Nurturing Connection: The Art Behind the Science

This article was published in our 2015 Annual Report.

Drs. Ovleto Ciccarelli and Nicolas Benoit

Drs. Ovleto Ciccarelli and Nicolas Benoit

Every surface was polished and shining and immaculately maintained: this is the detail that comes to mind when General Surgeon Dr. Ovleto Ciccarelli thinks back to his first visit to Gifford.

This small detail reflected a sense of connection and ownership that still impresses him today: staff members feel connected to the organization and take pride in their work.

“The people who work here take care of what’s theirs,” says Podiatrist Dr. Nicolas Benoit, who took over as Director of Surgical Services when Dr. Ciccarelli stepped down from the role in December.

Building relationships—to employees, to patients, to the people we serve—is key to Gifford’s success. They form a connecting thread that keeps us in touch with community concerns and needs, and has sustained us through a changing healthcare landscape for more than 100 years. People feel they are an important part of the organization and they want to help make it the best it can be.

“Gifford is very well-managed and has a concern for its employees some find unusual in the 21st century,” said Dr. Ciccarelli. “Every employee is in the same boat. You see this in our quarterly staff meetings, in how people are treated, and even in how we’ve weathered financial ups and downs: there’s never been a layoff. Everyone’s expected to not panic, to ride with it, and to pull a little harder.”

Over the years significant expansion and growth has been driven not by a business strategy, but in direct response to specific community needs (improvements to ensure access to quality local care or to fill needs like sports medicine or senior needs).

Doctors Ciccarelli and Benoit have witnessed major changes in their area in the last 10 years: the addition of a third operating room; a new ancillary services wing and patient-friendly surgical services floor; a systematized approach to wound care; and a radiology department transformed by the most modern technology and the expertise of two full-time radiologists. They say that the sense of an “employee team” has contributed to the organization’s growth over the years, bringing a resiliency and nimbleness that has allowed quick and thoughtful responses to internal and external change.

“I’m always impressed by how fast we can band together to get something accomplished here,” said Dr. Benoit. “People are willing to give the extra effort—if something seems impossible, we break it down in smaller steps to build it faster.”

The Art Behind the Science

Across the organization people are encouraged to collaborate and to help bring new colleagues up to speed when needed. As a surgeon in a small community hospital, Dr. Ciccarelli says peer support is especially important.

“The biggest challenge for a surgeon in rural health care is isolation,” he said. “Electronic media has made it easier to stay current, but most of surgery is an art, not a science: knowing what to do when is important, but how you do it and how much to do—this is where having peers becomes important.”

For Dr. Ciccarelli, nurturing relationships is especially important for recruiting a new generation of community health care providers—so many students are now encouraged to specialize or to take positions in larger hospitals, primarily because of student loan obligations. Both Leslie Osterman and Rebecca Savidge completed rotations with him as students, and both are now practicing at Gifford.

“Direct patient care is an honor and a privilege. Believe me, nothing beats being at a bedside with a patient!” he says. “We need to show young people how rewarding caring for patients can be.”

The OR Team: Bringing compassion and respect to patient care

This article was published in our 2015 Annual Report.

Gifford OR team

Members of the OR Team (l to r): Ella Armstrong, Josh Redden, Morgan Nichols, Jeanelle Achee, Andrea Scott, Tammy Schellong, Jamie Floyd, Rebecca Johnson, Caitlyn Welch, Jason Lewis, Victoria Pulie, Kelsey Mancini.

“Patients feel very vulnerable when they are in the hospital for surgery,” said Surgery Nurse Manager Jamie Floyd. “We provide our patients with high quality surgical procedures, and our strong team approach allows us to give safe and compassionate care.”

Rochester Health Center Welcomes New Provider

This article was published in our Spring 2016 Update.

Dr. Erwin LangeDr. Erwin Lange, who has been seeing patients in Rochester since November, is settling in as this community’s primary care provider.

Office Manager Dawn Beriau and Registered Nurse Gail Proctor, who have worked at the clinic for more than 30 years, have spent the last few months introducing him to local families—many who have been receiving care at the Health Center for generations.

Lange is filling the position that opened up when Dr. Mark Jewett retired last spring, after nearly 40 years at the Health Center. Lange says he has really appreciated how the community has welcomed him.

“Rochester really is an amazing community. Sometimes people have stopped in just to introduce themselves and visit, and that has been great!”

Board-certified in family medicine, he brings years of experience in rural primary and emergency care. He received a BA from Dartmouth College, a MD from the Brown Alpert Medical School in Providence RI, and completed a three-year residency in family practice at the St. Joseph Hospital Health Center in Syracuse, NY.

Lange began his career as a family practitioner in a small, rural community in New York State, but then moved into practice as an emergency physician in several NH and Vermont hospitals. When he decided to return to family medicine he was looking for a community like Rochester, where he could care for a variety of conditions but also establish ongoing relationships with patients and their families.

Dr. Lange sees patients at the center from 8:30 a.m. to 4:30 p.m., Monday through Thursday, and Physician Assistant Tammy Gerdes sees patients on Fridays.

Services include: annual physicals, blood work, sick visits, EKGs, chronic disease management, care coordination, and emergency procedures. To schedule an appointment, call 767-3704.

Federal Award Supports Increased Substance Abuse Services

This article was published in our Spring 2016 Update.

federal funding

Gifford was one of four Vermont health centers to receive Affordable Care Act funding in March for programs that will help address an escalating national heroin epidemic. The Department of Health and Human Services award will be used to expand substance abuse services, especially those for people addicted to opioids.

Chief Medical Officer Dr. Martin Johns said Gifford is collaborating with the Clara Martin Center to support a SBIRT (screening, brief intervention, referral to treatment) model of care. The award will primarily fund additional staff for the program (a primary care provider with training in substance abuse treatment, a
social worker, and supporting staff).

“We are thrilled to have this opportunity to expand services for alcohol and drug dependence and misuse in our community,” said Johns. “These funds will allow us to increase patient access and to collaborate with other community organizations to provide seamless, all-encompassing treatment for those seeking help.”

Nationwide $94 million in Affordable Care Act funding was awarded to 271 health centers in 45 states. The other three organizations in Vermont that received funding were the Community Health Centers of Burlington, Community Health Centers of the Rutland Region, and Northern Counties Health Care in St. Johnsbury.

Personalizing High Tech: Keeping core values while opening to change

This article was published in our 2015 Annual Report.

Gifford laboratory

Lab technicians Susie Curtis and Matt Clayton

Gifford’s laboratory, tucked into the heart of the hospital, provides essential services that touch all areas of patient care. Open 24 hours, the lab performs chemistry, hematology, blood bank, and microbiology tests so providers can diagnose and treat their patients.

The expertise and quality of our lab is well-recognized: when Centers for Medicare and Medicaid Services inspectors spent two days looking at the competency of staff, equipment, and all analytic processes (from blood drawing, testing, and delivery of results to providers), Gifford’s final score was “100 percent.”

“I’m amazed by the number of tests we perform here now,” says Laboratory Technician Susie Curtis, who has witnessed many changes in her more than 40 years in the lab.

She’s seen many “best practices” evolve. People no longer smoke in the lab or use their mouth to pipette, and now everyone always wears gloves. But she says one thing has remained the same: at Gifford the patient is the #1 concern.

“We always try to accommodate special situations—for example, a courier can bring specimens to the lab from a community clinic if a patient is unable to travel to Randolph.”

There have been major lab renovations and equipment upgrades, but Curtis says the biggest change has been in technology she uses every day.

“When I first started, the glucose testing machine was huge and it took forever to get results,” she said. “Now a machine half the size does 20-30 tests at a time.”

Over the years Curtis was mentored by several colleagues who had spent most of their careers here. They provided a sense of continuity, and passed on the importance of preserving Gifford’s core values while embracing change. Today she finds herself in that role, and enjoys working with new lab technicians like Matt Clayton.

“Matt is fresh out of school and has innovative ideas—we talk about them,” she said. “I explain why we do certain things the way we do, and together we come up with an approach that is best for the patients.”

Sophisticated Equipment, Less Travel, Compassionate Care

This article was published in our 2015 Annual Report.

Gifford mammography

Gifford’s Lead Mammographer Terri Hodgdon

When Lead Mammographer Terri Hodgdon came to Gifford in 1991, the Radiology Department had four full-time employees and she took medical images in just two areas. Now patients come for mammography, ultrasound, X-rays, MRIs, and interventional radiology treatment. The darkrooms are gone (images are digital now), and the department is staffed by nearly a dozen people, including technologists at the Sharon and Berlin clinics.

This growth responded to a need for local radiology services, so patients could avoid travelling for care. Hodgdon sees primarily sports-related injuries when working in Sharon, but in Randolph she helps patients with mammograms, cardiac and lung issues. The newest procedures use interventional radiology (using medical imaging for breast biopsies, to place PICC lines, or to find and drain abscesses), which are less invasive than surgery.

“In radiology you have to be a perfectionist—it’s really important that everything is lined up perfectly,” said Hodgdon. “Still, easing people’s anxiety is a big part of my job. We’ve expanded. We have the newest technology, but helping the patient through the process still comes first. That’s stayed the same over the years.”

In-House Imaging Expertise for Faster Reports

This article was published in our 2015 Annual Report.

Gifford’s radiologists Drs. Alan Ericksen and Jeffrey Bath

Gifford’s radiologists Drs. Alan Ericksen and Jeffrey Bath

For many, “Radiology” brings to mind a room filled with intimidating X-ray, CT, MRI, ultrasound, or mammogram machines. Few think about the people behind the cutting-edge equipment, specially trained physicians who translate images into accurately diagnosed diseases or injuries. These specialists work closely with providers to troubleshoot and find the most effective treatments for patients.

Last spring Gifford hired two new radiologists, Dr. Jeffrey Bath and Dr. Alan Ericksen, to create our first employee-staffed Radiology Department (radiology services were previously contracted through outside private practices).

This change strengthens our personalized patient-care focus by providing seamless physician collaboration and shorter reporting times. Using new voice recognition software, the radiologists can read images and dictate their findings right into the digital storage system –often within just a few hours.

“With radiologists in-house the whole process is streamlined —I don’t have to wait for technicians to send images out as I’ve had to do in larger hospitals,” said Pediatrician Dr. Christina DiNicola. “In an emergency I could have a report within 20 minutes, the time it takes a patient to cross the street to radiology, have the procedure, and return to my office to discuss treatment!”

The Best Beginnings: Personalized, 24-Hour Support for Moms and Newborns

This article was published in our 2015 Annual Report.

Gifford's Birthing Center

(L to R): Bonnie Hervieux-Woodbury, Ronda
Flagherty, Karin Olson, Kim Summers, Mary Borie, Bonnie
Solley, Jennifer Davis

For more than 35 years women have traveled from all over to have their babies at Gifford. Our nurses are famous for their loving care — many have helped welcome multiple siblings to a family.

“Our certified nurse midwives and Birthing Center nurses provide compassionate, personalized labor support for low-intervention births,” said Director of Women’s Health Bonnie Hervieux-Woodbury. “Women are attracted to Gifford because we offer a variety of choices, including epidurals and the back-up support of three ob/gyn physicians.”

Partnering to Improve Patient Access to Care

This article was published in our 2015 Annual Report.

Physician assistants and nurse practitioners are partnering with medical doctors to help patients get the care they need, when they need it. These health professionals have been specially trained to provide primary care and help patients learn how to make the lifestyle changes that will help them stay healthy.

Physician Assistants Certified (PA-C)

Physician assistants, under the supervision of a physician, are primary health care professionals who are trained to diagnose and treat acute illness and injury, assist in surgery, and manage chronic disease. Following a medical model, they use preventive medicine to promote healthy lifestyles and provide a broad range of healthcare services.

Education: Physician assistants graduate from a Master of Physician Assistant Studies program.

Certification: Physician assistants are certified by the National Commission on Certification of Physician Assistants and, like physicians, licensed by the state Board of Medical Practice.

Nurse Practitioners (NP), also known as Advance Practice Registered Nurses (APRN)

Nurse practitioners train to specialize in a specific area (including primary care). The core philosophy of the nurse practitioner field is individualized care, preventing illness, promoting wellness, and patient education.

Education: Nurse practitioners are registered nurses who have completed a minimum of a master’s degree and received training in the diagnosis and management of
common medical conditions, including chronic illnesses.

Certification: Nurse practitioners are certified through the American Nurses Credentialing Center or American Academy of Nurse Practitioners in specialized areas and are licensed by the state and overseen by the Vermont State Board of Nursing.

Rebecca Savidge, Chelsea Health Center PA-C

Rebecca Savidge Chelsea Health Center PA-C

Rebecca Savidge, Chelsea Health Center PA-C

“When I was growing up, I came to the Chelsea Health Center to see Starr Strong. The way she practiced medicine influenced my choice to become a PA.

Living close to those I care for is important to me. Now I see generations of patients in the same family. When I started, Starr passed her patient’s history on to me, as it had been passed on to her when she started. It’s like the passing of a community torch.”

Tammy Gerdes, Bethel/Rochester Health Center PA-C

Tammy Gerdes, Bethel/Rochester Health Center PA-C

Tammy Gerdes, Bethel/Rochester Health Center PA-C

“Patients want to be heard—when they feel heard, healing can happen. I wanted to be in a small clinic setting where I could give unique and individualized care because I treat every patient as if they were a member of my extended family.

Practicing medicine is a fine art. I have found that I am both a teacher and a student, asking questions on my medical journey. Gifford’s focus is on the patient, so I knew this setting would allow my practice style to flourish.”

Making a Difference: When Work Becomes Community

This article was published in our 2015 Annual Report.

Drs. Lou DiNicola and Christina DiNicola

Drs. Lou DiNicola and Christina DiNicola

In 1976 Pediatrician Lou DiNicola came to Randolph for an interview shortly after completing his residency. The first provider he met wore jeans and a flannel shirt, and he knew right then he was at an unusual organization.

“I spent the night at the CEO’s house—it really was a community hospital!” he said. “I wanted to work in Vermont, and I wanted to care for kids, not just see them and send them on to a larger medical center. I took the position.”

Forty years later, DiNicola is still practicing in Randolph (he also saw families in the Rochester clinic until 1992), and he has become a passionate and respected advocate for children’s health, helping to shape state legislation on a range of issues.

The organization has grown (there are now six community health centers), and you see fewer flannel shirts, but the feel of a “real community hospital” remains. The local Rotary Club holds morning meetings in the cafeteria, where at lunch the staff mingles with neighbors who come for great locally-sourced food; there are no reserved spaces for VIPs in the parking lot; and the computerized staff email directory is still arranged alphabetically by an employee’s first name.

In a small community everyone’s lives are intertwined. We care for people who repair our cars, teach our children, attend our church, or manage the store where we buy groceries. The lines that separate hospital from community, caregiver from patient, and even family from co-worker are less distinct.

“Everything that happens in the community —a town fire, school events, Hurricane Irene—comes into our office as well. I have patients now who are the grandchildren of patients I saw years ago,” said Dr. Lou DiNicola. “I live less than three miles from work; clearly this is my home.”

For Dr. Lou DiNicola the connection goes even deeper: Pediatrician Dr. Christina DiNicola spent a summer jobshadowing him before heading off to Stanford University in fall of 1994. Today her former mentor is both a colleague and her father-in-law.

“I wanted to live in the same community I worked in, to have the same accountability to community as to family,” said Christina, who came from a larger practice in Philadelphia last spring. “People care about each other, and about life outside work. There’s a special kind of familiarity this way. The people I see in the office I also see in my community—just in different roles.”

Both Dr. DiNicolas say this blurred line between their work and community roles brings relevance to their work, and shapes the way they deliver care. When something they do has a positive impact, they can see how lives are changed.

“In previous positions I was part of a team of rotating doctors,” said Christina. “My work in the clinic here is especially satisfying to me because I can follow up directly with patients and build ongoing relationships with families.”

Dr. Lou DiNicola says the opportunity for connection and community still attracts new providers. Another draw also endures, something he recognized when he visited years ago, and that is Gifford’s focus on quality. This ensures that the technology and expertise needed for direct patient care is available locally—most patients aren’t sent elsewhere after diagnosis. We do everything we can to treat our patients in the community setting.

“Today medical students are most often trained to be specialists at larger medical centers. Those who want to do more personalized care, and to see a wide range of cases, come to rural medicine,” he said. “I value my ongoing relationships with people in the community, but I also take satisfaction in being there for people who have come a long way for care. People from all over choose to have their babies at Gifford and helping them with the birthing process, whether routine or complicated, has also always been a rewarding experience. We have the best of both worlds at Gifford!”