President’s Update: December 2021

HCIF: A Study of a Highly Effective Board of Directors

Wendy Nickel

December 20, 2021

In 2019, attorney Thomas Hyatt authored a blogpost on the traits of high-performing boards. The traits include: full board involvement and a sense of engagement and participation; a respect for processes that further the organization’s mission; willingness to try new directions; strategic vs. operational focus; and an effective partnership with staff leadership. If I were to choose the characteristics that best describe HCIF’s Board of Directors, Hyatt seemed to read my mind a year before I even joined the organization. As a staff leader, I won the Board lottery!

Boards typically work behind the scenes in terms of driving strategic direction and organizational performance, and they don’t always get the credit they deserve. Although I have only been with HCIF for about 18 months, I am certain that HCIF has weathered the storms of the past 2 years because of the strength, commitment, and leadership of our Board members. Not only did our Board lead the organization through a search and leadership transition, they did this during the time of COVID – quite a challenging time to recruit and onboard a new leader. They proactively identified solutions and mitigation strategies to counter the financial ups and downs associated with the virus. They also reacted swiftly to the social justice issues of the summer of 2020 and made a powerful and committed statement about our organizational stance on racism. Finally, they have been active participants in an 8-month long strategic planning process to identify organizational priorities, including health equity, community engagement, and bridging population health and clinical care.

The Board has been capably and adeptly led by former Board chair, Steve Wray since 2017.  Steve has been a true partner in every sense of the word since I joined HCIF.  I recall my first Board meeting – 2 days after starting with the organization. I was nervous and (virtually) meeting some members for the first time.  I worried that I didn’t know Robert’s Rules very well, or that my technology wouldn’t work, or that one of my kids would interrupt the meeting. But Steve set the tone for the meeting, provided a little levity, and made me feel comfortable – as did all of our other Board members.

Mike Casey, our former vice-chair, was one of the first Board members I met during the interview process. With terrific business acumen, Mike has provided great strategic insights and recommendations during my tenure with the organization. I will always be grateful for his warm reception and gift of time during my first few months at HCIF. He has also been one of our go-to Board members to interview and recruit new members.

Joe Tate joined the Board as a consumer representative in 2016 and has provided great counsel on his experiences as a patient. Joe offered his legal expertise and guidance as we amended our bylaws in 2020 and has always contributed to our many strategic discussions.  Betty Craig also joined the Board in 2016 and brought her insights to our work from her role as a Chief Nursing Officer. Her contributions in providing firsthand accounts of clinician and patient experience has been essential to our work, especially during COVID.

Unfortunately, Steve, Mike, Joe, and Betty all had terms that expired at the end of 2021.  I am so appreciative of their commitment and contributions to HCIF and greatly value all that they have offered.  Now it’s time to welcome a new slate of leaders to the Board as we implement our new strategic roadmap. I am pleased to share that Patricia Sullivan, PhD, RN, Chief Quality Officer of the University of Pennsylvania Health System, will serve as our new Board Chair and Natalie Levkovich, Executive Director of the Health Federation of Philadelphia, will serve as our Vice-Chair.  I am looking forward to partnering with them on the next chapter of HCIF’s story. I am also excited to welcome Norm Weinstein to the Board for 2022. With our new leadership at the helm, I trust that we will continue to have a highly-effective and functioning Board that will continue to guide us as we encounter new triumphs and challenges.

President’s Update: November 2021

Wendy Nickel

November 30, 2021

November marks National Diabetes Month. For most of my career, the better part of 25 years or so, I have worked in programs focused on diabetes prevention and management. This disease is infuriating and no matter how many resources we seem to throw at it, it continues to rage on in our communities. What is most heartbreaking and frustrating about diabetes is how it ravages communities of color. African Americans are 60% more likely to be diagnosed with diabetes and are twice as likely to die from it. In Philadelphia, 17% of adults with diabetes are African American, while overall prevalence is 12% (Health of the City 2020, Department of Public Health, City of Philadelphia). Poor social conditions caused by systemic racism, such as poverty, lack of access to healthy food, and unsafe housing contribute to poorer outcomes.

While many of the programs I have been involved in throughout my career were noble in their efforts to improve prevention and management, they didn’t strike at some of the systemic issues that plague communities and cause diabetes in the first place.  For the first time, however, I feel hope that there is a way to combat diabetes.  With an “it takes a village approach,” HCIF’s Cities Changing Diabetes – Philadelphia program engages multiple stakeholders in addressing diabetes in innovative ways. What feels palpably different about this program is that it embraces the most vulnerable of communities, including recently incarcerated citizens, individuals living with disabilities, and other overlooked or underserved populations. The authentic engagement of these communities is how we embody our values and commitment to equity. Additionally, the program helps to integrate fundamental social determinants of health issues into diabetes prevention and management.

I have thought a lot about diabetes and equity recently. When you read about healthcare disparities in journal articles, it doesn’t quite hit home until you realize that people who you know are impacted by diabetes due to longstanding inequities. In trying to learn more about diabetes and disparities, I stumbled across the American Diabetes Association website and learned that they recently developed a Health Equity Bill of Rights:

One of the rights impacted me the most:

#8: The right to a built environment that does not put you at greater risk for getting diabetes.

This is something that many of us take for granted – access to clean air, clean water, safe places to exercise and play, and access to healthy food. To address these issues, it will take a village to create innovative solutions and a community-based approach. I am comforted that a program like Cities Changing Diabetes exists and am hopeful that in another 25 years when I look back, it will serve as a model for how we can improve outcomes and decrease disparities in chronic conditions in cities across the country.

President’s Update: October 2021

Wendy Nickel

October 28, 2021

Only two weeks until our Partnership for Patient Care 2021 Leadership Summit! As with most events during the past 18 months or so, the Summit has taken on a bit of a different direction this year. During the late spring and summer of 2021, we were deep in the throes of hopeful menu planning for our first in-person event in over a year. Deciding whether to serve wasabi tuna sliders or bruschetta on focaccia felt very important at the time. However, as COVID-19’s Delta variant began to surge in the mid to late summer, it became clear that we had a responsibility to our partners and health care stakeholders to move to a virtual event.

Although mainstays like the Delaware Valley Patient Safety and Quality Awards will continue to be a part of the program, the virtual platform has given us an opportunity to try new ways of delivering important content. We are thrilled to welcome Dr. Tejal Gandhi, Press Ganey’s Chief Transformation Officer, as our keynote speaker this year. Focusing on our theme of health equity, Dr. Gandhi will be providing critical insights about the connections between patient safety and equity. We will also have the opportunity to hear from leaders throughout the region about their health-systems’ health equity journeys. This virtual panel discussion will be moderated by Sara Lomax-Reese, CEO of WURD Radio.

While we had hoped to toast in person, we will have a virtual celebration of the 15th anniversary of our Partnership for Patient Care (PPC) program. We will be featuring virtual memories from the past 15 years of excellence in quality and safety from the program creators, participants, and HCIF staff. As we have recounted its history in planning for the Annual Summit, PPC has truly been a remarkable achievement. PPC’s original mission was to support the region in providing the highest quality and safest care in the country. Through the hard work and dedication of over 2,000 participants over the years, we are proud to say that PPC has contributed to reductions in hospital acquired infections, wrong site surgeries, and readmissions. It has also led to more transparent discussions about patient safety, and has allowed health-systems to share best practices without fear of retribution.

Today, PPC is recalibrating its focus on equity through a recently-launched program related to the collection of race, ethnicity and language data (REaL). The Health Equity Data Strategy (HEDS) program will provide organizations with the opportunity to evaluate their REaL data collection and utilization practices and learn about strategies to improve healthcare disparities. PPC’s evolution from safety to now include equity has been part of a natural progression in response to the needs of our region. I am so very proud of this program, the HCIF staff who lead it (Pam, Liz, Kaynaat, and Cassidy) and those who have been involved over the years. I am eager to see where we will end up 15 years from now.

Although we will have to forgo pigs in a blanket and hummus and carrots this year, the Annual Summit promises to deliver critical perspectives on health equity and serve as a celebration of PPC’s achievements over the past 15 years. We hope you’ll join us as we honor the past and look forward to the future.

Click here to register.

President’s Update: September 2021

What Do Patient Safety and Gratitude Have in Common?

Wendy Nickel

September 28, 2021

My house is very busy right now. With two kids in high school and one in middle school, the house is abuzz with activity by 6:30 a.m.  Packing lunches, arguing about who gets to shower first and shotgun, and putting books in backpacks, it is a familiar and welcome clamor. My children are going to school after a year and a half of being home. An unnatural interruption, a pause in life, a time lapse that I can only pray will not have long-term consequences on their development. They are going to school and I am grateful.

I am sincerely grateful to the clinicians who persevered against great odds to selflessly take care of COVID patients. Without appropriate personal protective equipment or enough knowledge for how to protect themselves or their patients, they used patient safety best practices and principles to fight against COVID. I am grateful to the frontline leaders and teams who analyzed and evaluated events related to COVID to ensure that future patients would be protected and harm would be minimized. I am grateful to the scientists who created a vaccine that is safe and effective. I am grateful to the first willing recipients of the COVID vaccines.

World Patient Safety Day, observed every year on September 17th, was established only two short years ago in 2019 by the World Health Organization. This past year and a half has been a constant reminder to clinicians, quality and safety leaders, administrators, and other healthcare stakeholders that patient safety must be a foremost priority when fighting a formidable enemy such as COVID. I propose that in observance of World Patient Safety Day (even though you may not be reading this column until after the day), we honor all of those who have sacrificed to protect our patients, keep them safe, and help us return to some sense of normalcy. If you are a healthcare worker who has been practicing in the throes of COVID, thank you.

As the alarm clock buzzes before dawn, the house slowly comes alive, and sounds of school buses rumble down the block, I am grateful.

President’s Update: August 2021

Vaccine Development Tells a Story of Perseverance and Sacrifice

Wendy Nickel

August 27, 2021

The topic of immunizations seems to open a Pandora’s box of emotions these days. Regardless of which side you stand on in the immunization debate, the development of vaccines has a truly fascinating history. In honor of National Immunization Awareness Month, I spent a little time learning about the history of vaccines and thought I’d share some of my findings. 

Although Dr. Edward Jenner is credited with performing the first smallpox vaccination in 1796, the antecedent to vaccination was variolation, a process that involved injecting a small amount of infectious material from smallpox postules under the skin. Those injected with smallpox material had a much lower mortality rate (1 in 50) compared to those who were not (3 in 10).  The subcutaneous method of variolation dates back to around 1000 CE and was introduced in India. This practice became commonplace in Europe throughout the 1700s.  However, in the late 1700s, Jenner and his colleagues noticed that people who had been infected with cowpox (usually people who worked on farms) didn’t get smallpox. This discovery ultimately led to the smallpox vaccine.  Smallpox was eradicated in 1977 and now only exists in two heavily secured laboratories in the US and Russia. The word “vaccine” comes from the Latin word “vacca” – meaning cow.

Another important chapter in vaccination history occurred in the 1950s when Henrietta Lacks, a black tobacco farmer, died at the age of 31 from an aggressive cervical cancer. At the time, it was common practice for physicians to collect human cells for research, without consent. Lacks’ cells had the ability to replicate indefinitely, while normal human cells are able to replicate on average around 50 times. This indefinite replication of cells allowed researchers to grow and study the cells in laboratory settings.  Researchers from all over the world have used this cell line (now knowns as HeLa cells) to further their research. The cells have contributed to many important scientific breakthroughs, including the development of the polio vaccine and the study of the human papillomavirus, leading to today’s widely available HPV vaccine.

While the scientific breakthroughs attributed to the HeLa cells are remarkable and many greatly profited from new discoveries, Lacks and her family never benefited from these contributions.  Her family was not aware that her cells had been in wide use in research until the 1970s (nearly two decades after her death).  This injustice has led to a reckoning of sorts in research and healthcare communities. Informed consent is now required for those who donate tissue and cellular materials for research. Additionally, Institutional Review Boards (IRBs) examine every research study involving human participants before it is approved. As for Henrietta Lacks, her legacy lives on and is being honored by Johns Hopkins, the institution where she received treatment. Several scholarships and symposia have been named in her honor and a new building on the Johns Hopkins campus will bear her name. A book and movie also were developed, “The Immortal Life of Henrietta Lacks,” and share details of her legacy.

Immunization history tells a fascinating story of adaptation, innovation, and ethical considerations. Undoubtedly, the development of the COVID vaccines will offer another milestone chapter in the history of immunizations. How fortunate we are today that humans had the fortitude to continue developing a vaccine that was most effective for smallpox eradication. And we owe a debt of gratitude to Henrietta Lacks and her family for their many contributions to science, as well as understanding ethical considerations associated with medical care and research. As someone who desperately wants to protect my loved ones and community and for my children to be able to safely return to school, I am grateful for the perseverance and sacrifices of those who have contributed to vaccine development.