Editors’ Note

Daniel Maughan brings over 25 years of clinical and leadership experience to Montefiore St. Luke’s Cornwall (MSLC). As immediate past President and Chief Operating Officer for MSLC, he was instrumental in MSLC’s transformation from reactive medicine to proactive healthcare management of the populations MSLC serves. These transformations include leading the efforts that brought MSLC’s COVID-19 Vaccination Program to fruition, vaccinating more than 20,000 Orange County Residents in the first months since inception. Maughan also spearheaded MSLC’s first ever Certification and Designation as a Level III Trauma Center and led MSLC’s response to the Opioid Epidemic, ensuring the community has access to Medication Assisted Treatment. He was responsible for securing more than $20 million in grant funding from NYSDOH which was necessary to facilitate expansion on both the Newburgh and Cornwall campuses as part of the multi-phased, Statewide Healthcare Facility Transformation Program, and is leading the third round of funding in 2022. Maughan has served in many clinical, operational, and leadership roles throughout his career. He is either a member or board member of Hospital Association of New York State (HANYS), Northern Metropolitan Hospital Association (NorMet), Greater New York Hospital Association (GNYHA), Orange County Partnership, Hudson Valley Economic Development Corporation (HVEDC), Orange County Board of Health, Orange County Chamber of Commerce, among others.

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. MSLC is a member to the Montefiore Health System which has allowed for the strengthening of the delivery of healthcare locally and enhancing access to exceptional specialty care for Hudson Valley residents.

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

Montefiore St. Luke’s Cornwall (MSLC) is a 242-bed, not-for-profit, acute care hospital, one of 10 hospitals in the Montefiore Health System. We are proud to be recognized by Healthgrades as a Top 5 Percent Hospital in the nation for Clinical Care, by the American Nurses Credentialing Center as a Magnet® designated organization, and by the “Great Place to Work®” global organization as a certified “Great Place to Work®”. Our services are nestled in the beautiful Mid-Hudson Valley, with our Acute Care Hospital in Newburgh, New York, and our Ambulatory Center in Cornwall, New York. As an economic engine and one of the region’s largest employers, we provide care to more than 250,000 patients annually. Our strengths are the more than 1,200 dedicated team members, along with our 400-plus community medical staff members, who embody the essence of MSLC.

The key to successful leadership at MSLC is the recognition and acknowledgement that our team and medical staff are most precious. Together, we are laser focused on providing exceptional service, ensuring a positive patient and family experience at every visit, and providing high-quality, safe care that is unmatched. We were recently recognized for the third consecutive year among America’s Top 250 Best Hospitals, placing MSLC in the top 5 percent of hospitals in the nation for clinical care, according to Healthgrades, and further acknowledged by Fortune as a Best Workplaces in Healthcare and Biopharma, one of only 21 hospitals in the nation recognized. This past year’s recognition was even more special as we learned that Fortune also recognized us as an overall Best Workplaces in New York. However, recognizing that our teams are our most valuable, one of our greatest accomplishments is being certified as a Great Place to Work® organization for five consecutive years. There is nothing better than this type of recognition as the results are determined through direct survey of our frontline teams.

You were recently appointed CEO of Montefiore St. Luke’s Cornwall. What are your priorities for MSLC as you assume the role and look to the future?

Maintaining our incredible culture, growth, improving efficiencies everywhere, enhancing our technology, and ensuring the well-being of our workforce as we navigate our new normal given the realities of COVID.

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

Adapting is something healthcare is good at. I also believe that resiliency is something most people who work in healthcare, especially hospitals, innately have. Our team displayed this throughout the peaks and valleys of the pandemic, however we should not be fooled to think that any of this is without long-term effects to the well-being of our people. As a hospital that has an 18-bed ICU, which overnight needed to increase capacity to more than 40 ICU beds a day with the staff to match, adapting was all we could do. Roles changed, spaces changed, everything changed. Regardless of the changes, each member accepted the challenges by thinking and responding differently, doing so through innovation and determination. Honestly, “proud” seems too small a word to describe the emotions I have for how our teams tirelessly cared for thousands of COVID patients. They showed up each day despite knowing what this virus was capable of, especially as they witnessed its devastating effects, all the while wondering if they were to become its next victim or if they were going to infect their loved ones. There isn’t a known word that could properly describe how I feel about the resiliency of the MSLC team. As such, ensuring their well-being was a huge focus during the last two years. Having access to 24/7 telephonic and onsite mental health professionals was and continues to be key for those who struggled and even those who didn’t know they were struggling. Selfcare typically comes second to many in the helping professions. We hope that we provided our teams with the tools to ensure they were putting themselves first and commit to ensuring well into the future.

The global realities presented by the pandemic inarguably highlighted tremendous opportunities in all sectors. There were many lessons learned and more we continue to discover. That said, an adaptation that all of us had to improve immediately was telemedicine. I believe telemedicine is probably one of the greatest examples of both a strength and opportunity. Its strength was pressure tested under the extreme condition of a pandemic, and for both the patient and provider, it provided a bidirectional lifeline; our patients needed us, and we needed them. However, some of the challenges/opportunities identified while implementing telemedicine can be easily remedied through enhanced assessment capabilities and equipment, as well as ensuring payer parity against an office visit.

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

Montefiore St. Luke’s Cornwall applies the Quadruple Aim framework at our core. Improving Population Health, Enhancing the Patient Experience, Improving Provider Satisfaction, and Reducing the Cost of Care are the tenets of this model which we firmly believe when adopted will improve patient care. Under our Health Systems Delivery System Reform program, MSLC implemented multiple programs to achieve the Quadruple Aim framework. Three examples of these programs at MSLC are the Medicaid Accelerated Exchange (MAX) Series program, Community Agency Care Manager co-location within our Emergency Department (ED), and utilization of a county-wide Mobile Mental Health program. Taking the lead as the community hospital, removing the barriers of our four-walls, and by partnering with our County Officials and Community Agency leaders, these programs were successfully implemented, improved quality and lowered costs – an added benefit was no additional expenses to the hospital or the agencies.

These models continue to provide connection to community-based resources through a reduction in avoidable hospital utilization. Specifically, the Mobile Mental Health Model at MSLC prevented 56 percent of patients presenting to the ED with a mental/behavioral health need from unnecessary transports to Psychiatric Facilities, allowing us to keep care local. Additionally, this program had a cost savings of just over $500,000.

Will you discuss MSLC’s efforts and response to addressing the Opioid Epidemic?

Orange County, New York, was a national “Hot Spot” of Opioid Addiction, with Newburgh, New York, a glaring opportunity. Issues with accessing treatment, Narcan training programs, peer support, and Medication Assisted Treatment (MAT) were all identified as culprits in our abilities to prevent overdose deaths. The lack of timely intervention related to the constraints of community agencies’ hours of operations added to an inability for on-demand care for those in crisis. All of these were quickly identified as barriers and became the genesis for a county-wide program that would lead to ensuring people with the disease of addiction had access to care. That care would need to include access, first responders being appropriately trained in managing an addicted person and how to use Narcan, implementation of community Narcan Training programs with free kits, education on MAT, and pathways for accessing MAT.

MSLC was very engaged in the county’s “Changing the Orange County Addiction Treatment Ecosystem Program.” Specifically, I, as the then Chief Operating Officer for MSLC, served as Co-Chair of the MAT sub-committee alongside the Orange County Commissioner of Mental Health. As a non-mental health and substance abuse acute care hospital, we recognized that we had to play a role as a hub for our local population. Through collaboration, MSLC was the first Emergency Department in our area to provide MAT, and we developed policies and procedures for its implementation in our inpatient settings and shared our program with all hospitals in our region. This resulted in our ability to connect our patients in crisis with real time community resources that directly link a patient to immediate access to addiction recovery programs. We also piloted an online app (PeerRX) that immediately connects peer resources for patients in addiction crisis – peer support staff immediately come to the bedside when activated. Peers provide a lived experience that is unmatched and, as such, their presence and support to a person in crisis often results in the acceptance of treatment.

Ultimately, the work of community partnerships reduced our overdoses and deaths county-wide.

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?

MSLC’s workforce matches the extensive diversity of our surrounding communities. Building a diverse workforce is critical as it gives a voice to ensuring an inclusive workforce. In 2017, MSLC developed the Justice, Diversity, Equity, and Inclusion (JDEI) committee that is solely dedicated to celebrating our differences and embracing the backgrounds of our workforce, ultimately aiding us in how we build community, care for our patients, and take care of one another. We are fortunate to have recruited and retained the most diverse and inclusive workforce in MSLC’s history throughout the last five years. However, we will not be able to retain a diverse and inclusive workforce without constantly observing, identifying, and evaluating our hospital and local communities for injustices. Once identified and evaluated, we must then implement a change that creates inclusivity. Our most recent project of the JDEI committee is to evaluate the Human Rights Campaign (HRC) Health Equity Index (HEI) Project Program and apply for recognition. We are fortunate to be a part of the Montefiore Health System, a recognized leader by the HRC, and a system that has achieved the highest tier of recognition from the HRC as a LGBTQ Healthcare Equality Leader. We look forward to entering the HRC’s HEI program at its foundational tier soon.

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

In 1977, at the age of seven, I immigrated to the United States with my family from Ireland. I am one of ten children, but unfortunately only one of seven living children when we immigrated to the U.S. We experienced poverty and its associated sequalae for a great portion of our lives. Shockingly, its prevalence is at staggering levels around the globe, including Ireland and the U.S. At the age of 15, I entered my high school’s Certified Nursing Assistant (CNA) training program. The program was the length of the school year and afforded me a free education that forever changed my life, as most high schools with a Career and Technical Education Program (CTE) often do. Once completed, I dropped out of high school and had to wait until that August to turn 16 and was then able to take my certification test; thankfully, I passed. From that point on, every day I went to work I would observe the roles of others and tried to figure out what I would do next. It was clear to me at the age of 16 that I wanted to be a nurse. As a Registered Nurse, I have had the opportunity to serve in a variety of nursing specialties and roles that have shaped my understanding of the human condition. This is especially true as it relates to identifying and helping to provide tools that prevent the pain and suffering associated with poverty and its sequala. Each time I changed my specialty or role, it allowed me to open myself up to experiences and possibilities that I didn’t know I wanted to be part of or wanted to achieve. Over time, I recognized that opening myself to all experiences and possibilities were essential to reaching any goals I had, have, or am waiting to experience.

Why is healthcare so special to me? Everything about helping others is special, and as my career in healthcare has progressed, I am profoundly aware that I was drawn to helping others. In my early days, it was likely an unhealthy choice to match the chaos of my life and to meet both my need for feeling good about helping others and making myself feel good. Today, healthcare is special to me because I know the work that I do impacts the lives of those who continue to struggle in the way that I once did.

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

The best advice I can give is to allow yourself to be open to whatever comes your way. Volunteer in all types of healthcare settings and experience what you can to help drive your direction. Do the work, enjoy the work and when it is no longer enjoyable, find something else to do. Enter with compassion, never lose your integrity, and always take care of yourself first. Putting yourself first and having good selfcare practices provides you the opportunity to better care for others.