NARH: Strategies In Place, Change Ahead

By Susan Bush
12:00AM / Monday, December 12, 2005

North Adams Regional Hospital Critical Care Unit Director Katie Henault is in a brand new CCU patient room. PHOTOS HERE

North Adams – A major construction project is nearing completion, a nurse education program is on the horizon, and despite its’ current financial woes, the North Adams Regional Hospital is moving toward a bright future, according to numerous hospital officials.

PHOTOS HERE

Evidence of a changing hospital was plainly visible during a Dec. 12 hospital tour and interviews with several NARH administrators.

The Bad News Is...

Last week, officials of the hospital’s parent company Northern Berkshire Healthcare announced a Fiscal Year 2005 loss of over $6 million, and also announced that by Fiscal Year 2007, the hospital expects to break even financially. A $1.5 million loss is expected for current Fiscal Year 2006.

A closely monitored “conservative budget” has been right on target for the first two months of Fiscal Year 2006, said Paul Hopkins, director of community relations for the NARH parent company Northern Berkshire Healthcare. Hospital budgets are based on patient volume and services rendered; the NARH FY 2006 budget was calculated using FY 2005 figures, Hopkins noted. Any patient increase would likely generate additional revenues and brighten the hospital financial picture, he said.

Cambio Brought On Board

The FY 2005 loss marks the fifth consecutive year of NARH red ink and earlier this year, NBH officials hired the Cambio Health Solutions LLC firm to assess the hospital’s financial structure and make recommendations for change.

Two Cambio team members are in place as temporary NARH administrators; John Schibler is serving as an interim chief financial officer and chief implementation officer while Joe Nolan is serving as interim CEO.

Speaking late Monday [Dec. 12] morning, Nolan talked about the renovation project. The project began in 2004 and is being funded with over $10 million of CARE Campaign contributions and about $13 million in bonds. The construction project is not linked to the NARH financial difficulties, but the completed work will likely benefit hospital coffers, according to Nolan and other hospital officials.

Physician Interest

“I think this is a great project and it’s one of the selling points for this hospital,” Nolan said. “You are going to have a brand-new ER, a better utilization of space. New operating rooms [in a renovated medical/surgical unit] are a great attraction and three new surgeons have expressed an interest in relocating here. A new admissions process is being implemented. One of the nicest things is maternity. Maternity will go from not the nicest surroundings to a very lovely place.”

Two urologists and an orthopedic physician have also expressed interest in the area and the hospital, Nolan said.

NARH Vice-president of Patient Care Services Billie Allard said that the renovated hospital coupled with regional appeal is drawing physician interest.

“They are looking at the quality of life they can have here, the four seasons, and the idea that the big cities are only a couple of hours away,” she said.

Construction completion is almost certain to benefit all aspects of the hospital, Hopkins said. The project is also expanding and modernizing the hospital’s critical care unit and main entrance and lobby.

“I consider this project a crucial thing,” Hopkins said. “You have to change, even when it’s difficult to raise the money. Part of the [NARH] financial difficulties happened because people of the community chose to go to another, more modern facility, and we know that.”

New CCU Like A Luxury Suite

Dr. Sohail Waien and dietician Kristin Civitella work at a new CCU nurses station.

A portion of the critical care unit is completed and patients are being admitted to the six available critical care beds or the two available telemetry or “step down” beds. Telemetry beds are designated for patients whose conditions have improved, explained NARH Vice-president of Patient Services Billie Allard. When finished, the CCU will have 10 critical care beds and three telemetry beds.

The finished section of the CCU boasts large, modern rooms with glass doors, windows that face a nurses station, and curtains that may be pulled for privacy. The patient rooms are equipped with a toilet situated about 10 feet from the bed; the design allows patient ease when using the toilet and also permits the patient to remain connected to monitors. Each room hosts a large window that looks over the hospital campus and a glider/recliner chair for a family member’s comfort.

The rooms were built to comfortably accommodate any emergency equipment and personnel that might need to access the patient. Each room has a closet, a television, and two sinks. Isolation rooms within the unit are outfitted with a negative pressure ventilation system and the telemetry rooms are equipped with private bathrooms that house a sink, toilet, and roomy shower station.

A monitor is in place along the hallway near the nurses station; the device monitors the vital signs of every patient admitted to the unit so that nurses can have immediate view of heart rates, blood pressures and other patient specifics.

Those who have been admitted to the completed section have been very pleased with the comfort and the medical accommodations, Allard said.

“One woman said that it was like going from a Motel Six to a suite in a luxury hotel,” she said.

On Monday, five critical care beds were in use as was one telemetry bed. At the nurses station, CCU Director Katie Henault, registered nurse Debbie Wood, hospitalist Dr. Sohail Waien and hospital dietician Kristin Civitella were all occupied with various types of patient care.

New Day Surgery Unit

The new medical/surgical unit is expected to open in January; 17 patient rooms are currently under construction, as are four fully modern operating rooms, pre-anesthesia and post-anesthesia areas, nurses stations, and storage areas. The unit is circular in design, which means unit staff can function at peak professional levels, Allard said.

“All of the surgical staff will be adjacent to each other,” she said.

Surgeon “scrub” sinks and operating room observation areas are also being built, and patient privacy is a priority.

The unit is also equipped with a PICIS automated scheduling/medical records system, which is linked to a “case cart.” Information about individual patients is kept at a “case cart,” and the total system increases the unit’s efficiency and assures that accurate information is captured and used for appropriate insurance billing and reimbursements.

Lou Ann Quinn has been named manager of surgical services, Allard said. Quinn is a registered nurse with a master’s degree in medical science and has previous management experience, she noted.

“Lou Ann is one of our strongest managers,” Allard said. “She is already making incredible things happen.”

ER Plans Partial February Opening

A fully renovated and redesigned emergency department should be up and running by August 2006. Emergency services will not be interrupted as construction proceeds; several new examination rooms are expected to be completed during early February and will be utilized while additional exam rooms are being built. Temporary nurses stations will be in place while permanent stations are erected.

The new facility is being built directly beneath the new hospital lobby. When finished, the ER will host 11 individual examination rooms with glass doors and curtains for privacy. All the rooms will be visible from nurses stations and an exam room dedicated to obstetrical/gynecological care is being situated in very close proximity to a private bathroom. Patients at the ER will no longer have to travel through public hallways for x-rays and other tests once the unit is completed.

Cambio Health Solutions LLC employee and NARH interim CEO Joe Nolan.

“The increase in privacy is a big benefit for the patients,” Allard said.

Dr. Paul Donovan will continue as the emergency department director, and Joyce Mickanin, a registered nurse and an emergency medicine nurse practitioner, has been hired as the ER nursing director.

Mickanin began her NARH employment after construction began during the fall of 2004.

“I’ve been here for just six months, so the construction is all I know,” she said.

Mickanin said she is very excited about a completed, modern, emergency services department.

“It’s the whole idea of individual patient rooms with doors,” she said. “The department is designed to be much more functional.”

Mickanin may have been hired after the ER planning was finished but “I have been getting my two cents in,” she said with a smile.

Maternity Unit Due Date

The much-anticipated new maternity unit is expected to open in August as well, which is about nine months from now, Allard said.

“So anyone who gets pregnant now could be in the new unit when they deliver,” she said.

The new maternity section will be situated on the hospital’s second floor; a temporary maternity unit will operate on the third floor while construction is underway. A much-touted and eagerly awaited feature of the new unit is private bathrooms for maternity unit rooms.

A new lobby is expected to open in February. Among the new features are large windows that allow an abundance of natural light, a meditation room directly to the left of the new entrance, and a small lab situated near a hospital admission area. An elevator will offer ground floor to fourth floor access. An exterior drive beneath a canopied entrance was designed to be able to accommodate large vehicles.

To most patients and the public, the hospital will appear as a completely new structure, Hopkins said.

“Most of the space that the patients and visitors will see will be new,” he said.

And there are even more changes ahead.

LPN Education Planned for 2007

A licensed practical nurse curriculum is expected to begin at the Charles H. McCann Technical High School in 2007, said Allard. School officials have hired a LPN program director and the classes are expected to be held at a vacant space situated between the NARH campus-based Ambulatory Care Center and the Clark House, Allard and NARH interim CEO Joseph Nolan said. Current plans are to offer the program during the evening, which will allow people to work daytime jobs and acquire LPN instruction at the same time, Nolan said.

The classroom space will undergo renovations before the program begins; McCann students will tackle the renovation work, Nolan said.

School Superintendent James Brosnan did not return a telephone call seeking comment on Dec. 12. Further details about the LPN program are expected to be announced in the near future.

Hospice Care at NARH Being Considered

Hospital officials are also working to establish several hospice beds at the hospital, Allard said.

“We have heard that there is a desire to have some hospice beds here at the hospital,” she said. “People have said that they would feel more comfortable.”

The NBH is the parent company of the Visiting Nurse and Hospice of Northern Berkshires and discussions about providing some hospice care at the hospital are underway, she said.

Stronger Volunteer Presence

Professional Drywall company workers Gerad Young and Joe Piantoni were on the job at NARH on Monday.

Hospital volunteers will be pivotal sources of information and assistance as the new units become operational and the volunteers are receiving additional, comprehensive training as preparation for their expanded presence, Allard said. Kathy Arabia is coordinating the volunteer training sessions.

“Our goal is that, as we open new areas, there will always be someone available to meet and greet and help people get where they need to be,” Allard said.

Hospital volunteers are considered valuable and integral resources; more volunteers are needed, Allard said.

“We would truly welcome more volunteers,” she said, and added that retired persons have found hospital volunteer efforts very rewarding.

Temporary signage has helped folks find their way around the hospital as construction unfolds and signage will be utilized when construction is completed, Hopkins said.

Hospital employees have met construction challenges and inconveniences with a spirit of cooperation, he noted.

Dealing With Construction

“The construction has gone very well,” he said. “Employees have handled this exceptionally well, and there have been changes literally week to week. The shuttle service [from an on-site parking garage to the hospital building] is being used and will likely continue in service until construction ends. It’s been especially helpful during the bad weather.”

Construction workers have contributed to the smooth operations during building, said Allard.

“The workers have been wonderful,” she said. “They have been very sensitive to our needs. They understand what we do here.”

In-house and community awareness of “what we do here” is essential to the hospital and the NBH, said Nolan.

Strategies and Moving Forward

For example, Cambio strategies include sharing financial information with numerous hospital entities and requiring accountability as well.

“One of the things that Cambio does is communicate all financial information to the board, to the finance committee, to managers and the medical staff so that we all have the same information,” he said.

Hospital department heads are responsible for the department budgets and “there are goals and accountabilities,” Nolan said.

“There has to be accountability,” he added.

As a community facility, “ we need to be user-friendly,” Nolan said. “We need to be sure that we are providing services, we need to be sure that we have competent staff.”

The facets of the NBH operate as part of a system as opposed to separate entities, he noted.

“I’m not sure that people understand that this is a health system,” Nolan said. “We need to make sure that the public knows what we do. We have a system here that many communities do not have.”

The NBH is the parent company of the hospital, the VNA and Hospice group, and the Sweet Brook Continuing Care Centers and the Sweetwood assisted living complex. A Transitional Care Center recently opened within the Sweet Brook facility. The NBH is also the parent company of the REACH Community Health Foundation.

The REACH foundation oversees several health initiatives, including a “Get Fit” program that offers a wide variety of programs, a “REACH for Breast Health” project, a comprehensive “North Star” project, a “Northern Berkshire Healthy Smiles” dental health initiative, a tobacco cessation program that includes a stop smoking session for pregnant women, a “Horizon” community caregiver program, and a men’s health partnership.

And more can be done, Nolan said.

A new NARH entrance and lobby could be open within the next few weeks.

“There is an aging initiative underway,” he said. “I would like to generate a stronger community presence. There are plans to utilize REACH as an educational resource.”

The hospital is poised to emerge as a local leader in health care and illness prevention, Nolan said.

“The message we want to send is that we have a workable strategy to solve our financial problems,” he said. “I think we will be very successful. This is the hospital for the area.”

A multi-photograph North Adams Regional Hospital construction slideshow will be posted at www.iberkshires during the upcoming week.

Susan Bush may be reached via e-mail at suebush@iberkshires.com or at 802-823-9367.