Beyond “Cookie-Cutter” Medicine: Keeping the Passion Alive

This article was published in our 2015 Annual Report.

beyond cookie cutter medicine

Drs. Jonathan Bjork and Robert Rinaldi

When podiatrist Rob Rinaldi first visited Gifford in 2003, he was struck by the energy and passion he encountered as he talked with staff.

“Everyone shared two ideals—to serve their patients in the best way they possibly could, and to make the hospital grow in good ways. Everyone wanted to make a contribution.”

Rinaldi says this first impression hasn’t changed over the years. The hospital has grown: clinics, buildings, and additional staff have been added and new technology brought in. He helped to create a new Sports Medicine program in 2005. Today, athletes come from all over the Upper Valley to the Sharon Health Center, which now has a physical therapy gym space, physical therapy treatment rooms, and a state-of-the-art gait analysis system.

“I’m amazed at how much has changed and happened, but the passion—the focus on the health and well-being of the people we serve—is still here,” he said. “We don’t treat patients with cookie-cutter medicine. People are not just numbers here.”

This focus on personalized care also brought Podiatrist Jonathan Bjork to Gifford last spring.

“I like to develop good, ongoing relationships with patients—not just performing surgery but also helping with rehabilitation, and treating patients in the clinics,” he said. “I saw I could do that here.”

Like Rinaldi years ago, Bjork was impressed by the open and supportive environment created by his colleagues.

“There’s no sense of hierarchy here,” he says. “People offer help and guidance, but it isn’t done with a critical eye.”

Rinaldi says that new providers at Gifford are nurtured by seasoned staff, many who have been at Gifford for years, and that this model transforms the traditional mentoring role.

“It’s unusual because the long-term providers all still have the passion they started with!” he says. “Now they are showing new providers—not how to be a better doctor necessarily, but about the rewards of personalized patient care and how this helps to keep the passion alive.”

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.”

New Offices, Staff Increase Access for Berlin Primary Care Patients

This article was published in our Spring 2016 Update.

Berlin primary careIn late April patients at the Gifford Health Center at Berlin began seeing primary care providers in a new facility, just up the hill from the existing health center offices.

New providers Dr. Kasra Djalayer, nurse practitioner Elizabeth Saxton, and providers from Gifford’s Behavioral Health Team have joined nurse practitioner Jeff Lourie in the new Primary Care building, making it easier for area patients to build a relationship with a local provider. Ob/Gyn services are now available in Berlin, and our team of certified nurse-midwives will provide well-woman and prenatal care from offices in this new location.

The existing Health Center building, which opened in 2007, is now dedicated to specialty practices, including Orthopedics, Physical Therapy, Podiatry, Neurology, and Urology. The vacated primary care space has been renovated for physical therapy services on site. Also provided in the specialty clinic are enhanced lab, X-ray, and diagnostic technology services, which include MRI’s from a visiting mobile unit.

Both buildings are conveniently located off Airport Road, with plenty of open parking spaces. Call today: 224-3200 (Primary Care) or 229-2325 (Radiology & Specialty Clinic).

Gifford Specialists Bring Quality Care Close to Home

This article was published in our Spring 2016 Update.

Gifford specialists are supported by the most current advanced diagnostic technology and offer a range of specialty services—all conveniently located right in your community, with easy access and parking. Specialty services include:

• cardiology
• general surgery
• neurology
• oncology
• ophthalmology
• orthopedics
• podiatry
• sports medicine
• urology
• rehabilitative services that include physical, occupational, and speech therapies

New Providers on the Specialty Services Team

General Surgeon Dr. Mario Potvin

General Surgeon Dr. Mario Potvin Born and raised in Quebec City, Dr. Potvin brings nineteen years of experience in general surgery, advanced laparoscopy surgery skills, and extensive knowledge of endoscopy and GERD investigation. He practiced in Canada for six years before accepting a position with the Mayo Health Systems in 1997. He has lived and practiced in Minnesota since then, but wanted to move closer to family in Quebec.

Oncologist Dr. Eswar Tipirneni

Oncologist Dr. Eswar Tipirneni Board certified in both internal medicine and hematology/oncology, Dr. Tipirneni is now seeing oncology patients one day a week in Randolph. He is also a provider in the UVM Health Network, and so brings the resources of an academic cancer research center to his patients at Gifford, including participation in multidisciplinary tumor boards and current clinical trials.

Anesthesiologist Dr. Anthony Fazzone

Anesthesiologist Dr. Anthony Fazzone has worked in several area hospitals, including the University of Vermont Health Care System, Springfield Hospital, and the Catholic Medical Center in Manchester, NH. He has a special interest in regional anesthesia, which uses nerve blocks, spinal taps, or epidurals to help patients avoid high doses of medication and provide pain relief for patients after surgery.

Gifford Welcomes Dr. Jonathan Bjork

Dr. Jonathan Bjork

Dr. Jonathan Bjork

Podiatrist Jonathan Bjork has joined Gifford Medical Center’s Randolph and Sharon clinics.

A board-certified podiatrist, he received a BS from St. Olaf College, a Doctor of Podiatric Medicine from Des Moines University, and completed his Podiatric Medicine and Surgery Residency at the William S. Middleton VA hospital in Madison, Wisconsin.

While in medical school, Bjork chose to specialize in podiatry because it would offer opportunities for a varied practice: performing surgery, working in a clinic, helping patients with rehabilitation, and treating sports injuries. He brings widespread clinical interests to his work, from rear foot and ankle surgery, flat foot reconstruction, and heel spur resection to diabetes-related infections, sports injuries, and treatment for bunions and hammertoes.

“I like to develop good, ongoing relationships with patients so I can get to know their needs and expectations,” said Bjork. “This allows me to consider a patient’s specific concerns when treating injuries or infections.”

Bjork and his wife have family near Boston and were looking to settle in a small town where they could raise their 4-month-old son. They have purchased a home near the hospital with a yard (space for a golden retriever) and easy access to the outdoor activities they love: skiing, mountain biking, and hiking.

“Randolph is a very warm and welcoming community,” said Bjork. “It is smaller than Platteville, Wisconsin, where I grew up, but it reminds me of my home.”

Bjork is the newest member of Gifford’s team of podiatrists, which includes Dr. Nicolas Benoit (Randolph), Dr. Samantha Harris (Berlin), and Dr. Paul Smith (Sharon). He is now accepting new patients at our Randolph and Sharon locations—call 728-2777 to schedule an appointment.

Gifford’s 2014 Highlights: July – September

The following article appeared in our 2014 Annual Report.

July

Gifford concert seriesThe White River Valley Chamber of Commerce and Gifford once again partner to offer concerts and now a farmer’s market on Tuesday evenings throughout the summer in the Gifford Park. Two community barbecues — one by Stagecoach and one by the Randolph Center Fire Department — also draw a crowd.

podiatrist Dr. Samantha HarrisPodiatrist Dr. Samantha Harris joins the Gifford Health Center at Berlin, providing full spectrum surgical and non-surgical podiatric care.

Gifford’s midwives hold an open house to introduce their new team to the community.

August

Dr. Kenyatta NormanAfter working at Gifford since January as a locum tenens physician, orthopedic surgeon Dr. Kenyatta Norman makes her position permanent.

A “Heartsaver CPR” certification course is offered to the community.

Last Mile RideJP’s Flea Market, formerly the Randolph Antique and Artisans Fair, is held in the Gifford park on Aug. 9. Cars line the street looking for deals and meals.

The ninth annual Last Mile Ride raises a record $60,000 for end-of-life care. This year’s event is spread over two days and attracts a record 386 Sue Schoolcraftparticipants.

Sue Schoolcraft of Randolph gains media recognition statewide for her work to make personalized quilts for Menig residents. Her work is supported by the Last Mile Ride.

ob/gyn Dr. Sean TubensOb/Gyn Dr. Sean Tubens joins the Gifford Ob/Gyn and Midwifery team from his hometown of Baltimore, bringing total laparoscopic hysterectomies to Gifford for the first time.

September

Dr. Melissa ScaleraDr. Melissa Scalera, an Ob/Gyn, joins Gifford’s women’s health team, providing complete gynecologic and obstetrics care in Randolph.

Colorado couple, sports medicine physician Dr. Nat Harlow and family nurse practitioner Christina Harlow, join Gifford’s Sharon sports medicine and Randolph primary care practices respectively. Dr. Harlow is fellowship trained. Christina holds a doctor of nursing practice degree.

Dr. Jeff LourieFamily nurse practitioner Jeff Lourie joins the Gifford Health Center at Berlin.

Project Independence of Barre officially merges with Gifford.

Gifford’s 2014 Highlights: April – June

The following article appeared in our 2014 Annual Report.

April

Gifford volunteersGifford employee Cindy Legacy, who shared her weight loss story in the 2013 annual report, starts a popular “Weight Loss Support Group” at Gifford on Wednesday evenings.

Gifford volunteers are celebrated at a luncheon. In 2013, 120 volunteers gave 16,678 hours to Gifford or 2,085 eight-hour days. Auxiliary volunteers working at the Thrift Shop gave another 6,489 hours or 811 eight-hour days. The celebration’s theme was “Hats Off to You.”

May

Gifford is named a Top 100 Critical Access Hospital in the nation by iVantage Health Analytics. iVantage used what it calls a Hospital Strength INDEX to compare Gifford against 1,246 Critical Access Hospital nationwide on 66 different performance metrics.

Starr StrongStarr Strong retires from the Chelsea Health Center after 21 years. She was the first physician assistant Gifford ever hired. An open house recognizes both Starr’s contributions and welcomes new providers to the clinic, which is packed for the event.

Sen. Bernie Sanders (I-Vt.) and officials from the Health Resources and Services Administration release a video holding up Gifford as a national model for primary care.

Casa RinaldiSharon Health Center staff members cut a ribbon on their newly expanded health center. Added are 2,600 square feet and a sign beside the front door declaring the building “Casa Rinaldi” in honor of podiatrist Dr. Rob Rinaldi who helped create the vision behind the popular sports medicine clinic.

New technology is also offered, such as a state-of-the-art Noraxon gait and movement analysis system, and a large wall-mounted monitor for a better look at live ultrasound imaging.

senior living facility groundbreakingGround is broken on a much-anticipated senior living community in Randolph Center. More than 100 are on hand to witness the start of the first phase of the project — a new, 30-bed nursing home to replace the current Menig Extended Care Facility.

A second “Infant and Child CPR” course is held, along with a second “Home Alone and Safe” course, a second “Babysitter’s Training Course” and another “Quit In Person” group smoking cessation series.

“Low Impact Water Aerobics for Chronic Conditions” is offered at Vermont Technical College’s pool for free for those with an economic need and chronic condition who are struggling to exercise.

June

Project IndependenceGifford announces that it will merge with Barre adult day program, Project Independence, at the end of September. Project Independence is the state’s first adult day program and serves 23 towns in Washington and northern Orange counties, providing an essential community resource.

The non-profit organization was facing financial struggles following flooding in 2011. A merger with Gifford means shared staff and reduced costs for the organization, allowing it to keep operating. The boards of both non-profits agreed to the merger in May.

Gifford renovationsGifford is the first hospital in Vermont to “go live” with the Vermont Department of Health interface for syndromic surveillance. The interface is part of federal meaningful use criteria.

Renovations begin on Gifford’s third floor specialty clinics to group medical secretaries, nurses, and patient waiting for improved efficiency and a modern model of care.

Chiropractor Steven S. Mustoe Joins Gifford’s Sports Medicine Team

Dr. Steve Mustoe

Dr. Steve Mustoe

Steven S. Mustoe, D.C. has joined the Sports Medicine clinic at the Sharon Health Center. A board-certified chiropractor, he has practiced for the last 18 years in Brattleboro, VT and Charlottesville, VA.

Mustoe became a chiropractor because of his own experience with an injured back. “The only relief doctors could offer was through medication. When I went off drugs, the pain returned,” he said. “I eventually found a chiropractor who helped me heal. To be able to relieve someone’s pain like that is an amazing thing!”

Originally from London, England, he received a Doctor of Chiropractic degree at Life Chiropractic West in California after relocating to the States to be with his wife, Gail. The two met 25 years ago when Mustoe was a tour guide on a seven-week bus tour through Europe. They’ve been together ever since, and now have two children.

After years in private practice, Mustoe looks forward to collaborating with a multidisciplinary sports medicine team that includes podiatry, general sports medicine, and physical therapists. He is also excited about the equipment and technology at the Sharon center—a physical therapy gym space; x-ray technology and mounted flat screens for reviewing radiological exams; physical therapy treatment rooms; and a state-of- the-art gait analysis system.

His special interest is in helping people regain the ability to enjoy their life: as an athlete, an injured veteran, or someone unable to perform daily tasks.

“I tend to work gently, to listen to people and then help with function as well as pain,” he said. “You don’t have to be an athlete—maybe what’s important to you is to be able to play with the grandchildren in the back yard.”

Dr. Mustoe is now seeing patients at the Sharon Health Center. Call 763-8000 to schedule an appointment.

Guiding the Future of Rural Health Care

The following article appeared in our 2014 Annual Report.

Gifford volunteers

Back (left to right) Linda Morse, Peter Nowlan, Sheila Jacobs, Paul Kendall, Matt Considine, and Lincoln Clark. Front: Jody Richards, Barbara Rochat, Gus Meyer, Dr. Ellamarie Russo-DeMara, Randy Garner, Sue Sherman, Joe Woodin, Carol Bushey, and Linda Chugkowski. Not pictured: Bill Baumann, Fred Newhall, and Bob Wright.

Volunteer board leads Gifford with vision, passion and energy

2014 was a year of great excitement for Gifford, as several projects moved from the planning stage into actual implementation. Our FQHC status, new senior living community, and the much-needed upgrade for inpatient rooms are all visible signs of Gifford’s readiness for quality community care in a larger landscape of changing healthcare reform.

Each of these accomplishments was built on years of behind-the-scenes planning. None of them would have been possible without the dedicated work of our 16 volunteer board members, who last year alone collectively gave more than 2,500 hours of their time to meetings and subcommittee activities. Board members bring passion and energy to the challenge of balancing the work that translates our mission (providing access to high-quality care to all we serve) with anticipating and planning for future healthcare needs.

“Gifford is woven into the fabric of this community. For more than 100 years generations have had the benefit of local access to quality care,” says board secretary Robert Wright, who was born at Gifford and now lives in Brookfield. “Gifford has been able to maintain that identity and also grow with the times, attracting highly skilled people and successfully investing in the equipment and facilities needed to provide the quality of care that people expect.”

Board members are recruited from across the community and have worked in various businesses and civic organizations. This diverse perspective keeps Gifford’s vision grounded in the community it serves, with a distinctive small town commitment to quality.

Board work is demanding, but members say learning about the hospital and participating in decisions that will shape the future of healthcare in their community is rewarding.

“It is by far the most rewarding volunteer activity that I have ever done,” says Randolph resident Randy Garner. “Gifford has shown me the model of being an actively engaged board member, and seeing the results of the board’s actions is extremely gratifying.”

Others want to give back to their community: “I joined the board because Gifford is community focused, a small town hospital that provides excellent healthcare and uses the latest technology,” says Northfield resident Linda Chugkowski. “I feel proud and privileged to be promoting the hospital during these troubled health care times.”

The job description for a Gifford board member might read: part planner, policy-maker, visionary, realist, promoter, cheerleader, and community advocate. It requires the ability to bring a pragmatist’s eye to sustaining robust primary care and a visionary’s openness to future possibilities. When asked what makes the institution unique, you’ll get the clear answer of a realist:

“Gifford is unique in that they are a small Critical Access Hospital and FQHC facility with niches that they do better than anyone else, like primary care, podiatry and sports medicine,” says Brookfield resident Carol Bushey. “They will never compete with the large hospital, but they will continue to do what they do better than anyone long into the future.”

But new possibilities and future community roles for Gifford are always part of the planning:

“I am excited to see the direction Gifford is going with the senior living community and hope that this continues to all levels so Randolph will have a place where folks can comfortably live out their lives,” says Garner. “Gifford will continue to be on the forefront of quality care with a small town feel.”

Gifford’s Dr. Rob Rinaldi Honored

Podiatrist/sports medicine advocate celebrated for His 12 years at Sharon Health Center

Dr. Rob Rinaldi

Dr. Rinaldi

Gifford staff gathered on March 25 to celebrate podiatrist Dr. Rob Rinaldi’s 12 years of service to an expanding community of athletes, and to wish him well as he transitions to new roles in the organization.

The party featured a cake shaped like a foot, lots of foot jokes, and heartfelt stories about Rinaldi’s many contributions and roles at Gifford: as generous mentor, sports medicine advocate, surgeon, and the force behind the very successful Sharon Health Center and sports medicine clinic.

“I flunked the first time I retired!” Rinaldi quipped, explaining that he missed seeing patients when he left a thriving Connecticut practice and retired to his farm in Chelsea in 2000. So when Gifford Administrator Joe Woodin approached him about expanding sports medicine at Gifford, he was receptive: “I didn’t want to sound too anxious, so I said yes!”

Rinaldi helped design the first phase of the Sharon Health Center, which opened in 2005. By 2008 a 2,200 square foot expansion was added to accommodate the thriving sports medicine clinic, and a final planned 2,600 square foot expansion was added in 2014.

Today, athletes come from all over the Upper Valley to the center, which includes a physical therapy gym space; x-ray technology and mounted flat screens for reviewing radiological exams; physical therapy treatment rooms; and a state-of- the-art gait analysis system. The sports medicine team includes: Michael Chamberland, DC (chiropractic/sports medicine); Paul Smith, DPM (podiatry/sports medicine); Nat Harlow, DO; and Peter Loescher, MD (sports medicine); and a team of physical therapists.

“Rob brought years of business experience to the creation of Sharon Health Center,” Woodin said. “But he also brought his pride in what he does, and his entrepreneurial spirit to Gifford.”

The stories Rinaldi’s colleagues told described a generous and compassionate mentor: “Rob was the voice of wisdom, the one people came to when facing some sort of challenge,” said Vice President of Surgery Rebecca O’Berry.

Although he will no longer be seeing patients, Rinaldi will continue to serve on administrative committees at Gifford, and will work with residents at the new Menig Nursing Home when it opens this spring in Randolph Center.