By Susan McDonald
The goal of any healthcare organization is to care for the people in its community; but to really make friends and family members feel comfortable, they must first feel represented by the team offering care.
That’s true for people from different ethnic, racial and socioeconomic backgrounds, those of every gender and sexual identity, and ones with varying intellectual and physical abilities.
In short, for us to best meet the needs of the diverse communities we serve, our team must reflect those communities. On multiple levels across Hartford HealthCare, there are projects and initiatives underway to ensure all patients feel safe and seen by us when they come in for healthcare. Efforts include: increasing Spanish speaking providers; pairing seasoned nurses with new graduates through a residency program; supporting those struggling with addiction and/or mental health concerns with people having lived experience; and educating ourselves about the value of correctly pronouncing someone’s name.
International Nurses Meet Need for Caregivers
By Hilary Waldman
One year ago, a handful of international nurses joined the ranks at St. Vincent’s Medical Center, filling staffing gaps caused by a national nursing shortage.
“In Hartford, you are so blessed with resources I have never seen before.”
Today, units at Hartford HealthCare hospitals are home to more than 90 international nurses, most from the Philippines, but also Kenya, India and Jamaica. New nurses arrive regularly, with the latest joining Charlotte Hungerford Hospital and HHC at Home.
The nurses start as contractors employed by Sheerwater Health, a recruiting agency that takes care of everything from visa processing to housing before the nurses start their jobs. The goal is for each experienced professional to settle into HHC and life in Connecticut and become successful, long-term colleagues and citizens after their temporary assignment.
The transition to a new country and healthcare system is not always easy, but support from HHC colleagues, assigned mentors and volunteers from the Asian American/Pacific Islander (AAPI) Colleague Resource Group (CRG) make the landing a little softer.
Everything is different
Ruth Sego, 43, left her husband and 5- and 8-year-old sons in Kenya to start a job on Hartford Hospital’s Bliss 8 med/surg unit last May. A nurse for 14 years, she was amazed by the U.S. healthcare system.
In Hartford, you are so blessed with resources I have never seen before,” she says.
In Kenya, the patient-to-nurse ratio was about 20:1 and most of her days were spent distributing medication. Intravenous medication was delivered by gravity drip, so she had to learn to use our electric infusion pumps, which deliver fluids at programmed rates or automated intervals.
Finding familiar groceries was also a challenge.
At Walmart, she finally found white corn meal needed to make a porridge known as Nsima, which is eaten with vegetable and/or meat stew in Kenya.
Good clinical skills
International nurses arrive with an average of six years acute care experience and often are familiar with electronic medical records. To smooth any gaps in knowledge, they gather at Hartford’s Center for Education, Simulation and Innovation (CESI) once a month for day-long skills refreshers.
Noreen Gorero, director, integration, patient and family transitions at the Heart & Vascular Institute (HVI), and Paul Paseos, a nurse at the Institute of Living, often join the nurses for lunch. Noreen was born in the Philippines and Paul’s parents are Filipino immigrants. As members of the AAPI CRG, they have become informal hosts to the Filipino nurses.
They connected the newcomers with a church, and encouraged driving lessons so they can buy a car and not rely on public transportation. They also have been supportive when some nurses experienced ugly, anti-Asian abuse on city streets and buses.
By last summer, Sego’s family joined her and she was beginning to understand the American accent, which she says made communication challenging at first, even though she is fluent.
Warly Remegio, vice president, nursing professional development and practice excellence, says the training emphasis for international nurses is autonomy. Many newcomers come from cultures where questioning doctors or elders is frowned upon.
“We teach them that you have to question,” he says.
Ruth agrees, saying, “I already feel empowered.”
She credits HHC colleagues with helping her feel welcome and adjust to her new life, and is grateful for the support of her manager and mentor. What surprised her most was how warmly other HHC colleagues have embraced her.
“Sometimes I felt like crying and a colleague will come up, put their arm around me and say, ‘Are you OK? How can I help you?’” she says.
Recovery Leadership Academy Provides Career Path for Those in Recovery
By Elissa Bass
Whenever she applied for a job, Kim Horowitz felt sick to her stomach, worried someone would ask her to explain the gaps in her resume related to her bipolar disorder.
Jacky Rodriguez wanted a career helping people, but time in prison in her 20s seemed to limit her to waitressing jobs.
And, no one knows better than Karen Kangas the career obstacles that mental health and addiction issues can create. Kangas was established in her career as an elementary school principal when she was diagnosed with bipolar disorder and became addicted to alcohol as a way to self-medicate. She was fired.
During her recovery, she decided to use her story to help others. In various roles over the years, she focused on helping those in recovery, including helping them find a purpose and a career. She launched the Recovery University curriculum to teach others in recovery to become peer support specialists. In 2016, she joined Hartford HealthCare’s Behavioral Health Network as director of recovery and family affairs and launched the Recovery Leadership Academy in 2019.
The goal, she says, is to teach people in recovery to become peer support specialists who can guide others to recovery based on shared experience and understanding of the challenges recovery poses.
The Recovery Support Specialist Training and Certification Program is an 80-hour course that prepares people in recovery from a psychiatric or substance use disorder or family members of people in recovery to become a certified recovery support specialist (RSS).
After completing the program, recovery support specialists are qualified to work in behavioral health systems anywhere in Connecticut.
Ambassadors of hope
Last May, 90 individuals graduated from the Academy. The Fall 2023 session filled early. Kangas estimates 40 RSSs work for Hartford HealthCare.
Having lived with addiction or mental illness themselves, they are “ambassadors of hope” for those in a recovery program.
They ask, ‘Will I ever get better?’ ‘Will I ever have a life?’ These are the kinds of things they struggle with. We can support them because we have had our own experiences,” she says, adding that RSSs also benefit. “People in recovery often are denied employment because of their mental health or addiction histories. This gives them a career.”
Thwarted from her career
Horowitz, who has bipolar disorder, PTSD and ADHD, has faced multiple challenges in her life, including caring for her dying mother and bouts with ovarian and uterine cancer. Now 45, she wanted to be a lawyer. After completing the educational requirements and passing the bar, she was given stipulations to practice law by the Connecticut Bar because she disclosed her diagnoses.
She learned about Recovery University and signed up to become an RSS. Kangas helped her find a job at Rushford, which offers prevention, treatment and recovery programs for mental illness and addiction. Today she is manager of inpatient recovery support services there.
“People can connect to me so quickly, because I’ve lived in my car, I’ve had no friends, I’ve had no ties with my family,” Horowitz says. “It’s so gratifying. It means so much to me to connect with people and see them take the next steps in their recovery.”
From waitress to social worker
For Rodriguez, who recently left HHC for other opportunities, it was a chance meeting with a stranger when applying for unemployment benefits that led her to the RSS program. Since graduating from Recovery Leadership Academy, she earned bachelor’s and master’s degrees and became a licensed master social worker. She worked at Rushford for three years as an RSS before moving to the Meriden Early Diversion, Referral and Retention Project (MERR), a partnership between the Meriden Police Department and Rushford that gives police an alternative to arrest when dealing with someone having a mental health crisis.
Earlier this year, she presented the work she does at the National Mental Health Conference.
“It’s a miracle,” Rodriguez says of her life today. “I’m so grateful I was able to overcome what I went through. If it wasn’t for RSS, I’d still be a waitress.”
Residency Program Ensures Smooth Onboarding for New Nurses
By Susan McDonald
About 100,000 nurses left the profession during or after the COVID-19 pandemic, a global phenomenon that left healthcare organizations like Hartford HealthCare scrambling to fill open positions.
At the same time, increases in patient flow and severity during the pandemic — plus restricted access to clinical units — meant many new graduate nurses started careers in a flurry of activity that was less than ideal, often with less clinical practice than typically required.
The exodus doesn’t surprise Warly Remegio, DNP, vice president of nursing professional development and practice excellence at Hartford HealthCare. He understands how overwhelming it became for nurses during the deadly pandemic as they isolated from their families, donned protective equipment, and soothed critically ill patients and their families while mourning losses of colleagues and loved ones. He also understands the need of new nurses to feel valued and supported when they start.
“We rely on nurses to ensure that we are providing the best care possible for all of our communities – in the hospital setting as well as medical offices and specialty clinics,” says MaryEllen Kosturko, DNP, executive vice president and chief nursing officer. “The shortage created by the pandemic was not sustainable and we needed to create ways to overcome pandemic burnout.”
As the nation recovered slowly from the pandemic, HHC’s nursing leadership team summoned all available resources and tapped every creative idea they came across.
“Nursing is such a dynamic and rewarding profession, and while the pandemic was overwhelming for many, the people of Connecticut deserve to continue to continue to receive outstanding health care from us. We just need enough nurses to help with that,” Dr. Kosturko says.
This summer, Dr. Remegio, and his team launched one of those ideas — the Hartford HealthCare nurse residency program. All newly graduated nurses hired by the system, and others with less than one year’s experience, will be enrolled in the 12-month program designed to support them with mentorship and competency resources, ensuring a successful transition into clinical care.
“Nursing teams across the system joined us in creating this program,” Dr. Remegio notes. “The work demonstrates our commitment to supporting new nurses and offering them opportunities for professional growth here.”
Residency coordinators were named in each region, and include: Sarah Viggiano, MSN, RN, Central; Heather Wheeler, DNP, APRN, and Michelle Ostrowski, MSN, RN, Fairfield; Melody Zande, MS, RN, East; Anne Vilhotti, MSN, RN, Northwest; Lauren Dabbo, MSN, RN, Central; Teresa Soule, MSN, RN, Community Network; and Karen Venice, MSN, RN, NPD-BC, Hartford.
The Nurse Residency Program combines and standardizes efforts that had existed at some Hartford HealthCare hospitals, and adds peer mentorship and evidence-based curriculum provided through the system’s partnership with Vizient/AACN Nurse Residency Program™.
“Participants will find a key layer of professional and personal support that goes well beyond standard orientation and preceptorship,” Dr. Remegio says.
They will join interactive professional development sessions that focus on:
- Enhancing and using effective decision-making skills.
- Developing communication and leadership skills.
- Encouraging the use of research-based evidence and data to help improve patient outcomes.
- Strengthening the professional commitment to nursing, while forming a professional development plan.
- Understanding the Hartford HealthCare strategic framework and operating models.
“By standardizing and expanding the nurse residency concept across our system, we now offer a robust infrastructure that helps new nurse graduates acclimate to professional practice,” Dr. Remegio explains. “This includes considering their overall well-being in a supportive environment with guidance from our experienced nurses, to help boost their confidence while they get hands-on training.”
HHC Working to Connect Providers with Communities
By Elissa Bass
When Sebastian Trabucco moved from Rhode Island to start his marketing job at Hartford HealthCare Senior Services, he needed a new primary care provider. As a gay man, it was important to him to find one well versed in caring for the LGBTQ+ community.
When HHC program management Director Mona Heredia was looking for a doctor for her Peruvian mother-in-law living with Alzheimer’s, the family wanted a provider who was fluent in Spanish and understands her Latin American culture.
It wasn’t easy for either colleague to find the provider they sought, even though they work at a large healthcare system. No clearinghouse of providers knowledgeable in LGBTQ+ care or who spoke Spanish existed.
That’s about to change.
HHC colleague resource groups representing LGBTQ+ and Hispanic/Latine colleagues have worked for more than a year to create provider directories specifically addressing the needs of their communities. The LGBTQ+ directory will include providers specializing in gender-affirming care as well as sexual and reproductive health needs.
The Hispanic/Latine provider and allies membership guide, which will be for internal use by HHC providers, will include Spanish-speaking doctors and anyone well-versed in Hispanic/Latine cultural norms. There is already a public-facing directory on the HHC Spanish-language website for patients.
“So often, individuals in marginalized communities are hesitant to reach out to providers for fear of being stigmatized or having to educate the provider,” says Laura M.I. Saunders, PsyD, director of HHC’s Center for Gender Health. “Having a directory that highlights specialized areas of competency in working with an underrepresented community will go a long way to improving access to quality care.”
It’s more than language
Heredia recalls looking for a residential facility for her mother-in-law and wanting to make sure staff were comfortable with a large Latin American family coming to visit, often all at once. She also wanted her mother-in-law to be comfortable.
“It is so important for patients to feel loved and taken care of in a way they understand,” Heredia says. “Healthcare providers need to be aware of cultural and language differences. You have to have confidence in the person taking care of you.”
Jennifer M. Doran, senior director of practice strategy and operations for HHC Medical Group, notes, “Healthcare can be complex and difficult to navigate. The added difficulties of language and cultural barriers makes it even more of a priority for our system to be sure all our Hispanic/Latine providers and allies are aware of each other.”
The directory, she adds, will provide “patients with access to doctors, providers and clinicians who can provide culturally competent care. Having a provider directory that is for providers themselves allows for the community to be supported and for connections to be made.”
For the LGBTQ+ community, Trabucco adds it’s not just listing providers with the necessary skills, which ranges from understanding and preventing/ treating HIV/AIDS to offering medical, surgical, mental health and support services for transgender and nonbinary people.
It’s not just a list
In 2020, the Chase Family Movement Disorders Center opened a Spanish-language center in Hartford with neurologist Maria L. Moro-deCasillas, MD, who led the initiative because she has witnessed the health inequities faced by the Hispanic/Latine community.
Realizing that duplicating a physical space like that across the system was impossible, the Hispanic/Latine CRG began talking about creating a similar network, says José M. García, Digestive Health Institute regional director for Hartford and Northwest regions. At the time, he and Doran cochaired the CRG.
“How could we take that concept and scale it across the system?” Garcia asks.
A workgroup conducted a listening tour, talking with providers about what they saw and how to overcome language and cultural barriers. Providers “are so excited” to be asked to participate, Garcia says. In addition, the group researched networks at other American healthcare systems.
“We can’t find anything like this elsewhere,” he says. “Our goal is to truly improve the outcomes for this population, to be the gold standard. It is an ambitious goal. We are building it from scratch but we feel this is the right thing for our patients.”
East Region Forms Community Advisory Council
By Elissa Bass
East Region teams are going directly to the source for input on how best to address community health issues.
Under the guidance of Anesta Williams, director of human-centered care, and Joe Zuzel, director of community health in the East, the Patient & Family Advisory Council (PFAC) serving Backus and Windham hospitals is morphing into a Community Advisory Council, tapping diverse community partners for feedback.
“We realized our PFACs didn’t really represent the population,” Zuzel explains. “We wanted a global, community-wide voice made up of diverse individuals from all walks of life, representing everything from intellectual/physical disabilities to ethnicities to sexual orientation.”
Traditionally, PFACs bring patients and family voices to the table to help address barriers that can interfere with optimal care. Members include colleagues, former patients and their family, and community members. The model, however, isn’t optimal.
“The healthcare landscape is changing and, in response, we are constantly assessing our impact on the communities we serve,” Williams notes. “As we embarked on our 2023 strategic imperatives related to access, affordability, equity and excellence, we recognized an opportunity to explore innovative alternatives to elicit feedback.”
It’s a natural progression for systems seeking input from those outside hospital walls.
“Hearing the voice of the consumer across the spectrum of care relationships is critical to informing our quality, safety, experience and innovation strategies,” says Gerry Lupacchino, senior vice president for human experience. “As we evolve to community advisory councils, we will learn more, not only from those who chose to come here for care, but also from those who haven’t, or haven’t yet, chosen HHC as their care provider.”
First, research; then, action
“We started by saying ‘What can we do differently to measure the impact of completed work and meet community needs?’” Williams says.
University of Michigan graduate students tackled research into CAC best practices, what helped them succeed and potential limitations. At the same time, Zuzel and Williams talked with community partners to “gain a better understanding of the barriers HHC’s East Region has faced in the past,” Williams says.
“Why are there individuals who are not seeking care? What are the barriers? What are the opportunities? We want to be supportive, not prescriptive. Then we can bridge that gap.”
They combined that information with identified specific needs, barriers and community demographics to create the CAC. The group will:
- Provide feedback from a diverse community regarding ongoing health issues and opportunities.
- Be made up of current and former patients, family members and caregivers, plus community representatives.
- Improve patient-centered care by sharing patient/ family experiences and perspectives.
- Identify existing gaps and increase community engagement with the system.
Hearing all voices
While the PFAC consisted of those who interacted with the system, the CAC will include people who have never stepped foot inside an HHC facility.
“The CAC will be more robust by focusing on the community perspective rather than just the patient’s,” Zuzel says. “That was just one perspective. We need to broaden perspectives to parts of the community currently going unheard.”
Ultimately, CAC goals are to align with the Community Health Improvement Plan, a document put together every three years to identify major barriers to health in geographic areas, and create solutions.
Anticipated community benefits include:
- Increased initiatives and associations with community groups
- Higher use of community services like Meals on Wheels
- Improved customer satisfaction regarding community involvement
“This work has the potential to affect improved outcomes for patients and increase our success in the East Region,” Williams says. “Additionally, this aligns with FY23 goals to increase access and improve affordability.”
What’s in a Name? Everything
By Susan McDonald
Much of the work being done by members of the Asian American/Pacific Islander Colleague Resource Group (CRG) is personal, including the What’s in a Name? initiative that is about as personal as it gets for some.
Recalling the various interpretations of their ethnic names throughout their lives, they work to help others understand that being aware of and sensitive to their different cultural background includes pronouncing — or at least trying to pronounce — their names correctly.
Names are important elements of identity and having your name regularly mispronounced can feel insulting or invalidating. The CRG in 2022 developed “What’s in a Name?,” an interactive activity to increase cultural awareness, starting with respecting and understanding colleagues’ names. If you haven’t already, use the QR code at right to try the activity yourself.
Members of the group recently reported the impact of the “What’s in a Name?” initiative to senior system leadership, noting that:
- 90 people had responded to the activity
- 98% reported feeling comfortable correcting someone who mispronounces their name
- 98% said they felt comfortable asking someone to pronounce and/or spell their name for clarity
- On a scale of 1-5, participants reported the interactive activity was a 4.62 in terms of being meaningful
Comments from participants included: “This really brings the definition of respect to others to a different level;” “I feel this to my core and I always ask 10 times until I get people’s name right;” and “This is an amazing resource.”
On the heels of the successful rollout of What’s in a Name?, AAPI CRG members are creating a one-page resource to train HHC leaders on the importance of pronouncing people’s names correctly. They, in turn, can train their teams.
Breaking the Cycle of Violence with Resources, Support
By Kate Carey-Trull
David Crump walks the Hartford Hospital campus wearing sunglasses and a smile, with a positive outlook he works hard to maintain with the daily challenges he sees patients face.
“We are still trying to solve the riddle of jobs, education and support to help people dealing with intergenerational trauma,” he says. “The pressure has been building and, unfortunately, sometimes people turn to violence to try to solve their problems.”
As Hartford Hospital’s first hospital-based violence injury prevention specialist (HVIP), he hopes to help stop the cycle of trauma and violence by working with patients and families impacted by violence, connecting them with support and education, and trying to reduce tensions.
Partnerships provide support
Crump works with community-based organizations, trauma service providers and social workers.
“It starts in the hospital, but we continue following up with families as part of a citywide initiative,” he explains, noting he can be a court advocate, connect them with medical, mental health or social services.
As someone who has lived experience with violence and inequality, he knows people feel trapped, sometimes hopeless, if opportunities are unequal.
Crisis intervention background
His background is varied, but steeped in the experiences that make Crump good at what he does. In 2008, he worked on a Boston trauma team, responding with police to de-escalate crime scenes, then helped build an intervention program at Brigham and Women’s Hospital in 2011, where he met Jonathan Gates, MD, a vascular surgeon and chief of trauma.
After living in Chicago for two years, Crump returned to Massachusetts to work as director of a workforce development program for youth involved with street activity and the criminal justice system. He later was a consultant for hospital based violence recovery and interruption programs before coming to Hartford Hospital in October 2022, reconnecting with Dr. Gates, who had arrived six years earlier.
Crump’s role, partially funded by an American Rescue Plan grant, is part of a citywide initiative that includes similar roles at St. Francis and Connecticut Children’s hospitals. The three work together to stop the cycle of violence and prevent people who come into the hospital with trauma-related injuries from returning for similar reasons.
Hearing discussion of the position, Dr. Gates says he thought Crump would be ideal after seeing his impact in Boston.
“We hope this HVIP position can help provide a safety net for families in the hospital and direct the transition to services they require for true healing of the patient,” Dr. Gates says.
Providing resources, education and job opportunities, he adds, can help reduce further community violence.
“There is no one answer, but there has been marked success in other cities with these types of programs,” Dr. Gates says.
The hope is to create an HVIP position template that can be applied at other Hartford HealthCare trauma centers at Backus Hospital, The Hospital of Central Connecticut and St. Vincent’s Medical Center, he says.
Equity Framework Being Developed
By Susan McDonald
Every good plan needs structure behind it, and while efforts to embrace diversity and equity swirl at all levels of Hartford HealthCare, a core team focuses on creating an unshakable foundation to ensure the work makes an impact for many years to come.
“We had never had a way of thinking broadly about equity,” says Gerry Lupacchino, senior vice president, patient experience. “We always aspired to, but there was no framework to look at performance and compare ourselves against others.”
It starts, adds Elisabeth Michel, equity system transformation manager, by committing to a guiding framework of intentions that embed equity in all we do, she says. HHC’s approved statement reads, “We commit to specific actions that measurably improve access, intentionally eliminate barriers, and create opportunity for all.”
“Simply having a statement would help ground us, but this quickly became much more,” she says.
Evolution of the equity commitment
In 2021, Michel, Lupacchino, Sarah Lewis, vice president, health equity, diversity and inclusion, and others met with the marketing communications team to flesh out a plan to communicate HHC’s equity commitment internally and externally.
“This is more than words on a page. This commitment is an activation; a purpose- and action-driven framework that helps our colleagues understand both why and how they can participate in advancing equity,” Lewis says.
“We want the words we say to match what we do, and help everyone understand that each of us has a part to play in eliminating barriers and creating opportunities for all,” Michel adds.
The commitment developed from sessions with a multi-disciplinary group of colleagues across the system, “engaging the voice of the customers,” she says. Participants went through a personal reflective questionnaire to evaluate how they engage with others around them, and create work environments that are respectful to people from all walks of life.
The results, which remained confidential to each individual, ranged from “naïve” to “fighter.” Neither extreme is optimal, rather Michel says true diversity change agents lie somewhere in between.
“This has to resonate with everyone to be successful. We focused on what it means for them to be change agents,” Lupacchino notes, adding that the majority of people at most organizations are labeled change “avoiders.” “We need to create an environment where avoiders feel supported to enact change.”
Blazing an equitable trail
To focus on where the organization is headed, Michel says the group looked at “what helps and what hurts,” reflecting on certain programs and practices that either advance or hurt the organization’s equity aims.
The goal is to inspire action and accountability, to get people asking themselves, ‘What can I do to improve access, eliminate barriers and create opportunities for all?’” she says.
This is key because while one HHC goal is to achieve quality patient outcomes, more people need to have access to care in the first place for that to happen. Addressing access improves outcomes and alters the way systemic racism impacts community health, Michel explains.
In addition, the equity commitment isn’t only about patients.
“Cultivating a culture of belonging also affects our colleagues. We want to empower our colleagues so everyone has a robust career journey,” Lewis says.
Every HHC colleague has a role to play in the work, starting with leaders who can create a psychologically safe environment for sharing and speaking up. At new colleague orientation, Michel is one of several members of the health equity department who give the presentation “You Have a Part to Play: Advancing Equity & Cultivating Belonging at Hartford HealthCare” to encourage new hires to use their voice and perspective.
“Each of us has ideas and can adopt specific actions that drive change,” Michel says.
Lupacchino agrees, saying, “As an HHC colleague, I am consciously aware of people around me and what I can do to help them be successful.”
“The equity commitment is more than just coming up with a list of project ideas. It’s a tool colleagues can use to reflect and engage the power they have every day to make a difference for their teams, their patients, and their community,” Lewis adds.
With each colleague on a unique journey, Michel says notes that, “Connecting across our similarities and our differences makes the organization stronger.”
Looking ahead at equity
Those embedded in HHC’s equity work asked the executive leadership team to review the equity commitment with their teams and model the behaviors in their workspace. The results will look different in various environments, but Michel says team feedback and perspective is key to sustainability.
“Our focus is to get the message out but also help to embody it across the system,” she notes. “We’re still talking about what people need to embody this so they feel supported. It’s planning, doing, studying and adjusting.”
In one year, she and Lupacchino predict there will be many colleagues who can say they did something or learned something because of HHC’s equity commitment. Maybe groups will launch book of movie clubs to explore a topic while connecting with each other, or develop a leadership mentorship series for those wishing to further their careers.
Other ideas include taking hikes as colleague groups, volunteering to share health information at public events or planning a community clean-up.
“By this time next year, we hope colleagues can say they see a difference at work or in their community because of specific actions they have taken to create change,” Michel says.