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April 19, 2016

At BMC, Patients Receive Help with Financial Wellness Too

Each year, millions of Americans sit down to file their taxes. While most of us make it through this process easily enough, many others miss out on tax credits and refunds they are entitled to. For some BMC patients, the money they can get through those credits can be a lifeline to financial – and overall – wellbeing. This year, a new program called StreetCred is helping BMC patients file their taxes and benefit from the refunds they are entitled to.

StreetCred began in 2015, when Lucy Marcil, MD, MPH, and Michael Hole, MD, MBA, both second year Pediatrics residents at BMC, realized that they could make a difference in their patients' health not just through medical treatment, but also by helping families address the poverty that underlies many health issues. Both began asking their patients what would be most useful for BMC staff to help with, and found that free tax help would be a welcome way to get families more money.

Many BMC families are eligible for the earned income tax credit, which is the third largest federal social welfare program, after Medicaid and food stamps. However, 20 percent of eligible families don't take advantage of the credit, which can lead to a refund of up to $6242 (the average is $2400). In addition, many families who do get the credit pay for someone to prepare their taxes, an additional expense.

"There's evidence that the earned income tax credit is linked to better health outcomes," says Marcil. "Various studies have shown that families who receive this credit have lower smoking rates and lower infant mortality, for example. Helping families at BMC get this credit is a simple intervention that makes their lives easier without much effort on their part, and that can have a real, positive effect on our pediatric patients. It also helps patients feel more connected to their providers beyond office visits."

StreetCred, which officially began in January and will run for about a week after April 15, has six staff members and 20-30 active volunteers at any given time. Staff members and volunteers call families who have appointments in Pediatrics before their visit and invite them to make a StreetCred appointment. They also ensure that patients know what documents they need to bring. When patients arrive at their StreetCred appointment, they fill out an intake form to confirm their eligibility – StreetCred can't help with very complicated taxes – and can either sit with the volunteer tax preparer or have their tax returns completed while they visit with their clinician. It takes volunteers approximately 20 minutes, depending on the complexity of the return, to complete federal and state returns using an electronic filing system. Completed returns are reviewed by another volunteer and by the client, then filed.

As of mid-March, StreetCred had filed returns for 137 BMC families. This has led to over $334,000 in returns, including $90,166 from the federal earned income credit.

"We learned a lot about how to reach families," says Marcil. "Many families we spoke to had already paid to have their tax returns filed, so next year we definitely plan on reaching out earlier. We also had many people hear about StreetCred through word of mouth, so we plan on taking greater advantage of that."

Prior to starting StreetCred, Marcil and Hole both had experience with health-related finance programs, but neither were well-versed in taxes. Therefore, they partnered with the Boston Tax Help Coalition, a partnership of nonprofits, businesses, and community organizations that provides free tax preparation assistance and financial education to low and moderate-income Boston residents. One way the Coalition does this is by administering Boston's federal volunteer income tax assistance (VITA) grant at 37 sites around the city. In order to provide tax assistance to patients, BMC became a registered VITA site – the first at a hospital.

The process took nearly a year for Marcil and Hole, with help from Robert Vinci, MD, chief of Pediatrics. BMC registered with the IRS as a VITA site, found space within the hospital for the program, worked through the legal implications of providing tax services at a hospital, and recruited volunteers, specifically looking for people who were interested in both health and finance. Volunteers, including BMC employees and premedical or medical students from Tufts University and Boston University, received training on how to use tax software and were required to pass a test given by the Internal Revenue Service. Marcil and Hole also worked closely with Human Resources to recruit employees to volunteer and to help ensure qualified employees were aware of the services being offered. This helped give the program a more holistic BMC focus.

Marcil and Hole plan on opening StreetCred again next year, with expanded services, such as offering more financial services and in clinics besides Pediatrics. They also would like the model to be replicable, and are working on formalizing a toolkit that can be used by other hospitals. Currently, they are spreading the word about StreetCred through the national network of residents and talking to the Boston Public Health Commission about expanding the program to other Boston hospitals.

"StreetCred envisions an American healthcare system addressing basic resource needs for all families raising children," says Hole. "We're building one-stop shops of anti-poverty tools so every family visiting pediatric clinics has the assets and resources it needs to raise healthy kids. What an incredible gift it has been that BMC shares this vision."

For more information on StreetCred, visit the program website.

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BMC Aims to Improve Patient Experience with AIDET

At BMC, we're focused on ensuring that patients have a positive experience while they're at the hospital. However, it can sometimes be hard to know exactly how to make that happen. To help facilitate a positive experience for all of our patients and families, more than 1,000 employees across BMC's Ambulatory practices have been trained to use AIDET, an approach to patient engagement.

"AIDET is about making sure we provide the type of care that we would want our loved ones to receive," says Kristen Kremer, Manager of Patient Experience. "It's not a script for employees to follow, but a way to help us stay consistently aligned with BMC's values of respect and commitment to providing outstanding care."

AIDET is a communication framework to help improve a patient's experience and reduce their anxiety. It stands for Acknowledge, Introduce, Duration, Explanation, and Thank You, which are key building blocks of a positive patient experience at BMC. Using this framework, employees should:

  • Acknowledge a patient by name and make eye contact, as well as acknowledge anyone else in the room.
  • Introduce themselves, their skill set, and experience.
  • Give accurate expectations for wait times (duration) and communicate next steps. If this is not possible, employees should give a time in which they will update the patient on progress.
  • Explain step by step what will happen and answer questions using language a patient can understand.
  • Thank the patient and anyone else in the room.

"I've noticed that when using AIDET, patients are more comfortable upon their encounter with me and so am I," says John Vilburn, practice assistant in the Rheumatology clinic. "I realize that AIDET makes the patients feel satisfied, secure, and accepted. They have knowledge of their importance in our hospital. With AIDET, we keep the patients informed of their current status and wait time and the patients genuinely appreciate it. The actions we take with AIDET let them know we care and makes them feel welcome to come back."

By reducing patient anxiety and improving patient experience through AIDET, employees can also help improve compliance with treatment and health outcomes. Using AIDET principles to communicate with patients connects emotions and intellect, so patients understand what is happening, why it is happening, and how it will affect them. The goal is to make patients feel that they are respected and will receive excellent care at BMC.

"A well-executed AIDET empowers the patient to take charge of their health in a collaborative way through respectful and accurate information exchanges occurring at every step of their visit," says Daniel Warren, practice manager in the Cardiology Department.

AIDET was first piloted in three departments – General Internal Medicine, Otolaryngology, and Obstetrics/Gynecology. The pilots found that the framework works well for BMC in helping to improve patient experience. In January 2016, all Ambulatory practices began training in AIDET. Currently, more than 1,000 employees have been trained, and the goal is to train 3,000.

"AIDET helps in easy and difficult situations," says Vilburn. "I've noticed the relived feeling patients have knowing that we care, all through the wonders of AIDET. My coworkers and I use AIDET as a team to make the clinical experience exceptional care."

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BMC Autism Program Helps Parents Help Each Other

BMC has a wide variety of resources to help our patients and families. One of our greatest resources, however, is our patients and families themselves. Recognizing this fact, BMC's Autism Program created the Parent Leadership in Autism Network (PLAN), an initiative that trains and empowers parents of children with autism to help support other parents of children with autism.

PLAN began three years ago when Shari King and Lauren Bartolotti, the program director and coordinator, reached out to clinicians, local schools, and other professionals to find parents interested in helping others, with the goal of creating a network of parent leaders. The pilot group was intentionally small, at six parent leaders, and in 2015 more than tripled in size to twenty-five.

"The parents we talked to didn't necessarily identify themselves as parent leaders, but all have a child with autism and have been incredible advocates for their children," says King. "While staff in the Autism Program at BMC always aim to provide the best support to families, we know that there's no substitute for parents connecting with one another. We learn so much from our parents every day and their sharing of insights, expertise and their own experience are gifts that they can give to one another through this program."

In coordination with interested parent leaders, PLAN initially worked to identify specific needs and define and map out the program itself. Once there was a clear plan for the program, including how it works, the process for assigning matches, and the time commitments, the parent leaders were trained on a variety of topics, including how to communicate, how to give advice and listen effectively boundary setting, how to navigate complex needs, and training on specific resources. PLAN staff also helped parents realize their own areas of expertise which come largely from their own experience. Such topics include communication strategies, dealing with difficult behaviors, navigating transitions and advocating for educational and therapeutic services.

Once parent leaders were trained, the matching program began. Families from the community – PLAN serves the Boston area, not just BMC – can be referred by a community organization, a clinician or resource specialist, or refer themselves to the program. Within one to two weeks, program facilitators help determine the best parent leader match, based on the needs of the family. The program makes 10-15 new matches a month, and some parents end up speaking with multiple parent leaders as greater needs emerge.

PLAN allows parent leaders and the family receiving support to identify the level of support necessary and the best way to communicate. Most parents use phone or email, but some meet in person. Support can range from referring the family to a support group to talking over the phone a few times to developing friendships.

"BMC patients face many complex issues, such as homelessness, exposure to violence, and linguistic and cultural barriers," says King. The role of the parent leader is to provide support around the challenges of having a child with autism and when a family needs support in other areas, we will help the parent leader refer the family to the right place."

Parent leaders also meet once a month to provide support for each other and get help with difficult situations. This ongoing training and support helps ensure that parent leaders are well equipped to handle any issue that might come their way, and is a distinguishing characteristic of the BMC program. Parent leaders benefit not only from relationships with the families they support, but also from their relationships with each other, which is a critical and unique part of the program. While there are formal trainings once a year for parent leaders, parents who are interested in becoming leaders can join these meetings before being trained, and the program will assess whether or not they are ready to take on matches.

"Many parents who have been helped have expressed interest in becoming parent leaders themselves," says Bartolotti. "It's great to see that PLAN can help empower parents to recognize their own potential. We're always trying to grow the group and expand its diversity. Some parents take on important roles within the program in addition to serving as a parent leader, such as managing social media outlets, fundraising, or working as the match coordinator."

Currently, there are 23 active parent leaders who represent a range of cultural and linguistic backgrounds – they speak English, Haitian Creole, French Creole, Arabic, Mandarin, and Spanish – and have children with autism who range in age from toddlers to adults. The cultural diversity of the parent leaders is an asset to the program, as parents are able to talk about not just what having a child with autism is like, but what it's like to have a child with autism within a specific culture.

"Massachusetts has better resources than many places, but they are still not ideal," says King. "Parents of cultural minorities can be particularly isolated, and we aim to help them overcome some of that isolation. Our parents are driven to create groups and services that work for them. We want PLAN to be a place where families are served and connected to a much bigger network outside of ours, where they can go on to have a continuous home for themselves and continue to meet their changing needs."

To learn more about PLAN and the Autism Program, visit the program website. Parent leaders will also be at BMC's Autism Awareness Day event on April 22 in the Shapiro Lobby.

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Early Warning System Identifies Patients at Risk

When The Joint Commission visited Boston Medical Center in February, the survey team praised many of the hospital's programs. One program that stood out was BMC's early warning system, an inpatient functionality in Epic that allows nurses and physicians to easily see and be alerted if a patient's condition starts to deteriorate.

BMC began using an early warning system (EWS), which grew out of Quality and Patient Safety-led work on sepsis, in April 2015. In that first version, the criteria the system used were too strict, and the Epic-based alerts did not go off often enough. New functionality in Epic has since allowed the team to change the criteria used to alert clinicians to potential sepsis, based on vital signs, mental status, and lab results. Using this improved functionality, the team expanded the program to flag all adults non-critical care patients with clinical deterioration, not just those with sepsis.

The early warning system uses a scoring rubric to automatically alerts a nurse when certain inputs – including respiratory rate, pulse, temperature, O2 stats, blood pressure, level of consciousness, and white blood cell count – reach preset thresholds. The alert directs the nurse to contact the medical team and the resource nurse, who then help to identify and implement clinical interventions to prevent further deterioration of the patient. In addition to the alert, there is a new EWS column in Epic that shows the latest EWS score and flags patients green, yellow, or red based on score severity level. Typically a patient is having multiple issues if an alert is triggered in the system.

The early warning system was piloted in November on Menino 6East and 6West. Analysis from the pilot program provided key information about the alert system. Alarms were helpful in notifying staff about issues in a timely manner – in fact, 20-30 percent of alarms went off before the care team was aware there was an issue – and staff did not feel overwhelmed by the number of alarms. They also found that resource nurses were involved after an alert only about half the time.

"In quality improvement, we often ask nurses to adhere to extra workflows, which can be difficult on top of their regular work," says James Moses, MD, Medical Director of Quality Improvement and Associate Chief Quality Officer, who spearheaded the early warning system. "However, there is a clear competitive advantage to our system, both for nurses on the floor and for higher-level nurses who are determining staffing assignments, as they can see which patients need the most attention. We've worked hard to simplify the process for nurses, and they've done a great job making use of the new system."

In mid-March, following the pilot program, the early warning system was expanded to all adult medical-surgical floors. Further analysis has shown that resource nurses are now involved approximately 60 percent of the time, and cite the system as the reason for their involvement with the patient approximately 90 percent of the time.

"The early warning system is helpful as a resource nurse because there is only one of us per campus and several patients, so it allows us to focus our attention to those patients that need it most and prevent RRT and code blue situations," says Katherine Scanlon, RN, MSN, CNS-BC, CCRN, now a clinical educator and former resource nurse at BMC. "It also helps us with patients recently discharged from the ICU, because we can follow these patients more closely and watch their scores to prevent bounce backs to the ICU within 48 hours."

Now that the early warning system is in place, the team will be looking at several outcomes, including whether there are fewer codes and rapid responses for floor patients, if inpatient mortality is improved, and if there is a decrease in readmissions from the intensive care unit. In addition, residents are being trained to use the system as part of their handoffs, and new residents will be trained on it in July.

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What do you do, Inna Fokina?

Name: Inna Fokina
Title: Volunteer, Preventive Food Pantry
Time at BMC: One year

Inna Fokina 

What do you do here?
As a Food Pantry volunteer, I prepare food carts and help bag food for patients to take home. I also help patients who need help carrying their bags. I also help people who come to the Food Pantry understand the food they're getting and how to cook with it. We get a lot of people from different countries and sometimes they don't understand how to use certain kinds of food that we give them.

What brought you to BMC?
A few things. I was a neurologist in Russia and want to be a doctor in the United States. To apply for residency programs, I need letters of recommendation and I wanted to get them while helping people. I heard that BMC serves the most immigrants in the Boston area and I thought they would understand what I need. BMC helps people adapt to this country and has very important programs for immigrants.

I also needed to improve my English conversation skills and I have the chance to do that here. I knew English, but speaking with people is so different. We have some patients who also don't speak English well, and we can sometimes help each other learn. My experiences in the Food Pantry have also helped me understand cultural differences and how people from different cultures can communicate well. In Russia, the population is mostly Russian people, but the United States has many cultures mixing together. I've passed all my exams to get a medical license in this country, but it's so important for me to learn differences between cultures and how to understand people. For example, sometimes people might not speak, but it's not because they're rude or anything like that. It's because they're afraid or ashamed to speak, like I used to be. Volunteering here has been so helpful for me. And the BMC employees at the Food Pantry are the best. They've helped me feel so comfortable, and they have the biggest hearts. I really thank them and the Volunteer Services staff for the opportunity they've given me.

Tell me more about your story in coming to the United States.
My story was a love story. I had a good life in Russia, with a 12-year neurology practice, but came because of a family situation.

I had a green card in 2004, and met my second husband after only ten days in the United States, on Valentine's Day. I felt like I had met the second part of me, so I decided to change my life. I took my bags, he spoke with my parents, and I stayed with him.

But I didn't realize that I couldn't work as a physician here. It's taken about eight years of preparation and exams, and I wasn't familiar with multiple choice tests or computers. It was so difficult but I really care about people and helping them, so it's worth it. And my husband is so supportive, even though I don't think he realized it would take so long.

What's one thing about volunteering at BMC that people might not guess?
It is such a comfortable experience. The staff and patients are really appreciative of your help, which is a really good feeling.

What do you like most about volunteering at BMC?
I like that I can help people who need my help. They're so thankful for even my small ways of helping, like helping someone carry a bag that's too heavy for them. The everyday help the Food Pantry gives is really important.

We know how expensive food can be if you try to eat healthy. But if you change your lifestyle, you can treat diseases – you have to treat your behavior and change your lifestyle, not just take drugs. The Food Pantry helps people understand what they can buy inside the store. A lot of people at BMC emigrate from countries where you don't have the big grocery stores that the U.S. has, and it can be hard to understand how these stores work. The cooking lessons BMC gives are also the best. They give really easy information to people who don't like or don't want to cook, and shows them that cooking healthy food takes the same time as microwaving something.

As a doctor, I've always been interested in diet. In Russia, we don't have dietitians, so doctors have to advise all about eating and lifestyle. I worked for a few years in sports medicine, and those people are very interested in what to eat. When I started to work here, it was a return to my interest in diet. It helps me use the knowledge I already had and keeps me learning new information. There's always new medical information for doctors to study – it's not a profession, it's a lifestyle.

What do you do for fun outside of BMC?
I like cooking and having friends over. My husband and I also liked traveling. I like to travel to places with good landscapes. I love working with people, but sometimes you need a relaxing landscape. My favorite recently was the Grand Canyon, which was amazing. I also really liked Niagara Falls.

Do you know a staff member who should be profiled? Send your suggestions to [email protected] .

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News of Note

Kate Walsh and BMC staff at the Celebrating Diversity Fair

Celebrating Diversity Week
From March 28 – April 1, BMC hosted a variety of events to celebrate and build awareness, acceptance, and pride around the extraordinary diversity of our hospital. Throughout the week, staff and patients enjoyed live music and multicultural food in the cafeterias, and on March 31, came together for the Celebrating Diversity Fair. The fair featured musical and dance performances, as well as displays of cultural items contributed by employees. Employee Resource Groups also showcased their working in providing spaces for diversity across BMC.

A new event this year was a panel discussion entitled "How Diversity Impacts Patient Experience." Five employees from across BMC shared their personal stories of diversity, how their stories have shaped their ways of providing patient care, and how we can all provide exceptional care to our diverse patient population.

"One thing we've all done well and need to continue to do well is to make patients feel like they belong here," said Glory Ruiz, the primary care practice manager, one of the panelists. "But we need to be honest about what our blindspots are and where our biases come from, and roll up our sleeves to understand our patients and where they come from."

Addiction Medicine Recognized as ABMS Subspecialty, With the Help of BMC Doctors
The American Board of Medical Specialties has officially recognized addiction medicine as a subspecialty, which means that physicians can become certified in the field. Certification in an ABMS subspecialty helps patients know that their physician meets the highest standards of practice and clinical knowledge, and has completed an approved educational program and process.

Addiction medicine is defined as the prevention of the risky use of substances, including nicotine, alcohol, prescription medications and other licit and illicit drugs, and the evaluation, diagnosis, treatment and management of the disease of addiction and related health conditions. Physicians specializing in this field also help family members whose health and functioning are affected by a loved one's substance use or addiction.

Jeffrey Samet, MD, MPH, chief of General Internal Medicine and Jane Liebschutz, MD, MPH, a GIM physician, were instrumental in the effort to get addiction medicine recognized as a subspecialty. In addition, BMC has the first addiction medicine residency program in the country, further positioning us as leaders in this field.

Jason Hall, MD, Joins Department of Surgery
Jason Hall, MD, has joined BMC's Department of Surgery as chief of colon and rectal surgery. He will also be the co-director of the Dempsey Center for Digestive Disorders at BMC and associate professor of surgery at Boston University School of Medicine.

Hall completed a fellowship in Colon and Rectal Surgery at Lahey Hospital & Medical Center. Dr. Hall has received a traveling fellowship from the American Society of Colon and Rectal Surgery, holds leadership positions in a number of national and regional societies, and has an active research career. Hall received his undergraduate degree from of the College of the Holy Cross and a medical degree from Harvard Medical School, as well as a Master of Public Health from the Harvard School of Public Health. He completed his residency in general surgery at the Massachusetts General Hospital and served as the Churchill Assistant in Surgery (Super-Chief Resident).

Eric Smith, MD, Joins Department of Orthopedics
Eric Smith, MD, has joined the Department of Orthopedics as a joint replacement surgeon. Prior to joining BMC, Smith was the director of the Total Joint Replacement Program at Tufts Medical Center, where he worked with many patients with multiple illnesses or serious neuromuscular disorders, such as paralysis following a stroke. Previously, he held positions in orthopedics departments at New England Sinai Hospital and New England Baptist Hospital.

Smith received a BS from University of California, Davis and an MD from Tulane University School of Medicine. He completed his surgical internship and residency at Tripler Army Medical Center.

Mihn Tam Troung, MBBS, BSc, Appointed Chief of Radiation Oncology
Minh Tam Troung, MBBS, BSc, has been appointed Chief of Radiation Oncology at Boston Medical Center and Chair of the Department of Radiation Oncology at Boston University School of Medicine. Troung has served as interim chief/chair since July 2015.

Troung joined BMC as an attending physician and clinical director in the Department of Radiation Oncology. Prior to joining BMC, she worked at New York University Medical Center.

Troung received her Bachelor of Medicine, Bachelor of Surgery and Bachelor of Science (Medicine) degrees from the University of New South Wales (UNSW) in Sydney, Australia. She completed her internship at Prince of Wales Hospital, also at UNSW and began her radiation oncology residency training at Westmead and Nepean hospitals, University of Sydney. She completed her radiation oncology residency, with her last year as chief resident, at New York University Medical Center.

Gabrielle Jacquet, MD, MPH, Named Medical Director of Child Family Health International
Gabrielle Jacquet, MD, MPH, an attending physician in the Emergency Department at BMC and assistant professor of emergency medicine at BUSM, has been named the medical director of Child Family Health International. CFHI is a non-profit organization that provides more than 30 global health education programs in ten countries.

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Awards and Accolades

BMC Named Best Place to Work in Healthcare
BMC has been named to Becker's Healthcare "150 Great Places to Work in Healthcare" for 2016. The annual list features provider organizations, including hospitals, health systems and ambulatory surgery centers, as well as nonprovider organizations, such as electronic health record providers and IT vendors. Winners are chosen based on workforce-centric awards received, benefits offerings, wellness initiatives, and efforts to improve professional development, diversity and inclusion, work-life balance, and a sense of community and unity among employees.

Grow Clinic Wins Nick Littlefield Award for Excellence in Community Health
BMC's Grow Clinic has been selected as the inaugural winner of the Nick Littlefield Award for Excellence in Community Health by the Blue Cross Blue Shield Foundation. As the winner, the Grow Clinic will receive $50,000 per year this year and in 2017 – a surprise change in the award, which was slated to be for one year only. The award recognizes an organization that is making extraordinary contributions to the health of low-income and vulnerable children.

James Piepenbrink Received AAMI Foundation & Institute for Technology in Health Care's Clinical Solution Award
James Piepenbrink, director of clinical engineering and co-chair of the Clinical Alarm Task Force at Boston Medical Center, was selected to receive the 2016 Clinical Solution Award from the AAMI Foundation & Institute for Technology in Health Care. The award honors a healthcare technology professional or group that has applied innovative clinical engineering practices or principles to solve a significant patient care problem or challenge facing a patient population, community, or group.

Piepenbrink is being honored for his work in combating clinical alarm fatigue, a condition in which clinicians become desensitized from the alerts and beeps coming from medical devices. Piepenbrink was part of a team at BMC that reducing audible alarms from approximately 88,000 to 10,000. In addition, he recently piloted a NICU program that uses mobile technology to improve staff awareness of and response to alarms. Initial results have shown a decrease in unit noise levels and an increase in staff satisfaction.

I-PASS Selected as Gage Award Remarkable Project
"I-PASS with SAFETY Nursing Bedside Handoff Improves Global Outcomes," was selected by the Gage Awards as one of this year's remarkable projects. The Gage Awards recognize the necessity for members to successfully carry out improvement projects, spread best practices and innovative programs to other organizations, and support America's Essential Hospitals' research, policy, and advocacy work by sharing stories of member success with a broad audience.

BMC Named 'Leader in LGBT Healthcare Equality' Three Years in a Row
Boston Medical Center (BMC) has been recognized as a "Leader in LGBT Healthcare Equality" by the Human Rights Campaign (HRC) Foundation, the educational arm of the country's largest lesbian, gay, bisexual and transgender (LGBT) civil rights organization. BMC earned top marks in meeting non-discrimination and training criteria that demonstrate its commitment to equitable, inclusive care for LGBT patients, and their families, who can face significant challenges in securing the quality health care and respect they deserve. This is the third year in a row BMC has been named a Leader in LGBT Healthcare Equality. Read more.

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