Children’s Hospital Boston: Sandra Fenwick, President and Chief Operations Officer

by HCE Exchange on April 15, 2011

“Children’s Hospital Boston is not only a large and very important contributor to the best pediatric care at the local, regional, national and international level, but we also blend scientific discovery with the most advanced pediatric clinical care. Our sweet spot is that translation – the interface between science and care,” said Sandra Fenwick, President and COO of Children’s Hospital Boston, one of the largest pediatric medical centers in the United States.

The 396-bed pediatric hospital is staffed by 1,077 physicians and dentists, and 181 other physicians hold courtesy or consulting status. The professional staff of more than 3,000 includes almost 1,000 residents, interns and fellows. It is the primary teaching hospital in pediatrics at Harvard Medical School.

Quality and Safety Programs for Unsurpassed Care

On the clinical side, everything contributes to unsurpassed care.

“Over the last five years, we have put an enormous emphasis on our quality and safety programs,” Fenwick said. “We are making some incredible headway. We have a five-part strategic plan for quality and safety, and it has taken hold and been embraced across the entire institution.”

An emphasis on quality has been added to every component of Children’s services.

“How do we look at governance and accountability? How are we going to increasingly do more evidence-based review of care?” Fenwick said. “We are looking at outcomes, not just process measures. We are benchmarking ourselves against ourselves, and then benchmarking our care outside the institution, particularly against other peer pediatric providers.

“It’s a very comprehensive look, and we’re excited because we are rigorously tracking this and we’re holding people accountable. But the most exciting part is the cultural change we have experienced. We are hiring people who are not just clinical experts or research experts, but quality experts. That’s part of their institutional and professional role.”

Translating Research to the Bedside

On the research side, they are working hard to remove barriers and to support the translation of basic science and research to the bedside.

“How do we close the loop so the science informs the care and the care re-informs the science?” Fenwick said. “Increasingly, you realize there are so many elements to supporting that.”

Information Technology, using Cerner as their primary IT system, is one way the organization is assuring this goal.

“We have spent a fair amount on new technology,” Fenwick said. “We are also building a small new clinical building, and part of that new building will help us advance technology at the bedside.”

As well, Children’s hired their first Chief Innovation Officer whose role is to go throughout the organization and identify innovators, as well as to help support them with seed grants, resources, and other measures such as scientific forums or websites where they can both look for funding and communicate with other innovators.

Excellent, Affordable Patient Care

As at every hospital, cost of services is a concern at Children’s.

“In the last three years we have gone across the organization and actually identified a hundred million dollars of savings,” Fenwick said. “We have taken that out of our budgets in fiscal years 2010 and 2011. We went back to the payers and said, ‘We will return the majority of these savings to you. We actually cut our prices in some of the services that even patients pay a portion of through their co-insurance.”

The hospital went back to its three major payers, which make up over 60 percent of their business, and opened contracts and gave them back rate increases.

“We also asked them to set aside with us $10 million of these savings in each of the next two years,” Fenwick said. “We collectively took that out of the patient care revenues and put it into a fund at the hospital and then asked them to join us in an advisory board where we would work on a series of initiatives at the hospital to reduce cost, improve health-related outcomes and transform current practice. We will continue to generate savings through reduced utilization and by how care is actually delivered.”

They have funded six projects in the first year of this initiative and are in the process of monitoring those projects.

“The exciting part is that not only will they transform the delivery of pediatric care at Children’s, they have the opportunity to transform both pediatric and adult care elsewhere,” she said.

Increasing Effectiveness for the Future

“I think that all of us as leaders in healthcare have to take responsibility and ownership to both reduce the cost of our services while concurrently increasing the effectiveness and the efficiency of what we provide,” Fenwick said. “That is our responsibility. Obviously, if we don’t do that, all the work we do to innovate, both the delivery system and the actual care itself, is at risk. I think that’s the message we’re trying to give internally. We own a part of this. We are employers ourselves, and we have a mission to continue to train the next generation, further the science and innovation and to give back to our communities. The only way we can continue to do that is if we all figure out how to deliver real value – care that is effective, efficacious and cost-efficient.”

-by T.M. Simmons

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