HARLEM—By the time she saw the thick black smoke rising from the Hudson River, Denise Soares, the new executive director for Harlem Hospital Center, was already on her BlackBerry.
Soares saw the smoke while on the roof of the hospital's new addition during a walk-through last week. A fire and explosion at the North River Wastewater Treatment plant meant the possibility of patients with burns, chemical contamination and the need for emergency surgeries. Twenty ambulances were already on the scene.
In a span of five minutes, Soares, a lifelong resident of the Bronx, called or texted the hospital police, the burn unit, the emergency department, the nursing department, the chief operating officer, admitting department, the operating room and the plastics surgery department.
The emergency room needed to be cleared for the decontamination area and operating rooms had to be prepped. The chief nursing executive was advised to prepare her staff for a possible onslaught of patients. The flurry of calls involved two BlackBerries, a land line, Soares' secretary and the associate director of public affairs.
"I know exactly what needs to be done because I've been there before," said Soares, who has a bachelor's degree in nursing from Hunter College-Bellevue School of Nursing and a Masters degree in health education from Teachers College, Columbia University.
"Having been in that capacity, you understand this is about what the patient needs. That's the difference in having someone with a clinical background in this position and someone who is more of an administrator," she said.
Appointed to the position in June, Soares never planned to be an administrator.
"I always wanted to be a nurse or a teacher," Soares said. "Even when I was in nursing school I didn't plan on being a chief nurse executive."
But when the chance to move into the ranks of management came, Soares says she began to look at is as an opportunity to be a "catalyst for change."
Now, Soares, who previously served as Deputy Executive Director and Chief Operating Officer of North Central Bronx Hospital and the Deputy Executive Director and Chief Nursing Executive of Jacobi Medical Center and North Central Bronx Hospital, will oversee 3,115 employees and an annual budget of $366 million.
She arrives at the hospital during an intense period of change. The closure of North General Hospital has placed more pressure on Harlem Hospital.
Doctors at the hospital narrowly avoided striking in December over changes to the hospital's association with Columbia University and pension benefits. Six doctors were laid off at an understaffed institution that cannot afford to lose practitioners, union leaders there said.
Also last year, it was revealed that as many as 5,000 echocardiograms went unread by Harlem Hospital doctors. Some doctors blamed the error on under-staffing. A review of more than 7,000 tests found 14 people who may have been misdiagnosed.
Soares said she plans to implement new procedures to prevent similar incidents. It involves letting staff on the front lines develop the procedures that prevent waste, fraud and improve the experience for the patient.
Some of the current efforts involve reducing emergency room wait times and improving patient satisfaction. Tackling long-standing health issues in the black community such as obesity, diabetes and cancer are also on her agenda.
"The only way to ensure compliance is to monitor. The staff has to be aware that we don't let things like that happen here," Soares said of the unread echocardiograms. "This is not an administration down process. It is the front-line people that can help solve these problems."
The past difficulties did not scare her off.
"I don't see challenges as much as I see the dust settling," she said.
The road to Soares' new role started in February 2010 when she was brought in while still at North Central Bronx Hospital, also part of the city's Health and Hospitals Corporation, to help Harlem Hospital prepare for its accreditation reviews with the Joint Commission and Centers for Medicaid and Medicare Services.
A bad review could have put the hospital's Level 1 Trauma Center status in jeopardy.
"I was able to see people at their worst," Soares said of the assignment that ended with positive results.
"But I also saw that the staff really works well together here. They are open to change and they are open to ways to improve. Morale is up, so now I'll get to see them at their best," Soares said.
The opening in August next year of the first phase of the hospital's new $249 million patient wing is also another step in improving the service at Harlem Hospital. The 195,000 square foot, seven story wing will include new and improved operating rooms, dialysis treatment areas, emergency room and intensive care unit.
In the current intensive care unit, patients are separated only by a curtain. In the new wing, each patient will have their own room equipped with the full complement of necessary medical equipment. The separate rooms will help cut down on the spreading of infections between patients.
"It will look like the ICU's you see on television," Soares said.
The new hemodialysis unit will more than double the amount of slots to 25 from 11. African-Americans are four times more likely than whites to develop kidney failure which requires dialysis or a kidney transplant.
The operating rooms are bigger. A new elevator will allow doctors to transport patients directly from the emergency room for surgery. Separate corridors will allow for the transport of sterile and dirty operating utensils. New patient rooms will no longer contain four patient beds, and instead be converted to single or double bed rooms with a bathroom.
Adorning the front of the new addition are a series of murals created for the hospital in the 1940s as part of the Works Progress Administration’s Federal Art Project. The original murals were saved and restored and will also line the walls of the pavillion's six-story atrium.
The changes should go a long way toward Soares' goal of patient-centered care. Providing modern facilities sends a message to hospital users. "You sometimes need to shell out the money to have quality patient care," Soares said.
When she's not listening to jazz, taking in a museum or traveling to places such as Ghana with the Organization for International Development, Inc., a group that travels to Africa and the Caribbean to provide free medical, nursing and dental care, Soares says she's brainstorming ways to improve the hospital.
It's already a place that is heavily-used by the community for every thing from graduations to programs for kids on Saturday. Soares plans to enhance that.
"My vision is to make this the hospital of choice for everyone in Harlem. It's not just Harlem Hospital, it's the Harlem Community Hospital," Soares said.