For example, we have several chronic disease collaboratives where we can tell—by physician and by patient—whether a diabetic’s blood sugar levels are controlled and, if not, how long the levels have been uncontrolled and what we can do to put a plan in place to correct that. So, to spend $150 million several years ago to procure that system and $25 million a year to maintain that system really gives us the ability to do some nifty things. And that’s what our President, Alan Aviles, is talking about when he says we are able to impact quality and improve the quality of the healthcare we provide by reviewing data available through the system.

IDN: That cuts down on the human error factor as well.

FC: The intelligence of the system is such that when HHC, through our CMO and medical directors at the facilities develop a protocol for a particular disease or subdisease, that data or intelligence is put into the system. When the attending physician and/or resident goes to prescribe a medication that may not fit within protocol, the system will not allow him or her to do that. There is a lot we have developed over the past 12 years that really cuts down on the human error factor because those protocols are built into the system.

IDN: Considering the climate of healthcare on a national level, what do you see as the largest issue that HHC will be facing in the coming year?

FC: From my viewpoint, the biggest thing we are facing is that New York State has a projected budget deficit of $15 billion over the next 15 months. Seventy percent of the state’s budget is education and healthcare—mainly Medicaid. Because HHC is 65% Medicaid, those anticipated cuts are going to work their way down significantly to HHC. We are looking at potential cuts as it stands now of $420 million over that 15 month period offset by maybe $130 million of additional revenue that would get to us from debasing the Medicaid inpatient payment fee scale and also looking at juicing the op rates.

The governor and commissioner of the New York State Department of Health have said they want to invest in outpatient services rather than have patients use the emergency room. The only way they can do that is if they raise the rates to cover the costs on the outpatient side. They are not going to be able to do that because of the budget deficit. We are going to be faced with decisions very shortly if we can’t turn back these cuts.

IDN: How do you approach culture change, building a strong internal culture, strengthening leadership, and attracting top healthcare workers?

FC: We have an aggressive patient safety agenda at HHC. At the helm of that initiative is a no blame culture. What we are encouraging staff to do is report near misses to Hospital Administration. We see by not taking punitive action, we are getting reports of near misses and then use Lean methodology. We refine our processes, make sure that mistakes are corrected, notify the staff about what we found and how not to replicate those errors anywhere in the system…and it’s working! It takes several years to turn culture around.

We celebrate our successes that come out of these reportings. For example, we have not had a hospital-acquired infection in some of our facilities for over 16 months. That’s celebrated, and that’s a result of tracking and improving our processes. We were one of the first, at least in the state of New York, who became transparent and put all of our indicators on our website for the public to see. We actually report our failures and our accomplishments. Very few hospitals and hospital systems want to do that, although they are going to be forced to do it. We did it willingly. You have to embrace it.

IDN: Your system has an IT infrastructure that creates a strong communication mechanism for data synchronization. Can you talk more about the role of IT in streamlining the clinical and administrative processes throughout your organization?

FC: We have a very talented individual in our central office, Dr. Louis Capponi, the Chief Medical Informatics Officer (CMIO). He is a respected physician that comes from the field. He has a staff and we have a steering committee with medical directors and other subject matter experts, such as physicians and nurses, who are involved in anything we do in the IT field. So if we are going to implement a new system or a new process within an existing system, that group of individuals—the people who are going to use it—have a say in how it’s structured, implemented, and how it’s going to translate in the field.

IDN: I read about the Smart Card program. Did that work for you? What’s next?

FC: It did. It was piloted at our Queens Health Network. It was a 64K chip card that had patient demographics the patient’s problem. The card was cheap at $3 to $5 each. We have 1.3 million patients, though, and if they lose those cards, it gets costly. Each of the boroughs has a Regional Health Information Organization (RHIO), a group that wants to standardize IT across the healthcare continuum. The Smart Card program has been morphed out to RHIOs to think of other ways to achieve the same goal. The real thing we need here is a unique patient identifier, which we are working on. That is a challenge for the entire healthcare system right now.

IDN: From your perspective, what makes HHC a System of Excellence?

FC: The staff. It’s our human resources. It’s everyone’s commitment, not to the organization, but to the patient; and commitment to the mission. I think if you get down to the bedrock, that’s what you are going to find at HHC. Many of us could be working elsewhere making double money. It’s not money. It’s the ability to affect someone’s health. It’s even more than that. It’s a sense of gratification when you can affect the healthcare of an individual who is disenfranchised and didn’t have access to healthcare but now has access because we are the safety net to provide it. And we are able to provide it in his or her language and customs to educate them so the next generation will have a better shot at good health than their parents did. There is a lot of gratification and good feelings you get from helping someone who has nowhere else to go.