Welcome to NMC

In keeping with the formal organizational values of "partnerships" and "our people, our community," as well as our belief in openness, inclusiveness, and transparency, NMC strives to provide multiple opportunities for public input in the hospital’s current services and our plans for the future. The goal is to foster discussion with community members in various formats relating to the health of the community, needs in the community, hospital services, and opportunities for improvement within our hospital and our local health care system.

Collaboratively Assessing and Addressing Community Needs & Priorities:

The hospital has been a long-standing collaborative partner in two formal community assessment and reporting projects (in addition to the work done in 2004 and 2006 through the Act 53 process). The Franklin Grand Isle United Way’s “Who We Are, How We Live, What We Need – Guide for Community Leaders” is a foundational document in planning efforts. Data and insight from that document is typically shared with the NMC Board, Leadership, and Medical Staff leaders during the hospital’s annual planning process – either directly during years of updates or indirectly as reference material associated with other presentations. NMC has also been an active participant in the development of the Franklin Grand Isle Community Partnership’s “Bridges to Community Well Being -- Regional Report Card.” The priorities, outcomes, and indicators from this document are similarly incorporated into planning considerations at NMC. Both of these community-based initiatives are developed by using a blend of statistically-valid quantitative community data, input from providers and community leaders, and qualitative/anecdotal data and input from the community at large. In 2009, the community collaborated to merge these two documents – further reducing duplication of effort and providing a single publication to summarize the community’s needs and the actions being taken to address those needs. NMC has had an active role in that effort. Naturally, as appropriate and feasible, the hospital is an active participant in, and supporter of, community-based collaborative efforts to address many of the issues identified in these reports. 

For 2012, NMC is working with the Franklin Grand Isle United Way and the Community Partnership to create an updated version of the “Bridges to Community Well Being” community needs assessment, looking at issues relating to income, education, and health.  In keeping with the latest Federal mandate on the matter, NMC is also in the midst of conducting a formal “Community Health Assessment” that includes both a review of quantitative statistics relating to our areas health as well as a significant qualitative survey of local residents’ perceptions of health in our community.  Both of those documents will be published in the second half of calendar year 2012.  Action plans to address the priorities identified will be developed by NMC and other organizations – both individually and collaboratively.  These assessments will also be folded into the hospital’s next wave of strategic planning as we work to create our FY’14-FY’16 Strategic Plan.

Achieving Openness, Inclusiveness, and Meaningful Public Participation:

NMC uses a variety of strategies to formally and informally engage the community in our own strategic planning efforts, decision making, and efforts to improve the health of our community:

• A statistically-valid community perceptions survey, typically administered every three years in keeping with the NMC strategic planning process (most recently completed in February of 2010, currently underway for 2012), to ascertain what the community knows about their local hospital-based healthcare resources, how they feel about those resources, what could be improved, and what is needed;
• A variety of other survey processes for both patients, members of the general public, and community leaders (historically including written surveys, telephone surveys, focus groups, personal interviews, etc);
• A variety of community discussions in various formats relating to hospital plans and activities, community needs and priorities, and health care topics;
• Personal contact facilitated through direct community involvement by hospital Staff, Board, and Medical Staff as volunteer members of local Boards, initiatives, and organizations;
• Personal contact facilitated through the geographic distribution of NMC Board Members and hospital staff.

NMC also gathers valuable public input through participation in community planning events by representatives of the NMC staff. These public meetings are typically focused on planning what the community can do in areas outside the direct provision of healthcare (such as crime and public safety, transportation needs, environmental conservation, Vermont’s energy future, etc). NMC participates as both a major employer and a healthcare provider, maintaining an active ear for opportunities in terms of “what can the hospital do” that may be supportive of the community’s efforts. These ideas are then funneled into the hospital’s short-term and long-term planning, creating a multi-directional planning channel that directly links the hospital to the community’s own efforts.

NMC engages the community through our role in a wide variety of community partnerships and initiatives. We take great pride in the community involvement by our staff as individuals as well as the formal involvement of NMC as an organization. The following is a sampling of the broader groups in which NMC participates within our community as an organization:

• The Franklin Grand Isle Community Partnership;
• The Franklin Grand Isle United Way (as a partner and supporter, not as a member agency);
• The Center For Health & Wellness;
• The Champlain Valley Area Health Education Center;
• EMS District 1;
• The Franklin Grand Isle Work Force Investment Board;
• The Franklin County Industrial Development Corporation;
• The Franklin County Regional Chamber of Commerce;
• The Grand Isle County Chamber of Commerce.

The 2010-2013 NMC strategic plan has been reviewed with the NMC staff, managers, Incorporators, physicians, and Board members. It has been endorsed by the Leadership Team, the Medical Executive Committee, and the Planning Committee of the Board. It was adopted by the full Board at their June, 2010 meeting. Work on the Background work on the 2014-2016 Strategic Plan will begin in July of 2012.

The environmental assessment conducted in the preparation of the 2010-2013 strategic plan showed that our population is growing, but slowly – an average rate of just under 1% per year for our primary and secondary service area. Much of that growth is concentrated in the southern portion of our service area (Fairfax, Georgia, and Milton). It also showed our population is aging – with the number of people over the age of 65 projected to increase by 23% between 2008 and 2013. The assessment also identified that Vermont itself has the second lowest birthrate in the nation which is declining, a trend we see reflected in our service area. NMC was right at the expected national benchmark for inpatient market share of 50% for a sole hospital in a county, however a top-performing hospitals in such areas achieve up to 70% market share. The initial physician needs analysis showed our service area could support six additional primary care providers.

Based on the findings of the Environmental Assessment and discussions during the planning process, six critical issues were identified as top priorities to be addressed:

The strategic plan carries a dashboard of measures used by the NMC Board and Leadership to monitor NMC’s status, providing empirical guidance to the strategic priority projects which flow from through the strategic plan.

Significant effort is ongoing as the hospital continues works to address priorities facing the community and the hospital, with highlights including:

For additional information on hospital strategic planning, capital plans, and/or depreciation schedules, please contact NMC’s Director of Planning & Community Services (see below).

In addition, NMC also engages the community in our efforts by welcoming their active participation in the hospital, through:

• Service as an NMC Volunteer (150 active volunteers, contributing over 19,000 hours).
• Service as an NMC Auxilian (351 members);
• Service as an NMC Incorporator (139 members);
• Service as an NMC Staff Member (657 employees);
• Service as an NMC Physician (95 Active/Associate staff); and
• Service as an NMC Board Member (12 members).
   

NMC’s Strategic Plan – Priorities & Updates:

NMC’s Board, Medical Executive Committee, and Leadership Team work together – drawing in expertise and facilitation from QHR -- to develop the hospital’s strategic plan. A comprehensive rewrite is conducted every three years, with yearly updates in the intervening years. Consideration is given to community needs and perceptions; demographics and other aspects of the local environmental assessment; political/regulatory pressures, marketshare, utilization, and financial performance; and a variety of additional factors:

• Valuing All Our Employees:  NMC will enhance our work environment to foster pride, career development, and a genuine sense of being valued.
• Access to Primary Care: NMC will be a leader in the recruitment and employment of primary care physicians, with a particular emphasis on Internal Medicine, to stabilize and expand access in our community.
• Physician Relations: We will develop mutually-beneficial trust-based relationships between NMC and the physicians. We will also assist in strengthening the relationships between our physicians – and between our physicians and other providers in the community.
• Sustainable Operational Model for New Regulatory/ Reimbursement Environment: NMC will actively participate in healthcare reform efforts while creatively adapting to the changing regulatory/reimbursement environment to preserve our ability to care for our community.
• Chronic Disease Management and Prevention:NMC will respond to the needs of our population through excellence in the management and prevention of Chronic Disease in collaboration with providers and our community.
• Distinguish Ourselves in the Market through Core Services and Process Redesign:NMC will maximize our market share through investment in the high-priority service lines where we can excel.
• Physical Space Needs:NMC will strategically invest in existing and new physical space to provide the resources necessary to care for our community.

Here is a glimpse at some of the initiatives flowing out of the 2010-2013 Stategic Plan:

• Access to Primary Care:    The 2011 Primary Care Study from the University of Vermont’s Area Health Education Center’s office shows that our region is underserved in terms of access to Primary Care physicians.  This is in keeping with the findings of the environmental assessment conducted during NMC’s strategic planning process.  As such, we have worked to stabilize and expand access to primary care.  The Georgia Health Center physicians are now employed by Northwestern Medical Center and they are welcoming a new provider, Nurse Practitioner Sarah DeSilvey.  NOTCH continues to expand and be an important collaborative partner in primary care, accepting patients at all of their locations.  “Northwestern Primary Care” has been established and has recently welcomed two additional primary care physicians, Dr. Juan Carlos Nunez and Dr. Jun Fu. 
• Blueprint For Health: To further strengthen our primary care base, improve the quality of care in the community, and align our community with State healthcare reform efforts, NMC has secured a grant to assist primary care providers become active participants in the Vermont Blueprint for Health.  More than 20,000 lives are now covered through NCQA certified Medical Home primary care practices.  NMC is leading a collaborative community effort to create and manage the “community care team” made possible by the Blueprint, bringing expanded and coordinated preventive, educational, and chronic disease management services to local practices.  NMC is also collaborating with VITL and local providers on the information technology advances required to support the Blueprint. 
• Northwestern Cardiology Services:  In keeping with the spirit of clinical integration within the strategic plan and healthcare reform efforts, NMC has established a formal collaboration with Fletcher Allen to create “Northwestern Cardiology Services.”  This practice has grown faster than expected and has received very positive feedback from patients who are now able to receive coordinated care in their own community.  Cardiology services in St. Albans used to be fragmented and disconnected, with little consistency or clarity for patients.  Now, the services are integrated and coordinated.  Dr. John Fitzgerald, a Fletcher Allen Cardiologist, is working out of NMC as the lead cardiologist.  NMC is providing a comprehensive range of diagnostic services as well cardiac rehabilitation (phases II and III).  Invasive cardiac surgery continues to be done at Vermont’s academic medical center, avoiding costly duplication of services.  This program went into full effect in May of 2011.  It has been well received and initial patient volumes are exceeding projections.
• Magnetic Reasonance Imaging (MRI):  Our strategic plan recognizes that NMC has reached the threshold where it was clinically beneficial to patients and less expensive to Vermont’s healthcare system for NMC to implement a fixed-site, large-bore MRI unit rather than continue to lease a mobile unit.  The State of Vermont issued a Certificate of Need to approve this project in November of 2011.  That advancement in care, and cost savings, will be complete in June of 2012.
• Facility Master Planning:NMC is in the midst of Facility Master Planning – a formal effort to ensure our buildings and campus are able to provide for the future needs of our community.  We have engaged national and state experts to assist in the forecasting of need and the anticipation of necessary services, which are then converted into physical space needs.  This plan is actively being created in mid-2012 with input from the Board, Leadership, Managers, Staff, and Medical Executive members and will be shared more broadly, including with our community, as it moves through the refinement and approval process. 

For more information on strategic planning and public participation, please contact:
Jonathan Billings
Chief Planning Officer/Director of Community Relations
NMC, 133 Fairfield Street, St. Albans, VT 05478
(802) 524-1044 * (802) 524-1291 fax * jbillings@nmcinc.org