One year ago, Islanders learned that the Martha's Vineyard Hospital (MVH) trustees had agreed unanimously to sign an affiliation agreement with Massachusetts General Hospital (MGH).
Essentially, the deal meant the Island's not-for-profit, privately owned hospital would become one of a group of hospitals, health clinics, and physicians' organizations owned by Partners HealthCare System, a $6 billion non-profit, founded in 1994 by MGH and Brigham and Women's Hospital, both in Boston. The Partners organization spends $1 billion annually on research.
Some Islanders worried over what the changes might mean for the small Vineyard hospital, founded in 1929. Islanders familiar with the news knew that it signaled a new era for health care on the Island.
The Partners organization also includes Faulkner Hospital, McLean Hospital, Newton-Wellesley Hospital, Spaulding Rehabilitation Hospital, North Shore Medical Center and Nantucket Cottage Hospital.
Under the agreement, Partners appoints 20 percent of the hospital board. Partners appointed four new board members, all of whom have extensive resumes in health care.
In recent telephone interviews The Times asked representatives of Martha's Vineyard Hospital, Partners and Mass General to discuss the year just past and look ahead to the future. All of those interviewed agreed that the year has been encouraging and looked forward optimistically toward changes still to come.
Tim Walsh, hospital chief executive officer, said he understood the anxiety in some quarter at the news of the Partners affiliation. "Whenever you do something like this, what you often fear the most is that people will be intrusive and second guess everything that you do," said Mr. Walsh. "When we were negotiating the agreement, they said that was not how they operate, and all of that has come true."
Mr. Walsh said Partners' Boston leadership has supported the Vineyard hospital and paid attention to its needs. "I am amazed at how much attention we can get, if we ask for help," he said. "Even on little things."
Much of the work over the past year has focused on aligning administrative systems.
From his office in a wing of the hospital building that now serves the needs of Island residents and visitors, Mr. Walsh can watch construction workers preparing the ground for a new $42 million building that will include state-of-the-art operating rooms, a new emergency room and patient suites.
Mr. Walsh said the timing of the MGH deal and the construction of a new hospital was a kind of perfect alignment of the stars. The affiliation has enabled the hospital to tap into all the considerable resources MGH and Partners have to offer.
As an example, he and other hospital officials recently went to Boston to meet with Mass General officials overseeing construction of an $800 million surgical wing. The meeting provided some fresh ideas and access to MGH vendors.
Mr. Walsh said he expects to take advantage of MGH vendor pricing and cutting edge medical expertise when it comes time to furnish the new operating rooms here.
Another benefit came when Mass General information specialists visited the Vineyard and reviewed the wiring plans for the new hospital. The group followed up with design recommendations that will serve the new hospital as it is wired for the future.
Mass General has a book that outlines in detail minimum standards for any hospital building construction and for materials to be used. Mass General provided the information to MVH architects.
"You gain all the positives of a big organization that has the clout and expertise to do things like that, without the expense, because they share it with Vineyard," said Mr. Walsh.
Space always available
Depending on a Vineyard patient's medical condition, it can be necessary to transfer patients from Martha's Vineyard Hospital to a mainland hospital. In the past finding space in Boston could be difficult. Under the affiliation agreement, MGH is always open to Vineyard transfers, a comforting provision for Vineyard hospital leaders.
Mr. Walsh is similarly enthusiastic about changes in medical coverage. He said the hospital would be looking at clinical needs and how those can be addressed by MGH. One area is vascular surgical coverage, he said.
"It is really working out well," he said.
Tim Sweet of West Tisbury, hospital board vice chairman, said that when the deal with MGH was announced, many people imagined great changes - for the worse and for the better.
"I have to say that looking back now, I feel as enthusiastic as I was when we first made this deal. Even more so," he said. "I have come to be even more in awe and respectful of Mass General and the whole Partners organization."
"They are exceptionally professional. They are without question totally dedicated to their mission of quality health care. It is a religion with them. Everyone that I deal with in all aspects of that organization could not be more helpful, more thoughtful, more concerned, and I have yet to see anything else better than that."
Mr. Sweet said he couldn't think of one reason the Vineyard hospital is not better off by being associated with MGH. He said as with all partnerships there was some apprehension.
One concern was a loss of autonomy that might change the character of the community hospital. He said that has not happened. "We set our own agendas, we set our own budget, and we craft our own future, and whenever we ask they supply help," he said. "We have yet to have an instance where they said no."
Counsel Brent Henry, seasonal resident
Among the four people Partners appointed to the hospital board are two with a direct personal stake in Martha's Vineyard.
Brent L. Henry, a graduate of Yale Law School and an Oak Bluffs seasonal resident, is vice president and general counsel for Partners HealthCare System, and now a member of the Island hospital's board.
Like many seasonal homeowners, friends introduced Mr. Henry and his wife to the Vineyard. Speaking from his Boston office last week Mr. Henry, said that on a drive around the Island during a visit in 2006, he and his wife saw a house in the Harthaven section of Oak Bluffs that needed a lot of work. They fell in love with the house and bought it.
They spent the summer working on their first, second home. In September, Partners and MVH began discussions. As general counsel, Mr. Henry became involved. "The legal work fell on me to do, so in some ways it was a labor of love," he said, "because I knew that it was something that was ultimately, over time, going to enhance my long term access to healthcare, but also would be a good thing for MGH and Partners and the Vineyard hospital."
As negotiations progressed during the fall, Mr. Henry got to know the Martha's Vineyard Hospital. He was impressed by what he saw and learned about the board, administration and staff.
"When you have a small, Island hospital like that, with a staff that are that dedicated, and then you have an opportunity to affiliate with a larger organization that can bring a lot of technical expertise, particularly in this day and age when so much information is digitized, it seemed to me like an ideal idea, so I was just happy to be able to work on it and bring it to reality."
He said his wife was happy when she heard the news of the affiliation, because of what it would mean for the couple in their retirement years. "The idea of the local hospital being affiliated with what we think is one of the best hospitals in the world is a win-win situation."
Mr. Henry said he enjoys attending the Vineyard board meetings. While the scale is different, he said the subjects are not markedly different from those covered at the MGH, with the qualifier that the Vineyard has only one hospital.
"When you are the sole hospital provider, particularly on an Island, you have responsibility for the whole Island population," he said. "What's nice about the board at the Vineyard is you have a good mix of year-round residents and seasonal residents."
Dr. Andrew L. Warshaw, part-time resident
Dr. Andrew Louis Warshaw is chairman of the MGH department of surgery, surgeon-in-chief, a MGH hospital board trustee, and a member of the Vineyard hospital board. He has a family home in Chilmark.
Dr. Warshaw describes himself as a part-time rather than a seasonal resident.
He said he has a personal stake in hospital, because he and his family spend a great deal of time on the Island. On occasion they have needed its services.
He said it has been a stimulating and positive experience to get to know the hospital and meet with physicians and members of the surgical staff.
"There's some real quality there," he said.
Dr. Warshaw said he has talked to Dr. Pieter Pil, MVH surgeon and chief of staff, about potential coverage arrangements, to see what Mass General can do as an institution to help.
"It is a total positive experience," he said. "I feel like I've got a stake in it and want to work to make it better and better."
Dr. Washaw has served on numerous professional and hospital boards. His experience on the Vineyard hospital board has provided a new perspective.
"I was fascinated because the workings at the level of the board are really quite different from those at MGH," he said. "It is much more of a hands-on board. It is much more involved. Everybody around the table has input from all kinds of different perspectives"
As part of his board responsibilities, he is involved with patient care assessment. "It is fair to say I have never been so down at the very specific level of evaluation and response as I have been on that particular committee," he said.
He said there is a great deal of attention paid to every detail and making sure care is correct. "There is nothing that is swept away, and that has been quite enlightening," he said.
Looking ahead, Dr. Warshaw expects to see the working relationship between both hospitals grow closer, and that will benefit Island patients and physicians.
Chief of medical staff's view
Surgeon Pieter Pil, a graduate of Yale University School of Medicine, came to Martha's Vineyard in 2002, after he had completed his surgical training at Brigham and Women's Hospital, one of the founding members of Partners Healthcare.
For Dr. Pil, the prospect of developing closer working relationships with Mass General and its lineup of physicians is an exciting prospect.
The past year has provided an opportunity to get to know Mass General physicians socially and professionally. He said that having Dr. Warshaw, one of the leading pancreatic surgeons in the world, take an interest in Martha's Vineyard Hospital can only provide significant benefits.
Although the medical relationship is still developing, there have been some concrete steps, he said. "The majority of our transfers are now going to Mass General, whereas before it was probably half of our patients."
Island doctors also have access to Partners' electronic medical record system, so patients can be tracked once they leave the Vineyard.
Dr. Pil said there is also work taking place that will allow for more electronic medical communication and diagnosis similar to the telestroke program now in place. In the future an MGH trauma specialist could offer advice electronically.
"I think that what is most exciting is that this world class hospital, some would argue the best hospital in the world, has taken an interest in little Martha's Vineyard Hospital, which I think is incredible," he said.