Stacy Hutton Johnson (00:03): Boston Hope was an amazing experience and call to the moment. But Boston Hope was never intended to be a longer term solution to some of these really challenging societal issues we were facing related to social determinants of health. I think what it has afforded us as a healthcare community is a much more elevated dialogue with the broader community.
Nacole Riccaboni (00:32): So many nurses have been called to do something during COVID. What’s really interesting about Stacy’s story is how she answered that call. Stacy helped set up a COVID field hospital in Boston’s downtown Convention Center, and in less than two weeks, her and her team created a facility with a thousand beds.
Boston Hope increased capacity. It also created a safe recovery space for COVID patients who could not isolate safely at home, or who were actually homeless. With two decades of experience as a nurse, Stacy already had a lot of insight into health disparities, but Boston Hope showed her how fast community needs can be met when providers, policymakers, and public health officials collaborate.
That’s what it’s going to take to make a lasting impact on health equity. But how do we keep this momentum going after the pandemic? Well, that’s exactly what we’ll be talking about the rest of the season, so keep tuning in.
My name is Nacole Riccaboni. I’m a critical care nurse working in Florida and your host for SHIFT Talk Season Two. SHIFT Talk is a podcast that brings nurses together to talk about the challenges we’re facing on and off the clock.
This season, we’re interviewing nurses who are working to ensure that all patients can have access to the resources and care that they need to be healthy. And that’s called health equity, by the way.
We’re going beyond the clinical and looking at the social factors that impact health, from a person’s zip code, to their health, to even their job and even structural racism. No healthcare provider knows more about nurses’ lives than nurses, right? We can really make an impact here, folks.
This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s change-makers. SHIFT is sponsored by the Robert Wood Johnson Foundation. Follow us on Instagram @shiftnursing, and for more amazing stories and real talk about nursing, head over to shiftnursing.com.
One final note: this episode was recorded in July, so please keep that in mind as you listen to this great conversation. Now let’s dig in.
Hi, Stacy. Welcome to SHIFT Talk. Can you tell us about your background and career as a nurse?
Stacy (02:52): Absolutely. Thanks Nicole. So my clinical background as a nurse has mostly been right here in the greater Boston area. I’ve been a nurse for over two decades. I started out here as a new graduate nurse at Brigham and Women’s Hospital. And after a few years at the bedside, it became very apparent to me that I had a passion for nursing leadership and development and a real interest in having an impact on patient care at a broader level.
So I took myself back to grad school at that time. And then at Northeastern, I was studying for my Masters in Nursing Administration and my MBA, and that really positioned me to come out and be a nurse manager or nurse director and really in the frontline of leadership where I’ve spent most of my career.
More recently, I was an associate chief nurse at Atrius Health, which we can talk a little bit more about in a bit, but I was at Atrius when the pandemic hit and Boston Hope was being stood up.
Nacole (04:02): Can you tell the listeners a little bit about the population in Boston in general?
Stacy (04:06): Yeah, absolutely. So Boston is an urban area, and like any urban areas in the U.S., we have incredible diversity of patient population needs across our city and the greater Boston area.
Nacole (04:23): Now, Stacy, you’ve been a nurse for well over two decades. Before we go more into Boston Hope, what are some of the challenges you’ve seen the patient population in your area face in achieving good health outcomes?
Stacy (04:37): I think back over the arc of my career — we’re talking so much more as a community about social determinants of health. But when I think back to my very early days as a bedside nurse, my first education around this happened when I was a bedside nurse on a medical unit at Brigham and Women’s Hospital.
And as a staff nurse, I was responsible for helping patients understand their chronic diseases, and I was doing some health education with a patient and managing his diabetes, and we were talking about diet and the kinds of foods he needed to eat. And it was really the patients who started educating me about concepts like food deserts.
And this just was not a possibility in his community. He had convenience stores, and he didn’t have access to the fruits and vegetables I was recommending as part of his plan of care.
Stacy (05:34): And so that experience was, I would say, the beginning of my education and it was being educated by my patients. And I think in nursing, we’ve evolved to understand that this is really about practicing with a lot of cultural humility and being open, right, and aware of our own worldview and how that probably has gaps, right.
We don’t understand sort of the lived experiences of some of our patients, but how do we come to those encounters with our patients open and learning. And so much of my time as a nurse director at Mass General was on a medical unit as well, where we were serving many underserved communities, including the homeless population, but also people who just lacked access to high quality healthcare services. It became clear, right, that distinction between having health coverage and health access. And there’s a really big difference there.
And so in that environment, starting to recognize sort of the resources we needed to access for patients, other team members that needed to be pulled in. Social work, connection to community resources. And so for me at that time, it really became more clear what our acute care responsibility was, to know about and be able to access resources in the communities where patients are to help them address these health disparities.
Nacole (07:11): I totally agree with you. I’ve experienced that myself in my community. We have a patient population that are brittle diabetics and I ask them, “You keep coming in here with DKA over and over again. I love to see you. I’m glad we’re conversating, but why haven’t you been able to go to the endocrinologist that I’ve referred you to?”
And the first question is, “Well, their office has a three month waiting list,” or, “I can’t get transportation,” or, “The insulin is too expensive.” So like you said, until you understand someone’s perspective and barriers in getting proper healthcare and it being available to them, you have to first fix those hurdles before you just go about judging someone for being non-compliant.
Stacy (07:51): Absolutely. And I think the caring that you show as a clinician to ask those questions, like help me understand the why, unpacks a whole different set of implications, right? If our patients are struggling with some of those social determinants that are the very basic of human needs with housing or food insecurity, being able to get to an endocrinologist, that is just a very high level need if they’re focused.
That openness to just ask, “Why? Help me understand what’s going on,” because then we can start going about solving those challenges and barriers that our patients are encountering and meet them where they are. This plan of care might need to be adapted to be more realistic to what you’re actually going to be able to execute on.
Nacole (08:45): And I think that’s an appropriate word, realistic. Realistically, how can they get to these resources? It’s great to print a medical plan and print packets and have a plan of care, but if they have no transportation, if they have no money for the insulin, if they have nowhere to physically live, those are things that you’re going to have to manage or at least address before you ask someone to follow up with a doctor and not help or support them in achieving any of those other issues.
Stacy (09:14): Yes, absolutely. And I think we’re starting to see progress in that area as well. When I look at some of the work that was happening when I was at Atrius Health, beginning to assess more thoroughly what people’s social determinants of health needs were, but also starting to look really long and hard at our own systems and processes of care down to something as simple as like, when are we offering appointments?
If our patients are not in jobs where they can just leave for two hours in the middle of the day to get to an appointment, we need to be offering those weekend, evening hours, we need to make our systems adaptable to what the patient’s needs actually are.
Nacole (10:04): I myself have difficulty getting appointments and I’m a medical professional, let alone someone that works two or three jobs, have three or four kids and they’re trying to squeeze in appointments.
And now with COVID, they won’t let you bring your kids in. I’m facing that now where you want me to go to an OB appointment, my husband’s out and I have two kids and I can’t bring my kids with me so I can’t go to the appointment.
I understand that this is a pandemic, I understand that they’re kids and you don’t want a lot of people in the waiting room, but also how do you think I’m going to get to this appointment? Not have a babysitter.
Stacy (10:41): Yeah, absolutely.
Nacole (10:42): What do you plan on me doing with my kids and you keep calling me about the appointment. I cannot go. I would love to go. I’m trying not to be non-compliant and difficult, but I also have my children with me that you have just told me that they cannot come. How do you overcome this barrier?
Stacy (11:00): Absolutely. So the reality for a lot of our patients in our communities is yeah, okay. They have healthcare coverage, but that is a major barrier if you’re talking about a family that’s living paycheck to paycheck and having food insecurity issues to come up with $80 a week for care.
These are the things that I think the COVID pandemic has really forced us to grapple with as a community in health care, but also as a broader society. It’s really shown us a very bright lens on issues that we knew about in healthcare that we’re beginning to try to address, but that we have so much work to still do.
Nacole (11:50): Now, what role did you take on in Boston during the beginning of the COVID pandemic?
Stacy (11:55): Yeah, when the pandemic first hit, I was an associate chief nurse for professional practice at Atrius Health, which is an ambulatory outpatient environment. And at the beginning of the pandemic, like everyone else, right, we were halting all non-emergent unnecessary treatments and really shutting down a lot of our practices early on in that pandemic.
But most of my career to that date had been in the acute care environment and academic medical centers, and I really felt the desire to help in some way. And it was at that time that I was having conversations with internal leadership at Atrius Health, really starting to convey this desire, this passion I had to be part of the response to COVID and then I heard about Jeanette Ives Erickson being called upon by Mass General Brigham to stand up a field hospital.
And in my years working at Mass General I had the opportunity to work with Jeanette. So I was able to call her up and just ask what sort of leadership needs did she have? Is there any way I could serve and help out at Boston Hope?
Nacole (13:14): That happened here locally as well. Our ambulatory stuff got shut down. It’s great to hear that you pivoted and you said, “What can we do to help you?” So it just took one phone call to kind of get this in motion?
Stacy (13:26): It did. Jeanette was in the throes of standing up Boston Hope. Boston Hope was being established at our convention center downtown. So a very nontraditional environment for healthcare services. And it was a collaboration that was happening between the Commonwealth of Massachusetts, the City of Boston and Mass General Brigham, in addition to the Boston Healthcare for the Homeless, right?
So it was really this collaborative work and they were in the throes of recruiting frontline clinical staff when I reached out to Jeanette and she certainly had this leadership need for a chief nurse officer.
And I really credit my colleagues at Atrius Health at the time because I reached out to my chief nurse officer for her support to allow me to go and pivot and focus at Boston Hope as a chief nurse officer and I just had such resounding support from them to go and serve in this way, without which this just would — not any of it would have been possible.
Nacole (14:31): Who specifically needed Boston Hope and who it was going to serve or the kind of the goal?
Stacy (14:37): So at this point in the pandemic, the intent of Boston Hope was really set up to serve as an emergency response to the capacity and overflow needs we were anticipating. We had learned a lot from watching what New York City had just been through and the capacity constraints their acute care facilities went through.
And so in response to that, and in that sort of rapid cycle learning, Boston Hope was set up really to help with overflow from our acute care environments and ensure that we still had the capacity as a community to serve as additional people had acute care needs. So it was really set up to decompress the hospitals as people became less acute in their healthcare needs.
It was licensed as an LTAC level. So it’s really a subacute facility. Our patients there were still requiring healthcare monitoring needs from nurses and physicians, so they still needed some help with activities of daily living.
We had the ability to give them oxygen there, to give them medications if they didn’t know how to take their own meds, but they were not at the acuity level where they would still require inpatient hospitalization. And so this provided that level of care and opportunity, but it also served for patients who could not safely quarantine or isolate at home.
So if an individual maybe even didn’t need oxygen anymore, or they were fine taking their own medications, they didn’t really need a lot of healthcare intervention, but they could not go home, maybe they were in an apartment where they were living with five other people in a two bedroom, right?
There’s not an environment for them to be able to isolate. So this facility also served that patient population and gave a space where people could safely quarantine and isolate and not expose their family members to COVID by going home.
Nacole (16:48): You saw other organizations having issues with dealing with overflow, with dealing with certain patients who couldn’t properly isolate, and instead of waiting for those issues to accumulate and occur in your community, you guys were proactive in creating this amazing project. That’s wonderful.
Stacy (17:04): Yeah. I really credit the leadership of our state, the governor, the mayor and then the healthcare executive leadership team that really saw this need. And I think it’s one of the great things. One of the hallmarks of healthcare is this rapid cycle learning and willingness of people to learn from what we were seeing. Just that little bit ahead of us gave us a minute. And literally it was from April 1st when the ask for this first occurred and we admitted our first patient on April 10th.
Nacole (17:39): Wow. You guys weren’t playing around.
Stacy (17:41): They were not playing around, so it was a very intense time with people doing incredible work to essentially build a healthcare facility in a convention center. And if you’ve ever been to an event at a convention center, it might kind of help you picture what this was like. It’s humongous, right? It’s this massive, vast area with concrete floors and bathrooms that are altogether too far down to one end of the facility, right?
So these were the things as a nurse and as the CNO stepping into the space for the first time that we immediately started to problem solve and address for how to safely stand up a healthcare environment to serve the needs of these patients in the safest possible way.
Nacole (18:32): Now you mentioned Boston Hope taking care of patients who had required oxygen or support, and maybe who could not quarantine. Now you also had a side of the convention center that also managed the homeless population?
Stacy (18:45): Absolutely. Yeah. So Boston Hope was a thousand bed facility. And half of it that I just spoke about was really the subacute hospital side. We had 500 beds and that’s where I was the chief nurse officer. The other side, the other 500 beds was really managed by the leadership from Boston Healthcare for the Homeless. And that served the homeless patient population in Boston and in the Eastern Massachusetts area, really so that if there were homeless people who were COVID positive, discharging them back to the street or discharging them to a shelter would represent obviously a public health concern.
So this was a place likewise, right, where they could go safely isolate and be connected to experts with the community resources and the infrastructure to support the needs of that unique patient population. So we have a great collaborative relationship between the two sides going both ways, right?
If we had a patient who was experiencing homelessness on our hospital side and they had medical needs, but then no longer did, there was an opportunity to discharge them really to that Boston Healthcare for the Homeless side of Boston Hope and vice versa.
When there are patients on the homeless side of the facility who were deteriorating clinically — because as we know with COVID, you’re getting better, getting better and then you can have these major setbacks. We were there and had systems in place to receive them quickly and get them sort of a clinical level of care that they needed right there on site.
So that collaboration was fantastic between the two sides of Hope for that population, as well as some of our population on the Hope side where they weren’t experiencing homelessness, but they’re just maybe many people living within the home.
People were eager to do the right thing and protect their family, but we really needed to have a system and a process by which they could successfully do that. And I think the two sides of Hope really helped address those gaps and those needs.
Nacole (21:05): Now, in terms of the program, how did you guys fix those issues that we’ve discussed throughout the podcast? What resources and care did you guys end up adjusting and changing?
Stacy (21:16): At Boston Hope, the reality is that was serving an emergent need that our community had during a pandemic. And it was set up with a lot of attention to the unique needs of the patient population, and I can talk about a few of those. But what it clearly was not going to solve was all these baseline health inequities, access to care, right?
We weren’t able to solve those broader issues, but what we could bring to this moment and this patient population’s need was really setting up many of the things that we knew served patients very well. And I’ll speak to my experiences at Mass General. We’re a Magnet recognized facility. The nursing listeners know that that means that we tend to be able to recruit and retain really high caliber nurses because of the focus on the quality of care and the empowerment of the nurses.
So we took some of those principles and were able to apply them at Boston Hope and make sure that we were designing the care model around the patient’s needs. So for example, ensuring that we had access to translation services. Over 48 percent of our patients at Boston Hope identified non-English as their primary language. And so we really needed to make sure we had phone, video interpreters available.
And then our physician colleagues also had an ability because of a pilot program at Mass General to flex in physician leadership that was Spanish speaking as their primary language and really trying to get our healthcare teams to be as representative as possible to the patient population.
We know from the literature that this makes a big difference to patients and the kind of care they receive. But we also address some of the other wrap around services. We were very fortunate to have physical therapy colleagues at Boston Hope, and our patients were able to get PT services every day, twice a day.
Nacole (23:41): I wouldn’t have thought that was an option. I’m going to be real honest with you. Getting PT in inpatient is hard, let alone at a field hospital. Well done!
Stacy (23:49): Yes, I think the need was so clear to make sure patients were able to ambulate without desaturation and so that need was definitely addressed as was the attention given to the mental health services. So we had psychiatry consultation available, social work was available to meet with patients and really help identify some of those underlying needs they had.
Nacole (24:18): I think your field hospital is better than some hospitals that are constructed. And that seems like a very comprehensive program that hits everything it needs to.
Stacy (24:29): Well, the benefit we had, right, and we alluded to this a little bit earlier, but there were many clinical people who maybe had some background in acute care in their past, but had moved into more primary care roles or ambulatory settings or education roles, and really were looking for an opportunity to pivot that skillset and knowledge and serve as things were shut down.
As those needs weren’t as critical, really looking to offer their services in this way. So that was an amazing thing to experience. Certainly the Boston area is a resource intense, shall we say, area. You know, Harvard Medical School is here. We have many high level academic medical centers, right? So we have Brigham and Women’s, Mass General and so we are very well-resourced in this area.
Nacole (25:30): Now throughout this entire experience, have you learned anything new, particularly about the impact of social determinants of health or any sort of barriers to get health?
Stacy (25:40): Yeah. I think Boston Hope was an amazing experience and call to the moment. And some of those services that I identified that we were able to provide patients while they were at Boston Hope, certainly aided in their recovery and being able to go home to their families and not worry that they were exposing loved ones at home.
But Boston Hope was never intended to be a longer term solution to some of these really challenging societal issues we were facing related to social determinants of health. I think what it has afforded us as a healthcare community is a much more elevated dialogue with the broader community.
I think more political leaders, even lay people and consumers of healthcare understand these issues of health inequities and social determinants of health better than they did before the pandemic for sure. And so there was a lot of work in health care that was underway to start addressing social determinants of health.
I think this taught me how quickly change and needs of a community can be met if we have resourcing and collaboration between healthcare leadership and our politicians. It showed me how much we could accomplish in literally nine days to stand up a field hospital.
Nacole (27:15): It’s amazing.
Stacy (27:16): Right? So if we put our minds to this, there is no reason that we can’t really start addressing the policy implications that are standing in our way of addressing some of these social determinants of health.
Nacole (27:29): If you were working at bedside today, what kinds of things would you be on the lookout for after your experience with Boston Hope?
Stacy (27:38): We really are having nurses come out of their programs with a much deeper understanding of issues related to social determinants of health, health equity, social justice, right? And many of us who completed our training many moons ago, decades, didn’t have that in our curriculum.
And so we really have this fantastic opportunity as nurse leaders to make sure that we’re identifying expertise on our teams, wherever it sits. I think what we know of nurses is we are inherently really fierce patient advocates.
Nacole (28:21): Oh, for sure.
Stacy (28:22): Right. And so we are so well positioned to really be a leading voice in this at the bedside and the care that we provide. We know the science behind this now.
So being aware of your biases and then for our nurse leaders at the frontline, the nurse managers, really helping them to understand the role they can bring in ensuring diversity and inclusion on their workforce, the value of having that workforce that really represents the patient population.
So there’s so much that I’m really excited that we are going to see in the next coming years for nurses to step into this space as leaders in health equity.
Nacole (29:11): Awesome. Thank you so much for this amazing interview, Stacy. I learned so much, I have all these notes and things that I’m going to look up myself and this Boston Hope project is amazing.
Stacy (29:22): Well, thank you for allowing me to be here and share this work. I hope it’s helpful to nurse listeners and others and I just want to, again, thank everyone who came to serve at Boston Hope. It certainly took a broad community to make something like that possible.
Nacole (29:41): Thank you again. Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s change-makers.
SHIFT is sponsored by the Robert Wood Johnson Foundation. The views expressed in this podcast are of the guests and hosts only, and do not necessarily reflect the views of the Robert Wood Johnson Foundation.
To learn more about our guests and to hear more awesome nurses talk about the important issues we’re facing right now, visit our website, shiftnursing.com, and please subscribe, rate and review SHIFT Talk wherever and however you get your audio content. Until next time, stay safe and keep being awesome.
