Editors’ Note

Joan Cusack-McGuirk is an executive and healthcare leader with 40 years’ experience. Earlier in her role as Vice President and Chief Nursing Officer, she was responsible for the successful integration of two divergent patient care cultures into a singular care model. She was promoted to Senior Vice President and Chief Nursing Officer and for the last several years led transformational changes related across the themes of rapid change which require necessary prioritization and impact on major roles to keep pace with the changing healthcare delivery system. Cusack-McGuirk graduated from St. Vincent’s Hospital School of Nursing and Medical Center in New York City, received her B.S. in nursing from SUNY New Paltz, earned a master’s degree from NYU, and is a graduate of the Johnson & Johnson Wharton Fellows Program. She is a past President of NYONE (New York Organization of Nurse Executives) and is active in community and professional organizations, as well as public policy at the regional and state level.

Institution Brief

Montefiore St. Luke’s Cornwall (montefioreslc.org) is a not-for-profit community hospital with campuses in Newburgh and Cornwall, New York. The hospital is dedicated to serving the healthcare needs of the Hudson Valley and has achieved excellence in the delivery of compassionate and comprehensive healthcare services. In January 2018, MSLC officially became part of the Montefiore Health System to strengthen the delivery of healthcare locally and enhance access to exceptional specialty care for Hudson Valley residents. In March 2019, the hospital changed its name from St. Luke’s Cornwall Hospital to Montefiore St. Luke’s Cornwall.

Will you provide an overview of Montefiore St. Luke’s Cornwall and what have been the keys to the hospital’s strength and leadership in the industry?

Montefiore St. Luke’s Cornwall (MSLC) is a 242-bed Acute Care Hospital and a proud member of the Montefiore Health System. MSLC provides more than 250,000 patient encounters annually on two campuses. MSLC’s strengths have evolved from our deeply-rooted presence and profound belief in our social responsibility to be role models in the communities we are privileged to serve. Not only do we hold ourselves accountable for leadership within the hospital, but believe we must be seen as a good citizen of our communities. Remaining an economic engine that employs more than 1,200 team members is one way we demonstrate our strength and leadership in healthcare. Additionally, because quality is never a negotiable and with our obligation to our community, we believe we must achieve milestones consistent with best practices and challenge ourselves to exceed both industry and non-industry measures of success. These include, but are not limited to: Named Top 5 percent in the nation for Clinical Excellence by Healthgrades, recognized and certified as a “Great Place to Work” by the Great Place to Work® Institute for the fourth consecutive year, and listed in Fortune’s “Top 40 Workplaces in Healthcare and Biopharma,” the only hospital of our size to do so. Given our staff satisfaction, it is not a surprise that MSLC has received such terrific recognition. MSLC’s most recent achievement was that of our designation as a Magnet Hospital by the American Nurses Credentialing Center’s Magnet Recognition Program®. At the end of the day, our strength and leadership in healthcare is the passion, commitment and dedication of our employees and medical staff. They are unequivocally responsible for our success.

How has Montefiore St. Luke’s Cornwall adapted the way it works to address the global pandemic and how proud are you to see the way your team has led and showed resilience during this difficult time?

I have never been prouder of the Montefiore St. Luke’s Cornwall team than during these last eight months of the COVID-19 pandemic. The phrase “stepping up” does not even begin to describe how each and every member of the MSLC team courageously took charge during these unprecedented times. Mere words could never give justice to the bravery that was demonstrated every single day and night throughout this pandemic. It wasn’t bravery without fear, but that said, the team came together to support each other, our patients, and their loved ones. In turn, the community supported us with an overwhelming amount of donations which came in many forms….monetary, personal protective equipment, meals and gift cards for our staff, and perhaps the most heartwarming were the handwritten cards and banners with words of encouragement and messages of gratitude, admiration and positivity. While many hospitals across the country were experiencing record high call-outs and staffing challenges, our teams worked extra shifts to support their fellow colleagues and our community of patients. The acts of heroism were displayed by every member of the team from our doctors, nurses, patient care assistants, environmental services, phlebotomists, respiratory therapists, food services, marketing, quality, human resources, security officers, registration, information technology, administration, coders, physical therapists, radiology, engineers – literally every department across the entire organization. The “bell rang” and everyone answered the call. Not only did our staff show up, but they came with heart, compassion, and dedication. Our expert medical teams worked tirelessly to fight something bigger than anything any of us ever thought we would see in the 21st century in a first world country. It is an honor to walk the same halls as these incredible individuals that I am privileged to call my colleagues.

How critical is it for Montefiore St. Luke’s Cornwall to build a diverse and inclusive workforce that mirrors the diversity of the patients and communities it serves?

Diversity and inclusion is mission critical at Montefiore St. Luke’s Cornwall (MSLC) and should be for any community hospital as we are seen as a hub to the communities we serve. As a community hospital, we have the unique benefit of a great deal of the MSLC workforce being community members themselves. More than 25 percent of MSLC employees reside in the city of Newburgh or town of Cornwall which is home to our two campuses. We care for our friends, neighbors and loved ones during some of life’s most critical moments. This deep-rooted connection and an understanding of the diverse backgrounds in the communities we serve allow us to create an environment that is inclusive of all. Our Diversity and Inclusion Committee is, by nature, a diverse group of employees, all of whom help to create the message of diversity and inclusion that draws so many to MSLC. The year 2020 has been a year of significance for diversity and inclusion, with a global COVID-19 pandemic in full swing, we saw blatant racism and social injustices that simply could not go on without a nation needing to respond. At Montefiore St. Luke’s Cornwall, it remains clear that we actively oppose racism and social injustice of any form. A commitment document was issued outlining the concrete steps we are taking to improve access to care and eliminate racial biases that contribute to poor health outcomes. Every voice matters as we work together to drive lasting change to create an inclusive environment for all. We collectively share in the future success of MSLC, all of which is built on trust and transparency.

What was your vision for creating the hospital’s Care Transition Program and have you been happy with its impact?

The Care Transition Program at Montefiore St. Luke’s Cornwall (MSLC) has been a transformational shift in the manner in which we provide care to our community. Through Care Transitions, the focus moves from being reactive toward illness to proactive toward wellness, something required when using a population health model of care. The role of the hospital has evolved over the years to change from treating those when they’re sick, to managing patients through the continuum of care and creating relationships within our communities to teach people how to lead a healthy lifestyle. MSLC has seen tremendous success in this regard, and even among the COVID-19 pandemic, our clinicians are working with patients long after they’ve left the four walls of our organization. Since inception in 2011, we’ve seen over a 15 percent decrease in hospital readmissions within 30 days for patients who are over 64 years of age through our Care Transition program. Throughout the pandemic, the importance of this program cannot be unscored enough. The need to care for patients and truly stay with them long after their acute care needs have been met is more evident now than ever before. As we continue to battle the long-term effects of this virus, the hospital’s efforts in this regard will be crucial in taking care of our community. The evolution of healthcare delivery is ever-changing and the more willing we are to adapt to such change determines not only our success as a vital access provider, but also the success of the health of our communities.

Will you highlight Montefiore St. Luke’s Cornwall’s efforts to provide the highest quality patient care in a cost-effective manner?

In 2018, St. Luke’s Cornwall Hospital became an official member of Montefiore Health System, allowing our community hospital to join forces with a leader in the nation for high-quality, innovative healthcare services and population health. Montefiore St. Luke’s Cornwall’s vision as an accountable and integrated healthcare delivery system with the hospital as a hub for the community has developed several high-quality, cost effective programs in an effort to achieve the Quadruple Aim (improving the health of the population, increasing patient satisfaction, lowering cost of care, and healthcare workforce satisfaction). MSLC has implemented innovative models to achieve its vision, including utilization of the Medicaid Accelerated Exchange (MAX) Series, co-location of Care Managers within the Emergency Department (ED) and utilization of a county-wide Mobile Mental Health Service, each without cost to the hospital. The models achieved all four elements of the Quadruple Aim as these partnerships created a community-based accountable delivery system that connects individuals to community-based resources and is focused on providing the right level of care at the right time for the right cost. For example, the MAX Series (super utilizer) program, which targets patients with six or more ED visits and at least three hospitalizations, in and of itself, addressed every aspect of the Quadruple Aim. This was done by achieving a 33 percent reduction in avoidable hospitalizations and ED visits in its population which ultimately lowered the cost of care, increased patient satisfaction because of the new community engagements and local connection to services, and increased ED staff satisfaction related to being able to help a population they used to feel defeated by. All this was accomplished despite these innovative models not yet supported by traditional fee for service (FFS) payment models. As previously mentioned, quality is never a negotiable, and when caring for a disparate population, we must have an eye towards cost of care. By becoming part of something larger than ourselves, MSLC has been able to provide the right level of care to all patients at a location that is easily accessible to them, connecting them to appropriate, available community-based resources, while moving our contracts to Value Based Payment models. This has assisted us in achieving our goals of providing high-quality care at the lowest possible cost. It’s been said before: “no margin, no mission.” We have a responsibility to our patients to provide the most cost effective, expert care to ensure we can be here to care for our community long into the future.

You have spent your career in the healthcare industry. What has made the experience so special for you?

My career in healthcare has been special for me for many reasons. The first one that comes to mind (and heart) is that in many ways I followed in my father’s footsteps. When I was a young girl my father was employed by the Health & Hospital Corporation in New York City. Every Saturday he would round, and I would accompany him, on one of the 11 hospitals for which he provided oversight. I watched him with such admiration and it left a lifelong impression on me.

I have had the privilege of being a nurse for greater than 40 years. I’ve worn many hats over the years, from bedside nurse, to chief nurse, to my current role as CEO. I’ve witnessed the joy of seeing and caring for new life being brought into this world as well as the privilege of being present in the passing of a life, and everywhere in between.

In my role as President and CEO, some of those special experiences include solidifying the partnership with Montefiore Heath System and being part of leading a transformational change that is occurring both at the local level and in the larger realm of healthcare delivery. Other special experiences are the opportunity to participate in state-wide professional organizations, serve on community boards as well as having the privilege to have heartfelt connections with the people of our community. In addition, leading an organization and being part of creating a culture of team participation where all are empowered to promote and create change has been a crucial element of my career. I have the unique privilege of being part of such a transformational shift. This could not be accomplished without the active engagement and participation of a supporting Board of Trustees, medical staff, all the employees that I am proud to call my colleagues and an Executive Team that is second to none. Last, and far from least, experiencing this COVID-19 pandemic - if we ever wondered as healthcare providers if we make a difference, our question was answered.

What advice do you offer young people interested in building a career in the healthcare industry?

First and foremost, you need to have a caring attitude and a willingness to serve. Serving not only the patient, but the community and our profession needs to be at the forefront. The industry is ever-changing and the desire to participate in that transformation is essential. A commitment to lifelong learning and the importance of technology as we move from a reactive state of “sickness” to a proactive stance on prevention and wellness will be key in this generation of upcoming professionals. The COVID-19 pandemic has showed all of us that healthcare delivery is truly a calling. It is an incredible career, one that is done successfully not only with a level of education and training, but also with heart and compassion. At the end of the day, it doesn’t get any better than being part of something bigger than yourself.