specialist who has focused her
11:29time in the ambulatory practice space.
11:31Previously we were we received a grant
11:34from the Frederick A DeLuca Foundation
11:37to start a new graduate nurse and a PP
11:41program for ambulatory Oncology and
11:43Christina will be leading those efforts.
11:46So we're very excited about her.
11:49Her change to a fellowship
11:52specialist to support that program.
11:54And then we also have Brooke Schramek.
11:57Schramek who was our Assistant
11:59Patient services manager for
12:01the care centers in Derby,
12:03Torrington and Waterbury and she
12:05has been promoted to the clinical
12:07program manager of those sites.
12:09So we look forward again to supporting
12:11her into seeing her leadership and
12:14supporting our teams and working with all
12:17of the interdisciplinary team members.
12:22We're going to go over just a
12:25couple announcements before before
12:27we have our presenter start.
12:29We did hear this week that the Yale
12:32New Haven Hospital is scheduled for
12:35their Joint Commission accreditation
12:37survey and what that means is
12:40that we could expect to see them
12:43at any time as early as Monday.
12:46We do expect that they probably
12:48will not be here until.
12:50Um, maybe February or through March but,
12:54but now they could come at any time.
12:56We are scheduled for a five day survey
12:59because of the size of our hospital.
13:01So they will arrive on a Monday.
13:03So we know that if they don't arrive on a
13:05Monday then we're good for the next week.
13:07But I think this is a time for us
13:09to be ready and we should always
13:12be Joint Commission ready,
13:13but it's even more of a a time
13:15where we need to be really vigilant
13:18about our environment and.
13:20And and in our documentation and
13:23just be ready for those surveyors
13:26to come around and and talk to us.
13:30It does include all of our
13:33ambulatory sites that are YNH.
13:35So and at our last survey several years ago,
13:38they did visit the majority
13:40of our smilo sites.
13:42So I would expect that especially because
13:44of the patient population that we care for,
13:47we give a lot of high risk treatments.
13:50And so our areas of our areas are ones
13:52of focus for the Joint Commission,
13:55the risk areas that our hospital
13:58regulatory department has.
14:00And really trying to share up in our
14:02practice and in our policies is really
14:05focusing on some of our documentation,
14:07our hand hygiene compliance and some
14:10of our infection control practices
14:11and the surgical attire that should
14:13only be worn in the OR settings.
14:16So those are some of the areas
14:18that are of high risk for us that
14:21we'll be paying attention to over
14:24these next several weeks.
14:25The other thing that we wanted to go over
14:29and Kevin talked a little bit about this,
14:32about our refocus on engagement this fall.
14:36Again,
14:37we had our.
14:38All of our Yale New Haven Hospital
14:41smilow staff were able to participate
14:44in a glint engagement survey where
14:47they were able to give feedback
14:49about their work environment,
14:51their sense of how they work
14:54with their team members,
14:55and their feeling of connection with
14:57the hospital and the health system.
15:00And we get scored on that based
15:02off of a national benchmark
15:04of how engaged are our teams.
15:06So you can see here that we had.
15:09A 77% response rate.
15:12So that is very good.
15:14We very much appreciate everyone that
15:16responded to this survey because then
15:19we can really take this feedback and
15:22and truly work with all of our team
15:24members to improve our work environment.
15:26Our engagement score though was at a 68,
15:29which we really would like
15:31to see that at around a 74.
15:34Umm that is really a a.
15:38Silently engaged team and
15:41you can see that we were at that benchmark
15:44back in 2020 and in 2021 in early 2021.
15:48But you can see the last two
15:50times we've had this survey,
15:51we've been holding steady around at the 68.
15:54So I know that all the local leaders
15:56are working with their teams on
15:58their local action plans that are
16:00due at the end of this month.
16:02But as a senior leadership team,
16:04we also have a responsibility to
16:06look at these results and say how
16:08can we help make a difference?
16:10And support and engaged work environment.
16:14So we just wanted to share some of
16:18those strengths and opportunities
16:19that we saw across all of smilo.
16:22So some of the things that our teams
16:24told us that we're doing well is that
16:27they feel they have opportunities for growth.
16:30They feel it's a respectful work
16:32environment and that there are
16:34opportunities to be recognized.
16:36But yet where we really need to
16:38focus over this next year is action.
16:40Taking on these results not just
16:42in Smilo but across the hospital,
16:45staff want to see that their voices
16:47are being heard and that real
16:50action is being taken again,
16:52opportunities around leadership and
16:54primarily around visibility and
16:57communication and then opportunities
16:59to stay focused on well-being.
17:02So these are all areas again like I
17:04said at the local level they have all
17:06of their results and teams are engaged
17:09locally to have their own action plan.
17:11But this evening,
17:12I'm just going to briefly talk
17:14about what our action plan is for
17:17the senior leadership at Smilo.
17:19So we are really committed to increasing
17:22our visibility and communication.
17:24So one of those things is having
17:26these monthly town halls and
17:28other forms for communication.
17:30And as Kevin said, it really being
17:33bidirectional again making sure that
17:34all of our sites are getting rounded
17:37on at least quarterly by the senior
17:39leadership team so that we have.
17:41Opportunities to recognize the
17:43things that are going really
17:45well and as Kevin mentioned,
17:46really understanding those
17:47opportunities and challenges and how
17:49we can help support our teams and
17:52and breaking down those barriers.
17:55So with that I'm going to stop
17:58sharing my screen and we're going to
18:01start with our first presentation
18:03which is Maureen and and Sarah,
18:06you guys are going to give
18:07the NP1 Breast Center update.
18:11I'm just validating that you
18:12guys can see the one screen.
18:14Is that correct? Can't
18:15see anything, Maureen.
18:16Oh, great. Oh, I understand. OK, hold on.
18:21Well, Maureen and Sarah work on
18:24this multimedia presentation.
18:26I'm going to interject and say.
18:29I cannot be more grateful
18:32to these two leaders.
18:33We are going on three years here,
18:36and Sarah has an oh, she's got it.
18:40Sorry. Well, I figured you could keep
18:42talking, Kevin, because I was like,
18:43hear those accolades. You keep going,
18:46but all of the moves that we have had
18:49to do to manage care of our cancer
18:53patients through COVID has largely been
18:56orchestrated under the very thoughtful
18:59direction of these two leaders.
19:02So I, I, we are all grateful.
19:05We can't thank you enough.
19:06It's been quite a journey and we're
19:09getting into the final laps here.
19:13Sorry, you went. That was the
19:15that was the secret signal for it.
19:16We can see two slides.
19:19There we go. How's that?
19:21Perfect. There you go. OK.
19:24Thank you, everybody and thank you,
19:26Kevin, for your comments.
19:28Yes, this presentation will really focus
19:30on the state of ambulatory services,
19:33mostly focusing on the York Street campus.
19:36So I'm going to turn it
19:37over to Doctor Shellhorn,
19:38who is going to go through the very
19:41many steps in our process of change.
19:45So I I we will whip through these
19:48first couple of slides quickly,
19:51but I just want to show you how many times
19:55we have moved since the spring of 2020.
19:58Each of these arrows is a project
20:01in and of itself that's orchestrated
20:03not just by the two of us by,
20:05but by entire teams of various
20:11multidisciplinary components
20:13to get each of these moves.
20:15First away from the York Street campus and
20:19then gradually back into our original space.
20:22In the spring of 2020, we vacated the
20:25North pavilion in almost its entirety,
20:27and in the fall of 2020,
20:29we started to make some progress coming
20:32back to the York Street campus again.
20:35Each of these moves a very intricate
20:38dance between lots of different
20:40members of our institution.
20:42We'll go to the next slide
20:44to show you where we were.
20:45The fall of 2020 through the spring of 2021,
20:48again more moves as we came,
20:52as our footprint looked more and
20:54more similar to where we started.
20:57I'll bring you to where we are
20:58now on the next slide.
21:00Maybe it's
21:02just a lot of moves.
21:03I mean I think the in in the last
21:07two years we've remained relatively
21:10stable in our current footprint with
21:13most of the North pavilion occupied,
21:15although some notable exceptions
21:17included the SRC, the Smilo rapid
21:20Evaluation Clinic which was in the
21:23previous breast center displacing the
21:25breast center up to the 4th floor and
21:28a number of our teams in North Haven.
21:31In the first and second floors with
21:34some infusion capacity on the 2nd
21:36and 4th floors of the 6th Devine St.
21:39Building in.
21:40However, at the beginning of this month,
21:43the SRC formally disbanded and we
21:46are now incorporating those patients
21:48who had COVID positivity into
21:51their local units and the breast
21:53center moved back to its space on
21:57on on NP1 as indicated here.
22:02Guenoc is still on the other side of NP1,
22:05but the prior NP1 infusion does remain
22:08part of the hospital as a medicine
22:11overflow unit and GI medical oncology.
22:14Some of the thoracic program liver
22:18and infusion remain in North Haven.
22:21And go to the next slide
22:22and I think I'll turn
22:23it over to Maureen.
22:24Thanks Sarah. And you know I think
22:27that you know those slides really
22:29just in many ways really typify the
22:32hard work that everybody has done to
22:35get us back to where we are today.
22:37And we couldn't have done any
22:39of this work without the senior
22:41leadership support really at the
22:44highest levels pushing for relocation
22:46of teams back to their home base.
22:48So on January 9th,
22:49the rest program moved back to.
22:51And P1 and just for a moment,
22:54I'd like to highlight what that rest program
22:57will look like today and in the future.
23:00First, it is reuniting our breast
23:02imaging colleagues with our breast
23:05surgeons and the medical oncologist
23:07and our plastics colleagues that will
23:10all see patients in the breast center.
23:13But the enhancements that we can
23:14now really that have been on a wish
23:16list and we can dream about or have
23:18been dreaming about can really
23:20start to become reality.
23:21As we look at ancillary
23:24programs like cancer genetics,
23:26joining us working side-by-side
23:27to really help partner with our
23:31clinicians and caring for our patients
23:33in extended expanded presence of
23:36our breast plastic surgery program
23:39for breast reconstruction options
23:41for our patients is vital to the
23:44patient experience and as well
23:47reuniting the breast program and this
23:50multidisciplinary practice back to MP.
23:52Time allows us to again resume our
23:55pilot site work and so the breast
23:57program as well as Guilford will
24:00be looking will be a pilot sites
24:02for the ASCO Medical Home program
24:04which we're really excited about.
24:07And as well we are the best program will
24:10be an operational pilot site for for a
24:13checkout and fluid rooming optimization.
24:16So it's really recognizing that
24:20across all of our areas we are.
24:23Um, struggling with checkout.
24:24And so we've looked at processes,
24:26many teams have looked at processes
24:28throughout the last two to three years
24:31during this transformation effort.
24:33And one of the pilot sites will be
24:34the breast program where we have
24:37this multidisciplinary practice.
24:38So it is really exciting to think
24:40about what the breast program we'll
24:42look like in a year from now.
24:45But with the move of the breast
24:48program from NP4 down to NP1,
24:52it does allow us some capacity on NP4,
24:56which for many, many years we have not.
24:59We've been asked for additional space.
25:01Many of you have asked us for that
25:03in the audience and oftentimes
25:06we accommodate where we can.
25:08This is the first time where we
25:11will have actually an opportunity
25:13to create new programs.
25:15For expanding programs,
25:17So what we will backfill and
25:20P4 space with not all of it,
25:23there's nine exam rooms is
25:26strategic data-driven,
25:27thoughtful placement of programs
25:29to allow for growth so that we
25:32can better care for our patients.
25:34And this is the real opportunity
25:36within the cancer program,
25:37especially in New Haven is to allow
25:39us to think about what we can really
25:41use that space for that will best
25:43enhance the care delivery that we provide.
25:46Our patients, the one challenge and
25:49something we have to be mindful
25:52of is that who returns to NP4,
25:55if it's medical oncology teams that need to
25:59treat their patients with chemotherapeutics,
26:02we still do our minus 18 chairs from NP1
26:07that remains a medicine overflow unit.
26:10So what does that,
26:11what is the challenge for that?
26:12That is really an operational
26:15opportunity for us to.
26:16We focus our efforts and our efficiencies to
26:20increase infusion capacity capacity on NP8.
26:23We have 38 chairs there.
26:25We know that we have capacity
26:28issues and scheduling challenges.
26:30It will be a real opportunity for us
26:33to really provide a refocused effort
26:36on adjusting addressing that capacity,
26:38which will allow for better treatment
26:41opportunities for our patients.
26:43And then finally,
26:44we'll be able to optimize
26:46workflow enhancements.
26:47Optimization to create efficiencies
26:49and maximize care delivery.
26:51So those are the exciting things that we
26:54have to look forward to in the upcoming year.
26:59And I I would be remiss if I did
27:01not thank the local clinical teams,
27:03both the multidisciplinary
27:05leadership team of NP4 and the
27:08clinical team and leadership of NP1.
27:11They worked.
27:12They were resilient,
27:14they showed humility,
27:16they showed focused patient care
27:18during all these moves and then coming
27:20back to the breast program was was
27:23truly seen as a victory for them.
27:25And I would thank Camille Servidio and
27:27all of her team on their hard work
27:29and dedication and bringing our team,
27:31our patients back to the breast program.
27:33But we couldn't have done that
27:36without relocating.
27:37Sarah mentioned the rapid evaluation
27:39clinic closed and the IT closed
27:41because we were now.
27:43Able to we agreed that we needed
27:45to think about processes to locate
27:47COVID care in the local units and
27:50so our COVID positive patients
27:52have been absorbed by the local
27:54disease team outpatient units.
27:56Visitor policy is very important
27:58because we know that we still in order
28:01to keep our patients and staff safe.
28:03I did put the visitor policy up here.
28:06I will just remind everybody
28:08that a patient and one caregiver
28:11is allowed to enter the.
28:13Facility,
28:14they are screened just for location
28:16of where they're going prior to their.
28:20Transition up to their local units
28:22for care and there are exceptions
28:25that will be made,
28:27but it's a joint discussion
28:29and collaboration between local
28:31leadership and operational management.
28:33If we want to expand to more than
28:36one caregiver and that is something
28:39that is it is not, it can't.
28:41The answer is no you the answer
28:43is let us all work on trying to
28:46get multiple family members in if
28:48that's the right thing to do,
28:49but we are really asking for.
28:51Our clinicians and our teams to support
28:54one family member as a caregiver
28:57to join the patient in that visit.
29:02So I'm going to escape that is really
29:07our update on our. The return to NP1.
29:10I don't know if we want to take
29:12questions or if you'd like to wait.
29:15We will hold questions till the end.
29:18Thank you both for it.
29:21Superb presentation is
29:22always an incredible work.
29:25It's a pleasure for me to
29:27introduce Michelle Kelvey Albert,
29:29our director of Quality and safety,
29:31who will update us on work
29:34doing work we're doing with the
29:36performance improvement plan.
29:41Got to remember to get myself off mute.
29:43Thank you Kevin for that.
29:45So I'm going to try to get through this
29:47pretty quickly so we have time for
29:49our questions and our next presenter.
29:52So thank you again for inviting
29:53me this evening to go over this.
29:58If my slides will advance,
30:00we'll be doing really good.
30:01OK, here we go.
30:04So performance improvement plan,
30:05our Pi plan for smilo.
30:07So we really start where it focuses
30:10on our current smilo initiative
30:12initiatives and also alignment with
30:14Yale New Havens corporate objectives.
30:17And really that's twofold because we need
30:20to look at what is currently happening,
30:22how are we resource for that,
30:24looking at efficiencies.
30:25And we also know that if we
30:27can align with other corporate
30:29objectives that are happening,
30:31we have access to data and access support.
30:34And shared practices across the system.
30:39So our API plan is completed annually.
30:42And really when I first
30:43started about 2 1/2 years ago,
30:45we had about 10 priorities,
30:48I think, in our plan.
30:49And as Kim Slesser and Karen Allison
30:51and I have been looking at it,
30:53we're really trying to pare it down
30:56till somewhere around four or five and
30:58really to to to look at those initiatives,
31:01we want to make sure any initiatives
31:03that we're picking that we are
31:05creating measures of success,
31:07we're picking targets,
31:08we're looking at that.
31:10For opportunities for improvement,
31:12we're establishing meeting standards
31:14so that there's shared learning
31:17best practices and we're making
31:19sure that we're able to promote
31:21staff involvement and participation.
31:24So if we for the meetings for
31:26each of these projects,
31:27it's not just the leaders,
31:29it's the frontline staff and the folks
31:31that are doing the work to be able to
31:34participate in success of the projects.
31:36So the priorities for this
31:38fiscal year and I'm going to go
31:40through them pretty high level,
31:42we had focused on 4.
31:45The first one is our ASCO medical home,
31:48which Maureen had mentioned.
31:50This is the American Society for Clinical
31:53Oncology Medical Home certification.
31:55We have looked at implementing
31:57this across all of our ambulatory
31:59settings and we realized we got
32:02a little ambitious and needed
32:04to kind of step back a bit and
32:06we felt it was better to pilot.
32:08This in two of our locations.
32:10So the the breast program on York
32:12Street and our Guilford Care Center
32:15really to to see how this will
32:18work and then be able to look at
32:21how our rollout will look across
32:23all of our ambulatory sites.
32:25I'll talk a little bit more in
32:26a next in a few more slides of
32:29why we decided to participate in
32:31the ASCO medical home.
32:32We also have our length of
32:34stay accountability project.
32:35So this is impatient focus we've all.
32:38Then on many meetings both on some of
32:41the morning safety for the hospital
32:44and the oncology morning safety
32:47huddles and timely discharges and
32:50the boarding in the Ed continues
32:53to be an issue across our system.
32:56And so the length of stay Accountability
32:59project will focus in on NP 11 and 12
33:03and really looking at reducing discharges,
33:07increasing mobility.
33:08And when appropriate discharges to
33:12Hospice care and the increase of mobility,
33:16we're hoping will also help
33:18us with our decreasing our
33:21falls patient experience.
33:22So we've had patient
33:24experience and RPI plan before,
33:27but this year in our ambulatory setting,
33:29we've now rolled out and implemented a
33:32new MD survey in our ambulatory settings
33:36and one of the reasons we wanted to do.
33:39That is as all of our clinics have been
33:42tracking their comments and their scores,
33:45we did not have a way to be able to kind
33:49of capture our physicians comments and
33:53the care that our clinicians are giving.
33:56So this survey which would was
33:59implemented on January 2nd,
34:01we provided very specific physician questions
34:05which will be looking at working on.
34:10A provider scorecard.
34:11So I'm, I'm very excited about that.
34:13I think that's going to be
34:15a really great initiative.
34:16And then our checkout process project.
34:18So this is something that myself that
34:20doctor Shellhorn and Kate Gill have been
34:23working on for well over a year now.
34:25And this was really to increase
34:29our disposition compliance.
34:31And I can describe this a bit of
34:34we've now have a a new smart order
34:37set in Epic and it really looks like.
34:41For those of you that might remember
34:43the old bubble sheet where you could
34:46circle the patient needs to come
34:48up back for follow up for labs for
34:50imaging for with the physician.
34:52But the other key part of this is
34:55so now to have one thing in a smart
34:57set that everything is there,
34:59but now it goes to a work queue and
35:01that work queue is really important
35:04from the scheduling perspective so
35:06that we're hoping this is going to
35:08cut down on some of the back and
35:10forth and that patients will leave.
35:11With their follow up orders and so we
35:14are starting to implement this and
35:16roll this out in different locations.
35:21So we need to remember when we're
35:24putting the Pi plans together,
35:27you know what else is happening
35:29across Milo because again we have to
35:31look at resourcing and and staffing.
35:34And so just a few things to keep in mind.
35:36Kim brought up the Joint Commission
35:38that we're in that window,
35:40but we also have our fact accreditation
35:43that we're looking at probably late spring,
35:46early summer for that survey to happen,
35:50our ASCO medical home.
35:52We will be completing our
35:55compliance documentation.
35:57So that's a bit of a show and tell if we
35:59say we have a policy or a new workflow,
36:01we have to show a report or a chart
36:04audit to prove that and that will
36:06be done in March of this year and
36:08hoping to get the recognition in June.
36:11And then our Commission on cancer for Yale,
36:14New Haven, that survey will be
36:18happening in October of this year.
36:22So just to take a minute to say,
36:24why are we participating
36:25in the ASCO medical home?
36:27Because this is across,
36:29again, a lot of domains.
36:31It's 7 standards.
36:33And really we're participating in this
36:36program because the requirements align
36:38with our mission for patient centered,
36:41highly coordinated care.
36:42And it really enables us to
36:45continue our work and to build
36:48on our practice wide quality
36:50standards and our future for value.
36:52This payment and just a couple of
36:54examples that I wanted to highlight.
36:57So for the standards and the things
36:59that we'll be rolling out and going
37:02live with starting on January
37:0430th is our end of life care.
37:06So ensuring that each patient
37:09has a documented goals of care
37:12conversation in a new E chemotherapy,
37:16a new I'm sorry a new chemotherapy E consent.
37:19Care coordination supporting our
37:21patients who have been hospitalized
37:24or in the Ed throughout the state,
37:26screening all our patients for
37:28challenges and social determinants of
37:30health and referring them for health.
37:33And lastly,
37:33making sure all patients have access to
37:36education are around advanced care planning.
37:38So those are,
37:39there's many more pieces to that,
37:41but I think those are some examples
37:44of why we wanted to do this program.
37:50So in our quality kind of strategic vision,
37:55something that Doctor Adelson, Dr.
37:57Billingsley, Kim Slosser and myself
37:59had been working on for probably about
38:026 to 8 months is our newly formed.
38:05Smilow quality and Safety Council.
38:07And so this was really exciting.
38:09We really wanted, we did have a
38:12forum for this when I first started,
38:14we kind of paused that needed to
38:16relook at it and see, you know,
38:18how we could make this a little bit better.
38:21And so we really form this starting in
38:24this past October of 2022 and it really
38:28was meant for an interdisciplinary
38:31leadership team across the smilo
38:33enterprise and really the goal of this.
38:35Was to oversee the development
38:37of this Pi plan.
38:39So they, this team,
38:41this Council will be helping decide
38:43what those priorities are really to
38:46review and monitor key quality metrics.
38:49It starts with the data.
38:51We need to be looking more at our data
38:53and making that actionable and really
38:56to promote a system wide culture of
38:58safety and in support of the principles
39:01of high reliability organization.
39:03So that's where we started.
39:06And So what I'm hoping that's going to do
39:09is help us break down some of the silos.
39:12Not to say that all our areas have silos,
39:15but we still have some.
39:17And so I think this Council is going
39:20to help us bridge that and with
39:22that hope so that we're all pedaling
39:25in that same direction and that
39:28quality care is everyone's mission.
39:30And we,
39:31if we can achieve that through
39:33the Quality Council this year,
39:35I I think we'll be.
39:36Doing what we set out to do,
39:39but in order to do that we've got some
39:42culture change and so really for smilo
39:45to advance on our delivery of high
39:48quality care, patient center care,
39:50you know we need our clinical teams,
39:52we need data transparency.
39:53So some of that when I was talking
39:57about the patient experience,
39:58the new survey looking at our scores,
40:02having now a provider scorecard
40:05reviewing those key.
40:06Metrics and also promoting the
40:08culture of accountability.
40:10And when I think about this,
40:13it makes me think of that,
40:14you know,
40:15phrase do what you say and say
40:17what you do and I think that's the
40:20accountability that we need as part
40:22of our quality and safety program.
40:24So I think that is my last slide.
40:27It is. So I'm going to stop sharing.
40:32And then hope to get some
40:34questions at the end. Thank you
40:35for letting me go through that.
40:37Thank you, Michelle.
40:40Our teams in the front lines don't
40:42always see the efforts that we're
40:44making to improve quality and safety.
40:46So kind of having that comprehensive
40:48view is very helpful and we,
40:51I think we will all aim as you say
40:55for a say to do ratio of 1 to one.
40:59So last but certainly not least.
41:02I it's a pleasure for me to introduce
41:05two of our clinical superstars who
41:08need really no introduction and I will
41:11share early on in the presentation.
41:13We highlighted our.
41:15Two of our recent this year Smilo
41:20Clinical Excellence CL Cancer Center
41:23Clinical Excellence Award winners.
41:25Both of our presenters this evening,
41:28Doctor Damast and Doctor Ratner
41:30are prior winners of the El Cancer
41:33Center Clinical Excellence Award.
41:35They both here are here representing
41:38different facets of the GYN oncology program.
41:41And as many of our audience know,
41:44January is cervical cervical Cancer
41:46Awareness Month and we asked
41:48Doctor Damask and Doctor Ratner to
41:50give us a brief program update.
41:53Thank you for being here.
41:56Thank you so much at the Billingsley.
41:58Thank you for the opportunity to
41:59be able to be with you today and
42:02give you this a brief update it.
42:04Doctor Thomas and I will kind of go
42:06back and forth to talk to you about the
42:08state of affairs for cervical cancer.
42:10And this kind of presentation is just
42:13speaks to the privilege and the honor
42:15that I have working with Doctor Thomaston.
42:18How we give this talk is how we take care
42:20of patients together and collegially and
42:23with great respect for each other so.
42:25Thank you for giving us both this
42:28opportunity to share with you.
42:30I will share my screen.
42:32I have been fortunate over the past
42:36couple of weeks to be able to give
42:40a bunch of TV interviews or news
42:43interviews because there has been a
42:46lot of stuff in the lay literature or.
42:50TV news about the advances of cervical
42:53cancer and what a difference it has made.
42:57So that the mass and I'm very excited
42:59to speak with you about management
43:01of cervical cancer and I am actually
43:03super excited to talk to you about
43:05prevention of cervical cancer,
43:07which is really just such a model
43:09in cancer care.
43:10You know,
43:11so much of what we do is about early
43:13detection and even better of course
43:16prevention and in cervical cancer
43:18amazingly and luckily we actually have.
43:20Be able to accomplish it with
43:23the use of vaccines.
43:25So I will take the first few minutes.
43:27I was asked to give a little update about the
43:30department and Division of Joanne Oncology.
43:33So Juan,
43:34oncology at the Smilow Cancer
43:36Center has greatly expanded.
43:39We have started with three faculty members.
43:44You know a few years back when I
43:46took over this division and now
43:47there's nine of us and there will
43:49be 11 hopefully by this summer.
43:51And that just speaks to the to the
43:56fact that we are very busy that we
43:59cover the entire state and also
44:01speaks to how we are changing the
44:04the way that you want to college
44:06works and we work collegially as a
44:08team taking care of our patients.
44:12We are really only as good as we are
44:15because of incredible support of our teams,
44:19both the nursing teams and our AP teams.
44:22We are incredibly fortunate to have really
44:25the best people with us taking care of
44:28our patients who are so dedicated to the
44:31practice and to the care of our patients.
44:33And again just we incredibly just
44:37fortunate and blessed to have
44:39such an incredible strong.
44:41Team just so happens women,
44:44which is in itself a blessing,
44:46taking care and partnering with us in
44:49the care of our patients both on the
44:52outpatient side and the inpatient side.
44:54Do you want ecology has multiple sites and we
44:58take care of women all throughout the state,
45:02all the way to Greenwich Hospital,
45:04Umm in in the South with big full
45:08time practices and Bridgeport.
45:11And all the way to Waterford
45:15as well as Waterbury.
45:17And we are just so privileged and
45:20so lucky to be able to provide care
45:24to women close to home where they
45:27are and be able to do surgeries
45:30for them in that setting as well as
45:33work with our medical and college
45:36colleagues to provide chemotherapy.
45:38We are very surgically busy.
45:40We do great number of cases.
45:42We have a.
45:43Quite high patient volume.
45:45Together with Doctor Mcgillian,
45:47we are incredibly dedicated to
45:50next day excess and something that
45:53really has transformed our practice
45:55since Doctor Mccallion started
45:57this outreach a few years back.
45:59We do probably give our own chemotherapy
46:01and we have a great number of patients
46:04who undergo chemotherapy at a time.
46:06And we also maybe because survivorship
46:08you know do you want to college you
46:11would really separates separates us
46:12here from many national other programs
46:14is that we're very big into quality of
46:18life and sexuality and survivorship.
46:21We have founded the very first in
46:25the nation's program of sexuality,
46:27intimacy and menopause that now has
46:30been replicated by many other programs
46:32nationally and internationally
46:34and a program that both.
46:36With the mast and I play a very big role
46:38and something that's really important to us.
46:41And we also have a pre Viber program
46:43where we work very closely with
46:45our breast colleagues and genetics
46:48taking care of women who are at
46:50higher risk of various cancers.
46:51And both of these, these programs are very,
46:55very important and really at
46:58the heart of our practice.
47:00Umm, we do do our own trials.
47:04We truly believe in personalized medicine.
47:07There's a great number of different trials
47:09that we offer for both of you in Canton,
47:11the Metrial cancer and cervical cancer.
47:14Some of them are research started by us.
47:17Some of it is national society trials.
47:23And we are very fortunate to be able to
47:25offer our patients multiple personalized
47:28targeted options according to their.
47:30These and again we are very happy that
47:34we're able to offer a lot of these trials
47:37in throughout the state in other settings,
47:40not just at Yale,
47:41New Haven.
47:46So now we're going to take like the
47:49mass and I will take a few minutes
47:51to talk about cervical cancer.
47:53You know I have been very pleased really
47:56over the past month and actually didn't
47:59realize kind of being on the inside
48:01of it the the world perception as to
48:04what's happening with cervical cancer.
48:06And we certainly as physicians and
48:08providers of course see decrease in
48:11cervical cancer that could Mastani
48:13definitely see decrease in later.
48:16Cancer, but I also see a great
48:18decrease in pre cancer lesions.
48:20A lot more.
48:23A lot less of women requiring procedures
48:27that influence their childbearing.
48:29So in the clinical practice,
48:31things have really,
48:32really changed and there's
48:34truly this paradigm shift.
48:35And of course it has to do with
48:38screening and with HPV vaccines.
48:40We know that cervical cancer,
48:43like some other cancers is really
48:45predominantly caused by the HPV vaccine,
48:48but the HPV infection,
48:49so the fact that we have started adding.
48:53HPV subtyping to our PAP smears really
48:56very much changed the prognostic
48:59nature of these PAP smears and has
49:03allowed us to catch precancerous
49:05and cancerous much earlier.
49:08Vaccines truly changed the nature
49:11of cervical cancer, you know,
49:13and all the interviews I've done.
49:14There's now a lot of debate,
49:15of course about vaccines.
49:16I feel like a few things are more
49:18debatable currently, the vaccines.
49:20But vaccine for HPV has been there,
49:23has been available for many years.
49:25It has only gotten better with time.
49:27When the vaccine first became available,
49:30it would vaccinate against just two and
49:33then four different subtypes of HPV.
49:35Now the vaccinates against nine and
49:38a vaccinates against high risk HPV
49:42that causes cancer and precancer,
49:44but it also vaccinates against low risk HPV,
49:47which causes genital warts,
49:49which are also very significant quality
49:52of life issue for men and women,
49:54but really particularly women.
49:56So this vaccines are recommended for
50:00young girls and boys starting at age 9,
50:03and if they get this vaccine before age 15,
50:05all you need is 2.
50:06If you get it after age 15,
50:09then you need three.
50:10And then you exciting thing that has
50:12happened over the past couple years
50:14is that it's no longer recommended
50:16just for adolescents with children.
50:18It is now acceptable to offer
50:20it to women until age 45,
50:23which is really something
50:24that kind of caused.
50:26Change again the course of
50:27this because a lot of women,
50:30even though they were exposed
50:31to HPV and have one of the HPV
50:34that they're already exposed to,
50:36there's others that they're not.
50:38And there's actually a large
50:40number of women even older in
50:43the 45 to get this HPV vaccines.
50:45You know,
50:46a lot of women are widowed or
50:48divorced and start dating again
50:50and exposed again to new sexual
50:52partners and receive these vaccines
50:54at different ages to be able to.
50:56Benefit from it.
50:59So you know again I think the
51:02most exciting thing about
51:03surgical cancer nowadays is
51:04really this, it's prevention.
51:05You know we are doing better,
51:07we can do much more minimally
51:10invasive procedures.
51:11You know we do,
51:12we do much better now cone biopsies,
51:15we use special lasers and we
51:17do everything we can to try to
51:20prevent women from having pregnancy
51:22complications for management of
51:24these pre invasive cervical lesions
51:26because unfortunately that is
51:27something that has been a very big.
51:29Risk we do a lot of surgeries
51:31in a fertility sparing.
51:32You know we do all kinds of things
51:35to try to allow women to continue
51:38living their lives and be able to
51:40carry pregnancies or get pregnant
51:43or we spare their ovaries we moved
51:45them out of the way for radiation.
51:48So we do a lot of truly personalized
51:51quality of life sparing procedures.
51:53But I think again the the exciting
51:56thing about cervical cancer right
51:57now is not necessarily this it's.
51:59Really the prevention and significantly
52:02less numbers of cervical cancers that
52:05we are seeing and taking care of.
52:07That's the best if you like to
52:09take it over for radiotherapy.
52:11Sure.
52:11So, so when the cancer
52:15is not going to be surgical,
52:16so that's going to be anything
52:18where it's stage two and higher.
52:20So that means it's involving the parametrium.
52:21Then those are patients that are
52:22going to get referred for radiation,
52:24they're not candidates for for surgery.
52:27But similar to advancements that Doctor
52:29Ratner was talking about in early stage,
52:31in the past 10 to 15 years,
52:33we've seen tremendous advances in the
52:35quality and the safety and the efficacy
52:38of the radiotherapy side as well and.
52:41I spoke about that a little bit a
52:42few weeks ago in the grand rounds,
52:44so I'm not going to go into detail here,
52:46but the treatment involves radiation
52:48with nowadays we use what's
52:50called image guided brachytherapy,
52:52which incorporates MRI imaging
52:54to allow us to very,
52:56very carefully place needles and break
52:59the therapy applicators into the target.
53:01We're able to do this better than
53:03we've ever done it before with more
53:05specificity and more guidance.
53:06And there's been trials now that show
53:09that this results in about a 90%.
53:11Local control for these patients.
53:13So that's really we're doing better and
53:15there's fewer and fewer toxicities.
53:16So this is when the cancer is advanced.
53:20The good news is that our treatments
53:21have really gotten much better and
53:23more tolerable with fewer toxicities.
53:25And I did want to mention one of the
53:28unique things about working at Yale,
53:30I think is working with Doctor
53:31Ratner and her department.
53:32And she mentioned the sort of
53:34the continuity and the closeness
53:35of all these different groups,
53:37whether it's the clinical trials or The
53:39Sims Clinic or the GYN oncology teams.
53:41And if you can advance to the next slide,
53:43Elena,
53:44I was going to say that within
53:47our own brachytherapy service,
53:49I did want to recognize that we have
53:52a lot of different providers and
53:54team members who are part of it.
53:55And I just wanted to recognize some of
53:57the providers within our department,
53:59Director Young and Doctor Campbell.
54:00And then we have a huge amount of
54:02folks who work on breakey therapy,
54:04but recognizing some of the the
54:06lead folks would be Lisa Simmons,
54:09who's our coordinator, Sabrina,
54:10who's our lead breakey therapy.
54:12Nurse Catherine Waldron,
54:13who's our lead therapist, Doctor Tian,
54:16who's our lead physicist and these
54:18are our lead dosimetrist as well.
54:20So there's a lot of coordination and
54:22effort within our department and then
54:23within our two departments as well.
54:29So we do not want to take more time and
54:31we certainly do not want to run over.
54:34The exciting thing again about systemic
54:36therapy for cervical cancer is this
54:39truly personalized approach that we
54:41are able to provide our patients.
54:43You know all the tumors get subtyped.
54:46There's a lot of success in
54:48immunotherapy which really has
54:50been a miracle for this disease.
54:52You know there's women who whose tumors
54:54truly just melt away with immunotherapy
54:56and we have been able to really.
54:58Change the nature of the treatment of this
55:00cancer with these targeted approaches.
55:05So this was an example of bringing
55:07immunotherapy just to the upfront setting.
55:09So it's made a huge advance in the
55:12recurrent and metastatic setting.
55:14But now with the trial open at Yale,
55:16looking at whether this can improve
55:18outcomes even in the upfront setting as
55:20well and this is enrolling currently.
55:24And then again we mentioned before
55:26that the survivorship and the
55:28sexuality is actually in particular
55:29so important in this population and
55:31women with rectal cancer on internal
55:34cancer and something that is so,
55:35so important to provide care to
55:37women with combination of medical,
55:39hormonal surgical interventions as
55:42well as psychology, we are working,
55:46we work very closely with our psychology
55:49partners in this practice to provide
55:52really comprehensive survivorship care to.
55:54Women so thank you so much
55:56for this opportunity.
55:57I'm sorry we ran a few minutes late.
56:03Alina and Sherry, thank you so much.
56:06It you know it is encouraging
56:09in the course of our clinical
56:12careers to witness that really the.
56:14The literal transformation of
56:17this very daunting disease,
56:19and not only are we carrying
56:21it more effectively,
56:23but carrying it with modalities that
56:25preserve function and quality of life.
56:28I know the hours late.
56:29There may be some questions if
56:32I could have the panelists stay
56:34for a few more minutes.
56:37Renee, let us know if you're
56:39seeing anything and we will look
56:41to see if there's anything on
56:43our questions coming in on chat.
56:53You know, I, uh, I may
56:55ask the first question.
56:59Of our of our 2G1 oncologists
57:02for women who are.
57:06Diagnosed with invasive cervical cancer,
57:09how many of them are undergoing
57:11radical hysterectomy at this point?
57:13Are the majority treated with non
57:16surgically or is surgery still a major
57:19pillar in the care of this disease?
57:23Yeah, managing question,
57:24Kevin, you know it depends.
57:26It's actually geographically it depends
57:29on the geography of the institution.
57:33It all depends on the late stage
57:35or early stage that women present.
57:37If women present at early stage,
57:39we certainly prefer surgical
57:40options and a lot of them again
57:43are fertility sparing options.
57:45So some of them are fertility sparing
57:47options and then more advanced disease
57:49as after the mass said managed with
57:51radiotherapy and I feel like nowadays.
57:54It's actually much more we find the
57:56cancer's a little bit later because I
57:58feel like the women who get the vaccines,
58:01it's prevented in the 1st place and
58:03unfortunately it's the women who do
58:04not have good medical care or women
58:06who are immigrants from elsewhere and
58:08unfortunately they cancers are quite
58:09advanced and we use we do much less
58:11surgery and much more radiation cherry,
58:13do you agree?
58:14I agree. And also MRI I think has
58:16increased finding parametrial
58:17extension a little bit earlier,
58:20so perhaps patients that
58:21before we were using widely.
58:24Using MRI, maybe they had a hysterectomy.
58:26Now we're kind of catching the
58:27parametrial extension early and
58:28referring them to radiation.
58:29So I think it's an interesting question.
58:31We don't see a lot of radical
58:32hysterectomies like Doctor Ratner said,
58:33they're either very early or very late.
58:38Thank you. I think, uh,
58:42in respect to the hour.
58:45We will look forward to our next town
58:48hall and I think we will wrap it up.
58:50Thank you to all of our panel.