Mission: Possible - Children's Hospital Boston

Dominican Republic continued from page 1
increase awareness. “These interventions are not high-tech or particularly costly,
so it’s very doable,” Wilson says. It’s been going so well, in fact, that she hopes
to expand to more outposts on the Haitian border by January.
When Wilson is back at the MEHC, she draws on her experiences in the DR to
provide more culturally aware care. She knows, for example, that since antibiotics
are available without prescriptions in the DR, her patients are used to taking
them frequently—even to treat minor
viral illnesses. So Wilson makes sure
to explain to patients why this isn’t
always beneficial. After seeing how
entire families, including infants and
young children, travel by moped in the
DR without helmets, she also began
educating her patients about safety
equipment like car seats and bike
helmets. She also learned how to adapt
Kim Wilson, at right, with
Dominican trainees.
medical treatment for patients with
diabetes or asthma, creating a regimen
that they can continue to follow while
they’re visiting family in their home country. This cultural awareness has had a
lasting impact on the many MEHC staff who’ve worked with Wilson.
Infante Sano now has offices in Bani and Boston, with 16 Dominican physicians,
nurses, support staff and volunteers. They’ve succeeded in renovating the
special care nursery and the pediatric section of Nuestra Señora de Regla Hospital
Bani, and opened two clinics in a rural part of the DR late last year. One
specializes in treating malnourished children and the other is a primary care
center. Together, their staff sees more than 300 mothers and children a week.
Still, there’s work to be done. “Our biggest challenge is to have a sustainable
impact,” Wilson says. “It’s very easy to do interventions with a temporary positive
effect, but we want to have a lasting one. We’ve struggled with how to do
that.” That’s why, for now, they’ve transitioned into having a sustained presence
there. But the hard work is gratifying. “What’s really rewarding is that it’s immediately
clear that we’re making a big difference,” Kim says. “I really enjoy seeing
the program grow and the enthusiasm of the people who are so excited to have
the opportunity to improve the care they deliver.”
Exceptional Care
Exceptional Service
Celebrating the first 100 suggestions
On July 9, Children’s Hospital Boston’s Exceptional Care, Exceptional Service (ECES) program
took a lunch break to honor the first 100 contributors to the ECES suggestions Web site. Since
January, 83 staff members have contributed a total of 110 suggestions on specific ways to improve
the hospital experience and its service. Those who submitted their ideas were invited to a tapas
lunch (replete with a Flamenco guitarist) in the Patient Entertainment Center.
Sandra Fenwick, COO, recognized the ECES team and those who shared their suggestions,
especially the 15 employees whose ideas have already been or are currently being implemented.
Their suggestions include department meet-and-greets for new employees and standardizing
telephone greetings and email signatures.
Christine Powers-Perry, executive assistant in Public Affairs, received a special award for
her six outstanding ECES ideas, three of which have already been put into practice. “No idea
is too small if it’s going to change someone’s experience at the hospital,” says Powers-Perry,
who created ECES training badges and designed and created ECES magnets. “The values of
ECES are all things we should be doing to work together and help support the hospital’s mis-
Asthma continued from page 1
lies by teaching them which cleaning products don’t worsen
asthma, how to seal off areas that collect moisture and offering
allergen-free bed and pillow covers or vacuums.
• Non-physician providers (such as nurses, respiratory therapists,
asthma educators and social workers) can provide
effective asthma education and environmental interventions,
often at a lower cost.
“Studies indicate that current approaches to managing asthma
aren’t working for a lot of people,” says Laurie Stillman, director
of the ARC. “This study shows we can improve asthma outcomes
in a cost-effective manner if high-risk patients are given
education and environmental improvements in the home.”
The study also calls on multiple sectors, including payers,
health provider groups, employers and policymakers to play a
role in implementing these programs.
Many of the study’s recommendations are contained in
legislation, filed this year by the Boston Urban Asthma Coalition
(BUAC) and Children’s, that would require insurers in Massachusetts
to cover asthma education and in-home environmental
interventions. At a hearing in May, parents of children with
asthma, community health advocates and hospital leaders and
clinicians—including Shari Nethersole, MD, medical director for
community health, and Susan Sommer, RNC, NP, nurse case
manager for the Community Asthma Initiative—testified in support
of the bill before the Joint Committee on Public Health.
With the study’s results to support them, Children’s will
continue working with its partners to bring about the necessary
changes to asthma care. “Too many families, particularly in
low-income communities, are struggling needlessly with the effects
of asthma,” says Lisa Mannix, coordinator of Child Health
Policy and Education at Children’s. “The evidence accumulated
in this business case shows there are interventions that work.
It’s time for decision-makers to take bold action to implement
them on a broader scale.”
Christine Powers-Perry receives her award
from Bess Andrews, director of Public Affairs.
In their own words
Kitty Scott, RN, retired coordinator of Patient Relations
A nurse looks back on 5 years at Children’s
In 1962, I came to Children’s Hospital Boston
as a young nurse with a plan to work at the
hospital for one year and then return home
to Nova Scotia. I’d written a letter to the Nursing
Department explaining my limited experience
and desire for a job. I received a letter
of acceptance with a start date. There was no
interview and I completed my application after I
arrived. My salary was $82 a week.
I was assigned to Division 35, the cardiology/cardiac
surgical unit. My head nurse did not
meet me until I had completed a few days of
orientation and I worked just a few days with a
senior nurse and then was on my own.
There were no intensive care units (ICUs)
at Children’s when I arrived. We cared for
patients who had open heart surgery in the
“Pump Room.” If patients required a ventilator,
they remained in the Recovery Room (now
the Pediatric Advanced Care Unit) but nursing
staff from Division 35 provided the care. In
some cases, patients were so unstable they
remained on the OR table while we cared for
them. Back then, open heart surgery couldn’t
be done until the child reached 45 pounds
because our heart-lung machine wasn’t adapted
for babies, so many children died waiting for
surgery. Some “blue babies” had palliative procedures
done in the hyperbaric chamber, which
was located in the basement of the Harvard
School of Public Health—now the Wolbach
Building. Imagine the challenge of transporting
a baby across the garden to the hospital following
surgery, sometimes in the dark.
In December of 1964, a very exciting thing
occurred. A Cardiac ICU (CICU) was opened
on Division 25, the first pediatric ICU in the
country. I assisted in transferring the first
patient into the unit. A month later, I became
Assistant Head Nurse for the night shift. In
those days, nurses didn’t apply for promotions,
but were chosen by nursing leadership. It
wasn’t unusual to work up to 10 shifts in a row.
In addition to a modest raise, this new position
gave me every other weekend off—regular
staff nurses worked eight-hour shifts and
worked two out of three weekends. Providing
adequate coverage was the priority, and the
nurses’ personal lives came second. As nurses,
we wore totally white uniforms, white shoes
and stockings, and, of course, the cap that
represented the school of nursing from which
we graduated.
Parents did not stay at
the hospital at night unless
the child was critically ill,
and at 8 p.m., all visitors
left. Parents were not
encouraged to participate
in their child’s care, so the
staff nurses provided all
care, except perhaps an
occasional diaper change
or bottle feeding. Except at
the highest level of nursing
administration, nurses were
not involved in decisionmaking
of the hospital. Staff
nurses did not serve on any
hospital-wide committees
and annual reviews were
done by the supervisors
with no peer input. Promotions
meant getting farther
and farther away from the
bedside.
Fourteen years ago, when I was the Nurse
Recruiter, I was asked to hire for a part-time
position in Patient Relations. A decision had been
made that a nurse should fill this opening. However,
it seemed that no nurses were interested
because no one applied. After a number of weeks,
my director came by to ask me if I would consider
the position. With much trepidation, I decided
to move into this new role while I continued to
do nurse recruitment.
After accepting the fact that an angry call
was not directed at me personally, and that
there are people one simply cannot please, I
learned as much as I could about billing and
insurance practices. I settled in and found
my last job at Children’s as challenging and
satisfying as caring for critically ill patients. I
have enjoyed the more complicated cases and
the challenges of situations involving Risk
Management and the Office of Legal Counsel.
Patient Relations allowed me to use my people
skills, clinical knowledge and familiarity with
the hospital and its players to address the ma-
jority of challenges that came my way. It was a
great job for an old nurse!
Since my early days, I have seen so many
changes—more than can be mentioned! In addition
to the fantastic advances in medical care,
we have gone from one small CICU and several
small “care rooms” to two large, state-of-theart
ICUs. Parents can visit 24 hours a day and
are encouraged to participate in their child’s
care. RN evaluations are done with peer input.
There is a Clinical Ladder that allows nurses to
advance but remain involved in direct patient
care. Most staff work 12-hour shifts and have
two out of three weekends off—not on. Now,
nurses wear brightly colored scrubs and there
is less formality than in the “old days.”
Children’s is an amazing place and I am
very proud to have worked here for so many
years. I have had eight different positions and
enjoyed the challenges and satisfaction of them
all, whether it’s been providing direct care to
the patients as a staff nurse or contributing to
the care in other ways. I’m leaving feeling very
good that I chose to be a nurse.
Do you know how many units (pints) of blood Children’s
collected in 006? Including donations from the Blood
Mobile and donations of whole blood, platelets and double
red blood cells from the Blood Donor Center, the total was
10,858 units!
sion,” she says. To make a suggestion, go to http://web2.tch.harvard.edu/eces/formESS.cfm.
6 Children’s News | August 2007 www.childrenshospital.org
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Kitty Scott, RN