Smilow Cancer Hospital Town Hall | January 26, 2023

January 31, 2023

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.

Information

ID: 9423
To Cite: DCA Citation Guide

Download Transcript

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.