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  • Monica Puga

    Memorial Healthcare System Appoints Monica Puga Chief Nursing Executive

    Monica Puga, RN, MSN, a nurse leader for nearly 20 years at Memorial Healthcare System, has been named chief nursing executive. The new senior vice president will utilize a data-driven approach to enhance care delivery, workforce development, and drive innovation.

    “A large part of my role is care transformation and cross-continuum care redesign, which will enable us to remove inefficiencies and improve on our high-quality outcomes,” said Puga, a graduate of both Nova Southeastern and Barry universities. “Our people, culture, clinical excellence, and passion for innovation will improve the Memorial experience for patients, families, staff, and providers.”

    Puga, a Weston resident, began her career at Memorial as a registered nurse in 2001, quickly advancing through a variety of clinical and administrative leadership positions that led to the executive suite. One of her first strategic initiatives will be replenishing, retaining, and recognizing nursing staff impacted by COVID-19. Puga says she’ll begin by promoting workforce development programs that include more residency and fellowship opportunities, introducing innovative staffing models, and creating an environment that focuses on the health and wellness of the entire care team.

    “Monica has a distinctive leadership vision for nursing and patient care delivery which, in these challenging healthcare times, I’m confident will help us advance on many fronts,” said Nina Beauchesne, FACHE, executive vice president and chief transformation officer at Memorial Healthcare System.

    As she has for the past seven years, Puga will continue to oversee Memorial’s population health initiatives and Care Coordination Center.

    Puga took her place on Memorial’s Executive Staff in September. She succeeded Maggie Hansen, RN, who retired after nearly 40 years with the healthcare system.

  • MemorialDocNow

    Memorial Healthcare System To Waive Fees For Telehealth Consultations Through October 13

    As part of its ongoing effort to aid those affected by Hurricane Ian, Memorial Healthcare System will waive the fee for a one-time telehealth visit through October 13. Individuals can enter the coupon code “IAN” on the MemorialDOCNow website or mobile app for the free, medical consultation.

    “We understand many individuals throughout Florida are struggling in the aftermath of the storm and are pleased to offer a convenient, no-cost option for those needing non-emergency medical care,” said William Manzie, administrative director of telehealth strategy for Memorial Healthcare System.

    MemorialDOCNow is available 24 hours a day, 7 days a week, with online doctors able to diagnose and prescribe medication for minor health issue issues that include allergies, asthma, coughing, flu, pinkeye, sinus infections, strep throat, and urinary tract infections.

    For more information, visit MemorialDOCNow.

  • Jennifer Goldman, MD

    “Social Determinants of Health” Impact Individuals, Communities More Than Even Medical Teams May Realize

    “49-year-old male with hypertension, diabetes, and chronic kidney disease. Patient has been non-compliant with health recommendations and prescribed medications.”

    The word “non-compliant” (failing to act in accordance with a wish or command), when used in a medical context, sounds paternalistic and inappropriately simplifies the clinical situation. It feels as if the medical community is placing patients in boxes, labeling them rather than looking at the underlying reasons why someone doesn’t follow a treatment plan.

    Keep in mind, for some patients, just making and keeping a doctor’s appointment presents some or all of these challenges:

    • Wait months for the visit
    • Get time off from work
    • Find childcare
    • Find transportation
    • Have money for the copay
    • Wait hours for the doctor

    It can all cause an increase in blood pressure, after which the doctor may diagnose something difficult to understand and prescribe medication that, if you Google, has side effects ranging from hair loss to impotence to death. And the price of that medicine? Anywhere from $10 to more than $1,000.

    As a healthcare community, we must understand that visiting a doctor, including following all instructions afterwards, can be especially daunting for those facing daily life challenges. We have to help providers and care teams identify patients that require assistance, stop labeling them with loaded terms, and connect them with the help they need.

    FINDING SOLUTIONS

    All individuals, regardless of where they are treated, have some type of electronic health or medical record generated to provide a digital file of patient-related information. At Memorial Healthcare System, we’ve added tools to our patient’s medical records that identify those who may have a harder time keeping appointments or following a care plan.

    Known as the “Social Determinants of Health,” it accounts for those who don’t have access to healthy, affordable food, stable housing, caregivers, childcare, transportation, and more (these challenges impact communities of color more than others, with its roots in structural and political determinants beyond the scope of this column). Nevertheless, it’s imperative for healthcare systems and providers to seek additional resources for those in need.

    We now task staff with documenting in a patient’s records that person’s struggles with food insecurity, housing, transportation, etc. This “problem list,” combined with the patient’s active, chronic conditions, helps coordinate care across the healthcare continuum and between systems, enabling any clinician to get a complete picture at a glance.

    Taking it a step further, providers are now alerted when a patient screens positive for a Social Determinants of Health, automatically adding it as a diagnosis on the problem list and alerting the care team the individual needs assistance. Medical staff now get annual reminders to re-evaluate these important measures of health outcomes.

    As a physician leader, I’ve worked with IT to make our patient records more relevant and easier for providers to navigate. The changes ensure our teams know where gaps exist, making wellness visits and advanced care planning conversations more intuitive and effective. We’ve expanded telehealth and same-day visits to help patients get the care they need, when they need it.

    MAKING CHANGES

    Going back to our earlier example, imagine if that patient’s chart had a problem list that included: “hypertension, diabetes, kidney disease, food insecurity, housing insecurity, and caregiver fatigue.” Would care teams interact and communicate with that person differently? Would a surgeon view the scheduling of elective surgery and the post-op rehab/care the patient requires from a different perspective? Would it impact the team’s outreach after the visit? As importantly, would we be so quick to label patients as “non-compliant” if they aren’t able to follow all the instructions?

    Having devoted my career to community medicine and as an advocate for the marginalized, my hope is the answers to those questions change the thinking and record-keeping processes of healthcare providers. It would improve the quality of care and make medical outcomes more equitable.


    About the Author

    Jennifer Goldman, DO, MBA, FAAFP, is a board-certified family physician and the chief of Memorial Primary Care for the Hollywood-based Memorial Healthcare System.