Do you remember your first day at the Lying- in?

CHRIS COLLINS Interviewed by Ann Conway, PhD I m Christine Collins. I m the Executive Director of Patient Access Services of the Brigham and Women s/faulkner Hospitals. Chris, I know you ve been here a long time, and I d like you to just start off and just tell me why you stayed so long here at the Brigham. So I started out obviously much younger in the late sixties. I came for a little part time job that ended up being a lifetime and have never felt the need to leave the Brigham and Women s. I started at the Boston Lying- in, was lucky enough to become the Director of Admitting of the Boston Hospital for Women, which as the merger of the Boston Free Hospital for Women and the Lying- in in the late sixties. Which was the predecessor to the merger of the Brigham and Women s in 1980. Do you remember your first day at the Lying- in? I do. I do. I had just, and as I say, it was just a little part- time job. I was doing someone a favor and I had just had a small child and I was working at the information desk. And I remember, I actually do remember, I remember quite well because I remember saying, this is, I almost felt like this is where I belong. Did you? Yeah and it was just in I ve been fortunate. From there, the director of admitting at the time at the Boston Lying- in asked me if I would be interested in a part- time job and I toyed with it because I did have a young child at the time, who is now past 47 years old. And said I d think about it. But I ended up saying, you know this is where I want to be so I ended up working two evenings a week for a few years and the rest is history. People, I never actually pursued a job. People pursued me, which is a great place to be. And so I went from there, someone asked if I d 1

be interested in working at the Free Hospital for Women and at that time the Free and the Lying- in had merged so it was the Boston Hospital for Women. And so I went over and worked, decided I loved the job scheduling the ORs for both the Lying- in and the Free, and subsequently was offered a terrific job by one of our now retired, actually a physician who has passed away, and the good news is that they wouldn t let me leave. And I became the Director of Admitting of the Boston Hospital for Women. And I d say that was in the seventies. And real history, lots of wonderful names and surgeons and physicians who were predecessors to the Brigham and Women s Hospital who made the place, you know put the place on the map. You know, John Rock, who developed the birth control pill and had just retired when I went to work there, but many of his younger residents who have now, who would have been well over their hundreds was still there and still doing great things. And Dr. Easterday, who did the first RH negative transfusion in the baby. I mean all of these people were the younger generation at the time. And then you came over to Brigham and Women s? Yeah, and so then in the late seventies we had the merger of the Peter Bent Brigham, the Robert Breck Brigham, and the Boston Hospital for Women, which was four facilities and so it was very exciting time in the late seventies working towards moving into this big gigantic hole in the wall at the time and building a plan. And it was that, that was probably the first time I said, This is where I want my future. And over the years I tried to get as much education and knowledge that I could about acute care hospitals because I d been always in a women s and babies. And off we went to so they were looking for the director of admitting at the time and it was the Affiliated Hospitals Center, AHC. The name didn t get changed until after we moved in here in the eighties to the Brigham and Women s. And so I applied for the job, went to the search committee; it was scary as hell but in the end it was really you would have thought they were hiring the president. It was in a board room and there was various high level people from each facility. But long story short, I got the job. And then it was a very turbulent time. You re merging four different medical staffs because even though it was three facilities, three hospitals, it was still four facilities. And the merger of the Free Hospital for Women and the Boston Lying- In they were still not 100% merged as far as medical staff and the way people did business. So to move that entire culture, employees, patients all into one building was really an accomplishment. And when I look back at all the things I ve done in my life, it was one of those good news/bad news stories. The worst day of my life and the best day of my life. Because it was so chaotic. Can you share a little bit about those first days? 2

Yeah, so I can give you an example. So in July when we moved over, it was the Boston Hospital for Women, the Parkway Division, which was the Hospital that was the Free Hospital for Women that was called the Parkway Division after the merger. And they came in on a Sunday. And of course they maybe moved 30 or 40 patients. The Peter Bent Brigham patients came down the Pike, so everybody that knows the Pike was the main [thoroughfare] there in the hospital. And it was always the Pike of the Peter Bent Brigham. And so for the Peter Bent Brigham physicians, most of them didn t move their offices. All that happened was the patients moved down the Pike into new rooms. So it wasn t the trauma and the disruption as it was for the patients that came down from the Robert Breck Brigham. Their physicians- they had new parking, new places to hang your coat, new offices, and everybody felt like they were more like an outsider initially. And I think it was very hard because every institution had a rich, rich history. And to leave their offices, everything they were used to to come into a brand new building that was not quite finished. We didn t have a cafeteria. We had firemen on every floor for months. People had no place to hang coats. It sounds you think back now, it was a lesson learned for everything we ve done going forward. We always make sure that all of this is in place, but it was such a huge undertaking to open a brand new 700+ bed hospital and then to think that you move patients from three facilities into this hospital within a couple of days. The Boston Lying- in, the babies and the postpartum mothers didn t come until the following February. So the people that came in July were the staff from the Peter Bent Brigham, the staff from the Parkway Division of the Boston Hospital for Women, and the Robert Breck Brigham and all the staff that went with the patient population. I m glad you mentioned all this because I don t think people realized that it was in stages so I m glad. And so I mean, when I look back and why I say it was one of the best days of my life and it was one of the worst days of my life, is on Sunday we had moved in on either Friday or Saturday and Sunday we were getting for new patients. And I always remember that one of our, not just Ron, but many of our gynecologists, and that was the group I knew best at the time because I came from the Boston Hospital for Women, came in on Sunday to drop off orders and when they saw that we were in such turbulence and they all offered to take patients to their rooms for me. So I had Dr. Kistner, who was an incredible world- renowned physician come in in his Bermuda shorts, looking as dapper as can be, bringing up patients and bringing up records up to various units because he could see that I was on the brink. And so there were so many wonderful physicians. And then there was Peter Bent Brigham physicians too, who came right down on the first or second day and said to me, what can I do to help. Because it was clearly, as I say, it was a tough, tough day and tough few months. The ORs weren t ready to open. 3

Many of us slept here for days. We would work during the day and rather than go home, we would stay here. The people like Judy Riley who was in CPD who is still here she was one of the people that was staying here to make sure that all of the instruments were ready for all the surgical cases. Peggy Gaughan Doyle was here. She and her staff spent the night. Everybody just wanted to make sure that everything was perfect. Many of our administrators, they d be vice presidents in this era but at that time they were called administrators, actually the night before we moved, were washing the lobby floor. So I mean, people as I say came together as you can t imagine. And as I say we opened the front doors with firemen on every floor, canteen truck outside to feed us and for the admitting department who used to be responsible and still is actually, for billing. They had to do it as a midnight census. We d have to go over, we d borrow a Children s Hospital computer and they d have to go over at midnight to Children s with all the information. So we were on paper, we were on computer and people just made it work. We had a bird flying around our office which we weren t sure was good luck or bad luck. The Irish- it s bad luck but I understand there are other cultures that say it s good luck. Well in our case it was very good luck. This was really interesting. I was wondering if, you talked about your role in admitting and how much you liked your career here and I was struck when looking at some of the notes from our prior interview you loved being at the front door of the place and being sort of the official greeter. And you spoke about how Dr. Nesson had encouraged you so much in the past. What would you say have been some of the highlights of your work here? I d say many, I think the highlight is the way we always work as a team. From the medical staff, all the clinical staff, that every you want to do what s best. And I think that s what always been so great about the Brigham and Women s. It s because it was new, even though we all have a very very rich history and came from a very rich history, it was actually a brand new place. And for those of us that really believed that, we were able to just soar. But the people that actually didn t, who couldn t let go of the past, it was a difficult time, but there were many people, and you mentioned Dr. Nesson who at the time when we moved in was the vice president of the ambulatory who subsequently became president, he was an incredible physician, an incredible human being who just recognized talent and fostered and always would encourage you to make the right decisions, just make them, you don t have to, do what you think is right and you will never fail. And Jim Wiczai, who was his chief operating officer, I always say we moved in in 1980 and within five years of moving in to this facility, we made the ten best hospitals list. That s incredible to me. But imagine all the energy that must have gone in and we were just constantly breaking new frontiers. And we didn t seem to get as caught up within a lot of the things that I think had been in business for a long time you might have been reluctant to make the change. But because we 4

were so new that there was a lot more ability to move the needle. And I think we were constantly raising the bar and encouraged to raise the bar. Well it sounds like what you re talking about is people and their ability to innovate and it s characterized a lot of the success of the Brigham and your career here. What innovations have you been able to make in admitting over the years? Over the years we went from just you would greet people, you d admit people. Now patient access is the whole front end. It s from the time you schedule the OR to the procedure, it s all integrated until you get the bill cut, as they say. It s the front end. So it s been able to integrate OR scheduling, we ve integrated the whole financial screening process, a lot of the concierge services that are provided in waiting rooms is part of patient access services. We ve done a lot systematically. We have an incredible and actually we re the first place in the country that had a dynamic OR schedule that interfaces so it s real time, so that we are able to tell the family when anesthesia starts, when the surgeon makes the first cut, when he starts or she starts to close. We ve done a lot of I could go on and on about all of the innovation we ve had in the patient access field. We ve been very fortunate. Wow that s really impressive. But what I know in reading about Dr. Nesson was he was involved in health information technology. Absolutely. And the Brigham was as well. So we were ahead of the curve in that. When Dr. Nesson was here, he was the vice president ambulatory actually. He, as he should have been, was concerned about our information system. He just thought we lived in the old and I probably shouldn t use the name of a company but we were in the IBM world, which was definitely a transaction world. We had a big mainframe and like everybody else we had all just converted to computers in all of the facilities in the late seventies and early eighties. So we had not had a computer system, we were on paper and pen until that time. And then actually one of our goals when we were moving here in 1980 was that we would have all of our facilities up on the admission discharge system which is your billing system before we came into the new facilities. But it left much to be desired and it went down in the middle of the night as computers did at that time. And for we seemed to work for the computer, the computer didn t work for us. And Dr. Nesson then became president and many of us that were vocal about wanting something better, and he created a blue ribbon committee with some key people and said there s got to be a better way, and he brought John Glasser and brought at the time, we developed our system on a whole different platform than had ever been known - actually in the 5

world and we were one of the first facilities. And that went on many computers and I m probably not being as technical as I should be but what can I say. And so we had a very different way of doing business and it was all about the users should be designing the system and that the IT folks should be they had the IT expertise but we had the expertise in how things should be done. And Dr. Nesson led that whole charge and it was like going from night to day in the information technology field. Absolutely. Again he was just such an inspiration to many of us. Patients were always the priority. Just as I say believed if I were to say who was the most instrumental in my career and why - - what got me motivated, it was Dr. Nesson and at the time. And still to this day I think of him all the time. His portrait is up on the Pike and very much a part of my life is his wife who is still alive is [ ] who I speak to frequently. And he, it s just he set the stage. Everybody that s come after him has brought it to the next level. Dr. Gottlieb, Jeff Otten, now Dr. Nabel. We ve always, everybody has built on the foundation that Dick Nesson and his team put in place. So I ve been lucky. I think people look. It s funny as I get ready to retire, you say who s going to have the history, so I m thrilled that we re doing this but because we have such a wonderful history. And I think that you always want to look forward but you should never forget your past. Are there other, you mentioned Dr. Nesson of course as a key figure in your career, and you mentioned other people who have influenced you over the years, are there other particularly memorable people who have influenced you? Yeah, I remember when we first moved in here and again there was Dr. Mellons who was at the time, I think he was Chief of Radiology, and of course Marshall Wolf, who s still here, and when you look you see David Brooks and Chip Moore, their residents now, they were residents then, they re senior physicians now. And there s just, and I know that I m not thinking of everybody but there s been such, there s been such, as I say some of the key people in nursing, just people that were here and the fact that there are still so many people here in 2012 that were part of the move in 1980 I think that in itself is unbelievable. There s still so many people that are still here, still working, still think it s the best place in the world. As I said over the years, I ve had many offers, I ve had headhunters call me, I still have headhunters call me which amazes me at my age, but I always say there s no better place to work. I ve always been allowed to grow in this position. My job this year is not the same as it was last year. Every year its I have more responsibility or something is different. So there s never been a reason to leave here. Because the place just continues to move forward. As I say, it continues to move forward. But that is one of the things that I ve always loved about the Brigham and Women s. Betsy Nabel who s our president was a resident here in the 1980s. And how wonderful to think that one of our 6

residents who left in the 80s after being trained comes back and is now the president of the Brigham and Women s and Faulkner Hospitals. That s just wonderful. That tells you something. You ve alluded to this kind of spirit of the Brigham, if you will, last time we spoke, because you were mentioning some of the same characteristics that you re talking about today, like you talk about it being the happening kind of place, or we were moving forward, is there anything else? Well I think just the clinical innovation, Ann, that you, just to me, the Brigham and Women s it s like where else would you rather be. The clinical innovations that take place on a daily basis, the incredible staff, the volume of patients that come through our doors, and it s just as I say to me it s the only place to work. And when I think back to the 80s, and I ve probably said that even though there may not be scads of there are lots of new people but people seem to be because of what happened in the merger of the 80s and people coming together as I say I liken it to a war. It was months and months, and remember this was a group of people getting to know each other at all levels from the top to the bottom. But that spirit of working together to make things happen at that time has become the culture. People just want to, people just want to do the right thing and bring us to the next level. We re always raising the bar as far as I m concerned. It s never the status quo. It s always, What can we do better? Just going back a minute Chris, because you alluded to this in your last interview, what was it that began to really bring people together in the merger when everybody came together? So a couple of things. When you came together in the merger, to be honest, I m sure in the day to day scheme of things people really didn t want to leave their comfort zone. But yet like most things you really don t have a choice. And I think that people having to give up, as they say, many of the physicians, many of the staff, everybody went to a new place. I think everybody thought they were going to be able, I know they didn t intellectually know this but I thought there was this feeling that everybody was going to have their own door. Every like the Robert Breck Brigham would enter one door, and the Boston Hospital for Women would enter another door, the Peter Bent Brigham. Initially the plan was going to be there was going to be three towers but that went away very quickly because that s not how you do business in a very efficient fashion. But I think everybody, we all came in the front door and we came down the Pike. And I think one of the things that was very difficult for everybody was it was a time when people were and I - people weren t happy. Change is tough. And I think everybody kept talking about the old place and it there was even a group that wore some black arm bands for a while, and how sad. But the reality was that you had to go to the new place. So that s what we 7

all everybody would say the new place, the old place. And it sort of became, no matter which old place, whether it was the Peter Bent Brigham, the Robert Breck, or the Free, or the Parkway, or the Lying- in. Everybody had that home place that they loved. And from a leadership standpoint I remember that we were all at very, probably 3 months, 4 months, I don t remember exactly, in the Bornstein Amphitheatre and people complained about the elevators. Again we moved into a building that wasn t completed. We had firemen at every floor. We didn t have a cafeteria. And so those of us it was but yet we were all very proud of what we had accomplished during those months but I remember at the time when Dr. Hassan was in charge and I remember Dr. Hassan stood up in the amphitheatre and just said, you know, You can either stay or you can leave. But unless you re going to go forward, you need to leave. And I think it was a day that which we all realized that if you weren t going to be part of the new, if you weren t going to be part of Affiliated Hospitals, I don t think we were Brigham and Women s yet at that point, then you needed to make a real decision and you needed to leave. And people did. And there s no question some of the physicians just decided they didn t, they missed being in a small facility and some went to the Baptist or went somewhere else. Staff, some staff probably left as well. But many of us said why wouldn t you want to go forward and be part of this great facility. And again it s like, at the end of the day, anybody that was part of the leadership that was part of bringing these four facilities into what is now the Brigham and Women s Hospital, had to have been incredibly proud. Because we d done such a wonderful thing. So that s still when I say when I look back to 1980, it was one of the worst times of my life but clearly one of the best. So it was a tough time. But when you look back it s all good. And now you can look back at our history and you can be proud of the Free and you can be proud of the Lying- in and you can be proud of the Peter Bent and Robert Breck Brigham; they all did incredible things. We wouldn t be here today if it wasn t for our predecessors but you move on. Well one last thing I want to ask you Chris, is about the external community of the hospital, in the last, in your role it seems like you interface with the world coming into the Brigham s doors and in our last interview you talked the community outside as being sort of the backbone of the hospital. I wonder if you can elaborate about that? Yeah, so if you think back when you think of our predecessors - - one was on top of Mission Hill, the Robert Breck Brigham, the Peter Bent Brigham is right here, right where we are here, Boston Lying- in was on Longwood Avenue, and the Free Hospital Parkway Davison was over on Pond Avenue in Brookline. And so if you think about our location, the Parkway Division was further away but the Lying- in, the Peter Bent Brigham and the Robert Breck Brigham were all Mission Hill. And I think that Mission Hill is a very very vibrant community. The history is 8

incredible. You probably know it. It was the Irish, and it s been the Irish, and then it s also Hispanic, its college students. It s the most diverse neighborhood and has been for many many years and they re the backbone of our staff. They ve been the backbone of our staff for many many years. Many of our nurses were from the area. Many of our support staff grew up right around the corner. And so the community has also been very very important to us. Also many of our facilities are now in areas of former very vibrant neighborhoods within this area. And so its important for us that our community feels like this is their hospital and that we always want to be good neighbors and they ve certainly been very good neighbors to us. And it s a great neighborhood and I think we ve not been without our [ ] Again, when we moved in many of the houses, then a different era. In the late 70s people were taking away houses with no thoughts to what this does to neighborhoods. But it s a different era now, and I think we ve worked hard over the years to build really strong community relationships. It s a terrific neighborhood. As I say you ve got Brookline, you ve got Roxbury, you ve got Jamaica Plain. It s very much multicultural, diverse, it has it all. That s what so spectacular about the neighborhood. 9