DF/BWCC marks 10th anniversary
Patients Joe Nies and Barbara Greenspan handled the ribbon cutting as BWH's new inpatient cancer units opened on Jan. 29, 1997. Brigham and Women's CEO Jeffrey Otten (far left) and Dana-Farber President David G. Nathan looked on. (Steve Gilbert photo)
On Saturday, Feb. 15, 1997, staff from Dana-Farber gathered on the 12th and 14th floors of the Dana building to begin the arduous task of moving Dana-Farber's adult inpatients to newly renovated oncology units at Brigham and Women's Hospital.
Most of the patients made the trip that cold morning by wheelchair and gurney, accompanied by their nurses, doctors, and other caregivers. The group traversed the hallways and bridges through the Jimmy Fund Building and Children's Hospital Boston before arriving at Tower 6 and 7 of BWH. Balloons and staff lined their route, and medical equipment, beds, and colleagues awaited them on the other side. Nine months later, the majority of BWH's adult outpatient cancer service underwent a similar transfer to the Dana building.
A decade after those monumental days, the reverberations are still being felt. By merging their adult oncology services in a partnership now known as Dana-Farber/Brigham and Women's Cancer Center, staffs from these two institutions offer patient- and family-centered care.
Although the first steps of this partnership — in a Jimmy Fund Auditorium ceremony on Sept. 19 — were accompanied by considerable work and trepidation for patients, families, faculty, and staff, most of those involved agree they were essential.
In 2001, construction continues on a bridge to provide a direct connection from Dana-Farber to Brigham and Women's Hospital. (Laura Wulf photo)
"Before the move, we had two excellent cancer programs that were 90 feet away from each other, but not working in tandem," explains Lawrence Shulman, MD, Dana-Farber chief medical officer and a BWH physician leader during the 1997 merger. "The potential power of bringing them together was an overwhelmingly compelling reason to do so. There was really nothing to be gained by keeping them separate, and everything to be gained by bringing them together."
Single vision, joint accomplishments
Dana-Farber/Brigham and Women's Cancer Center has grown into a high-performing model in which inpatient oncology care is delivered at Brigham and Women's, with all the associated services of a world-class hospital, and outpatient care is provided at Dana-Farber, with the focus and research of a dedicated cancer center. Although most outpatient cancer services (such as chemotherapy and checkups) are carried out at Dana-Farber, outpatient surgery, radiation, diagnostics, and bone marrow transplants are still performed at BWH. Laboratories that process patient specimens have also been consolidated.
Constant communication and collaboration ensure that caregivers on both sides of Binney Street are kept informed about each step. A unified leadership team oversees the DF/BWCC, including Dana-Farber President Edward J. Benz, Jr., MD (president); Brigham and Women's Surgeon-in-Chief Michael Zinner, MD (clinical director); Dana-Farber Chief Operations Officer Janet Porter, PhD (deputy director), and BWH's Dianne Cerce (executive administrative director of oncology services).
"We've evolved incredibly well in terms of our care processes and how we focus on patients and families," says Patricia Reid Ponte, RN, DNsC, senior vice president for Patient Care Services and chief nurse at Dana-Farber and director of Oncology Nursing and Clinical Services at BWH. A Brigham-based nursing leader during the 1997 move, she says the last few years have seen an especially potent change in how the institutions work together. "Since both hospitals set major strategic planning initiatives in concert, we've been able to create a mutual plan to be the most cohesive joint center possible."
Numerous other programs and initiatives have arisen since the 1997 merger, including:
- Twelve specialized disease centers devoted to different types of cancer, each with its own multidisciplinary team composed of medical, radiation, and surgical oncology; inpatient and outpatient nursing; and numerous social workers, other specialists, and support staff.
- The Gillette Center for Women's Cancers, where patients can receive comprehensive breast and gynecologic oncology treatment, as well as many support services, within a single center.
- The Adult Patient and Family Advisory Council, a group of volunteers who offer the wisdom of experience while working alongside doctors, nurses, and other staff to improve the delivery of DF/BWCC care at all levels.
- The Leonard P. Zakim Center for Integrative Therapies, where patients can seek treatment as a complement to "traditional" medicine, including acupuncture, massage, and nutritional consultations.
- The Eleanor and Maxwell Blum Patient and Family Resource Center and its satellite rooms, where patients and families can obtain information about cancer and its treatment, along with support.
"The Dana-Farber and Brigham and Women's partnership represents the kind of collaboration that can take place when institutions put patients and families first," says Dana-Farber President Emeritus David G. Nathan, MD, who led the Institute from 1995-2000. "I had felt, for many years before I became president, that cancer centers should maintain their beds in excellent general hospitals so that all the bells and whistles of modern medicine can support the oncology patients."
Mission accomplished
The 1997 events were the result of 18 months of planning and numerous committees that worked from a 12-foot-long master list of 5,000 tasks. In addition to the patients, many Dana-Farber nurses and other employees made the move as well — becoming Brigham employees literally overnight.
"It was frightening going from our small clinic on Dana 1 to a 700-bed facility, but everybody was on site to support us," recalls Eileen Molina, RN, BSN, one of the nurses who made the shift and is now a nurse manager for hematologic oncology patients on Brigham 5A and 5B. "For a while, patients would ask us, 'Are you a Dana-Farber nurse or a Brigham nurse?' but we don't hear that anymore. We've grown larger on both sides, but we really do provide seamless care."
Today, many patients have no idea Dana-Farber/Brigham and Women's Cancer Center was once two separate entitities — a sure sign that all has gone as planned.
"There are lots of business, administrative, and academic reasons that could have mandated the creation of the DF/BWCC," says Benz, "but the fact is that it was inspired by our patients and their families' desires for more user-friendly care, and driven by the need we felt to take the highest quality aspects of care at each hospital and make them apply everywhere."
Patient voices weigh in on the move
In addition to staff, patients from both hospitals were also concerned before the 1997 move. "There was apprehension and anxiety on both sides," says Cynthia Medeiros, LICSW, then director of Social Work and Psychosocial Services at Dana-Farber and now director of Patient Care Services ministration. "Dana-Farber patients were worried about losing the intimacy and comfort of a smaller facility focused solely on cancer, and Brigham patients were worried about losing their anonymity and ability to not be seen as cancer patients outside the oncology clinic."
To help address these concerns, leaders tapped a key resource. Current and past Dana-Farber patients and family members were involved in each stage of planning, and afterwards visited daily with their newly moved brethren. They conveyed concerns and needs to staff, and came to be valued as key advisors worthy of their own formal group. Thus was born one of DF/BWCC's most valuable assets, which in January marks its own 10th anniversary: the Adult Patient and Family Advisory Council.
"We answered patients' questions, eased their concerns, and, on the day of the move, we were out there helping bring them over," recalls Joe Nies, one of the advisory council's first co-chairs and still a leading patient advocate. "We found we could make an impact as people who had been down the same road. I was a transplant patient, so if I walked in and told another transplant patient, 'Don't worry, this is going to be OK,' it meant something."
— Saul Wisnia
saul_wisnia@dfci.harvard.edu
