2002 Annual Report - Yale-New Haven Hospital

Choose a hospital that remains true to its missions…that is committed to teaching and education;translates the most basic research into bedsidemedical advances;consistently demonstrates a deep commitmentto its community;continuously improves its patient care;is committed to the safety and quality of care;attracts and retains expert physicians, nurses,technicians and other professionals;offers the latest equipment, facilities and upto-dateinformation;trains the next generation of caregivers;has regional, national and global recognition.2

ale = teachingYNHH serves as the primaryteaching hospital for itsaffiliate, the Yale UniversitySchool of Medicine, andoffers training opportunitiesfor nurses and other alliedhealth care professionals.YNHH provides the settingfor ongoing clinical researchthat helps bring medicaladvances from the laboratoryto the patient’s bedside.ew = advancingmedicineaven = communityserviceYNHH provides sensitive,high quality, cost effectivehealth care to all patients,regardless of their abilityto pay.YNHH serves the communitywith public health advocacy,support and services whichrespond to the area’s healthcare needs through healtheducation, health promotionand access to care.patientcareospital = patient

Advanced medicine encourages communication, teamwork and innovation.Yale-New Haven Hospitaland its clinics provide abroad array of high-quality,comprehensive healthcare services, rangingfrom primary and preventivecare to subacute,acute, intensiveand rehabilitation care.YNHH has two emergencydepartments, one foradults and one forchildren — both certifiedlevel 1 trauma centers.The emergency departmentoffers a crisisintervention unit, andchest pain and urgentcare centers.The Yale-New Haven Heart Centerprovides advanced diagnostic andtherapeutic options for cardiacproblems. YNHH also has specialpediatric, adolescent and geriatricassessment centers, and a sportsmedicine center, among others.YNHH offers comprehensivewomen’s health services, organtransplantation, joint replacement,endocrinology services,advanced laparoscopy servicesand interventional radiology.YNHH houses the nationally-designatedYaleCancer Center; as wellas federally-funded clinicalresearch centers forboth adults and children.Yale-New Haven receivesnational and internationalreferrals and, in conjunctionwith Yale UniversitySchool of Medicine, hasnationally-recognized centersof excellence, such asthe Cancer PreventionResearch Unit, DigestiveDisease Research Centerand Claude D. PepperOlder AmericansIndependence Center.11

quality & safetyThe hospital you choose should have a comprehensive performanceimprovement plan to optimize patient safety, improve clinicalprocesses and support quality improvement.Over the past year, YNHH’s patient safety committee has beenconcentrating on medication safety; hospital-acquired infections;patient identification; and safety education. YNHH recently installeda special medication delivery system, and a computer system calledAVOID (Adverse Drug Outcome Intervention Detection) which looksfor medication errors due to drug-drug or drug-allergy interactions.Only about 25 percent of hospitals nationwide provide onlineaccess to medical histories, nurses’ notes, medical record entries,order entries and clinical results. For almost 10 years, YNHH has hada computerized physician order entry system — a safety standard inwhich a physician enters a drug order into a computer which displaysthe drug use guidelines, offers relevant alternatives, and suggestsappropriate doses and frequencies.One good indicator of quality in hospitals is accreditation bythe Joint Commission on Accreditation of Healthcare Organizations(JCAHO), which reviews hospitals every three years to make surethey meet certain standards such as quality of staff, equipment andsuccess in treating patients. Sometimes hospitals receive commendationsfrom outside groups, agencies or publications. One of themost popular is U.S. News & World Report. YNHH has been listedamong the nation’s top hospitals in this survey for 11 consecutiveyears. YNHH was named among the best in 12 different medical specialties,and was the third highest ranked hospital in the Northeastin the number of specialties listed. Yale-New Haven Hospital is theonly Connecticut hospital to be consistently rated each year.12

In selecting a hospital, the issues of quality and safety are important — and also difficult to determine.YNHH also has special quality improvement programs not foundin most hospitals. One is called Six Sigma, a partnership with GeneralElectric Medical Systems, to evaluate the use of a statistically-basedperformance improvement technique used successfully by Fortune500 companies. Another is the Center for Outcomes Research andEvaluation (CORE), which measures, improves and reports performancein the care of hospitalized and ambulatory patients. CORE coordinatesYNHH’s participation in state and national benchmarkingactivities for several medical diagnoses.Choose a hospital that is committed to the quality and safety of care…that meets national quality and safety standards;is accredited by the Joint Commission onAccreditation of Healthcare Organizations;∑is recognized by state, consumer or other groups;has good overall treatment results (complicationrates, mortality rates, success rates) with experienceand good outcomes with your condition;and offers programs and services to measurequality of care, improve patient safety and reducemedical errors.Your health is your most important possession. Your hopes and dreams, the loves of your life, your work and play, and yourvery future all depend on your health. You can not control everything that affects the status of your health — but you cantake an active role. You can make intelligent choices and decisions. You can seek the information you need. And you can picka health care partner who can be a powerful ally in the pursuit of health — Yale-New Haven Hospital.13

2002 Year-End MessageA Year of Focus, Care and DisciplineQuality of care and patient safety initiatives dominated Yale-New HavenHospital’s (YNHH) efforts and achievements in its 176th year of operation.There were also significant improvements in overall patient satisfaction.Our focus on quality also resulted in recognition as the top heart hospitalin Connecticut by Healthgrades; the Consumer Choice award for southernConnecticut; and for the 11th consecutive year, YNHH was listed among thecountry’s best hospitals by U.S. News & World Report. YNHH, the onlyConnecticut hospital to be consistently rated each year, was named amongthe best in 12 out of 17 medical specialties. Of 6,045 hospitals in the U.S.,YNHH was thirteenth overall for the most number of specialties listed andin the northeastern region, ranked third behind only Massachusetts GeneralHospital and the Hospital of the University of Pennsylvania.FocusCareYNHH’s mission guided the year’s activities, as it has in the past. Muchprogress was made towards achieving the Hospital’s primary goals ofensuring patient safety, advancing clinical performance and programs, andimproving patient, physician and employee satisfaction. Safety was addressedwith a concentration on medication safety, reducing hospital-acquired infections,ensuring correct patient identification and providing broader educationfor patients, families and staff. One of the year’s exciting successes was anew computer system called Adverse Drug Outcome Intervention Detection(AVOID), which automatically alerts hospital pharmacists about potentiallyadverse drug-to-drug or drug-allergy interactions.YNHH continued to focus on providing patients with a wide array of highlyadvanced clinical services, investing in new clinical programs, enhancingexisting services, and renovating patient care areas to make them moremodern, efficient and welcoming. YNHH supported the needs of patientsand families by maintaining accessible, advanced facilities and providingcomprehensive support services. YNHH continued to ensure a comprehensive,team-based approach to improving clinical quality and service. Centers ofexcellence this past year included the Yale-New Haven Heart Center, theYale-New Haven Psychiatric Hospital, oncology services, pediatric servicesand the emergency department.This year, YNHH and the Yale University School of Medicine jointlyinvested more than $8 million to establish three new centers for the treatmentof lung cancer, pediatric cardiovascular disease and inflammatory boweldisease. To more effectively meet community needs, the Hospital is planningto open a new Yale-New Haven Shoreline Medical Center in Guilford in 2004,with ambulatory surgery, endoscopy, laboratory and pre-admission services,radiation therapy and emergent and urgent care.The second year of the Hospital’s three-year, $51 million renovationof the South Pavilion was completed, with two medical intensive care unitsfinished and new family waiting areas opened. A two-year clinical laboratoryrenovation project, to improve efficiency, service and turnaround time,began this year, with the consolidation of the chemistry and hematologylaboratories.In addition to services and facilities, improving patient satisfaction wasa high priority in 2002. YNHH significantly increased patient satisfactionscores in the adult and pediatric inpatient services, adult and pediatric emergencydepartment and the outpatient clinics. YNHH was named a winner ofthe prestigious national Press, Ganey 2002 Compass Award for outstandingimprovement in patient satisfaction in its outpatient clinics.Care in the CommunityHelping to meet the needs of the community is a key component of our mission,and as is our tradition, YNHH’s community service was felt through itsongoing commitment to care of the medically indigent, advocacy for a varietyof public health issues and support of key community services. In 2002,YNHH provided an estimated $55 million for the care of the poor and theuninsured, $17 million for free and uncompensated care and $38 million tomake up for the shortfall in caring for patients covered by Medicaid. In fact,in a special issue of Yale-New Haven magazine published in 2002, YNHHoutlined some of the benefits it brings the greater New Haven community,including services, programs and investments worth over $381 million a year.YNHH provided a wide range of community services, including immunizations,prenatal care, well-child care, physical exams for adults, preventiveservices and screenings, school-based health centers, mental health counseling,support groups, pharmaceuticals and dental services. YNHH also providedsupport, including financial, technical, in-kind, participation on boardsand endorsements, to local not-for-profit providers, health departments andcommunity and mental health clinics.YNHH and the Greater New Haven Partnership for a HealthyCommunity, a YNHH-led coalition, concentrated on several communityhealth programs, including a community-wide asthma initiative; children’sdental needs; maternal/child health programs; and a federally-funded communityaccess program to coordinate care for uninsured patients througha health information network connecting community health centers andthe Hospital.Health education initiatives over the past year reached thousands ofstudents with programs and services related to health promotion and educational,career exploration and volunteer opportunities. YNHH operated eightschool-based health centers and sponsored school partnerships, careerexploration and service programs. YNHH also offered health education andprevention programs to the community on numerous issues. ➪14

DisciplineIn its role as an academic medical center hospital, YNHH also focused onmedical education and advancing medical treatment. YNHH sponsored 28physician residency training programs and co-sponsored, with the YaleSchool of Medicine, about 40 additional subspecialty residency/fellowshipprograms. This year, the national association that oversees the residencyprograms set new national residency guidelines effective in 2004. YNHHled by example in the drive to improve residents’ education and work hoursby revamping its surgical residency program, and investing in other healthprofessionals to ease the burden on the new physicians-in-training.The health care environment remained as challenging as ever, with anincreased demand for services coupled with flat or declining reimbursement,escalating costs and increased expectations by consumers, employers andphysicians. However, Yale-New Haven maintained its position as the state’smarket leader, this year increasing inpatient discharges by 3percent. Yale-New Haven Children’s Hospital (YNHCH) also ledConnecticut in pediatric inpatient cases, treating more thanone-quarter of all hospitalized children in the state.YNHH was able to handle the increased number ofpatients with existing beds and staff by managing the use ofbeds and decreasing the length of stay. The decrease had thesame effect as a gain of 30 additional beds for the Hospital —the equivalent of an entire patient care unit. In addition, emergencyand outpatient visits were also higher than last year.Along with handling more patients, the Hospital concentratedon improving patient, employee and physician satisfactionand maintaining a positive, attractive employment environment.As a result of these combined efforts, YNHH produced an operating gain ofabout 3 percent, despite the challenges of the health care environment, permittingthe Hospital to continue to invest in upgrading and introducing newpatient programs, technology and facilities.LeadershipThe Hospital’s Board of Trustees, clinical leadership and senior managementteam continued to play critical roles in the organization’s clinical, financialand operating performance, as well as the quality and enhancement ofpatient care. In October, 2001, Marvin K. Lender was re-elected as chairmanof the Board of Trustees, and new trustees included Robert L. Culver, MarionRussell and Peyton R. Patterson.Clinical leadership was re-energized in several areas. Charles J.Lockwood, M.D., was named chief and chair of obstetrics and gynecology.Peter M. Glazer, M.D., Ph.D., was named chief and chair of therapeuticradiology. Margaret K. Hostetter, M.D., was appointed chief and chair ofpediatrics. Alan E. Kazdin, Ph.D., was named the new director of childpsychiatric services at YNHH, and Joseph L. Woolston, M.D., was namedacting chief of child psychiatry.Support from the SystemThe Yale New Haven Health System (YNHHS) helped the Hospital achievestrong performance by supporting new clinical programs and the effectiveuse of resources. The System includes delivery networks inBridgeport, Greenwich and New Haven, and affiliate WesterlyHospital in Rhode Island. YNHHS is dedicated to improving thequality and scope of health care services by coordinating andcollaborating on patient safety, clinical and service quality andprogram development, as well as medical education through itsrelationship with the Yale School of Medicine. The System hassuccessfully fulfilled its original goals by increasingly sharingideas and best practices, and by coordinating and collaboratingon innovative initiatives. It has also demonstrated that thebenefits of a system are extensive, continuous and increasewith time. YNHHS has helped its members improve their operatingperformance by increasing revenue, enhancing managedcare contracting, reducing expenses by creating economies of scale, improvingefficiency, increasing information technology, developing managementand clinical leadership, and other tangible benefits. As a result, Yale-NewHaven, Bridgeport and Greenwich Hospitals achieved stronger, more sustainableresults than would have been possible as independent institutions.YNHHS also led preparation for the implementation of the HealthInsurance Portability and Accountability Act (HIPAA). The System took aleadership role in responding to the events of September 11 by creating aSystem-level office of emergency preparedness to coordinate efforts toprepare and respond to terrorism incidents.YNHH’s strong performance during the past year reflects its unwaveringdedication to its mission and vision, the continued support of its Board ofTrustees, and the dedication, commitment and quality of its medical staff,management team and employees. These factors ensure that Yale-New HavenHospital will continue to be among the premier academic medical centerhospitals in the nation.16

Yale-New Haven Hospital Senior Leadership( left to right )Marvin K. LenderChairman of the Board of TrusteesMarna P. BorgstromExecutive Vice President and COOJoseph A. ZaccagninoPresident and CEOPeter N. Herbert, M.D.Chief of Staff15

Board of TrusteesComparative StatisticsManagementMedical StaffFriends and Donors17

Board of Trustees( As of September 30, 2002 )Richard G. BellVice ChairRichard L. Edelson, M.D.John L. LaheyWalter H. Monteith, Jr.Elsa L. Stone, M.D.Marna P. BorgstromExecutive Vice President & COORobert A. HaversatSecretaryMarvin K. LenderChairJ. Richard MunroPatricia B. SweetBishop Theodore L. BrooksPeter N. Herbert, M.D.Chief of StaffRichard C. LevinPeyton R. PattersonJames A. ThomasJonathan BushAssistant SecretaryBetty HollanderLinda Koch LorimerBernard A. Pellegrino, Sr.Nathaniel D. WoodsonJoseph R. CrespoVice Chair and TreasurerDavid A. Kessler, M.D.Julia M. McNamaraVice ChairMarion RussellHenry K. Yaggi, IIIRobert L. Culver18Joseph A. ZaccagninoPresident and CEO

Comparative StatisticsBalance Sheet(in thousands) September 302002 2001AssetsCurrent AssetsCash $ 14,765 $ 14,576Marketable Securities 114,091 110,387Accounts Receivable (Net) 92,800 91,069All Other Current Assets 23,141 32,454Total Current Assets 244,797 248,486Assets Limited As to UseBoard Designated Fundsfor Plant Improvement and Expansion 127,931 115,704Beneficial Interest in Perpetual Trusts 10,752 12,259Escrow Funds for Long Term Debt 668 992Total 139,351 128,955Long Term Investments 105,196 115,156All Other Assets 29,402 22,100Property, Plant and Equipment (Net) 229,523 229,927Construction in Progress 19,611 14,613Total Assets $ 767,880 $ 759,237Liabilities and Net AssetsCurrent LiabilitiesAccounts Payable 28,642 28,568Accrued Expenses 68,172 63,195Other Liabilities 14,369 19,118Current Portion of Long Term Debt 3,995 3,870Total Current Liabilities 115,178 114,751Long-Term Debt, Less Current Portion 124,830 129,120Accrued Post Retirement Benefits other than Pensions 28,644 27,276Other Long Term Liabilities 62,347 64,017Total Liabilities 330,999 335,164Net AssetsUnrestricted 326,879 308,449Temporarily Restricted 83,918 88,532Permanently Restricted 26,084 27,092Total Net Assets 436,881 424,073Total Liabilities and Fund Balance $ 767,880 $ 759,23719

Comparative StatisticsStatement of Operations(in thousands) September 302002 2001Operating RevenueNet Patient Service Revenue $ 577,371 $ 532,566Other Revenue 3,387 1,381Total Operating Revenue 580,758 533,947Operating ExpensesSalaries and Benefits 326,836 300,944Supplies and Other Expenses 249,631 238,229Depreciation and Amortization 28,941 28,372Bad Debts 3,070 3,379Interest 7,496 7,745Total Operating Expenses 615,974 578,669Recovery of Expenses fromGrants and Other Institutions (52,930) (50,442)Total 563,044 528,227Operating Gain Available forDebt and Capital Needs 17,714 5,720Clinical Development Fund (5,750) (5,750)Debt Repayment (3,995) (3,870)Balance for EquipmentReplacement andNew Technology $ 7,969 $ (3,900)Outpatient Clinic VisitsYear Ended September 302002 2001Primary Care Center 42,044 41,311Women’s Center 59,038 56,335Medicine 84,221 81,337Ophthalmology 22,257 20,514Surgery 23,211 22,599Pediatrics 30,467 27,224Dermatology 16,484 17,317Otolaryngology 10,891 8,930Orthopedic 20,301 21,427Dental 5,932 5,846Urology 7,491 7,119School Based Clinics 9,068 9,386Total Outpatient Clinic Visits 331,405 319,345Emergency Services 91,259 86,641Occupational Health 17,626 17,236Total Outpatient Visits 440,290 423,222Inpatient StatisticsYear Ended September 302002 2001AdultsMedical 25,958 24,606Surgical 8,217 8,001Total Adults 34,175 32,607Total Pediatrics 4,583 4,741Total Newborn 4,758 4,718Total Inpatient 43,516 42,06620

Management( As of September 30, 2002 )AdministrationCommunity and Government AffairsKyle BallouCommunity HealthJames E. RawlingsEngineering and Facilities ManagementWilliam MahoneyFacilities Planningand Administrative ServicesStephen MerzFinanceStephen AllegrettoHeart CenterR. Kyle KramerMarketing and CommunicationsWilliam R. Gombeski, Jr.Oncology ServicesArthur LemayPatient ServicesKaren Camp, R.N.Bernadette Forget, R. N.Richard LisitanoPerioperative ServicesRichard Stahl, M.D.Psychiatric ServicesPaul M. HaeberleWomen’s and Children’s ServicesDiane Vorio, R.N.Administrative DepartmentsAdmittingCarol HollandBed ResourcesVictor Morris, M.D.Clinical LaboratoriesDenise FioreClinical QualityThomas Balcezak, M.D.Clinical Systems and SupportHoward GoldbergCompensation and BenefitsJoan Moon-KoehlerDay Care CenterJody PlatnerDecision Support and ManagementSystemsCharles Torre, Jr.Diagnostic ImagingStephen BencivengoEmergency ServicesJohn A. Schriver, M.D.Roberta Chuong, R.N.Environmental ServicesKent ZergiebelEpidemiologyLouise Dembry, M.D.Facilities Design andConstructionC. Bradford BeversFinancial Planning and AnalysisLisa StradaPatient AccountsBernard LanePhysician ServicesTheresa Zinck LedererPlanning and System DevelopmentCarolyn SalsgiverPlant Engineering and Security ServicesDouglas DoylePsychiatric ServicesLeslie O'Connor, R.N.Radiation TherapyNicholas PapaleRecruitment and StaffingNancy CollinsReligious MinistriesRev. Margaret LewisRespiratory Care and RehabilitationServicesMichael ParisiSocial WorkPaula CrombieVolunteer, Patient and Guest ServicesJeannette HodgeAuxiliary Executive CommitteePresidentMarion RussellFirst Vice PresidentGloria SchoolfieldSecond Vice PresidentBarbara LoucksRecording SecretaryAnn PfistererCorresponding SecretaryDebbie KlotzerTreasurerEleanor F. JonesGift Shop Co-ChairsLynne BradstreetSylvia GreeneToy Closets Co-ChairsMarjan WackersAnnie Garcia Kaplan, Ed.D.Projects Chair (ex officio)Leatrice MalloyAdministrative Liaison (ex officio)Brian CondonSr. V.P. Clinical AdministrationBoard of ManagersKaren AndersonLyn BeltLouise DiRuccioElizabeth FearonStephanie JatlowJean LaCameraLuisa McCannKathrine NevilleWendy O’BrienChaplain Dolores O’ConnellIngrid ParriGay SteinbachBeverly WeinbergLily WuFood and Nutritional ServicesMelissa ZelaznyGraduate Medical EducationRosemarie Fisher, M.D.Internal AuditLaura MacalusoLegal Affairs and Risk ManagementSarah Cohn, Esq.Materials ManagementCarlos LourencoOccupational Health ServicesMark Russi, M.D.Perioperative ServicesBrooke Karlsen, R.N.Quality AssuranceWilliam Crede, M.D.Outpatient Registration and CISHarry Nicholls23

➪➪➪➪➪➪Yale-New Haven Hospital’s2002 Annual Report is publishedby the Department of Marketingand Communications.Senior Vice President,Marketing and Business Development:Clayton MedeirosAdministrative Director,Marketing and Communications:William R. Gombeski, Jr.➪Davenport Avenue ➪Yale Physicians BuildingWriter and Editor:Katherine KraussConcept, Design and Art Direction:Sopkin Design / Guilford, CTCover photo, corporate photo (p. 15):Frank PoolePhotography:Kvon, Robert Lisak, Frank PooleDigital Illustration: (cover, pp. 5, 7, 9, 11):Bill SimpsonPrinting:Harty PressSpecial thanks to:Bruce Fischer, New HavenDepartment of Trafficand ParkingLot 1PermitParking➪ York Street ➪Howard Avenue ➪If you received a duplicate copy ofthe annual report, please pass italong to a friend and send thelabel you would like deleted to:Yale-New Haven HospitalMarketing and Communications20 York Street-GB 441New Haven, CT 06510-3202Telephone: (203) 688-2488fax: (203) 688-2491email: krauss@ynhh.orgwww.ynhh.org➪➪EntranceAmbulancesERParkingChildren’sHospital(WestPavilion)SouthPavilion➪Howard Avenue ➪Park StreetAtrium▲EntranceGraceBuildingLot 9EastPavilion➪Published in the spring of 2003Copyright 2003, Yale-New HavenHospital. All rights reserved. No part ofthis publication may be reproduced ortransmitted by any means or in any formwithout written permission from YNHH.An EEO/AAP employer.➪ Route 34 ➪➪ South Frontage Road ➪➪Dwight ➪Lot 2AirRightsGarageNorth Frontage RoadHowe ➪HowardAvenueGarageHoward Avenue ➪➪PrimaryCareCenterDana Clinic BuildingHunterRadiationTherapyto Lot 8Cedar Street ➪➪ York Street ➪to91/95from91/95

Philanthropy, or “love of humankind,” has been a shaping force atYale-New Haven Hospital for nearlytwo centuries. The citizens of thiscommunity have long been calledupon to support our Hospital, andthey have responded with warmth and generosity.From Dr. Jonathan Knight and the otherfounders who pledged a portion of their incometo support the new hospital back in 1826 to thechild who, last year, donated his birthday moneyto Yale-New Haven Hospital, our friends and supportershave served as a beacon to others whomight be similarly inspired to give of themselves.Thank you to everyone who made a gift to Yale-New Haven Hospital in 2002. Whether you chooseYale-New Haven Hospital for your health care orfor your philanthropy, we appreciate your faithin us. We will continue to strive to be the righthospital for you and those you love.If you would like to make a donation to Yale-New Haven Hospital, please use the encloseddonation card or contact:Yale-New Haven Hospital Office of DevelopmentP.O. Box 1849New Haven, CT 06508-1849or 203-688-YNHH (9644)www.ynhh.org/develop/develop.htmlFinding the right hospital … giving for the right reasons20 York StreetNew Haven, CT06510-3202Address Service Requested(203) 688-2488Non-Profit Org.U.S. PostagePAIDNew Haven, CTPermit No. 773